Patient Education

U.S. Dermatology Partners, formerly Southwest Skin Specialists, provides you with animated, in-depth overviews of different skin conditions and treatments.

Mohs Micrographic Surgery

Introduction

Mohs micrographic surgery, a surgical treatment for skin cancer that offers a very high rate of cure, was developed by Frederick E. Mohs, M.D., at the University of Wisconsin. The technique of Mohs surgery is time-consuming and requires highly specialized training and personnel. You were referred to us because Mohs micrographic surgery has been proven to be a highly successful form of treatment for your type of skin cancer.

The Mohs procedure will be performed by Joseph Giancola, MD, a board-certified dermatologist who is also a Fellow of the American College of Mohs Surgery (ACMS). Chosen through an extremely competitive review and selection process, fellows of the ACMS are required to complete an intensive 1-2 year post-residency fellowship training program. While any board-certified dermatologist may perform Mohs surgery, only members of the ACMS have undergone rigorous fellowship training.

This information is designed to advise you about skin cancer as well as outline what you can expect on the day of your surgery and during the period after surgery. We have also included a section that outlines preventive measures you can take to decrease the possibility of developing skin cancers in the future. Please read all this information in its entirety before your surgery. If you have questions, call us at (602) 494-1817.

How Skin Cancer Forms

Cancer of the skin, like other cancers, is a disease of cells, which are tiny structures that make up all parts of the body. Although they differ in shape and function in various organs, all cells reproduce themselves by dividing. Normal growth and repair of tissue take place in this orderly fashion.

When cell division is not orderly and controlled, abnormal growth occurs. Masses of tissue called tumors build up. Tumors can be benign or malignant. A malignant tumor is a cancer.

Benign tumors do not spread. But cancerous or malignant tumors invade and destroy surrounding normal tissue as they grow. Occasionally, cancer cells may break away from the tumor and spread (metastasize) through either the blood or lymphatic vessels to distant parts of the body where they form additional tumors.

Types of Skin Cancer

There are three primary forms of skin cancer: Basal cell carcinoma, squamous cell carcinoma, and malignant melanoma.

Most cases of skin cancer are either basal cell carcinoma or squamous cell carcinoma. Of the two, basal cell carcinoma occurs more frequently and grows more slowly. It rarely spreads through the blood or lymphatic systems to distant parts of the body.

Squamous cell carcinoma is the second most common skin cancer. It is more serious since it has a greater ability to spread internally to nearby lymph nodes and to other parts of the body.

Malignant melanoma may be life-threatening if not treated early. It usually appears as a brownish-black spot or bump in the skin that enlarges and sometimes bleeds. Sometimes melanomas arise in moles that have been present for many years.

Causes of Skin Cancer

Exposure to the sun is the leading cause of skin cancer, which commonly develops on the face, neck, and arms as these are the most sun-exposed areas of the body. Fair-skinned people develop skin cancer more frequently than dark-skinned people. Cancers of the skin are most common in the southern United States.

Skin cancer also can be hereditary and occurs very frequently in certain ethnic groups, particularly those with fair complexions such as Northern Italians, Scandinavians, and Celts (especially Irish and Anglo-Saxons). Other possible causes of skin cancer include X-rays, chronic injury, and certain chemicals.

Signs of Skin Cancer

Although most skin growths are benign, any new growths on the skin or a sore that does not heal should be brought to your dermatologist’s attention.

Skin cancer has many different appearances. It may begin as a small, waxy lump that eventually bleeds and crusts; like a dry, scaly, red patch; or in several other ways. Although it may begin very small, skin cancer can grow to become very large.

Skin cancer may sometimes form from a noncancerous skin condition called actinic keratosis. These are red, rough patches of skin that develop as a result of sun damage and are commonly found on the face, neck, or hands.

If the doctor thinks that a skin growth may be cancerous, a biopsy is performed. The whole area or a sample of the area is removed surgically and sent for examination under the microscope. The biopsy is used to confirm or rule out a diagnosis of cancer and to determine the type of any cancer found.

Treatment of Skin Cancer

Several treatment methods include surgical removal, or excision, with suturing (stitching); curettage and electrodesiccation, which is scraping and burning with an electric needle; radiotherapy (X-ray treatments); cryosurgery (freezing); and Mohs micrographic surgery. Many of these treatments have high cure rates, but Mohs micrographic surgery uniformly produces the highest success rate, especially for the most difficult tumors.

What You Should Know About Mohs Surgery

Mohs micrographic surgery is a specialized technique for the total removal of skin cancers. The procedure is done in several steps:

  1. A local anesthetic (usually lidocaine) is injected around the skin cancer.
  2. Surgical removal of the cancer is done in a specific fashion so that the entire undersurface and skin edges can be examined microscopically.
  3. The tissue is dyed and a corresponding map is drawn so that any tumor found microscopically can be located exactly on the patient.
  4. The surgeon then examines the slides under the microscope to look for cancer cells.
  5. Subsequent tissue is removed in a similar manner until no more cancer cells are found. In most cases, the surgery is done on an outpatient basis; however, in some cases, the doctor may recommend hospital admission. This is especially true for patients with large tumors, but admission is the exception rather than the rule.

How to Prepare for Surgery

No real preparation, other than a good night’s sleep, is required. Eat a light breakfast on the day of surgery. If you are currently taking medication, continue as usual unless directed otherwise by your physician. Eliminate aspirin or any medications containing aspirin, such as Bufferin or Anacin, for at least 7 days before surgery. This is because aspirin tends to prolong bleeding during the operation. Also, eliminate medications containing ibuprofen, commonly found in Advil, Motrin, and Aleve for at least 7 days before surgery. If you need a pain reliever, you may take acetaminophen, which is found in Tylenol.

