Angiomas
Angiomas
Angioma is a term describing any growth involving blood vessels. There are many types of angiomas. Some are dangerous and others are not but may be of cosmetic concern. Cherry angiomas are small, round, bright red spots that appear with age. They most often occur on the trunk and arms but may be found on the head and legs. These are benign growths and are not dangerous. Many people choose to remove them for cosmetic reasons. Removal is easily performed in a short office procedure with the VBeam® pulsed dye laser. Most cherry angiomas are removed after one laser session, however cherry angiomas larger than 2 to 3 mm may require a second or even a third treatment. New growths will continue to appear over time, and removal would require additional treatments.
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Botox Cosmetic
Botox is a purified form of the Botulinum toxin produced by bacteria. Botox is FDA approved for cosmetic use in the area between the eyebrows. Injections into any site other than between the eyebrows, for example the forehead or the "crow's feet," is considered an "off-label" use of Botox. In 2007, there were 4.6 million Botox procedures performed in the U.S.
Botox treats wrinkles by causing relaxation of the muscles underlying the wrinkles. By relaxing the muscle the wrinkle smoothes away. However, sometimes the crease is so deep that even when the muscle is relaxed a wrinkle is visible and Botox alone may not completely erase the wrinkle.
Botox is injected in small amounts with a tiny needle directly into the skin. The treatment may sting but is not painful. It may take 7-10 days to see effects after your treatment. The duration of the effects cannot be predicted. The effects usually last an average of 3 months, but may last longer or shorter depending on the individual. With repeated treatments over time, the effects of each injection have been shown to last longer. If you stop receiving treatments, the lines will gradually look like they did before treatment. Very rarely people have developed antibodies against Botox and treatments have stopped working.
After your treatment you will be able to return to all of your normal activities. You should, however, remain upright and not lay down for 4 hours after your treatment. After the treatment you may have a small bruise or red spot which may last a couple of days. You may cover this with makeup.
For more information on Boxtox click here.
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Chemical peels
Chemical peels
A chemical peel is the application of a liquid to the surface of the skin that dissolves the top layers of skin, resulting in an exfoliation of these top layers. Chemical peels are used to improve the appearance of the skin by treating discoloration and uneven pigmentation, fine wrinkling, acne, and mild acne scarring. By removing the top, older layers of skin which make the complexion appear dull, chemical peels enable light to reflect more evenly off the skin surface and the skin looks more vibrant and fresh. Chemical peels also allow your skin care products to work more effectively because they are better able to penetrate into the skin after a chemical peel exfoliation. The degree of improvement that can be expected after a chemical peel varies according to your skin type, the severity of the problem, and the strength of chemical solution used.
During a chemical peel, many patients report feeling warmth, tingling or a slight burning sensation during the process, which may last approximately 2 to 5 minutes. Immediately after the treatment, the skin may feel slightly tight and/or appear rosy. The degree of peeling and the amount of redness varies from invisible to noticeable, depending on your skin type and the solution used. With the most common type of peels, glycolic acid peels, peeling usually begins 1 to 3 days after the treatment and may continue through days 5-7. Deeper peels may cause a more persistent redness and more significant peeling that may last up to 10-14 days. There may be slight swelling, particularly around the eyes, which is relieved with ice packs. It is also common to see temporary darkening of the skin, especially in patients whose skin is naturally dark, which may last until the peeling is complete.
Complications are uncommon and include scarring due to poor wound healing, skin discoloration that does not blend with normal pigmentation, allergic reaction, wind or sun sensitivity, and infection. If you have a history of herpes of the lips or mouth Dr. Gilman may give you oral antiviral medication to prevent an outbreak. You must not suntan your skin for 3-4 weeks prior to the treatment, as suntanned skin is more likely to heal with discoloration. Do not apply any drying or irritating products (retinoids, glycolic acids, bleaching creams, etc.) until the healing process is complete. You will notice a subtle improvement in your skin after each peel. Depending on the type of peel that you are receiving, you may have repeat treatments every 2 to 4 weeks.
Collagen
Collagen
Collagen is a naturally occurring protein in the skin that gives the skin structure, support, and volume. As we age, we lose collagen and elastic tissue in the skin and we lose volume. This results in a saggy, hollow, or sunken appearance to the face, thin lips, and a bony appearance to the hands. Collagen was one of the first anti-wrinkle fillers available. Fillers are injectable materials that replace this lost volume, restoring a more youthful look. Fillers are also used for lip enhancement, to provide a fuller more plump appearance to the lips.
