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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