It is best to wear a shirt that buttons down the front. No makeup or jewelry should be worn if surgery is to be performed on your face. Bring a good book or magazine with you, as you will spend a significant amount of time waiting while the microscopic slides are prepared and interpreted.

What to Expect on the Day of Surgery

Shortly after your arrival, you will be taken to one of the treatment rooms, where the tumor area will be numbed with a needle and local anesthetic.

The doctor will remove a thin layer of skin surrounding the cancer. After this has been done, any bleeding will be stopped with an electrocautery machine. You will then be bandaged and be able to return to the waiting room or you may stay in the treatment room. By this time, the removed tissue will be in our laboratory. There it is cut, dyed and made into microscopic slides. It usually takes 20-30 minutes for the layer of tissue to be removed and the bleeding to stop. However, it takes about 1 hour for the tissue to be prepared into microscopic slides for examination. During this time, you may chat with the person accompanying you, read a book or step out for fresh air.

If examination of the microscopic slides reveals that your tissue still contains tumor cells, the procedure will be repeated. Further tissue is removed only from the areas where tumor cells were found.

The goal is to remove all of the skin cancer while preserving the greatest amount of healthy tissue. However, skin cancers can grow deeply and develop roots extending beyond the area that you actually see. As a result, the final size of the surgical incision will be determined by the extent of the tumor.

The average number of surgical sessions required is 1-3. However, you may require more before your skin cancer is completely removed. Fortunately, this can usually be done in the course of a single day. When surgery is completed, a decision will be made as to the best way to manage your wound.

How Postoperative Wounds are Managed

Once it has been determined that your skin cancer has been completely removed, we will decide how best to manage your wound. In some instances, the wound should be allowed to heal by itself – this is called “healing by second intention.” In other cases, the wound needs to be repaired with stitches, or a skin graft or flap. The decision will depend on the size and location of your wounds. If a repair is needed, this usually can be done the same day or, in some cases, the following day. On rare occasions, you may be referred to another reconstructive surgical specialist.

If your wound is left to heal by itself, you will need daily bandage changes for 3-6 weeks. You will be given written instructions that describe how to change your bandages.

What to Expect After Surgery

Pain. Most patients do not have severe pain but may experience slight discomfort. If this occurs, we suggest you take Tylenol every 4-6 hours as needed.

Bleeding. Occasionally, bleeding follows surgery. If this happens, do not become alarmed. Lie down and place steady, firm pressure over the wound as close as possible to the bleeding area. Apply the pressure continuously for 20 minutes (timed). Do not lift the bandage to check on the bleeding. If bleeding persists after 20 minutes of steady pressure, apply pressure for an additional 20 minutes. If bleeding still continues, call our office at (602) 494-1817 or go to the nearest hospital emergency room.

Swelling. Swelling is very common following surgery, particularly when it is performed near the eye. All wounds swell a little. Usually, this is not a problem and the swelling diminishes as the wound heals. Ice packs and elevation may help reduce the swelling.

Drainage. All wounds will drain to some extent during the first 1-2 weeks. This is why frequent dressing changes are necessary.

Infection. Infection of the wound is unusual. However, if you see thick, foul-smelling fluid coming from the wound, or notice increasing redness, pain, warmth, or swelling call our office immediately. An antibiotic may be necessary.

Redness. All wounds will develop a halo of redness, which disappears gradually. If the area becomes extremely red and itchy, you may be allergic to either the ointment or the tape. Call our office if this condition develops.

Scarring. All surgeries leave a scar. However, your scar will improve and become less noticeable as time passes.

Stitches and skin grafts. If we close the wound with sutures (stitches) or place a skin graft, you should keep the area clean and follow the care instructions given to you until your next visit.

What to Expect After the Wound has Healed

You may experience some tightness, or drawing, as the wound heals. This is normal and usually lessens with time. Patients also commonly experience some itching after their wounds have healed. Rubbing a small amount of plain petroleum jelly on the scar often relieves this. Frequently, tumors involve nerves, and it may take up to a year, or even 2 years before normal feeling returns to an area. Sometimes the area remains numb permanently. Only time will tell.

The scar tissue that grows over the wound contains many more blood vessels than the skin that was removed. This results in a red scar that may be sensitive to temperature changes. This sensitivity improves with time and the redness gradually fades.

Sometimes the scar is unacceptable to the patient and the patient’s family. If this is the case, surgical scar revision may be considered. However, we usually advise patients to wait 12 months before having the scar revision performed. This is because the scar continues to improve in appearance and becomes less conspicuous for up to 1 year after surgery.

Defense Against Future Skin Cancer

The most important thing you can do to lessen the possibility of developing future skin cancers is to protect your skin from further sun damage. This is easily achieved by the daily application of sunscreen to all exposed skin, including the tops of the ears. You also may wish to obtain further protection by wearing a broad-brimmed hat and appropriate protective clothing.

Apply sunscreen 20 minutes before you go outdoors. It may wash off with water or heavy perspiration, so be sure to reapply sunscreen after swimming or exercise, and use a sunscreen labeled “waterproof.”

A number of excellent sunscreens are available. Whatever sunscreen you choose, it should be broad-spectrum (block UVA/UVB) and have a sun protection factor (SPF) of at least 30.