Fillers are injected into the skin with a small, thin needle. To minimize the discomfort you will have a numbing cream applied to the area for approximately 20 minutes prior to the treatment. Because these are injections, most people have some mild bruising afterward which may be covered with makeup. You should not take aspirin, ibuprofen, Advil, or Motrin for 10 days prior to the treatment in order to minimize the bruising. Many vitamins and supplements also promote bleeding, so you should check with Dr. Gilman if you have any questions about what you are taking.
Collagen fillers are temporary, lasting 3-4 months depending on the type used, the amount used, your age, and your skin type. As we age and the contours of the face change, Dr. Gilman may need to modify the placement of the product in order to achieve your desired results. The skin is dynamic and changes over time. That is why temporary fillers are a better choice than permanent fillers.
Discoloration
Discoloration
Brown spots, freckles, and skin discoloration appear on the skin due to heredity and sun exposure. Over time, more and more spots appear, and contribute to a prematurely aged appearance. Discoloration may actually make a person look older than his or her wrinkles do. Freckles or sun spots may be removed with chemical peels or intense pulsed light (IPL) treatments. Fading creams are also helpful in reducing the appearance of brown spots.
Facial veins and broken blood vessels
Facial veins and broken blood vessels
Most people develop visible blood vessels on their faces as they get older. Sun exposure and smoking increase these "broken" blood vessels. People with the skin condition called rosacea also get red skin and visible blood vessels. The most effective treatment for these visible blood vessels is laser treatment. The VBeam® pulsed dye laser is the gold standard for treating red lesions such as broken capillaries, visible blood vessels, and facial veins. It targets the red and purple pigment in these vessels and destroys them. Some people see complete results after one treatment but most people need two or even three treatments. The cheeks usually respond quickly, but the vessels around the nose are more resistant.
While the laser does remove these red lines and broken blood vessels, it doesn't remove what caused them to form in the first place. It is important to wear sunscreen every day, avoid direct sun exposure, and not smoke. And if you have rosacea, see Dr. Gilman to get started on treatment.
Fillers / Anti-wrinkle fillers
Fillers / Anti-wrinkle fillers
As we age, we lose volume in our soft tissue and skin which is most noticeable in the face and the hands. This results in a saggy, hollow, or sunken appearance to the face, thin lips and a bony appearance to the hands. Fillers are injectable materials that replace this lost volume, restoring a more youthful look. Currently available fillers include Restylane®, Perlane®, Radiesse®, and Juvederm®. These are approved by the FDA for injection in to the lines and folds around the mouth (nasolabial lines). Injection into any other sites is considered an "off-label" use of the product.
Fillers are injected into the skin with a small, thin needle. To minimize the discomfort you will have a numbing cream applied to the area for approximately 20 minutes prior to the treatment. Because these are injections, most people have some mild bruising afterward which may be covered with makeup. You should not take aspirin, ibuprofen, Advil, or Motrin for 10 days prior to the treatment in order to minimize the bruising. Many vitamins and supplements also promote bleeding, so you should check with Dr. Gilman if you have any questions about what you are taking.
These fillers are temporary, lasting 6-12 months depending on the filler used, the amount used, your age, and your skin type. As we age and the contours of the face change, Dr. Gilman may need to modify the placement of the product in order to achieve your desired results. The skin is dynamic and changes over time. That is why temporary fillers are a better choice than permanent fillers.
Fraxel
Fraxel re:store laser treatment smooths and retexturizes skin, and repairs aging and sun damaged skin. Fraxel treats fine lines and wrinkles, scarring, textural irregularities, and pigment irregularities such as age spots, sun spots, and melasma. Fraxel laser provides many of the benefits of ablative laser resurfacing but with very little downtime. Traditional ablative laser resurfacing removes the entire skin surface, but with Fraxel microscopic laser columns penetrate deep into your skin to create tiny wounds. The area surrounding these columns remains intact and the body's natural healing process creates new healthy tissue in place of the imperfections. With Fraxel re:store there is little downtime, a very low risk of scarring or discoloration, and faster healing.
