Cosmetic Dermatology

Injectable Fillers Q&A

What are injectable fillers?

Injectable fillers (sometimes called dermal or cosmetic fillers) are solutions injected into the skin to reduce the appearance of lines and wrinkles and to plump up areas of the face, including the cheeks and lips, where volume has been lost due to aging. Fillers can also be used to reduce the appearance of acne scars and other scars. Many fillers also stimulate the production of natural collagen to help skin feel and look firmer and more resilient.

What happens during treatment?

Prior to treatment, the doctor will assess the patient’s objectives and their facial anatomy and aesthetics to determine the best choice of filler as well as the optimal sites for injections. The injection sites will be carefully cleansed and an anesthetic can be applied to minimize discomfort, depending upon the area being treated. Multiple injection sites are used to treat larger areas to ensure the material disperses for a consistent, natural-looking result. Following injections, there may be some mild redness or swelling in the injection sites, but these issues will quickly resolve. Cool compresses can be used to reduce temporary discomfort and swelling.

What kinds of fillers does your practice offer?

We offer a range of the most advanced, most effective cosmetic fillers to address wrinkling, loss of volume and other issues throughout the face, including:

• Belotero™
• Juvederm™
• Radiese™
• Restylane™
• Sculptra™

Because different fillers can be more effective treating different issues and different areas of the face, the choice of filler will be determined following an evaluation of the facial anatomy and a careful review of the patient’s specific concerns and treatment objectives.

Can cosmetic fillers be used in combination with BOTOX®?

Yes; in fact, many women and men opt to have both fillers and BOTOX® to treat wrinkles and other issues in all areas of the face so they can enjoy the benefits of a “mini facelift” without surgery.

How long do the results of fillers last?

That depends on the type of filler that’s used, the issue that’s being treated and where the fillers are being injected. Most fillers last from a year or more, and “touch-up” treatments can help results last much longer.

Laser Treatment Q&A

What kinds of laser treatments does your practice offer?

Luminous Dermatology is a top-provider of laser treatments in the Santa Barbara and Santa Maria area, offering a comprehensive array of state-of-the-art laser skin treatments for many cosmetic issues, including:

• wrinkle reduction and skin resurfacing and rejuvenation
• brown spots, red spots and hyperpigmentation
• hair removal

Our practice features the most advanced laser systems to enable patients to have multiple issues addressed in one location.

How does laser hair removal work?

Lasers emit energy, and that energy is absorbed by hair. By targeting the hair follicle and root, the laser energy heats up and destroys the root, reducing or preventing future hair growth. Because hair grows in cycles, most patients need multiple laser treatments to ensure each follicle and hair is treated at the appropriate time to halt growth. The number of treatments depends on the patient’s hair type, skin type and other factors.

How do lasers work to rejuvenate skin?

Lasers use very highly-focused beams of energy to target tissue damage below the surface of the skin, resolving damage while promoting the development of collagen so skin looks and feels firmer, more resilient and rejuvenated.

What happens during laser resurfacing?

Laser resurfacing begins with a careful evaluation of the skin to create a custom treatment plan based on the patient’s specific needs. During treatment, the laser handpiece will be passed over the treatment area and the laser energy will be emitted at precise intervals. A topical anesthetic may be applied first to reduce any potential sensations of stinging or mild discomfort. As the laser passes over the skin, the energy penetrates the surface of the skin to reach areas of damaged tissue. The length of treatment will depend on the size of the area being treated and other factors. Once treatment is complete, a soothing gel may be applied to reduce redness and discomfort and to help condition the skin. Many patients experience mild redness (similar to a light sunburn) that resolves within a few days.

Wrinkle Reduction Q&A

What is Smartskin+™?

Smartskin+™ is an innovative laser system that uses multiple advanced technologies to treat an array of cosmetic concerns, including:

• wrinkles
• dark under-the-eye circles
• age spots
• scars
• sun damage
• hyperpigmentation and redness

Plus, the Smartskin+™ system can be used to tighten loose, lax skin and to rejuvenate the hands and the neckline area in addition to the face.

How does the Smartskin+™ laser system work?

