Photo Dynamic Therapy (PDT)

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What is Photodynamic Therapy?
Photodynamic therapy (PDT) is the use of a topical medication (Levulan) activated by intense pulsed light (IPL).   Light converts the Levulan (ALA) into a photo-sensitizing agent, which destroys the targeted sun damaged and precancerous cells (Actinic Keratosis or AKs).   Another positive benefit with PDT is the reduction of pore size since the sebaceous glands are tempered, reducing oil flow and consequent pore blockage.  The use of IPL with levulan also results in targeting of melanin and hemaglobin.  The combination of IPL with Levulan is synergistic resulting in destruction of pre-cancerous cells, reduction in acne causing bacteria and amplifying the benefits of IPL photorejuvenation, for increased cosmetic results.

What can be treated with Photodynamic Therapy?
PDT is typically prescribed to remove actinic keratosis (AKs or pre-cancersous cells) all over the body, but mainly on the head, face, neck, hands and other sun exposed areas.  PDT is also effective for treatment of acne as well as a more aggressive form of IPL photorejuvenation.

Benefits of PDT for Actinic Keratosis
– It has no long-term side effects when used properly.
– It’s less invasive than surgery or cryotherapy.
– It usually takes only a short time and is most often done in-office.
– It can be targeted very precisely.
– PDT can be repeated many times at the same site if needed.
– There’s little or no scarring after the site heals.
– Cosmetic benefits of IPL photorejuvenation are achieved at the same time as AK destruction

Actinic Keratosis (AK) before and after PDT

Levulan for Acne
Levulan has also shown excellent results for the treatment of acne.  IPL with Levulan can be used to treat light to moderately-severe acne and may be suitable for those patients who wish to avoid taking heavy medications to rid their skin of acne.  Mechanisms include reduction of acne causing bacteria,  shutting down the oil glands (sebaceous glands) in the skin, and exfoliation of the skin to unclog pores.  If you have acne that is not responding to medications, or if you are unable to tolerate oral or topical medications for acne, photodynamic therapy with Levulan may be right for you. Combined with a light source, Levulan kills the p.acnes bacteria in your skin, decreases sebum (oil) production and often provides long term improvement of acne.  Results may vary depending on each patient’s unique physiology and lifestyle factors.

Acne before and after PDT

Levulan for general skin rejuvenation
Adding Levulan to an IPL treatment, is somewhat like putting your IPL photorejuvenation on steroids.  The Levulan photo-sensitizes the skin, allowing the IPL energy to be better absorbed by the targeted pigmented and vascular chromophores.  This results in a higher level of correction of freckles, sunspots, skin discoloration, broken blood vessels and redness compared to photorejuvenation alone. Although, Levulan does not penetrate to dermal layers of the skin, the heat and inflammatory response caused by PhotoDynamic Therapy does reach the Papillary dermis.  This heat stimulates the fibroblast to produce collagen.  This combination treatment also benefits enlarged oil glands (sebaceous hyperplasia), enlarged pores and uneven skin tone & texture.


What should I do prior to my PDT treatment?
It is extremely important to protect the treated skin from the sun for a full 4 weeks prior to PDT. This is best accomplished by the use of a quality SPF 30+ sunscreen daily and a hat worn during times of greater exposure to the sun’s rays.   Artificial tanners should be stopped 3 weeks before treatment.  All pre-treatment guidelines for regular IPL treatments should also be followed.  Your face should be washed immediately prior to your appointment to remove any make-ups or creams.

How is the procedure performed?
First your skin is pre-treated with an acetone scrub, to remove oil from the skin’s surface.  Sometimes microdermabrasion is also preformed before the Levulan is applied.  Microdermabrasion will remove dead skin cells and cause blood vessels to dilate, which will result in a more aggressive treatment. After the skin is prepared the Levulan Kerastick is cracked open and applied to the skin. The ALA is left on the skin to incubate, typically for 1 hour.  A longer incubation time can cause more reaction as well as more correction.  Non-facial skin generally tolerates a longer incubation time.  After the Levulan has been on for the determined amount of time, the skin is then treated with IPL to activate the Levulan and provide additional photorejuvenation effects.

