Download Stuart B. Kincaid - Plastic Surgery San Diego

Cosmetic Laser Procedures and
Facial Contouring with Injectables
©2009, American Society for Aesthetic Plastic Surgery
Stuart B. Kincaid, MD, F.A.C.S.
San Diego/La Jolla Office
8929 University Center Lane, Ste. 201
San Diego, California 92122
Phone: 858-450-4199
Temecula/Inland Empire Office
40963 Winchester Road
Temecula, California 92591
Phone: 951-695-9934
Toll Free: 1-866-BEST IMAGE
Email: [email protected]
Web site: www.SkincaidMD.com
Fax: 858-450-4197
Before and after patient photographs are provided by the American Society for Aesthetic Plastic Surgery. Other photographs used for graphic design purposes are not actual patients.
©2009, American Society for Aesthetic Plastic Surgery
Nonsurgical choices can provide safe, beautiful results when you
wisely choose a qualified doctor and an approved, branded
injectable or skin rejuvenation treatment.
©2009, American Society for Aesthetic Plastic Surgery
A cost effective option with little or no downtime, non-invasive
procedures treat facial wrinkles, improve signs of aging, contour
facial features and help skin imperfections.
©2009, American Society for Aesthetic Plastic Surgery
Injectables and rejuvenation techniques can be performed during
an office visit, rather than requiring a trip to the operating room,
and do not require general anesthesia.
©2009, American Society for Aesthetic Plastic Surgery
Sun exposure, heredity and lifestyle factors including nutrition,
alcohol consumption and smoking all may contribute to facial
and body wrinkling.
©2009, American Society for Aesthetic Plastic Surgery
A treatment appropriate to temporarily weaken or paralyze the
muscle that causes active lines or early wrinkles is a neurotoxin,
like Botulinum Toxin type A.
©2009, American Society for Aesthetic Plastic Surgery
Botox® is best suited for treating expression lines caused by
muscle contraction. Common injection sites include
horizontal forehead furrows, vertical lines between the eyes,
“crow’s feet” around the eyes and peri oral smoker’s lines.
©2009, American Society for Aesthetic Plastic Surgery
©ASAPS
The effects will generally last 3-4 months and risks include
bruising at the injection site, rare chance of an infection, and
the possibility of unintentionally affecting nearby muscle
groups.
©2009, American Society for Aesthetic Plastic Surgery
Dermal fillers are substances injected at varying depths
within the skin and soft tissues to fill facial imperfections
such as wrinkles, creases and concave scars, as well as to
enhance the fullness, or volume and shape of facial tissue.
©2009, American Society for Aesthetic Plastic Surgery
Temporary dermal fillers like collagen and hyaluronic acid,
are commonly used to fill fine lines and facial creases,
enhance the volume of the lips and other facial features, and
to fill in scars and other depressions.
©2009, American Society for Aesthetic Plastic Surgery
Collagen is a naturally occurring connective tissue component
that provides strength and structure to the skin. Most commonly
injected into the lips, these fillers tend to last 3 to 6 months, and
have a very natural feel.
©2009, American Society for Aesthetic Plastic Surgery
Hyaluronic acid like Juvederm or Restylane is a filler that
binds moisture and provides fullness between the skin cells.
Results last from 3 months in high mobility areas (such as the
lips), and up to 1 year in regions such as the nasolabial folds.
©2009, American Society for Aesthetic Plastic Surgery
More semi-permanent dermal
fillers do not readily absorb and
are injected deep within the soft
tissue for more long-lasting and
large volume correction.
Radiesse or calcium
hydroxylapatite or
polymethylmethacrylate are
FDA approved and used in
these cases.
©2009, American Society for Aesthetic Plastic Surgery
An alternative to synthetic fillers is autologous fat injections,
which takes fat from one area of the body to enhance another.
This is natural-appearing, lasts a long time, and has less risks.
Autologous fat is effective for changing body contour, revising
scars, filling depressions created by liposuction, and
rejuvenating the hands and face.
©2009, American Society for Aesthetic Plastic Surgery
Any filler can be used alone or in conjunction with other
facial plastic surgery procedures such as surgical rejuvenation
and skin rejuvenation techniques.
©2009, American Society for Aesthetic Plastic Surgery
An important treatment for aesthetic facial beauty is
enhancing your skin’s overall texture, color, and complexion
with skin rejuvenation techniques.
©2009, American Society for Aesthetic Plastic Surgery
You may be a good candidate for skin
rejuvenation if you have one or more of the
following conditions:
• wrinkled or sun-damaged facial skin
• vertical wrinkles around your mouth, such as those that
cause lipstick "bleed"
• "crow's feet" lines around your eyes and perhaps some skin
laxity in your lower eyelid area
• fine wrinkling of your upper eyelids
• brown spots or blotchy skin coloring
• certain precancerous skin growths
• acne or chicken pox scars
• superficial facial scars from a past injury
©2009, American Society for Aesthetic Plastic Surgery
Chemical peels, Dermabrasion and laser skin rejuvenation
remove layers of skin and, as the healing process progresses,
a new, healthier-looking skin emerges.
