image Dermatology - Dr. Jeanine Downie online

BOTOX ® Cosmetic
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Treatment for Dynamic Facial Lines and Wrinkles .

What You Should Know
image Dermatology is a National Training Center for physicians for BOTOX ® Cosmetic. Dr. Downie has been awarded a platinum recognition level. She is also faculty for the National Exchange Forum (NEF) for BOTOX ® Cosmetic and Juvederm.

When does BOTOX ® Cosmetic start to work, and how long does it last?
The results of BOTOX ® Cosmetic treatment start to appear in three to ten days. The treated muscles will gradually regain their action over three to four months. When the frown line starts to return a simple repeat treatment is all that is necessary to maintain the desired results. Therefore, the lines can be prevented if you start early enough or they can be decreased significantly if you start later.

What are the other uses of BOTOX ® Cosmetic ?
BOTOX ® Cosmetic has also been shown to soften and reduce crows feet and forehead wrinkles. BOTOX ® Cosmetic can reduce the appearance of some lines that are caused by other hyper functional facial muscles such as nose creases, neck lines, neck bands, chin dimples, and can improve a smile with a lot of gum show.

BOTOX ® Cosmetic can dramatically reduce excessive sweating from the armpits, hands, and feet for three to six months. It is now FDA approved for this medical usage.

Who can perform BOTOX ® Cosmetic treatment?
BOTOX ® Cosmetic therapy should only be performed under the direction of a physician experienced and trained in the use of BOTOX ® Cosmetic.

Has BOTOX ® Cosmetic been tested?
Absolutely! BOTOX ® Cosmetic has been used since 1980 for the treatment of strabismus (lazy eye), and blepharospasm (uncontrolled eye blinking). BOTOX ® Cosmetic has been used for hyperfunctional facial lines since 1989. Major reviews of BOTOX ® Cosmetic therapy have been published in the journal of the American Academy of Dermatology (1966; 34: 788-97), and Dermatological Surgery (1998; 24: 1168-1254). Dr. Downie has been injecting BOTOX ® since 1994 on her patients and since 1996 on herself.

Side effects?
As with any injection there can be temporary pain, swelling, redness, bruising, headache or local discomfort. The side effects are mainly related to the effect of BOTOX ® Cosmetic on local muscles. Rarely, patients have been reported to develop a slight lowering of an eyelid (ptosis), or slight lowering of the forehead. This is temporary, and resolves in a few weeks. Some patients many have a uneven or incomplete response to treatment. BOTOX ® Cosmetic does reduce the action of the muscles of facial expression. Patients with neuromuscular disorders should inform their doctor before therapy, as they may not be candidates. BOTOX ® Cosmetic therapy should not be administered during pregnancy or while breast feeding.

What is BOTOX ® Cosmetic?
BOTOX ® Cosmetic is the trade name of Botulinum Toxin Type A, a purified protein produced by the bacterium Clostridium botulinum. In large amounts, this protein blocks the nerve impulses to muscles, which causes the muscles to not be able to contract.

BOTOX ® Cosmetic, in extremely small doses, is injected directly into the specific muscles that cause frown lines. These isolated muscles are affected by the BOTOX ® Cosmetic, and can no longer contract. The action of frowning is stopped, and frown lines diminish.

Frown Lines
Frown lines are caused by the bunching of skin from facial muscle contraction. When we frown the skin between our eyebrows is gathered into a fold which eventually causes a chronic furrow. This gives our face a frustrated, discouraged, and angry look which is distracting to others and a bother to ourselves.

Now you can soften and reduce these frown lines without surgery and without scars, by a simple five to ten minute treatment with BOTOX ® Cosmetic.

Where do you put the BOTOX ® Cosmetic?
The frown line between the eyebrows is caused by the action of a muscle called the corrugator. You can feel this muscle as a thickening just below the inside of your eyebrows, when you purposefully make yourself frown.

Injecting BOTOX ® Cosmetic directly into the corrugator muscle stops your ability to draw your eyebrows together when you frown. Once the muscle is relaxed, it cannot contract, and the frown line gradually fades away.

BOTOX ® Cosmetic can also be placed in forehead lines, crow's feet and around the mouth and chin. The FDA has approved BOTOX ® Cosmetic for cosmetic treatment of frown lines between the eyebrows and they are currently in clinical trials for FDA approval for treatment of forehead lines and crow's feet. Finally, BOTOX ® Cosmetic is used to decrease sweating and can be injected in the armpits, hands and feet.

General Before and After

General Before and After

Before and After, Frowning

Before and After, Frowning

Before and After, Raised Forehead

Before and After, Raised Forehead

BOTOX ® Cosmetic
Quick reference guide

What is BOTOX ® Cosmetic?
It's a simple, nonsurgical procedure that smoothes the lines between your brows. The natural, purified protein relaxes the muscles that cause wrinkles.

What is a BOTOX ® Cosmetic procedure like?
It's a simple, 10-minute treatment that consists of a few tiny injections. The doctor decides exactly where to administer the BOTOX ® Cosmetic for the best results.

Is the procedure painful?
Most patients compare the sensation to a bug bite. Overall, the discomfort is minimal and temporary.