What should I do after the PDT treatment?
– Sun protection including quality SPF 30+ sunscreen and a hat are mandatory for at least 48 hours after each treatment.  Avoid direct sunlight to the face even for a minute. Wear sun protection as above even when sitting near a window or in a car.
– Make-up may be put on gently 3-5 days following the procedure unless there is crusting or intense redness.
– Scrubs and facials must be avoided for 1 week after the procedure.
– Retinoids (Retrinal, Retinol, Retin-A, Renova) and glycolic acid products may be restarted after 5 days only if the skin is no longer red, swollen or peeling.
– Light scaling and peeling as well as mild to moderate redness are expected to occur for 2 to 7 days. Any areas of crusting or oozing should be covered at least 3 times per day with Vaseline petroleum jelly or Aquaphor ointment. Notify our office if heavy crusting, intense redness or swelling, or other unwanted side effects occur. Symptomatic relief may be obtained by placing cool tap water compresses on the skin. Compresses made from one cup of cool tap water mixed with one tablespoon of white vinegar may provide additional relief from discomfort if necessary. Advil (ibuprofen) and Tylenol (acetaminophen) can also help alleviate discomfort.
– All post-treatment guidelines for regular IPL treatments should be followed.

Side effects
Redness, swelling, increased warmth and tingling sensations may occur for 1 to 3 days after treatment. Redness and scaling may be present for up to 1 week depending on the degree of sun damage.  Crusting, darkening or lightening of areas of the skin, intense redness and prolonged swelling or stinging may occur.  These generally resolve with proper skin care.  Sun avoidance is absolutely necessary for 48 hours after the procedure.  A quality spf 30+ sunscreen containing titanium and zinc oxide must be worn daily.  Patients must wear a hat to protect the face from sunlight while outside during this 48 hour period as well.  Patients should also stop the use of any topical acne creams and avoid hot showers during this time to allow skin to properly heal.

Will I feel any discomfort during the treatment with the Levulan® PDT system?
Although the Levulan® Photodynamic system has been designed for less patient discomfort, many patients do report some stinging and burning, swelling and temporary reddening. At least 50% of patients experienced significant stinging and burning during the light treatment, usually plateauing in intensity at about 6 minutes.  Almost all patients experienced swelling and temporary reddening immediately following light treatment. This will begin to subside soon after treatment and will be gone in a few weeks. The discomfort usually occurs immediately following treatment, rather than in the weeks following.

How many PDT treatments are required?
Current recommendations suggest 1 to 2 treatments are necessary to achieve results.  Recent data suggests approximately 90% of patients obtain significant improvement from this regimen.  Improvement will last longest with continued use of sunscreens and anti-aging creams such as retinoids (Retrinal, Retinol, Retin-A, Renova).  Maintenance PDT treatments may be required at different intervals ranging from 6 months and up, depending on patient response, aging, exposure to sun and other environmental lifestyle factors.

IPL Photorejuvenation

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Rocasea B&A Two IPL Treatments