Follow-up Visits

Once your surgery is over, periodic follow up exams by your referring physician are important for at least 5 years. These visits can help with early detection and treatment of new skin cancers that may develop, as well as the rare recurrence of the skin cancer that was treated. If you notice any suspicious areas on your skin between visits, it is best to check with your doctor to see if a biopsy is needed.

For more information regarding Mohs surgery please visit the American College of Mohs Surgery at www.mohscollege.org

Cosmetic Dermatology

Procedures and Products Offered:

Look Your Best

Women and men who wish to improve the health and appearance of their skin have many excellent options today. For most people, the unwanted facial changes that give rise to “aging” are due to muscle imbalance and loss of volume support. In many individuals, previous sun exposure, injuries, and skin conditions have caused scarring, textural changes, skin thinning, and discoloration.

Our board-certified cosmetic dermatologists, Drs. Julie SalmonMiriam Cummings, Shannon Heck, and Jennifer Sawaya, are experts at in-office procedures, such as laser, botulinum toxin, and soft-tissue filler treatments, which can effectively balance form and function and improve skin quality. If the fabric of your skin is damaged, discolored, or wrinkled, our dermatologists can tailor a program specific to your needs. Their goal is to create intelligent beauty: an enhanced, more vibrant appearance that optimizes health and does not look “treated.”

*(For safety purposes, we offer the products in the list above only to our patients.)

Experience and Expertise

Our dermatologists have been providing safe and effective non-surgical and minimally-invasive procedures for skin rejuvenation long before the surge in popularity of botulinum toxin, soft tissue fillers, and lasers for aesthetic purposes. They attended the first conference in the world on the cosmetic use of Botox® and were among the first to use hyaluronic acid fillers, such as Restylane®Juvéderm®, and Voluma™. Our dermatologists traveled to evaluate the first Fraxel® laser prototype prior to its eventual launch. Our cosmetic dermatologists stay current, regularly exchanging ideas with other leaders, and investigating innovations in the rapidly-changing field of aesthetic medicine.

Highest Standards of Care: Safety and Aesthetics

Our dermatologists explore the wide spectrum of new treatments but select only those that they deem highly safe and effective. By thoroughly researching new procedures and products with a critical eye, our physicians make informed choices to optimize patient care. Our patients’ best interests always come first.

Individualized Care

With exceptional technical expertise and experience, as well as a reputation honed over many years as dedicated and caring physicians, our cosmetic dermatologists now serve a devoted international clientele. Each treatment is individualized and each patient is given the attention that he or she requires and deserves. If you are interested in discussing ways in which you could optimize the health and appearance of your skin, schedule a cosmetic consultation at either our Phoenix or Scottsdale office.

Nonsurgical or minimally-invasive cosmetic procedures for:

  • Age spots (sunspots) and unwanted pigmentation
  • Excessive sweating
  • Facial asymmetry
  • Facial lines and folds
  • Facial volume loss
  • Lip enhancement
  • Scars
  • Skin laxity
  • Spider veins and telangiectases (enlarged blood vessels)
  • Stretch marks
  • Wrinkles

Procedures and Products Offered:

  • Aesthetic laser treatments, including Cutera CoolGlide®, Fraxel® ReStore, Palomar intense pulsed light system, and VariLite™
  • Chemical peels
  • Botox® Cosmetic (for frown lines)
  • Botox® (for excessive sweating)
  • Dysport® (for frown lines)
  • Soft tissue fillers (includes products for facial wrinkles, folds, lip enhancement, cheek enhancement): Belotero Balance®, Juvederm™ Ultra/Ultra Plus, Restylane® / Perlane®, Sculptra® Aesthetic, Voluma™ XC
  • Skin care, including Avene, Blue Lizard®, Colorescience®, elure® , EltaMD®, Epionce, Glytone, Epionce, Neocutis, NIA24®, Ocean Potion®, Revaléskin®, SkinCeuticals®, SkinMedica®

Aesthetic and Laser Treatments

Aesthetic and Laser Treatments

Cutera Coolguide

Manufactured by Cutera®, the CoolGlide® laser is a versatile Nd:YAG laser system that can be used to treat pigmented and vascular lesions and improve the appearance of wrinkles, scarring, redness and more.

Vein Therapy

Many men and women develop unsightly and sometimes painful veins on the face and/or legs, which can significantly affect their quality of life both physically and emotionally. CoolGlide Vein Therapy can painlessly and effectively remove these veins through a series of treatment sessions that deliver pulses of light energy to the affected area(s).

Treatment with the CoolGlide laser system is considered safe for most patients with only a minimal risk of complications. Side effects such as redness, swelling, and mild bruising are considered common and usually, go away on their own within a few days. Your doctor will discuss the safety of the CoolGlide procedure with you before your treatment.

Fraxel Restore

The Fraxel® Restore is an FDA-approved, non-ablative laser system that is used to rejuvenate the appearance and texture of the skin on the face, neck, chest, hands, or arms. The Fraxel Restore laser treats a wide variety of skin conditions, including fine lines, wrinkles, melasma, brown spots, age spots, enlarged pores, and acne scarring.

The Fraxel Restore laser utilizes a technology known as fractional resurfacing. Fractional resurfacing breaks down and separates beams of light in order to deliver this energy only to targeted, highly specific areas of the skin’s surface. The surrounding undamaged skin is preserved between the laser treatment sites, which results in rapid healing following the procedure. Treatment with Fraxel Restore is safe and effective for patients of all skin types and textures.

