Skin Conditions: In-Office Dermatology Treatments

Newer dermatologic treatments, including Botox, laser surgery, and dermabrasion, are now available and can be performed in the dermatologist’s office.

Botox

Botox injection is a cosmetic procedure used to reduce fine lines and wrinkles. Botox is the brand name of a toxin produced by the bacterium Clostridium botulinum. Small, diluted amounts can be injected directly into specific muscles, causing controlled weakening of the muscles. As a result, the injected muscle cannot contract, causing the wrinkles to relax and soften. Botox is most often used on forehead lines, crow’s feet (lines around the eye), and frown lines.

The procedure takes only a few minutes and no anesthesia is required. Botox is injected with a fine needle into specific muscles with only minor discomfort. It generally takes three to seven days to take full effect.

The most common side effect is temporary bruising. A small percentage of patients may develop eyelid drooping, which usually resolves in three weeks. This development is usually caused by migration of the Botox; for this reason, you shouldn’t rub the treated area for 12 hours after injection or lay down for 3 to 4 hours.

Chemical Peel Treatments

A chemical peel, also known as dermapeeling, is a technique in which a chemical solution is applied to the skin. The affected skin peels off, leaving the new skin smoother.

Chemical peels are performed on the face, neck or hands. They can help reduce:

  • Mild scarring
  • Certain types of acne
  • Wrinkles
  • Sun spots
  • Liver (age) spots
  • Freckles
  • Dark patches caused by pregnancy or birth control pills

To perform a chemical peel, the doctor cleanses the skin and then applies a chemical solution (such as glycolic acid, trichloroacetic acid, or salicylic acid) to small areas on the skin. These applications produce a wound, paving the way for regenerated skin.

After the chemical peel, your skin will be red and will peel for up to a week before the benefits can be seen. The process can be repeated as necessary.

Possible side effects include reactivation of cold sores (herpes infection) in patients with a history of herpes outbreaks. This can be prevented or treated with an oral medication.

Dermabrasion

Dermabrasion, or surgical skin planing, is an abrasive procedure that “sandblasts” the skin to create a smoother layer of skin. Dermabrasion is used to treat scars, pox marks, age (liver) spots, and skin lesions.

In the dermabrasion procedure, the doctor cleans and freezes the skin. To perform the abrasion, the doctor uses a high-speed instrument equipped with a wheel or brush to strip off the top layers of skin.

Your skin will feel rough and “burned” after the dermabrasion procedure, and will be pink for a while before the benefits of dermabrasion can be seen. Stay out of the sun for several months and be sure to use sunscreen when you do go outdoors.

Risks of dermabrasion can include uneven changes in skin color, scarring, and infection.

Sclerotherapy

Sclerotherapy is a procedure that is used to eliminate varicose veins and “spider veins” (enlarged blood vessels that are visible on the skin, especially on the nose, face, and legs). Sclerotherapy involves an injection of a salt solution directly into the vein. The solution irritates the lining of the blood vessel, causing it to swell and stick together, and the blood to clot. Over time, the vessel turns into scar tissue that fades from view.

The procedure itself takes approximately 15 to 30 minutes. The number of veins injected in one session varies, and depends on the size and location of the veins, as well as the general medical condition of the patient.

Side effects after sclerotherapy include itching and raised red areas at the injection site and bruising. Other side effects may include the following:

  • Larger veins that have been injected may become lumpy and hard and may require several months to dissolve and fade.
  • Brown lines or spots may appear at the vein site.
  • The temporary development of new, tiny blood vessels.

Warning: If you develop inflammation within five inches of the groin, a swollen leg, or small ulcers at the injection site after sclerotherapy, contact your doctor immediately.

Collagen Injections 

Collagen injections are used to replenish the skin’s natural collagen. The dermis layer of the skin is primarily made up of the protein collagen. Collagen is the main component of the dermis, and acts as the support structure for the skin.