What are IPL (Intense Pulsed Light) treatments used for?
– Evening out skin tone
– Lightening and removing flat, benign pigmented lesions (freckles, sunspots, age spots and general pigmentation) on the face, neck, chest, hands and other areas of the body
– Lightening and reducing facial vascular lesions, and telangiectasia (spider veins, broken capillaries and red spots ) diffuse redness and rosacea on the face, neck and chest
– Lightening and reducing red scarring, stretch marks, Campbell de Morgans spots or cherry angiomas (red spots of varying size) and Poikiloderma (redness, pigmentation and a spotty look to the neck and/or décolletage)
– Helping to control flushing
– General improvements with uneven and blotchy skin
– IPL treatment also has a lesser effect of improving skin texture & firmness through collagen stimulation and improving pore size by temporarily reducing skin oiliness
– IPL treatments are sometimes beneficial for Acne breakouts, but individual results may vary
– Destruction of pre-cancerous lesions (actinic keratosis) when used in conjunction with Levulan (a light activated topical drug) is described in another blog posting
– Note that the ND:YAG Laser is the preferred treatment modality for moderately sized vascular lesions; however, medical grade IPL is a good choice for small vascular lesions, diffuse redness and general overall skin rejuvenation.  The ND:YAG laser provides a single high power wavelength that is targeted at hemoglobin or melanin, but the IPL device (which is not a laser) provides a broad range of colors, not all targeted.
– IPL is NOT recommended for Melasma.  Melasma is the brown splotchiness on the forehead, cheeks, upper lip, or jaw line that is triggered by hormones and light.  Hormones stimulate the growth of cells (melanocytes) that make brown pigment.  Natural light (and IPL) stimulates the production of even more brown pigment (melanin).  The Clear & Brilliant laser would be an option for treatment of Melasma.How does the IPL treatment work?
The IPL machine emits high energy bursts of light that is absorbed by hemoglobin (the red blood cells in the blood vessels) or melanin (the brown pigment in freckles and age spots).  The light energy passes through the skin and is absorbed by either hemoglobin or melanin resulting in damage to the vessel wall or fragmentation of melanin pigment. These tiny vessels and the melanin pigment are then absorbed by the body, rendering them less visible.How many treatments are required?
Treatment of benign pigmented lesions generally require 2-5 treatments performed approximately every month or once all the darkened cells have sloughed off.  Vascular lesions or diffuse redness generally require 2-5 treatments at monthly intervals to achieve the best results. This is so we can progressively destroy the vessels without damaging the surrounding skin.
The number of treatments and subsequent results will depend on the condition and area being treated. You can expect to see some improvement with each treatment, but each individual’s response may be slightly different to each treatment. The more sun damage or redness you have, the more likely you are to require more treatments.  IPL machines that are sold to salons and spas generally have less power than the IPL machines sold to physician’s offices and may require more treatments for similar results.Is Your Skin Suitable For IPL Treatment?
The table below is used to classify skin according to its melanin (pigment) content and the skin’s reaction to the sun. The lighter the skin type, the more suitable it is for IPL treatment.

Skin Type Classification Colour Indication for IPL  
I  Always burns easily and never tans White Best skin for IPL treatment
II Burns easily and tans minimally White Good skin for IPL treatment
III Sometimes burns and tans gradually White Good skin for IPL treatment
IV Burns minimally and always tans Moderate Acceptable skin for IPL treatment
V+ Rarely burns, naturally dark skin Dark Brown+ Not recommended for IPL treatment

Do I require a consultation before I schedule a treatment?
You must be seen in consultation prior to your first IPL Photorejuvenation treatment.  During your consultation any specific concerns or questions will be addressed.  The cost of consultation will be applied against your first treatment.

What should I do prior to my IPL treatment?
– Please shave the area before your IPL session.
– If you have a history of herpes close to the area being treated, it is recommended that you take antiviral medication before the treatment.
– Avoid self-tanners and unprotected sun exposure 4 weeks prior to treatment.  Use quality SPF 30+ daily on sun-exposed skin that is to be treated.
– If you have a history of hyperpigmentation, you may be prescribed topical agents to apply 4 weeks prior to treatment to prevent any hyperpigmentation.
– You will need to discontinue any medications cause light hypersensitivity  for a week before each treatment, such as antibiotics (minocycline, tetracycline, doxycycline) or Vitamin A compounds (Retin-A/Renova).
– You may be asked to avoid taking aspirin, ibuprofen, or Aleve one week prior to treatment unless medically indicated as these medications can promote bruising.
–  You will be required to discontinue oral isotretinoin (accutane) for 6 months prior to treatment.
– IPL should be avoided if you are pregnant, have a history of seizures, healing problems or keloid formation, severe dermatitis or eczema (within the treatment area), active infections or open wounds in treated area, have a significant systemic illness, have a history of skin cancer or suspicious lesions, are hypersensitive to sunlight, take anticoagulants or medication that alters wound healing, have received gold therapy, or are experiencing cold sores / herpes outbreaks.

What is a typical IPL treatment like?
Prior to treatment, all makeup creams and lotions will be cleaned from the treatment area.  Your therapist will put special goggles over your eyes to protect them from the intense flash of the IPL machine.   A cool gel is then placed on the skin being treated.  The IPL handpiece is gently applied to your skin and pulses of light are administered.  Our equipment also utilizes Zimmer cooling technology for increased comfort and safety.  Test spots are utilized to reduce the risk of complications and optimize results.  You will experience a slight sensation as the light pulses are passed over your skin.  The sensation is usually mild and easily tolerated, but there may be some mild discomfort during the treatment (the first treatment typically has the most “zing”).  As your skin begins to clear, the treatments usually become more comfortable.  At the end of the treatment, the gel is removed and the skin is cleansed with a cloth and moisturizer with sunscreen is applied.  If there is any mild swelling, you may be given a cold pack to apply for five or ten minutes.  Typically you may reapply foundation or concealer immediately after a treatment.  Treatments usually take 30-90 minutes, depending on the size of the treatment area.  Levulan treatments follow a different protocol that is described in another blog post.