Fraxel Restore laser treatment sessions usually last about 30 minutes, and do not require the use of pain medication. There is little downtime needed for recovery, with most patients resuming activities in 1 to 3 days. Optimum results are generally achieved after 4 or 5 treatments, performed in intervals of 3 to 4 weeks. Following treatment, patients often notice a significant improvement in their skin’s appearance.

Palomar Intense Pulsed Light System

The Palomar Icon™ Aesthetic System is an advanced, light-based form of treatment designed to alleviate a variety of skin conditions. It offers concentrated laser power with a built-in calibration feature to optimize the treatment of a targeted area. This versatile device provides a safe, effective solution for dealing with a wide range of surface and subsurface skin problems.

The Palomar Icon system features patented state-of-the-art technology to provide patients with the most comfortable experience as well as the most successful results. It uses the Skintel® Melanin Reader, which is the only melanin reader that has received FDA clearance. This device measures the average melanin density in the skin before the treatment begins in order to tailor treatment settings to that patient’s unique skin characteristics.

Varilite

Varilite is an advanced laser system used to treat the appearance of vascular, pigmented, and cutaneous lesions on the face and other areas of the body. Lesions on the skin are destroyed with precisely delivered heat energy while surrounding healthy cells are left intact.

This treatment takes less than an hour to perform, although the actual length may vary depending on the area being treated. No anesthesia is needed, and most patients achieve their desired results in just one to three visits.

Benefits of VariLite

The Varilite laser is effective in eliminating or reducing the appearance of vascular lesions, blood vessels, or other types of pigmentation on the skin. With minimal discomfort and no downtime, most patients are more than satisfied with the results of this procedure.

Risks of VariLite

Varilite laser treatment is safe for most patients and can be used on nearly any skin type. After treatment, patients may experience mild redness, swelling, and flaking. These side effects usually go away on their own within two weeks and can be covered with makeup if patients desire.


Botox Cosmetic

Botox Cosmetic

How Does Botox Work?

Botox® Cosmetic is a prescription drug that, when injected, temporarily paralyzes muscles. It contains a purified and safe form of botulinum toxin A, which is produced by the microbe that causes botulism. Manufactured by Allergan, Inc., it is used to treat permanent furrows and deep wrinkles in the skin that are formed by the continual contraction of facial muscles. In addition to its cosmetic applications, it is used to treat a number of medical problems, including excessive sweating, overactive bladder, neck spasms, crossed eyes, chronic back, and jaw pain, and migraines.

What Can Botox Treat?

Although originally approved by the U.S. Food and Drug Administration for the treatment of eye and muscle spasms, Botox Cosmetic was quickly recognized for its cosmetic value. Properly placed injections of Botox Cosmetic block nerve impulses sent to muscles, weakening them to the point where they cannot contract, and temporarily eliminating moderately severe furrows and lines. Botox Cosmetic is used to treat the following:

  • Forehead furrows
  • Frown lines
  • Crow’s feet
  • Skin bands on the neck

According to Allergan, Botox Cosmetic has been “extensively researched, with approximately 2500 studies.”

What Results Can I Expect from Botox Cosmetic?

Using a very fine needle, Botox Cosmetic is injected directly into facial muscles that are causing furrows and lines. Receiving the injections requires no anesthetic, but some doctors choose to numb the area to be injected with ice packs or topical anesthetic cream. Results can usually be seen within a few days of treatment, and typically last up to four months, although areas that are treated on a regular basis may retain results longer. Injections should be given only by qualified medical professionals.

What are the Side Effects of Botox Cosmetic?

Injection-site Botox side effects are usually mild and temporary, and include the following:

  • Pain
  • Infection
  • Inflammation
  • Tenderness
  • Swelling
  • Redness
  • Bleeding
  • Bruising

Normal activities may be resumed immediately after receiving injections.


Botox Cosmetic Treatment for Hyperhidrosis

Can Botox Cosmetic Treat Excessive Sweating?

Hyperhidrosis is a common condition that involves excessive sweating of certain parts of the body, including the face, hands, feet, and underarms. Those with this condition often need prescription-strength antiperspirants to control sweating and may have to change clothes frequently or avoid wearing certain fabrics.

Hyperhidrosis can be treated with Botox® Cosmetic injections, which block the nerves that stimulate the sweat glands, significantly reducing the amount of sweat produced. Most patients notice a significant reduction in underarm sweating in 4 weeks, with results lasting for more than 6 months. Although symptoms gradually return, results can be maintained with routine follow-up treatments.


Chemical Peels

Chemical Peels

Chemical peels remove damaged outer layers of skin to make skin smoother, reduce scarring and remove blemishes. Ranging from mild to strong, there are three types of chemical peels: alpha hydroxy acid (AHA), trichloroacetic acid (TCA) and phenol. The strength of each peel is tailored to the patient. Peels can be combined with other procedures, such as facelifts, for additional improvement to skin. Chemical peels may be covered by insurance if they are performed for medical rather than cosmetic reasons.

Chemical peels are performed in a plastic surgeon’s or dermatologist’s office, or an outpatient surgical center. Anesthesia is not required because TCA and phenol have anesthetic properties, and AHA produces only a slight stinging.

Chemical Peel Procedure

During a TCA or phenol peel, the skin is cleansed and the solution is applied, which may cause a brief stinging sensation. Petroleum jelly or a waterproof adhesive tape may be put on the skin following a phenol peel. During an AHA peel, the skin is cleansed and the solution applied; there is no need for post-peel ointment or covering.

