Frequently Asked Questions
Skin Irregularities
Q: When is the right age to begin cosmetic treatments?
A: The ‘right’ age is determined by how you feel about your appearance. When you feel unhappy with the skin texture and tone or are bothered by lines and wrinkles – then the time is right for you. It should be noted however that the more repair the skin needs, the more repeat or extensive procedures will be required. Therefore, it is encouraged to begin at the first signs of aging.
Q: When I have a skin treatment, how long will it take to recover? Will I need to take off work? Will people notice?
A: The recovery time after any skin treatment is directly related to the skin depth treated. The deeper into the skin the treatment goes, the longer is the downtime, the greater the risk but also the greater the correction. For example, microdermabrasion or glycolic acid peels exfoliate only the top most layers of the skin so there is virtually no down time, hence the name ‘lunchtime peel’. On the other hand, a medium depth TCA peel will require about 5 to 7 days of downtime, however the correction achieved will also be much more dramatic and longer lasting.
Another option is Fractional Laser Skin Resurfacing. This is accomplished using an Erbium laser to create tiny ablative zones wherein the epidermis and upper dermis are destroyed (ablated). The surrounding area of intact skin acts as a reservoir and in this way, healing is rapid with zero downtime. Immediately following treatment, the patient can return to their normal activities and may even apply cosmetics. Since this procedure allows a reservoir of intact skin for healing, delicate skin areas such as the neck, chest, hands and arms can be resurfaced.
Micro-Needling is the newest skin rejuvenation treatment. Needle depth will determine the amount of social down-time but it’s usually very minimal even with a more aggressive treatment.
Skin tightening with Radio-frequency Accent is accomplished by heating the deep dermal layer of the skin while leaving the top layer (epidermis) intact. Because the top layer is left undisturbed, this process is nonablative, and there is no downtime.
Q: I’m starting to feel that I look older then I really am, but think I’m too young to start treatments. When is a good age to begin taking care of my skin?
A: Since 95% of skin aging is secondary to sun damage (photodamage), good skin care should be started early with emphasis on sun protection. A good place to begin is to use medical-grade skin products that include NeoStrata Skin Actives. This utilizes Alpha-hydroxy acids, antioxidants and other active products that all work synergistically. For skin that is damaged and in need of deep repair, the Obagi ZO Skin Health system is the logical choice. Because the work-horse of this system is Retinoic Acid, correction is achieved at the cellular level. Thus, the natural skin decline which begins at age 30, can be slowed or prevented and damage already present in older skin can be reversed.
Q: My skin is dull. How do I recapture the “glow”?
A: Dull skin results when skin circulation and natural exfoliation decrease. This problem can be corrected with the NeoStrata Skin Actives, Obagi ZO Skin Health system, or fractional laser resurfacing or Micro-Needling. SilkPeel Dermal Infusion helps improve dull skin at a more superficial level.
Q: As I get older, my skin seems dry, and moisturizers aren’t correcting this. What can I do?
A: With age, the skin loses its ability to retain moisture. The cells responsible for the moisture holding properties need to be stimulated. This can be addressed with NeoStrata Skin Actives or the Obagi ZO Skin Health system.
Q: How can skin wrinkles be treated?
A: Fine wrinkles can be reduced with use of medical-grade skin care, a chemical peel, laser resurfacing (fractional), or radio frequency skin tightening. Deeper expression lines are treated with Botox or Dysport, or fillers such as Restylane, Juvederm™ Injectable Gel or Radiesse. Often, the presence of wrinkles is due to the over-all loss of volume in the face. This loss is best corrected with a stimulatory filler such as Sculptra.
Q: What causes age spots, and how do I treat them?
A: As we get older, the pigment in our skin is no longer evenly distributed, and age spots appear. These can be eliminated with the Obagi ZO skin program, laser photorejuvenation or fractional laser resurfacing. Sun protection is the most important deterrent and should be practiced daily.
Q: I have a mole on my face. My doctor said it’s not cancer and to leave it alone, but I hate the way it looks. Can something be done?
A: These lesions can usually be removed very effectively with radiosurgery. Healing is normally quick, and chances of scarring are much reduced over traditional methods of removal with a scalpel.
Q: Is Accutane the only solution for severe acne?
A: Accutane is a very powerful acne medication and used to be the last resort for many patients who had failed other acne therapies. While it can be very effective, it also comes with a long list of side-effects (including birth defects in pregnant women). A break-through treatment called Photodynamic treatment (ALA/PDT) now offers a wonderful alternative to the problems and toxicities of Accutane. This treatment is indicated for all forms of acne and pairs Levulan with laser to provide as dramatic an improvement as that seen with Accutane – but without the systemic side-effects! Three to five treatments spaced two to three weeks apart will decrease acne-causing bacteria and oil production. In most cases, this greatly reduces or even eliminates the need for topical creams and antibiotics. A device known as the Clarisonic Cleanser is also very beneficial for acne-prone patients. It cleanses the skin much more effectively than by hand alone and results in greater absorption (by 60%) of any acne care product applied afterward. SilkPeel Dermal Infusion is another option for acne treatment and is especially helpful in hastening the resolution of an active acne flare.
Lips
Q: What can be done to ‘plump’ thin lips?
A: Filler material like Juvederm™ Injectable Gel or Restylane can be used in the lip border. Or if more fullness is desired, the entire lip can be enhanced. The goal should always be lips that are natural-looking and balanced to the face.
Q: How can I treat smokers lines above my upper lip?
A: Vertical lip lines (or smokers lines) are caused by years of repeated movement by the major muscle of the mouth. Weakening this muscle with Botox® Cosmetic or Dysport will allow these lines to smooth out over time and inhibit their re-appearance. However if these lines do not completely resolve after this treatment, a filler such as Juvederm™ Injectable Gel, Restylane or Belotero can provide further correction.
