Skin Care and Non-Invasive Treatments

Botox® (Botulinum Toxin)

In the mid 1990's, plastic surgeons began using Botox® injections to treat facial wrinkles. It has been used safely for decades to treat eye twitches, excessive sweating of the hands, feet and underarms, and for the treatment of some types of headaches. Commercially produced Botox® is very safe in the small doses used for cosmetic purposes.

Botox® can significantly improve frown lines between the eyebrows. It can also be used off-label to improve horizontal forehead wrinkles, crow's feet, “bunny lines” on the nose, and vertical wrinkles of the upper lip. These are wrinkles caused by the movement of facial muscles pulling on and wrinkling the skin. Botox® works by temporarily weakening or halting the muscle movements that cause these wrinkles. Even young people in their 20s and 30s can benefit from Botox by treating wrinkles just as they are beginning to form and potentially preventing them from ever becoming a real problem.

Botox® can be used for so much more than just eliminating wrinkles! It can be used to elevate and shape the eyebrow, widen the eye opening, decrease a “gummy smile” (when too much of the upper gum shows when smiling), decrease chin wrinkling, elevate the nasal tip, and decrease the vertical bands in the neck. The effect of Botox lasts approximately 3 months, but even if you only have it done a few times a year, your wrinkles will still be better than if you never do it at all. If your wrinkles are not due to muscle movement (for instance, if they are in your cheeks or in the nasolabial fold area), Botox® will not be effective. Instead, you may want to consider fat grafting, a filler, or possibly a chemical peel or laser treatment (see below).

Botox® can also be used to treat a condition called hyperhydrosis, or excessive sweating of the underarms, palms of the hands, and soles of the feet. Botox injected into these areas for sweating tends to last seven months or longer.

 

Restylane and Perlane

Restylane and Perlane are substances called hyaluronic acids, which are similar to the slippery fluid that you have in your joints that helps the bones to glide on one another. They are “fillers” approved by the FDA to diminish the visibility of fine lines and wrinkles in the skin. They can also be used off-label to augment and sculpt the cheeks, lips, lower eyelids, nose, chin, and jaw line. Restylane may last for 4-8 months, but in some areas of the face where there is a lot of mobility (for instance, around the mouth) it may be slightly less. Perlane is slightly thicker than Restylane and has the potential to last slightly longer. There is tremendous variability from patient to patient in terms of how long the product lasts. Some fine wrinkles may not be amenable to filling with Restylane and may be better treated with a chemical peel or laser treatment.

Juvederm

Juvederm is also a type of hyaluronic acid. Like Restylane, it’s an FDA approved filler used to temporarily smooth wrinkles and folds in the skin. It can also be used off-label to augment and sculpt the cheeks, lips, lower eyelids, nose, chin, and jaw line. Juvederm may last 4-8 months, but in areas of the face where there is a lot of mobility it may be slightly less. There is tremendous variability from patient to patient in terms of how long the product lasts. Some fine wrinkles may not be amenable to filling with Juvederm and may be better treated with a chemical peel or laser treatment.

 

Radiesse

Radiesse is a different type of filler that is also approved by the FDA for the correction of wrinkles and folds in the skin. It is made up of tiny bits of calcium suspended in a natural gel. You will see an instant correction after the injection of Radiesse, as the gel fills in the wrinkle or fold. Over time, the gel gets reabsorbed by your body and the calcium bits remain behind and stimulate the growth of your own collagen. Radiesse can last for 4-12 months. There is tremendous variability from patient to patient in terms of how long the product lasts. It is a slightly thicker filler than Juvederm and Restylane and works well to contour the cheeks, chin, and jaw line. Because it is thick, however, it isn’t a good choice for the lips or the lower eyelids where the skin is particularly thin.

 

Sculptra™

Sculptra is an injectable product made from poly-L-lactic acid and water. It has been approved by the FDA to fill wrinkles and folds of the skin. The effects of Sculptra are not immediate, but instead you will see a build-up of your own collagen after 2-3 injection sessions spaced a month or two apart. After completing these injection sessions, the results can last for up to two years. It works particularly well when there is a large area to be treated, as the product is relatively thin and will spread easily. Since the effects are not immediate, it can be combined with Juvederm, Restylane or Radiesse to give you an immediate result as well as to achieve a more lasting filling.

 

Chemical Peels

Light Peels - Glycolic and Salicylic acid peels are considered light or superficial peels because they do not penetrate deep into the skin. Light peels act primarily at the surface of the skin and can refresh a dull complexion. Because these peels do not penetrate deeply, the recovery is minimal and you can usually return to work immediately. Light peels can be repeated monthly and may be performed on any skin type. Salicylic acid peels are particularly good for enlarged pores. For people prone to acne, a combination of Salicylic acid peels and our acne laser can make a remarkable difference in the appearance of the skin and it can also decrease the frequency of acne recurrence.

