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Cosmetic Dermatology Dermatologists Dermal Filler Anesthesia
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Dermatology for SeniorsSoft Tissue Fillers (Dermal Fillers) "Restylane,Perlane, Juvederm, Evolence, Sculptra, Radiesse" Soft tissue fillers are injected under the skin, mainly for marionette lines and loss of lip fullness. They are used to "plump up" the skin to improve contour and correct wrinkles, furrows and hollows in the face. The current state-of-the-art hyaluronic dermal fillers are Perlane and Juvederm Ultra Plus which do not require a skin test and lasts about 12 months. For a more natural look, Dr. Hughes and Tichy will add "pillows" to the lower lip when doing lip enhancement. Hyaluronic acid is a long lasting but non-permanent filler that blends nicely with normal skin. Never use a permanent filler as it will show as a linear nodule with age! For this reason, we are not using Artefill, a new plastic PMMA permanent filler.
 In a new scientific study, "Cold Air Anesthesia in Dermasurgery" by Philip Hughes, M.D., reported in Dermatology Times. Restylane injections are more comfortable with cold air anesthesia combined with topical LMX5 numbing cream. With this combination, there is no need for injectable nerve blocks (dental blocks). This is a significant advance in patient comfort, safety and satisfaction. In adition, the injections are more accurate since patient facial mobility remains normal. The cold air is provided by a German "Zimmer Cryo 5" cold air machine which delivers air at -34 C.Hughes Dermatology is now offering "Sculptra" treatments as a volume filler for cheeks. This is helpful for thin, fit women or men who have lost facial cheek volume and have resultant looseness and wrinkling in this area. A recent article in Dermatology Times provides a nice overview of this treatment.
Sculptra before and after, 3 sessions Lasting 2 years (or more), it has been called a "liquid facelift." Injections of biodegradable Sculptra are done every 6-8 weeks with volume improvement (secondary to new collagen production) occuring slowly over 8-12 weeks. Typically, 3 sessions are required for optimum correction. There is no down-time other than occasional bruising. Sculptra is initially expensive but is safe, cost effective and long-lasting. Radiesse is an FDA-approved (12/06) biodegradable calcium hydroxylapatite microsphere filler that lasts longer (12-18 months) than the hyaluronic acid fillers. It is used primarily for nasolabial and marionette lines. It should not be used in lips. It is comfortably done using topical LMX5 followed with infiltration and cryoanesthesia. There is swelling that lasts a couple of hours, but then the improvement is immediate. Because it is injected deeper, it has more "lifting power" than hyaluronic acid fillers. It can even be used as a non-surgical rhinoplasty ("nose job") in some patients, if part of the nose needs added volume. Our patients have been pleased with Radiesse volume correction. Radiesse and Sculptra are both being used by Hughes Dermatology to add volume to the tops of hands, creating "hand rejuvenation." We use the new "depot" technique which produces less bruising.
Evolence, a new J&J porcine-derived collagen filler, was approved by the FDA 7/1/08. Drs. Hughes and Tichy are Star-certified Evolence injectors. It is a long-lasting filler that now available in our office. It is particularly effective for ablating nasolabial folds, marionette lines and the pre-jowl sulcus.
Elevess is another new filler. This one is hyaluronic acid with a local lidocaine anesthetic, making it a more comfortable injection. It is currently the least expensive filler. Sidney Coleman, M.D. states, "Aesthetic surgery is moving rapidly away from excision and suspension procedures to augmentation procedures for rejuvenation in particular. The primary event of facial aging is atrophy or loss of fullness. The obvious solution for atrophy is restoration of volume or fullness." Before getting a traditional invasive face lift, consult with Dr. Hughes or Dr. Tichy to see if you are a good candidate for this noninvasive more natural alternative. Facial Redness (Telangiectasia)This is caused by a multitude of tiny red vessels (telangiectasia) and is generally inherited or sun-induced. It often coexists with acne rosacea. Other than prevention with early use of sunscreens (or picking different relatives!), treatment of small red vessels consists of laser eradication with our 585nm pulsed dye laser (Cynosure Photogenica V). This is done after 30 minutes of topical anesthesia (LMX5) and the new Zimmer Cryo 5 cold air machine is used during the procedure. The procedure leaves a superficial bruise that lasts 7 to 10 days and can be covered with Dermablend make-up. About half the time a second touch-up session is done a month or so later. Hughes Dermatology has had a decade of experience successfully treating this problem.
