What is the difference between the different fillers containing hyaluronic acid?  
 Can BOTOX® be used for  areas other than the upper face? 
 What can be done for sun damage on my chest and décolleté? 
 What laser works best for stretch marks? 
 What causes dark circles under the eyes?

 What is the difference between the different fillers containing hyaluronic acid?

Hyalouronic acid (HUA) is a natural constituent of our skin, providing both structure and hydration. It is a complex type of sugar molecule, and thus it doesn’t induce allergic reactions, so there are no skin tests are not required, unlike with older fillers like collagen. In practical terms this means that HUA's can be used as an instant way to take off 10 years from your appearance by softening up the deep lines that make people look aged. It is long lasting (8-12 months), and according to recent studies, actually causes your own skin to build itself with new collagen around where the HUA is injected under the skin. The long term effect is that the wrinkles get less deep over time.
The most widely used HUA in the USA is Restylane, although there are others (Juvederm, Hylaform and more). Restylane seems to last longer than the others; otherwise, except for their origin and how they are synthesized, they are very similar. Perlane is just a more concentrated version of Restylane, made by the very same company in Sweden. I tend to use Restylane for the most part, as the cost to the patient is somewhat less, the result long lasting, and it can be used in any part of the face, unlike the thicker Perlane.

Non HUA fillers, such as Radiesse, are also available, however they are more costly, and unlike with HUA's, there is bruising and some swelling for several days after it is injected. It also can not be used to plump up the lips, a favorite procedure of many of my patients.

 Can BOTOX® be used for areas other than the upper face?

The current indications for BOTOX® are for use for the frown lines of the eyebrows and forehead. However, BOTOX® has been shown to produce a nice softening of the smoker’s lines when injected in very tiny amounts. It can also be used to gently elevate the corners of the lips that tend to point down with
age, and can soften the horizontal and vertical lines on the neck often found in women in their forties and older.

Other areas Botox works well are the crows feet around the outer parts of the eyes, eliminating the lines created by smiling. The newest -and FDA approved- application is for sweating under the arms, which is a source of embarrassment to many. Injection with Botox can solve the problem for as long as a year and a half! Prior to the treatment, I perform a (painless) test to outline the areas that sweat, thus maximizing the accuracy of the treatment.

Unlike in many other practices, a free touch up 7-10 days later is included with Botox treatments, to ensure the best outcome for the patient.

 What can be done for sun damage on my chest and décolleté?

This is a very important cosmetic area for women and should be treated for aging and sun damage. First, a combination of Vitamin A derivative creams such as Retin-A, Glycolic Acid creams and bleaching creams containing Hydroquinone is used. This regimen will start minimizing brown pigmentation and fine lines. Next, the Alexandrite laser can take out any brown age spots, and non-ablative laser treatment with the Pulse Dye laser (PDL) eliminate red blotchy marks as well as stimulate the skin to produce new, healthy collagen, thus improving any age and sun-induced furrows. Microdermabrasion helps smooth the skin and restore its even, healthy glow. All this is very important, since it doesn’t look appealing to have the facial skin of a young person with the décolleté of a much older one.

Our latest laser technology, combining Radiofrequency (RF) and Infra-red (IR) waves has proven to be outstanding in fading out the pigmentation as well as targeting the accompanying capillaries in the skin at the same time. This treatment can be utilized not only on the décolleté area (Fotobody RF), but also to restore the smooth, even tone and texture of the skin on the face (Fotofacial RF). For especially stubborn marks, we use the Alexandrite or PDL in addition to the Fotobody RF, thus ensuring maximum improvement.

 What laser works best for stretch marks?

The Pulse Dye laser has been used for many years now for these stubborn lines. Not only does it work well for the fresh, reddish stretch marks following for example childbirth, but it often does improve the older, white colored ones remaining after weight loss and other events. Some lasers work by trying to repigment the white areas of the marks. The Pulse Dye laser likely works by stimulating new collagen production in the stretch mark, similar to its effect on scars.

 What causes dark circles under the eyes?

Dark circles are very common, often from an early age on. You know you have them when people start asking you, "Are you tired? You look like you could use some sleep!

"Dark circles are a result of one of several processes. Some people have genetically oversized muscles around the eyes, which throw off heavy shadows. Another reason may be that skin in thinner in the delicate area under the eyes, and muscles and blood vessels show through. Other times, aging causes the area to become sunken, thus making it look darker. Ironically, what looks like pigmentation under the eyes, has nothing to do with actual pigmentation.

Treatments vary and the results are often unpredictable. It is always worthwhile to use a topical cream. In my office, I offer an Eye Repair Serum, which contains vitamin K, and helps some people lighten up the skin -- vitamin K decreases the visibility of the blood vessels in the area.

It takes time to show an effect, however. Other topicals such as bleaching creams containing hydroquinone do not seem to work.

I have tried a variety of laser treatments without consistent success. Very light laser peels with our Erbium Yag laser can at times provide improvement. Restylane, an FDA-approved filler, can also be used to plump up the hollow under the eye. It decreases the shadows of overly thick muscles and puts some layers between the skin and underlying blood vessels and muscles. The result is a much lighter, even looking under eye area.

Last but not least, a lower-eyelid surgery called blepharoplasty can help improve or even eliminate the circles. The surgery tautens the skin and lightens the look. However, I would leave plastic surgery as a last resort if all other, less aggressive treatments fail.