You will notice changes in your skin after your first treatment, as it becomes softer, smoother, and fresher. As you progress through your treatment series your skin tone, texture, and quality will be noticeably improved. The more treatments you have, the more noticeable your results. Most patients opt for 4 to 6 Fraxel treatments. Depending on the condition of your skin before you begin treatment and the problems you are addressing, you may be satisfied after four treatments. You may decide to add more treatments to your series, or you may decide to have more treatments at a later date.
Fraxel treatments provide for noticeable improvement in fine lines/wrinkles, scarring, texture, and pigment with very little downtime.
For more information on Fraxel click here.
Glycolic acid treatments
Glycolic acid treatments
Glycolic acid is an alpha-hydroxy acid used for chemical peels and present in many skin care products. Glycolic acid dissolves the top layers of skin, revealing newer fresher skin cells below. Regular glycolic acid peels can reduce brown pigmentation (sun spots, freckles) and evidence of sun damage, treat acne, minimize pore size and smooth the appearance of fine lines and wrinkles.
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Juvederm
As we age, we lose volume in our soft tissue and skin which is most noticeable in the face and the hands. This results in a saggy, hollow, or sunken appearance to the face, thin lips and a bony appearance to the hands. Fillers are injectable materials that replace this lost volume, restoring a more youthful look. Lip enhancement is performed to achieve a fuller, more plump appearance to the lips.
Juvederm® is a sterile, colorless gel consisting of non-animal stabilized hyaluronic acid. Hyaluronic acid is a naturally occurring sugar found in all living things, which holds onto water and plumps up the skin when injected. It is injected into the skin with a very fine needle and is FDA approved for use in the United States to correct facial lines, wrinkles and folds around the nose and mouth. Injections into any sites other than the nasolabial lines, such as the lips, cheeks, and under eyes, is considered an "off-label" use of the product. The effects of these fillers are temporary and reversible, requiring repeated injections. In 2007, over one million hyaluronic acid filler treatments were performed.
Fillers are injected into the desired sites with a small needle. To minimize discomfort, a numbing cream will be applied to the skin in the treatment area for 20 minutes. Also, there is a small amount of anesthesia mixed into the filler.
The results are immediate. Side effects include discomfort, swelling, bruising, and temporary asymmetry and are usually resolved within 7 days after treatment. Do not take aspirin or ibuprofen (Advil, Motrin) for 10 days prior to the treatment, to minimize your risk of bleeding and bruising. Many vitamins and supplements also promote bleeding, so you should check with Dr. Gilman if you have any questions about what you are taking.
After treatment you may return to all of your normal activities. You may apply makeup to cover any redness or bruising.
For more information on Juvederm click here.
Laser hair removal
Laser hair removal
Laser hair removal is a permanent long term reduction in hair growth. It is not a permanent removal of all of the hair in the treated area. Most people can expect an 80% reduction in hair in the treated area after 4-6 treatments. Periodic "touch-ups" may be needed yearly.
How does the laser work?
A laser produces a beam of highly concentrated light. Different types of lasers produce different colors of light. The light emitted by the laser is absorbed by the pigment in hair follicles and hair shafts, damaging the follicle. The laser pulses for a fraction of a second, just long enough to affect the pigment but not long enough to damage the surrounding skin. The laser has a handpiece with a chilled tip, and this contact-cooling further protects the skin. Because the laser energy is absorbed by pigment, it is very important to not be suntanned for one month prior to treatment. If you do have a suntan, the pigment in the skin may absorb some of the laser energy, resulting in a white spot on the skin that may or may not return to the normal skin color.
What does the treatment involve?
Eye protection during treatment is required. Depending on the area being treated, an anesthetic cream may be applied for 15 to 20 minutes to minimize discomfort. When the laser "fires" you will feel a stinging sensation similar to the feeling of a rubber band being slapped against the skin. The handpiece is repositioned and the laser is activated again. The size of the area to be treated will determine the number of laser activations, or "pulses", required.
Is laser hair removal for you?
Although laser hair removal is generally safe, some people make better candidates for the procedure than others. People who may not make ideal candidates include those being treated for removal of red, blonde or gray hair, those being treated with isotretinoin, those prone to keloid scarring, and those with suppressed immune systems. Patients with a history of herpes infections in the treatment area will be given oral herpes medication to prevent an outbreak.
