Clinical Services
Cosmetic and Laser Treatments
Fraxel
Botox
Fillers/Volumizers
Sclerotherapy
IPL (Intense Pulsed Light) Photofacials
Diode (532 nm)
Q-switched Nd: Yag (1064, 532 nm)
Photodynamic Therapy (PDT)
Superficial and Medium-Depth Chemical Peels
Product Lines
Fraxel
This procedure provides the benefits of intense laser resurfacing without the lengthy recovery time and side effects seen in the past with treatments such as CO2 laser and other ablative treatments. The Fraxel produces thousands of deep columns of treatment zones in your skin. Because there are islands of untreated skin surrounding these columns, this speeds recovery time and reduces side effects. Since each session treats approximately 20% of the target area, usually four to five treatments are necessary for maximum benefit. The Fraxel has been effective in treating many different skin problems, including lines and brown spots due to photoaging on the face, neck, chest, and hands. After Fraxel treatments, patients notice great improvement in the overall texture and appearance in their skin as well. It has also been effective in treating scars due to acne or other causes, melasma, and enlarged pore size. It also may help reduce the appearance of sebaceous hyperplasia. Of note, Dr. Erica Kelly and Dr. Julie Sracic are currently performing a study on the efficacy of treating burn scars with the Fraxel with promising results.
Botox
This has become increasingly popular over the past two decades for treatment of dynamic wrinkles, as well as numerous other indications. Initial use of the product was for non-cosmetic purposes, such as treatment of strabismus and various dystonias. Therefore, it has a long track record of safety, even before cosmetic use became widespread. Here at UTMB, we only use Botox Cosmetic supplied by Allergan, which we reconstitute with sterile saline. Botox, initially FDA-approved for glabellar frown lines, has expanded uses as well. In the recent past, the FDA approved its use for hyperhidrosis, or excess sweating. It has also been successfully used to treat crow’s feet, horizontal forehead lines, “bunny lines” along the sides of the nose, perioral lines, drooping corners of the mouth, neck bands, and puckering of the chin. Often, when injected into the glabellar frown lines, patients will notice somewhat of a brow lift, which results in a more rested, relaxed, and younger appearance.
Fillers/Volumizers
These are substances that can fill in superficial lines and deep folds in the face. Some of the fillers composed of larger particles can also treat sunken cheeks and temples as well as hollowing of the eyes. While in the past, face lifts were considered the best way to remedy an aging face, now many physicians focus on restoring volume loss with various fillers. These can be used alone or in combination with various cosmetic procedures and for many patients can help delay the need for a facelift temporarily or indefinitely. Each type of filler differs in its components, depth of injection, and duration of effect.
Hyaluronic Acid Fillers: Restylane, Perlane, Juvederm Ultra, and Juvederm Ultra Plus: While in the past, some fillers have been derived from animal products, such as bovine (cow) collagen or rooster combs, now the most commonly used substances are non-animal derived. This eliminates the need for skin tests for hypersensitivity to the products. Hyaluronic acid is a substance already present in your skin, and once injected into the mid-dermis, the material takes on water and expands to fill out deep folds or wrinkles. These products are commonly used for the nasolabial folds, the lines connecting your nose to the corners of your mouth. They are also injected into the lips, areas of volume loss under the mouth, so-called “marionette lines” that connect the mouth to the chin, the tear trough, and volume loss along the jowls. In addition to treating signs of aging, they have also been used to smooth the contour of depressed scars. Of note, Juvederm is the first injectable hyaluronic acid FDA-approved as safe and effective for persons of color.
Here are some before and after pictures of Restylane:
Sculptra: Like the hyaluronic acid fillers, Sculptra is entirely synthetic, with no animal products, and so does not require a skin test before injection. It is composed of poly-L –lactic acid, which is injected into the deep dermis or dermal/subcutaneous junction. Once injected, Sculptra forms scaffolding, which over the course of many months, provides continual improvement in volume loss. Though not its initial FDA-approved use, it can successfully fill in very deep volume loss of sunken cheeks, deep folds, hollowed-out eyes, and other areas of volume loss due to aging. Our physicians are also very experienced at performing its FDA-approved use of correcting HIV-associated lipoatrophy.
Cosmoderm: This filler is composed of highly purified human collagen. Because it is non-animal derived, no skin test is recommended by the FDA. Cosmoderm is used to fill fine lines as well as acne scars. Probably its most popular use is to fill perioral (around the mouth) lines and augment lips.
