Cosmetic Skin Care

Cosmetic Procedures: 2013 - “Keeping Skin Healthy and Beautiful”

I.  Skin Surface Aging:

Skin surface aging is primarily due to sun exposure over a lifetime, but it is also influenced by hormones, environmental pollutants, cigarette smoking, genetics, nutrition and general health status.  Typical changes include discoloration with brown-pigmented spots, prominent pores, fine lines, red and purple veins, and a general loss of brightness with yellowing and dullness of the skin. These signs of aging can be improved in many ways.  Most important is to protect the skin from further sun damage.  We are happy to offer recommendations for sun-protection as well as at-home skin-care routines.

We perform mild peels with salicylic acid.  These may be done as often as every 1-3 months along with an effective at-home regimen for ongoing benefit over time.

Even more substantial improvement may be seen with a series of light and laser treatments.  After more than a year of research we purchased a device from the Sciton company (  It combines a laser platform called the Joule and a pulsed light device called BBL (Broad Band Light).

The Joule utilizes an Erbium laser for procedures such as spot laser treatments to remove growths, micro-laser peels (MLP) of varying depths, fractional resurfacing where small fractions of the skin are treated with the laser (Pro-Fractional), as well as full-surface treatments (TRL: Tunable Resurfacing Laser).  The amount of healing and downtime can be tailored to your needs.   You might consider a series of light laser peels with rapid recovery or deeper peels with a longer healing period.  

The BBL is used to improve brown spots, freckles, veins, and to smooth texture (Photo-Facials, Photo-Rejuvenation, Fotofacial). It includes a unit called SkinTyte that delivers infra-red heat to the skin in order to tighten sagging areas such as jowls, necks and eyelids.  A series of BBL and/or SkinTyte treatments offers improvement to the skin without any downtime.  Typically, a series of 5 treatments 3-4 weeks apart with yearly or twice yearly maintenance sessions can result in substantial improvement in appearance.

These laser and BBL applications can be used alone, or can be combined to address more than one aspect of aging and sun-damage.

Hair removal may also be accomplished with our Cynosure Elite laser that contains both Alexandrite and Neodynium-Yag allowing effective and safe treatment for all skin types.

Photodynamic therapy (PDT) is offered to improve appearance, and to remove pre-cancerous areas of sun damage.

II. Wrinkles and Lines Due To Muscle Movement

Horizontal lines on the forehead, vertical lines between the eyebrows, radiating lines to the sides of the eyes, sagging of the eyebrows and eyelids, vertical lines around the lips, sagging of the corners of the mouth, jowls, and lines on the neck can all be improved by temporarily weakening the muscles that produce these lines.  Botulinum toxin is a chemical sold under several brand names, the most popular of which are Botox and Dysport.  Injecting tiny amounts of Botox into target muscles of the face or neck can result in a three to four month improvement.  The discomfort of the treatment is minimal and improvement is seen as early as 72 hours after the injections.  Starting these treatments early helps prevent the skin from forming deep permanent lines that become more and more difficult to improve.  These permanent lines can be softened with a variety of fillers or with lasers to smooth the surface. By beginning such treatments at a relatively young age you help prevent the skin from forming permanent creases that won't relax completely with the Botox.

III.  Volume loss and loss of tone creating deep folds and sagging

For years, volume has been added by injecting fillers into lines to try and plump them up.  More recent studies of facial anatomy have revealed that most volume loss occurs from thinning and shifting of pads of fat beneath the skin as well as loss of muscle mass and thinning of bones.  If most adults look at photos of their face at five or ten-year intervals, this loss of volume from the temples and upper cheeks becomes noticeable.  This results in sagging of the lower face causing creases from the nose to the corners of the mouth and below.  Because of this new understanding, it is becoming popular to try and replace some of the lost volume, rather than just injecting lines.  This has a lifting effect on the skin and helps to flatten some of these lines. We also lose thickness of the skin with aging due to thinning of collagen and hyaluronic acid within the skin itself.  Collagen is rarely injected anymore because it lasts for only a short time.  Hyaluronic acid is made synthetically and is sold by many companies under many brand names including Juvederm, Restylane, Perlane and others.  Injections usually last for 6-9 months.  There are also two newer products Sculptra and Radiesse made of different synthetic compounds that may last even longer.  The advantage of Juvederm and other hyaluronics is that if any lumps or allergic reactions occur (uncommon), there is an enzyme called hyaluronidase that can be injected to dissolve the filler.  Sculptra and Radiesse cannot be dissolved if a bad reaction occurs.  The degree of improvement depends on how much of the material is injected. A good strategy for gradual long-term improvement is to inject several syringes of Juvederm into areas of volume loss every six months until you've reached the degree of fullness you desire.  This results in gradual filling and at the same time stimulates the skin to produce its own collagen.

For those who prefer a more natural approach to skin rejuvenation, we offer Selphyl Platelet Rich Plasma treatments in which your own platelet blood cells are removed from a vein, concentrated and injected back to the skin.

We recommend several lines of products that may be purchased in the office for use at home.

We also carry Latisse solution for growing longer eyelashes.

Cosmetic Consultations:  If you would like to schedule a cosmetic consultation, we will carefully address your concerns and will recommend the best and safest remedies.  You will receive a cosmetic “prescription” suggesting how such areas might be improved.  We will discuss the treatment options as well as potential risks and will give you an understanding of the nature of the procedures as well as the recovery.  We’ll try to estimate how many sessions will be needed and whether ongoing maintenance will be appropriate.

Forrest Resnikoff, MD, FAAD