What can I expect after the IPL treatment?
Your skin may may have a mild “glow” or light sunburn like sensation lasting for 2 to 5 hours after your treatment.  Your skin will often feel smoother and have a more even tone.  The treated area is generally more sensitive to heat for 2 days following treatment.
– For diffuse redness, generally, the skin looks redder after the treatment then gradually lightens within 1-3 weeks. Makeup can be used right after the treatment, as long as it is applied and removed very gently. Rarely, there is bruising, which can take 1-2 weeks to resolve.
– Contact sports or any other activity that could cause bruising should be avoided.
– After treatment of vascular lesions they will typically either disappear immediately or appear grey or purplish in colour.  Vascular treatments generally require at least 3 treatments for best results.
– For freckles and age spots, the spots generally look darker for 3-7 days. Crusting can occur, which may last up to ten days. The lesions will then begin to clear and will generally be resolving at one month. It can take an average of 3-5 treatments to clear age spots.
– Acne prone skin may sometimes have a breakout after treatment.

Are there side effects from IPL treatment?
The main side effects are mild, temporary swelling, redness, an accentuation of the brown spots, crusting, and an occasional bruise or small superficial blister.  Do not pick blisters or skin crusting as this may lead to a scar.  Treated pigmented lesions will typically slough off in 2-3 weeks.  Do not shave the treated area if crusting is evident.  Another side effect of IPL treatment is some hair reduction; however, IPL is not as effective as laser hair removal, and more treatments are generally required to achieve similar levels of hair reduction.
Darker patches of pigment on the skin may occur a couple of weeks after treatment (this is not the immediate darkening of pigment we expect when treating pigmentation). This can last from 2 weeks up to 1 year and can be treated with a special lightening cream. You are more at risk of this occurring if you have a darker skin type.
Whiter patches on the skin can occur. This can last 2 weeks up to 1 year, though also has the potential to be permanent. You are more at risk of this occurring if you have a darker skin type.
Higher treatment levels increase treatment effectiveness, but also increase the possibility of adverse effects.  Test spots can aid in finding the optimal treatment settings.

How long will results last?
IPL Photorejuvenation will improve many of the visible signs of aging and sun-damaged skin; however, with the passage of time and with environmental exposure, skin ages as we do.  If you are exposed to a lot of sun and do not use sunscreen, the underlying issues, will return sooner.  However, if you follow a good preventative skin care regime and keep it protected from the sun, your skin will continue to look good.  Quality sunscreen, hats and sunglasses are excellent protection for overall skin health.  Typically, maintenance IPL treatments are recommended every 6-12 months, depending on individual factors.

Rocasea & Thread Veins B&A IPL treatments

Laser Vein Treatments

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Spider veins are small (less than 3 mm) veins often found on the face, thighs and ankles. These veins are typically purple, blue or red and usually appear in three basic shapes: linear, branch-like or spider-shaped.

What causes spider veins?
These veins are often provoked by sun exposure, pressure, hormonal changes, heredity, or other factors. For example, many women tend to develop leg veins after pregnancy due to increased pressure and hormonal changes, or those with rosacea tend to have a weak capillary network under the skin which is often genetic. Some individuals develop a red flushed complexion due to over use or abuse of harsh skin care products while others develop red broken capillaries around the nose due to aggressive extraction. Although the exact cause is often unknown, these spider veins can be safely and effectively treated with the appropriate technology.

How are spider veins treated?
The Nd:YAG laser used at Azure Advanced Aesthetics penetrates deeply into tissue, targeting the hemoglobin in the vein and protecting the surrounding skin with Zimmer cooling technology.  The targeted spider vein is thermally coagulated causing it to collapse, forcing the body to absorb and repair the area.

What Results can I expect?
Laser Vein Removal is very effective when used on appropriate veins.   Most finer or spider like veins can be removed within 1 to 2 treatments. Larger or deeper leg veins may require more treatments.  For some, the veins will disappear completely without any visible trace.  Others, however, may experience some bruising or discoloration which can take up to several weeks to resolve completely.  It may take 2-6 weeks for your body’s healing response to begin and it may take up to 4-8 weeks for your body to absorb and eliminate the coagulated vessels.  Treatments are generally spaced 4 to 8 weeks apart.

