Treatments & Procedures

Q. What is collagen?

A. The skin is your body’s largest organ. It’s also the most visible. And, as you may know, it consists of two layers. The upper most layer, called the epidermis, serves to control the loss of water from cells and tissue. Without this protective barrier, the body would quickly dehydrate.

Just below the epidermis lies the second layer, the dermis. The dermis, although it contains blood vessels, nerves, and hair follicles, is primarily made up of a protein called "collagen". This protein forms a network of fibers that provides a framework for the growth of cells and blood vessels. Because it is the primary component of the dermis, collagen acts as the support structure for the skin.

Q. Why do lines appear?

A. In young skin, the collagen framework is intact and the skin remains moisturized and elastic. It’s resilient to the many facial expressions we adopt as well as everyday wear and tear. But, over time, the support structure weakens and the skin loses its elasticity. The skin begins to lose its tone as the collagen support wears down. Every time you smile, frown or squint, you put stress on the collagen in your skin. The effect of these facial expressions is cumulative and facial lines begin to appear.

Q. Aren’t creams containing collagen enough to smooth out lines?

A. Collagen creams work only on the skin surface. A moisturizer with or without collagen cannot penetrate the skin and is not designed to be absorbed. No moisturizer can undo the cumulative effect of collagen loss. Creams primarily slow the rate of water loss from the skin and help keep the skin supple.

Q. How was collagen replacement therapy developed?

A. The history of collagen dates back decades to when animal collagen was used in surgical sutures. Continued research led to the wide use of collagen in a number of applications including heart valves and as an agent to help stop bleeding during surgery. Later, a group of biochemists and physicians at Stanford University experimented with alternative materials for skin grafts. Their research pioneered the concept of purifying animal collagen so it could be used to replace lost tissue.

Years of research by the Collagen Corporation led to the development of Zyderm™ and Zyplast™ collagen implants which are used today by trained physicians. Collagen replacement therapy is a non-surgical treatment in which Zyderm™ and Zyplast™ collagen are placed into the skin on a maintenance schedule. This provides an immediate visible difference in your face.

Q. How does collagen replacement therapy work?

A. Collagen replacement therapy replenishes the skin’s natural collagen. The natural beauty of your skin is enhanced as the contour of the support structure is restored. Zyderm™ and Zyplast™ collagen are natural substances that replace the collagen your skin loses over time. Derived from purified bovine (cow) collagen, Zyderm™ and Zyplast™ collagen are placed just beneath the skin where the body readily accepts it as its own.

Collagen is injected into your skin only by a trained healthcare professional. By supplementing your skin’s own collagen, collagen replacement therapy helps smooth facial lines as well as most types of scars.

Q. What can I expect with collagen replacement therapy?

A. It’s important to discuss with your physician exactly what you can expect from each treatment. Together, you can prioritize which areas are most important to you, and discuss how many treatments you may need and the estimated cost. It’s important to know that one treatment may not remove every line on your face. And, full correction requires continued treatments.

Q. How many treatments will I need?

A. Just like natural collagen, collagen replacement therapy begins to lose its form and will eventually wear down. Full correction occurs and is maintained only with a series of treatments.

A treatment series may require collagen replacement therapy approximately two times per year to maintain the smoothing effects. Depending on your age, skin condition, amount of sun damage and genetics, your treatment program will be specifically tailored to incorporate your individual needs.

Q. How do I find out if collagen replacement therapy is right for me?

A. Start out by having a skin test in your forearm to determine if you are sensitive to Zyderm™ or Zyplast™ collagen. You must watch the area very carefully over a four-week period. Ninety-seven percent of men and women who tested show no reaction to the skin test and can be treated. But, before taking the skin test, you and your physician will discuss your medical history and the areas you want treated. Collagen is not appropriate for certain lines and scars or given certain medical conditions. It is very important to discuss and understand what collagen replacement therapy can do for you.

Q. What is laser?

A. Laser stands for Light Amplification by the Stimulated Emission of Radiation. A laser device which supplies a powerful and highly focused beam of light whose energy can selectively eliminate tissue abnormalities.

