No, I am not aware of any non-invasive treatment modalities that can remove a lipoma. A lipoma is just a benign overgrowth of fatty tissue and like most benign tumors, slowly grows and enlarges over an extended period of time. Any noninvasive modality really would not affect the lipoma in any significant way and it would continue to grow. The only option for treatment of a lipoma is removal. The only minimally invasive technique that may work would be liposuction through a very small incision. The downside of this technique is that more than likely a small amount of the lipoma would be left behind and over an extended period of time this lipoma would therefore recur. Otherwise, I have removed lipomas from various areas of the face using endoscopic techniques so that no visible scars would be needed. This involves placing the incision up in the hair and then performing the dissection out to the lipoma via endoscopic guidance using small cameras and specialized instruments. The lipoma then can be removed endoscopically and the small incision in the hair closed with dissolvable sutures. This is a more expensive technique of lipoma removal and only occasionally will insurance cover the additional cost for this technique. It is therefore more commonly performed for cosmetic reasons in patients that are very concerned about a more traditional surgical excision.
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In experienced hands, jowl liposuction has very little risk; however, in inexperienced hands, jowl liposuction can cause irregularities or depressions that would be extremely difficult to correct. When performing jowl liposuction, one has to be very judicious regarding the amount of fat that is removed and one has to feather the fat removal along the edges of the proposed fullness to prevent any sort of a visual depression. There is very little risk to any sort of injury to major blood vessels or nerves as long as the liposuction is performed in the appropriate level, which is just below the skin. I find that many patients that feel they are a good candidate for jowl liposuction really are not as the majority of the jowl is not due to subcutaneous fat, but due to laxity of the midfacial structures over time. These patients obviously would benefit from a more surgical approach such as a minilift or extended SMAS deep plane facelift for adequate correction of this concern.
First of all, it is truly impossible to remove a scar no matter where it is on the face. What we can do is make a scar that is quite visible become quite inconspicuous by various modalities. If the scar is quite depressed and is in a location that can be easily resected, the scar is simply removed and then a scar revision is performed to make the resulting appearance much more cosmetically acceptable. There are newer technological breakthroughs that can improve the appearance of a scar significantly. I am mainly speaking of ProFractional laser treatments, which cause tunnel-like injuries in the skin almost like aerating the lawn. These tunnels injure the dermis of the skin and the resulting injury creates a healing response that causes new collagen growth and skin tightening. The new collagen growth can significantly
In my opinion it really depends on the number of lines that are above the lip as to whether I would recommend fillers or dermabrasion for treatment. If there are only a few relatively deep lines across the upper lip, I think fillers are an excellent way to rid the patient of these unsightly lines. I highly recommend the hyaluronic acid fillers and would recommend that the patient stay away from virtually any other filler in this area. The only downside is that the result is only temporary and will last somewhere in the six to twelve month range. Dermabrasion on the other hand can provide a more permanent solution to the problem, but I certainly would not recommend actual dermabrasion, but would highly recommend laser skin resurfacing as this is a safer and more consistent way to obtain the result without the risks of pigmentary issues or scarring. If we are just treating the area around the mouth, these laser treatments can be performed in the spa setting using local anesthetic and are exceptionally successful at ridding the patient of these lines above the lip. This really would be the only recommendation that I would have for patients who have multiple lines above the lip and this certainly is a common problem that I see in my practice where patients will present with 10 to 20 or even more relatively deep lines across the upper lip. This really would not be an indication for fillers in this circumstance and an aggressive erbium laser resurfacing would provide absolutely outstanding results with only approximately six days of any sort of downtime.
My answer to that question would depend on who the nurse is that is going to be injecting Botox, Juvéderm or Restylane. If the nurse has been trained by a well qualified physician such as a facial plastic surgeon and has extensive experience with injectables, then I feel that it is absolutely appropriate for a nurse to perform these procedures. The problem is that there are far too many people out in the community that are performing these injections without adequate training. I am not just speaking about nurses, but other health care personnel such as physician’s assistants, nurse practitioners, estheticians, and even many medical doctors. I think many feel that this is an industry which they can enter into and make additional money and even though they have no formal training or any significant background in treatments of the face or certainly any treatments of an esthetic nature, they nonetheless enter into this industry. My personal goal is not to prevent these people from entering into the industry, but to educate them in the proper techniques, indications, and contraindications to these procedures so that patients will have successful outcomes without the complications that occur from treatments by unqualified personnel. That is why we are planning on starting the Quintessa Institute, which is specifically
Historically speaking, IPL was less effective than other modalities such as the diode laser, specifically the LightSheer, or the Alexandrite laser that is essentially considered the gold standard in hair removal technology. Today, with the advent of broadband light by Sciton, which is a more advanced and more powerful form of intense pulsed light, laser hair removal can be accomplished quite successfully using this modality. At Quintessa Medial Spa we not only have the broadband light by Sciton, but we also have the new laser hair removal system by Lumenis called the Duet, which combines six diode laser heads in a single device in association with a suction that performs laser hair removal in one-sixth of the time and with virtually no discomfort and no need for messy gels. We are very excited about this new technology as I think it has taken another revolutionary step for hair reduction.
