Cosmetic ServicesWe are pleased to offer medical rejuvenation treatment and cosmetic and laser surgery for aging skin, fine lines and wrinkles, sun damaged skin, unwanted moles, skin tags and age spots, spider veins of the face and legs, birthmarks, hair removal and acne, chickenpox and surgical scar correction. Contact us if this is appropriate for you (413) 686-9620. All cosmetic surgical services are performed by Board Certified Dermatologists.
- An Overview of Skin Conditions and Treatment
- Cosmetic Dermatology Consultation
- Acne Scar Treatment
- Belotero Balance
- Botox Cosmetic
- Filler Materials
- Chemical Peels
- Step Treatment Program to Healthier and More Beautiful Skin
- Treatment for Aging Skin
- Treatment of Skin Discoloration
- Tumescent Liposuction
NEW ENGLAND DERMATOLOGY & LASER CENTER BOTOX COSMETICBOTOX® (botulinum A toxin) has been used for nearly two decades in children and adults to improve medical conditions characterized by muscle spasms. BOTOX® cosmetic is for the cosmetic treatment of frown lines (the wrinkles between the eyebrows), forehead wrinkles, wrinkles around the eyes ("crow's feet"), upper lip wrinkles, chin, neck and nose ("bunny lines"). BOTOX® is also used to treat excessive underarm perspiration, migraine headaches, and overactive bladder among many other uses.
Injection of small amounts of BOTOX® cosmetic into muscles of the face and neck cause these to weaken, thereby improving the appearance of the overlying wrinkles, reducing frowning, and resulting in a softer, smoother appearance of the overlying skin.
New England Dermatology & Laser Center Botox Treatment Results
The results of BOTOX® treatment are reliable and predictable with high rates of patient satisfaction. Some residual muscle movement is necessary and natural. The goal is not to appear "frozen" but to look rested and relaxed. Visible results typically develop over 3-10 days. There is a gradual weakening of the treated muscles that is maximal at about 2-4 weeks after treatment. Results typically last 3-5 months and can vary from patient to patient. Treatment with BOTOX® is not permanent. Over time, as the material is slowly absorbed, fine lines or wrinkles will reappear. Further treatment may be repeated to maintain correction, if so desired. With continued treatment, patients often note that their results tend to last longer. After multiple treatments, a majority of patients come in only twice yearly to maintain improvement and some even less often.
Botox® Cosmetic Injections for Facial Lines and Wrinkles ~ Video with Dr. Aimee Leonard
Most patients are very pleased with their results from BOTOX® injection. However, as with any cosmetic procedure, there is no guarantee that you will be completely satisfied. There is no guarantee that fine lines or wrinkles will disappear completely, or that you will not require additional treatments to achieve the results you seek. Sometimes, the initial correction is just what you wanted but seems to wane quicker than you expected. Other times, the correction is less than what you had hoped for or expected. In either circumstance, additional treatments may be required to try to meet your expectations. Occasionally, results can be improved or prolonged when fillers are used with BOTOX®. Costs for treatment are based upon the amount of BOTOX® injected and filler if used.
Over time, alterations in face and eyelid appearance may continue to occur as a result of aging, weight loss or gain, sun exposure or other circumstances not related to BOTOX® injections. Although there is some evidence to suggest that continued treatment with BOTOX® may help to prevent the development or deepening of fine lines and wrinkles, BOTOX® does not arrest the aging process.
Botox Risks and Complications
Complications and side effects from BOTOX® are generally mild and transient. Most people have lightly swollen pinkish bumps at the sites of injection, which generally last for a few hours or less. Other potential side effects include bruising, numbness, irritation, or tenderness at an injection site, and headache. Rarely, an adjacent muscle may be weakened following an injection. This may cause double vision or difficulty in raising the eyelid or eyebrow. This complication can last several weeks or longer and occurs in less than 3% of treatments. If this complication occurs, eye drops can be prescribed to minimize the effect. In a very small number of individuals, the injection is not as effective as expected.
As everyone has slight differences in facial musculature, there may be an uneven appearance of the face with some muscles more affected by the BOTOX® than others. In most cases, this uneven appearance can be corrected with additional treatment. However, in rare instances, this appearance can persist for several weeks or months. Several treatment sessions may be needed to obtain desired results.
Rarely, uncommon reactions have been reported such as headache, flu-like symptoms with mild fever, respiratory problems such as sinusitis and bronchitis, dizziness, nausea, infection, nerve damage and allergic reaction.
Botox Cosmetic Patient Safety Information
NEW ENGLAND DERMATOLOGY & LASER CENTER BOTOX PRE-TREATMENT INSTRUCTIONS:
- Please come to the office with a clean face free of makeup and moisturizers in the area to be treated.
- To minimize the possibility of bruising, non-essential blood-thinning medications or supplements should be
discontinued for 10-14 days prior to treatment if possible. These include aspirin, ibuprofen, Advil, Motrin, Midol,
Aleve, Excedrin, Alka-Seltzer, vitamin E, green tea, garlic, gingko biloba, ginseng, and St Johns wort. Please
note that if you have been prescribed aspirin or another blood thinning medication such as Plavix or Coumadin for
medical reasons, do NOT discontinue these medications. Please be advised the bruising does not affect the
success of treatment.
- BOTOX® injections are generally very well tolerated with minimal discomfort. The use of a topical anesthetic is
optional and generally not required. If you wish to apply a topical anesthetic at home, please notify your
physician for a prescription.
- If you are pregnant, breast-feeding, or trying to become pregnant, please alert your physician, as you are not a
candidate at this time.
- If you are unable to keep your appointment, please call 413-733-9600 to cancel or reschedule. Patients will be charged for any missed appointment that is not cancelled at least 24 hours in advance.
- Do not lie flat for at least four hours after your treatment. After four hours, you may resume your normal activities.
- Do not touch, massage, or in any way manipulate the injection sites.