Is Laser Therapy painful?
During treatment, you may feel a sensation somewhat like a rubber band snapping.  The Laser system used at Azure Advanced Aesthetics for vein treatments, includes an integrated Zimmer cooling system for increased comfort and to prevent damage to the surrounding skin.

How Long Do the Results Last?
Spider vein removal is permanent; however, those who are prone to spider veins may notice the appearance of new vessels due to genetics and lifestyle / environment.

How do I know if I am a candidate for laser vein treatment?
All individuals are evaluated prior to laser therapy. Spider veins do not cause symptoms and are of a cosmetic concern only. For those who have symptoms, further investigation is done to ensure that they do not have varicose veins. Laser therapy is most effective for the very small spider veins and not used to treat large varicose veins.

What preparations should I take before treatment?
There are no major preparations required before the laser treatment, but you will want to avoid sun exposure, aspirin, alcohol and smoking for at least a week prior to the procedure.  On the day of treatment, avoid all creams, lotions and moisturizers on the area that is going to be treated. Also, wear comfortable clothing that allows easy access to the body part(s) being treated.

What protocols should I follow after treatment?
• Aggressively cool area after treatment
• Apply ice packs or cold aloe vera for comfort or if redness or swelling continues
• If there is no extended redness, blistering, or scabbing, resume make-up, shaving, and regular skin care the next day
• If scabbing of blistering occur, keep moist with aloe or other cream of choice
• Wash the treatment area gently with soap and water. Do not soak.
• Do not shave the treated area if crusting is evident.
• Avoid contact sports or any other activity that could cause bruising of the treated area.
• Avoid sun exposure between treatments. If sun exposure is unavoidable, use a good quality 30+ SPF sunblock to cover exposed, treated areas.
• You may continue with normal daily activities, however, you need to refrain from hot baths or exercise for up to 3 days.
• Compression stockings may be recommended for leg veins.

What are side effects of laser therapy?
The skin above the veins will often have a reddish, cat-scratch appearance. This generally disappears over the next two days.  Laser vein treatment may remove some hair that may be in the treated area.

What are potential complications of laser therapy?
The risks associated with laser vein therapy are minimal. Your eyes will be shielded during the treatments.  A state-of-the-art cooling system is used during treatment, thus the treatments are low risk and relatively pain-free.  Following post treatment protocols will help to reduce potential complications.

Choosing a Provider for Laser Vein Treatments:
When selecting a provider for laser treatments, give your decision the same level of care and scrutiny that you would for a medical procedure.  Even though it is non-surgical, Laser vein treatment is still a complex procedure that requires specific training, knowledge and skill to ensure safe treatment and effective results.  You’ll want to choose a provider with extensive experience and access to a well trained physician for any potential questions or complications.  Typically a plastic surgeon or dermatologist practice has the requisite training and experience for the best outcomes.  A reputable and experienced Laser provider who has access to other skin treatments will know what Lasers can do for your skin and what they can’t.  Each person is unique; therefore, at your initial consultation, your provider should address your concerns in a comprehensive, integrative manner.

 

 

What are Injectable Dermal Fillers?

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Dermal fillers are gel-like, volumizing substances that are injected beneath the skin to restore lost volume, smooth fine lines and deep creases, or enhance facial contours.

How Can Dermal Fillers Enhance My Appearance?
Many visible signs of aging are related to volume loss. As facial tissues thin out, lines become etched around the nose and mouth and cheeks look a little hollow. Dermal fillers can replace lost volume to help smooth wrinkles, plump the lips, and restore a more youthful appearance.  While dermal fillers are known simply as “wrinkle fillers,” they can do much more such as:
– Enhance & restore volume to sunken cheeks
– Plump & enhance the lips
– Smooth out nose / mouth / vertical lip lines or chin creases
Injectable wrinkle fillers can give you a more youthful look for a fraction of what a traditional facelift costs.

What are Dermal Fillers Made With?
There are a variety of FDA approved filler products that cosmetic surgeons use to achieve an individual patient’s goals. Each is uniquely formulated to have a certain texture, density, and injection depth, which means that certain fillers work better for certain areas of concern.

