Mohs surgery, Mohs micrographic surgery (MMS), developed by Dr. Fredrick Mohs in the 1930s, is a technique that uses both pathology and surgery to remove skin cancers in a doctor’s office. During the surgery, the tissue is removed, sparing as much normal skin as possible and while the patient waits, 100% of the surgical margin of the specimen is examined in the laboratory located in the doctor’s office to determine if any more cancer remains. If the margins are involved, the orientation of the residual skin cancer is mapped so the surgeon knows where exactly to trim more around the spot removed in the prior Mohs stage. This continues until all of the skin cancer is removed. Dr. Mohs is credited for inventing this ingenious technique of creating the most minimal size defect while providing the highest cure rate. Reconstruction can then be accomplished the same day immediately after Mohs Micrographic surgery.
Today, Mohs surgery has come to be accepted as the single most effective technique for removing Basal Cell Carcinoma and Squamous Cell Carcinoma, the two most common
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Dermal fillers aren’t new. Soft tissue augmentation for cosmetic improvement was pioneered in the 1800s. The first FDA-approved injectable filler became commercially available in the United States in 1981. Today we use an assortment of safe, effective dermal fillers from a number of reputable manufacturers to lift, soften wrinkles, augment lips, and contour facial planes.
So you may be wondering why patients in New York City need Voluma™, yet another dermal filler. The answer is that no one product is right for every patient, every treatment area, or type of enhancement. Voluma™ is the first and only injectable filler approved by the FDA for a very specific purpose – instant correction of volume loss in the midcheek area. It has a longevity that may be double normal fillers – Voluma™ can last up to two years.
As we age our faces lose hydration, fat, muscle tone, and even bone. That causes youthful, smooth contours to become more angular, and allows hollows to develop beneath the cheek bones. Without supportive volume, skin sags into wrinkles and folds.
Voluma™ is a smooth, clear gel formulated with hyaluronic acid (HA). This substance occurs naturally in skin and binds to water to provide plumpness. But HA levels decrease as we age, and in response to UV exposure, environmental pollutants, and smoking.
Voluma™ replenishes HA at this precise area, providing instant uplift that softens the appearance of wrinkles and restores rounded contours. A treatment session takes only about 30 minutes, and there is essentially no downtime. Results are long-lasting – about two years in clinical studies.
Yes, as an experienced, Board certified dermatologist I already have a variety of weapons in my arsenal of non-surgical, minimally invasive rejuvenation techniques. And yes, there is room for one more. I use Voluma™ along with neuromodulators and other types of soft tissue fillers, in customized combination protocols specifically designed for each individual patient.
Voluma™ is a powerful tool for a younger looking you.
The U.S. News and World Report’s doctor finder service lists 1,197 dermatologists in New York City. The majority of those doctors offer a variety of non-surgical, minimally invasive devices and techniques for face and body rejuvenation. While treatment choice is ultimately the patients’, it is natural for them to rely on advice from the dermatologist on how to proceed. I find myself recommending ThermiRF ™ with increasing frequency. Here is more information for patients who want to know why.
What is ThermiRF ™ ?
This is a versatile FDA-cleared device that uses radiofrequency (RF) technology to generate heat in deep layers of skin without harm to the surface. We apply the focused RF to induce metabolic changes that tighten skin, improve body contours, and soften wrinkles.
How is it used?
The ThermiRF ™system is a console with a hand piece and several application tips.
ThermiRase relaxes frown lines and tightens skin on the forehead, between the eyebrows. A micro-invasive tip delivers RF energy. It causes an interruption of impulses from nerves that tell muscles to contract. That softens the appearance of wrinkles in much the same way as Botox® Cosmetic, without the use of drugs.
ThermiTight can help lift the sagging lower face, including smile folds, jowls, jaw line, corners of the mouth, and the neck.
For fat reduction and body contouring, a very small probe is passed through the skin into the fatty tissue layer. The probe sends a controlled dose of RF energy to melt targeted fat cells, which are then flushed harmlessly from the body over the next few months.
What makes ThermiRF ™ different?