Q. What are the benefits of laser surgery?

A. Treatment of skin growths or conditions with lasers may offer the following advantages:

• reduced risk of infection
• relatively bloodless surgery
• precisely controlled surgery which limits injury to normal skin
• an alternate to traditional scalpel surgery, in some cases
• safe and effective outpatient same-day surgery

Q. What are the common laser systems?

A. Carbon dioxide laser is an invisible light that is attracted to water in the skin. It is one of the most frequently used surgical lasers for skin disease because it can be used in two different ways—“focused” for removing (cutting) deeper skin cancers and growths, and “defocused” for superficially vaporizing skin in the treatment of warts or shallow tumors. The “ultrapulsed” and “scanner” carbon dioxide lasers are used to treat wrinkles (also known as laser resurfacing or laser peels), scars and other benign growths such as warts.

Argon laser uses a blue-green light to treat blood vessel growths, portwine stain birthmarks, malformations of skin blood vessels known as hemangiomas, enlarged blood vessels on the face known as telangiectasia, and the “red nose” syndrome that occurs as a result of acne rosacea or nasal surgery.

Argon-pumped tunable dye laser produces blue-green, yellow or red light and is used in the treatment of a wide variety of blood vessel conditions of the skin. In addition, this laser can be adjusted to produce the red light used in photodynamic therapy, an experimental technique for the treatment of skin cancer.

Flashlamp-pumped pulse dye laser produces a yellow light used to treat portwine stain birthmarks, dilated blood vessels and some types of hemangiomas. It has also been found effective in treating stretch marks. Like the other yellow light lasers, this system can be used to reduce the risk of scarring from treatment.

Excimer laser produces a wavelength of 308 nm within the UVB spectrum. It has been approved for use in the treatment of psoriasis and vitiligo. It is recommended for mild to moderate stable disease. Studies have shown excellent results after just five to six treatments with clearing lasting up to six months.

The causes of excessive hair growth are multiple. Hair growth is mainly a result of heredity and hormonal levels. Some drugs as well as certain illnesses can stimulate hair growth. For millions of men and women who suffer from unwanted facial or body hair there are solutions for permanent hair removal: laser hair removal and electrolysis.

Laser (Intense Light) Hair Removal

Laser hair removal provides a breakthrough in epilation with the capability to treat a wide range of hair colors, textures and skin types. Laser hair removal is a non-invasive light therapy process that successfully and safely removes unwanted hair of most colors from all parts of the body on most skin types with excellent results and minimal thermal injury to surrounding skin tissue.

This method of hair removal offers the following benefits:

• Low incidence of side effects
  Reported adverse effects are substantially fewer and less severe than those of other treatment modalities. Most side effects are temporary and usually resolve within 2-4 weeks.
• Less likely to cause permanent pigment changes
• Less likely to cause scarring
• Virtually no burning
• No needles or injection
  There is no use of needles and no skin punctures associated with the procedure, thereby reducing the risk of infection.
• Less discomfort
  The treatment feels like the snap of a rubber band, causing only slight discomfort compared to other hair removal methods.
• No local anesthetic or other pain medication is required
• No waxing or coloring with a black carbon substance prior to treatment
• Faster treatment time
  The device's large spot size allows removal of a very large number of hairs per flash and permits safe and effective removal of hair from large body areas
• Convenient
  There is no need to suffer the daily unpleasantness and irritation of shaving or the pain of waxing.
• The average patient will require three treatment sessions at approximately six week intervals to achieve permanent hair removal from a given area.

Electrolysis

Electrolysis is a way of removing individual hairs from the face or body. Today's medical electrolysis devices, called epilators, destroy the growth center of the hair with a short-wave radio frequency. A very fine probe is inserted into the hair follicle at the surface of the skin. The hair is then removed harmlessly with forceps.

Electrolysis is a time-tested method that was invented over 100 years ago to remove irritating, ingrown eyelash hairs. It can be used to safely treat most areas of the body including the eyebrows, face, thighs, abdomen, breasts and legs.

