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Chemical Peels, Laser, Dermabrasion, Microdermabrasion, Mole Excision and Scar Revision For most people, stress and aging first appear in the texture of facial skin. Facial skin performs several crucial functions. It is the body's most accurate visible register of health and its first line of defense against the various assaults of the physical and emotional environments it encounters. Years of performing these functions inevitably leave signs of the past that many people would rather not see in their faces. Acne, especially adult acne, can leave small scars or reddened spots on the face that fade very slowly or not at all. Sun exposure often causes flat, dark “age” spots and wrinkling. Smoking dulls skin while drinking bloats it, and both contribute to wrinkling. Weight gains and losses can further contribute to surface irregularities. Of course, over time, the normal expressiveness of a face also leaves its marks. Dr. Loving can improve the texture and appearance of a patient's facial skin with any one or several of the methods described below. During a consultation with him, a patient can explain his or her objectives so that Dr. Loving can recommend one or more of the following procedures according to skin type and the desired results. Chemical Peels Chemical peels are an effective and non-invasive method of treating these complaints and of improving the texture of facial skin. Chemical peels are neither painful nor time-consuming. Results are quick to appear, and the peels are economical compared to surgery and many commercially-available beauty treatments and anti-aging products. Chemical peeling is a useful treatment for fine wrinkles on cheeks, foreheads and the eye and mouth areas. For these reasons, chemical peels are often the first procedure chosen by patients who consult Dr. Loving about cosmetic rejuvenation. There are many different kinds of chemical peels. Following a consultation, Dr. Loving and the patient will make the appropriate choice from among the options according to the patient's skin type and cosmetic desires. Alphahydroxy acid (AHA) peels and Betahydroxy acid (BHA) peels have the significant benefits of requiring little procedure time and no recovery time. They do, however, require dedication on the part of the patient to a maintenance program, usually of one peel a month. These peels can be performed only by medical doctors. They are much stronger, more effective and safer than peels performed in beauty salons and spas, though generally not more expensive. Alpha and beta peels treat fine wrinkling, areas of dryness, uneven pigmentation and adult acne. Trichloroacetic acid (TCA) peels are used for medium-depth peeling of the skin's outer layers. TCA peels are effective on surface wrinkles, some acne scars, blemishes and pigment problems. TCA peels require about a week's recovery time, and are often done more than once in order to achieve the desired result. Phenol peels are the strongest peels. They require the most recovery time (about ten days to two weeks), and offer the most dramatic results. Phenol peels are performed on patients with coarse facial wrinkles, blotches caused by birth-control pills or sun-damage and/or pre-cancerous growths. Chemical Peeling Procedures AHA and BHA peels may cause slight stinging and redness, though these sensations usually subside before the patient even leaves the doctor's office. AHA and BHA peels may be used on the neck, chest and other body areas, such as the hands. These peels take less than a half hour to perform. Significant improvements in the treated areas is usually evident after 3-4 peels. TCA peels cause initial stinging, redness and sensitivity, which last about a week. Treatment takes 10-15 minutes and results are visible as soon as redness fades. TCA peels can be used on parts of the body other than the face. Phenol peels cause stinging, redness and sensitivity which last about two weeks. The procedure may take about an hour, and patients will need someone to escort them home. No anesthesia is needed for this peel, though sedation may be used to relax the patient. Patients must be aware that some permanent lightening of the skin may occur. Sun protection is extremely important following this type of peel. Results are dramatic, long-lasting and apparent as soon as skin has healed. Laser resurfacing, sometimes called a laser peel, is another way of improving the appearance of the skin. Dr. Loving uses the Erbium laser and Nlite to minimize scars, fine lines around the eyes and mouth, and to treat areas of uneven pigmentation and/or sun damage. The laser is a very specific method that can target small areas or details of the face. It can also be used on the entire face and neck area. Laser treatments cause little to no discomfort. They produce dramatic results and can be performed