 Blue vessels of the face are safely ablated with the long-pulsed Nd:YAG laser (Laserscope Lyra-i), or sclerotherapy. The blue nasal blood vessels shown here are best treated with Hughes Dermatology's long-pulsed Nd:YAG laser; sclerotherapy with 23.4% sodium chloride (hypertonic saline) would be an alternate option.Mole ManagementIf a mole is abnormal according to the ABCD rule, it should be examined by a dermatologist with a dermatoscope. If it is irregular under the dermatoscope, it should be biopsied. Usually this can be done via a cosmetically elegant shave biopsy right at the time of the initial visit. Hughes Dermatology recommends annual whole body skin cancer checks in order to identifya malignant melanoma at an early and curable stage. If a mole is malignant (malignant melanoma) prompt surgical excision is done in our office surgery suite.  Moles that are irregular in color and shape or bigger than a pencil erasor should be promptly biopsied (malignant melanoma shown here)! New: In addition to prompt surgical excision, Aldara (imiquimod, a topical immune modulator) is used as adjunctive treatment to destroy any residual malignant cellsAnnual skin cancer exams Patients should be examined "head to toe" annually to check for suspicious moles, pre-malignant and malignant skin tumors. In most cases, a dermatoscope will be used for mole evaluation. A basal cell cancer is shown here; it was removed by Mohs cancer surgery. New non-surgical approaches to basal cell cancer include imiquimod cream, an immune inhancer, and the pulsed dye laser. Skin Wellness RegimenThis fundamental regimen is always the starting point in an anti-photo aging regimen. It consists of prescription topical retinoids, prescription topical alpha-hydroxy acids, chemical mini-peels, sunscreens and oral antioxidants including multiple vitamins and green tea and practicing sun safety (and avoidance of tanning parlors) . It is an affordable start since the cost for each visit is billed as an "office visit." (Plus, we are not selling you products!)It helps fine lines, eradicates whiteheads and blackheads, erases early liver spots and pre-malignant keratoses. New: Hughes Dermatology is reintroducing topical conjugated estrogen creams in post-menopausal women for its documented youthful effect. Topical estrogens are safe. The next "minimally invasive" additional steps may include management of wrinkling (crows feet, frown lines) in the upper third of the face with Botox, dermal fillers for marionette lines and loss of lip fullness (Juvederm & Restylane), volumizing the lipo-atrophic face with Sculptra, cryosurgery to remove actinic keratoses and liver spots, improvement of rhytids around the mouth with Er:YAG laser resurfacing, ablation of red vessels with the pulsed dye laser, scar management, and laser rejuvenation (collagen and ground substance production with the long-pulsed Nd:YAG laser). Sidney Coleman, M.D. states, "Aesthetic surgery is moving rapidly away from excision and suspension procedures to augmentation procedures for rejuvenation in particular. The primary event of facial aging is atrophy or loss of fullness. The obvious solution for atrophy is restoration of volume or fullness." Chemical Peels Chemical peeling is a technique used to improve the appearance of the skin which is typically performed on the face, neck or hands. In this treatment, a chemical solution is applied to the skin that causes it to peel off. The intensity of Hughes Dermatology peels varies from a "mini-peel" with 10% TCA to a moderate "combined peel" (Jessner's solution followed by 35% TCA). The new, regenerated skin is usually smoother and less wrinkled than the old skin. Sometimes laser resurfacing (for deep lines around the mouth)is combined with chemical peeling elsewhere on the face. Chemical peeling is also done to enhance the penetration of medications into the skin when using 5-fluorouracil creams for premalignant solar spots(actinic keratoses) treatment or to enhance the penetration of Retin A. Chemical peels are an essential part of melasma ("mask of pregnancy") treatment.Hughes Dermatology has had many years of experience with all the peels. Consult Dr. Hughes or Dr. Tichy to determine the most effective chemical peel for your condition. Laser ResurfacingLaser resurfacing is an ablative procedure, done with the erbium:YAG laser, usually for deep wrinkle, rhytids, around the mouth. The surgery is done in the office and has a 5 day healing time post-op. This procedure significantly improves these peri-oral lines and wrinkles and tightens the skin. . Laser resurfacing improves certain types of acne scars (box car scars). Laser resurfacing is used to erase traumatic or surgical scars of the face, but this must be done within 4 to 6 weeks. The Er:YAG laser produces a plume that is viral-free and safe, as discovered by Hughes Dermatology. Hughes Dermatology has a decade of experience with laser resurfacing, has published original papers in the Journal of the American Academy of Dermatology and Dermatologic Surgery, been a speaker at the American Society of Dermatologic Surgery, taught laser resurfacing nationally.
Botox Injections"Frown lines" are produced by an overactive superficial facial muscle (the corrugator muscle) which pulls the the eyebrows together and produces a permanent fold. "Crows feet" are produced by an overactive orbicularis muscle. Years of squinting and frowning tend to leave deep wrinkles in the skin between the eyebrows and on the bridge of the nose, across the forehead, at the corners of the eyes ("frown lines," "bunny lines," and "crows feet"), and even around the mouth ("smokers lines"). These lines may produce an angry or sad look that detracts from a pleasant facial appearance. "Platysmal bands" are linear bands on the neck produced by overactive platysmal neck muscles. Hughes Dermatology can now improve all these lines and bands without surgery and without scars by a simple injection of botulinum toxin type A which relaxes these overactive muscles. Please mention this concern during your next appointment. New medical uses of Botox include the treatment of post-zoster neuralgia (persistent pain after shingles), notalgia paresthetica (unrelenting localized itching), and lichen simplex chronicus. Hughes Dermatology is a Botox training facility for dermatology residents.
HyperhidrosisHyperhidrisis is excessive sweating, usually of the palms and underarms. If first-line topical treatments fail, this embarrasing malady can now be successfully treated with Botox injections! The injections are comfortable since a topical anesthetic and our Zimmer cold air anesthesia machine are used. The good news is the results are fairly longlasting, sometimes for one year. Please make an appointment with Dr. Hughes or Dr. Tichy for evaluation and treatment. Hughes Dermatology is a Botox training facility for dermatology residents. Female Baldness Hughes Dermatology can diagnosis and treat most types of female baldness. Following a consultation appointment which will include a hair telogen count and laboratory evaluation, a specific diagnosis will be made (examples: telogen effluvium, female pattern baldness, alopecia areata, tinea capitis, psoriasis, lupus, etc.). Telogen effluvium is treated by recognition and treatment of the underlying medical cause. Pattern baldness, which is genetic, is successfully treated with 5-alpha reductase inhibitors and topical minoxidyl. Please see us for treatment of this psychologically devastating malady! |
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