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Melasma is annoying, and a challenge to treat. Once a melanocyte knows how to produce pigment, that becomes its sole mission. Any heat or sun exposure can kick up the activity which is why I do support using topicals prior to and during the process of recovery. The only true FDA approved topical agent scientifically reported to lighten pigment is hydroquinone. It is sold in varying strengths, and has a little bit of bad press. I feel it is reasonable to use this for no longer than 3 months, then stop for a spell. I do like it prior to any treatment that might invoke a perceived trauma that could possibly trigger melanin production (like a peel or a laser). So, one option for you would be to start using Hydroquinone 4% once daily for 2-4 weeks before the peel. I carry one made by vitality institute at my office that is priced at $116.

Another more complete option is to use a pigment correcting kit which includes morning and night products for use to complement the peel. Morning includes a specific moisturizer that includes prep/brightening agents and a vitamin C product; and evening includes use of a tretinoin serum as well as 4% hydroquinone. (kit is $300 and would supply you for a couple of weeks both pre and post treatment).

With regards to the peel, you could do a Vi peel specific to pigment correction (that would be my recommendation). The peel is applied by me and is self-neutralizing. You rinse after 4 hours. It comes with a small kit of post peel towelettes that actually extend the peel’s penetration. The flakiest days for the peel typically are days 3, 4, 5. Sunscreen will be super important after—but you’re already in the habit so that should be easy! Give your current sunscreen a try and if you want more recommendations let me know!

There is one more thing you might want to look into particularly if you like being outdoors a bit during the nicer months. Heliocare Advanced antioxidant is a fern leaf extract that has been made into a nutritional supplement and actually protects you from UV rays when taken internally (sort of an internal sunscreen). You can buy it at the drug store—and you might even be able to purchase it online. Scientifically proven—I anticipate more products like this coming in the next several years.

Help is on the way!

*all pricing subject to change

Toying with the idea of a little lip augmentation, but not wanting to look “ducky”? Relax, lips can be very tastefully done!

There are many things to consider—first up is finding an injector who is passionate about what they do and with whom you can clearly communicate with. You may know what you’re hoping for, but you have to rely on their expertise to assess your anatomy, have a working knowledge of what products they carry and how each of them will respond in the area being treated. Then those ideas have to be married in a way to optimize your ultimate outcome. Getting your lips to their perfect state is a team sport!

When I assess first time lip goers the first question is “what are you hoping for?” Are you looking for volume or light hydration? From there I can start turning my little brain cells over to decide what filler I want to use. Some hyaluronic acid fillers provide more structure for crisp borders, some are soft and fluffy for a luscious pout. Some are super soft and stretchy and others are more firm, but may have more durability.

What are your native lips like? Does the upper lip have a swoop, like a ski jump? Are there points to your cupid's bow or is it more tubular? Does your upper lip seem to vanish when you give a toothy smile? Is your lip more like a raisin, or a little more inflated like a prune? We can enhance your born-with lip, but do have some limitations. You can’t put larger tires on a Prius and make it look like a Tesla…it just doesn’t work that way. These factors contribute to my final filler decision.

After conversation, cleansing and topical anesthesia—we get to work on creating a wow lip. And whether or not you are looking for va-voom or just a little less ho-hum once I get to the sweet spot and hand you the mirror to see them for the first time, there is a classic gasp in first time filler patients.

In your brain you silently say, “OMG, they’re big. Maybe this was a bad decision”. Then I work on talking you off the fence. Some of what you see is filler, and some inflammation from the needle pokes. I know that one syringe of filler is 1/5 of a teaspoon, and I know how much I have put in; but to the filler newbie they are quite different than what you came in with, so seem larger than life.

Then I warn you: “later tonight or tomorrow morning you will likely be swollen and what is currently huge will seem ginormous. But rest assured the swelling will go down. And in all likelihood by the end of tomorrow when you are less puffy, you will probably wish they were a little more swollen.”

During the first 2 - 4 weeks the filler will attract more body fluid (that’s what hyaluronic acid does, it attracts 1000 times its molecular weight in water). During the time of fluid movement, you may detect irregularity, even lumpiness—particularly detected by your probing tongue. Please leave it alone it will soften on its own. If you squish it, massage it or manipulate it not only can you potentially make the swelling worse but you may move filler around in the plane of tissue it was carefully placed in. Fourteen days out, if there is a visible lump that makes you crazy because your entire focus is on it—let us know and we can help guide you!

