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Acne Phototherapy

What is ALA?
ALA is short for Aminolevulinic acid and it is a clear solution that is applied to the skin during the treatment. ALA occurs naturally in the body and it is involved in the synthesis of hemoglobin. ALA is preferentially absorbed by abnormal skin cells and therefore causes no damage to normal tissue.

How does PDT work?
When the skin absorbs the ALA it coverts it to a natural photosensitizer called Protoporphyrin IX (Pp IX). The skin is then illuminated with the light source and this begins the Photodynamic process of singlet oxygen production. The release of the singlet oxygen from Pp IX destroys acne causing bacteria and shrinks the sebaceous glands for long lasting results.

What can I expect?

  • The technician will do an aggressive acetone scrub, using cotton squares, on the area to be treated. Then ALA will be applied using a paint brush. The ALA will incubate for 30-60 minutes. After the incubation period, you will wash off the ALA and the SpaTouch machine will be used to administer light and heat, over about 15-20 minutes.
  • Subsequent treatment sessions may need longer incubation times depending on the patient's response and tolerance to redness and peeling.
  • After the treatment is completed you must remain completely out of the sun for 24 hours because sunlight can further activate porphyrin.
  • You may get a sunburn like reaction and experience some mild discomfort. Red, chapped and/or peeling skin may continue for a few days after the treatment.
  • Shortly after the first few treatments you may have a substantial breakout. The treatment is bringing out the acne forming deep below the surface of the skin. It's important to note that no new acne is being created.
  • You will be given more details in the Consent Form and Aftercare Instructions at the time of your first appointment.

    How many treatments will I need?
    To achieve maximum improvement in your acne, 4 PDT treatments are recommended. It is important to note that you will continue to see improvement in your acne long after the fourth treatment is completed.

    How effective is Photodynamic Therapy at treating acne?
    In worldwide clinical experience, phototherapy with SpaTouch LHE has been shown to successfully treat moderate to severe acne vulgaris with all skin types, in males and females of all ages, and with results lasting on average 6-12 months, often longer.

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Precancerous Phototherapy

What is an Actinic Keratosis?

Actinic Keratoses (AKs) are rough, scaly patches on the skin, caused by excessive exposure to the sun, that can sometimes progress into dangerous skin cancers. Many doctors believe that AKs and squamous cell carcinomas (skin cancer) are really the same condition at different stages of a continuing process.

How long has Photodynamic Therapy (PDT) been around?
ALA/PDT technology has been around for more than 20 years. It was approved
by the Food and Drug Administration for the treatment of Actinic Keratoses in 1999.

What is ALA?
ALA is short for Aminolevulinic acid and it is a clear solution that is applied to the skin during the treatment. ALA occurs naturally in the body and it is involved in the synthesis of hemoglobin. ALA is preferentially absorbed by abnormal skin cells and therefore causes no damage to normal tissue.

How does PDT work?
When the skin absorbs the ALA it coverts it to a natural photosensitizer called Protoporphyrin IX (Pp IX). The skin is then illuminated with the light source and this begins the Photodynamic process of singlet oxygen production. The release of the singlet oxygen from Pp IX destroys the cell membrane of the targeted cells.

What can I expect?

  • You will be given a series of three treatments, about two weeks apart.
  • The technician will do an aggressive acetone scrub, using cotton squares, on the area to be treated. Then ALA will be applied using a paint brush. The ALA will incubate for 30-60 minutes. After the incubation period, you will wash off the ALA and the light source will be used to administer light and heat, over about 15-20 minutes.
  • Subsequent treatment sessions may need longer incubation times depending on the patient's response and tolerance to redness and peeling.
  • After the treatment is completed you must remain completely out of the sun for 24 hours because sunlight can further activate porphyrin.
  • You may get a sunburn-like reaction and experience some mild discomfort. Red, chapped and/or peeling skin may continue for a few days after the treatment.
  • You will be given more details in the Consent Form and Aftercare Instructions at the time of your first appointment

 

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Aging and Sun Damaged Skin

The Ravages of Time and the Sun
Although it is not possible to turn back the hands of time, its effects can be dramatically slowed down and improved with the arsenal of procedures and techniques available to the dermatologic surgeon.

The natural aging process generally produces lines and wrinkles, age spots, splotches and pigmentation problems, broken capillaries, dull skin texture and color, and other skin flaws. Also, a once-attractive mole or birthmark may change into an unattractive protrusion.
Sun-damage compounds the aging process. Ultraviolet light from the sun penetrates not only the outer layer of skin, but also those layers underneath which fortify the skin and lend it resilience.

Anti-aging creams and topical products are usually used to treat the milder symptoms of aging such as damage to the skin's uppermost layers.

For more advanced signs of aging and sun-damage, the dermatologic surgeon can choose methods best suited to your individual skin condition. Following are some categories of treatment to refine your appearance and make your skin look and feel healthy and attractive.