alone or in conjunction with procedures such as facelifts or eyelid surgery. Laser resurfacing is an excellent option for patients whose skin is sensitive to chemical peels and dermabrasion. Dermabrasion is a physical, as opposed to chemical, treatment that reduces the appearance of scars, lines and uneven coloring in the epidermis. It is an excellent way to treat acne scars and uneven skin texture. It works by removing the upper, damaged layers of skin so that the skin below produces new, smoother layers. The depth and extent of dermabrasion depends on the patient's skin. Dermabrasion is a very effective and delicate procedure that should be performed by a surgeon rather than a dermatologist. It is related to microdermabrasion, but it is a more aggressive procedure. Dr. Loving's extensive surgical experience and intimate knowledge of the skin's layers make him able to precisely employ this method so as to permanently improve the skin's appearance. To choose between chemical, laser, dermabrasion and microdermabrasion treatments, a patient must have a consultation with Dr. Loving so that his or her skin and objectives can be evaluated. Like dermabrasion, microdermabrasion is a medical exfoliation treatment for the skin that does not employ chemicals or laser. Microdermabrasion is often called a Megapeel. This is a natural procedure that uses crystals to resurface the top layers of the skin. It is a gentler treatment than dermabrasion and does not require any anesthetic or healing time. The procedure takes twenty to thirty minutes and produces only minor redness in the skin that lasts from thirty minutes to a day. This redness is readily concealed with makeup or face powder. Therefore, a patient can easily have a Megapeel during a lunch hour break and return to work. Megapeels are usually performed in series of about a peel every three weeks or once a month. Fulfillment of a Megapeel series will improve the signs of aging such as fine lines, wrinkles and sun damage. It is also an effective way to minimize scars. Furthermore, Megapeels are highly effective at treating active acne--especially adult acne--as the peels remove troubled upper layers of skin and help to keep the pores clear. Many people have facial or body moles that they wish to have removed for cosmetic reasons. Dermatologists are often reluctant to remove benign moles on the basis of aesthetics because they would produce a scar that the patient would find as aesthetically undesirable as the mole. As a plastic surgeon, however, Dr. Loving is able to remove a mole and realign the layers of skin around it so as to leave little to no mark. Plastic surgeons, unlike dermatologists, are trained to operate on the skin layer-by-layer, thereby producing more subtle, cosmetically-pleasing results. Photographs of mole excisions performed by Dr. Loving are available for viewing in his office. All of the methods described above: chemical peels, lasers, dermabrasion and microdermabrasion, can be useful in improving the appearance of scars. Scars from acne, burns, cuts and mole treatments can all be softened and, in some cases, erased through one or more of these procedures. Surgery is also an option for scars such as those from childhood accidents which were treated without the expertise of a plastic surgeon. Surgical scar revision involves reopening the scarred area so as to reattach, layer by layer, the underlying tissue. In this way, the area heals smoothly and the resulting scar is much less visible than the original one. To request more information or to schedule a consultation with Dr. Loving, please call 212-472-0900. Collagen, Dermalogen, Fat Injections and Botox in Cosmetic Surgery In recent years, cosmetic injectables such as collagen, Dermalogen, a patient's own body fat and Botox, have become the first, and most subtle, line of defense against the signs of aging and skin damage. Dr. Loving's extensive experience as a plastic and cosmetic surgeon gives him a comprehensive understanding of muscle and tissue structures and the effects of aging and gravity on the layers beneath the skin's surface. In addition, his years of training and practice in the more dramatic rejuvenating procedures such as face lifts, liposuction and breast surgery, have made him an expert in proportion, balance and the discreet aesthetics of cosmetic rejuvenation. These talents, applied to cosmetic injectables, allow Dr. Loving to significantly-but without surgery or scars--diminish the wrinkles and deflations that appear in aged or damaged skin. Uses of Injectable Fillers Injectable fillers are a temporary, but effective and easily-maintainable way to treat frown lines, acne scars, cheek depressions, vertical lip lines, marionette lines (the lines between the corners of the mouth and the chin), worry lines in the forehead, minor and deep smile lines and facial scars. Types of