Acne
Breakouts- Acne is a disease involving the sebaceous glands
of the skin and affects over 80% of adolescents and many adults.
During puberty, our bodies produce large amounts of an oily substance
called sebum. Sebum, when combined with excess skin debris, sticks
together in our pores causing the pore to become plugged. Without
effective treatment, these plugged or clogged pores can become
infected, red, swollen and unsightly pimples that can lead to
scarring.
My approach to acne patients initially is with
topical application of current acne medications and washes.
If the response is not satisfactory I will advance the patient
to either accutane or Photodynamic
therapy. I prefer PDT
before accutane because if accutane is utilized first, light
therapy would have to be delayed at least 6 months because of
the possible side effects of laser or light after accutane use.
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Acne
scarring- Depending upon the type of scar that acne produces
subcision or detaching the upper portion of the skin from the
deeper fibers that are retracting the skin surfaces is a viable
means of improving the scar. Sometimes I will excise the scar
itself and close the skin with tiny sutures.
Several different types of fillers
can be injected into the skin after subcision. Some fillers
I would use are Cosmoplast,
Restylane, Radiesse, Juvederm
and Sculptra.
On occasion I will perform a mid to upper dermal trichloracetic
acid peel, like
the blue peel. I have gotten impressive results treating the
rolling acne scars with the nd1064 YAG laser and the Q switched 1064 laser with 4 to 5 treatments spaced 3 weeks apart.
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Actinic
Keratosis or solar keratosis are the most common pre-malignant
skin lesions and are noticed as rough areas of skin in areas that
are exposed to the sun. They can become sore and irritated and
are strongly linked with lifelong exposure to ultraviolet light
(i.e. sunlight).
Traditional treatments have been Efudex and
liquid nitrogen. As present, I am pretreating the area with
either efudex or aldara and then treating with Aminolevulinic
acid and photodynamic
therapy. Depending upon the number and extent of lesions
several treatments may be necessary.
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Brown
Spots, referred to as lentigines (lentigo, singular),are
flat, light brown-colored spots and are the result of chronic
sun exposure. They usually occur on the face and on the back of
the hands and arms.
Laser treatment
provides a quick and affordable way to eliminate these unsightly
lesions.
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Crows
Feet are the result of years of squinting
and laughing creating fine to deep wrinkles around the outside
edges of the eyes.
These wrinkles can quickly be diminished with injections of BOTOX.
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Deeper
Facial Lines- After years of squinting, laughing, frowning,
smoking and worrying, the skin around the eyes and on the forehead
will often develop deep lines and wrinkles.
Along with nasolabial and perioral areas, I
will treat with a combination of BOTOX
and fillers such as Restylane,
CosmoPlast, Hylaform, Juvederm, Radiesse and Sculptra.
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Enlarged
Pores - Pores of the facial skin are the openings of the
duct which houses a tiny hair follicle as well as the sebaceous
gland. Enlarged pores can be causes by genetic factors, acne,
environmental exposures as well as aging itself. Usually there
is a loss of collagen and support from the surrounding dermal
structure which supports the pilosebaceous unit which causes the
laxity to enlarge the duct opening. The treatment is to tighten
the surrounding dermis of the pore by increasing collagen with
retin-A and different laser
procedures.
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Excessive
Sweating or Hyperhidrosis may be limited to a few problem
areas or may be all over. The armpits and the palms are the areas
most often troublesome. Excessive sweating starts after puberty
and may be present to some degree all the time. However it can
be at it's worst when under stress such as during exams, interviews
or dating.
Treatment of this condition of excessive sweating
can be accomplished with a combination of Iontophoresis
and BOTOX injections.
Iontophoresis consists of applying a low amperage current thru
the area of increased sweating such as the palms. Repeated treatments
help to plug up the sweat glands so excessive sweating can be
inhibited for several months. A series of nine initial treatments
and then maintenance therapy every few months will control the
condition. BOTOX
injections are an alternative and can be administered into the
palms, underarms and soles. A majority of patients can be relatively
sweat free for up to 12 months. Certain insurance companies
will cover the cost of Botox treatment.
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Expression
Lines are wrinkles along the forehead and eye area that
can appear when laughing or smiling, etc.
If these lines are bothersome to the individual
I will diminish these lines with injections of BOTOX.
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Facial
Redness (Rosacea)- Rosacea is a chronic and potentially
life-disruptive disorder primarily of the facial skin causing
diffuse redness, red papules and vein appearance, which may flare
up and subside at times. Usually a hereditary predilection, rosacea
typically begins any time after age 30 as a redness on the cheeks,
nose, chin or forehead that may come and go and is usually triggered
by environmental factors such as stress, heat, and ingestion of
caffeine and alcohol. In some cases rosacea may also occur on
the neck, chest, scalp or ears. Over time, the redness becomes
ruddier and more persistent, and visible blood vessels may appear.
Left untreated, bumps and pimples often develop.
Depending upon the type of Rosacea and the severity
I would treat the patient with a combination of topical
and oral medications as well as different laser
or IPL treatments. The utilization of a good UV-A and UV-B
sunblocker is a significant part of the treatment.