- In order to minimize redness and bruising, avoid anything that will make your face or body flush such as direct sunlight, exercise, alcohol, hot showers, or spicy foods for 24 hours. If bruising does occur, it will go away in several days.
- You may apply cool water compresses to the treatment sites if they are uncomfortable or red.
- If you develop a headache, Tylenol is permissible. Do not take aspirin or ibuprofen as these agents may increase the risk of bruising.
- You may wash your face gently the evening of treatment but you should not resume your normal facial care including makeup until the next day.
- As every patient has a different facial anatomy, asymmetry of the treatment result can occur with BOTOX® injections. Sometimes the correction is less than what you had expected or wanes quicker than you had expected. Additional treatments may be required to try to meet your expectations. Please call our office to be seen for follow-up should any of these concerns arise.
- If you develop a droopy eyebrow or eyelid, do not be alarmed. This uncommon side effect is not serious. You should call our office, as there are eye drops that can be prescribed which will alleviate this problem. This problem generally resolves in several weeks to several months.
Since the use of BOTOX® is considered cosmetic, you will be responsible for the cost of treatment including the cost of additional treatments if necessary or desired. Full payment is due at the time of service. Unfortunately, credit cannot be extended. Please discuss the estimated cost of treatments prior to undergoing the procedure. Your treatment may be more or less than the estimate depending on the amount of BOTOX® used to achieve your correction. If you have any questions, please make sure they are answered to your satisfaction.
We are pleased that you have chosen New England Dermatology & Laser Center for your skin care and we appreciate your confidence in us. If you have any questions or concerns regarding your treatment, please call us at (413) 733-9600.
NEW ENGLAND DERMATOLOGY & LASER CENTER KYBELLA
- Kybella Consultation
- Kybella Injection Consent
- Kybella Patient Information
- All cosmetics, including eye care products and mascara, moisturizers, and sunscreens.
- Medicated facial products such as acne products, Retin A, Renova or similar products, Alpha Hydroxy Acids such as Glycolic Acid.
- Clay mask, scrubs, or other exfoliating agents.
- Self-tanning agents.
- Facial waxing or electrolysis.
- Avoid sun tanning at least 6-8 weeks before treatment.
- You should not have taken Accutane for at least one year prior to your treatment.
- If you have a history of cold sores, fever blisters, or herpes infections, please notify us.
- Arrive at the office at the appointed time with a freshly shampooed scalp and washed face (free from make-up or closely shaven).
- Generally, make-up can be applied the next day.
- Avoid exercise for at least a few hours after the procedure.
- Direct sun exposure without sunscreens of SPF 15 or higher should be avoided.
- You may resume normal daily skin care and moisturizers immediately after treatment.
- Do not resume glycolic acid products, Retin A, Renova, or other medicated creams until peeling is complete.
- Remember that improvement is not immediate and a series of peels is necessary to obtain optimum results.
- Unfortunately, as with all cosmetic procedures, no assurances or guarantees can be given regarding the final result.
- Skin tone, texture, color: Topical cosmeceuticals, chemical peels, microdermabrasion, microneedling, photo rejuvenation using photodynamic therapy (PDT) Levulan/Blu-U light or intense pulse light (IPL), pulse dye laser, Fraxel laser.
- Facial redness/Fine visible facial blood vessels: Green tinted neutralizing makeup, pulse dye laser, IPL.
- Brown flat spots: Topical cosmeceuticals, light chemical peels, liquid nitrogen, laser, IPL.
- Brown crusty spots (seborrheic keratoses): Liquid nitrogen, surgical removal.
- Actinic keratoses (AKs): Topical cosmeceuticals, topical chemotherapy, photodynamic therapy (PDT) using Levulan/Blu-U light, liquid nitrogen/surgical removal.
- Forehead lines: Botox, filler, surgical lift.
- Crow's feet lines around eyes: Cosmeceuticals, chemical peels, Botox, filler, microneedling, Fraxel laser.
- Brow lift: Botox, filler, surgical lift.
- Excess upper/lower eyelid skin: Fraxel laser, blepharoplasty (surgical removal of excess skin).
- Dark circles under eyes: Topical cosmeceuticals, filler, lasers.
- Deflated or hollowed cheeks: Filler.
- Lines and wrinkles around mouth, upper lip lines, "smile" and "sad" lines: Filler, Botox, microneedling, Fraxel laser.
- Small thin lips: Filler.
- Jowls: Botox, filler, skin tightening devices (Thermage/laser), facelift.
- Neck skin lines and laxity: Botox, filler, microneedling, laser, surgical neck lift.
- Double chin: Kybella fat dissolving injections, cryo lipolysis, liposuction.
- Skin tightening: Topical cosmeceuticals, skin tightening devices (Thermage/laser), surgical facelift.
- Depressed acne/chickenpox-like scars, surgical scars: microneedling, Fraxel laser, filler, surgical correction.
- Bring a pair of shorts to wear during the procedure; you will be more comfortable, and it will be easier to administer treatment.
- Bring a pair of loose fitting slacks or a long skirt to wear after the procedure, as you will have multiple cotton balls applied with tape over the treated sites.
- Please notify us if you are allergic to tape.
- Do not shave your legs the day of the procedure. We use alcohol as a skin cleanser, and you may experience a great deal of burning if you have shaved that day.
- Do not put moisturizer on your legs the day of the procedure; it will impede the ability for the tape to hold cotton balls on your legs.
- If possible, refrain from aspirin, aspirin-containing products, or medications such as Advil (Ibuprofen) for ten days prior to your anticipated treatment, as you are more likely to have bruising and bleeding during the procedure. However, if you do take them, it will not affect the results of your treatment.
- You must not take birth control pills for two weeks prior to treatment and two weeks after treatment, since these medications may make you more susceptible to blood clots and could possibly increase complications related to treatment. Low dose hormone replacement therapy may be continued.
- If you were advised to wear support stockings after sclerotherapy, bring them with you. They should be worn over the cotton balls for 48 hours day and night.