©2009, American Society for Aesthetic Plastic Surgery
A chemical peel involves the application of a solution to
either your entire face or just certain regions, such as the
crow's feet area around your eyes or the vertical wrinkles
around your mouth.
©2009, American Society for Aesthetic Plastic Surgery
Superficial peels using alpha hydroxy acids (AHAs) or
Salicylic Acid often give your skin a fresher, healthier
appearance and a radiant glow. Repeated treatments can
further improve skin texture and tone.
©2009, American Society for Aesthetic Plastic Surgery
After a skin rejuvenation procedure, your doctor will
recommend a maintenance program using glycolic or retinoic
acids that you can apply at home on a regular basis.
©2009, American Society for Aesthetic Plastic Surgery
©ASAPS
Deep chemical peels such as high concentration
trichloroacetic acid (TCA) and phenol are generally one-time
procedures that will result in a longer downtime, during
which new skin forms over the treated area.
©2009, American Society for Aesthetic Plastic Surgery
TCA formulas are often preferred in treating darker-skinned
patients or for spot peeling of limited areas such as around the
mouth or eyes because they have less bleaching effect than
solutions containing phenol.
©2009, American Society for Aesthetic Plastic Surgery
A full-face deep chemical peel takes approximately one hour to
perform. A light sedation is recommended as there is a burning
sensation as the solution effects the area to be treated (avoiding
the eyes, brows and lips).
An ointment stays in place for several days as the skin develops
rapidly underneath.
Effects of a phenol chemical peel are long lasting, and in some
cases are still readily apparent up to 20 years following the
procedure. Unlike TCA peels, phenol cannot be used on your
neck or other parts of your body.
©2009, American Society for Aesthetic Plastic Surgery
Dermabrasion uses a small, rapidly spinning wheel with a
roughened surface to remove the upper layers of skin. This
rejuvenation procedure can reduce the appearance of acne
scars and vertical lines around the mouth without affecting
skin pigmentation.
©2009, American Society for Aesthetic Plastic Surgery
Chemical Peel Treatment Chart
Peel Type
AHA Peels
(Glycolic Lactic,
etc.)
Jessner’s Peel
(14% Salicylic
Acid, 14% Lactic
Acid, 14%
Resorcinol)
TCA Peels - Low
Concentration
10-35%
TCA Peels - High
Concentration +
Jessner’s or
Glycolic Acid
Phenol/Croton
Oil Peels, Baker
Gordon or
Litton Formula
Fine Lines
Some
Improvement
Little
Improvement
Little
Improvement
Moderate
Improvement
Good
Improvement
Acne
Good
Improvement
Good
Improvement
Little
Improvement
Little
Improvement
Good
Improvement
Acne Scars
Little
Improvement
Little
Improvement
Some
Improvement
Moderate
Improvement
Good
Improvement
Deep Wrinkles
Little
Improvement
Little
Improvement
Little
Improvement
Moderate
Improvement
Good
Improvement
Pigmentation
Some
Improvement
Some
Improvement
Moderate
Improvement
Good
Improvement
Good
Improvement
Year+
Good
Improvement
Effects
Risks
Recovery Time
1 to 3 months
1 to 3 months
3 to 6 months
Low
Low
Medium
High
High
(with Cardiac
Risks)
1 Day
2-4 Days
2-4 Days
5-7 Days
7-10 Days
©2009, American Society for Aesthetic Plastic Surgery
A less abrasive treatment that does not require anesthetic and
brightens up the skin while reducing fine lines and scarring is
Microdermabrasion. It stimulates the production of skin cells
and collagen, has almost no side effects, but requires periodic
treatments.
©2009, American Society for Aesthetic Plastic Surgery
Skin rejuvenation with laser technology refers to removing
the outermost layers of the epidermis to improve skin
discoloration, fine lines, and texture, while at the same
time, using heat/thermal energy in the dermis to promote
collagen contraction, remodeling, and stimulation of new
collagen.
©2009, American Society for Aesthetic Plastic Surgery
Like the other rejuvenation methods, the laser is effective in
treating wrinkles, blotchiness or age spots, and scars from
acne or other causes. Side effects include redness, swelling
and change in the pigmentation of the skin.
©2009, American Society for Aesthetic Plastic Surgery
Laser Skin Rejuvenation
Can treat the following conditions:
•Effects of Aging
•Facial Blotching (Melasma)
•Fine Lines
•Large Pore Size
•Neck and Chest Pigmentations
•Pigmentation
•Pigmented Birthmarks
•Scars and Acne
•Stretch Marks
•Tattoo Removal
•Wrinkles
©2009, American Society for Aesthetic Plastic Surgery
Two types of treatment options including non-ablative (no
downtime/appropriate for all skin types) and ablative
(downtime and not appropriate for all skin types) treatment to
assist patients achieve their laser rejuvenation goals. This
patient had non-ablative laser treatment for his acne.