Is the procedure safe?
BOTOX ® Cosmetic is a natural, purified protein that is administered at very low does. The effects of BOTOX ® Cosmetic are usually confined to injected region. It does not travel throughout the body.

Will I need anesthesia?
No. But your doctor may choose the numb the injected area with a cold pack or anesthetic cream before the actual treatment.

Do I need to take time off from work to recuperate?
Most patients go right back to work or continue their activities immediately after the procedure.

When will I start to see results?
You should begin to see a significant improvement within a few days.

How long will the effects last?
The effects of BOTOX ® Cosmetic last up to 4 months.

Will I experience any side effects?
It's unlikely that you'll develop any significant side effects, but you many notice a slight bruising where BOTOX ® Cosmetic was injected. This is only temporary and can be covered by makeup. The most common side effects are headache, respiratory infection, flu syndrome, temporary eyelid droop, and nausea. BOTOX ® Cosmetic should not be used if there is an infection at the injection site.

Will my facial expressions look unnatural?
Although the results are dramatic, it will not radically change your facial appearance. The muscles are simply relaxed, so you can still frown, smile, or look surprised without the wrinkles and creases.

Is BOTOX ® Cosmetic expensive?
Actually, it's quite affordable. In fact, BOTOX ® Cosmetic is one of the least expensive facial aesthetic procedures, ranking 7th in the 9 most widely used procedures in the country.

How can I find out more about BOTOX ® Cosmetics?
You can visit the Web site www.BOTOX ® Cosmetic.net

Hyperhidrosis
BOTOX ® Cosmetic (botulinum toxin type A) is FDA approved for the treatment of severe primary axillary hyperhidrosis (underarm sweating). A debilitating medical condition, excessive underarm, hand and foot sweating affects an over 7 million Americans.

As this condition affects millions of people and many people who suffer from primary underarm sweating do not realize they have a chronic, but treatable, medical condition, and that many physicians are not fully aware of how to diagnosis and treat hyperhidrosis.

In the Phase III clinical study that involved 322 patients, more than 80 percent treated with BOTOX ® Cosmetic experienced a greater than 50 percent decrease in underarm sweat production. The treatment, administered by injection, lasted an average of 6.5 months.

When current topical treatments do not produce the desired results, BOTOX ® Cosmetic may provide many patients living with severe primary axillary hyperhidrosis with an effective alternative. BOTOX ® Cosmetic is contraindicated in the presence of infection at the proposed injection site and in individuals with known hypersensitivity to any ingredient in the formulation. Serious or immediate hypersensitive reactions have been rarely reported. These reactions included anaphylaxis, urticaria, soft tissue edema, and dyspnea. If such a reaction occurs, further injection of BOTOX ® Cosmetic should be discontinued and appropriate medical therapy should be immediately instituted.

Hyperhidrosis can be measured using the Hyperhidrosis Disease Severity Scale (HDSS),
A four-point scale designed to assess the severity of primary axillary hyperdrosis in everyday clinical practice or in clinical research. The HDSS can be administered by an interview of self-completed by the patient. Patients rate the severity as:

1= “Underarm sweating never noticeable/never interferes with daily activities”,
2= “Underarm sweating tolerable/sometimes interferes with my daily activities”,
3= “Underarm sweating barely tolerable/frequency interferes with my daily activities”,
4= “Underarm sweating intolerable/always interferes with my daily activities”.

About BOTOX ® Cosmetic
BOTOX ® Cosmetic is a sterile, purified protein that works by blocking the nerve impulses that, in the case of severe primary axillary hyperhidrosis ineffectively managed with topical agents marks the fourth therapeutic indication for BOTOX ® Cosmetic in the U.S. Worldwide, BOTOX ® Cosmetic is currently one of the most widely researched medicines with approximately 20 approved indication in more than 70 countries.

Hair Loss
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Hair has been called our "crowning glory." Society has placed a great deal of social and cultural importance on hair and hairstyles. Unfortunately, many conditions, diseases, and improper hair care result in excessive hair loss.

People who notice their hair shedding in large amounts after combing or brushing, or whose hair becomes thinner or falls out, should consult a dermatologist. With correct diagnosis, many people with hair loss can be helped.

Dermatologists specialize in treating diseases of the hair and skin, will evaluate a patient's hair problem by asking questions about diet, medications including vitamins and health food products taken in the last six months, family history of hair loss, recent illness and hair care habits.

Hormonal effects may be evaluated in women by asking about menstrual cycles, pregnancies and menopause. After examining the scalp and hair, the dermatologist may check a few hairs under the microscope. Sometimes blood tests or a scalp biopsy may be required for an accurate diagnosis. It is important to find the cause and whether or not the problem will respond to medical treatment.

Normal Hair Growth
About 90 percent of the hair on a person's scalp is growing at any one time. The growth phase lasts between two and six years. Ten percent of the hair is in a resting phase that lasts two to three months. At the end of its resting stage, the hair is shed. When a hair is shed, a new hair from the same follicle replaces it and the growing cycle starts again. Scalp hair grows about one-half inch a month. As people age, their rate of hair growth slows. Natural blondes typically have more hair (140,000 hairs) than brunettes (105,000 hairs) or redheads (90,000 hairs). Most hair shedding is due to the normal hair cycle, and losing 50-to-100 hairs per day is no cause for alarm. However, if you are concerned about excessive hair loss or dramatic thinning, consult your dermatologist.

