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Sculptra™

Sculptra™ is a new injectable product used to counteract the loss of fat beneath the skin, a condition called lipoatrophy. Sculptra™ is injected into the deep dermis layer of the skin to improve the appearance of sunken cheeks, hollow eyes, indentations and wrinkles. There is no need for allergy testing, since Sculptra's main component is an alpha hyrdoxy acid that has been used for 20 years in surgical products such as dissolvable sutures. Clinical trials have shown that the benefits of Sculptra™ treatments last up to two years.

Collagen Injections

Collagen is a naturally occurring protein found in the second layer of skin (the dermis) which "plumps up" the skin, joints, bones and ligaments. Injections counteract the effects of gravity, sun exposure and years of facial muscle movement by filling out sunken areas and smoothing lines for a rejuvenated look. Results may begin to fade in a few months, depending on the patient's age, genetic background, skin quality, lifestyle and body site. Because of this, and because injections cannot improve severe wrinkles or deep folds, the procedure is often combined with facial resurfacing or plastic surgery for more a satisfying and longer-lasting outcome.

Radiesse® - a Longer-Lasting Alternative to Collagen!

Radiesse®, formerly known as Radiance, is the first calcium hydroxylapatite injectable cohesive implant used for soft tissue augmentation. Over the last seven years, Radiesse® has proven to be a safe and effective alternative for those patients wishing to avoid the potential side effects of bovine and solid implant materials. Radiesse® is a long-lasting injectable filler ideal for treating wrinkles. Radiesse® offers similar benefits to collagen but the results may last for 6-9 months and even years instead of only a few months.

Calcium hydroxylapatite is a synthetic form of a mineral found in our own bones and teeth so the body does not perceive it as "foreign," and there is no allergic reaction. Therefore, a skin test is not required (as is necessary with bovine-derived collagen).

By supplementing your skin's own depleted collagen with Radiesse®, we can smooth out wrinkles and most scars. It can be used to treat the wrinkles between the nose and mouth (nasolabial folds) and the lines from the mouth to the chin ("marionette lines"). In some cases, Radiesse® can be used to fill certain kinds of scars.

Radiesse™ is injected during a simple office procedure using a numbing cream or local anesthetic for comfort.

Juvéderm™ - What Is Juvéderm™ Injectable Gel?

As we age, our skin changes. Over time, the natural volume of youthful skin begins to diminish as wrinkles and folds form. But, with JuvédermT injectable gel, you don't have to just sit back and let it happen! Recently approved by the FDA, JuvédermT injectable gel is a "next-generation" dermal filler. The smooth consistency gel helps to instantly restore your skin's volume and smooth away facial wrinkles and folds, like your "smile lines or nasolabial folds-the creases that run from the bottom of your nose to the corners of your mouth.

JuvédermT is a smooth consistency gel made of hyaluronic acid-a naturally occurring substance in your skin that helps to add volume and hydration. JuvédermT is injected under the skin to provide a smooth, natural look and feel-so everyone will notice (but no one will know)! In fact, studies show superior results of JuvédermT compared to a collagen-based dermal filler.* And, almost 90% of all study volunteers who were treated with both JuvédermT injectable gel and another dermal filler* preferred JuvédermT! In addition, JuvédermT injectable gel is the first FDA-approved hyaluronic acid dermal filler that is proven to be safe and effective for persons of color.

Restylane Injections

For smoothing wrinkles, sculpting lips, and improving other facial features, Restylane injections are a growing favorite. Approved by the FDA in December 2003, Restylane can produce positive results on facial wrinkles, particularly around the mouth and nose. Another benefit is the long-lasting results, as the effects of Restylane treatments can last six months or more.

The Restylane Procedure

Restylane injections are administered in the doctor's office, typically for patients aged 35 to 60. It is most often performed with local anesthesia, especially if the lip is being treated. Since Restylane contains no lidocaine like collagen, patients may experience some pain and discomfort from the needle during injection. Depending upon the extent of the treatment, the procedure can take from a few minutes up to 30 minutes. Patients return home shortly after the procedure.

Restylane is a clear liquid gel, a non-animal-based hyaluronic acid (a natural sugar compound).

• Step One: The doctor may first select one or more injection points for each location to be treated. Antiseptic is also applied.
• Step Two: The doctor will then identify the correct amount of Restylane to be used.
• Step Three: The Restylane filler is then injected beneath the skin. Hyaluronic acid in the filler adheres to the skin as the water contained in the acid helps to retain volume under the skin's surface. The acid acts as a magnet for water, which helps to preserve the renewed volume of the skin.

Results are fully evident within one week. Restylane has a success rate for reducing or eliminating deep wrinkles that cannot be accomplished with other procedures such as chemical peels or microdermabrasion.

