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In recent years, advances in technology have greatly increased the
capabilities of dermatologists. Newer treatments, including Botox injections,
laser surgery, and dermabrasion, are now available and can be performed in the
dermatologist’s office.
Here are some of the skin care procedures that the dermatologist can perform
in the office:
Botox
Botox is the brand name of a toxin produced by the bacterium Clostridium
botulinum. Small, diluted amounts can be directly injected into specific
muscles, causing controlled weakening of the muscles. The injected muscle 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 eye), and frown
lines.
The procedure takes only a few minutes and no anesthesia is required. Botox
is injected with a fine needle into specific muscles with only minor discomfort.
It generally takes three to seven days to take full effect.
The most common side effect is temporary bruising. A small percentage of
patients may develop eyelid drooping, which usually resolves in three weeks.
This development is usually caused by migration of the Botox; for this reason,
you shouldn’t rub the treated area for 12 hours after injection or lay down
for 3 to 4 hours.
Chemical peel
treatments
A chemical peel, also known as dermapeeling, is a technique in which a
chemical solution is applied to the skin. The affected skin peels off, leaving
the new skin smoother.
Chemical peels are performed on the face, neck or hands. They can help
reduce:
- mild scarring
- certain types of acne
- wrinkles
- sun spots
- liver (age) spots
- freckles
- dark patches (melasma) caused by pregnancy or birth control
pills
To perform a chemical peel, the doctor cleanses the skin and then applies a
chemical solution (such as glycolic acid, trichloroacetic acid, or salicylic
acid) to small areas on the skin. These applications produce a wound, paving the
way for regenerated skin.
After the chemical peel, the patient’s skin will be red and will peel for
up to a week. The process can be repeated as necessary.
Possible side effects include reactivation of cold sores (herpes infection)
in patients with a history of herpes outbreaks. This can be prevented or treated
with an oral medication.
Dermabrasion
Dermabrasion, or surgical skin planing, is an abrasive procedure that
"sandblasts" the skin to create a smoother layer of skin. Dermabrasion
is used to treat scars, pox marks, age (liver) spots, and skin lesions.
In the dermabrasion procedure, the doctor cleans and freezes the skin. To
perform the abrasion, the doctor uses a high-speed instrument equipped with a
wheel or brush to strip off the top layers of skin.
Your skin will feel rough and "burned" after the dermabrasion
procedure, and will be pink for a while. Stay out of the sun for several months
and be sure to use sunscreen when you do go outdoors.
Risks of dermabrasion can include uneven changes in skin color, scarring, and
infection.
Sclerotherapy
Sclerotherapy is a procedure that is used to eliminate varicose veins and
"spider veins" (enlarged blood vessels
that are visible on the skin, especially on the nose, face, and legs).
Sclerotherapy involves an injection of a salt solution 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.
The procedure itself takes approximately 15 to 30 minutes. The number of
veins injected in one session varies, and depends on the size and location of
the veins, as well as the general medical condition of the patient.
Side effects after sclerotherapy include itching and raised, red areas at the
injection site and bruising. Other side effects include:
- Larger veins that have been injected may become lumpy and hard
and may require several months to dissolve and fade.
- Transient hyperpigmentation (brown lines or spots) may appear
at the vein site.
- Neovascularization (a temporary development of new, tiny blood
vessels)
Note: If you develop inflammation within five inches of the groin, a swollen
leg, or small ulcers at the injection site after sclerotherapy, contact your
physician immediately:
Collagen
injections
The dermis layer of the skin is primarily made up of the protein collagen.
Collagen forms a network of fibers that provides a framework for the growth of
cells and blood vessels. Because it is the main component of the dermis,
collagen acts as the support structure for the skin.
In young skin, the collagen framework is intact and the skin remains
moisturized and elastic. 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.
Collagen injections replenishes the skin’s natural collagen. CosmoDerm and
CosmoPlast are bioengineered human collagen products that are placed just
beneath the skin, in the dermis, where the body readily accepts it as its own..