How many sessions are needed?
The number of sessions will vary for each person. Usually, we recommend between 4-6 visits, every 4-6 weeks, for best results per area. Some areas of the body may require fewer sessions. During your first visit, the laser disables those follicles in the "active" phase of the growth cycle. Follicles in the "dormant" phase will not be affected. Since follicles cycle through "active" and "dormant" phases, additional sessions may be desired once the "dormant" follicles become "active".
What do you need to do to prep for your laser treatment?
Make sure you have not waxed or tweezed in the area to be treated for at least 4 weeks prior to your treatment. You should shave the area being treated the day before your appointment. You must not be tan by the sun, creams, sprays or a booth before your treatment.
Are there any risks or side effects?
Immediately after the treatment the skin, particularly at each of the hair follicles, will look pink and slightly swollen, and may itch. This usually subsides within an hour or two, but may persist for one to two days before returning to normal. Most people return to work or normal activities immediately after treatment. The hair in the treated area will shed from the follicle over the next 2 weeks, and you may experience a period of hairlessness in the area while you wait for your next treatment. Some of the hair that is initially gone may return, which is why it is important to follow up for your next treatment. In very few cases, a darkening or lightening of the treated skin may occur. Burning or blistering of the skin is also possible. While these adverse reactions are uncommon and temporary, they can last a few months in some cases.
Laser treatments
Laser treatments
A laser produces a beam of highly concentrated light. Different types of lasers produce different colors of light. The type of laser used for a particular treatment is chosen based on the color of the target (what it is you want to treat). The VBeam® pulsed dye laser treats red and purple, the intense pulsed light device treats brown and red, and the Lumenis Nd:YAG laser treats red-blue-purple.
Leg veins
Leg veins
Many people are concerned about the appearance of leg veins. Up to half of adult women have unsightly leg veins, which are most common on the thighs but can occur anywhere on the legs. Factors that contribute to the appearance of leg veins include genetics, weight, activity level, and whether there is prolonged standing during the day. Some people have leaky veins deep in the legs, which causes a back-up of blood flow leading to visible leg veins. For this reason, Dr. Gilman may ask you to have a non-invasive test that evaluates the blood flow in these deep veins before proceeding with vein treatments in the office.
During treatment, the larger veins will be addressed first with sclerotherapy. Sclerotherapy is a procedure where the vein is injected with a solution that irritates it and causes it to collapse. After sclerotherapy, the smaller veins will be treated with a combination of injections and laser.
Risks of leg vein treatments include bruising and discomfort during the treatment. Sometimes there will be a small scab or crust at the injection site. There is a risk that if this occurs it may heal with a discoloration or scar. Not all veins may be treatable in one visit. Repeat treatments may be required to treat as many veins as possible and to treat new veins that appear over time. Sometimes new veins appear after injections, and these are so small that they require laser in order to clear.
Lip augmentation
Lip augmentation
Thin lips can be given a naturally plump appearance by treatments with fillers such as Restylane® and Juvederm®. These soft tissue fillers are made of hyaluronic acid, which is a natural part of your skin. The filler itself provides volume when injected into the skin, and it also attracts and holds water. This provides volume and improves skin hydration. The lips are very sensitive, so lip augmentation is perfomed with local anesthesia to ensure minimal discomfort. Because hyaluronic acid is a naturally occurring substance, there is no risk of allergic reaction. Your body naturally breaks down the filler over a period of time, and repeat treatments are required in order to maintain the desired appearance.
Microdermabrasion
Microdermabrasion
Microdermabrasion is a non-surgical procedure that removes the top layers of skin revealing fresh skin below. A diamond-tipped wand is passed over the skin, removing the top layers. The wand also uses light suction which stimulates the skin to produce new collagen. Microdermabrasion is completely comfortable and requires absolutely no downtime. Treatments can be performed every 2 to 3 weeks. Microdermabrasion is used to treat mild acne scarring, acne, and fine wrinkles. It also gives a glow to the skin because the older, dead, superficial skin layers are removed. Regular microdermabrasion allows your skin care products to be more effective because they are better able to penetrate into exfoliated skin.