Hair
Q: How do I get rid of unwanted hair?
A: Hair removal by means of laser is state-of-the-art treatment for permanent hair reduction. It is much faster and can more easily treat a larger area than electrolysis (which is the only other option for permanent hair removal).
Q: Does laser hair removal treatment hurt?
A: Traditional hair removal lasers work by delivering short bursts of intense light energy to the hair follicle. While this is very effective, the sensation is similar to that of a rubber band being snapped on your skin. Always known as the “gold standard” laser for hair removal, the 810 Diode laser has been elevated further by offering a super hair removal (SHR) mode. This new mode differs dramatically in that the follicle is heated gradually resulting in a virtually painless treatment. Treatment is fast (a man’s back can be treated in about 30 minutes). No chilling is required, and even tanned skin can be treated!
Q: What does laser hair removal involve?
A: Prior to the treatment, the area must be shaved but not waxed or plucked. The size of the hair bearing area will determine the length of treatment time, but it is normally fairly rapid. The hairs in the treated area usually fall out four to six days following treatment. Repeat treatments are determined by body area, as hair growth is different in different areas. Typically treatments are spaced 4-6 weeks apart. Sun avoidance is recommened before and after treatment unless treating in the super hair removal mode.
Q: How many treatments will I need to eliminate unwanted hair?
A: At least three to six treatments are required. These are administered about four to six weeks apart (to catch the hairs as they enter their active phase of growth).
Q: What can be done for thinning hair?
A: The most common cause of hair thinning/loss is Androgenetic Alopecia. This is a hereditary condition. It affects females as well as males and while nothing can be done to change this predisposition, medications can be used to help off-set it. Hair thinning is also experienced by many women after menopause. The best way to address this is to replace lost Estrogen and Progesterone with Bio-Identical hormones. The newest treatment for hair loss/thinning is in using Platelet Rich Plasma (PRP). It acts to restore and rev-up the hair follicles themselves.
Dermal Fillers
Q: Will my face look fatter will filler?
A: The roll of a filler is to lift and shape, to revive lost volume and to reestablish the smooth contours of the face. The goal is not to recreate, but to restore your face. The result should be very natural looking.
Under-Chin Fat (Submental Fullness)
Q: I hate my double chin! What can be done?
A: Prior to Kybella, the only option to eliminate submental fat was surgical Liposuction. However Kybella, FDA approved in June 2015, is now widely used to treat this common problem. It is a non-invasive, in-office procedure that can be done in about 20 minutes. The number of treatments required is dependent on the amount of fat present.
Bruising
Q: Will treatments cause bruising?
A: Anytime a needle pierces the skin, bruising can occur. Application of ice to the treatment site can help alleviate this and we commonly give our patients a vitamin K bruise cream if bruising occurs. Oral ingestion of Arnica Montana (5X/Day), Kiwi fruit or Pineapple can hasten the resolution of a bruise as well. Pre-treatment avoidance of the following can help prevent bruising: Anti-inflammatory medications (Advil, Alleve, Motrin, Celebrex etc.); Aspirin, Cinnamon, Ginger, Ginseng, Ginko bilboa, Vitamin E, Fish oil, and red wine are the most common.
Facial Veins
Q: How can the veins around my nose or on my cheeks be treated?
A: Radiofrequency or laser treatment.
Q: Will more than one treatment be needed to eliminate my facial veins?
A: That depends on the size of the vessels. Very tiny vessels may respond to one treatment, however patients are normally advised that more than one treatment may be required.
Q: I have Rosacea, and am embarrassed about having a red face all the time. Can this be treated?
A: Medication can help control the acne-form lesions of Rosacea but the tiny vessels which cause the skin ruddiness can only be effectively treated with a laser, IPL (Intense Pulsed Light), or PhotoDynamic Therapy(PDT/ALA).
Varicose and Spider Veins
Q: What causes varicose veins?
A: No one knows for sure, but certain families are predisposed, and they are more common in females.Certain factors such as prolonged standing, prolonged sitting, female hormones and pregnancy can worsen the condition.
Q: What is the best vein treatment?
A: For spider veins and small to medium varicose veins, Sclerotherapy is the ‘gold standard’ of treatment.
Q: What is sclerotherapy?
A: The injection of a medicine into the vessel itself, which causes it to scar shut and disappear.
Q: Does sclerotherapy hurt?
A: It is virtually painless.
Q: Can leg veins be treated with a laser?
A: If the veins are small enough, can be visualized, are close to the skin’s surface, and are not being ‘fed’ by a larger vein, they may respond. However, a complete evaluation is necessary to determine whether this is the case or not. Sclerotherapy still remains the “gold standard.”
Tattoo
Q: How can I get rid of my unwanted tattoo?
A: Laser tattoo removal is the best option. The only other choice is surgical excision which of course results in an unsightly scar.
Q: Does laser tattoo treatment hurt?
A: Most people tolerate the treatment well (the sensation is similar to that of a rubber band snapping on the skin) however, a topical or local anesthetic is available at the patient’s request.
Q: How many treatments will I need to remove my tattoo?
A: This depends greatly on the colors of the tattoo, the age of the tattoo, and whether or not it was professionally applied. Nonprofessional tattoos respond best (three to six treatments) whereas a professional tattoo may require six to twelve treatments.
The Randali Centre
Q: Will my appointments be in a private room?
A: Yes. All visits are private and confidential.
Q: Who will perform my treatments? What experience do they have?
A: All injectibles (Botox®, Fillers and Kybella); R.F. surgery, laser treatments and sclerotherapy are delivered by Dr. Cohen herself. Dr. Cohen is a board certified physician with over 25 years of experience.