While chemical depilatories (liquids or creams) may be an effective means of removing leg hair, these products cannot be used on the face. Depilatories contain irritating chemicals and can also be time-consuming and messy. Likewise, bleaches contain harsh chemicals and do little to disguise dark hair. They may also discolor the skin.

Waxing is another temporary method of hair removal and is usually done in salons. A hot wax is applied to the skin and removed once it has dried over the hair. The hair is stripped off when the wax is removed. Waxing can be painful and costly. Home waxing kits are available but they can be difficult to use and messy. There are electrical devices available for home use that try to copy the devices used by professional electrologists. These devices are often unsafe for use by anyone who is not trained in electrolysis.

Electrolysis also offers these advantages:

• No significant discomfort
  Electrolysis usually does not cause any discomfort. Modern electrolysis methods have reduced any discomfort to mere tingling.
• Safe and effective
  There are rarely permanent side effects. Sometimes, a slight reddening of the skin occurs during or immediately after treatment, but will only last for a short time. Electrolysis is very safe and, unlike depilatories or bleaches, no harsh chemicals are used.

Since many factors influence hair growth, several treatment sessions will be necessary. The total number of sessions needed to remove hair permanently from a particular area will vary from person to person. Most patients return once a week or every other week, but the unwanted hair will be gone forever once the treatments have been completed. Each treatment lasts between 15 minutes and 1 hour.

Botox^® is the name of a substance derived from botulinum toxin. In large amounts, this toxin causes a form of muscle paralysis known as botulism. Very small amounts, however, can be directly injected into specific muscles, causing controlled muscle weakness.

The FDA approved such usage in 1989 when it was found that Botox^® could stop blepharospasm (uncontrolled blinking) and strabismus (lazy eye). In 2002, the FDA approved Botox^® for the treatment of glabellar (frown) lines. In 2004, it approved Botox^® for the treatment of axillary hyperhidrosis (excessive sweating).

Physicians have also used this drug off label successfully to treat other facial wrinkles and creases, as well as excessive sweating of the palms.

How does Botox^® work?

Botox^® blocks signals from the nerves to the muscles. The injected muscles can no longer contract, which causes the wrinkles to relax and soften.

Botox^® is most often used on forehead lines, crow’s feet (lines around the eyes), and frown lines (glabellar). Wrinkles caused by sun damage and gravity will not respond to Botox^® and are best treated with other treatments.

How is the procedure performed?

The procedure takes only a few minutes. No anesthesia is required. Botox^® is injected with a fine needle into specific muscles, causing only minor discomfort. It takes three to 14 days for Botox^® to take full effect.

In order to minimize bruising, it is best to have no alcohol two days before the treatment as well as to stop taking aspirin and anti-inflammatory medications two weeks before the treatment.

How long does a Botox^® injection last?

The effect will last three to four months. As muscle action gradually returns, the lines and wrinkles begin to re-appear and wrinkles will need to be re-treated. Wrinkles often appear less severe with time because the muscles are being trained to be less active.

What are the side effects of Botox^®?

Temporary bruising is the most common side effect. Headaches, which resolve in 24 to 48 hours, can occur, although rarely.

A small percentage of patients may develop asymmetry or ptosis (eyelid drooping). This usually resolves in three weeks. (This is usually caused by migration of the Botox^®. For this reason, we ask that you don’t rub the area for 12 hours after injection). There have been no allergies associated with Botox^® to date.

Who is a candidate for Botox^® injection?

Patients who are pregnant, breast feeding, or have a neurological disease should not use Botox^®. Since Botox^® doesn’t work for all wrinkles, a consultation with a dermatologist is recommended.

Sclerotherapy is a medical procedure used to eliminate varicose veins and "spider veins." Sclerotherapy involves an injection of a solution (generally sodium chloride – a salt solution (known as Heparsol or Sotradecol) directly into the vein. The solution irritates the lining of the blood vessel, causing it to swell and stick together, and the blood to clot. Over time, the vessel turns into scar tissue that fades from view. Sclerotherapy is a well-proven procedure and has been in use since the 1930s.

How will I know if I am a candidate for sclerotherapy?

