Acne

NYC Acne Treatment Center

Acne

Implicated in a wide range of conditions and illnesses, hormones also play a role in the development of acne. Androgens, male hormones that are secreted in different amounts by both men and women, play an important role in most cases of acne. Androgens stimulate the hormone-sensitive sebaceous glands, which produce oil, known as sebum. Sebum, in turn, has been called "the fuel that feeds the flame of acne."

Genetics also seem to play a role. There are some families in which severe acne is inherited. Unfortunately, the exact genetic component is not known yet.

If the acne does not respond to home and over-the-counter treatments after two months, it is a good idea to see a dermatologist before the condition produces scarring and/or takes an emotional toll. Dermatologists have numerous prescription medications and procedures available.

Acne is a very common skin problem that shows up as outbreaks of bumps called pimples or zits. These usually appear on the face, neck, back, chest, and shoulders. Acne can be a source of emotional distress, and severe cases can lead to permanent scarring.

What Causes Acne?

Acne begins when the pores in the skin become clogged and can no longer drain sebum (an oil made by the sebaceous glands that protects and moisturizes the skin.) The sebum build-up causes the surrounding hair follicle to swell.

Hair follicles swollen with sebum are called comedones. If the sebum stays beneath the skin, the comedones produce white bumps called whiteheads. If the sebum reaches the surface of the skin, the comedones produce darkened bumps called blackheads. This black discoloration is due to sebum darkening when it is exposed to air. It is not due to dirt. Both whiteheads and blackheads may stay in the skin for a long time.

Bacteria called Propionibacterium acnes (P. acnes) that normally live on the top of the skin can enter the clogged pores and infect the sebum. This causes the skin to become swollen, red, and painful.

Infected sebaceous glands may burst, releasing sebum and bacteria into the surrounding skin, creating additional inflammation. In severe cases, larger nodules and cysts may form in the deeper layers of the skin.

What Are the Different Types of Acne?

Acne can be categorized by its severity:

1. Mild acne describes a few scattered comedones (whiteheads or blackheads) with minimal inflammation (no pustules).
2. Moderate acne describes a denser collection of comedones as well as red, inflamed, pus-filled lesions (pustules).
3. Severe acne, also called nodular or cystic acne, describes widespread and deep lesions that are painful, inflamed, and red. This form of acne is likely to lead to scarring if left untreated.

Mild acne with comedones on the forehead      Moderate acne with pustules

Who Gets Acne?

Anyone can get acne, but it appears most often in teenagers, whose surging levels of androgen (a type of hormone) create larger and more active sebaceous glands. Acne may continue for people in their twenties and thirties, and even women over forty. Acne also appears more commonly in people whose parents had acne.

What Factors Make Acne Worse?

Acne lesions can come and go. These factors can cause acne to flare:

• Changing hormone levels in women 2 to 7 days before their menstrual period, during pregnancy, or when starting or stopping birth control pills
• Oil from skin products (moisturizers or cosmetics) or grease in the workplace (for example, a kitchen with fry vats)
• Pressure from sports helmets or equipment, backpacks, tight collars, or tight uniforms
• Environmental irritants, such as pollution and high humidity
• Squeezing or picking at blemishes
• Hard scrubbing of the skin

What Are The Treatment Options for Acne?

Almost all cases of acne can be effectively treated. Treatment goals are to heal existing lesions, stop new lesions from forming, and prevent scarring.

Acne treatments aim to control one or more of the underlying causes of acne. For instance, topical retinoids, such as Differin or Retin A Micro, may help unclog sebaceous glands and keep pores open. Antibiotics may be used to fight the P. acnes bacteria. Accutane or hormonal agents, such as birth control pills, may be used to reduce sebum (oil) production.

           Before Treatment                           After Treatment

A. Topical medications (applied to the skin)

Over the counter

• Benzoyl peroxide—This is found in many products including Clearasil and Proactiv. It is a mild antibiotic that kills the P. acnes bacteria. It is available in different concentrations. Higher concentrations are more likely to irritate the skin. It does not unclog blocked pores so is not as helpful for reducing whiteheads and blackheads.
• Sulfur and salicylic acid—These have some mild ability to break down whiteheads and blackheads.

Prescription

• Topical retinoids (Differin, Retin A Micro, Tazorac, tretinoin)—These are among the most effective and commonly used acne medications. Topical retinoids are unique in their ability to unclog swollen pores. They may be used alone for mild acne or combined with other medications for moderate-to-severe acne. They may also be recommended for long-term use, even after the acne is under control, to keep the skin clear.
• Topical antibiotics—Antibiotics applied to the skin, such as clindamycin (Clindagel) and erythromycin, kill the P. acnes bacteria that leads to inflammation.

