The Cosmetic Center - Facial Rejuvenation

There are multiple options for the treatment of wrinkles, which involve in office procedures with minimal down time.  These procedures include Botox injections, wrinkles fillers, chemical peels and various laser treatments.  When talking to patients about facial aging, I feel it is most important for patients to be on a good skin care regimen.  One of the most important things a patient can do to decrease early signs of aging or prevent these early signs, is to take good care of their skin and to use a topical vitamin A product, such as retin-A, renova, avage or tazorac. These products increase cell turnover, clear acne, and reduce fine lines. Vitamin A products are the only available skin care products, which have scientific evidence of decreasing wrinkle formation, and are therefore the most important part of a skin care regimen. We will also recommend using a hydroquinine product if the patient has problems with uneven pigmentation of their skin.  Antioxidants such as vitamin C have most recently shown promise in helping fight the aging process.

Wrinkle Fillers

In contrast to Botox® which decreases wrinkle formation by eliminating muscle function, fillers plump up the wrinkles.  Wrinkle fillers are commonly used in the nasolabial folds, marionette lines, lips, tear troughs beneath the eyes and in front of the jowls on the chin. There are multiple types of wrinkle fillers available.  Human and collagen injections were the first wrinkle fillers developed and are still occasionally used today, but are the shortest lasting fillers available, lasting approximately 3 to 6 weeks. 

In 2003, the first hyaluronic acid dermal fillers were approved for correction of moderate-severe facial wrinkles and folds. Since then, hyaluronic acid fillers have become the fastest growing non-surgical treatment. Hyaluronic acid fillers are the most commonly used fillers and are made from hyaluronic acid, which is a chemical naturally produced in the skin.  Hyaluronic acid fillers are performed in the outpatient setting through several needle sticks.  Local and topical anesthesia are used before the procedure. After numbing, the injections take approximately 15-45 minutes.  The more extensive the wrinkles, the more product will be necessary to get the best results.  Patients will notice swelling and possible bruising for a few days after the procedure.  They may notice redness, which can be covered with makeup.  They also will occasionally notice firmness in the area, but if placed properly, this will be minimized.  Ice should be used after the injection to help decrease swelling.  Depending on the filler used, the product lasts anywhere from 6 to 18 months.  The product tends to last longer in areas where there is not a large amount of movement, such as the cheeks.  The patients do not need to have a skin test with the hyaluronic acid as the chance of allergic reaction is quite rare. 

Chemical Peels

Chemical Peels are used to resurface the skin. The depth of resurfacing is dependent on the chemical agent used.  Superficial peels, such as glycolic acid and alpha hydroxyl acid remove the upper layer of dead skin cells allowing them to penetrate into the upper layer of dermis. The peels allow increased penetration of skin care products, dry up acne, soften fine lines, stimulate collagen growth, and give the skin a rosy glow. Superficial peels have minimal to no downtime with mild burning and redness. They are performed in the office by the nurse or aesthetician.

Medium depth peels involve higher strengths of glycolic acid or a stronger solution known as trichloracetic acid(TCA). The medium peels remove fine lines, improve skin texture, even out irregular pigmentation and reverse effects of sun damage. TCA peels are performed in the office under topical or local anesthesia. Crusting and swelling occur for 2-4 days after the procedure and redness lasts 1-3 weeks.

Deep peels use higher concentration TCA or phenol. The deep peels are the most effective at reducing or eliminating fine lines and work amazingly well for wrinkles around the mouth. These are also done in the office under local or topical anesthesia. The swelling and crusting is greater lasting 5-10 days. Redness can last for several months and there is a chance of permanent lightening of the skin where the peel is done.

Laser Treatments

Treatment of Spider Veins

Sclerotherapy is an office procedure to treat spider veins of the legs and hands. The procedure involves injection of a solution into the veins, which irritates the vein walls causing them to collapse and no longer fill with blood, resulting in reduction or elimination of their appearance.  Sclerotherapy generally requires 1-3 treatments 4-6 weeks apart. The procedure is done in the office and does not require anesthesia. Burning or cramping with the injection is common but tolerable.
Spider veins may also be treated by laser therapy. It has been our experience that both methods can work well, but that some patients respond to sclerotherapy more than laser therapy and vice versa. We will often start with sclerotherapy, as we have found the injection to be less painful and better tolerated than the laser therapy.  If the patient desires, a small test patch with the laser will also be performed so that we may compare the results and determine what is the best option for the second treatment.
The procedure can take 15-60 minutes depending on the size of the areas to be treated. Compression stockings are ideally purchased before the procedure and worn for 23 hours/day the first 4-7 days. For best results, you should avoid high impact exercise or excessive standing for 1-2 days after the procedure. Bruising, swelling, itching, redness can be seen the first few days after sclerotherapy or laser therapy.  Fading of the veins is usually seen at 2 weeks with continued improvement up to 12 weeks.  Rare risks of the procedure include discoloration, leg cramps, scarring, blistering, ulceration, infection, and vein clots.