Recovery after Restylane Treatment

Swelling may be pronounced, lasting for two or three days. Normal activities can be resumed immediately, though patients are advised to stay out of the sun. Unmanageable pain, as well as symptoms that are progressive or abnormal, should be reported to the doctor immediately.

Restylane treatments reduce wrinkles by about 80 percent. Restylane is a temporary solution and follow-up treatments may be needed.

Complications and Risks of Restylane

The most common side effects of Restylane include headache, nausea, flu-like symptoms, redness, and pain at the injection points. Infrequently, patients experience muscle weakness, which resolves itself within days, or in some cases, months after the procedure.

Your doctor should help you understand the possible complications and remedies during your initial consultation.

Alternative and Additional Treatments

There may be alternative treatment options, depending on your condition. Other minimally invasive procedures include Botox and fat fillers. For severe signs of aging, surgical procedures may be more appropriate, such as a facelift, forehead lift, and eyelid surgery. Your doctor may recommend additional treatments in conjunction with Restylane, such as chemical peel, laser skin resurfacing, or microdermabrasion.

Lip Fillers

Full, sensual lips have long been considered an aesthetic ideal. Lip augmentation with lip implants or dermal fillers plumps up lips and enhances the look of the entire face. Those who have thin lips can especially benefit from lip enhancement. Recovery time after a lip augmentation procedure is typically short, making lip enhancement one of the easiest ways to make the face more visually appealing. http://www.1800blemish.com What is Lip Augmentation? Lip augmentation enlarges the lips through the use of a cosmetic lip filler or lip implants. Often performed in conjunction with face lift, brow lift, rhinoplasty, and cheek implant or chin implant procedures, lip augmentation methods enhance lips to create a look desired by both women and men. Candidates for Lip Augmentation Anyone who desires fuller lips is a good candidate for lip augmentation. Women who have thinning lips or wrinkles around their lip line due to aging can benefit greatly from lip enhancement. Find out if you are a candidate for lip augmentation. http://www.dermatologynyc.org Lip Augmentation Cost The cost of a lip augmentation procedure will vary based on certain factors, such as the doctor who performs it, the type of lip augmentation method, and the geographic location in which the procedure is performed. Most doctors accept major credit cards, and some will work with patients to devise a payment plan that will allow them to pay for the procedure over time. Find out more about the factors that will influence the cost of lip augmentation. Lip Implants One lip augmentation method involves the use of lip implants. Lip implants are shaped like a small tube and filled with synthetic material. A small needle is used to insert the implants into the lips through tiny incisions. One benefit of this method of lip augmentation is that the results are long-lasting. Unlike injectable lip fillers, the implants are not absorbed into the body, but remain fixed in place. Learn about the different types of lip implants and the surgical procedure to place them. Lip Augmentation with Fillers With so many different types of injectable fillers available for lip enhancement, you are sure to find one that suits your needs. Common types of fillers include fat, collagen, and Restylane® . The effectivness of each lip filller as well as the duration of each filler’s effects will vary. The lip augmentation procedure is quite simple, lasting only a few minutes and having a low incidence of lip sensitivity. Learn more about the different types of lip fillers. Lip Augmentation with Fat Transfer Lip augmentation with fat transfer is a revolutionary method for improving the volume of the lips.With this form of cosmetic lip surgery, the doctor carefully prepares fat liposuctioned from one area of the body for injection into the lips. Since the tissue used in this method comes from your own body, it is less likely to be rejected by your body, and the result is supple, natural-looking lips. Learn more about lip augmentation with fat transfer. Lip Augmentation Recovery The extent of your recovery will depend largely on which lip augmentation method you choose. For lip fillers, only a topical anesthetic to numb the injection site is typically required, and recovery consists of mild discomfort for one to two days. The healing period for lip implants and fat transfer is longer and may involve several weeks of recovery. Lean more about the recovery process following lip augmentation. Risks and Benefits of Lip Augmentation Very few patients experience significant complications with lip enhancement, but like all surgical procedures, risks do exist. Bleeding, infection, and swelling are a possibility with any surgery. Side effects more closely associated with lip augmentation include lumping, scarring, numbness, cold sores, and asymmetrical lips. The benefits of a lip augmentation procedure include fuller, shapelier lips, and a more vivacious, youthful appearance. Many patients experience long-lasting results that look completely natural. http://www.nycdermatologist.com

The NYC Dermatology Center of Skin of Color  addresses the unique needs of
patients with pigmented skin, hair and nails. The
focus of NYC Dermatology is to diagnose and treat skin problems of African-American, Hispanic, Indian and Asian patients.  Dr. Gary Rothfeld a board certified dermatologist at NYC Dermatology is devoted to the  dermatology needs of patients of skin of color, which he provides unparalleled treatments, cosmetic interventions and diagnoses