Non-surgical brow lift
Non-surgical brow lift
As we get older the skin loses collagen and elastic tissue, leading to wrinkles and drooping skin. This is especially noticeable in the eye and brow area. The brows look heavy and the eyelid skin gets loose. A combination of non-surgical treatments can significantly improve the appearance of the brow and eye area, giving you a refreshed, more youthful appearance.
Thermage radiofrequency treatments tighten the collagen and lift the skin. After one treatment, some people may see the improvement immediately, and in others the results appear gradually over one to two months after treatment, and continue to improve for six months. The results of one Thermage treatment last one to three years, depending on your skin type, skin quality, history of sun exposure and smoking, and skin care regimen. However, the aging process continues and most patients elect to have additional treatments.
Botox treatments to the area between the eyebrows and to the crows feet area can open up the eyes. These treatments relax the muscles that pull the brows downward, lifting the brows and opening up the eyes.
Fillers can be used in the brow area to lift up sagging skin and restore the youthful contour of the outer part of the brow.
Perlane
As we age, we lose volume in our soft tissue and skin which is most noticeable in the face and the hands. This results in a saggy, hollow, or sunken appearance to the face and a bony appearance to the hands. Fillers are injectable materials that replace this lost volume, restoring a more youthful look.
Perlane® is a sterile, colorless gel consisting of non-animal stabilized hyaluronic acid. Hyaluronic acid is a naturally occurring sugar found in all living things, which holds onto water and plumps up the skin when injected. It is injected into the skin with a very fine needle and is FDA approved for use in the United States to correct facial lines, wrinkles and folds around the nose and mouth. Injections into any sites other than the nasolabial lines, such as the lips, cheeks, and under eyes, is considered an "off-label" use of the product. The effects of these fillers are temporary and reversible, requiring repeated injections. In 2007, over one million hyaluronic acid filler treatments were performed.
Fillers are injected into the desired sites with a small needle. To minimize discomfort, a numbing cream will be applied to the skin in the treatment area for 20 minutes. Also, there is a small amount of anesthesia mixed into the filler.
The results are immediate. Side effects include discomfort, swelling, bruising, and temporary asymmetry and are usually resolved within 7 days after treatment. Do not take aspirin or ibuprofen (Advil, Motrin) for 10 days prior to the treatment, to minimize your risk of bleeding and bruising. Many vitamins and supplements also promote bleeding, so you should check with Dr. Gilman if you have any questions about what you are taking.
After treatment you may return to all of your normal activities. You may apply makeup to cover any redness or bruising.
For more information on Perlane click here.
Pulsed dye laser: VBeam
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Pulsed dye laser: VBeam
The VBeam® is a type of laser called a pulsed dye laser. This laser treats red skin blemishes and discolorations, such as blood vessels, on the face, body, arms, and legs. Over time, many people develop broken blood vessels on the face, especially on the nose. People with a history of rosacea or sun exposure have a higher likelihood of developing these marks. Red discoloration appears on the skin after a lifetime of sun exposure, and is usually most noticeable on the face, neck, and chest. Angiomas are tiny red dots that appear on the body, arms, and legs, and can easily be treated with the VBeam® pulsed dye laser. Any red blemish that is due to the presence of blood vessels can usually be treated with this laser.
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Radiesse
As we age, we lose volume in our soft tissue and skin which is most noticeable in the face and the hands. This results in a saggy, hollow, or sunken appearance to the face and a bony appearance to the hands. Fillers are injectable materials that replace this lost volume, restoring a more youthful look.
Radiesse® is an injectable filler consisting of calcium hydroxylapatite particles suspended in a gel made of water, glycerin, and carboxymethylcellulose. Radiesse® not only replaces volume loss but also stimulates new collagen growth for longer-lasting cosmetic results. The calcium gel forms a scaffold around which the body produces new collagen, to naturally restore the full, youthful beauty of the face. The tiny microspheres gradually break down into calcium and phosphate ions that are naturally absorbed by the body over time. The results of Radiesse® treatments have been shown to last one year. The FDA has approved Radiesse® for injection into the vocal cords and the nasolabial folds. Use of the product on other areas, such as the hands, cheeks or jawline, is considered "off-label" use of Radiesse®. Radiesse® is not for use in the lips.
Radiesse® is excellent for volume replacement, and to correct a sunken appearance of the face. It is also a great choice to treat a bony appearing hand. Radiesse® typically lasts 9-12 months, although the duration of effects may vary from person to person.