Corrective Procedures

Soft Tissue Fillers
Soft tissue fillers involves injecting a filling substance under the skin. It is used to "plump up" or contour and correct wrinkles, furrows and hollows in the face. Filling substances include Restylane (hyaluronic acid) and related materials. More information on Restylane and fillers.

Botulinum Toxin
Botulinum toxin type A is a muscle blockade that is injected in very tiny amounts into specific muscles to treat and improve lines, wrinkles and furrows associated with facial expression. Its use for cosmetic purposes and for eyebrow positioning is "off-label" use of a FDA-cleared drug. More information on Botox.

Non-Ablative Resurfacing
Non-ablative resurfacing has several of the benefits of traditional laser resurfacing without wounding the top layers of the skin, providing rapid postoperative healing. One relatively new treatment option to rejuvenate aging and sun-damaged facial skin is to employ Photodynamic Therapy. This treatment utilizes a drug called Aminolevulinic Acid (ALA) which occurs naturally in the body and it is involved in the synthesis of hemoglobin. ALA is preferentially absorbed by abnormal skin cells and therefore causes no damage to normal tissue. When the skin absorbs the ALA it coverts it to a natural photosensitizer called Protoporphyrin IX (Pp IX). The skin is then illuminated with the light source and this begins the Photodynamic process of singlet oxygen production. The release of the singlet oxygen from Pp IX destroys the cell membrane of the targeted cells.

What to Expect:

  • You will be given a series of three treatments, about two weeks apart.
  • The technician will do an aggressive acetone scrub, using cotton squares, on the area to be treated. Then ALA will be applied using a paint brush. The ALA will incubate for 30-60 minutes. After the incubation period, you will wash off the ALA and the light source will be used to administer light and heat, over about 15-20 minutes.
  • Subsequent treatment sessions may need longer incubation times depending on the patient’s response and tolerance to redness and peeling.
  • After the treatment is completed you must remain completely out of the sun for 24 hours because sunlight can further activate porphyrin.
  • You may get a sunburn-like reaction and experience some mild discomfort. Red, chapped and/or peeling skin may continue for a few days after the treatment.
  • You will be given more details in the Consent Form and Aftercare Instructions at the time of your first appointment.

Before & After Pictures:

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General Dermatology

  • Acne
  • Dermatitis
  • Eczema
  • Pigmented lesions
  • Pre-cancerous lesions
  • Psoriasis
  • Rosacea
  • Skin cancer
  • Warts
  • Any process involving skin/hair/nails

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Skin Cancer

Skin cancer is the uncontrollable growth of abnormal cells in a layer of the skin. It attacks one out of every five Americans, making it the most prevalent form of cancer. However, the majority of all skin cancers can be cured if detected and treated in time.

There are several different kinds of skin cancers, distinguished by the types of cells affected. The three most common forms of skin cancer are:

Basal Cell Carcinoma
Basal cell carcinoma usually appears as raised translucent lumps. This cancer develops in 300,000 to 400,000 persons each year. Although the disease does not usually spread to other parts of the body through the blood stream, it may cause considerable damage by direct growth and invasion.

Squamous Cell Carcinoma
Squamous cell carcinoma is usually distinguished by raised, scaly reddish lumps or growths. This form of cancer develops in 80,000 to 100,000 persons per year. The disease can spread to other parts of the body. Approximately 2,000 deaths occur each year from this form of cancer.

Malignant Melanoma
Malignant melanoma typically first appears as a light brown to black irregularly shaped blemish. This serious form of cancer results in death if undetected and untreated. It can spread to other parts of the body through the bloodstream and the lymph drainage system.

Treating Skin Cancer
The dermatologic surgeon will select the most appropriate treatment for a particular skin cancer or precancerous condition from among the following procedures and techniques:

  • Curettage
    Malignant tissue is scraped away with a sharp instrument. This method is most effective for small, superficial cancers that were not treated previously. It is often followed by destruction of the cancerous tissue with an electric needle.

  • Surgical Excision
    Surgical excision, or cutting into the skin and removing the growth. The skin is then closed with stitches.

  • Cryosurgery
    Liquid nitrogen is applied directly to the skin to freeze cancerous tissue, in a more aggressive fashion than treating pre-cancerous growths

  • MOHS Micrographic Surgery
    Excision of a tumor and its surrounding skin with the aid of a microscope. This method allows the dermatologic surgeon to trace the outline of a cancerous growth, layer by layer, with exceptional accuracy. For more information please visit the website for the American Society for MOHS Surgery.

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BOTOX / FILLERS

Botulinum Toxin Treatments:

Wrinkles and Frown Lines
Frown lines are the result of gathering or knitting the tissue between the eyebrows into a fold. These unattractive folds and furrows are caused by the repeated action of underlying muscles associated with facial expression. Years of squinting and frowning tend to leave deep wrinkles in the skin between the eyebrows and on the bridge of the nose, across the forehead, and at the corners of the eyes. On many people, frown lines produce an angry or sad look that detracts from a pleasant facial appearance. These lines can now be improved without surgery and without scars by a simple injection of botulinum toxin type A.

