Why doesn’t Retin A Work for me?

Short answer: Wait for it.

Retin A works on the basal (the deepest) layer of the skin. Normal skin maturation (growth) takes about 90 days for a skin cell to pass from the deepest layer to the surface. So, if Retin A is working, you will not see a change that begins at the basal layer for 90 days, or about 3 months.

Most of the complaints I receive are from patients who have simply not been using it long enough.

Retin A comes in a variety of concentrations, expressed as %. Another possibility is that your skin requires a higher concentration. Talk to your doctor.

Some patients expect their skin to peel while using Retin A. This is usually an indication of too high a concentration. Retin A is working even though you may not be peeling.

Some doctors insist on a higher concentration to create some peeling so that the patient can see something happening while they wait the 90 days. This is unnecessary (but saves on complaints – except now patients complain that they are peeling!)

Everyone’s skin is different. Come on in, we will check you out, and make sure you get the right stuff,

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I Exercise, but My Skin Still Sags!

Short answer: you are right.
Exercise can tone the muscles that are deep to the skin, and even increase their size, and exercise can decrease the fat between the muscles and the skin, but EXERCISE DOES NOT AFFECT THE SKIN. So what can you do. Well it depends on how much extra skin remains. If the skin is just a little loose, then a course of peels or laser can help by tightening up the looseness a bit. But, if there is a lot of loose skin – you have to be honest with yourself here – then the only way to tighten the skin is to take out the looseness with some sort of surgery: tummy tuck for abdominal laxity, brachioplasty for the upper arms, facelift (or S lift) for the face – you get the idea. You might not need a great deal of surgery – sometimes just a little pull is all you need – but still too much for a peel to take care of. FInd a doctor that you can trust to tell you the truth and not take advantage of you, and you will be happy.

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Lasers, Dermabrasion and Peels, Oh My! What’s it all about?

Short answer: different ways to treat the skin surface.
The goal is to reduce wrinkles. None work well for large skin folds – for this problem, the folds must be removed – some form of facelift is needed.
For finer wrinkles all of the techniques work.
The more aggressive the technique, the more downtime, but you will need fewer treatments. Want minimal downtime? you will get results with a milder treatment, but you will need many treatments.
Also, the milder techniques are not as long lasting. An aggressive laser or chemical peel can take weeks to heal, but may last several years.
A microdermabrasion treatment has no downtime, and leaves you with healthier, plumped up skin and fewer fine wrinkles, but may last only a few weeks.
Less aggresive laser treatments (fractionated), or milder peels, fall in between these two, with only a few days of downtime, the need for repeat treatments, and are less long lasting.

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What about Vitamin E?

Short answer – vitamin E slows wound healing. DO NOT take vitamin E either before or immediately post operatively. If you take a multivitamin, check the fine print. There will be a listing of each vitamin in the preparation, and how much of each, expressed as the RDA, the recommended dietary allowance. You need vitamins to survive, but more than 100% RDA is unnecessary (unless depleted). If your preparation contains more than 100% RDA of vitamin E, stop taking it while you are healing. That said, vitamin E may help to reduce scars. Scarring is an integral part of wound healing, in that the scar is the final product of collagen metabolism which is slowed by Vitamin E. Once the initial wound is healed, vitamin E may be of benefit to reduce scarring. Other products, such as aloe, and cocoa butter work similarly.

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What if I’m on the HcG Diet?

The issue is wound healing. Wounds, or surgical incisions, need protein, calories and vitamins to heal. Without these, wounds either will not heal, or they will heal slowly, or they will be weak, form poor scars, fall apart with minimal trauma, and be more susceptible to infection which in turn will not respond as quickly to antibiotics.
The typical HcG diet restricts calorie intake to around 500 calories – not enough to provide for adequate healing after surgery.
We know that post operative and trauma patients require significantly more calories and protein intake – as much as double. If you are considering cosmetic surgery and are on the HcG diet, please let your doctor know; stop the diet at least two weeks before surgery, and do not resume the diet until at least three, preferably six weeks post op.

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S lift or Facelift – What’s the difference?

Answer: the amount of lift that can be achieved by a facelift is much more than with an S lift. In both procedures incisions are hidden in front of and behind the ear. Then the skin is lifted off of the underlying tissues and pulled gently upwards and back, stretching the skin slightly (not too much!!), and reducing wrinkles.
The S lift, with its limited dissection can be done in the office under local anesthetic, whereas the facelift requires general anesthesia in an outpatient surgical center for safety.
S lift patients can return to work the next day, facelift patients generally need about one week off work.
Bruising and swelling is much less with an S lift.
A facelift will last longer than an S lift.
S lifts cost about one quarter to one third of the cost of a facelift.

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Facial Wrinkles – causes and treatment: age lines

Skin changes as we get older:

  • skin gets thinner
  • fat pockets under the skin get smaller
  • gravity pulls everything down
  • the bones of the face change shape
  • wear and tear from years of exposure accumulate
  • age spots, veins, discoloration develops

To treat these effectively, we must identify their causes and treat them appropriately:

  • thin skin –¬†improve cell turnover with Retin A,¬† tighten thin skin with peels (chemical or laser)
  • loss of facial fat – restore volume with fillers
  • gravity – lift and remove excess skin (facelift or S lift) – note: fillers can provide some lift.
  • facial bone thinning – redefine cheekbones and jawline with deep, more permanent fillers
  • skin damage – restore skin health and prevent further damage; moisturizers, sunblock, exfoliation
  • age spots, discoloration – hydroquinone to even out skin color
  • veins – treat spider veins with lasers
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