- After forty-eight hours, the cotton balls may be removed. Soaking in a warm soapy bath will make removal easier. Once the cotton balls have been removed, support stockings should be worn during the day for 3-6 weeks.
- It will take approximately six weeks to see your response to treatment. No guarantee can be made regarding the outcome, and multiple treatments may be required before a satisfactory result is achieved. As discussed in the sclerotherapy brochure, you should anticipate improvement, but those who expect perfection are likely to be disappointed.
Kybella is the first and currently, the only FDA-approved injectable treatment to improve the appearance of fat beneath the chin also called "double chin". The active ingredient in Kybella is deoxycholic acid, a naturally occurring substance in the body. It is similar to bile produced by the gallbladder which helps in the digestion of dietary fat. When injected into the fat below the chin, fat cells are broken down and can no longer accumulate fat. Both men and women can be treated. The ideal candidate is one who has moderate to severe accumulation of fat under their chin, but who also has good skin tone. In those patients who have neck skin laxity and wrinkling, this procedure could conceivably make that look worse. It is anticipated that for most who have good skin tone, it will contract and tighten once the fat is removed, much like that which occurs after pregnancy. The procedure is performed in the office with topical anesthesia and takes about 30 minutes. Results are seen roughly 4-6 weeks after treatment. A series of 1-6 treatments spaced at 1 month or longer intervals may be required to obtain the desired results as improvement is incremental with each treatment session. Rarely there may be less than desired or no appreciable improvement. Most patients can appreciate improvement after 2-3 treatments. Kybella Brochure
NEW ENGLAND DERMATOLOGY & LASER CENTER FILLER MATERIALSBelotero Balance® and ask your local dermatologist if this is appropriate for you.
Fillers are one of the most common procedures performed by physicians for lips and cosmetic improvement for facial lines, wrinkles, scars and depressions. Their popularity is a reflection of their efficacy, predictability, and safety. The results are almost immediate with little or no "downtime" and most if not all of the few and minor side effects which may occur are short-lived.
Radiesse® Volumizing Filler Injections ~ Video with Dr. Stanley Glazer
JUVÉDERM® Rejuvenating Filler Injections ~ Video with Dr. Kristina Collins
Fillers are materials injected (as opposed to topically applied products containing similar ingredients) underneath the depressed scar to raise it to the skin surface level. Fillers include hyaluronic acid (Restylane, Perlane, Juvederm) and collagen stimulators (Radiesse, Sculptra) and there will be others available in the near future. Each product produces its result in a unique way. Collagen products can be thought of as the "bricks of a wall" providing support; hyaluronic acid products are the "mortar" holding the "bricks" (collagen) together as well as acting like a sponge to hold water in the skin; and the collagen stimulators are products which stimulate the body to produce its own new collagen. All of the products noted are considered "natural" as they are normally present in the skin. Like the body's own collagen and hyaluronic acid which are continually being broken down and replaced, these injectable materials are similarly metabolized by the body resulting in a loss of their correction over time. In general, the duration of correction from these products may last 3-24 months with collagen-based products maintaining their correction the shortest duration, hyaluronic acid products, intermediate, and collagen stimulators the longest. These are general guidelines as the duration of the correction is also dependent upon the facial area injected, the size and type of scar, the amount of material injected, and there is also variation among individuals. In general, the safety profile of the filler materials is excellent. Expected consequences of treatment include but are not limited to pain of injection, redness, swelling, bruising, and lumps and bumps. Redness, swelling, and bruising may last several days. If lumps or bumps develop they may last several weeks to several months. These side effects are least common with the collagen-based products, somewhat common with hyaluronic acid products, and most common with the collagen stimulators. None of these products are permanent and regular maintenance treatments are required for continued correction. Permanent fillers and implants are available but have both good and bad attributes. On the "good" side, if you obtain the results you like, it will stay indefinitely. However, we will all continue to age with time in spite of our best efforts but permanent products will not change and could become visible over time. Secondly, if you obtain an undesirable or unexpected result, the only way to correct it is surgical removal of the product, which may result in a scar.
NEW ENGLAND DERMATOLOGY & LASER CENTER CHEMICAL PEELS
Light peels are performed using either glycolic acid (also known as fruit acid or alpha hydroxy acid) or salicylic acid (a beta hydroxy acid) depending upon the condition being treated.
The skin is not actually "peeled off" in a single sheet or layer, but rather is irritated in such a manner as to slowly and almost imperceptibly flake off over a period of several days. These peels are nearly painless and can be applied in less than 15 minutes. You can return to work or other activities immediately, with only mild redness as a sign that the procedure has been done. Unlike deeper chemical peels, there is very little or no time needed after the peel for recovery. Most patients require 6-10 peels at 2-4 week intervals to achieve optimum results. You will also be given recommendations for daily skin care and sunscreen use, which are necessary to maintain this improvement.
Light Chemical Peels Pre-Operative Preparation
Avoid the following for at least 48 hours prior to your peel.
NEW ENGLAND DERMATOLOGY & LASER CENTER TREATMENT OF AGING SKINHow and why we age largely remains a mystery but we do know certain facts. Aging of the skin is at least partly due to biologic and genetic factors, which at the moment we cannot control and partly due to environmental and life-style factors of which we have some control.
The biologic and genetic factors such as our natural skin color and how our parents "aged" will in part determine how we age. It is known that individuals with darker skin age "better" than those with lighter skin given the same amount of sun exposure due to their "natural" photo protection. On light skinned individuals compare, for example, the sun-exposed skin of the forearm and back of the hand to the non-exposed skin of the inner arm and notice the difference in color, tone, texture, and wrinkling. The tendency to develop lines around the eyes, so-called "crows feet", droopy eyelids, fullness of the lower eyelids, and some of the deeper lines and wrinkles of the forehead and around the mouth are primarily thought to be genetic in origin. The tendency to develop brown spots is also probably genetic, but certainly aggravated by sun exposure. As we age, we may gain or lose weight and the face is one of the first places to reflect those changes. Additionally, there is a natural and gradual loss of skin elasticity as well as loss of fat and bone structure in the area around the mouth. Dental health is also important as the teeth and upper and lower jaw support the skin and loss of these structures can affect facial appearance. Lastly, gravity pulls everything downward. All of these factors contribute to what we perceive as aging including deeper "smile" and "sad" lines around the mouth, thinning of the upper lip and the development of jowls around the jaw.