Side Effects of Chemical Peels

A phenol or TCA peel can result in tingling or throbbing, reddened skin, a crust or scab, and significant swelling that lasts depending on the strength of the peel used, about a week. With a phenol peel, eyes may be swollen shut at first, and the patient may be put on a liquid diet and advised to keep talking to a minimum. Any tape used is removed after a day or two. AHA peels can cause temporary stinging, redness, and irritation, as well as flaking or crusting. After a chemical peel, it is essential that the skin is protected from the sun.


Dysport Injectable

Dysport Injectable

Prescription Dysport® injectable is a U.S. Food and Drug Administration-approved treatment for temporarily lessening or eliminating moderate-to-severe frown lines between the eyebrows. Like Botox® Cosmetic, Dysport injectable is placed directly into the muscle underneath a furrow, weakening the muscle to the point where it cannot contract.

Dysport, also known as Reloxin, is made from a neurotoxin produced by the bacterium Clostridium botulinum; it is the same neurotoxin used in Botox Cosmetic.

Applications for Dysport Injectable

Medically, Dysport injectable is used to treat excessive underarm sweating; symptoms of cervical dystonia, which include neck pain and abnormal head position; and muscle spasms. Cosmetically, Dysport injections are used to treat the following:

  • Forehead furrows
  • Frown lines
  • Crow’s feet
  • Skin bands on the neck

Dysport Injectable Procedure and Results

Using a very fine needle, Dysport injectable is placed directly into facial muscles that are causing furrows and lines. No anesthetic is required, but some doctors choose to numb the area to be injected with ice packs or topical anesthetic cream. Results can usually be seen within a few days of treatment, and typically last up to 4 months, although areas that are treated on a regular basis may retain results longer. Injections should be given only by qualified medical professionals.

Candidates for Dysport Injectable

According to the manufacturer’s website, candidates for Dysport injectable are “adults less than 65 years of age” who want “temporary improvement in the look of moderate-to-severe frown lines between the eyebrows (glabellar lines).” It may not be suitable for those with the following:

  • Allergies to Dysport injectable or its ingredients
  • An allergy to cow’s milk protein
  • Surgical facial changes
  • Very weak muscles in the treatment area
  • A face that looks very different on each side
  • Inflammation or infection in the area to be injected
  • Droopy eyelids or sagging eyelid folds
  • Deep facial scars
  • Thick, oily skin
  • Wrinkles that cannot be smoothed when spread apart

Anyone who is pregnant or breastfeeding, or has a neuromuscular disease, should not receive Dysport injectable.

Differences Between Dysport Injectable & Botox Cosmetic

Although made from the same bacterium, there is anecdotal evidence that Dysport injectable may last longer, spread farther and take effect more quickly than Botox Cosmetic.

Side Effects of Dysport Injectable

Side effects of Dysport injectable are usually mild and temporary, and normal activities may be resumed immediately after receiving injections. Injection-site side effects include the following:

  • Pain
  • Infection
  • Inflammation
  • Tenderness
  • Swelling
  • Redness
  • Bleeding
  • Bruising

Eyelids can droop when Dysport injections are made in the glabellar region; they usually return to normal within 3 weeks. Side effects of Dysport injectable are the same as those of Botox Cosmetic.


Soft Tissue Fillers

Soft Tissue Fillers

Belotero Balance

Belotero Balance

Belotero Balance is the latest, most advanced form of dermal filler available today. It has a unique ability to integrate with the tissues of the skin, providing volume and a more youthful shape to the face. FDA-approved to treat moderate to severe wrinkles and folds, Belotero Balance can reduce lines and other signs of aging while enhancing facial structure and contours.

This treatment achieves smoother skin and very natural-looking results. Belotero Balance is gentle enough to treat the delicate skin around the lips but it can also be very effective for treating deep furrows such as the smile lines of the nasolabial folds.

The active ingredient in Belotero Balance is hyaluronic acid, or HA, a naturally-occurring substance within the skin. The HA binds to water, plumping the skin tissues, and filling in wrinkles and lines around the treatment site.

Belotero Balance Treatment Areas

Belotero Balance dermal filler can help restore a more youthful, well-rested appearance to the face. It is particularly effective in treating certain areas of the face, including:

  • Smile lines, or nasolabial folds, that appear between the side of the nose and the corner of the mouth
  • Vertical lip lines, or perioral lines, that form just above the upper lip
  • Corners of the mouth, or oral commissures, because when volume is lost in this area it can give the appearance of a persistent frown
  • Marionette lines, which form between the corners of the mouth and the chin and tend to become deeper with age

Good Candidates for Belotero Balance

Adults of any age who are concerned about facial lines or wrinkles may be good candidates for treatment with Belotero Balance. These are often problems that become more significant as people get older, but even younger men and women may experience common signs of aging due to sun exposure, heredity, or other factors. It is also important for a patient’s expectations to be realistic about what the treatment can achieve.

Advantages of Belotero Balance

Belotero Balance has a thinner, more lightweight composition than many other dermal fillers. This helps the gel that is injected to be distributed much more evenly and provides a smooth transition between the treatment area and the surrounding skin. It does not form lumps as some alternative forms of dermal filler occasionally do. Another benefit is that Belotero Balance may be injected close to the surface of the skin to maximize its effects. When other HA fillers are injected near the surface, they can produce a blue tint in the skin at the treatment site.