Hyaluronic Acid (HA)
Hyaluronic acid is most commonly used and is a naturally occurring substance that is already present in your skin. It helps keep skin plump and hydrated. HA fillers are typically soft and gel-like. The results are temporary, lasting 6 months to 24 months (or longer with thicker fillers in areas with less movement) before the body gradually and naturally absorbs the HA.  As the HA molecules are broken down, they collect more water and so they maintain their volume until they near the very end of their lifespan.  Certain HA fillers are infused with lidocaine to help minimize discomfort during and after treatment. FDA approved HA fillers include: Juvederm, Volift, Voluma, Belotero, Restylane and Perlane.

Calcium Hydroxylapatite (CaHA)
Calcium hydroxylapatite is less commonly used but is a naturally occurring substance, found in our bones. When used in a filler, the calcium particles are suspended in a gel.  Calcium hydroxylapatite may stimulate natural collagen production, and it is typically used for deeper lines and wrinkles. FDA approved calcium hydroxylapatite fillers include Radiesse.

Poly-L-lactic Acid
Poly-L-lactic acid is a biocompatible (meaning it is safe to use in the body), biodegradable synthetic substance. It has been used for many years in a number of medical devices, such as dissolving stitches. Poly-L-lactic acid fillers are considered “semi-permanent,” as the results typically last more than 2 years, and can help stimulate collagen production. As a thicker filler material, Poly-L-lactic acid is typically used to treat deeper facial wrinkles. FDA approved Poly-L-lactic acid fillers include Sculptra Aesthetic.

Polymethylmethacrylate (PMMA)
Polymethylmethacrylate (PMMA) is a synthetic, biocompatible substance that has been used in medicine for much of the last century. When used in dermal fillers, PMMA takes the form of a “microsphere” or tiny ball, that remains beneath the skin indefinitely to provide continued support. PMMA fillers will also contain collagen, a naturally occurring substance in the skin that provides structure and firmness. FDA approved PMMA fillers include Artefill.

Autologous Wrinkle Fillers
Fat is the most commonly used substance in this category and incredibly well studied. Your own fat is surgically removed from your thighs, buttocks, or stomach, treated, then injected into the desired area.  Fat “take” can be variable depending on the patient and the location but the fat that “takes” is then permanent.

There are other autologous treatments that are marketed, such as platelet-rich plasma injections (“vampire lift”) but the science is not conclusive and any results are temporary.

How Long Do the Results Last?
How long the effects of dermal filler treatments will last varies widely, depending on the product used, the area of treatment, and the patient.  Generally speaking, the denser the product is and the more deeply it is injected, the longer it will last, although this is not a hard and fast rule. To maintain your results, your cosmetic surgeon will simply repeat treatment, adjusting the amount and techniques as necessary to ensure optimal results.

Hyaluronic acid fillers tend to be the most temporary option, and therefore are often recommended for first-time filler patients. These will typically last from 6 to 24 months, depending on treatment. For example, injections to the lips will wear out a little faster than those to the nasolabial folds.  Certain HA fillers, such as VOLUMA, are formulated to last longer, but are usually limited to certain areas, such as the cheeks, jawline, and the top of the nasolabial fold.  Calcium Hydroxylapatite fillers will typically last about 12 months for most patients.

Synthetic fillers tend to be longer lasting, as they are not absorbed by the body. They can be a great option for the right patient, but you’ll want to be ready to commit to results that will be there for several years—and take care to choose an experienced, qualified provider whose aesthetic style you like.

Fat injection results are permanent, although you may need a series of injections done over time because not all of the fat “takes”.

Side effects:
Most side effects associated with soft tissue fillers happen shortly after injection and most go away in less than two weeks; however, any soft tissue filler can cause long-term side effects or permanent side effects.  Common short term side effects may include: bruising, redness, swelling, pain, tenderness, itching and rash.  Uncommon side effects may include: migration / movement of filler material from the site of injection.  Extremely uncommon side effects include: raised bumps in or under the skin (nodules or granulomas), infection, allergic reaction, vision disturbances (from injections around the eyes) and injury to the blood supply to the skin causing necrosis (tissue death).

