Botox Cosmetic is now FDA approved for the treatment of the forehead

Botox and Dysport have been  used to treat the forehead for nearly 2 decades as an “off label indication”.  This has no impact on the treatment of the forehead furrows, but it does have the FDA’s stamp of approval.

To celebrate this we are offering treatment of the forehead for $199. This does not include the treatment of any other area (frown lines or crow’s feet). You must present this article to receive this special offer.

Restrictions apply–inquire to find out more. This offer expires November 1, 2017.


PRP: is it worth all the hype?

Celebreties are raving about it, doctors are promoting it for many things, but is it really worth the hype?

In short, PRP is not FDA approved for anu Dermatologic or Cosmetic indication. There are several small studies that concluded that there is benefit when treating androgenic alopecia. That being said, larger, well-designed studies are needed. For other indications, such as photo-rejuvenation, studies are even more poorly designed.

There is a good scientific basis for why PRP may help a variety of conditions. Unfortunately, due to a lack of good clinical studies further research is needed. So the answer to the question of whether is is worth the hype is maybe. 

Often, PRP is combined with another procedure–laser resurfacing+PRP, or Restylane+PRP. When doing so, it is difficult to know if the PRP is adding any benefit.

Best treatment for fine lines

Since the release of Restylane Silk, the treatment of fine lines on the face has changes. Restylane, which has been an extremely popular filler, was used for fine lines for well over a decade with good results. The larger particle size of Restylane was not optimal for fine line treatment, but worked well. The new smaller-particle sized Restylane Silk has changed the game for fine line treatment. With extremely natural results and the safety profile of Regular Restylane, this product was an instant hit!

If you have not tried it, take a look! Instant results, no downtime, and minimal risk.


The 60 minute facelift – no kidding.

The Silhouette lift uses sutures placed under the skin to create an instant lift. A small incision is made above the sideburn hidden in the hair to insert the sutures. Usually four sutures are placed on reach side. With minimal risk, minimal downtime, this procedure is a great alternative to traditional facelift. It is performed right in the office under local anesthesia.

Quick non-surgical rejuvenation

So often patients will ask for a quick pick me up. A quick refresher. Something non-surgical. Well, now there are lots and lots of options. I will list a few of the things that can help.

1. Toxins.  Botox and Dysport can help reduce forehead furrows, frown lines, smile lines, and in experienced hands chin dimpling and lip lines. Most get about 3-4 months out of a single treatment, which may take 2 weeks to see results.

2. Fillers. There are many different fillers available to reduce fine lines, folds, and hollows. Depending upon which filler is used and how it is injected, one can see 6 months results and occasionally 1 year with some.

3. Chemical peels. There are superficial peels (i.e. Glycolic, Jessners, 20% Salicylic acid) which are skin fresheners–help even out skin tones and may reduce fine lines a little bit. Healing generally takes a few days. Deeper chemical peels have more significant results, but take longer to heal.

4. Microdermabrasion. This time-tested procedure removes the dead skin cells making the skin feel smoother. It does not have any significant long term benefits, although topical regimens may be more effective. Some combine this procedure with light chemical peels to get a deeper peel, and hence more downtime.

5. Fractional skin resurfacing. This procedure uses laser to heat the skin by making little tiny columns of destruction. This reduces line lines and wrinkles and evens out skin tones. Healing can take 3 days or one week.

6. Ultherapy. This uses ultrasound energy to  heat the skin resulting in tightening. There is no downtime, although results take at least 2-3 months to see any improvement. Treatment of the forehead, cheeks, and neck is common. Now fine lines can be treated too, especially around the mouth and lips, neck and chest, although more than one treatment is often needed for those areas.

7. Radiofrequency. This has similar indications as Ultherapy, although multiple treatments are often necessary.

8. Photofacial / IPL: Using light energy, blood vessels and skin pigmentation can be reduced. Usually 3-5 treatments are recommended and results can be quite impressive.

Botox, Dysport, what’s the difference?

Often I am asked if Botox and Dysport are the same. Or, more commonly, a patient will prefer one over the other. The simple answer is that the active molecule is essentially the same and the protein that surrounds it is different.

For the most part, they work the same. Unfortunately, the units are different (how they are measured), so one unit of Botox is not the same as one unit of Dysport. In my opinion, the manufacturer of Dysport overstated their conversion–meaning that the recommended conversion was not strong enough. Therefore, I have found that one must use more than the original recommended amount.

In general, I often get better “deals” from one company at a given time, which I personally pass down to the patient. The two products do behave a little differently (how they spread), but for the most part I think the results are extremely close.

Liquid Facelift: Worth the Hype?

In the past few years, the popularity of “liquid facelifts” has grown. What is it? Is this better than a traditional surgical facelift? Well, to put it simply, it is very different. Using a sub-dermal filler (one that is injected under the dermis, skin is lifted, not tightened. Well, why does this work and for who?

As we age, our cheeks flatten as we lose bone. This causes the cheeks to sag and folds develop (i.e. smile lines and puppet’s lines). In the past, a surgical facelift was used that pulled the skin back. This wind tunnel look was an improvement for some, but certainly was no fountain of youth. In the recent decades, fat was used to restore volume back to the cheeks that could be performed alone or in conjunction with a surgical facelift.

With the advances of sub-dermal fillers, such as Radiesse, Sculptra, and Voluma, one can restore the lost volume in the cheeks in 30 minutes or less, restoring the youthful shape of the face often alleviating the need for a surgical facelift. When skin tightening is needed, one can often use Ultherapy (especially for the lower face, neck, and forehead), chemical peels, or fractional laser resurfacing.

So the simple answer is, maybe. For many, these volume replacement treatments may be a great alternative, for others this may work in combination with other procedures, while still others may be best going under the knife. The good news is that we now have more non-surgical options than ever and the need to go under the knife has been steadily reduced year after year.