Almost all of the perceived "negative" consequences of biologic and genetic skin aging noted above can be made even worse or on the contrary hopefully improved by environmental and life-style choices. It is indisputable that long term ultraviolet light exposure and smoking contribute to and accelerate skin aging. Ultraviolet light, whether it be nature sunlight or artificial indoor tanning contributes to the development of brown spots, visible fine facial blood vessels, facial lines and wrinkles, thickened leather-like skin, red, scaly, and crusted lesions known as actinic keratoses (AKs) which are precancers, basal and squamous cell skin cancers, and melanoma, the most serious and potentially life-threatening of all skin cancers. Smoking contributes to the lines around the mouth, especially upper lip lines, and poor wound healing, among its many other negative effects. It goes without saying that avoiding tanning and smoking is a good start to prevention. Maintaining good physical and mental health is dependent upon preventive medicine with regular checkups by your primary care physician and upon a healthy "life-style" paying attention to a healthy diet, regular exercise, good hygiene, adequate sleep, and stress reduction.
Furthermore, critical facial assessment reveals most of us are asymmetrical; that is, the right and left sides of the face are not identical, but more like "sisters". Eyebrows are often different height or shape, one side of the face may be fuller or flatter, and lines and wrinkles don't match up. Some of these differences may be explained by sun exposure patterns (driving a car exposes the left side of the face), sleep patterns, and underlying bone and dental structure. These are factors we must take into consideration when evaluating, treating, and assessing outcomes. Improvement is expected, but perfection is not realistic.
While the benefits of cosmetics, cosmeceuticals, moisturizers, exfoliants, alpha and beta hydroxy acids (glycolic, lactic, and salicylic acids), retinoids (Retin-A, Renova, Retinol, Tretinoin, Tazarotene, Differin), bleaching creams, antioxidants, vitamins including Vitamin C, growth factors, enzymes, and the like may be debatable, there is unequivocal evidence that sunblock and physical protection from ultraviolet light by wearing a hat, sun protective clothing, and UV protective sunglasses retard photoaging. The spectrum of ultraviolet light responsible for photoaging (brown, red, scaly, and crusted spots, fine lines, and wrinkles) is called UVA and is present in equal intensity, morning to evening, all year around, and regardless of whether the sun is shining or not and passes through window glass. On the other hand, ultraviolet B (UVB) is most intense 10 a.m. to 2 p.m. during the summer, causes sunburn and is primarily responsible for skin cancer. Therefore daily year round use of a broad spectrum (UVA/UVB) sunblock SPF 30 or greater preferably containing Zinc oxide/titanium dioxide is recommended. In fact, the Food and Drug Administration allows any product containing a sunblock to be labeled "anti-aging", "rejuvenating", "revitalizing", "anti-wrinkle", etc.
Basic skin care includes cleansing with a gentle or soap-free skin cleanser and applying a moisturizer with a sunblock SPF30 or greater everyday. Makeup application and type is a matter of personal preference and certainly acceptable. The benefits of applying other cosmeceuticals, as noted above, can be debated, as clearly, not all of the claims made by these products "come true". By law, products which require prescription must demonstrate sound unbiased scientific evidence verifying their efficacy for the majority of users and their safety. Non-prescription products which include many of the cosmeceuticals do not have to prove efficacy but only that they are safe. That said, many of these products may be helpful but certainly not for everyone who uses them. Unfortunately, some do not live up to their expectation. Our licensed aestheticians and medical assistants have been trained by us and are available to assist you with many of your skin care and aesthetic needs.
Skin conditions can be loosely categorized into those which affect COLOR, TONE, TEXTURE, AND VOLUME and often are a combination of these factors. Skin is what we see but its appearance also depends upon underlying fat, muscle, and bone which nourish and support it. All of these factors need to be taken into consideration when approaching treatment.
LISTED BELOW ARE SOME OF THE MOST COMMON TREATMENT OPTIONS FOR THE FOLLOWING CONDITIONS:
Botox and fillers are two of the most common procedures performed by physicians for cosmetic rejuvenation. Their popularity is a reflection of their efficacy, predictability, and safety. The results are almost immediate with little or no "downtime" and most, if not all, of the few and relatively minor side effects which may occur, are short-lived.
BOTOX and fillers are two of the most common procedures performed by physicians for non-surgical cosmetic rejuvenation. Their popularity is a reflection of their efficacy, predictability, and safety. The results are almost immediate with little or no "downtime" and most, if not all, of the few and relatively minor side effects which may occur, are temporary and reversible.
Botox, Dysport, and other similar neuromodulators are injectables used to relax facial and other muscles, which when tense, cause or aggravate facial lines and wrinkles primarily of the upper face (forehead, frown lines, and crows feet around the eye). The injections are minimally uncomfortable and do not require anesthesia. Immediately after treatment (which takes less than 15 minutes), there may be minimal localized swelling, redness, and rarely bruising lasting a few hours to a day or two at most. The results of smoother, relaxed, more youthful appearing skin begins about three days after treatment and reaches its full correction at about four weeks. After the initial treatment, results start to fade at three to four months and repeat treatments are necessary to maintain the correction. After several treatment sessions, the duration of correction may last longer for some patients. Many patients come in twice yearly for their treatment. In patients who continue to exhibit unwanted lines and wrinkles after Botox, the addition of filler material, microneedling or Fraxel laser can be used to improve results. Botox is very safe in the dosages used for cosmetic purposes even though it is a toxin. Side effects of Botox include but are not limited to headache, droopy eyebrows, eyelids, or lip, facial asymmetry (one side of the face does not look the same as the other), and double vision. These side effects are infrequent and are completely reversible (go away completely even without treatment).