Choosing a Provider for Filler Treatments:
When selecting a provider for injectable treatments, give your decision the same level of care and scrutiny that you would for a surgical procedure.  Even though it is non-surgical, filler treatment is still a medical procedure that requires specific training, knowledge and skill to ensure safe treatment and natural-looking results. You’ll want to choose a provider with an extensive knowledge of facial anatomy, a well-developed aesthetic eye, and a surgeon’s skill and precision. Injections should be provided by an experienced board certified physician who has been well-trained in facial anatomy and operates in sterile facilities. Typically a plastic surgeon or dermatologist has the requisite training and experience for the best outcomes.  Ask if they use blunt cannulas instead of needles for injections in sensitive areas (around the eyes, near facial blood vessels or for patients who have a tendency to bruise).

A reputable and experienced injector who has access to other skin treatments will know what fillers can do for your skin and what they can’t. For example, you may optimize your results by combining dermal fillers with Botulinum toxin or other skin treatments, such as a medical skin care regimes, topical treatments or skin rejuvenating lasers.  You may be better off tightening your skin through surgery, lasers or RF devices 1st and then adding fillers, if needed.  Don’t forget to treat your skin well.  If your skin is a beautiful canvas, it will allow other treatments, such as injectable fillers, to show to their best advantage.  Each person is unique; therefore, at your initial consultation, your physician should address your concerns in a comprehensive, integrative manner.

 

 

What is Botulinum toxin?

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Wrinkle Relaxing Injections
Botulinum toxin (BTX) is a protein produced by the bacterium Clostridium botulinum that acts on nerve endings to prevent their action on muscles or sweat glands. Botulinum toxin types A and B are commonly marketed under the brand names Botox, Dysport and Xeomin in North America.

Medical Uses:
Botulinum toxin was first used to treat spasmodic torticollis of the neck in the 1980`s. Since then it has been used to treat disorders characterized by overactive muscle movement and to relax clenching of muscles all over the body (neck, jaw, scalp, arms, legs, bladder). It is also often used to treat disorders of hyperactive nerves including hyperhidrosis (excessive sweating), neuropathic pain, and types of chronic pain.

Cosmetic uses:
Injection of botulinum toxin into the facial muscles causes relaxation of those muscles, resulting in the smoothing of the overlying skin.

Richard Clark, a plastic surgeon from Sacramento (CA), was the first to document a cosmetic use for botulinum toxin. He corrected facial asymmetry caused by one-sided facial paralysis by injecting toxin into the non-paralyzed muscles. Doctors Jean and Alistair Carruthers from Vancouver observedthat blepharospasm patients who received injections in the muscles around the eyes and upper face also enjoyed diminished facial wrinkles, thereby initiating the highly-popular cosmetic use of the toxin. In 2002, following rigorous clinical trials, the FDA approved Botox Cosmetic, botulinum A toxin as safe and effective for temporary improvement of the appearance of moderate-to-severe facial wrinkles.

Side Effects:
While botulinum toxin is generally considered safe in a clinical setting, there can be side effects from its use. Most commonly, botulinum toxin can be injected into the wrong muscle group or spread from the injection site, causing paralysis of unintended muscles. Bruising at the site of injection is not a side effect of the toxin but rather of the mode of administration. Both toxin spread and bruising are minimized or prevented when BTX is administered by a skilled and properly trained physician. There are other rare side effects reported, such as headache, allergic reaction or low grade fever.

Choosing a provider:
Where you get your botulinum toxin and who does the injecting matters a lot. Safety should be the primary concern of your physician. Injections should be provided by an experienced board certified phsyician who has been well-trained in facial anatomy and operates in sterile facilities. Typically a plastic surgeon or dermatologist has the requisite experience for the best outcomes. BTX should be administered in a medical setting, not at a party or at the mall. Proper storage, correct dilution, sterile hygiene, legal use, and honest practices are all factors that influence the quality of a BTX treatment. Results will be dependent on physician experience and detailed knowledge of facial anatomy. A skilled and experienced physician will typically inject lesser amounts with better results and a decreased risk of side effects. Furthermore, a reputable and experienced injector who has access to other skin treatments will know what BTX can do for your skin and what it can’t. For example, you may optimize your results by combining BTX with dermal fillers or other skin treatments, such as a medical skin care regime, topical treatments or lasers. Each person is unique; therefore, at your initial consultation, your physician should address your concerns in a comprehensive, integrative manner.