Prior to the procedure, you will have an initial consultation with a dermatologist or vascular medicine specialist who will advise you on your eligibility for sclerotherapy.

You are not eligible if you are pregnant or are bedridden. You can have sclerotherapy if you take birth control pills. If you have had a blood clot in the past, your eligibility will be decided on an individual basis and will depend on the overall health of the area needing treatment, as well as the reason for the clot.

Veins that are potentially usable for future surgical bypass procedures (i.e. use of the saphenous vein, a large vein in the leg used for coronary artery bypass graft surgery) will generally not be considered for sclerotherapy.

How is sclerotherapy done?

In most cases, the saline (salt) solution is injected through a very fine needle directly into the vein.

At this point, you might experience mild discomfort and cramping for one to two minutes, especially when larger veins are injected. The procedure itself takes approximately 15 to 30 minutes. You should plan to wear shorts during the injection.

The number of veins injected in one session varies and depends on the size and location of the veins, as well as your general medical condition.

Sclerotherapy is performed in the doctor’s office by a dermatologist or a surgeon and requires that you do not partake in any aerobic activity for two days after the procedure

What do I need to do before the procedure?

Prior to vein injection, you should avoid certain medicines. Tetracycline, an antibiotic, might possibly cause a staining of the skin if taken seven to 10 days before or after sclerotherapy. If you need to take an antibiotic before sclerotherapy, contact your doctor. Do not apply lotion to your legs before the procedure (tape will not stick). Some doctors recommend avoiding aspirin, ibuprofen (i.e. Advil and Nuprin), or other anti-inflammatory medications for 48 to72 hours before sclerotherapy. Tylenol, however, should not affect this procedure.

Could sclerotherapy cause any side effects?

You might experience certain side effects after sclerotherapy. There are milder effects, such as itching, which can last for one or two days after the procedure. Also, you might experience raised, red areas at the injection site. These should disappear within a few days. Bruising might also occur around the injection site and can last several days or weeks.

Other side effects include:

• Larger veins that have been injected might become lumpy and hard, and might require several months to dissolve and fade.
• Transient hyperpigmentation is brown lines or spots that might appear at the vein site. In most cases, they disappear within three to six months.
• Neovascularization describes a temporary development of new, tiny blood vessels - also known as "flares," "mats," or "blushing." These tiny veins can appear days or weeks after the procedure, but should fade within three to 12 months without further treatment.

If any of the following side effects occur, contact your doctor immediately. These include:

• Inflammation within five inches of the groin
• A sudden onset of a swollen leg
• Formation of small ulcers at the injection site.

Allergic reactions to the sclerosing agents might occur at the time of the injection and are rarely serious. If you have a history of allergies, you have a greater chance of experiencing an allergic reaction to the agents. A minor allergic reaction will cause itching and swelling. To avoid any serious complications, your doctor will test the agents on a small area before applying the solutions to a larger area.

If you have any concerns or questions following this procedure, contact your doctor.

What happens after the treatment?

After the treatment you will be able to drive yourself home and resume your regular daily activities. Walking is encouraged. You will be instructed to wear support hosiery to "compress" the treated vessels. If you have compression hosiery from previous treatments, you are encouraged to bring them with you to be certain they still have adequate compression. Department store support stockings will not be adequate if a heavy compression stocking is needed. Your doctor’s office can recommend where to purchase heavy compression stockings. Following the injections, avoid aspirin, ibuprofen, or other anti-inflammatory medicines for at least 48 hours. Tylenol may be used if needed.

Also, you should avoid applying the following to the injected areas for 48 hours after treatment:

• Hot baths
• Hot compresses
• Whirlpools or saunas
• Direct exposure to sunlight

Showers are permitted, but the water should be cooler than usual. The injection sites might be washed with a mild soap and tepid water.

How effective is sclerotherapy?

Studies have shown that as many as 50 percent to 80 percent of injected veins might be eliminated with each session of sclerotherapy. Less than 10 percent of the people who have sclerotherapy do not respond to the injections at all. In these instances, different solutions can be tried. Although this procedure works for most patients, there are no guarantees for success.

