SKIN REJUVENATION PROGRAM

Our office has instituted a facial rejuvenation program for the purpose of refreshing and tightening lose skin, for removing fine wrinkles, discolorations and age spots, and for making skin look and feel smoother and softer.

The program consists of a full spectrum of Laser Skin Resurfacing, peels and fillers.  We make use of glycolic acid, TCA and phenol peels.  Our filler substances are Collagen, Dermalogin, Gortex, Alloderm and Autologen.  Botox is also used for forehead and crows feet lines.

The program is based on ceasing and reversing sun damage.  The first priority is to stop on-going sun damage by sun avoidance (i.e. proper clothing and the use of hats) and sunscreens.  This combination will, in itself, reverse some sun damage if exercised for over 1-2 years.

 

About sunscreens .....
 

Suncreens are substances which either physically block or absorb the sun's penetrating UV rays.  The fairer your skin, the more you should use sunscreens for protection.  South Floridians should be in the habit of using sunscreens on a daily basis, such as SPF 15 in a moisturizer. Sunscreens should be reapplied frequently when perspiring or swimming as the lotion is often washed away.  It is important to cover all exposed areas including the lips, ears and nose.  Sun rays penetrate the skin even on hazy or cloudy days, so protection should be used during these times as well.  We recommend using a protection factor (SPF) 30 or higher when participating in outdoor activities. This means you will receive 30 times less sun damage than unprotected skin during a certain time interval.  And yes, you will tan through sunscreens - only more slowly.

Retin - A / Renova.......

Next is the use of Retin-A/Renova - a derivative of vitamin A.  It has been significant for reversing sun damage, but in and of itself will NOT return skin to the texture we strive for.  Used properly it  can normalize the turnover of skin causing a decrease in fine irregularities of the skin.  Retin A /Renova reverses the accumulation of scales and rough formations on the skin as well as improving the circulation of the skin just below the surface.  Used in combination with our skin rejuvenation program, Retin-A /Renova contributes significantly in smoothing and revitalizing your skin. Renova is Retin-A in an emollient base in order to decrease the drying and reddening effects.

One modality for the treatment of fine and moderately deep wrinkles is the use of chemical peels. These peels vary amongst light, medium or deep depending on the area to be peeled and the depth of the crease.  We use light peels, (glycolic acid) as a maintenance peel and use medium or deep peels (TCA or phenol) intermittently as needed for deeper wrinkles.  Chemical peels also treat actinic keratosis - or pre-skin cancers. On the face, chemical peels are useful especially around the eyes and mouth, but are also helpful for fine wrinkling throughout the face and neck.  The particular area of the face and the depth of wrinkling determines which peel would be best suited for you.

We look at the aging process as an ongoing phenomenon.  With this in mind, we believe that chemical peels should be thought of as an ongoing maintenance program.  Light or medium peels done once, or twice per year can be expected to give the best results. We think this philosophy keeps your skin more natural and healthy.

Light peels can be done in the office setting without anesthesia. AHA home maintenance should be used 1 to 2 weeks prior to peel.  The light chemical peel does not cause severe swelling or distortion of the skin.  Mild burning occurs during the chemical peel which is generally rinsed off with water - neutralizing the acid.  You might have what appears like a sunburn on the following 2-4 days, but this would not keep you from your normal activities ( assuming no sun exposure).  Light chemical peels must be periodically repeated. A series of six peels is recommended, we suggest bi-weekly peels for the length of the series, then a peel bi-monthly for maintenance purposes. Maintenance lotions are also recommended between peels.  Glycolic acid is an example of a light chemical peel. Jessner's peels are also used as a light  chemical peel , using lactic and salicylic acid, for problem skin.

Medium depth chemical peels such as TCA peel (trichloroacetic acid) cause a slightly deeper tissue destruction.  This, in turn, produces quicker results.  It also causes more swelling and redness.  A medium depth peel - also performed in the office setting - requires no anesthesia.  It causes mild burning for a few minutes, then the pain resolves.    After the superficial skin peels off (3-5 days) the redness gradually diminishes over a period of several weeks.  Make up is allowed after 7-10 days. Again, avoidance of sun exposure during the post peel recovery is very important.  With a medium depth peel you will probably be out of work for 7-10 days.