 

 

 

The 3 Ds of aging skin

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facial-aging

As we age and as environmental factors take their toll on our skin, we begin to notice the 3 Ds in our face: Degeneration, Deflation and Descent.

Degeneration:
Aging, genetics, sun damage, smoking and other environmental factors result in a loss of collagen and elastin and an overall decrease in skin quality (degeneration). Often we notice pigmentation (colour) issues, uneven tone and texture, loss of elasticity, loose skin and creases, lines & wrinkles.

Deflation:
Deflation refers to the loss of volume that happens in the face, resulting in hollows under the eyes, flattening of the cheeks, and a more gaunt appearance, with thinner lips.

Descent:
Gravity results in the descent of facial structures. We start to develop “jowls” or “turkey neck” for example.

Typical progression of the aging face:
Many will experience some hooding and tiredness around the eyes in the 40s.
In the 50s, the cheeks (Jowls) become troublesome.
Finally, in the 60s, the neck (waddle) is often a trouble area.

aging-male

Solutions:
There are many solutions to correct and reverse the effects of aging and skin damage:

1) High quality sun screen and sun avoidance is the number one defence against aging skin!
2) Potent topical skin care products
3) Dermabrasion and advanced facial treatments
4) Lasers and Radio Frequenct energy devices
5) Injectable Hyaluronic Acid (HA) fillers (commonly branded as Juvederm or Restylane) or fat injections
6) Injectable Botulinum toxin (commonly branded as Botox)
7) Collagen and Elastin stimulators
8) Surgical procedures such as brow lift or face lift.

Toenail fungus FAQ (Onychomycosis)

By | Laser, News | One Comment

Did you know:

  • Over 35 million people in the US have toenail fungus.
  • The Oral antifungals (terbinafine (Lamisil) and itraconazole) have a clearance rate around 50% (lower rates in patients over 65y) and require liver testing due to liver toxicity.
  • New topical antifungals (like Kerydine or Jublia) are expensive ($1500 per nail) and need to be used for 11 months but have a clearance rate just over 50% and old ones have much lower rates Efinaconazole (only 18%) and Tavaborole (6-9%).
  • The most common complications of topicals were skin peeling, redness, or itching at the site, or ingrown toenail.
  • In the health food literature patients have tried tea tree oil or grapefruit seed extract or eating garlic tablets.  There are no statistics on the clearance rates of these home remedies and, of course, there is no standardization of health food products with respect to active ingredients.
  • Lasers have been used successfully for treatment of nail fungus:  http://www.ncbi.nlm.nih.gov/pubmed/22964325
    The right laser with the right treatment parameters and good patient compliance are important contributing factors to higher clearance rates.

onychomycosis

Typical Onychomycosis

  • Part of the difficulty in evaluating any therapy for onychomycosis is in distinguishing between reinfection and treatment failure.  Factors such as repetitive nail trauma, dystrophic nails, poor nail hygiene, and diabetes predispose patients to multiple episodes of infection.
  • Some clinicians / researchers have suggested that perhaps it would be more appropriate to approach onychomycosis as a chronic disease necessitating regular episodes of therapy to prevent nail dystrophy, rather than a discrete episode of infection that can be guaranteed to be cured outright.

Fraxel® by the numbers

By | Facial Procedures, Laser, News | No Comments

Did you know:

  • Fraxel® is available in more than 80 countries worldwide
  • Over 2,500 physicians offer Fraxel treatments
  • Over 800,000 procedures have been performed
  • More than 55 peer-reviewed articles have been written
  • Over 45 patents have been issued on unique fractional laser technology
  • Fraxel received aesthetic clearance in November 2003

Typical Before and After 135 micron Fraxel® re:pair single treatment

Did you also know that our Fraxel® fractionated carbon dioxide (CO2) laser comes in 4 unique modalities

  • 135 micron narrow spot size for deep ablation and aggressive skin tightening
  • 600 micron spot size for superficial / wider coverage ablation and skin pigment correction
  • 2mm Ablative spot size for the reduction, treatment, and/or removal of actinic and seborrheic keratosis, chelitis, cutaneous horns, hemangiomas, keloids, nevi, including spider, epidermal and protruding, rhinophyma, syringomas & warts
  • 0.2mm incisional Laser Scalpel for surgical applications including laser incision and/or excision for the performance of upper and lower eyelid blepharoplasty and vermilionectomy of the lip.