ThermiRF ™ is an “in between procedure” – in between non-invasive treatments such as Ultherapy®, Pellevé®, and Thermage®, and surgically invasive procedures like face or neck lift. The difference lies in the technology and the results. It is the only temperature controlled aesthetic therapy that penetrates to subdermal layers, with a thermal camera to monitor surface temperature and an internal probe that records actual temperature achieved by the tissues that the physician intends to tighten. That allows deep heat for maximum collagen remodeling and fat reduction, without the limitation of temperature tolerance of surface skin. The difference is a high safety profile, precise application with effective outcomes.
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There was a time when cosmetic surgery was the only solution to improve the appearance of sagging skin. Today, however, men and women in New York City are fortunate to have a variety of convenient and cost effective, surgery free options. These non- and minimally invasive treatments are ideal for patients who need more rejuvenation than a topical cream can deliver, but aren’t ready for cutting, sutures, recovery time, or scars.
During an initial consultation, I often hear the concern, “will it hurt?” While we take every measure to ensure that patients have comfortable treatment experiences, I make it a rule to answer questions like that very frankly. Procedures like injectables that pierce the skin naturally pinch a little, and some patients are sensitive to treatments that heat or cool deep tissue layers. I can, however, assure every patient that skin tightening treatment with Pellevé is not painful. In fact, if there is any sensation of pain, the patient is supposed to tell the provider who dials down the energy. It’s actually a pleasant sensation for most people and it is often described as a deep heat massage.
We use a mobile hand piece to basically give a facial massage. As the device sends radiofrequency energy to the deep skin strata that meets the fat layer, it creates a warming sensation – but it is not at all painful. No anesthesia is needed, and normal activities (including wearing makeup) may be resumed right away.
The RF energy creates a thermal response in the skin’s collagen bundles. They contract and produce new collagen, providing a firm, smoother foundation for surface skin. Results that are immediate are from microscopic swelling. Fine lines look better and this is often used by patients to have a treatment a day before an evening function to look better. The real improvement occurs as skin tone and texture continues to occur over three to six months. Four treatments are ideally done as a series, two to three weeks apart. The improvement can last more than a year and maintenance treatment can help one stay ahead of the aging curve. I’m pleased to offer Pellevé to patients of The New York Aesthetic Consultants. This pain-free skin tightening option is very effective, alone or in combination with other treatments like neuromodulators (Botox and Dysport), dermal fillers, and skin resurfacing techniques.
Dermal fillers are an extremely popular aesthetic treatment in NYC for very good reasons. The procedure is minimally invasive, requiring only injections so there’s none of the risks or recovery time associated with cosmetic surgery. Fillers effectively add volume to improve facial contours and smooth the appearance of wrinkles. However, the change is subtle and natural. It is also temporary, with duration depending on the type of filler used. That can be comforting to first timers. In my experience, though, patients love the results and are eager to schedule periodic touch-ups.
One of the questions I often get from patients new to the soft tissue filler experience is, “Which dermal filler is best?” or sometimes more specifically, “Is Restylane better than other fillers?”
No one product is best. I work with a variety of soft tissue fillers because I believe that each patient deserves a customized program of injectable treatment designed to resolve his or her specific concerns. Each type of filler is FDA approved for a specific purpose, and safe to use off label in experienced hands. I also integrate neuromodulators like Botox and Dysport and light and laser resurfacing techniques into those protocols for maximum rejuvenation.
Restylane, from Medicis, is popular because the brand name gets a lot of marketing exposure, although, Juvederm from Allergan, has been gaining a considerable market share and has developed name-branding. I enjoy working with Juvederm around the mouth because of its versatility, soft-to-the touch feel after its in the skin, and how easy it flows during the treatment. The hyaluronic acid formulation grabs many times its own weight in moisture to add volume and definition to lips. I use it to further enhance the mouth by smoothing nasolabial folds (from nose to mouth) and sad mouth corners. In some cases it is appropriate for forehead lines and crow’s feet, and contouring the chin, nose, and forehead.
No, Restylane isn’t better than other dermal fillers. But it has been one of my powerful tools for delivering more youthful complexions.