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Facial
Veins- These tiny broken veins may be part of the normal
aging process, sun induced, hereditary or as part of the skin
condition known as rosacea.
I use a nd1064 nm YAG laser
to remove larger facial veins and the Lumenis
IPL for the smaller diffuse veins
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Fine
Facial Lines- Those patients with such finer wrinkles would
also benefit from the Obagi
treatment as an acid
peel or a deep tissue heating laser
such as the nd1064 YAG or 532 Q switched laser.
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Forehead
Lines are visible creases on the forehead
often associated with aging skin. Frequent exposure to sun as
well as exposure to cigarette smoke are factors that can increase
lines on the forehead.
I have very good results
treating these forehead lines with BOTOX
injections.
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Hyperpigmentation
problems such as Melasma- Hyperpigmentation is a common condition
in which patches of skin become darker in color than the normal
surrounding skin. Melasma is an example of hyperpigmentation that
occurs on the cheeks, forehead and mandibular area.
This condition can be treated with the Obagi
skin care program, aggressive multiple session Microdermabrasion
and acid peels.
Superficial hyperpigmentation would be treated in a similar
manner as sun damage.
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Leg
Veins and Spider Veins- Unsightly leg veins, or varicose
veins, are the large ropey veins seen in the legs and spider veins
are smaller red or blue lines. A vein becomes varicose when the
valves in its wall malfunction and fail to help bring blood back
to the heart. Spider veins are the thread-like veins seen on the
surface of the skin. They are usually less painful than varicosities,
but without treatment may bleed or worsen. Although most commonly
seen in the legs, spider veins may be present on the face and
other parts of the body.
My basic treatment for unsightly leg veins is
Sclerotherapy with
either a glycerin solution or an assortment of concentrations
of sotradecol sulfate. I also use foam sclerosants for certain
vessels. An nd1064 YAG Laser
is used for certain veins of the legs for those patients who
prefer not to have needles. I usually recommend a dopler and
duplex ultrasound work up if the veins reveal a significant
degree of incompetence. If this should be the case the patient
would be referred to one of our associated specialists who perform
either endovenous laser or radio frequency ablation of the veins
as well as phlebectomy.
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Loss
of collagen or fat- As aging occurs, the body loses about
1 percent of its natural collagen per year. This loss of collagen
results in reduced fullness of lips and skin as well as sagging,
wrinkled skin over time.
The outline of the lip can be augmented with
several different fillers
that would also ameliorate some of the vertical lines surrounding
the lips. The body and mucosal portion of the lips can also
be injected with certain fillers
that rejuvenate the fullness and texture of the main body of
the lips. These fillers are considered temporary and can last
up to nine to twelve months. I usually enhance the effects of
the fillers of the lips with injections of BOTOX.
Enlarged
Pores- are the result of genetics, smoking, sun exposure,
acne, and aging. With loss of collagen the pilosebaceous unit
loses its support and as a result the opening or pore becomes
larger.
I strongly recommend for these patients a good
topical regimen such as the Obagi
skin care program. Topical therapy with Retin-A, microdermabrasion
and laser therapy are helpful in diminishing
pore size.
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Redundant
skin and jowls of the face and neck area- As we grow older
the skin, especially around the neck and jowels can start to sag
due to the skins lack of elastin and collagen proteins resulting
in unsightly sagging jowels and loose skin.
Soon we will incorporate the new Titan
laser into the practice which can treat those problem
areas with minimal discomfort.
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Sun
Damage, rough texture- Years of exposure to the sun's damaging
rays can damage the surface of the skin leaving it rough and uneven.
I strongly recommend for these patients a good
topical regimen such as the Obagi
skin care program. Once the patient is established on this regimen
I would use a combination of light sources such as the Lumenis
IPL with or without PDT
and ALA, 1064 yag Laser or the Q switched 1064/532 laser. An
acid peel would
also be a viable treatment modality. Microdermabrasion
would also be incorporated into the treatment regimen.
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Tattoos-
Lately, getting a tattoo has become more popular than ever and
so has removing them! An estimated 20 million Americans have tattoos
and many of them now feel that having a tattoo does not fit their
new image. With today's advanced laser technology, your tattoo
can be removed safely and quickly and in most cases, without leaving
a scar. Multicolored tattoos can be treated safely and effectively
with the Medlite C6 Q switched laser.
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Unwanted
Hair- can now be removed from anywhere on the body safely
and effectively using advanced laser
technology. The procedure is customized according to hair
color, texture and body location. Nearly all hair colors - black,
brown, and red - can be treated. Treatment is effective on all
skin types, including dark-skinned individuals of all ethnic origins.
To find out if you are a candidate, ask to schedule a consultation.
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Wrinkles
are caused by the body's gradual breakdown of collagen and elastin
fibers in the skin. Unfortunately no one is immune from experiencing
this normal aging process.
However, I offer many different procedures for
treating wrinkles including BOTOX,
CosmoDerm, CosmoPlast,
Hylaform, Restylane, Radiesse, Juvederm,
Sculptra,
Chemical Peels,
and Microdermabrasion.
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