Don Mehrabi MD - Dermatologist Los Angeles Dermatology & Skin Care

What Is An Incisionless Neck Lift?

rmendoza — Thu, 19 Apr 2012 19:46:02 +0000

With younger patients now seeking cosmetic procedures, surgeons and dermatologists are exploring alternatives to invasive surgery. This includes creating methods to reduce fat and tighten loose muscles under the neck. One technique that has been developed over the last decade is called the trampoline or Iguide neck lift. Generally, some variation of this surgery is what is being referred to when the term incisionless neck lift is discussed.

What Does the Surgery Entail?

Although it is advertised as incisionless, the treatment does require breaking the skin. The technique involves performing liposuction to remove unwanted pockets of fat. This requires the use of a cannula (tube) to introduce the anesthetic and suction out the liquefied fat. Since skin in the neck is delicate and the amount of fat that needs to be removed is small, a microcannula is often used to keep scarring to a minimum. Lipo only slims the neckline by reducing fatty tissue. This still leaves sagging from muscle laxity to be dealt with.

So, the other half of the procedure involves creating an artificial support system for the area under the chin. A suspension suture is threaded below the skin to hold the muscles up. The suture is attached to a stainless steel rod that is coated in polymer and equipped with a fiber optic tip. A series of punctures are made in the skin to allow the lighted rod to be guided between the skin and the underlying muscle tissue. The thread is woven back and forth in an intersecting pattern (like corset or shoe laces). Then the thread is pulled tight and secured to complete the incisionless neck lift.

Iguide Neck Lift Technique Not Widespread

Since this technique (in its current form) is fairly new and not performed by very many physicians, there is little information available about long term results for patients. As with any procedure that involves puncturing the skin, there is a risk that the instrument will penetrate too deeply and cause damage to underlying tissues. Infection, bleeding, and other complications may occasionally occur with liposuction and suture based neck lifts.

This procedure is performed on an outpatient basis under local anesthesia. So, some patients may select this option to avoid the risks associated with general anesthesia. However, this treatment does not address neck drooping caused by excess skin. So, older patients with “turkey wattles” aren’t necessarily good candidates for this procedure. They may wish to pursue a traditional, surgical neck lift that includes the excision of loose skin.

The Microcannular Approach To Chin And Neck Liposuction

rmendoza — Thu, 12 Apr 2012 19:16:57 +0000

Most people are familiar with the use of liposuction to remove fat from the abdomen and thighs. This technique can be used to remove significant quantities of unwanted fatty tissue and reshape the contours of the body. The metal tube used to break up and suction out fat cells is called a cannula. With a large cannula, more fat can be removed in a shorter period of time. However, sometimes the goal is actually to remove very small pockets of fat – such as those around the chin and neck. Liposuction techniques now include a “microcannular” option for sculpting these more delicate areas. As the name suggests, a tiny cannula is used to perform this procedure. This gives the dermatologist or plastic surgeon a greater level of control for a more precise outcome.

Who Is a Good Candidate for This Procedure?

Microcannular liposuction of the face and neck is designed for patients who are within 30% of their ideal body weight and who have good skin elasticity. It isn’t a substitute for a face or neck lift that involves excising drooping skin or pulling it taut. Basically, the skin needs to be healthy and “youthful” enough to tighten up on its own after the fat is suctioned out. If the skin is too loose, a lift may need to be performed along with liposuction. For patients who are under the age of 45 and for those with only a small amount of fat being removed, lipo alone is often sufficient to achieve the desired results.

Procedure Overview

This type of liposuction is done on an outpatient basis using only local anesthesia introduced under the skin. The liquid anesthetic mixture contains epinephrine and Lidocaine. This formula causes the tissue to swell up making it easier for the cannula to target fat cells and leave surrounding tissue unharmed. The solution also reduces bleeding and numbs the area.

Several tiny incisions are made in the skin so the microcannula can be introduced. The cannula is moved gently back and forth under the skin to break up and aspirate (suck out) fat. Most of the anesthetic liquid is drained from the area at the end of the procedure; but a little bit is left in the tissue to continue providing pain relief. Compression bandages are used for several days to keep swelling to a minimum.

This procedure generally has a quick recovery period because chin and neck liposuction doesn’t involve making long incisions or removing large quantities of fat. Patients can expect to experience some swelling, bruising, and other moderate side effects that can be managed with proper post-operative care.

