Radiesse – hand filler

Hello I am Dr. Peter Accetta from Orchard Park Dermatology, board certified dermatologist but today I am going to be the patient and we are going to demonstrate Radiesse for the fillings of the backs of hands. As we get older we all lose fat in subcutaneous tissues from the dorsum of our hand making the veins and the tendons much more prominent. If you take a close up of the back of my hands see here you can see that the veins and the tendons have become more prominent. The over lining skin is thinner than it was a few years ago and some of that is sun and some of that is ageing. With a couple of small injections and we are going to demonstrate that shortly – we are going to actually fill in this lost subcutaneous tissue. Radiesse comes in this prefilled syringe and one syringe is about 1.5ccs which is the perfect amount of doing the back of one hand.

Okay today we have Emily Goldstein, she is a physician assistant with Orchard Park Dermatology she has been here for years and is a skillful injector not only in Radiesse but of the many other hyaluronic acid fillers that we use principally on the skin of the face. So she has done these injections before and I am going to let her take over. My hands have been injected with alcohol. Naturally we inject the material and then we will massage it and it will spread evenly thought the back of my hand. We typically inject 3 or 4 different sites next Emily is going to massage out the Radiesse. The duration of improvement is anywhere from 18 to 24 months.

That looks great! I like it! I just had both hands injected with Radiesse and the material we massage it to even out the distribution and that is for 10 minutes or so I am going to sit on my hands and that will further compress the Radiesse and spread it evenly throughout the backs of my hands. So here we are back one day later, after having my hands injected with Radiesse, we used a syringe on each side, and I have to say I am very pleased – pleasantly surprised actually with just how good a result I was able to get with this treatment, and absolutely no bruxing no pain – and just minimal swelling at this point. You can never tell anything was done. I think it looks really great actually I am impressed! (laughs) so if you take a close look at my hands I was injected yesterday afternoon I have no bruising I have minimal swelling I have absolutely no pain and the hands look great, and I am quite pleased with the result and I would not hesitate to recommend it to anyone who is interested in restoring some of the lot volume from the backs of their hands – it is a great procedure.

Hi my name is Mary I had a phenol peel done 4 months ago – prior to that time, my eyelids were not right, my eye lids were droopy and you could only see part of the pupil of my eye. After this as you can see I have nice round eyes, I have an eyelid I am extremely pleased with this procedure, I would recommend it to anyone – Dr. Accetta was the optimal professional and I have had many comments from people asking me what’s different about me not quite knowing that I had this done! So I would recommend this to anyone.

This is Mary before her eyelid peel as you can see she has very lax upper eyelid skin. She would benefit from an eyelift but like many of our patients – did not want surgery.

Today we are performing a Phenol upper eyelid peel followed by a micro punch technique to help shrink the upper loose skin of the eyelid. Under local anesthesia she has been numbed already. WE apply a single coat of Phenol solution and we get this nice white frost so we are now going to go over and we are going to treat the other side, as well. Applying the Phenol to the left upper eyelid, we keep the solution below the brow and above the tarsal crease and we apply until we achieve a uniform white frost. Here are some before and after photos taken of Mary taken several months after the peel. The before are on top, the after’s are on the bottom. Although this is not an eye lift procedure for a 30 minute office procedure she has had some significant tightening of the skin, and as you heard in her testimonial she is more than pleased with the results.

Hi I am Dr. Peter Accetta from Orchard Park Dermatology and we are here today with Melissa to do a demonstration on Allergen’s product Juvéderm as a lip augmentation. Melissa has had fillers in the past, mainly for the marionette lines below the lips but what we are addressing today is her upper lip. She reported to me that when she looks at her wedding photos that she noticed that there is a loss of red show on the lateral aspects of her upper lip and what we are going to try and do is to not make her lips larger but we are trying to augment that the edge of her lips there so that she gets that lip show she had in the past.

Juvéderm has supplied us a clear gel and the gel contains hyaluronic acid. Hyaluronic acid is a filler that comes with a pencil eraser in that if we ever had some asymmetry or some nodules develop we can inject some hyaluronidase and we can dissolve part of that filler. So we are going to start using a lipo droplet technique on the lateral aspect. She has been numbed but just with a topical numbing solution. We are just going to inject very slowly down into the body of her lip. Juvéderm contains a local anesthetic so as we progress, she will experience a little progressive numbness. I am just putting small amounts into the body of her lip where she has lost that volume. Once we smoothen and make sure there are no lumps or bumps. So we have just completed Melisa’s right side of her upper lip here and using very small amount of material you can see that we have more of the red show on the vermilion of her lip here as compared to the untreated side on the left. So we certainly didn’t make her lips any larger but we just restored lost volume.

We are going to do the same micro droplet technique just suing very small amounts of the filler substance just into the body of the lip. Very small amounts – and remember the lidocaine in the filler will start to kick in after the first few injections and make this a more comfortable procedure for her. So I like to go from a couple of different angles and a couple of different planes – and again we are just restoring what was once there. So I will massage during the course of the procedure to makes sure I don’t feel any lumps or bumps. With this fine needle we have very little bleeding. Good – Next we are going to move up and do the junction between the red lip and the cutaneous lip – we call that the white roll. It shows the separation of the lip from the skin. One again we massage, to make sure there is a nice even distribution of the Juvéderm. I think we can use a little bit more down here – this very small amounts of injections. So we are going to augment the tubercles of her lip – we are going to give her a little volume right here, below the Philtral columns, we have a natural peak on either side of cupid’s bow and again now that we have augmented her upper lip – we can do a little bit on the lower lip here, we have some lines there where again we are not trying to volumize her lips but just give her a smoother appearance.