FILLERS are materials injected (as opposed to topically applied products containing similar ingredients) to fill lines and wrinkles and replace volume loss primarily of the lower face, but are used in the upper face as well. Fillers include those which are hyaluronic acid based (Restylane, Juvéderm, Belotero, Voluma) and collagen stimulators (Radiesse, Sculptra) and there will be others available in the near future. Each product produces itsresult in a unique way. The collagen stimulators are products which stimulate the body to produce its own new collagen. Collagen can be thought of as the "bricks of a wall" providing support; hyaluronic acid products as the "mortar" holding the "bricks" (collagen) together as well as acting like a sponge to hold water in the skin. All of these products are considered "natural" as they are normally present in the skin. Like the body's own collagen and hyaluronic acid which are continually being broken down, these injectable materials are similarly metabolized by the body resulting of a loss of correction over time. In general, the duration of the correction of these products is between three and twenty-four months with the hyaluronic acid products providing shorter term and collagen stimulators longer term correction. These are general guidelines as the duration of the correction is also dependent upon the facial area injected, the amount of material injected, and there is also variation among individuals. In general, the safety profile of the filler materials is excellent. Expected consequences of treatment include, but are not limited to pain of injection, redness, swelling, bruising, and lumps and bumps. Redness, swelling, and bruising may last several days but the development of lumps and bumps may last several weeks to several months. None of these products are permanent and regular maintenance treatments are required for continued correction. There are some permanent fillers and surgical implants available but these products have both good and bad attributes. On the "good" side, if you obtain the result you like, it will persist indefinitely. However, we all continue to age with time in spite of our best efforts, but permanent products will not change and could become visible over time. Secondly, if you obtain an undesirable or unexpected result with a permanent product, the only way to correct it is with surgical removal which will likely result in permanent scarring.
SKIN TIGHTENING can be accomplished to a minimal degree using cosmeceuticals and there are devices such as radiofrequency (Thermage), and specialized lasers claiming results but none of these devices can approach the results of a surgical facelift. Of course, with these more aggressive procedures, the trade off for their more significant results is a longer downtime and recovery, and much higher side effect profile.
Microneedling is a procedure utilizing a mechanical device which creates microscopic invisible holes in the skin which close and tighten skin. It is used to reduce acne, surgical and traumatic scars, stretchmarks, fine lines and wrinkles around the eyes and mouth, and reduce pore size.
LASERS are light beams with specific characteristics. There is a laser for almost every color in the rainbow. For instance if we wanted to remove a brown spot, we would use a laser that specifically targets the color brown and that laser beam when pulsed would target the brown color and ignore any other surrounding colors. The same theory would hold true for the color red (blood vessel) or any other color. These are color specific lasers. There are some other lasers which are not color specific but target water in the skin. They are used for skin tightening, photo rejuvenation, reducing lines, wrinkles, acne, and surgical scars. Some of these lasers are nonablative (Fraxel) which do not leave a crust on the skin after treatment but they need to be used on a monthly basis for three to six sessions and the results are seen gradually over time. There are also ablative lasers (CO2 Fraxel) which mean the leave a crust on the skin, much like a burn which may take several days to several weeks to heal but the results are more immediate. Lastly, there are non-laser light sources called intense pulse light (IPL) and photodynamic therapy (PDT) whose results for photo-rejuvenation are similar to the nonablative lasers. Most of the photo-rejuvenation treatments require multiple sessions (3-6) at monthly intervals to obtain results.
RENEW AND THE SPA, our aesthetics department are staffed by medically trained licensed aestheticians who are supervised by our board-certified Dermatologists. They are available to counsel and give advice about skin care and hygiene, sun protection, makeup choices and application under physician supervision. Our highly skilled and trained aestheticians perform facials, pore extraction, chemical peels, microdermabrasion, microneedling, facial hair waxing, laser hair removal, intense pulse light (IPL) and photodynamic therapy (PDT) for overall facial skin rejuvenation. These dedicated skin care specialists provide expertise and service which are an integral part of our overall approach to helping you obtain and maintain healthy skin.
In conclusion, these are some of the many options available for the treatment of aging skin and there will likely be many more to come. Choosing what is "right for you" can be both confusing and challenging. When undergoing any procedure, cosmetic or otherwise, fulfilling patient's expectations is a physician's greatest challenge. Paramount to a satisfactory outcome is for both physician and patient to have equally realistic expectations that are reasonable and not inflated. For example, we cannot expect our skin to look like it did when we were 20-years old or to compare with models in glamour magazines. We can expect your skin to look "better" after treatment, but better is relative and improvement in one person's eyes may not be the same as to another. Lastly and unfortunately, favorable and desired outcomes cannot be guaranteed and sometimes unintended and undesired results occur. If this happens, we will work with you to try to solve the problem.
Our goal is to educate you so that you have a clear understanding of the treatment options, risks, benefits, and alternatives before proceeding with treatment. We are honored and pleased that you have chosen to place your trust and confidence in New England Dermatology & Laser Center for your skin care. Together, we will strive to meet your expectations.
NEW ENGLAND DERMATOLOGY & LASER CENTER MICRONEEDLING
Micro Needling is performed using topical anesthesia. A facial treatment is completed in about 30 minutes. While responses vary from patient to patient and from treatment to treatment, results are typically achieved in an average of 3 to 6 treatment sessions spaced at about 4 weeks apart or longer.
All procedures carry some degree of risk. The most common expected side effect of this treatment is temporary redness, swelling, and discomfort of the treated site. Risks include pinpoint bleeding, infection, acne flares, skin discoloration and scarring are possible but uncommon. Facial skin discoloration is usually temporary, lasting weeks to months, but could be permanent. Careful adherence to all postoperative instructions, including strict sunscreen use and sun avoidance, will minimize the risk for complications. Multiple treatment sessions are usually needed to achieve desired results. The results of any one treatment may not be apparent for 4- 6 weeks; at that time, continued treatment may be performed to try to obtain additional improvement. Unfortunately, no assurances or guarantees can be given as to your response to treatment.