The Belotero Balance Treatment

The quick and nearly painless procedure typically takes approximately 20 minutes. Using a fine gauge needle, the Belotero Balance gel is injected into the skin at the treatment site. The results of a Belotero Balance treatment will be visible immediately. However, the corrections achieved by the filler injection are not permanent and vary by individual. For many patients, the effects are still apparent nine months after an injection. To best maintain the results, follow-up treatment sessions are typically recommended every six to 12 months.

Recovery from Belotero Balance Treatment

There is no downtime needed after an injection with Belotero Balance. Most people can return to work or other normal activities immediately after the treatment session.

Side Effects of Belotero Balance

While considered a safe form of treatment, injectable dermal fillers may be associated with certain side effects. The most commonly occurring side effects after Belotero Balance treatment tend to be redness, irritation, swelling, itchiness, bruising, or tenderness around the area of the injection. These reactions are typically mild and short-lived if they arise, usually improving on their own within a few days. However, if they do not resolve, patients should contact their doctor.


Juvéderm Injectable Gels

Juvéderm Ultra & Ultra Plus Injectable Gels

Juvéderm® Ultra and Ultra Plus injectable gels are U.S. Food and Drug Administration-approved dermal fillers that, according to their manufacturer, Allergan, Inc., are designed to “temporarily treat moderate to severe facial wrinkles and folds such as nasolabial folds” in people older than 21. JUVÉDERM Ultra is used on moderate wrinkles and folds, whereas the thicker Ultra Plus is used on deeper ones.

Juvéderm Ultra and Ultra Plus are smooth-consistency gels that restore volume to the skin and lessen the appearance of wrinkles and folds. They are made of hyaluronic acid (HA), a sugar that occurs naturally in the body. In terms of the skin, HA’s role is to deliver nutrients and hydration and act as a cushioning agent. Young, healthy skin contains a lot of HA, but factors that include aging and sun exposure reduce the amount, causing the skin to lose structure and volume. JUVÉDERM injectable gels are most effective at improving the appearance of nasolabial folds, the lines that run from the bottom of the nose to the corner of the mouth on both sides of the face.

Juvéderm Ultra and Ultra Plus Injectable Gels Procedure

Juvéderm Ultra and Ultra Plus injections take about 15 minutes to administer in a doctor’s office. A fine needle is used for each injection, which is given under the skin in the targeted area to add volume or fill in wrinkles and folds. Because Juvéderm injectable gels do not contain lidocaine, a topical anesthetic may be used to minimize discomfort. Afterword, the doctor may gently massage the treated area(s).

Once treatment is completed, patients can return, with virtually no downtime, to their regular activities. For the first 24 hours after treatment, to reduce the risk of complications, patients should avoid strenuous exercise, excessive sun or heat exposure, and alcohol consumption.

Results of Juvéderm Ultra and Ultra Plus Injectable Gels

The results of JUVÉDERM Ultra and Ultra Plus are visible immediately after injection; any swelling and bruising, to which ice can be applied, should subside during the next few days. Results can last 6 to 9 months, and, in some cases, up to a year. However, according to its manufacturer, “Results from injectable dermal filler vary and correction is temporary. Supplemental ‘touch up’ treatments may be required to achieve and maintain optimal correction of . . . wrinkles and folds.”

Risks of Juvéderm Ultra and Ultra Plus Injectable Gels

Although Juvéderm Ultra and Ultra Plus are considered safe, there is a risk of side effects. They are usually limited to the injection site, and include the following:

  • Redness
  • Pain or tenderness
  • Firmness
  • Swelling
  • Lumps or bumps
  • Bruising
  • Itching
  • Discoloration
  • Infection

Juvéderm injectables are the first HA fillers that are FDA-approved for use on people of color.

There are also Juvéderm formulas that contain lidocaine to reduce any discomfort from the injections: Juvéderm Ultra XC and Juvéderm Ultra Plus XC.


Juvéderm Voluma™

Juvéderm Voluma™

Juvéderm Voluma™ is a new, FDA-approved dermal filler formulated specifically to add volume to the face around the cheeks and chin. This is the only injectable gel created to provide a subtle, natural enhancement to the mid-face, addressing changes in definition that occur over time. Juvéderm Voluma can help restore more youthful contours by plumping up the area that so often loses volume as part of the aging process. It can also return a firmer shape to the jawline when some softening has set in.

Juvéderm Voluma is not only an effective treatment method, but it is long-lasting as well. In many patients, the results will last for a period of up to 18 months.

The active ingredient in Juvéderm Voluma is hyaluronic acid (HA), which is a substance naturally produced within the skin. As we get older, the levels of HA present in the skin begin to decline, resulting in a loss of volume and sunken or sagging cheeks. Juvéderm Voluma integrates into the existing collagen and elastin in the skin tissue to offer greater support and elasticity. This can provide a noticeable smoothing and firming to the skin and lend the facial structure a more substantial definition.

Juvéderm Voluma is the latest in the Juvéderm line of dermal fillers. These various formulas have a successful history of reducing the appearance of wrinkles and folds in the skin and rejuvenating the face.

Good Candidates for Juvéderm Voluma Treatment

Adults of any age who notice changes to their mid-face or at the chin or jawline may be considered good candidates for treatment with Juvéderm Voluma. Typical early signs of aging may include a visible decrease in volume, a sagging of the cheeks, or the loss of noticeable contour around the chin. While these are more common problems that people face as they age, younger men and women may experience them as well due to weight loss, heredity, or a number of other factors.