Radiesse® dermal filler is made of calcium-based microspheres suspended in a water-based gel, and is injected into the skin through a simple and minimally invasive procedure. It is FDA approved to fill the nasolabial folds, as well as contour the face generally to create a more youthful appearance.
EVOLENCE® dermal filler is made of natural collagen, one of the most prevalent materials in your body. The advanced collagen in EVOLENCE® has been naturally cross-linked, so it mimics the 3-dimensional structure of your skin's own collagen. This allows it to integrate beautifully and support your skin's own existing collagen network by adding structure, strength, and volume for a natural look and feel that last.
Sclerotherapy
Our physicians are experienced at treating superficial veins with sclerotherapy, the “gold standard” for vein therapy. Here at UTMB, we inject hypertonic saline (very concentrated saline solution) with a very tiny needle. Most commonly treated areas include the thighs, legs, and ankles. Other areas may be treated as well, but the face is best avoided. Most patients require several treatments, which are performed every six weeks. Serious venous disorders and large varicose veins should be treated by a vascular surgeon.
IPL (Intense Pulsed Light) Photofacials
Using technology similar to a laser, the IPL uses intense light pulses that are passed through particular filters depending on what condition your physician is treating.
Excess or unwanted hair: The IPL targets the dark pigment in the hair bulb. Due to this fact, blonde or white hairs are not effectively treated. Treatments are well-tolerated and have high satisfaction rates, and usually are performed at one month intervals. In patients of color, it is often necessary to use lower power levels in order to avoid any unwanted side effects. This may mean that more treatment sessions are required.
Dilated blood vessels and redness due to rosacea and other causes: The IPL targets the wavelength of light reflected in hemoglobin within dilated blood vessels close to the skin’s surface. Patients are very pleased in the improvement in the evenness of skin tone that results, and the dramatic results in reducing a constant “flushed” appearance.
Brown spots: The IPL targets the wavelength of light reflected from the darker pigment in these areas. When the areas are treated, they typically slough off in about a week’s time. Again, improvement in the evenness of skin tone results. Though not permanent, results may be well-maintained with diligent sun protection.
Diode (532 nm)
This is a true laser that targets the hemoglobin in blood vessels close to the surface of the skin. Because it is more precise than the IPL, it is best used to trace and ablate individual blood vessels that have become dilated. Most patients have noticed these around the nostrils, though they may occur elsewhere. This laser may also treat benign lesions called cherry angiomas, as well as dermatosis papulosis nigra, which is most commonly seen in African American patients.
Photodynamic Therapy (PDT)
Initially, this therapy has been approved by the FDA to treat pre-cancers (actinic keratoses) which have potential to evolve into squamous cell carcinomas. This is often good news to patients who are apprehensive about freezing by liquid nitrogen. In addition, the cosmetic results of PDT are typically excellent. PDT can also be used to treat photodamage and sebaceous hyperplasia. In addition, it has been shown to be effective in acne vulgaris. For patients who wish to avoid antibiotics, this offers an effective treatment with virtually no potential systemic side effects. PDT itself involves applying a 20% solution of amino-levulanic acid to the affected areas. Then, the medicine is allowed to absorb into the skin for 30 minutes to 1 hour. The patient then is exposed to a blue light for a specific duration, depending on the condition treated. After treatment with PDT, most patients experience redness, and occasionally mild swelling, similar to a mild to moderate sunburn. It is very important to avoid natural sunlight and bright indoor light for 24-48 hours after the treatment.
Superficial and Medium-Depth Chemical Peels
Superficial Peels: At UTMB, we perform both the 20% and 30% strengths of the Beta-Lift peel, which is composed of salicylic acid. It can improve overall texture and appearance of the skin, and specifically improve superficial brown spots, epidermal melasma, diminish fine facial wrinkles, and decrease pore size. In addition, due to specific properties of salicylic acid, it can improve lesions in acne vulgaris, especially with repeated treatments. Light peels are usually performed in a series of several sessions one month apart. This type of peel leaves the skin with a red glow which only lasts for a day or so, followed by several days of mild to moderate peeling.
Medium-Depth Peels: We perform a combination of Glycolic acid/Trichloroacetic acid 35% peels at UTMB. This type of peel is only performed once every couple of years. Medium peels have the same benefits as light peels and in addition remove deeper wrinkles and precancerous skin lesions because of deeper penetration. The main draw-back is that a medium peel produces intense redness and peeling for one week, much like a severe sunburn. During this week of recovery, the patient must stay indoors and be extremely careful about any sun exposure. One advantage of this peel over liquid nitrogen is that it can treat pre-cancers too small to be seen with the naked eye (sub-clinical).