Radiesse® is injected into the desired location with a needle. A numbing cream will be applied to the skin in the treatment area in order to minimize any discomfort. Local anesthetic will also be mixed with the product and injected into the skin. Do not take aspirin or ibuprofen (Advil, Motrin) for 10 days prior to the treatment, to minimize your risk of bleeding and bruising. Many vitamins and supplements also promote bleeding, so you should check with Dr. Gilman if you have any questions about what you are taking.
The most common side effects are swelling that may last for one week and bruising that may last 1-2 weeks. You may apply make up to cover any bruising. The treated area may feel firm to the touch for 1-2 weeks, then will soften and feel completely natural.
For more information on Radiesse click here.
Restylane
As we age, we lose volume in our soft tissue and skin which is most noticeable in the face and the hands. This results in a saggy, hollow, or sunken appearance to the face, thin lips, and a bony appearance to the hands. Restylane® is a soft tissue filler, which is an injectable material that replaces this lost volume, restoring a more youthful look.
Restylane® is a sterile, colorless gel consisting of non-animal stabilized hyaluronic acid. Hyaluronic acid is a naturally occurring sugar found in all living things, which holds onto water and plumps up the skin when injected. It is injected into the skin with a very fine needle and is FDA approved for use in the United States to correct facial lines, wrinkles and folds around the nose and mouth. Injections into any sites other than the nasolabial lines, such as the lips, cheeks, and under eyes, is considered an "off-label" use of the product. The effects of these fillers are temporary and reversible, requiring repeated injections. In 2007, over one million hyaluronic acid filler treatments were performed.
Fillers are injected into the desired sites with a small needle. To minimize discomfort, a numbing cream will be applied to the skin in the treatment area for 20 minutes. Also, there is a small amount of anesthesia mixed into the filler.
The results are immediate. Side effects include discomfort, swelling, bruising, and temporary asymmetry and are usually resolved within 7 days after treatment. Other, rare side effects include acne-like bumps or swelling around the implant and may appear days to weeks after treatment and may persist for several weeks. Do not take aspirin or ibuprofen (Advil, Motrin) for 10 days prior to the treatment, to minimize your risk of bleeding and bruising. Many vitamins and supplements also promote bleeding, so you should check with Dr. Gilman if you have any questions about what you are taking.
After treatment you may return to all of your normal activities. You may apply makeup to cover any redness or bruising.
For more information on Restylane click here.
Rosacea
Rosacea
Rosacea is a common skin condition that causes redness, broken blood vessels, acne-like bumps, and facial flushing. It is most common in people with fair skin but is seen in people of all skin types. It typically begins in the central face but may involve the entire face, head, ears, and neck. Some people have eye involvement, which may manifest as a burning or gritty sensation in the eyes and eye redness. Rosacea is a chronic condition, meaning it is long lasting and does not spontaneously disappear. Rosacea symptoms worsen over time if not treated.
There are often triggers for rosacea that make the symptoms worse. These include extremes of temperature, hot food or beverages, spicy foods, sunlight, alcoholic beverages, and sometimes cosmetics. People with rosacea should try to identify the triggers that make them worse and take care to avoid those triggers. It is also very important for people with rosacea to limit their sun exposure by wearing sunscreen every day. Some sunscreen ingredients may actually be irritating, so people with rosacea should look for sunscreens that contain zinc oxide or titanium dioxide as the active ingredient(s). Mild facial cleansers should be used instead of soap, which may be irritating and exacerbate rosacea.
Many people are able to successfully treat their rosacea with topical medications (applied to the surface of the skin). However, some people may need oral medications in order to minimize their symptoms and reduce their flares. Oral medications may be used for a short period of time or for many months. The goal of treatment is to stop the progression of rosacea and reduce or eliminate flaring
Lasers are an important part of rosacea treatment, and are used in conjunction with topical and oral medications. Once broken blood vessels have appeared on the skin they will not go away with topical or even oral medication alone. Laser treatment is required to remove these red marks, and also reduces overall facial redness. The laser treatment is a simple in-office procedure. There may be mild redness afterward that lasts 1-3 days. Some people have small bruises where larger vessels were treated, which are absorbed by the body over several days to 1 week.