NEW ENGLAND DERMATOLOGY & LASER CENTER SCLEROTHERAPY OF LEG VEINS
A. Sclerotherapy is an office procedure which has been practiced for over 60 years whereby a sclerosing solution is injected into small superficial leg veins in an effort to make them disappear.
Q. What is a sclerosing solution and how does it work?
A. A sclerosing solution is one which when injected into a small vein causes it to become inflamed and which eventually obliterates and destroys it. The most commonly used solution is hypertonic saline which is basically salt water; however, depending upon one's response to treatment, there are others available.
Q. In what situations has sclerotherapy been used successfully?
A. It is used primarily to treat cosmetically unacceptable small blue, or red, dilated venules, sometimes referred to as "spider veins", "sunbursts", or "broken capillaries", of the thighs, legs, and ankles.
Q. What causes "spider veins" and can they be prevented?
A. The cause is unknown. They may be hereditary, influenced by hormonal changes, and/or the result of injury. Unlike varicose veins which may be associated with phlebitis, weight gain, and other medical conditions, "spider veins" are of no particular medical consequence and are purely of cosmetic concern. There is no known preventative treatment.
Q. How should one prepare for treatment?
A. Do not shave or apply moisturizer to your legs for 24 hours before treatment. Bring shorts to wear during the procedure. Don't wear tight clothes on the day of treatment. A full skirt or loose slacks are ideal. Make a note of those areas you want treated.
Q. How is the procedure performed and what should one expect?
A. With the patient lying down, the sclerosing solution is injected through a very fine needle into the unwanted vein. The patient may experience a slight discomfort associated with the insertion of the needle into the skin followed by stinging, burning, or a feeling of warmth during the injection of the solution which lasts a matter of seconds. Additionally, some patients experience leg muscle cramps during the injection procedure which disappear as fast as they come on. Most patients tolerate the procedure extremely well.
Q. How many veins can be injected at one visit?
A. This depends upon the size of the vessels to be injected. Obviously, larger vessels are easier to inject than smaller ones. For the physician, the procedure is quite tedious as a keen eye and steady hand must be maintained. Additionally, most physicians wear magnifying glasses to help them. Because of the tediousness of the procedure, most physicians find that a 15-30 minute treatment session gives optimum results. In general, approximately 10-15 veins can be successfully injected per visit. However, each vein may connect to several others so that the successful injection of one vein may be accompanied by the disappearance of others to which it is connected.
Q. What should one expect after treatment?
A. There is usually no post-treatment discomfort. Some veins may temporarily become red and swollen because of the irritating nature of the injected sclerosing solution. A cotton pressure bandage will be applied to each treated site and should be left in place for 48-hours. Normal activities may be resumed immediately, but strenuous physical activity, prolonged standing and bathing should be avoided for 48 hours. If you have support stockings, they should be worn after treatment.
Q. How successful is sclerotherapy?
A. Because of technical difficulties, not every unwanted vein can be successfully injected. Even if it could, not all successfully injected veins disappear after treatment. It is necessary to have reasonable and realistic expectations before undergoing this or any other cosmetic procedure. Those who demand perfection are likely to be disappointed. Additionally, sclerotherapy does not prevent new "spider veins" from appearing and occasionally treated veins may reappear requiring a touch-up treatment.
Q. How many treatment sessions will be necessary and how frequently may they be given?
A. This depends upon the severity of the problem, the success of each treatment, and the point at which the patient's needs have been satisfied. These factors are quite variable from patient to patient. Treatment sessions are generally spaced at six week intervals as it takes approximately six weeks after any one treatment to evaluate its success.
Q. Are all patients candidates for sclerotherapy?
A. No. An in-depth consultation to determine if you are a candidate is required before treatment can be scheduled. We do not recommend this procedure to patients who have had problems with their legs such as phlebitis, infections, swelling, or pain. Additionally, it is not recommended to patients who are pregnant, have high blood pressure, who have had blood clots of any kind or who are taking hormones (birth control pills, estrogen, progesterone). If you are taking hormones, we suggest stopping them (with the permission of the prescribing physician) two weeks before and for two weeks after treatment, at which time they may be resumed. We do not treat large varicose veins or veins which are painful. If you have varicose veins or pain which you feel is related to your veins, we recommend you seek consultation with a vascular surgeon before pursuing sclerotherapy.
Q. What are the potential complications?
A. No surgical procedure is without risk and sclerotherapy is no different, although complications are infrequent and usually minor. Mild bruising in the area of treatment is quite common and usually fades rapidly as any ordinary bruise would under normal circumstances. Occasionally, discoloration may occur lasting weeks to months before disappearing, but it is almost always temporary. Swelling of the ankles may occur in patients who have lower leg and ankle veins injected, but rapidly disappears. Rarely, small skin ulcers may develop at the site of injection which might heal with a permanently discolored and depressed scar. Also, very rarely, a treated vein may become inflamed (superficial phlebitis) causing mild persistent discomfort. This can usually easily be treated. Very infrequently, new veins appear around the treated site. In most cases these are temporary and disappear without treatment.
Q. Are there alternative treatments for "spider veins"?
A. Yes. Cauterization using an electric needle and more recently lasers have been used. As laser technology advances, more satisfactory results are being obtained. It is not necessary for patients to be off hormonal therapy when having veins treated by laser and this might be an advantage for some patients. Additionally, those patients who are afraid of needles might also be good candidates for laser treatment, as the laser does not employ any needles. Lastly, an alternative treatment is to use leg make-up, which does satisfy some patients.