The Smartskin+™ laser system uses fractional technology, treating tiny columns of skin and leaving neighboring areas untouched so patients can achieve the same results of a traditional laser treatment but with far less downtime and far less discomfort. The system is completely customizable, enabling patients to get just the treatment they want for optimal and truly personalized results. The laser’s highly-focused energy is delivered through a special handpiece that enables the treatment provider to alter multiple parameters throughout the treatment session, making real-time, immediate adjustments for optimal control and customization. The laser energy helps reduce the appearance of lines, wrinkles and scars by treating damaged tissue and promoting the production of collagen, one of healthy skin’s natural building blocks, so skin looks and feels firmer and more resilient. The system’s unique delivery system offers faster and more effective treatments, as well as less downtime and discomfort compared to many other lasers.

What happens during a laser rejuvenation procedure with the Smartskin+™system?

Prior to treatment, the patient’s skin is carefully evaluated to identify “trouble spots” and concerns and to construct a customized treatment plan based on the patient’s specific needs and goals. Depending on the area being treated and the extent of the treatment, a topical anesthetic may be applied along with a cooling gel to make treatment more comfortable. During the treatment session, the handpiece will be passed over the treatment area and the laser energy will be emitted at very fast and very specific intervals. The depth and frequency of energy emissions can be adjusted throughout the treatment as needed. Once treatment is complete, a soothing gel will be applied and patients will be provided with instructions to help them care for their skin as it recovers. Mild redness typically occurs following treatment and resolves within a few days.

Pigment disorders refer to conditions that affect the color of the skin, hair, or eyes, caused by an abnormality in melanin production. Melanin is the pigment produced by melanocytes in the skin, which determines the color of the skin, hair, and eyes. Pigment disorders can result in either hyperpigmentation (darkening) or hypopigmentation (lightening) of the skin.

Types of Pigment Disorders

1. Hyperpigmentation (Excess Pigment):
   • Melasma: A common skin condition characterized by dark, irregular patches, usually on the face (cheeks, forehead, upper lip). It is often triggered by hormonal changes (such as pregnancy or birth control) and sun exposure.
   • Post-Inflammatory Hyperpigmentation (PIH): Dark spots or patches that appear after an injury or inflammation of the skin, such as acne, eczema, or burns.
   • Solar Lentigines (Age Spots or Liver Spots): Small, darkened patches of skin caused by sun exposure, usually appearing on the face, hands, shoulders, and arms as people age.
   • Freckles (Ephelides): Small, flat, brown spots that appear on sun-exposed areas and are more common in people with lighter skin tones.
   • Acanthosis Nigricans: A condition characterized by dark, thickened patches of skin, often in skin folds (e.g., neck, armpits), associated with insulin resistance or hormonal disorders.
2. Hypopigmentation (Loss of Pigment):
   • Vitiligo: A condition in which the immune system attacks and destroys melanocytes, leading to white patches of skin. It can affect any part of the body and vary in size.
   • Albinism: A genetic disorder characterized by little or no melanin production, resulting in very light skin, hair, and eyes. People with albinism are more sensitive to sun exposure and may have vision problems.
   • Pityriasis Alba: A common skin condition in children that causes light, scaly patches, often on the face. It is usually associated with dry skin and can be more noticeable in darker skin tones.
   • Tinea Versicolor: A fungal infection that leads to small, discolored patches on the skin, which can be lighter or darker than the surrounding skin.
3. Mixed Pigmentation Disorders:
   • Lichen Planus Pigmentosus: Presents with dark brown to grayish patches, usually on sun-exposed areas or folds, often associated with inflammation.
   • Idiopathic Guttate Hypomelanosis: Small, white spots that appear on the arms and legs as a person ages, likely due to sun damage.

Causes of Pigment Disorders

• Genetic Factors: Some pigment disorders, like albinism and vitiligo, have a genetic basis.
• Sun Exposure: UV radiation can increase melanin production, causing hyperpigmentation, or it can damage melanocytes, leading to hypopigmentation.
• Hormonal Changes: Pregnancy, birth control pills, and hormonal disorders can lead to conditions like melasma.
• Inflammation or Skin Trauma: Injuries, burns, acne, or eczema can cause post-inflammatory hyperpigmentation or hypopigmentation.
• Infections: Fungal infections like tinea versicolor can cause changes in pigmentation.
• Autoimmune Disorders: Conditions like vitiligo are caused by the immune system attacking melanocytes.