Scars
Scars
A scar is a mark that occurs on the skin after a wound, disease or surgery. Scars are usually pink to red when they are new and fade to white over time. Some scars are flat while others are raised. A scar is made of fibrous tissue and is not normal skin. Scars do not have hair follicles and do not have sweat glands.
Scars in areas of the body where the skin is under tension, such as the chest, shoulders, or back, are more likely to be thick or raised in appearance. Some scars "over heal" and are larger than the initial wound or injury that led to formation of the scar. Some scars are small and barely noticeable, while others are of great cosmetic concern. Some scars, especially new ones, may itch or hurt.
There are several approaches to treating a scar. The goal of treatment is to minimize any symptoms, such as itching or tenderness, and to improve the appearance as much as possible. Laser treatments with the VBeam® pulsed dye laser have improved the color and texture of raised scars for many patients, and may reduce itching or burning sensations. Raised or thick scars may also be treated with injections of cortisone, which helps to shrink the tissue. Indented scars, such as acne scars, may improve with microdermabrasion, chemical peels, and injections of tiny amounts of soft tissue fillers.
Most therapies for scars result in gradual but significant improvement. There is no treatment that will completely eliminate the scar or restore the skin to the way it appeared before the injury, surgery, or disease process that caused it.
Sclerotherapy
Sclerotherapy
Many people are concerned about the appearance of leg veins. Up to half of adult women have unsightly leg veins, which are most common on the thighs but can occur anywhere on the legs. Factors that contribute to the appearance of leg veins include genetics, weight, activity level, and whether there is prolonged standing during the day. Some people have leaky veins deep in the legs, which causes a back-up of blood flow leading to visible leg veins. For this reason, Dr. Gilman may ask you to have a non-invasive test evaluating the blood flow in these deep veins before proceeding with vein treatments in the office.
During treatment, the larger veins will be addressed first with sclerotherapy. Sclerotherapy is a procedure where the vein is injected with a solution that irritates it and causes it to collapse and eventually disappear. After sclerotherapy, the smaller veins will be treated with a combination of injections and laser.
Risks of leg vein treatments include bruising and discomfort during the treatment. Sometimes there will be a small scab or crust at the injection site. There is a risk that if this occurs it may heal with a discoloration or scar.
The number of treatments needed to improve or clear veins is different for each patient. Medium-sized (blue) and small (red) veins usually respond best to sclerotherapy. Some veins are not amenable to treatment with sclerotherapy, and a small minority of patients have only fair or poor results even after multiple treatments. Laser treatment is often combined with sclerotherapy in order to achieve the best possible results. Not all veins may be treatable in one visit, and repeat treatments may be required in order to treat as many veins as possible as well as new veins that appear over time. Sometimes tiny new veins appear after sclerotherapy injections, and these are so small that they require laser in order to clear.
Skin care
Skin care
Proper skin care is essential to keeping your skin healthy and looking its best. A good skin care regimen does not have to be complicated. The basics include mild, non-soap cleansers, daily sunscreen, and gentle moisturizers. Sunscreen is the single most important thing you can do for healthy skin and is essential to every good skin care routine. Ultraviolet radiation from the sun (and from tanning beds) damages the skin leading to discoloration, wrinkles, and skin cancer.
It is important to moisturize regularly to help the skin maintain healthy function. When the skin gets dry it can be itchy and easily irritated. Dry skin is more prone to eczema and contact dermatitis.
As we age, the skin gets thinner and loses collagen and elastic fibers. This leads to wrinkles, skin sagging, and texture changes. An important weapon against aging is the use of retinoids. Retinoic acid comes from vitamin A and promotes the formation of new collagen within the skin, improving the texture of the skin and smoothing fine lines and wrinkles.
Antioxidants are also an important skin care product. Antioxidants inactivate free radicals, which are in ultraviolet light, environmental pollution and cigarette smoke. Free radicals break down the collagen in the skin leading to skin wrinkles, broken blood vessels, and discolorations. There are a variety of creams and serums that contain antioxidants that you can easily integrate into your daily routine.
Depending on your skin type and your individual needs, you may also choose to use a product containing glycolic acid or salicylic acid. These ingredients help to exfoliate the surface of the skin, improving wrinkles and skin texture, and are anti-acne, as well.