One Drug Wins Out As Preferred Cellulitis Treatment

rmendoza — Thu, 05 Apr 2012 19:15:15 +0000

Doctors making decisions about cellulitis treatment now have evidence-backed guidelines to follow showing that vancomycin is often the best choice. Previously, other antibiotics in the penicillin and cephalosporin families were also frequently prescribed. However, the Henry Ford Hospital has released study results showing that patients on intravenous vancomycin had better outcomes than those on other IV antibiotics.

Data from Henry Ford

The study compared results among a group of 425 patients who were admitted to the hospital with cellulitis over a 3 year period. Their records showed that, on average, patients who received vancomycin stayed one less day in the hospital. From both a cost standpoint and from the viewpoint of patient wellbeing, this is a significant enough difference to make a change in prescribing guidelines.

Additional Reason to Use Vancomycin

Another reason to treat cellulitis with this particular type of antibiotic is that it can knock out even MRSA. Cellulitis can be caused by a number of different bacteria, but methicillin resistant staph is one of them. It is particularly likely to be involved in the severe cases that require hospitalization. So, using an antibiotic that has a high success rate for stopping this aggressive infection as a first course of treatment may save patients from having to undergo multiple rounds of antibiotics. As community acquired MRSA becomes more prevalent, doctors anticipate seeing a continued increase in cases of skin infections caused by this pathogen.

More about Cellulitis

Typically, the skin of a healthy individual keeps bacteria safely sequestered on the outer surface. However, an injury to the skin can allow bacteria to invade the deeper layers of skin and underlying tissues. When this happens, the skin can become inflamed. With a cellulitis infection, redness and swelling are typically accompanied by pain and tenderness. The area may also feel warm to the touch.

Cellulitis treatment for a mild case that is not spreading rapidly can usually be treated with oral antibiotics. However, medical conditions such as diabetes and other diseases that interfere with the immune system are risk factors that can increase the likelihood of cellulitis and the severity of the condition. For these patients, antibiotics may need to be administered intravenously. In extreme cases, surgery may drain the infected area or remove infected tissue.

It is possible for immune-compromised patients to show signs of cellulitis when the pathogen is actually fungus instead of bacteria. This would require a different course of drugs to clear the condition. A consultation with a dermatologist and testing may be required to determine the exact cause of the infection.

Remedies for Excessive Sweating

rmendoza — Thu, 29 Mar 2012 19:06:19 +0000

Hyperhidrosis (excessive sweating) is sometimes linked to diseases that cause fever or thyroid disorders that affect the endocrine system. However, when sweating is focal (localized to specific areas of the body such as the hands, feet, and armpits), it is caused by a problem with the parasympathetic nervous system. These nerves help control the activity of many glands in the body – including sweat glands. For people with focal hyperhidrosis, the signals the nervous system sends are out of proportion to the body’s actual need to sweat to cool off. These individuals may sweat continuously, but the problem is often worse in hot weather or during periods of emotional stress. The liberal use of antiperspirant is usually the first line of therapy. There are also several other remedies for this condition:

Armpit Sweating Treatments

Botox is one option for sweaty armpits. These injections block nerve activity and keep the sweat glands from being hyperactive. The toxin wears off over time and injections must generally be repeated every few months. There may be some post-procedure swelling and discomfort.

The sweat glands may be physically removed using an approach similar to liposuction. The glands are suctioned out through small incisions in the armpit. This is done on an outpatient basis and entails minimal downtime. The treatment does not eliminate sweating altogether, but has been shown to significantly reduce excessive sweating. Hyperhidrosis does recur in some patients, but this is apparently not typical.

Lasers such as the YAG are now being investigated for their ability to damage sweat glands without invasive surgery. The process is similar to hair removal, but with more intense settings. The treatment often leaves the armpits sore for a while. Further studies are still needed to determine how long the effects last.

Excessive Sweating of Hands & Feet

Iontophoresis is a treatment that involves immersing the hands and feet in water that has a moderate to high mineral content. A mild electrical current is run through the water. This appears to cause the top layers of skin to thicken slightly, blocking sweat from reaching the surface.

An invasive therapy called an endoscopic thoracic sympathectomy (ETS) is also available from some surgeons. This is generally only attempted as a last resort since it involves severing the nerves that signal the sweat glands. There are greater risks associated with ETS than with other hyperhidrosis therapies since it involves the use of full anesthesia and it is possible for the wrong nerves to be cut accidentally. Side effects of successful treatment can include increased sweating on other areas of the body and difficulty regulating body temperature.