Be kind to your lips during the early healing phase. Do not use old lipstick or gloss until your needle injuries have closed. Do not use your new lips excessively for extracurricular activities (straw sucking, referee whistling, oral gratification, drug paraphernalia such as bong use or the like)—give yourself 4 or 5 days of relaxation—but admire them in the mirror all you’d like!

Once you adjust to having fullness you likely won’t want to be without. Each person makes a varying amount of the enzyme that breaks filler down, so it’s really hard to say exactly how long it will last, but for those who love having moist lips plan on a refresh every 6 months or so. First time lips tend to not last quite that long, but consider that you’re building a foundation on top of which the house will stay strong!

There are lots of different injectables in my practice! Some relax movement and yield wrinkle reduction, some dissolve fat cells, and others volumize. And amongst those that volumize there are 18 to 20 to choose from in my tool box! Most are hyaluronic acid based, but others have additional characteristics. How do I decide which is the right one for the job? Well, that depends on many factors including your anatomy and goals, and your patience.

I guess if I had to categorize, my younger patients tend to seek volume improvement in a specific area, like the lips or the cheeks. There, immediate gratification is also sought out, making hyaluronic acid a great choice. My more mature clients might however be looking for improvement of the bigger picture, global enhancement, reduced appearance of laxity (by way of mild volumization of tissue), and perhaps have a wee bit more need for attention to the periphery of the face (think peanut temples, hollowing just in front of the ears). And while I’m not saying that “NOW” isn’t nice, it might be okay to look forward to younger looking, healthier skin overall in 4-6 months and have it last, than the need for one area to simply be volumized. It could take lots of syringes of filler to fill up with hyaluronic acid alone, ignoring the looseness of the tissues structure as the real issue.

Sculptra is one such “filler”. It is made of poly-l-lactic acid and when injected it behaves as a bio-stimulant (you guessed it, stimulates your own biology). It starts as a powder which is then reconstituted with bacteriostatic water and a little lidocaine, then injected under the skin or along the bone. I personally like to use a cannula to deliver this delicious liquid—which reduces your overall risk of bruising (but does not eliminate it) and in some areas, a needle is still best. While you immediately look fuller—keep in mind it is simply all the liquid filling out the regions treated. The water is reabsorbed over the next few days, and the PLLA is left behind. This is the magic which teases your skin into developing your very own collagen matrix! Post treatment requirements on your end are to massage for 5 minutes, 5 x day, x 5 days after injection—that’s just to keep all those particles evenly distributed so that when the water disappears you have a sprinkling of pixie dust evenly throughout the region intended to be treated. Collagen fibers are formed over the next few weeks, then reorganize themselves over time to being even more amazing! Important to think of this as a tool for skin laxity, not just volume replacement. A solid treatment plan for the face includes is 2 vials x 2 treatments roughly 8 weeks apart, then put on your patient panties and wait to let the magic happen. It yields a subtle, but natural effect and the durability of it is based on your body’s ability to produce it and reduce it—so everyone is different. And of course it isn't limited to the face (off label). There are amazing photos and testimonials on if you’re interested in checking it out, keep in mind it requires you to have a healthy immune system to work optimally.

When you snoop on the internet to learn more, you might hear about the “Sculptra Glow”! When injected more superficially patients have reported healthier and glowier skin overall. There isn’t one of us that wouldn’t be for that as a bonus!

Sculptra isn’t for those who need an “event” fix (i.e. immediate). But it is for anyone who wants to be sure the foundation for the house is solid before they start building the structure. My favorite places to use Sculptra includes the temples, along the cheekbone, the preauricular space (in front of the ear), along the jawline and the nasolabial fold. No-no areas? Yes, there are a few of those: around the eyes and immediately around the lips (because of the way those muscles contract, it can leave you with clusters of product and an effect you aren’t quite seeking). At the time of this writing, pricing for Sculptra is $850/vial, down time is a couple of days of swelling and maybe bruising; though if you’re like me, you go right back to it the next day. This procedure can be accomplished at any of our locations with Teri at the helm, and if you want more intel for you specifically--book a virtual consultation where we can speak freely!

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