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Aesthetic Services

Non-Surgical

Surgical

Non-surgical Services:

Botox and Xeomin

Both are used for treatment of dynamic wrinkles and some static wrinkles, some forms of facial asymmetry, and medical conditions related to overactive muscles like spasms. After assessing your needs, a typical injection session will take 5-10 minutes, with minimal downtime. Weakening of the muscles occurs over 1-2 weeks and lasts about 3 months for most areas. Remember, these medications work by relaxing muscles and preventing contraction, which cause wrinkles by dimpling skin. Enough relaxation and time must be given until suitable wrinkles can fade, sometimes taking even up to a year in the most severe cases. Repeat injections are usually performed every 3-6 months, depending on the severity of wrinkles. Botox and Xeomin have similar efficacy and have a long profile of safety for both medical and cosmetic use, although I recommend reading about the side effects at each's product website. 

Hyaluronic acid fillers

Restylane-L and Restylane Silk

Voluma XC

Hyaluronic acid, or HA filler, are used to correct volume loss and 3 dimensional projection of various areas of the face in on and off label fashion. They can also be effective in treating severe wrinkles that may not resolve with Botox or laser treatment alone. Typical treatment areas include under the eyes, cheeks, lips, nasolabial fold, marionette lines, in addition to less common areas such as the temple, along the upper eyelid//eyebrow junction (hollowed eyelids), nose, chin, forehead, jaw, and ears. There are some off-label medical uses of HA fillers, including treatment of upper and lower eyelid retraction, which can be of great benefit to patients with poorly closing eyes who are not good surgical candidates. After determining where volumization and rejuvenation is required, a topical anesthetic cream will be placed over the areas to be treated for 15-30 minutes. The injections can take anywhere from 10-30 minutes depending on location and the amount of product needed. Results can be seen immediately and last 6-24 months depending on the product used and the location placed, with minimal downtime. HA fillers have a long profile of safety for cosmetic use, although I recommend reading about the side effects at each's product website. 

Kybella (Deoxycholic Acid) Injection

This is a non-invasive treatment aimed at reducing the area commonly known as the "double chin." The medication itself will dissolve fat under the skin over the course of 1-2 months, along with some mild tightening effect as well. It works best in those with mild and moderate heaviness in this area, predominantly caused by excess fat and not skin laxity. We can determine whether you are a suitable candidate for Kybella or other alternatives as needed. A treatment session will take about 30 minutes, with half the time used to numb the skin with a topical agent. After treatment, there is mild downtime for about 1 week characterized by swelling in the treated areas as the medication is reacting to the fat cells as intended. Patient's usually will require anywhere from 1-3 treatments based on severity, and are performed no earlier than 2 months apart. The side effect profile is excellent and typically all transient, although one should read about them on the product's website. 

Trichloracetic (TCA) chemical peel and CROSS

Fine wrinkles and photo (sun related) damage can be effectively treatment in some by retexturing the superficial layers of the skin, including the epidermis and anterior dermis. The depth of treatment varies by strength of concentration used and by the number of applications during a treatment session. As such, this peel can be superficial or deep. The face, neck, chest (decollete area), and hands are areas we commonly treat. A treatment session will take about 15-30 minutes, with mild downtime. After application of the chemical peel, the skin will appear variably frosted due to coagulation of the upper layers of the skin, and feel slightly wind-burnt. A topical ointment/lotion is placed to cover the treated areas until the skin re-epithelializes (the superificial layer of skin cells grows back over the treated areas), usually occurring in about 1 week. During this time, the skin will slough off the treated skin and reveal new, fresh skin, which will be slightly pink for usually a couple of weeks. Once the skin re-epithelializes, make-up may be applied if necessary. TCA CROSS is a similar concept but involves treating focal depressions, like ice-pick scars from acne, to help fill in these areas. Since the treatment areas are small, downtime is essentially minimal. 