Skin rejuvenation
Skin rejuvenation
We can't stop aging, but we can slow it down and we can minimize the signs. Aging is a complex process involving changes on the surface as well as in the deeper tissues. As we age, the skin gets thinner and loses collagen and elastic fibers. This leads to wrinkles, folds, skin sagging, and texture changes. A youthful face is a full face, and as time passes the face loses volume leading to flatness or even hollows in areas that were once full and round. In addition, a lifetime of exposure to the sun leads to discoloration, rough texture, and broken blood vessels. Skin rejuvenation involves erasing some of the existing signs of aging as well as making changes that slow down the ongoing aging process.
Dermatologists are skin experts, and have the knowledge, experience, and expertise to keep skin looking young and healthy. There are a variety of skin rejuvenation methods, ranging from the daily applications of skin creams to simple in-office procedures such laser treatments and fillers. There is much you can do to fight aging before turning to surgical procedures. It is important that your skin be evaluated in its current state and in the context of your past experiences, lifestyle, and habits.
Some of the currently available skin rejuvenation techniques include:
- Retinoids are the cornerstone of anti-aging treatments. Retinoids are derived from vitamin A and the regular daily application of retinoid creams or serums will promote new collagen production in the skin. This leads to the smoothing of fine lines and improves the texture of your skin. Retinoids also exfoliate the surface of the skin, making it looks more vibrant and youthful.
- Chemical peels remove the top layers of skin cells that naturally come off easily when we are young, but stay on the skin surface longer as we get older. Chemical peels smooth the texture of the skin and improve discolorations. The skin looks tighter and refreshed. Most chemical peel treatments have no downtime.
- Broken blood vessels and visible capillaries can only be effectively treated with laser therapy. The VBeam® pulsed dye laser is a quick, in-office treatment that requires no downtime.
- Botox treatments smooth away wrinkles by relaxing the muscles that cause the wrinkle to form. The results are seen several days to weeks after the treatment depending on the location and depth of the wrinkle and how long it has been noticeable. This is not a permanent solution, and repeat treatments are needed to maintain the results.
- Fillers are used to replace lost volume in the skin and face, the loss of which has led to lines and hollows. Fillers are also used to restore fullness and volume around the mouth and in the mid-face that is lost with age. Lip enhancement is performed with fillers, to plump up the lips. There are several different types of fillers. You and Dr. Gilman will determine which filler is best for you based on your skin type and your particular needs.
It is important to have your skin evaluated by a dermatologist before deciding on a skin rejuvenation plan. Not every treatment is right for every person. Dr. Gilman can determine which treatments are best for your individual needs.
Thermage
Collagen in the skin becomes depleted or damaged over time, particularly from the sun and other environmental factors. The result is visible signs of aging such as thinner or loose skin and wrinkles. Thermage is a treatment that provides skin tightening and lifting without surgery, with no downtime, and with minimal risk. Thermage uses radiofrequency energy to heat the skin, tightening the collagen and giving a smoother, lifted look to the skin.
Treatment to the forehead and eyes can give the appearance of a mini-brow lift. Treatment to the mid and lower face can minimize the laugh lines and lift the cheeks. Treatment to the lower face and upper neck can tighten the jawline and jowls, giving a lifted look. Some patients notice improvement immediately after surgery. Most patients see a gradual improvement within 8 weeks of treatment, and the skin continues to improve for 6 months. Treatment can be performed every 6 months for continued improvement. Results from a single treatment will last 1-3 years, depending on your skin type, skin quality, history of sun exposure and smoking, and skin care regimen. However, the aging process continues and most patients elect to have additional treatments. Many are so pleased with the results that they continue to have treatments every 6 months for several years.
During the treatment, you must not wear any makeup. The treatment will feel very warm or hot. Some patients elect to take an anti-anxiety or pain medication, such as Valium or Xanax, before treatment. If you take anti-anxiety or pain medication you must have a driver or friend take you home after treatment. Each time the energy is delivered to the skin you will feel a cool sensation followed by a quick hot sensation followed by another cool sensation. This cooling helps keep the skin protected while heating the collagen below the surface. The treatment may take from 45 min to 1 ½ hours depending on the size of the area you are having treated.
You may immediately return to your normal activities. Your skin will be pink for up to several hours after treatment. You may be a little swollen for 1-2 days. The incidence of adverse events is exceedingly small.
For more information on Thermage click here.
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