In young skin, the collagen framework is intact and the skin remains moisturized and elastic. But, over time, the collagen support structure weakens and the skin loses its elasticity and tone.

During collagen injections, CosmoDerm or CosmoPlast, bioengineered human collagen products, are placed just beneath the skin, in the dermis, where the body readily accepts it as its own. As a result your skin feels and looks toned.

When you have a collegen injection, you will receive a small injection of local anesthesia to numb the area being treated. There is a possibility of slight bruising, and you may experience puffiness, redness and tenderness around the treated site.

Just like natural collagen, collagen replacements eventually begin to lose form and wear down. In order to keep up appearances, you will need a series of treatments, two to four times a year.

Carbon Dioxide Laser Skin Resurfacing

Carbon dioxide lasers have been in use for many years to treat different skin conditions. A new generation of carbon dioxide lasers use very short pulsed light energy (ultrapulsed) or continuous light beams that are delivered in a scanning pattern to remove thin layers of skin with minimal heat damage to the surrounding structures. These lasers are used to treat wrinkles, scars, warts, linear epidermal nevi (birthmarks), rhinophyma (enlarged oil glands on the nose), and other skin conditions.

Carbon dioxide laser resurfacing is usually performed on an outpatient basis, using local anesthesia in combination with orally- or intravenously-administered sedative medications. The areas to be treated are numbed with a local anesthetic. (General anesthesia may be used when the entire face is treated.) A partial-face laser abrasion takes 30-45 minutes, and the full-face treatment takes 1-1/2 to 2 hours.

Following the laser resurfacing procedure, a special dressing is applied to the treatment sites for 24 hours. The areas usually heal in 10-21 days, depending on the nature of the condition that was treated.

Side effects include:

  • Milia (small white bumps) in the laser-treated areas. These may be removed by gentle cleansing with a washcloth.
  • Hyperpigmentation, andsometimes, hypopigmentation
  • Reactivation of herpes simplex cold sore, especially after laser resurfacing around the mouth. This can be prevented by giving an antiviral medicine before the surgery and continuing it for seven to 10 days afterwards.
  • Bacterial infections. These can be prevented by taking an antibiotic prior to the surgery and continuing for seven to 10 days afterwards.
  • Scarring (rarely)

Laser Tattoo Removal

Lasers remove tattoos by breaking up the pigment colors with a high-intensity light beam. Depending on the size and color of your tattoo, the number of treatments will vary. Your tattoo may be removed in two to four visits, though more sessions may be necessary.

During laser tattoo removal the doctor places a hand piece against the surface of the skin and activates the laser light. (Protective eye coverings should be worn.) The laser may be slightly painful. Smaller tattoos require fewer pulses while larger ones require more. At each treatment, the tattoo should become progressively lighter. Immediately following treatment, an ice pack is applied to soothe the treated area. The patient will then be asked to apply a topical antibiotic cream or ointment. A bandage or patch will be used to protect the site; it should be covered with a sun block when outside.

There are minimal side effects to tattoo removal by lasers, including infection and scarring.

Photodynamic Therapy

Photodynamic therapy has recently been approved for treatment of actinic keratosis, a precancerous skin lesion, as well as for acne and sun-damaged skin.

To treat actinic keratosis, the doctor applies a drug called the photosensitizing agent to the skin (in liquid form) and then exposes the area to a light that activates the agent and kills the lesion’s cells.

Side effects of photodynamic therapy include increased sensitivity to light, burns, and swelling.

Vascular Laser Treatments

Lasers are also used to treat vascular lesions (those that involve blood vessels) such as spider veins, hemangiomas (abnormal growths of blood vessels that appear on the face and head), and port wine stains (purple lesions, also on the face and neck, that eventually take on a “bumpy” appearance) by shrinking the dilated blood vessels.

This procedure can be performed without anesthesia. In most cases, the procedure must be repeated several times to completely treat the disorder.

Side effects include swelling and redness at the treatment sites, skin lightening, and minor blisters.

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