Medium Peels - TCA peels, or Trichloroacetic Acid peels, penetrate more deeply than the light peels and are therefore more effective in improving wrinkles, removing brown spots and pre-cancerous lesions, and improving the overall skin texture. Because TCA is stronger, however, there is a period of actual peeling that can take up to one week to complete. Medium peels may be repeated every three to six months. Treatment of the skin with Retin-A and sunscreen between peels can help to maintain the positive effects.

 

Thermage

Thermage is an FDA approved, non-invasive treatment that uses radiofrequency energy to tighten the skin. It is similar to a laser, but the energy source is different. The procedure is done by applying a gel to the surface of your skin and then applying the Thermage device, which heats the collagen beneath the surface of the skin and causes it to tighten, or shrink slightly over time (2-3 months). When the procedure was first introduced, it was performed at very high levels and was therefore very painful and, in a few cases, seemed to cause the fat in the face to dissipate. The new protocol involves decreasing the energy to a more comfortable level and going over the treatment area numerous times. The effect is occasionally immediate, but the real tightening occurs over the course of the next few months. There is usually only very mild pinkness to the skin when the procedure is done and you can resume your normal social and physical activities right away. We have been using the Thermage device on patients of all skin types since 2004. We began treating the skin on the face and now we have the ability to treat the thin skin of the upper and lower eyelids, the abdomen, and the knees. The effects are not as dramatic as those seen with surgery, but it provides a subtle, natural tightening that does not require any healing or down time. It can be repeated every 6 months, if desired.

 

Zeltiq (CoolSculpting)

Zeltiq is a new, non-invasive way to reduce body fat for specific areas such as the abdomen, love handles, back, and thighs. It is appropriate for patients who are not overweight and have small “bulges” they cannot reduce. It is a device that is applied to the skin which causes controlled cooling, or Cryolipolysis, of the fat cells beneath the skin. The fat cells crystallize and then over the next 2-4 months, they break down and are eliminated from your body. An application on one area of your body will take one hour, but during that time you will be very comfortable and can read, work on your computer, etc. If additional areas are done, it is one hour per application. On average, each procedure will result in about a 20% reduction of the fat layer in the area treated. This translates to a reduction of about 1/3 of an inch. If you have more fat than what the Zeltiq device can treat, you may be a candidate for liposuction (see section on Liposuction).

 

Obagi Skin Care

The Obagi Nu-Derm System is a physician-prescribed skin care regimen that actually transforms your skin to make it look and function in a more healthy manner. It can be used on all skin types and will be customized to address your specific needs. It is particularly helpful if your skin has brown spots, fine lines and wrinkles, acne, and overall poor tone and texture. It involves several different products applied morning and evening. Initially, the skin may appear slightly worse, as part of the process is to remove all of the built-up sun and environmental damage. As the new, healthy, plump skin cells come to the surface faster, you will flake off the old, damaged skin cells. This may result in some redness and flakiness, but if you persevere, it will resolve. In a few months time, your skin will look amazing, even without make up.

 

Jan Marini Skin Care

The Jan Marini skin care line is another professionally supervised program that addresses aging and sun damaged skin, acne, rosacea, and skin discoloration. The products in this system are gentle, yet they are highly effective. We offer a variety of products to complement the other procedures and services available at Tribeca Plastic Surgery. Dr. Saboeiro particularly recommends the C-Esta Serum and the Age Intervention Sunscreen.

 

LASER Services

The Sciton laser that we selected for our practice offers a wide range of treatment options for our patients. Depending on the settings chosen, the laser will target different types of problems. The following are some of the ways the Sciton laser can be used:

• Skin Tightening and Collagen Stimulation – These are two procedures that provide subtle tightening of the skin of the face and neck.
• Acne Therapy – The acne laser works by targeting the bacteria that causes acne as well as the sebaceous (oil-producing) glands. Alternating this treatment with light Salicylic acid peels can dramatically improve the skin.
• Treatment of Sun Damage – This component of the laser treats brown spots, red spots, and broken capillaries on the face, neck, chest, and hands. Multiple treatment are usually necessary.
• Hair Removal –Six to eight treatments are usually required for hair removal, but there is often a significant reduction in the amount of hair with even one treatment. All skin types can be treated safely.Skin Resurfacing - The erbium laser is used to treat fine lines and scars by removing the superficial skin layers and then allowing the skin to heal. Depending on the depth of the resurfacing, healing can take a few days or up to one week. To ensure your comfort, the deeper resurfacing is usually done with some type of sedation.
• Skin Resurfacing - The erbium laser is used to treat fine lines and scars by removing the superficial skin layers and then allowing the skin to heal. Depending on the depth of the resurfacing, healing can take a few days or up to one week. To ensure your comfort, the deeper resurfacing is usually done with some type of sedation.