When you have a collegen injection, you will receive a small injection of
local anesthesia to numb the area being treated. There is a possibility of
slight bruising, and you may experience puffiness, redness and tenderness around
the treated site.
Just like natural collagen, collagen replacements eventually begin to lose
form and wear down. In order to keep up appearances, you will need a series of
treatments, two to four times a year.
Carbon dioxide
laser skin resurfacing
Carbon dioxide lasers have been in use for many years to treat different skin
conditions. A new generation of carbon dioxide lasers use very short pulsed
light energy (ultrapulsed) or continuous light beams that are delivered in a
scanning pattern to remove thin layers of skin with minimal heat damage to the
surrounding structures. These lasers are used to treat wrinkles, scars, warts,
linear epidermal nevi (birthmarks), rhinophyma (enlarged oil glands on the
nose), and other skin conditions.
Carbon dioxide laser resurfacing is usually performed on an outpatient basis,
using local anesthesia in combination with orally- or intravenously-administered
sedative medications. The areas to be treated are numbed with a local
anesthetic. (General anesthesia may be used when the entire face is treated.) A
partial-face laserabrasion takes 30-45 minutes, and the full-face treatment
takes 1-1/2 to 2 hours.
Following the laser resurfacing procedure, a telfa dressing is applied to the
treatment sites for 24 hours. The areas usually heal in 10-21 days, depending on
the nature of the condition that was treated.
Side effects include:
- Milia (small white bumps) in the laser-treated areas. These may
be removed by gentle cleansing with a washcloth.
- Hyperpigmentation, and sometimes, hypopigmentation
- Reactivation of a herpes simplex cold sore, especially after
laser resurfacing around the mouth. This can be prevented by giving an
antiviral medicine before the surgery and continuing it for seven to 10 days
afterwards.
- Bacterial infections. These can be prevented by taking an
antibiotic prior to the surgery and continuing for seven to 10 days
afterwards.
- Scarring (rarely)
Laser
tattoo removal
Lasers remove tattoos by breaking up the pigment colors with a high-intensity
light beam. Depending on the size and color of your tattoo, the number of
treatments will vary. Your tattoo may be removed in two to four visits, though
more sessions may be necessary.
During a laser tattoo removal:
- The doctor places a handpiece against the surface of the skin
and activates the laser light. (The patient wears protective eye coverings.)
The laser may be slightly painful.
- Smaller tattoos require fewer pulses while larger ones require
more. At each treatment, the tattoo should become progressively lighter.
- Immediately following treatment, an ice pack is applied to
soothe the treated area. The patient will then be asked to apply a topical
antibiotic cream or ointment. A bandage or patch will be used to protect the
site; it should be covered with a sun block when out in the sun.
There are minimal side effects to tattoo removal by lasers. The tattoo
removal site is at risk for infection. You may also risk lack of complete
pigment removal, and there is a slight chance that the treatment can leave you
with a permanent scar.
Photodynamic
therapy
Photodynamic therapy has recently been approved for treatment of actinic
keratosis, a precancerous skin lesion, as well as for acne and sun-damaged skin.
Photodynamic therapy consists of a drug called a photosensitizing agent and a
light. To treat actinic keratosis, the doctor applies the photosensitizing agent
to the skin (in liquid form) and then exposes the area to a light that activates
the agent and kills the lesion’s cells.
Side effects of photodynamic therapy include increased sensitivity to light,
burns, and swelling.
Vascular laser
treatments
Lasers are also used to treat vascular lesions (those that involve blood
vessels) such as spider veins, hemangiomas (abnormal growths of blood vessels
that appear on the face and head), and port wine stains (purple lesions, also on
the face and neck, that eventually take on a "bumpy" appearance).
These disorders are also known as vascular malformations.
To treat these malformations, laser treatments are employed to shrink the
dilated blood vessels. This procedure can be performed without anesthesia. In
most cases, the procedure must be repeated several times to completely treat the
disorder. Side effects include swelling and redness at the treatment sites, skin
lightening, and minor blisters.
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