Causes of Excessive Hair Loss
Improper Hair Cosmetic Use/Improper Hair Care - Many men and women use chemical treatments on their hair, including dyes, tints, bleaches, strengtheners and permanent waves. These treatments rarely damage hair if they are done correctly. However, the hair can become weak and break if any of these chemicals are used too often. Hair can also break if the solution is left on too long, if two procedures are done on the same day, or if bleach is applied to previously bleached hair. If hair becomes brittle from chemical treatments, it's best to stop until the hair has grown out.

Hairstyles that pull on the hair, like ponytails and braids, should not be pulled tightly and should be alternated with looser hairstyles. The constant pull causes some hair loss, especially along the sides of the scalp.

Shampooing, combing and brushing too often can also damage hair, causing it to break. Using a cream rinse or conditioner after shampooing will make it easier to comb and more manageable. When hair is wet, it is more fragile, so vigorous rubbing with a towel, and rough combing and brushing should be avoided. Don't follow the old rule of 100 brush strokes a day-that damages hair. Instead, use wide toothed combs and brushes with smooth tips.

Hereditary Thinning or Balding - Hereditary balding or thinning is the most common cause of hair loss. The tendency can be inherited from either the mother's or father's side of the family.

Women with this trait develop thinning hair, but do not become completely bald. The condition is called androgenetic alopecia and it can start in the teens, twenties or thirties. There is no cure, although medical treatments have recently become available that may help some people. One treatment involves applying a lotion, minoxidil, to the scalp twice a day. Another treatment for men is a daily pill containing finasteride, a drug that blocks the formation of the active male hormone in the hair follicle.

When confronted with thinning hair or baldness, men and some women consider hair transplantation, which is a permanent form of hair replacement. Anyone who has suffered permanent hair loss may be a candidate for hair transplantation. The procedure of hair transplantation involves moving some hair from hair-bearing portions (donor sites) of the head to bald or thinning portions (recipient sites) and/or removing bald skin. Because the procedures involve surgery as well as time and money, they should not be undertaken lightly.

Your dermatologist will help decide which method or combination of methods is right for you.

Alopecia Areata - In this type of hair loss, hair usually falls out, resulting in totally smooth, round patches about the size of a coin or larger. It can, rarely, result in complete loss of scalp and body hair. This disease may affect children or adults of any age.

The cause of alopecia areata is unknown. Apart from the hair loss, affected persons are generally in excellent health. In most cases, the hair regrows by itself. Dermatologists can treat many people with this condition. Treatments include injections, topical medications, a special kind of light treatment, or in some cases pills.

Childbirth - When a women is pregnant, more of her hairs will be growing. However, after a woman delivers her baby, many hairs enter the resting phase of the hair cycle. Within two to three months, some women will notice large amounts of hair coming out in their brushes and combs. This can last one to six months, but resolves completely in most cases.

High Fever, Severe Infection, Severe Flu - Illnesses may cause hairs to enter the resting phase. Four weeks to three months after a high fever, severe illness or infection, a person may be shocked to see a lot of hair falling out. This shedding usually corrects itself.

Thyroid Disease - Both an over-active thyroid and an under-active thyroid can cause hair loss. Your physician can diagnosis thyroid disease with laboratory tests. Hair loss associated with thyroid disease can be reversed with proper treatment.

Inadequate Protein in Diet - Some people who go on crash diets that are low in protein, or have severely abnormal eating habits, may develop protein malnutrition. The body will save protein by shifting growing hairs into the resting phase. Massive hair shedding can occur two to three months later. Hair can then be pulled out by the roots fairly easily. This condition can be reversed and prevented by eating the proper amount of protein and, when dieting, maintaining adequate protein intake.

Medications - Some prescription drugs may cause temporary hair shedding. Examples include some of the medicines used for the following: gout, arthritis, depression, heart problems, high blood pressure, or blood thinners. High doses of vitamin A may also cause hair shedding.

Cancer Treatments - Some cancer treatments will cause hair cells to stop dividing. Hairs become thin and break off as they exit the scalp. This occurs one to three weeks after the treatment. Patients can lose up to 90 percent of their scalp hair. The hair will regrow after treatment ends. Patients may want to get wigs before treatment.

Birth Control Pills - Women who lose hair while taking birth control pills usually have an inherited tendency for hair thinning. If hair thinning occurs, a woman can consult her gynecologist about switching to another birth control pill. When a women stops using oral contraceptives, she may notice that her hair begins shedding two or three months later. This may continue for six months when it usually stops. This is similar to hair loss after the birth of a child.

Low Serum Iron - Iron deficiency occasionally produces hair loss. Some people don't have enough iron in their diets or may not fully absorb iron. Women who have heavy menstrual periods may develop iron deficiency. Low iron can be detected by laboratory tests and can be corrected by taking iron pills.