B. Oral medications (taken by mouth)

• Oral antibiotics—These medications, which include tetracycline, doxycycline (Adoxa, Doryx), and minocycline (Dynacin, Solodyn), act systemically and can reach bacteria in the deep layers of the dermis. They are also used for their anti-inflammatory effects.
• Oral contraceptives (Ortho Tri-Cyclen, Yaz)—For women who experience hormonally triggered acne, birth control pills may be prescribed to reduce sebum production.
• Anti-androgen drugs—Some drugs used for other medical conditions are known to reduce androgen levels, such as spironolactone (Aldactone). These may be used in some cases of acne.
• Isotretinoin (Accutane, Sotret)—Isotretinoin remains the most effective treatment for severe acne or acne that does not respond to other treatments. Isotretinoin treats all causes of acne: excess sebum, clogged pores, bacterial overgrowth, and inflammation. Most patients take the medicine for 15-to-20-week periods that may be repeated if necessary. Treatment requires monthly office visits, monthly lab tests, and strict contraception. It is critical that women of child-bearing age do not get pregnant while taking isotretinoin because of the serious risk of birth defects. The iPledge program was developed to reduce the likelihood of birth defects and other side effects.

Many of these medications have side effects, such as burning, redness, and irritation. With some medicines, such as topical retinoids, these side effects usually decrease or go away after the medicine is used for a period of time. If side effects are severe or don't go away, tell your doctor.

C. Procedures

For persistent lesions that are inflamed or unresponsive to medications, some doctors recommend additional methods, including extraction, light therapy, or corticosteroid injections.

How Will I Choose a Treatment Plan?

Your doctor will recommend a treatment based on these factors:

• Severity of your acne. Mild acne may respond well to a topical retinoid alone. Moderate acne may respond better to a combination of topical retinoid with an antibiotic or other medication. Severe acne with scarring may need treatment with an oral retinoid (Accutane, Sotret).
• Results of previous treatments. Medications may be added in a step-wise fashion, only if previous treatments are found to be ineffective.
• Degree of scarring. More aggressive therapies may be started earlier if acne scars have already started developing.
• Gender. Some treatments are available only for females, such as birth control pills.

Whatever your treatment plan, it is important that you give it enough time to work. This may mean waiting 6 to 8 weeks to see results. While the older acne lesions are healing, the medication is hard at work keeping new lesions from forming. Staying on your medication is the most important step to getting acne under control.

How Can I Keep My Acne Under Control?

After your acne clears, your doctor may recommend that you continue therapy with a topical retinoid to keep it under control. It is always a good idea to maintain good skin care and use skin care products labeled as “non-comedogenic” (do not promote acne)

What About Self Care and Prevention?

For ongoing self-care and prevention of acne, follow a few simple guidelines:

• Clean skin gently—Use a mild skin cleanser twice a day, and pat skin dry. Harsh cleansers and astringents can actually worsen acne.
• Do not pop, squeeze, or pick at acne lesions, as this can promote inflammation and infection. Keep hands away from your face and other acne-prone parts of the skin.
• Limit sun exposure—Tanning only masks acne at best. At worst, sun exposure can lead to skin damage, especially if you are using an acne treatment that makes your skin more sensitive to sunlight and UV rays (this includes tanning booths).
• Choose cosmetics with care—As mentioned above, choose non-greasy skin products, and look for words like “non-comedogenic”, “oil-free”, and “water-based”. Some facial products contain active acne-fighting ingredients, such as benzoyl peroxide or salicylic acid, to help keep mild acne at bay.
• Be patient with your treatment—Find out how much time it should take for your acne treatment to work (generally 6-8 weeks) and then stick with it. Stopping treatment early may prevent you from seeing good results or even cause a relapse of symptoms. Your skin may look worse before it begins to improve. You may need to try more than one type of treatment.

 

Cleansing

Acne has nothing to do with not washing your face. However, it is best to wash your face with a mild cleanser and warm water daily. Washing too often or too vigorously may actually make your acne worse.

.

Cosmetics

Wear as little cosmetics as possible. Oil-free, water-based moisturizers and make-up should be used. Choose products that are "non-comedogenic" (should not cause whiteheads or blackheads) or "non-acnegenic" (should not cause acne). Remove your cosmetics every night with mild soap or gentle cleanser and water.

A flesh-tinted acne lotion containing acne medications can safely hide blemishes. Loose powder in combination with an oil-free foundation is also good for cover-up.
.

Treatment

 

Control of acne is an ongoing process. All acne treatments work by preventing new acne breakouts. Existing blemishes must heal on their own, and therefore, improvement takes time. If your acne has not improved within two to three months, your treatment may need to be changed. The treatment your dermatologist recommends will vary according to the type of acne.

Occasionally, an acne-like rash can be due to another cause such as make-up or lotions, or from oral medication. It is important to help your dermatologist by providing an updated history of what you are using on your skin or taking internally.
Many non-prescription acne lotions and creams help mild cases of acne. However, many will also make your skin dry. Follow instructions carefully.