The Juvéderm Voluma Procedure

Juvéderm Voluma injections typically take about 15 minutes to administer in the doctor’s office. The gel formula contains lidocaine to minimize discomfort, so there is no need for additional anesthesia. The injection is designed to reach the deep layers beneath the skin’s surface to provide the most benefit.

The results are visible immediately after the procedure. There is very little or no downtime required following a treatment with Juvéderm Voluma. Most patients can resume all of their typical daily activities right away after their treatment session.

Juvéderm Voluma Side Effects

While Juvéderm Voluma is considered a safe form of treatment, all injectable dermal fillers are associated with some risk of side effects. The most commonly occurring side effects that may result from Juvéderm Voluma treatment include swelling, tenderness, the formation of a lump, firmness to the skin, bruising, redness, itching, discoloration, or pain at the injection site. When these arise, they are generally mild to moderate and resolve within a few weeks.


Perlane®

Perlane®

Perlane® is an injectable filler used to soften wrinkles and reduce the appearance of lines and folds for patients unhappy with the effects of aging on their skin. Perlane can be used for lines around the lips, mouth, nose, and forehead, and is especially effective for the nasolabial folds, which stretch from the nose to the corners of the mouth. Perlane is made of hyaluronic acid, as is Restylane®, but contains larger gel particles that can more effectively fill deep depressions on the skin.

Perlane injections typically take 30 to 45 minutes to perform and are administered with a topical anesthetic. Patients can return to regular activities immediately after injections, with no downtime. Results are visible right away and can last for six to eight months, depending on the individual patient’s age, skin condition, and various other factors. Touch-up injections once or twice a year are recommended to maintain results.

Perlane is a safe procedure, but there are risks associated with any procedure. Some patients may experience swelling, redness, bruising, and discomfort after treatment, but these side effects usually subside within a few days. Although rare, Perlane carries a risk of infection, bleeding, or allergic reaction. Choosing a qualified physician for your Perlane treatment can greatly minimize the occurrence of complications.


Restylane®

Restylane®

Restylane® is a biodegradable gel used by dermatologists in injections targeted at smoothing out wrinkled skin. Restylane is primarily composed of hyaluronic acid, a natural substance occurring within the body. This compound is also the only FDA approved dermal filler on the market for use in treating wrinkles. In addition, not only does the injected volume of Restylane add fullness to skin, but it also attracts water molecules to the site of injection, further enhancing its effectiveness.

While inside the body, Restylane provides longer-lasting results that are apparent almost immediately after injection, although it may take a day or two before natural body processes and swelling subside. A follow-up appointment will be scheduled for a later date (4-8 months) for another set of injections to further prolong the effect.

There are very few complications associated with Restylane. The compound itself is derived from bacterial origins, so most allergies should not be an issue (unless specific to bacterial proteins). The side effects are minimal and will not interrupt your daily routine. These may include:

  • Slight redness
  • Minor swelling
  • Mild discomfort

These will all subside within three days or less as your body adjusts to the new hyaluronic acid. Consequently, the suggested recovery period of Restylane treatment is just under three days. It is advised to refrain from rubbing or massaging the treated area for approximately 48 hours.


Sculptra® Aesthetic

Sculptra® Aesthetic

Sculptra® Aesthetic injectable is used to reverse the signs of facial fat loss that occur with aging. By restoring collagen, which decreases as the body ages, it fills out shallow-to-deep wrinkles and folds that run from the sides of the nose to the corners of the mouth (nasolabial folds). It is not appropriate for use in the eye and lip areas.

Sculptra Aesthetic’s main component is an alpha hydroxy acid called poly-L-lactic acid (PLLA), which is a safe and long-lasting synthetic (artificially created), biocompatible (can be used harmlessly in the body), biodegradable (able to be broken down by the body) substance. PLLA has been used for more than 20 years in many surgical products, including dissolvable sutures and soft-tissue implants.

Benefits of Sculptra Aesthetic Facial Injectable

U.S. Food and Drug Administration-approved for the treatment of nasolabial folds, Sculptra Aesthetic is considered safe and effective for most patients. Because it works gradually, patients achieve a more youthful, natural-looking appearance with subtle, yet noticeable, results. Although not FDA-approved to treat them, according to manufacturer Valeant Aesthetics, Sculptra Aesthetic can be used on marionette lines (at the corners of the mouth) and chin wrinkles. Because it contains no animal, human or bacterial components, allergy testing is not necessary prior to treatment. There is little-to-no downtime after receiving Sculptra injections; most patients return to their normal activities immediately.

Treatment & Results of Sculptra Aesthetic Facial Injectable

Sculptra Aesthetic injections are designed to be a one-time treatment. A patient can have up to 4 injection sessions, which are spread 3 weeks apart. When injected into shallow-to-deep folds and lines, the additional collagen that is produced smooths them out and adds volume to the skin. Results of Sculptra injections vary but, in a clinical study, their effects were shown to last for up to 2 years in most patients.

Side Effects of Sculptra Aesthetic Facial Injectable

Possible side effects of Sculptra injections include localized bleeding, tenderness, discomfort, redness, bruising, and swelling. Side effects usually fade within a few days, although can last longer.

According to Valeant Aesthetics, “Other side effects may include small lumps under the skin that are sometimes noticeable when pressing on the treated area. Larger lumps, some with delayed onset with or without inflammation or skin discoloration, have also been reported.”

General Dermatology

The specialty of general dermatology includes the medical and surgical diagnosis and treatment of diseases and conditions affecting the skin, hair, and nails. Although many of these skin conditions are quite rare, others are very common, affecting millions of people.