Major Surgery/Chronic Illness - Anyone who has a major operation may notice increased hair shedding within one to three months afterwards. The condition reverses itself within a few months but people who have a severe chronic illness may shed hair indefinitely.

Fungus Infection (Ringworm) of the Scalp - Caused by a fungus infection, ringworm (which has nothing to do with worms) begins with small patches of scaling that can spread and result in broken hair, redness, swelling, and even oozing. This contagious disease is most common in children and oral medication will cure it.

Hair Pulling (Trichotillomania) - Children and sometimes adults will twist or pull their hair, brows or lashes until they come out. In children especially, this is often just a bad habit that gets better when the harmful effects of that habit are explained. Sometimes hair pulling can be a coping response to unpleasant stresses and occasionally is a sign of a serious problem needing the help of a mental health professional.

Questions?
See Dr. Downie - Excess hair loss can have many different causes. Hair will regrow spontaneously in some forms of hair loss. Other forms can be treated successfully by a dermatologist. For the several forms of hair loss for which there is no cure at present, there is research in progress that holds promise for the future.

Laser Treatments
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Why is Lyra The Best Solution?
The Lyra is the first laser FDA cleared for hair removal in all skin types. Lyra is the first and only treatment FDA cleared for the treatment of shaving bumps.

Prior to Lyra, dark complected and tanned patients could not be treated with a laser due to the high absorbency of light in the pigment of the skin.

Lyra's low absorption in pigment makes it an ideal and safe treatment, achieving outstanding results while maintaining the normal appearance of the skin.

Shaving bumps "no more"

How Does Lyra Work?
Lyra's laser beam passes through the skin and is absorbed in the hair follicle residing underneath the skin's surface. The laser energy destroys the follicle with the heat it generates. Destroyed hairs are then either dissolved within the skin or ejected by the body.

Because the laser beam is larger in diameter than the hair follicle, a large number of hairs can be treated simultaneously.

What Should I Expect During Treatment?
Most patients experience a stinging or burning sensation when a laser pulse is delivered. While general anesthesia will not be required, a topical anesthetic may be applied to sensitive skin. To further reduce discomfort, Lyra utilizes a special patented cooling system that lowers the temperature of the skin at the treatment site before, during and after laser exposure.

Unlike electrolysis, which requires a needle to be inserted into each hair follicle, this laser system can be used to quickly treat large areas of the body. It is a safe and gentle methods for removing unwanted hair without skin irritation, discoloration or inflammation associated with other lasers or hair removal methods.

How Many Treatments Will Be Needed?
The number of treatments required to obtain optimal results varies with hair density, hair color, skin types, the treatment area and your hair growth cycle. The density of your hair and its growth cycle are affected by many things such as your age, ethnic background, hormones or medications. Laser treatments impair the growth capacity of hair follicles when they are in a growth cycle at the time of treatment. All hair follicles are not active at the same time. Depending upon the growth cycle of the follicles when the treatment is applied, several treatments with a few weeks in between may be required to obtain the desired effect.

What Should I Expect After Treatment?
After treatment with Lyra, you may return to your regular routine immediately. Some patients may experience a slight reddening around the hair follicles immediately following treatment. This reaction typically disappears within a few minutes.

It may seem that the hair continues to grow for a period of one or two weeks after laser treatment, but in fact, these hairs are actually lifeless and are simply being cast out of your body.

What Is Pseudo-Folliculitis?
Pseudo-folliculitis (PF), commonly known as shaving bumps, is an inflammatory condition, widespread among individuals with thick curly hair. As the hair grows out of the skin, it curls and re-enters the skin. The skin reacts to it as a foreign object and becomes inflamed and irritated, creating bumps and discoloration. Often hairs start curling even before growing out of the skin, creating ingrown hairs. The bumps become quite large, causing discomfort to the patient. Sometimes relief can be achieved with the use of topical steroids and exfoliating agents. Growing hair is sometimes curative as well. More commonly though, the ingrown hair is pulled out after each shaving session.

Although this is a solution, it can be painful and time consuming. Don't Settle For Out-Of-Date Solutions. The old fashioned ways of removing hair - shaving, tweezing, creams, waxing - are time consuming and short lasting. And although electrolysis can permanently remove hair, it is an extremely slow and painful method. But you don't have to settle for out-of-date solutions. Now you can obtain long-lasting results with laser hair removal treatments. The Laserscope Lyra laser system delivers long-pulse laser light down to the follicles, destroying them or impairing their growth. The laser beam is computer guided and passed through a cooling window to protect your skin. You are assured of gentle treatments that produce smooth results.

The laser light shown here is targeting the hair within the hair follicle

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Skin Cancer Removal
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Skin cancer is the most prevalent of all cancers. It is estimated that more than one million Americans develop skin cancer every year.

Sun avoidance is the best defense against skin cancer.

Over exposure to sunlight (including tanning) is the main cause of skin cancer especially when it results in sunburn and blistering. Other less important factors include: repeated medical and industrial x-ray exposure, scarring from diseases or burns, occupational exposure to such compounds as coal tar and arsenic, and family history. Fair-skinned people who sunburn easily are at particularly high risk for skin cancer.