Topicals

• Your dermatologist may prescribe topical creams, gels, or lotions with vitamin A acid-like drugs, benzoyl peroxide, or antibiotics to help unblock the pores and reduce bacteria. These products may cause some drying and peeling. Your dermatologist will advise you about correct usage and how to handle side effects.
• Before starting any medication, even topical medications, inform your doctor if you are pregnant or nursing, or if you are trying to get pregnant.

Special Treatments

• Acne surgery may be used by your dermatologist to remove blackheads and whiteheads. Do not pick, scratch, pop, or squeeze pimples yourself. When the pimples are squeezed, more redness, swelling, inflammation, and scarring may result.
• Microdermabrasion may be used to remove the upper layers of the skin improving irregularities in the surface, contour, and generating new skin.
• Light chemical peels with salicylic acid or glycolic acid help to unblock the pores, open the blackheads and whiteheads, and stimulate new skin growth.
  
• Injections of corticosteroids may be used for treating large red bumps (nodules). This may help them go away quickly.

Oral

• Antibiotics taken by mouth such as tetracycline, doxycycline, minocycline, or erythromycin are often prescribed.

Birth Control Pills

     

• Birth control pills may significantly improve acne, and may be used specifically for the treatment of acne. It is also important to know that oral antibiotics may decrease the effectiveness of birth control pills. This is uncommon, but possible, especially if you notice break-through bleeding. As a precautionary measure use a second form of birth control.

Other Treatments

• In cases of unresponsive or severe acne, isotretinoin may be used. Patients using isotretinoin must understand the side effects of this drug. Monitoring with frequent follow-up visits is necessary. Pregnancy must be prevented while taking the medication, since the drug causes birth defects.
  
• Women may also use female hormones or medications that decrease the effects of male hormones to help their acne.
  
• Photodynamic therapy using the blue wavelength of light can be helpful in treating acne as well.

Your dermatologist will evaluate you and suggest the appropriate treatment regimes considering your age, sex, and the type of acne you have.

Treatment of Acne Scarring

The dermatologist can treat acne scars by a variety of methods. Skin resurfacing with laser, dermabrasion, chemical peels, or electrosurgery can flatten depressed scars. Soft tissue elevation with collagen or fat-filling products can elevate scars. Scar revision with a microexcision and the punch grafting technique can correct pitted scars, and combinations of these dermatologic surgical treatments can make noticeable differences in appearance.

Proper Care is Necessary

No matter what special treatments your dermatologist may use, remember that you must continue proper skin care. Acne is not curable, but it is controllable; proper treatment helps you to feel and look better and may prevent scars.
To learn more about acne and acne treatments please consult with  Dr. Rothfeld at NYC Acne Treatment Center of New York, NY.

 

Retinoic acids.
Available as creams and lotions, these vitamin A acids can help unblock pores and reduce the skin's bacteria.

Topical antibacterials or antibiotics.
These creams and lotions can help reduce acne inflammation and skin bacteria.

Oral antibiotics.
Though not usually the first course of treatment, oral antibiotics such as tetracycline are often used to help reduce the inflammation of acne.

Birth control pills.
Women who use oral contraceptives may notice that their acne improves significantly. In fact, the FDA has approved one birth control pill specifically for acne treatment.

Isotretinoin.
For severe acne that does not respond to other treatments, your dermatologist may prescribe isotretinoin. This medication must be used with care, however, since it can cause birth defects.

Surgery.
It is never a good idea to remove blackheads or whiteheads (both called comedones) or pimples on your own. A dermatologist has the proper equipment to extract them without leaving scars.

Millions of people suffer the ravages of acne scars long after adolescence has passed and the acne condition has faded. Acne in its most severe form can leave sufferers with deep permanent scars. Acne typically results in two types of scars - "icepick," or pitting scars, and "depressed," crater-like scars.

Treating Scars
Thanks to the refinement of a number of dermatologic surgical techniques, acne scars can be treated with a variety of safe, effective procedures that improve the appearance of a patient's skin and boost the patient's self-esteem. Dr. Rothfeld, a dermatologic surgeon will choose the technique or combination of treatment approaches based upon the nature of the scarring. The following are common techniques and procedures used to improve acne scarring:

Dermabrasion The dermatologic surgeon freezes the patient's skin or uses tumescent anesthesia and then removes or "abrades" the skin with a rotary instrument. The skin undergoes a "remodeling" process as it heals, resulting in a smoother and fresher appearance.

Excision and Punch Replacement Graft A depressed acne scar is surgically removed, and a patch of skin from elsewhere on the patient's body.

Soft Tissue Fillers Bovine collagen, collagen-related fillers, polymer implants or a patient's own fat (taken from another part of the body) is injected in small quantities below the surface of the skin to elevate depressed scars.