Some common skin conditions diagnosed and treated in general dermatology include;

Acne

As the most common skin disorder in the United States, acne affects nearly 50 million Americans. Acne is typically characterized by the presence of pimples, cysts, nodules and blackheads/whiteheads that form on the face, neck, upper chest and back. Although it occurs most frequently among teenagers, acne can occur in all age groups. Many new and effective therapies are available to treat acne and help prevent the scarring that can result.


Actinic Keratosis

Actinic keratoses (AKs) are premalignant skin lesions caused by frequent or excessive sun exposure. AKs are among the most common skin lesions treated by dermatologists, affecting half of the global population. These lesions appear as scaly or crusty areas on sun-exposed skin, gradually thickening into larger, wart-like growths. Since many actinic keratoses will progress into skin cancer (squamous cell carcinoma), treatment and eradication is recommended. Several treatment modalities including topical creams, liquid nitrogen (cryosurgery), light therapy, and surgery are used by dermatologists to destroy AKs before skin cancer develops. Most people diagnosed with an actinic keratosis are likely to develop more lesions as they age, emphasizing the importance of periodic dermatologic skin examinations and treatments.


Hair Loss (Alopecia)

The average person loses 50-100 hairs daily. Gradual permanent hair thinning is part of the normal aging process. However, sudden hair loss in greater amounts than normal can be caused by certain diseases, illnesses, hormone-related disorders, nutritional deficiencies, medication, stress, pregnancy, and other factors. In many of these cases, identifying and treating the underlying cause can stop hair loss and promote regrowth of hair.


Dermatitis (Eczema)

There are many types of dermatitis including atopic dermatitis, contact dermatitis, seborrheic dermatitis (seborrhea), and nummular dermatitis. This type of inflammation of the skin usually causes swelling, redness, itching, and burning of the affected areas. Dermatitis can occur at any age and is commonly seen in infants and young children. Since certain infections of the skin can mimic dermatitis, an accurate diagnosis is critical in establishing an effective treatment plan.


Nevi (Moles)

Most people have several, if not many, benign moles called nevi. Changes in the size, shape, or color of a mole may be indicative of the transformation of a benign mole into an abnormal mole (atypical or dysplastic nevus). Such changes could also represent a skin cancer (malignant melanoma) developing within a mole. Dysplastic nevi (atypical moles) can look very similar to lesions of melanoma. It is important to recognize such changes and have any changing mole evaluated by a dermatologist.


Psoriasis

Psoriasis is a common skin condition that can affect small areas of the skin surface or the entire body. The most common form, plaque psoriasis, appears with raised, red, scaly patches most often located on the elbows, knees, and scalp. However, these patches can appear anywhere on the body. Topical therapies are useful in controlling mild and moderate cases of this chronic skin condition. Systemic drugs and biologic agents are used for more severe cases when topical treatment proves ineffective.


Rosacea

Rosacea is an adult form of acne which consists of redness, acne-like blemishes, and prominent capillaries of the face. This condition is usually exacerbated by hot beverages (coffee, tea), certain foods, and sun exposure. Treatment with topical and/or systemic therapies is effective in controlling this chronic skin condition.


Skin Cancer

The three most common types of skin cancer include basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma.

Basal cell carcinoma is the most common form of skin cancer. Although these cancers most commonly develop in sun-exposed areas, basal cell carcinomas can be diagnosed anywhere on the body. These lesions can appear similar to other benign growths (moles) and conditions (dermatitis) of the skin. Small basal cell carcinomas often appear as skin-colored or pink, dome-shaped growths. They can also present as red, scaly patches that can be mistaken for eczema or as waxy-appearing, hard growths that resemble scars. In most cases, basal cell carcinomas grow more slowly than squamous cell carcinomas and do not spread to other parts of the body.

As the second most common form of skin cancer, squamous cell carcinoma usually develops on sun-exposed skin but can form anywhere, including the lips. These skin cancers often appear as red, rough, crusted or scaly bumps on the surface of the skin. They can also appear as red, scaly patches, or as nonhealing, bleeding sores. Squamous cell carcinomas are considered to be more serious than basal cell carcinomas because they have a greater ability to metastasize (spread) to nearby lymph nodes and internal organs. 25% of all skin cancer deaths are caused by squamous cell carcinomas.

Malignant melanoma is the most serious of the three common forms of skin cancer. Melanomas can be life-threatening if not diagnosed and treated early, so it is important to check moles regularly for signs of change that could signal transformation into melanoma.

Dermatologists refer to the ABCDEs of malignant melanoma to watch for: Asymmetry (one-half of the lesion looks different from the other half); Border (the outer edge of the lesion is irregular or poorly defined); Color (the lesion has a variety of colors rather than the same even tan color throughout); Diameter (larger than 6 mm – the size of an eraser on the end of a pencil); and Evolving (the lesion looks different from other moles on the body or is changing in size, shape or color). Any mole or skin lesion with any of these characteristics should be evaluated by a dermatologist as soon as possible.


Warts (Verrucae)

Warts are noncancerous but contagious, skin growths caused by the human papillomavirus (HPV). Warts are typically skin-colored with rough surfaces but can also appear brown or gray, smooth, and flat. Warts can grow anywhere on the body but are most often found on the hands, feet (plantar warts), face (flat warts), and legs. There are numerous treatment options for warts including topical acid therapy, cryotherapy (liquid nitrogen freezing), cauterization (burning), curettage (scraping), and laser surgery.