Prevention means guarding the skin against the known causes of skin cancer. Since the sun's ultraviolet rays are the main culprit, the most effective preventive method is sun avoidance.

Seek shade between 10:00 A.M. to 4:00 P.M. when the ultraviolet rays are the most intense, especially when your shadow is shorter than you are tall.
Wear light-colored, tightly-woven, protective clothing, and wide-brimmed hats (3-inch brim).
Apply sunscreens with a SPF (Sun Protection Factor) of at least 15.
Wear UVA/UVB protective sunglasses

With a SPF 15 sunscreen applied properly, a fair-skin person who sunburns in 20 minutes can tolerate 15 times 20 minutes (300 minutes) without burning. However, the use of sunscreens should not be an excuse to spend extra time in the sun because other sunrays still go through the sunscreen, such as UVA or infrared, which can age the skin and damage the skin's immune system. Begin early use of sun protection in childhood because it is estimated that 80 percent of lifetime sun exposure occurs before age 18. Children under 6 months of age should not have prolonged sun exposure.

The use of sunscreen should always be part of a program for sun avoidance and never as an excuse for increasing sun exposure.

Early detection is the surest way to a cure.
Develop a regular routine to inspect your body for any skin changes using the simple procedures suggested at the end of this section. If any growth, mole, sore, or skin discoloration appears suddenly, or begins to change, see your dermatologist. Each of the skin cancers depicted on the following pages can be readily detected.

Precancerous Skin Conditions
Actinic keratoses are small scaly spots most commonly found on the face, lower arms, and back of the hands in fair-skinned individuals who have had significant sun exposure. If not treated, some actinic keratoses may become skin cancers, requiring more extensive treatment. If diagnosed in the early stages, actinic keratoses can be removed by cryotherapy (freezing), by applying a cream or lotion form of chemotherapy, or by chemical peeling, dermabrasion, laser surgery or other dermatologic surgical procedures. Sunscreens help prevent actinic keratoses.

Actinic Keratosis

Cancerous Skin Conditions
There are three forms of skin cancer:

Basal Cell Carcinoma - This skin cancer usually appears as a small, fleshy bump or nodule - most often on the head, neck, and hands. Occasionally these cancers may appear on the trunk as red patches. Basal cell carcinomas seldom occur in African Americans, but they are the most common skin cancers found in fair-skinned persons. People who have this cancer often have light-colored eyes, hair and complexions, and don't tan easily. These tumors don't spread quickly. It can take many months or years for one to grow to a diameter of one-half inch. Untreated, the cancer will begin to bleed, crust over, heal, and then the cycle repeats. These skin cancers can also ulcerate and invade soft tissue and organs.

Basal Cell Carcinoma

Although this type of cancer rarely metastasizes (spreads to other parts of the body), it can extend below the skin to the bone and cause considerable local damage.

Squamous Cell Carcinoma - This skin cancer may appear as a bump, or as a red, scaly patch. Squamous cell carcinoma is the second most common skin cancer found in fair-skinned persons. Typically, it is found on the rim of the ear, the face, the lips, and mouth. It is rarely found in dark-skinned persons. This cancer can develop into large masses. Unlike basal cell carcinoma, it can metastasize. When found early, and treated properly, the cure rate by dermatologic surgery for both basal cell and squamous cell carcinoma is 95 percent.

Squamous Cell Carcinoma

Malignant Melanoma - It is projected that this most deadly of all skin cancers will develop on the skin of 44,000 Americans annually. Every year, an estimated 7,300 Americans will die from melanoma. It is important to note that the death rate is at last declining because patients are seeking help earlier. Like the less aggressive skin cancers, basal cell and squamous cell carcinomas, melanoma is almost always curable when detected in its early stages.

Melanoma has its beginnings in melanocytes, the skin cells that produce the dark, protective pigment called melanin. It is melanin that makes the skin tan, acting as partial protection against sun. Melanoma cells usually continue to produce melanin, which accounts for the cancers appearing in mixed shades of tan, brown, and black. Melanoma can also be red or white. Melanoma tends to spread, making treatment essential.

Melanoma may suddenly appear without warning, but it may also begin in, or near a mole, or another dark spot in the skin. It is important to know the location and appearance of the moles on our bodies so any change will be noticed. The most important step you can take is to have any changing mole examined by a dermatologist so that any early melanoma can be removed while still in the curable stage.

Excessive sun exposure, particularly sunburn, is the most important preventable cause of melanoma, especially among light-skinned individuals. Heredity also plays a part since a person has an increased chance of developing melanoma if a family member has had melanoma. Atypical moles (dyplastic nevi), which may run in families, and a high number of moles, can serve as markers for people at higher risk for developing melanoma.

Dark brown or black skin is not a guarantee against melanoma. Dark-skinned people can develop melanoma, especially on the palms of the hands, soles of the feet, on the genitals, in the buttocks, under nails, or in the mouth. Warning signs of melanoma include: changes in the surface of a mole; scaliness, oozing, bleeding, or the appearance of a new bump; spread of pigment from the border into surrounding skin; and change in sensation including itchiness, tenderness, or pain.