Injectable Fillers Collagen Replacement Therapy is perhaps the best-known of injectable fillers. Facial lines and depressions are caused by the thinning of the body's natural collagen due to sun exposure, smoking and aging. Collagen is the main component of the dermis, which lies below the uppermost layer of the skin. The dermis is the supporting structure for the skin above it. When the collagen in the dermis degrades, the overlying skin shows these changes by developing wrinkles, lines, furrows and depressions. Collagen Replacement Therapy addresses the age- and stress-related wear on the skin's natural collagen by supplementing it, thereby compensating for the structural losses and erasing the undesirable effects they have on the skin's surface. Collagen is injected in the doctor's office, takes about a half hour, is minimally painful and leaves no scars. The only sign of this treatment is minor redness which fades in a few hours. While collagen is made from purified bovine (cow) sources, Dermalogen is made from purified human tissue. Dermalogen can usually be tolerated by those patients who are allergic to collagen. Some patients have also found that the plumping and recontouring effects of Dermalogen lasts longer than do those of collagen. Like collagen, Dermalogen is injected in the doctor's office in a procedure that takes about a half hour. It leaves no scars, only some very temporary redness. A patient's own fat may also be used as an injectable filler. Under local anesthesia, fat is removed from a pre-determined area of the patient's body via a tiny tube which is inserted under the skin. This procedure does not require any stitches and leaves only a small surface mark which usually does not scar and fades over time. The fat that is removed is then spun into an injectable that has little to no possibility of causing rejection or allergic reaction in the patient since it is entirely composed of the patient's own tissue. Using a patient's own fat as an injectable is a more involved process than is using collagen or Dermalogen, but it has the considerable advantages of being non-allergenic and longer-lasting. After being injected into the determined sites, the fat is partially absorbed and partially vascularized. That is, some of the fat is adopted by the surrounding blood vessels and tissue, making it a permanent addition and correction to the area. Maintenance of Injectable Fillers When a patient's own fat is used as an injectable, it may be desirable to repeat the procedure after a year or two. Collagen and Dermalogen maintenance is usually done about every three to six months. The lips tend to absorb injectables more rapidly than do smile lines, frown lines, cheek areas and scars. Depending on the look desired, patients may want to maintain lip injectables every two to three months. Most patients find that the maintenance involved in using injectables is usually less time-consuming, more rewarding and often less expensive than that required by their regular hair appointments. Over the past few years, Botox has become the most effective and popular non-surgical way to erase some of the most resistant wrinkles and lines in the face and neck. Botox is injected in very minute amounts into the muscles under and around wrinkled areas. These are usually areas that are susceptible to expression lines, such as the space between the eyes, where many people create wrinkles by repeated frowning. Botox is a purified and highly refined neurotoxin complex which works by inducing an atrophic lengthening of the injected muscle and a corresponding shortening of the muscle's antagonist. Following an injection, muscles in the wrinkled area are unable to assume the position that caused the skin to fold and wrinkle. In effect, Botox does chemically what many patients do when they look in the mirror and momentarily smooth their lines and wrinkles with their fingers. Even deep furrows between the brows can be smoothed, as the muscles that allow the skin to settle into grooves are rendered inactive by Botox. Patients considering Botox should understand that the complex's effect is motor, not sensory. A patient who has Botox, therefore, will not be able to furrow his or her brow, but feeling and skin sensitivity in that area between the eyes will not be at all diminished. Botox is most commonly used to diminish lines in the forehead, around the eyes and on the neck. Maintenance of Botox The effects of Botox usually last from six weeks to several months. Most patients have injections every two to four months. While the muscular effects are completely reversible over time, the wrinkle-soothing effects are cumulative and usually dramatic in their improvement of the treated area. To request more information or to schedule a consultation with Dr. Loving, please call 212-472-0900.
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