Q. What is the cost of treatment?
A. The fee charged is on a per visit basis. Generally, multiple treatments are required at six week intervals to obtain a satisfactory result and therefore the total cost of treatment can only be estimated as it depends on the number of treatments which might be required to obtain a satisfactory result. Sclerotherapy is considered a cosmetic procedure and payment for service is due at the time of treatment. No credit can be extended.
Q. Will my insurance company cover sclerotherapy?
A. Insurance companies generally do not pay claims for surgery performed purely for cosmetic purposes. Therefore, the consultation visit and all treatment costs are your responsibility.
NEW ENGLAND DERMATOLOGY & LASER CENTER SCLEROTHERAPY INSTRUCTIONS
NEW ENGLAND DERMATOLOGY & LASER CENTER TUMESCENT LIPOSUCTIONANSWERS TO YOUR QUESTIONS ABOUT LIPOSUCTION AND THE TUMESCENT TECHNIQUE
Liposuction removes unwanted localized accumulations of fat around the neck, arms, abdomen, hips and thighs, which are often diet and exercise resistant, sculpting the body into a slimmer and more esthetic profile. It is not a treatment for obesity.
WHAT IS THE HISTORY OF LIPOSUCTION AND THE TUMESCENT TECHNIQUE?
Liposuction has become one of the most common operations performed for cosmetic reasons in the United States. Since its first U.S. introduction in the early 1980's, many refinements have been made. The most significant improvement is the use of local tumescent anesthesia instead of general anesthesia.
The Tumescent Technique, which permits the local anesthesia of large areas of subcutaneous fat, was developed by dermatologic surgeon Jeffrey Klein, M.D., in 1985. He first presented his findings in 1986 at the Second World Congress of Liposuction Surgery in Philadelphia. The first scientific publication describing the Tumescent Technique appeared in the American Journal of Cosmetic Surgery in 1988. More recently, Dr. Klein's study detailing the benefits of the Tumescent Technique for liposuction surgery was published in the prestigious Plastic and Reconstructive Surgery (November, 1993).
WHAT ARE THE BENEFITS OF THE TUMESCENT TECHNIQUE OVER MORE TRADITIONAL METHODS OF LIPOSUCTION?
The Tumescent Technique utilizes large volumes of saline solution, containing dilute local anesthetic and adrenalin, which is injected into the fatty tissue. The injected area then becomes locally anesthetized. There is usually only minimal, if any, discomfort during the process of injection. With this technique, liposuction patients need no general anesthesia, as with more traditional liposuction methods, and rarely require intravenous sedation or narcotics. In fact, the vast majority receive only minor sedation to help them relax, and are completely conscious and comfortable during surgery.
After surgery, patients can get up and walk out of the office themselves, and are usually back to their regular routine in a couple of days. With the Tumescent Technique, postoperative discomfort is significantly reduced, since the local anesthesia remains in the surgically treated tissue for 8 to 16 hours after surgery. The use of smaller cannulas (or tubes) to remove the fat minimizes bleeding and bruising. Patients frequently require only extra strength Tylenol or Tylenol with Codeine for postoperative discomfort after having liposuction surgery using the Tumescent Technique.
HOW IS THIS PROCEDURE PERFORMED?
The basics of liposuction are really quite simple. A small stainless steel tube, called a cannula, is inserted through tiny incisions in the skin and the fat is removed utilizing suction. Because of the strides made in liposuction over the years, and due to the use of the tumescent solution, the cannulas used today are very small, measuring one quarter inch or less. The incisions are usually so small that they heal themselves without the use of sutures and with minimal, if any, scarring.
Detailed further, The Tumescent Technique utilizes large volumes of saline solution that contain dilute Lidocaine (local anesthetic) in combination with epinephrine (adrenaline), which temporarily constricts the capillaries. In addition, dilute sodium bicarbonate in the solution reduces the unpleasant stinging otherwise associated with the Lidocaine and epinephrine.
The Klein solution is injected into the fatty tissue through small, anesthetized incisions made in mostly inconspicuous places, causing the tissue to become firm and inflated, or, tumescent. This allows the surgeon to extract the fat in a more accurate and uniform fashion, thereby producing smoother results. The anesthetic agent in the solution is allowed time to diffuse throughout the fatty tissue, assuring optimal anesthesia as well as vasoconstriction of the capillaries. The shrinkage of capillaries is instrumental in minimizing bleeding and bruising during and after surgery. Not only does this make the surgery safer, it also speeds up postoperative recovery. As a result, most patients can return to work or their regular routine in a couple of days.
WHAT AREAS OF THE BODY CAN BE TREATED?
Fat deposits beneath the chin, on the flanks, hips, abdomen, inner and outer thighs, knees and legs are areas where body contouring with liposuction produces impressive results. The most frequently treated areas in women are the abdomen, hips, thighs, and knees, while in men, the "love handles", abdomen and enlarged male breasts (gynecomastia) are the most often treated. Also treatable by liposuction is the condition that causes excess underarm perspiration. Sweat glands in the underarms can be removed by liposuction with no adverse affect on the body's ability to cool itself.
AFTER THE FAT IS REMOVED, CAN IT GROW BACK?
We believe that once the fat cells have been removed by liposuction, they do not grow back. The patient's new, more balanced and pleasing silhouette is permanent. However, if the patient does gain weight later on, the change tends to be distributed proportionately over the entire body. The same applies to weight loss. It is thought that the total number of fat cells in the body of an adult, once established during adolescence, is fairly constant. The more fat cells there are in a specific location, the more difficult it is to reduce that area simply by dieting. Weight gain is the actual enlargement of these existing fat cells, not the creation of new ones. This is why dieting reduces the size of all fat cells proportionately, leaving the basic silhouette unchanged to a large degree. The change of body contour produced by liposuction is the equivalent to focusing the effects of dieting to specific areas of the body.
WILL MY SKIN CONTRACT TO FIT MY NEW PROFILE?
The degree of skin contraction after liposuction is the same as one would expect after having lost an equal amount of fat in the area by dieting. The skin is an amazing organ, with the ability to stretch and contract to a great degree. A perfect example is pregnancy. Most women's abdominal skin contracts to its original condition soon after delivery.