How Skin Cancer is Treated - If a skin biopsy reveals that an area of the skin is cancerous, the dermatologist has an array of surgical procedures to treat the cancer depending on the needs of the individual patient. Early detection and removal offer the best chance for a cure.

Dermatologists recommend that one helpful way to discover early skin cancers is to do periodic self-examinations. Get familiar with your skin and your own pattern of moles, freckles, and "beauty marks." Watch for changes in the number, size, shape, and color of pigmented areas. Call your dermatologist if any changes are noticed.

Asymmetry - One half doesn't match the other half.

Border irregularity - The edges are ragged, notched or blurred

Color - The pigmentation is not uniform. Shades of tan, brown, and black are present. Dashes of red, white, and blue add to the mottled appearance.

Diameter - The width is greater than six millimeters (about the size of a pencil eraser). Any growth of a mole should be of concern.

Periodic Self-Examination - Prevention of melanoma/skin cancer is the best weapon against these diseases. But if a melanoma should develop, it is almost always curable if caught in the early stages. Practice periodic self-examination to aid in early recognition of any new or developing lesion. The following is one way of self-examination. To perform your self-examination you will need a full length mirror, a hand mirror and a brightly-lit room.

Examine body front and back in mirror, then right and left sides, arms raised.
Bend elbows, look carefully at forearms, back of upper arms, and palms.
Next, look at backs of legs and feet, spaces between toes, and soles.
Examine back of neck and scalp with a hand mirror. Part hair to lift.

Spider Vein, Varicose Vein Therapy
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Spider veins are small-enlarged superficial blood vessels that appear red or blue. They commonly occur on the legs, but frequently occur on the face or elsewhere.

These dilated blood vessels may be short, unconnected lines each about the size of a large hair or connected in a matted, "sunburst" pattern.

They may also look like a spider web or a tree with branches. Sometimes, they occur in a small area and aren't very noticeable, or they can cover a large area of skin and be quite unattractive.

Larger dilated blood vessels called varicose veins may be raised above the skin surface. They may occur along with spider veins.

Patients can have pain, ranging from a dull throbbing pain to a burning sensation. The larger vessels are more likely to cause discomfort, although smaller blue veins have been shown to cause pain.

If spider veins are unsightly or uncomfortable, they can be treated with laser or by injection of a solution that will cause them to disappear or become much smaller. There is about a 50 - 90 percent chance for a greatly improved appearance.

What causes these blood vessels to become visible?
The cause of spider veins is not completely known. In many cases they seem to run in families. Identical twins can be affected in the same area of the body and to the same extent. The condition rarely occurs as part of an internal disease. Obesity and crossing your legs typically make spider veins worse.

Spider veins appear in both men and women, but more frequently in women. The female hormones may play a role in their development. Puberty, birth control pills, pregnancy or hormone replacement therapy often seem to bring them out. They may also appear after an injury or as a result of wearing tight girdles or hosiery held up with tight rubber bands. Spider veins may also occur in association with large varicose veins.

Spider veins on the nose or the cheeks of fair skinned persons may be related to sun exposure.

Can spider veins be prevented?
Spider veins can't always be prevented. Wearing support hose may minimize unwanted blood vessels from developing. Keeping one's weight at a normal level and exercising regularly may also be helpful. Eating a high-fiber diet and wearing low-heeled shoes may also help. Sun protection is important to limit the number of unwanted vessels on the face and it can help with the legs.

How are unwanted blood vessels on the legs treated?
The injection method, a procedure called sclerotherapy is used to treat unwanted blood vessels. One of several kinds of solutions, called sclerosing solution, is injected with a very fine needle directly into the blood vessel. This procedure has been used for spider veins since the 1930's and before that for larger veins. The solution irritates the lining of the vessel, causing it to swell and stick together and the blood to thicken. Over a period of weeks, the vessel turns into scar tissue that is absorbed, eventually becoming barely noticeable or invisible.

Sclerotherapy

A single blood vessel may have to be injected more than once, some weeks or months apart, depending on its size. In any one treatment session a number of vessels can be injected.

The solutions available are slightly different and the choice of which solution to use depends on several factors including the size of the vessel to be injected. Dr. Downie will choose a solution that is best for your particular case.

Occasionally larger varicose veins are underneath or associated with the spider veins. In such cases, some physicians believe these vessels should be treated before the spider veins. This can be done by sclerotherapy or intravascular laser followed by compression.

How successful is sclerotherapy?
After several treatments, most patients can expect a 50 percent to 90 percent improvement. However, fading is gradual, usually over months. Disappearance of spider veins is usually achieved, but similar veins may appear in the same general area.

Can sclerotherapy or lasers be used on all skin types?
Yes. All skin types and skin colors respond equally well.

Will insurance cover the treatment of unwanted blood vessels?
Usually not. Insurance rarely covers treatment of spider veins but may sometimes cover larger vein treatment. If the treatment is solely for cosmetic reasons, it will not be covered. Sometimes a second opinion, laboratory studies or photographs are required by insurance companies before treatment is started to get the procedure covered for larger varicose veins.

Are there side effects to spider vein treatments?
Even with a highly experienced physician performing the treatment, there are some possible side effects. They include:

Stinging or pain at the sites of injection, swelling of the ankles or feet or muscle cramps - Some solutions for injection are relatively pain-free. Muscle cramps almost always occur when the injection solution is hypertonic saline. These usually go away within 10 to 15 minutes after injection.