Learn more about Botox Treatments Los Angeles.

Who Can Use A Non-Surgical Nose Job?

rmendoza — Tue, 27 Mar 2012 20:04:04 +0000

Rhinoplasty is one of the most commonly performed cosmetic procedures in the field of plastic surgery. Patients often request that a bump on the bridge of the nose be shaved down to create a smoother profile. The only way to do that is via invasive surgery. However, there are a number of other nasal features that can be corrected with injectables at a dermatologist’s office. For example, an asymmetrical nose might be balanced out with the addition of filler in the right place. An unwanted dip in the bridge of the nose could potentially be filled in as well. Injectables such as Restylane or Radiesse could also be used to add length or reshape the tip of the nose to create a more pleasing overall effect.

This technique does not work to make a nose smaller. It can only be used for reshaping. Fortunately, smoothing the contours of the nose to even out bumpy areas can make this facial feature less noticeable. This is occasionally the outcome patients are actually seeking when they ask for a “smaller nose”.

Ideal Candidate

Patients who want fast results with little downtime and post-procedure pain sometimes opt for this minimally invasive procedure. It is done quickly (especially compared to surgical rhinoplasty) on an outpatient basis. The treatment usually entails a recovery period of a couple of days. Outcomes tend to be best for individuals who only want a minor correction. Injecting large amounts of filler can have poor results because the substance may shift around and cause unsightly bulging under the skin. The procedure may actually be done over a series of sessions to make sure that just the right amount of filler is used.

More About Injectables

It is important to note that a non-surgical nose job is a temporary fix since the effects generally wear off over time. The results may last for a few months or over a year depending on the material used. When hyaluronic acid filler is used, the non-surgical nose job may be immediately reversible with the injection of a dissolving agent if the patient is unhappy with the result. Other filler materials are longer lasting. Silicone is actually a permanent filler; but the use of this material for a delicate feature such as the nose is not always recommended.

Additional Considerations

Non-surgical rhinoplasty isn’t suitable for patients who really need corrective surgery to restore functionality (e.g. fixing a deviated septum). It only affects the outer appearance of the nose and not the underlying structure when administered correctly. Injectables can sometimes be used to minimize the appearance of errors that may have occurred in a previous, surgical rhinoplasty. This is not a technique recommended by all dermatologists since the outcome and side effects are more unpredictable with a nose that has been surgically altered.

Alternatives to Hydroquinone for Skin Tone Correction

rmendoza — Tue, 20 Mar 2012 19:45:01 +0000

Hydroquinone is the most commonly used prescription drug for correcting moderate hyperpigmentation (uneven skin tone and brown patches on the skin). However, some pigment problems may also be addressed with other substances. These formulas are generally available over the counter. Many patients try these skin lightening ingredients prior to seeing a dermatologist. Or a dermatologist may recommend one of many alternative products for mild hyperpigmentation to minimize the potential for skin irritation. This doesn’t mean all OTC products are gentler than hydroquinone. The sensitivity of your skin generally dictates how you will respond to skin lighteners.

A Few Popular Non-Hydroquinone Agents

The biological process that results in melanin production involves many chemical reactions. The active ingredients in skin lightening creams work by interfering with or inhibiting one of these reactions or by killing melanocytes. You can see a great overview of how the melanin cycle works here.
Niacinamide – This B vitamin compound is sometimes recommended for acne as well as skin tone improvement. It’s usually not used as a skin lightening agent all by itself, but is an additive in many skin lightening formulas.
Kojic acid – This acid is derived from a fungus as a byproduct of grain fermentation. It inhibits melanin production but has a reputation in some countries for being too irritating for regular use.
Soy – You’ve heard of taking a milk bath to get whiter skin. That’s not likely to work. But there’s some evidence that washing your face with unpasteurized soy milk every day for 3 months can even out your skin tone. This ingredient inhibits enzymes that are involved in the melanin production process.
Arbutin – This plant extract derived from fruits like mulberry and bearberry is often discussed as an alternative to hydroquinone. Actually, it is simply a milder, naturally occurring variant of synthetic hydroquinone and works in much the same way.