Treatments for Pigment Disorders

1. Topical Treatments:
   • Hydroquinone: A skin-lightening agent used to reduce hyperpigmentation.
   • Retinoids: Promote skin cell turnover and can help in the treatment of both hyperpigmentation and hypopigmentation.
   • Corticosteroids: Used to treat inflammatory skin disorders that may cause pigmentation changes.
   • Vitamin C: An antioxidant that can help reduce pigmentation and promote even skin tone.
2. Chemical Peels:
   • Peels containing glycolic acid, salicylic acid, or trichloroacetic acid (TCA) can exfoliate the skin, improve texture, and reduce pigmentation irregularities.
3. Laser Therapy:
   • Q-switched lasers and Fractional CO2 lasers can target hyperpigmented areas by breaking down excess melanin.
   • Excimer lasers are used to stimulate repigmentation in vitiligo.
4. Microdermabrasion and Dermabrasion:
   • Exfoliating treatments that remove the top layers of skin, helping reduce the appearance of hyperpigmentation.
5. Phototherapy:
   • Narrowband UVB or PUVA therapy (Psoralen combined with UVA) can help in cases of vitiligo by stimulating melanocyte activity.
6. Oral Medications:
   • Medications like tranexamic acid have shown effectiveness in treating melasma.
7. Camouflage Makeup:
   • Medical-grade makeup can be used to conceal pigmentary issues, especially for conditions like vitiligo.

Milia removal involves the treatment and extraction of milia, which are small, white, or yellowish cysts that appear on the skin. Milia form when keratin (a protein found in the skin) gets trapped beneath the skin’s surface, creating small, firm bumps. They are commonly found around the eyes, cheeks, nose, and forehead but can occur anywhere on the body.

Milia are generally harmless and painless, but they can be cosmetically bothersome for some people. While milia can sometimes resolve on their own, removal may be desired for quicker results or aesthetic reasons.

Types of Milia

1. Primary Milia: Develops directly from trapped keratin and can occur in newborns, children, and adults.
2. Secondary Milia: Develops when something clogs the sweat ducts, often due to skin damage such as burns, blisters, or skin resurfacing treatments.

Methods for Milia Removal

1. Topical Treatments:
   • Retinoids: Over-the-counter or prescription retinoid creams can help exfoliate the skin and prevent the formation of new milia. Retinoids promote cell turnover, which can help release trapped keratin.
   • Exfoliating Acids: Alpha hydroxy acids (AHAs), such as glycolic acid or lactic acid, and beta hydroxy acids (BHAs), such as salicylic acid, can help exfoliate the skin and reduce milia

Xeomin is a brand name for a prescription medication known as incobotulinumtoxinA. It is a type of botulinum toxin, similar to Botox, and is used in both medical and cosmetic treatments.

Uses:

1. Medical: Xeomin is used to treat certain medical conditions such as:
   • Cervical dystonia (a neurological disorder that causes severe neck muscle spasms).
   • Blepharospasm (involuntary eyelid twitching).
   • Upper limb spasticity (muscle stiffness in the arms).
   • Chronic sialorrhea (excessive drooling).
2. Cosmetic: Xeomin is also used to reduce the appearance of facial wrinkles, particularly frown lines between the eyebrows, often referred to as “glabellar lines.”

How It Works:

Xeomin works by blocking the release of a neurotransmitter called acetylcholine, which reduces muscle activity and helps to relax the muscles in the treated area. This results in a temporary reduction in the appearance of wrinkles or the relief of symptoms associated with muscle overactivity.

Differences from Botox:

• Purity: Xeomin is often referred to as a “naked” neurotoxin because it does not contain any additives or complexing proteins, unlike Botox. This can reduce the likelihood of the body developing resistance to the treatment.
• Storage: Xeomin does not require refrigeration before reconstitution, making it more convenient for storage and handling.