Red, raised areas at the sites of injection - These should disappear within a day or so and are like hives.

Brown lines or spots on the skin at the sites of treated blood vessels - Probably made up of a form of iron in the blood, these darkened areas may result when blood escapes from treated veins. These dark areas occur more often in patients who have larger veins treated. In most cases, they disappear within 6 months to a year, but in a small percent of patients they may last longer. Laser treatment may cause skin discoloration.

Development of groups of fine red blood vessels near the sites of injection of larger vessels, especially on the thighs - About a third of patients develop these; most disappear by themselves, some go away with additional injection treatment or laser therapy, a few may last.

Small, painful ulcers at treatment sites either immediately or within a few days of injection - These occur when some of the solution escapes into the surrounding skin or enters a tiny artery at the treatment site. These can be successfully treated, but it is necessary to inform the physician of them immediately. Lasers may cause small areas of skin breakdown, which look like insect bites and heal rapidly.

Bruises at the site where the needle went into the skin - These will disappear in a few weeks and are probably related to the thinness of blood vessel walls.

Allergic reactions to certain sclerosing solutions - Although such reactions can be serious, they are extremely rare and can be treated by your dermatologist. Minor reactions can be treated with antihistamines.

Before
sclerotherapy

After 6 weeks
of sclerotherapy

After 14 weeks
of sclerotherapy

Inflammation of treated blood vessels - This is very unusual but when it occurs it is treated with medications such as aspirin, compression, antibiotics or heat.

Lumps in injected vessels, particularly larger ones, may develop - This is coagulated blood, similar to a bruise within the vein, but is not dangerous. The dermatologist may drain the blood out of these areas a few weeks after injection.

Will treated veins recur?
Larger veins may recur even after surgical procedures. Spider veins may also recur and it is quite common for new vessels to form. It may seem that a previously injected vessel has recurred, when, in fact, a new spider vein has appeared in the same area.

Is a history of blood clots in the lungs or legs a reason to avoid therapy?
Not necessarily, but the procedure must be done with caution to lessen the risk of blood clots.

Are there other treatment methods?
For larger varicose veins, radiofrequency may be used instead of stripping. Great advances have been made in the use of ultrasound to guide injection of varicose veins not visible at the skin surface.

Surgically tying veins off (ligation) or pulling them out (ambulatory phlebectomy) are other procedures for treating unwanted blood vessels. These methods are usually reserved for larger varicose veins.

How are spider veins on the face treated?
There are several ways to treat spider veins on the face. Many different lasers and intense pulsed light have been used quite successfully.

What do I do after treatments?
Physicians may differ in their after-treatment instructions to patients. Most advise their patients to "pump" the sclerosing solution out of the circulation by walking following the procedure.

Some physicians bandage the injected areas and instruct patients to "compress" the treated vessels by wearing support hose. This may help seal the treated vessels, keep the blood from collecting under the skin and reduce the development of dark spots. It also may reduce the number of treatments necessary, and the possibility of recurrence. Others put tape dressings on the areas and do not use compression unless the veins are large or in special locations.

Between treatments, many physicians recommend the use of compression or support hose. This may be particularly recommended for people who spend a lot of time on their feet or work in a standing occupation.

The treatment of spider and varicose veins can be successful. Treatment methods vary depending on the size and location of the abnormal veins. The injection method is presently most commonly used but great advances have been made in other techniques such as lasers.

Mole & Skin Tag Removal
Removing annoying moles or skin tags is quick and easy. Please visit Dr. Downie at image Dermatology to make your own image a mole-free one. Dr. Downie specializes in mole removal from the face, neck and any other areas of your body.

In many cases she can remove the mole on the same day as the initial consult. These moles are then sent off to a separate laboratiory for microscopic evaluation. Laboratory results are usually available within ten days.

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Restylane and Perlane

Restylane®
…..Redefining beauty™
Including Perlane®

Long-lasting wrinkle correction for about six months…

The newest member of the Restylane® family:Perlane®
Before choosing a dermal filler treatment, there are a few things you should know.

What are Restylane® and Perlane®?
The Restylane® family of products includes Restylane® and Perlane®. Both are cosmetic dermal fillers that replace lost volume and restore youthful contours to the skin to smooth away moderate to severe facial wrinkles and folds, such as the lines from your nose to the corners of your mouth (nasolabial folds).

How do I choose between Restylane® and Perlane®?
You don’t have to. In clinical trials, Restylane® and Perlane® were used in the same patients. The hyaluronic acid in both products is made by the same biotechnical process. The difference is in the gel particle size. Perlane® gel particles are larger and designed for deeper injection than Restylane®. Dr. Downie will decide which product is right for you.

How does Dr. Downie know when to use Restylane® and Perlane®?
Dr. Downie will decide which product is right for you based upon an evaluation of facial wrinkles and folds.

How long do Restylane® products last?
Restylane® products are proven to deliver long-lasting results. Restylane® lasts about six months. Perlane® lasts at least six months, in a majority of patients. The products’ patented stabilization technology helps maintain the cosmetic effect for those time periods.