In general, spider veins respond in three to six weeks, and larger veins respond in three to four months. If the veins respond to the treatment, they will not reappear. However, new veins might appear at the same rate as before. If needed, you may return for injections.

Will my insurance cover sclerotherapy?

Insurance coverage varies. If your varicose veins are causing medical problems, such as pain or chronic swelling, your insurance might offer reimbursement. If you are pursuing sclerotherapy for cosmetic purposes only, your insurance carrier most likely will not provide coverage. You should discuss your concerns with your doctor. If you have questions, please call your insurance company. Your insurance company might request a letter from your doctor concerning the nature of your treatment and medical necessity.

New cosmetic surgery techniques will continue to grow as demand grows. Procedures such as facelifts, which were previously performed with scalpel, will in the future be done with lasers. Recovery times will be quicker and scarring will be less.

In decades to come, the possibilities in plastic and cosmetic surgery will become close to endless. Tissue engineering is no longer something out of a science fiction novel. The creation of living tissues in a laboratory setting for use as a replacement for damaged or diseased body parts is on the horizon. Think about it -- the growing and reproduction of skin grafts, breast tissue, muscles, cells from vital organs and even nerves – lie just ahead in the medical future. And though the science is still in its infant stage, there is no doubt that the future of cosmetic and reconstructive surgery will likely have tissue engineering at its core.

In the short-term, however, keep your eye on news about the products and techniques listed below. They are either newly available, or will become available in the near future.

Cosmetic Treatments

Artecoll:

Used in Europe since 1989, Artecoll may be the first permanent injection to treat wrinkles. The science behind it involves the injection of microscopic plastic beads suspended in bovine collagen into the area needing treatment. Once the body absorbs the injected collagen, the tiny beads trigger the body to produce its own collagen, thus keeping the cycle of collagen production permanent. Every time the collagen depletes, the beads tell the body to produce more.

Botulinum toxins:

For some people Botox is not strong enough, does not last long enough, or may simply not be an option due to their body’s natural resistance to the botulinum toxin. For these people the future may hold Myobloc or Dysport. Myobloc is botulinum toxin type B (Botox is type A) and therefore may benefit people who are resistant to Botox. Its dosage is larger than Botox, but its effects are more immediate and studies have suggested that they last as long or a little longer. Like Botox, Dysport, too, is a botulinum toxin type A. It, too, is a larger dose than Botox. Patients treated with Dysport require two treatments a year as opposed to the four treatments a year often needed by Botox patients. Neither of these products are yet approved by the FDA for cosmetic treatments and both carry the same risk of allergic reaction as does Botox.

CosmoDerm and Cosmoplast:

To understand the technology behind these products you must go a little lower; specifically to the discarded foreskins of infant boys after circumcision. Using the collagen producing cells (fibroblasts) found in newborn foreskins scientists have been able to isolate and then replicate these cells to produce the collagen needed for injection. Like the bovine collagen commonly used to treat wrinkles today, these products are eventually reabsorbed by the body and require another treatment 3-6 months later. However, unlike bovine collagen, Cosmoderm and Cosmoplast – used to treat fine lines and deep wrinkles respectively – the patient does not need to be tested for allergies to the collagen. CosmoDerm and Cosmoplast were both approved by the FDA for use on March 12, 2003.

Hyaluronic acid:

This is a component of skin tissue. Its function is to provide cushioning and lubrication to the skin. Currently, two brands of hyaluronic acid – Restylane and Hylaform are approved for use in mild wrinkle and scar treatment in Europe, Canada and South America . Restylane, which is a synthetic form of hyaluronic acid, has been shown to last up to an entire year, while Hylaform, derived from the hyaluronic acid of rooster combs lasts anywhere from 3-6 months. Both of these products are pending approval with the FDA.

Radiance:

Derived from calcium hydroxylapatite, a substance found in human bones and teeth, Radiance is an injectable paste used to enlarge the lips and fill folds and lines that reportedly lasts 2-5 years. Because it is derived from human tissue, there is little chance of allergic reaction. Radiance is not approved by the FDA for use in cosmetic treatment.