Risks of chemical peeling include hyper and hypopigmentation, infection, persistent redness, post-inflammatory hyperpigmentation, and in extremely rare cases, scarring. The best candidates and those at least risk for these side effects are individuals with fair skin, or Fitzpatrick skin type 1-3. Higher Fitzpatrick skin types should be judiciously handled, often with much lower strength or no treatment at all. We can arrange for a skin test to assess the one's potential reaction to TCA if needed.  

Laser resurfacing

Surgical Services:

Cosmetic upper eyelid blepharoplasty

This is a surgery aimed at correcting excess skin, fat, and overall aging changes of the upper eyelid. The puffy tissue is a result of forward migration of fat normally contained within the eye socket, due to aging. Excess skin is a result of loss of elasticity and redundancy over time.

  • A skin incision is usually made with one’s own natural lid crease. If the crease is too high or low, or if a patient desires a certain height to the lid crease, a new crease can be made at the desired or ideal location.
  • Skin is removed, leaving behind a safe amount so the eyelids can close naturally.
  • Areas of puffiness may be related to fat protruding forward from aging around the eyelid and may be removed at the same time.
  • The skin incision can be closed with absorbable or non-absorbable sutures. The cosmetic outcome has been shown to be the same 3 months after surgery. If a laser is used to make the skin incision, non-absorbable sutures should be used and are usually removed 5-7 days after surgery.
  • The incision line may be red for 2-4 weeks, and typically fades to a faint fine line over time.
  • After excess skin is removed from the upper lid, patient’s may notice less need to elevate the brows to open the eyes which make the brows appear to have descended.
  • Excess lateral hooding, or skin falling over the sides of the eyes, is strongly related to brow ptosis (aging changes to the brows causing them to fall), and may sometimes require direction correction the the eyebrows. If not overly severe, extending the blepharoplasty to take skin in this area can be helpful without any brow surgery.  

Lower eyelid blepharoplasty

This procedure is used to remove excess puffiness and/or skin of the lower eyelid, in addition to accentuation of the tear trough area or the line that develops between the junction of the cheek and the inferior part of the lower eyelid. The puffy tissue is a result of forward migration of fat normally contained within the eye socket, due to aging. Excess skin is a result of loss of elasticity and redundancy over time, while the tear trough results from a combination of the above factors along with descent and volume loss of the cheek.

  • If the lower eyelid is found to be loose, redundant, or decreased in elasticity, a tightening procedure will commonly be performed as described in “ectropion repair.” If a concomitant upper eyelid blepharoplasty is performed, and no more than a moderate amount of laxity of the lower eyelid is present, a suture can be placed through the upper eyelid incision to tighten the lower eyelid, avoiding an additional incision in the corner of the eye as described in “ectropion repair.”
  • This surgery is usually done internally if only mild amounts of excess skin are present. An incision is made behind the lower eyelid, after which the fat pockets isolated and identified. The fat pockets can be conservatively removed, flush with the bony rim of the lower eye socket, or sutured to rest over the bony rim to help efface the tear trough. If desired, laser resurfacing or TCA chemical peel may be applied on the skin to help tighten it. A tiny amount of excess skin may be trimmed if amenable. 
  • In cases of excess skin, the internal fat removal/repositioning described above is performed in addition to placement of an external incision a few millimeters below the eyelashes. An appropriate amount of skin is then removed, and the orbicularis oculi muscle, which surround and helps in eye closure, is tightened laterally around the corner of the eye. This procedure requires a slightly longer incision extending from the outer corner of the eye to allow proper correction of lower eyelids. 

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Eyelid crease formation: full and minimal incision

Canthoplasty and epicanthoplasty

Brow lift

Face lift

Neck lift

Forehead reduction

Midface lift

Bone contouring, chin, cheek, and temple implants

Ear lobe rejuvenation

Cosmetic lesion removal

Scar revision

Vein ligation and stripping