Laser Therapy By delivering short pulses of the laser beam, the dermatologic surgeon can smooth, sculpt and normalize the appearance of acne scars. The ultrapulsed carbon dioxide laser, the erbium YAG laser and the pulsed dye yellow light laser are most commonly used for treating acne scarring.

Chemical Peeling By applying a chemical solution to the skin, mild scarring and certain types of acne may be treated. The procedure enables new, regenerated skin to appear, improving the appearance of the condition. Chemical Chemical peels have been a mainstay of Dermatology for decades. Chemical peels work by ungluing the top layer of damaged skin and discolored skin so it can peel away and reveal the fresh new skin beneath.   Come into Dr. Rothfelds' office to discuss the different type of chemical peels that would be appropriate for you.

Chemical peeling uses a chemical solution to improve the skin's appearance. It can reduce or eliminate fine lines under the eyes and around the mouth, correct uneven skin pigmentation, remove precancerous skin growths, and soften acne or treat scars caused by acne. The procedure can also treat wrinkles caused by sun damage and scarring, as well as skin blemishes common with age and heredity. Chemical peels can be performed on the face, neck, chest, hands, arms, and legs.

Possible complications associated with chemical peels may include but are not limited to the following:

• change in skin tone color
  For certain skin types, there is a risk of developing a temporary or permanent skin color change. Taking birth control pills, being pregnant, or having a family history of brownish discoloration on the face may increase the possibility of developing the abnormal pigmentation.
  
  
• scarring
  Chemical peels can cause scarring. However, if scarring occurs, it can usually be treated effectively.
  
  
• cold sores and fever blisters
  Those who are susceptible to cold sores, or herpes simplex infections, may have a reactivation of cold sores or fever blisters following a chemical peel.

A chemical peel is most commonly performed for cosmetic reasons to enhance appearance and self-confidence and may be performed in conjunction with a facelift. However, a chemical peel is not a substitute for a facelift and does not prevent or slow the aging process.

Chemical Peels

Phenol, trichloroacetic acid (TCA), and alphahydroxy acids (AHAs) are used for chemical peels. The precise formula used may be adjusted for each patient.

• alphahydroxy acids (AHAs)
  Alphahydroxy acids (AHAs) such as glycolic, lactic, or fruit acids are the mildest of the peel formulas and produce light peels that can often provide smoother, brighter-looking skin. AHA peels may be used to accomplish the following:
  
  
  • reduce fine wrinkling
  • treat areas of dryness
  • reduce uneven pigmentation
  • aid in control of acne
  • smooth rough, dry skin
  • improve texture of sun-damaged skin
    
    
  AHA peels may cause the following:
  
  
  • stinging
  • redness
  • irritation
  • crusting, flaking, or scaling
  • dryness

  Generally, no anesthesia is needed for AHA peels since they cause only a slight stinging sensation during application.

  Protecting skin from the sun is important following AHA peels.

• trichloracetic acid (TCA)
  Trichloroacetic acid (TCA) can be used in many concentrations and is used to accomplish the following:
  
  
  • smooth fine surface wrinkles
  • remove superficial blemishes
  • correct pigment problems

TCA can be used on the neck or other body areas, and may require pretreatment with Retin-A or AHA creams. This procedure is preferable for darker-skinned patients.

Anesthesia is not usually required for TCA peels because the chemical solution acts as an anesthetic. Although, sedation may be used before and during the procedure to help the patient relax. Two or more TCA peels may be needed over several months to obtain the desired result, although mild TCA peels may be repeated more frequently.

The results of a TCA peel are usually less dramatic than and not as long-lasting as those of a phenol peel. More than one TCA peel may be needed to achieve the desired result.

TCA-peel patients are advised to avoid sun exposure for several months. The procedure also may produce some unintended color changes in the skin.

• phenol
  Phenol is the strongest of the chemical solutions and produces a deep peel. A phenol peel is mainly used to accomplish the following:
  
  
  • correct blotches caused by sun exposure, birth control pills, or aging
  • smooth out coarse wrinkles
  • remove precancerous growths
    
    
  Phenol:
  
  
  • should be used on the face only, as scarring may result if used on the neck or other body areas.
    
    
  • is not recommended for darker-skinned individuals.
    
    
  • may pose risk for patients with heart problems.
    
    
  • may permanently remove facial freckles.
    
    
  • may cause permanent skin lightening.
    
    
  • may leave lines of demarcation.

  Recovery may be slow and complete healing may take several months.

  After a phenol peel, new skin may lose its ability to produce pigment. The skin will be lighter and will always have to be protected from the sun.

About the procedure:

The procedure involves a chemical solution that is applied to the skin. The solution causes a layer of skin to separate and peel off. The new, regenerated skin underneath is usually smoother, less wrinkled, and more even in color than the old skin

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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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