Are Restylane® and Perlane® FDA approved?
Yes. They are approved by the FDA for the treatment of moderate to severe facial wrinkles and folds, like the ones from your nose to the corners of your mouth. Ask Dr. Downie whether treatment is right for you.

What is the history of Restylane®?
Restylane® has been used in over 1.4 million treatments in the U.S. and is available in more that 70 countries. It is the most-studied cosmetic dermal filler in the world with dozens of publications in medical literature. Clinical studies showed no significant differences in the safety of Restylane® and Perlane®.

What should patients do prior to treatment?
Restylane® and Perlane® require no pretesting, but you should take a few precautions before being treated. Avoid using aspirin, non-steroidal anti-inflammatory medications, St. John’s Wort, or high doses of Vitamin E supplements prior to treatment, because these may increase bruising or bleeding at the injection site. Also, if you have previously suffered from facial cold sores, discuss this with Dr. Downie, who may prescribe a medication to minimize reoccurrence.

Do Restylane® and Perlane® require an allergy test?
No. Restylane® and Perlane® do not require an allergy test and can be administered immediately—no waiting is required.

How are Restylane® products administered?
Restylane® and Perlane® are administered by injection to the treatment site. Before treatment talk to Dr. Downie about pain management.

Is any of the material left in the skin after it has dissolved?
Restylane® products are injected directly into the skin in small amounts by an ultrafine needle. As with all injections, some patients may experience discomfort. To increase your comfort, Dr. Downie will assess your need for pain management and determine what technique is right for you.

How much do treatments cost?
A Restylane® or Perlane® procedure is customized to your specific needs, so the cost will vary. In general, the cost is comparable to the cost of similar procedures. Ask Dr. Downie to give a cost estimate based on your particular needs.

How often should I schedule an appointment?
How long the aesthetic correction lasts is very individual. Talk to Dr. Downie about the benefits of scheduling a follow-up appointment in about six months.

What are Restylane® and Perlane® products made of?
Restylane® was the first cosmetic dermal filler made for hyaluronic acid that has been modified slightly to last longer than the body’s hyaluronic acid. In the human body natural hyaluronic acid provides volume and fullness to the skin.

How are Restylane® products different than other hyaluronic acid-based products?
Restylane® and Perlane® contain no animal proteins. This limits any risk of animal-based disease transmission or allergic reaction. You should not use Restylane® or Perlane® if you have allergies to microorganisms known as gram-positive bacteria.

How do Restylane® and Perlane® products differ from Botox® Cosmetic?
Botox® Cosmetic and Restylane® are used to correct wrinkles in different ways.

Restylane® products are natural, cosmetic fillers injected into the skin, adding volume to smooth wrinkles such as the lines from your nose to the corners of your mouth (nasolabial folds). In contrast, Botox® relaxes the muscles that cause frown lines between your eyebrows.

Important safety considerations of Restylane®
Restylane® restores volume and fullness to the skin to correct moderate to severe facial wrinkles and folds, such as the lines from your nose to the corners of your mouth (nasolabial folds). After your treatment, you might have some swelling and redness. This will normally last less than seven days. Although rare, red or swollen small bumps may occur. If you have had herpes before, an injection can cause the herpes to return. In rare circumstances, Dr. Downie may inject into a blood vessel, which can damage the skin. To avoid bruising and bleeding, you should not use Restylane® if you have recently used drugs that thin your blood or prevent clotting. If you are pregnant, breastfeeding, or under 18, you shouldn't use Restylane®.

Restylane® should not be used by people with previous bad allergies, particularly to certain microorganisms known as gram-positive bacteria, or by people with previous bad allergies to drugs that have required in-hospital treatment. Restylane® should not be injected anywhere except the skin or just under the skin.

The use of Restylane® at the site of skin sores, pimples, rashes, hives, cysts, or infection should be postponed until healing is complete. Use of Restylane® in these instances could delay healing or make your skin problems worse.

Important safety considerations of Perlane®
Perlane® restores volume and fullness to the skin to correct moderate to severe facial wrinkles and folds, such as the lines from your nose to the corners of your mouth' (nasolabial folds). After your treatment, you might have some swelling, redness, pain, and bruising. This will normally last less than seven days. Although rare, red or swollen small bumps may occur. If you have had herpes before, an injection can cause the herpes to return. In rare circumstances, Dr. Downie may inject into a blood vessel, which can damage the skin. To avoid bruising and bleeding, you should not use Perlane® if you have recently used drugs that thin your blood or prevent clotting. If you are pregnant, breastfeeding, or under 18, you shouldn't use Perlane®.

Perlane® should not be used by people with previous bad allergies, particularly to certain microorganisms known as gram-positive bacteria; by people with previous bad allergies to drugs that have required in-hospital treatment; or by people with bleeding disorders. Perlane® should not be injected anywhere except the skin or just under the skin.

The use of Perlane® at the site of skin sores, pimples, rashes, hives, cysts, or infection should be postponed until healing is complete. Use of Perlane® in these instances could delay healing or make your skin problems worse.

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M.D.forte Skin Care