WHO IS THE BEST CANDIDATE FOR LIPOSUCTION?
Those individuals best suited for liposuction contouring are active, healthy persons of average or near average weight, (those overweight can also benefit), have good skin tone and also have realistic expectations. Age by itself is not a significant factor. Liposuction is a good choice for those who've done just about everything possible to lose the unwanted fat accumulations and who seek improvement on their body's silhouette.
WHAT KIND OF RESULTS CAN I EXPECT?
Although the results of liposuction can be quite spectacular, it is not realistic to expect perfection. Liposuction is the skillful recontouring of the body by removing inches in unwanted areas, rather than pounds. Patients are often advised that while liposuction can enhance one's appearance in clothing, it cannot be guaranteed to improve the appearance of a person who is nude or wearing a skimpy bathing suit. Skin and muscle tone play an important role in the overall appearance of a person--esthetic aspects of one's appearance that liposuction alone cannot influence. The need for surgical excision of excessive skin (or a "tuck") is rarely needed, but occasionally it can be required to enhance the results of liposuction. Additionally, the problem known as "cellulite", or the doughy, puckery appearance most commonly seen in female skin, cannot be expected to improve with liposuction.
WHAT SIDE EFFECTS SHOULD I BE AWARE OF?
As with any surgical procedure, liposuction is associated with possible side effects such as bruising, swelling, temporary numbness, and discomfort in the surgically treated area. Although irregularities of the skin are possible following liposuction, this side effect is greatly minimized by the Tumescent Technique. The swelling gradually improves one to three months after surgery, with optimum results being apparent at about six months. Bruising varies from person to person, though any noticeable amount is usually gone within a couple of weeks. Because the Tumescent Technique minimizes post-surgical soreness, simple pain relievers such as Tylenol are most often all that are required. In some instances, Tylenol with Codeine, or even stronger pain relief medication, is necessary. Judged by current worldwide experience, liposuction using the Tumescent Technique is amazingly safe. Serious complications such as blood clots, infection or allergic reactions are extremely rare. We will, of course, discuss all possible side effects with you prior to surgery.
WHEN CAN I BEGIN ACTIVITIES AND EXERCISE?
One of the primary benefits of the Tumescent Technique is the rapid recovery afforded by the use of local anesthetic rather than general anesthesia. We encourage walking as soon as possible after surgery, particularly the next day, and most patients feel well enough to go for a walk or drive a car by this time. In fact, patients report feeling better if they keep moving around, as opposed to sitting or lying down in one position for too long. Light exercise may be resumed one week after surgery, occasionally sooner, though we strongly suggest avoiding vigorous exercise for two weeks. Activities that put excessive stress on treated areas may cause bruising or some discomfort. Our experience is that the majority of patients return to their work and regular routine within a couple of days. Some report being slowed down somewhat, and others don't miss a beat.
WHAT CAN I EXPECT THE DAY OF SURGERY AND HOW CAN I BE PREPARED?
Upon receiving a scheduled surgical appointment, you will be given separate, detailed materials outlining all preoperative instructions that will help you prepare for surgery. The following, however, will give you a better idea of the actual experience of liposuction surgery and what you can expect.
We ask that patients plan to arrive at our office about 20 minutes prior to scheduled surgery time. You must plan ahead and make arrangements for someone to pick you up after surgery, especially if you were given a mild sedative. Even though our patients report feeling remarkably good, we still insist on this precautionary measure.
After you check in and have signed the surgical consent form, we take preoperative photographs and mark the areas of your body that are to be treated with liposuction. After a trip to the bathroom, you will enter the surgery suite. At this time, a nurse will "paint" the surgical areas of your body with an antiseptic wash. You may also be offered a mild sedative to help you relax. Then you may get comfortable on the surgical table in the position best suited for the area to be treated.
We usually start an IV in your arm to give fluids directly. In most instances, a blood pressure cuff is placed on your opposite arm. In addition, a pulse oximeter may be placed on a finger to measure the amount of oxygen in your blood. Next, we anesthetize the sites where the small incisions will be made, and finally we are ready to begin surgery. It generally takes about an hour of preoperative set-up time before surgery actually begins.
Although there is some variation from patient to patient, the actual injection of the anesthetic solution into the fatty tissue is surprisingly easy. Many patients report feeling more pressure from the inflation of the tissue than they do discomfort from the injections themselves. Then we allow some time for the anesthetic to diffuse into the tissue and fully anesthetize the area. Once the area has been completely "numbed", the actual liposuction proceeds with little to no discomfort while you are fully awake. If tender areas are encountered, more anesthetic solution will be injected. It's our objective to make this a comfortable experience for you. Depending on the area or areas to be treated, you may be asked to shift to different positions, making surgical access easier.
Post-operatively, the small incisions are washed and covered with an antibiotic ointment and sterile gauze dressings are applied. Because the incisions are so small, they usually heal without the need for sutures.
Finally, after the monitors and blood pressure cuff are removed and the IV discontinued, the surgical area may be taped or covered with a thin layer of foam designed to inhibit swelling. Then you will be helped into your elastic compression garment, which also controls swelling and you're ready to get dressed and go home. Because of residual local anesthetic in the tissue, it may be up to twelve hours or more before significant soreness, if any, begins. It's a good idea, however, to have someone keep you company for the first night after surgery.
Before you leave, we'll give you written postoperative instructions. It's very important that you follow these implicitly to assure the best results possible. We'll also make a follow-up appointments at which time the garment, dressing, taping or foam will be removed. Although the swelling tends to resolve itself slowly, often you will note a new slimmer body profile within the first seven to thirty days. And we're usually as excited as you are!
Should you have any additional questions or concerns about liposuction surgery, please don't hesitate to call our office at 733-9600. We can also put you in touch with one of our nurses, or even patients who have had liposuction surgery and who can offer valuable information about the surgical experience and post-surgical recovery.