Every year manufacturing companies make advances in the field of esthetic medicine and come out with products that are better, less expensive, or last longer. Unfortunately, I do not see a product, at least in the near future, that will be similar to Botox or Dysport and yet last much longer. The reason I say this is that the mechanism of action of Botox and Dysport is irreversible. That means that the molecule of Botox and Dysport binds to the nerve ending permanently. The nerve then reacts to this by creating a new nerve ending and the amount of time that it takes the nerve to grow this new ending is how long the Botox or Dysport will last. This is typically in the three to four-month range. In order for a product to last longer than this, it would have to be able to prevent the nerve from creating a new ending and this type of mechanism could potentially create all sorts of undesirable side effects. One day such a product may exist and they may end up perfecting this to avoid any sort of side effects or complications, but I do not see this happening in the very near future. The good news is that Botox and Dysport are extremely safe, extremely reliable, and do a wonderful job at rejuvenating the upper half of the face. With the new competition to Botox from Dysport and some newer neuromodulators that will become available in the very near future, I see the price of these products actually decreasing in the near future so that overall the treatment will be a more affordable option for many patients.
Yes, Asian patients can indeed have intense pulsed light treatments. Obviously the device is set with a different filter and different energy settings to take into account the significant increased pigmentation that is in Asian skin. We further tend to take significant precautions with Asian skin to prevent postinflammatory hyperpigmentation as it is extremely common in this skin type. These precautions include very consistent use of a sunblock as well as consistent use of a hydroquinone product and frequently the additional use of a Retin-A type product as well. We want to be very careful that these products do not cause any irritation to the skin as the irritation can also contribute to postinflammatory hyperpigmentation; however, when this is performed properly in conjunction with the intense pulsed light, we can successfully treat very difficult skin conditions such as melasma even in Asian patients. They are counseled that even very brief amounts of sun exposure can cause the abnormal pigmentation to recur.
Yes, I believe that most of my patients would benefit from the use of Retin-A on a daily basis. Some patient’s skin is more sensitive than others and this has to be titrated so that an appropriate amount of Retin-A can be used, but any sort of irritation and redness can be minimized. Retin-A is a very nice agent to improve cellular turnover. This in and of itself is a very light peeling agent and will rid the skin of the topmost layer called the stratum corneum and allow the skin to look more fresh and hydrated. Further, it is very useful to help with pigmentary issues due to the fact that it does increase cellular turnover. This therefore allows the skin’s own natural processes to rid itself of unnatural pigmentation in a more timely fashion. Retin-A in combination with hydroquinone is a very effective means of improving pigmentary issues in patient’s skin and if this is too irritating, we typically then place the patient on a combination therapy of the Retin-A, hydroquinone, and a topical steroid, which commercially available is called Tri-Luma. The bottom line is I feel that the far majority of my patients should be on Retin-A on a daily basis and that they just need to adjust the amount used to prevent any sort of irritation to the skin.
That really depends on how you react to Botox. Botox is a temporary solution to dynamic facial lines and is most commonly used to treat the lines between the eyebrows, the wrinkles across the forehead as well as the crow’s feet area. When the Botox is affective, the muscle is relaxed and the lines are greatly improved. This affect typically lasts three months initially and so, every three months the patient will need to return for repeat injections by a qualified injector. Many patients; however, do get longer lasting results as time goes on and I even have patients who see me approximately once a year for a Botox injection as they have essentially retrained themselves not to use this facial muscle excessively. A more permanent solution for the aforementioned areas would be an endoscopic browlift as during an endoscopic browlift, the muscles that are treated by Botox are resected. The brows are elevated into a more appropriate position, so the patient has less desire to consistently raise their brows and due to the brow elevation, the crow’s feet are is also improved. You can consider all of your options during a consultation at Quintessa Medical Spa.
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