Specifics of colored skin Our  Dermatologist Dr. Rothfeld explains: Ethnic skin contains the same amount of melanocytes as Caucasoid skin, (melanocytes are cells located in the bottom of the skin's epidermis), but it contains different amounts of melanosomes, which produce melanin, what gives skin its color. They exist in far greater amounts in colored skin, they're bigger and they exist all over the epidermis. This is what gives ethnic skin a more intense colour. Specifics Collagen fibres and fibroblasts are denser and more compact in the dermis, which means that aging occurs much later in colored skin. The most common skin complaint in colored women is acne, according to ethnic skin specialist Dr. Rothfeld. Acne is the most common problem, not because ethnic skin is more prone to it but because it causes more damage to colored skin than it does to Caucasoid skin. After spots, ethnic skin is prone to pigmentation and patches." Dos and don'ts Ethnic skin is better adapted to the sun: it sweats and hydrates itself naturally, a bit like internal air conditioning! However, when exposed to a cold, dry climate, this mechanism becomes less effective and the skin loses its protective hydrolipidic film and its natural radiance, often becoming dull and grey-ish. Dr.Rothfeld a board certified dermatologist at NYC Dermatology says: There are certain products that aren't recommended for ethnic skin. I don't think regular exfoliation is ideal, though once in a while it can do your skin good as long as you use a gentle exfoliator. Peeling masks/wraps are generally okay, but you should never use just any old product on your skin. It's important to see a dermatologist to find out what's right for you. Laser treatment doesn't always work on ethnic skin and can even cause permanent depigmentation, so you need to be careful.

BOTOX®, Botulinum A Exotoxin

About BOTOX®

BOTOX® is a highly purified naturally occurring protein complex that has been used for over twenty years, in adults, children and even infants for the treatment of a variety of conditions caused by muscle spasm, including spasm of the vocal cords. The cosmetic use of BOTOX® is a direct outgrowth of these previous uses.

BOTOX® is effective in improving the appearance of a gingival smile by relaxing the muscles that cause excess gums to show.

Benefits

• Treats upper facial lines, wrinkles, hyperhidrosis (excessive sweating), and some headaches
• Can be used in the lower face and neck for treatment of the "downward smile" and neck

  Before BOTOX®

  bands
• Can be used to shape the eyebrows
• One of the safest and most effective treatments for smoothing these lines and wrinkles
• Treats some thickened lower eyelids and enlarged jaw muscles
• Over time the shallower lines will frequently repair themselves

Alternatives to BOTOX®

• Fillers such as Restylane and Juvéderm

Question & Answers about BOTOX®

How does it work?

It has long been observed that when a patient has a stroke that paralyzes one-half of their face, they lose the wrinkles on that same side of their face. For the treatment of wrinkles, a very dilute solution of BOTOX® is injected just under the skin into the overactive muscles producing the wrinkles. This blocks the impulses from the nerves to those muscles and produces a temporary muscle weakening, allowing the skin to regenerate and eliminate the lines.

When the muscles are kept under the influence of BOTOX®, they become shrunken (atrophic) and the BOTOX® effect starts to become more long lasting. The first BOTOX® treatment may last two to four months, but if the next treatment is given before the BOTOX® effect has significantly worn off, the second treatment will often last three to five months. With the third treatment, if given before the effects of the previous treatment have worn off, the effect tends to become even longer lasting. We've had patients come in saying "I had BOTOX® given a year ago, somewhere else, and it didn't work." A statement like this reflects a misunderstanding of the use of BOTOX®. We tell patients that to get optimal results they need to think of BOTOX® as a series of treatments, not just a one time or short term therapy.

Frowning before BOTOX®

Frowning after BOTOX®

BOTOX® is used primarily to correct lines on the upper one-half of the face, particularly the frown lines, the forehead lines, and the crow's feet. These lines can add years to your appearance and can project a false impression of anger, concern or depression. BOTOX® can also be used to improve fine and deeper lines in the upper lip, the "downward smile" (the downward drooping of the corners of the mouth that occurs with aging), to improve the "gingival smile" (excessive gum show on smiling) and the creases and folds in the neck. BOTOX® has also been used to decrease the roll of muscle just below the lower lid margin and accentuated by smiling in some individuals. BOTOX® can also be helpful treating webbing of the neck and the transverse neck creases. Unfortunately BOTOX® cannot be used to correct lines that are not caused by muscle contraction, but in some of these instances Restylane and other fillers may be of help. At times fillers and Botox are administered at the same time.