©2009, American Society for Aesthetic Plastic Surgery
Intense Pulsed Light treatments such as IPL™ Photo
rejuvenation is a non-invasive skin and revitalizing treatment
that corrects sun damaged skin, skin conditions marked by
premature aging and or vascular conditions such as rosacea.
©2009, American Society for Aesthetic Plastic Surgery
The IPL™ is versatile because it can treat the face, the neck, chest
and hands rather than a single isolated area. With a series of
treatments, IPL™ can help restore your skin to a more healthful and
youthful appearance without the downtime or long recovery period as
seen with other types treatments.
©2009, American Society for Aesthetic Plastic Surgery
The Erbium Nd: Yag and Erbium fractional rejuvenation
may be used for deep acne scars and is similar to fraxel
repair.
©2009, American Society for Aesthetic Plastic Surgery
The MicroLaserPeel is also a good option to the CO2 laser
which is still considered the "gold standard" but comes with
greater risks, full anesthesia and much longer downtime.
©2009, American Society for Aesthetic Plastic Surgery
Fractionated Lasers is a relatively new facial procedure that
eliminates old skin cells to improve tone and texture, erase
unwanted brown spots, smooth wrinkles around the eyes as well
as hide scars, and rejuvenate the skin around the chest, neck, and
hands. The skin’s natural healing process will allow for healthier
and tighter skin to form, which will rid the skin of
imperfections.
©2009, American Society for Aesthetic Plastic Surgery
Laser Chart
Laser Type
IPL
Non-Ablative
Fractional
Ablative Fractional
Erbium/YSGG (Full
Field)
Co2 (Full Field)
None
Moderate
Good
Very Good
Very Good
ModerateGood
Poor
Poor
Poor
Poor
Acne Scars
Poor
Excellent
Excellent
Very Good-Excellent
Very Good-Excellent
Deep
Wrinkles
Poor
Moderate
Good-Very Good
Excellent
Excellent
Excellent
Moderate
Good
Very Good
Very Good
Redness/Burn
Redness/Irritation
Redness, Irritation
Redness, Irritation
Prolonged
Erythema,
Hypopigmentation
None
1-3 days
3-7 days
3-14 days
14-21 days
Fine Lines
Acne
Pigmentation
Risks
Recovery
Time
©2009, American Society for Aesthetic Plastic Surgery
Some patients also may benefit from the laser's mild
"tightening" effect on the skin, particularly in the lower eyelid
area where the skin often becomes somewhat loose as a result
of aging.
©2009, American Society for Aesthetic Plastic Surgery
Infrared Light Source or Radio Frequency waves are safe,
non-surgical processes for skin tightening. There is no
downtime and treatment is done with topical anesthesia.
©2009, American Society for Aesthetic Plastic Surgery
There is an immediate tightening noted and also a delayed
tightening that occurs over a few months. Results are noted
after 1 procedure but better results are achieved after 2-3
treatments spaced a month apart.
©2009, American Society for Aesthetic Plastic Surgery
Laser Hair Removal is a non-invasive, gentle technique that
reduces undesirable hair from most parts of the body.
©2009, American Society for Aesthetic Plastic Surgery
Multiple sessions are needed but can treat large areas
effectively. The best results are achieved when the patient
has dark hair and a light complexion.
©2009, American Society for Aesthetic Plastic Surgery
Here are examples of tattoo removals using laser
technology.
©2009, American Society for Aesthetic Plastic Surgery
The Following is a List of Vascular
Treatments with Lasers
•Red Acne Scar Removal
•Rosacea Treatment (Facial Redness)
•Scar Removal-Keloid, Surgical and Other Scars
•Spider Vein Removal (Facial and Legs)
©2009, American Society for Aesthetic Plastic Surgery
Skin care, including
hydration and regular sun
protection, in the form of
sunscreen and sunglasses,
can further enhance your
refreshed appearance and
maintain skin health.
These regimens are
essential to the prevention
of unwanted changes in
skin color, and to minimize
age-related skin changes.
©2009, American Society for Aesthetic Plastic Surgery
Every device has its unique characteristics to give a
certain result and your doctor can help you decide
which procedure, or combination of procedures is in
your best interest.
©2009, American Society for Aesthetic Plastic Surgery
With realistic expectations, there are a variety of
nonsurgical treatments and options that can lead to
effective and satisfactory results.
©2009, American Society for Aesthetic Plastic Surgery
Stuart B. Kincaid, MD, F.A.C.S.
San Diego/La Jolla Office
8929 University Center Lane, Ste. 201
San Diego, California 92122
Phone: 858-450-4199
Temecula/Inland Empire Office
40963 Winchester Road
Temecula, California 92591
Phone: 951-695-9934
Toll Free: 1-866-BEST IMAGE
Email: [email protected]
Web site: www.SkincaidMD.com
Fax: 858-450-4197
©2009, American Society for Aesthetic Plastic Surgery