Deep chemical peel  causes a greater tissue destruction.  This peel is more capable of removing the “ mild to medium deep wrinkles”.  Phenol is an example of a deep chemical peel.  Deep chemical peels  also cause more swelling and redness.  While phenol peels are performed in the office, monitoring must be done for safety   purposes .  These peels generally cause burning for several minutes.  The burning subsides within one hour.  Again pain relievers are prescribed. Swelling and redness occur within 24 hours and progressively diminish over a 7-10 day period.  Makeup may be used after the “new” skin has been laid down.  You would be able to return to work using makeup after 10-14 days.

Another important aspect of our skin rejuvenation program is the use of filler substances, i.e. Collagen, Gortex, Alloderm or Autologen

Gortex  (polytetraflouroetheline) is a materiel developed by W. L. Gore & Associates during the later 1960’s for blood vessel replacement.  The material has an extremely high suture holding capacity that resist pull out.  It has excellent handling characteristics and good biocompatability - the body has little to no urge to reject it.  Gortex has been used successfully since that time for many other purposes including facial recontouring in facial plastic surgery procedures.  We have made use of the material quite often in nasal reconstruction and wrinkle correction with excellent results and very little problem.

Pre Gortex Lip Augmentation         Post Gortex Lip Augmentation

 
The material itself is white and is processed in sheets or strands of 1, 2 or 4 millimeter thickness.  The sheets are cut into the appropriate size and shapes as necessary. The material’s consistency is that of foam rubber, however, Gortex is more pliable and much stronger.  Gortex does not resorb, it is permanent.  When placed beneath the skin, it raises any depression above it.  In addition, its pliability allows it to feel like normal skin.

Alloderm is preserved human dermis which is transplanted without rejection.  The natural structure is repopulated by the patient's cells and becomes part of the patient's tissue.  Alloderm can be used not only as a surface grafting material, but also beneath the surface for the repair and replacement of skin.  Alloderm improves lines and grooves on the face, as well as enlarges lips.  

Collagen is a protein complex approved by the FDA for improving deep or fine creases and wrinkles.  We require two collagen skin tests prior to injections as allergic reactions may occur if used otherwise.  The injections consist of Zyplast, Zyderm I and Zyderm II.  They cause a mild redness at the injection site.  This redness resolves by the following day.  Injected collagen material usually diminishes after 2-4 months and requires re-injection.  Different body sites retain collagen  longer than others.

Dermalogen is an injectable filler used to improve fascial lines and grooves. Like Alloderm it is safely formulated from human dermis. Like Collagen, the results will diminish over time necessitating additional periodic injections in order to sustain the desired results. 

Autologen  is a human injectable collagen implant material made from your own skin.   Through a patented process, patient skin is excised during several types of cosmetic surgery such as a facelift or forehead lift and turned into a collagen rich dispersion which is then injected back into the depressed dermal areas of the same individual.   For those who do not require surgery, skin can be obtained with a minimally invasive surgical procedure.   The injection site from the Autologen is red for about 48 hours.  Bruising may result which could take a few weeks to heal.  Autologen is thought to last longer than collagen because it is your own tissue.

Botox  

Botox is a Purified Neurotoxin Complex which when injected into a muscle causes paralysis of  that specific muscle.  Injecting Botox into the muscles of the forehead wrinkles causes these muscles to  paralyze thus smoothing out the area.  Botox is very useful in the forehead, between the eyes, the crows feet area and in the "crunch lines" across the nasal bridge between the eyes.  The results normally last 4 to 6 months.  The injection normally takes 5 minutes or less.  There is no down time associated with Botox injection, such that you can return to work or your social activities immediately.  The effect normally occurs within 3 days and the full effect is normally noted after 1 week.    Botox is a new and exciting safe way to improve certain areas of the face without the time and inconvenience related to surgery and laser skin resurfacing.

Pre Botox                                    Post Botox

Pre Botox                                    Post Botox

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