What is Botulinum Toxin?
Botulinum toxin is a purified toxin and, when given orally in large amounts, it blocks the nerve signals from the brain to the muscle, causing a generalized paralysis called botulism.

However, by injecting very tiny amounts into a specific facial muscle, only the targeted impulse of that muscle will be blocked, causing a local relaxation and weakness. In this way, botulinum toxin acts as a muscle blockade to immobilize the underlying cause of the unwanted lines and prevent "wrinkly" expressions.

Botulinum toxin has been used since 1980 to treat many muscle disorders, such as lazy eye, eye ticks and uncontrolled blinking. Pioneered by dermatologic surgeons in 1987, the use of botulinum toxin for cosmetic purposes is an "off-label" use of a FDA-cleared drug.

Treatment Areas
Botulinum toxin is injected directly into the target muscle to treat vertical lines between the eyebrows and on the bridge of the nose, the squint lines or crows feet at the corners of the eyes, the forehead horizontal lines, and the platysmal muscle bands often visible on the neck, commonly known as turkey neck. It may also be used for eyebrow positioning. Once the muscle is weakened and relaxed, it cannot contract. Since there is no way to make the undesirable facial expression, the lines gradually smooth out from disuse, and new creases are prevented from forming. Other muscles like those needed to raise the eyebrows are not affected so a natural expression is maintained. Botulinum toxin may not be as effective on the smile lines around the mouth because the muscle action in this area is needed for expression and important functions like eating.

Botulinum Toxin Therapy
Treatment involves injection of very small amounts of botulinum toxin into the underlying muscles to immobilize them. The actual treatment is well tolerated and takes just a short time with minimal recovery. Botulinum toxin takes effect about 3 to 7 days after treatment. The improvement generally lasts about 3 to 4 months before the effect gradually fades and muscle action returns. It is anticipated that the average patient will require reinjection at various intervals. With repeated treatments, atrophy (thinning) of the muscle may occur which usually produces longer-lasting results.

Other Applications
Excessive sweating can be alleviated with injections of a highly diluted form of botulinum toxin directly into the underarm skin or skin on the palms and soles of the hand or foot. There it paralyzes the sweat glands of the skin which are responsible for excessive perspiration. A single treatment session can provide months of relief, and experts believe that injections can be repeated indefinitely once or twice a year to maintain dryness.

Side Effects
Side effects are minimal and typically relate to the local injection. Soreness or mild bruising, while uncommon, may occur around the injection site. Makeup may be worn after treatment, but care should be taken to avoid pressing or massaging the area for several hours. In rare instances, patients may develop temporary weakness of the neighboring muscles, a temporary droopy brow or eyelid, or a headache.

Restylane
Restylane was approved by the U.S. Food and Drug Administration (FDA) in December 2003, for use as an injection to help correct moderate to severe facial wrinkles and folds, including the lines between the nose and mouth.

Restylane is a unique FDA-approved dermal filler made of a biodegradable non-animal stabilized hyaluronic acid (NASHA™). Upon being injected beneath the skin's surface, the NASHA gel adds natural volume and lift to smooth wrinkles and folds. Hyaluronic acid is a natural substance found in all living organisms and provides volume and fullness to the skin. Restylane does not require any allergy or skin test prior to injection.  For more information see the Restylane website at www.restylaneusa.com.

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M.D. FORTÉ®

The M.D. FORTÉ® alpha-hydroxy acid (AHA) skin care system is based on two decades of glycolic acid research resulting in products with higher AHA levels than similar products, giving you the strength to deliver beautiful results-without irritation.

AHAs shed, or exfoliate, dead cells of the dry outer layer of the epidermis, which results in the appearance of younger, healthier-looking skin.

AHAs also limit transepidermal water loss, thereby improving the skin's moisture-binding ability. Skin that retains more water becomes smoother and younger-looking, and diminishes the effects of sun damage.

Glycolic acid, naturally found in sugar cane and available in M.D. FORTÉ® products, is a particularly effective form of AHA. This is because its small molecular size means more active molecules of glycolic acid are available in a given concentration as compared with lactic acid and polyhydroxy acid (PHA). The result? More activity for faster delivery of unique benefits when and where they're needed most.

However, while glycolic acid helps shed dead skin cells and hydrate the skin, it can also cause irritation. In fact, the higher the concentration of glycolic acid, the better the results-but the greater the irritation too.

M.D. FORTÉ® is unique in that it achieves a healthy balance between concentration and comfort, maximizing the advantages of glycolic acid with minimal irritation.

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Content ©2005 American Society of Dermatologic Surgery


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