BOTOX® acts to improve the line or crease by weakening the muscle that folds the skin. It is this repeated folding and unfolding that causes the crease. When the muscle activity stops the fold rapidly becomes less prominent because the skin tends to flatten out in the absence of muscle activity. However, the line in the skin remains initially. Fillers fill the fold, elevating it, but that does not stop the muscle activity. Sometimes BOTOX® and fillers will be used together in a single location, to produce more rapid initial improvement.

Are there people who should not use BOTOX®?

People who are pregnant, breast feeding, have rare neurological disorders, or who are allergic to albumin should not be treated with BOTOX®.

Frowning before BOTOX®

Frowning after BOTOX®

What results can you expect from BOTOX®?

Within two to fourteen days, you should begin to see decreased movement of the muscles injected. Over the next one to two weeks, you should see a further reduction and possibly a complete absence of movement of the treated muscles. We will frequently see patients back after two to three weeks to evaluate the effectiveness of the treatment. If there is still some muscle movement we may inject additional BOTOX®. As the treated facial muscles remain weakened, the skin gradually remodels itself and the lines are first reduced and then frequently eliminated. The effect of BOTOX® generally lasts about three months, although thick, strong muscles may need to be treated more frequently initially. With repeated treatments, as the muscles become weaker, the effect of BOTOX® may last longer. This depends on keeping the muscles inactive. If the effect of the BOTOX® is allowed to wear off, the muscles regain their strength, the folds and creases redevelop and the muscles do not shrink in size. The BOTOX® effect lasts on average three to six months, although on occasion it may be longer or shorter. For best long term results the BOTOX® must be re-injected as it begins to wear off. It is essential to keep the muscles in a weakened state so that the lines do not reform.

Before BOTOX®

After BOTOX®

What about safety and side effects?

Dermatologists and ophthalmologists have been using BOTOX® since 1980. It has an excellent record of efficacy and safety and was first used in infants to correct overactive eye muscles. Although there have been recent news articles about the safety of BOTOX®, problems have occurred only in children with cerebral palsey who were receiving large doses BOTOX® into their neck muscles to treat spasticity (hyperactivity of the muscles). It is our belief that BOTOX® is exceptionally safe and effective and can help prevent you from projecting emotions that you're not feeling. We had one woman patient who said that much of the communication in her marriage involved her husband repeatedly asking her "Why are you angry?" Despite her repeated denials, it took BOTOX® therapy for them to be able to move on to other topics of conversation. BOTOX® does not affect the nerves transmitting sensation, so there is no numbness associated with BOTOX® administration.

There have been no long-term side effects, allergic reactions or health hazards related to cosmetic BOTOX® use thus far. Some patients have been getting BOTOX® treatments for more than 10 years, with no problems. Side effects may include nausea, headache or mild flu like symptoms, usually with doses above those used for cosmetic purposes. If you should stop BOTOX® treatments, your appearance will gradually revert to the appearance you would have had if you had never been treated with BOTOX®.

How long will it take to recover?

One of the many advantages of BOTOX® is that there is no down time. Although occasional bruising may occur, the treatment produces no other immediately noticeable effect and you may immediately apply make-up and go about your usual activities. No local anesthetic or sedative is required, so you will be able to continue with all of your usual activities immediately after your treatment. You will even be able to drive yourself home after a treatment. BOTOX® treatments take only a few minutes.

Does it hurt?

BOTOX® treatments are short and gentle. Because of the extra care and equipment we use, every patient who has received BOTOX® elsewhere has confirmed that our California BOTOX® injections are significantly less painful than any of their previous BOTOX® treatments. A minimal amount of discomfort may be experienced when the needle is inserted and a few drops of BOTOX® are injected into the muscles which need relaxation. The discomfort lasts only a few seconds, and new patients very frequently exclaim that the pain was much less than they had anticipated.

What should I do after my BOTOX® treatment?

You should exercise the treated muscles for two hours following your BOTOX® treatment. This will allow the best possible uptake of BOTOX® by the treated muscles during normal facial movements. Do not rub or touch the areas that were treated with BOTOX® for two hours following your procedure. Rubbing and pressing the injected areas could spread BOTOX® out of the treated muscles and into non-targeted muscles. If your BOTOX® moves out of the muscles it is injected into, there could be less effect on those muscles, and unwanted temporary relaxation of nearby facial muscles. After two hours, there are no restrictions.

Who performs the treatments?

Dr. Rothfeld will personally administer your BOTOX®

How many units of BOTOX® will my treatment require?

Typical treatments are as follows:

• Glabellar lines (between and just above the eyebrows): 20-40 units
• Upper forehead lines: 15-30 units
• Crow's feet (wrinkles and squint lines radiating outwards from the outer corners of the eyes): 10-20 units
• Anterior neck (to reduce jowls, and to reduce vertical and horizontal lines on the anterior neck): 30-40 units 

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