Options Abound for Lightening and Brightening

Many other natural ingredients from licorice to azelaic acid are available in various combinations over the counter for skin lightening. Proprietary products such as Lumixyl (oligopeptide) and Melaplex are designed for skin “brightening” but provide a measure of lightening as well since melanin buildup in dead layers of skin cells is a common cause of dullness.

Laser Therapy for Treating Non-Melanoma Skin Cancers

rmendoza — Thu, 15 Mar 2012 19:37:06 +0000

There are currently many available treatments for dealing with actinic keratoses (pre-cancerous skin lesions), squamous cell, and basal cell carcinomas. These conditions can be treated topically with Aldara or Imiquimod creams, cryotherapy, or chemical peels. But laser treatment is really starting to come into its own as an option now – especially for eliminating multiple lesions. Dermatologists are trying out different lasers and various settings to see which techniques offer the best results with the fewest side effects.

Ablative Lasers

CO2 lasers are used to target the epidermis and the upper layer of the dermis, heating it enough to eliminate abnormal squamous cells. The depth of resurfacing treatment can be varied based on the type of cancer (basal cell or squamous cell) that is present. It’s not necessarily the right approach to use when the tumor is thick or if it penetrates deep into the skin, but it may be used in combination with curettage for some patients. So far, laser ablation appears to have the same success rate (about 80-90%) and the same remission rate at 5 years as chemical peels and topical creams.

Vascular Lasers

Basal cell carcinomas (BCCs) tend to involve a number of small blood vessels. Coagulation of these vessels cuts off the blood supply to the tumor. This can be achieved with a pulsed laser that is set to selectively heat vascular tissue while leaving the surrounding skin alone. Such a targeted approach to removal for BCCs may create less post-procedure scarring than surgical excision. Follow up with biopsy may still be needed to verify clearance of the abnormal cells.

Fractional Lasers

Fractional lasers that cause less skin damage than traditional ablative lasers are proving useful for controlling actinic keratoses (AKs). This variety of laser is suitable for full facial skin rejuvenation which means it may also catch other AKs before they reach the visible stage. Patients enrolled in a pilot study all reported at least “good” results with 3 out of 4 ranking their results as “excellent”. Multiple treatments were sometimes necessary to achieve the desired results. Larger trials with longer follow up periods will be needed to determine whether results are maintained beyond the 9 month mark.

Dark Circles Under the Eyes

eklingler — Sun, 04 Mar 2012 18:58:39 +0000

One of the most common questions we are asked in dermatology is, “what can I use for the dark circles under my eyes?” . The are multiple reasons for the dark discoloration under the eyes. The major factors contributing to dark circles under the eyes include:

genetic factors and facial topography
allergies
lack of sleep or hydration
aging

To fully understand under eye dark circles, it is important to understand that the dark component of dark under eyes is due to two contributory factors: true hyperpigmented skin and vascular components. Hyperpigmentation is generally ethnic or genetic, as is the vascular component, but the vascular component is deeper and gives a more bluish/purple appearance.

For most people, dark circles are caused by genetic or ethnic factors. Most darker races tend to naturally have darker areas under their eyes. Facial topography also contributes to the appearance of dark circles as those people with deeper set eyes tend to have an overlying shadow from the eyebrow. Both of these are the primary factors for under eye darkness in darker skin patients. For lighter skin patients, the vascular component may be a prominent cause and can lead to the bluish or purple tinge that many people complain about.

Allergies lead patients to constantly rub their eyes thereby leading to an induced hyperpigmentation response. Lack of proper hydration gives the appearance of a sallow and sunken set back set of eyes. Proper water intake plus the use of moisturizing eye creams can really help eliminate this possible cause of dark circles.

Treatments

There is no truly excellent treatment for dark under eye circles. However, the use of eye creams can make the appearance of under eye circles less. These creams work mainly by hydrating the skin, but in combination with bleaching creams prescribed by your dermatologist, may have an impact on natural hyperpigmentation. Of course, proper allergy treatment and prevention of irritation/rubbing is necessary in eliminating any allergy component. Here are some eye cream recommendations, and in some of these cases, excellent wrinkle treatment is often included.

Our recommended eye creams are:

Olay Regenerist Eye Lifting Serum

Kinerase Pro Therapy C8 Under Eye Peptide

Obagi Elastiderm

Teamine Eye Complex

Using these creams at night or twice daily should help greatly in reducing the appearance of dark circles. Knowing the possible primary factors is helpful in getting the full rage of treatment advice in order to get the best results possible.

Surgical Tattoo Removal Procedure

rmendoza — Tue, 28 Feb 2012 19:50:10 +0000

Surgical tattoo removal is one available option for effectively getting rid of an unwanted tattoo. It is more invasive than laser treatment, but there are times when it may be an option to consider. A dermatological surgeon can make this recommendation based partly on the size and location of the tattoo as well as how deep the pigment is in the skin. Unlike laser therapy, surgery actually removes a tattoo rather than simply fading it. However, pigment that has migrated into the tissues below the dermis may still remain. This may or may not show through after the procedure.
There will be some scarring regardless of the size of the tattoo removed. Individuals who tend to develop keloid or hypertrophic scars may be less satisfied with the outcome of an excision. Patients with health issues (such as diabetes) that impact wound healing may not be good candidates for this procedure.

Tattoo Removal Procedure

A small tattoo may be removed in a single operation. The area is cleaned and sterilized. The skin is numbed with a local anesthetic. A scalpel is used to excise the pigmented area of skin. Blood vessels may be cauterized to minimize bleeding during the procedure. The edges of the wound are sutured together over this tissue to speed healing.
A larger tattoo may require multiple sessions for removal to avoid causing too much trauma to the skin at one time. This approach is called a staged excision. Skin grafts taken from other parts of the body may be required to replace the skin that is removed. Or, tissue expansion may be used in conjunction with a staged excision. This process involves inserting a balloon under the skin near the tattoo to stretch and expand it over a period of several months. The goal is to grow enough excess skin to cover the portion that will be excised. The skin used for grafting in this way stays connected to its original blood supply, so there is less chance of tissue death.

Pros and Cons of Surgical Tattoo Removal

Surgery offers immediate removal for a small tattoo as opposed to laser treatment which may take many sessions. If scarring is minimal, it will be less noticeable than the tattoo was – especially as the scar fades over time. The success rate is very high from the perspective of thorough tattoo pigment removal.
The downside of surgery is that it involves some pain, bruising, and inflammation during the healing stage. There is a risk of infection and other surgical complications, especially with multiple procedures to excise a large tattoo. Scarring may be unpredictable.

Xeomin Enters Market to Challenge Botox and Dysport

rmendoza — Thu, 16 Feb 2012 19:25:15 +0000

In July of 2011, the FDA approved a new brand of botulinum toxin for treating vertical brow wrinkles in adults. This cosmetic treatment (incobotulinumtoxinA) goes by the brand name Xeomin. It is manufactured in Germany by Merz Pharmaceuticals but is approved for distribution in the U.S. So far, the production process has started and the proper safety labeling on the cartons has been determined. The first shipments are expected to be available to doctors in the United States in early 2012.

Xeomin Approved for Medical & Cosmetic Use

Like other botulinum products, this one was developed for medically necessary purposes such as treating eyelid spasm or chronic neck pain. However, it has also been used in 2 clinical trials for cosmetic improvement of glabellar lines (wrinkles between the eyebrows). The product offered a noticeable minimization of frown lines compared to placebo at the 30 day mark after treatment. Since this product has basically the same active ingredient as Botox and Dysport and works in the same way by blocking nerve signals to the muscles, Xeomin moved fairly quickly through the FDA approval process.

Product Safety Profile

The company will be required to continue testing for some time to further evaluate safety in various patient groups, but the results and the overall risk profile are expected to be similar to other botulinum toxins. The protein solution which carries the toxin molecule is different in Xeomin than in Botox and is hoped to cause fewer side effects in the larger doses used to treat medical conditions. However, many dermatologists feel this change won’t have any impact when it comes to the small doses used for cosmetic treatment. The most commonly mentioned side effect among patients receiving wrinkle treatment with Xeomin was headache.

No Comparison Trials Yet Done

So far, no split face studies have been conducted in the U.S. comparing Xeomin to Botox or Dysport to determine which one is the most effective for wrinkle reduction. It’s not likely that Xeomin will provide significantly longer lasting effects than other botulinum injectables. Brow wrinkles become noticeable again as the nerves in the face repair themselves, causing the muscles to begin contracting normally and reinforcing frown lines. It’s not so much the drug “wearing off” as the body healing itself. This tends to occur at a similar rate in most people after exposure to botulinum toxin. Some patients can go longer between Botox treatments over time, but this effect varies from one individual to another. In the final analysis, the main advantage of having similar products competing is likely to be greater affordability for consumers.