When treating the lower lip we concentrate on the central 2/3rd of the lip because we don’t go out to the edge we don’t want to create any kind of ducky appearance! So we are going to go right into the body of the lip, re-inject very slowly. Just enough to smooth those lines up! Okay open – now we are going more towards what we call the wet dry border! We are going to add just a little bit of volume there! And there is minimal bleeding and so far I don’t see any bruising so that is terrific!

Again we just check for smoothness, make sure we don’t fel any ups and everything is ice and smooth! Close again, I think we can go again for just a little bit more right in the center, and you can see the wrinkles and the vertical lines just pretty much disappeared.

So I just completed the Juvéderm treatment on our patient Melissa as you can see it is a subtle improvement. She will notice, everyone will notice but no one will know that she had any filler performed on her lips. Remember our goal was to increase the amount of red show on the lateral aspects of her lip – essentially restoring her smile the way it used to be. Very small needles, lidocaine in the filler so it does feel a bit numb, and she has no bruising what so ever. So we will send her home and we will ask her not to massage the area – and if she likes she can use some cool compresses but that is probably not going to be necessary she can go right back to work!

Sclerotherapy

Orchard Park Dermatology – Adult skin care and surgery

Spider Vein Treatment

Today I am going to demonstrate foam Sclerotherapy for spider leg veins. Sclerotherapy is a procedure that has been around for probably a hundred years but over the past several years some significant improvements have been made. Instead of using salt water or either chemicals we use a detergent foam and as you will see as I start to inject her the foam will displace the normal blood that is in the vein and irritate the lining of that vein and the vein will fade over the next several weeks. This is a terrific treatment for our patient with the superficial spider varicosities. These are what we sometimes call road map veins. The foam displaces the blood and will travel the full course of the vein – and you can see she is going to have a terrific result. I like to do Sclerotherapy during the fall and winter months because part of the treatment is that our patients will wear compression stockings for 2 weeks after wards and that can get a little bit warm during summer because we like to wear them day and night because they will just get better results, most patients will do between one and 3 sessions to get maximum improvement and maybe touchups every few years or so. The improvement that we see today is permanent. These veins won’t recur. However patients that are prone to spider varicosities may continue to develop new ones! Okay, it is a satisfying procedure for both the physician and the patient, and it is fun! Foam Sclerotherapy is a very satisfying procedure for both the patient and myself the physician – it is a fun to watch the veins disappear knowing that they will continue to fade over the next several weeks. Most patients do one oth 2 sessions for maximum improvement we sometimes do 3 sessions after that the veins are permanently gone and if they develop new ones we can always do touch ups down the road.

Fantastic look at them run!

May is skin cancer awareness month. And today I’m gonna share with you a technique that we use in the office to help identify skin cancers at a very early stage. In fact, it’s something we have some of our patients do in between visits, so they themselves can diagnose the skin cancer sooner rather than later. At the end of this video, I want you to stay tuned because I’ve included a live patient demonstration. I’ll be performing the technique on a real patient and, uh, and you can see exactly how it’s performed. Hi, I’m Dr. Peter Asta, board certified dermatologist, skin surgeon, and the owner of Orchard Park Dermatology. Know, every year in the United States, there are more than 5 million new cases of skin cancer. Uh, that’s more than all other cancers combined. Now, skin cancer has a couple things going for it. Number one, probably the most easily prevented cancer with sunscreens and some protective clothing.

Uh, but more importantly, skin cancer is the cancer you can see. Now, it helps if you know what you’re looking for. So let’s get into that. Right now, the most common skin cancer is basal cell skin cancer. And where do we find it? Well, patients tend to be a little bit older, usually older than age 50. They tend to have fair skin. They tend to have a history of, uh, severe sunburns, maybe even blistering sunburns dating back to childhood. Uh, very often there’s a, uh, personal or family history of, uh, prior skin cancers. [00:01:30] So the basal cell carcinomas very often look like pink scaly patches or plaques. Very often they’re coin shaped. And with a simple alcohol prep pad, what we can do is we can scrub one of these patches. Now, if it’s a basal cell, we’re gonna notice two things. Number one, uh, the plaques very often become shinier than the surrounding skin.

And as we continue to scrub, uh, they’ll often develop small little bleeding points. Now, scrubbing normal skin should never result in bleeding. So if you see shininess and bleeding points, well maybe you should be concerned. So before I show you the live patient, uh, demonstration, uh, I hope you find this, uh, valuable. And if so, you’ll share it with family and friends. Heck yeah. You might be able to diagnose one of these yourself. So wet alcohol-saturated gauze, uh, but you can do it with a simple alcohol prep pad. So our patient here presents, uh, today with this pink patch on her shoulder. And uh, I’m gonna  do that little test where we’re gonna scrub it with the alcohol pad and we’re looking for this plaque to get, uh, shinier and we might even get some little bleeding points to develop. So I want you to come in close from the side here and we can take a look here and let’s see what happens as we scrub away.

Can you appreciate that? The plaque gets a little shinier than the surrounding skin. And you see, as we continue to scrub, we’re starting  to see these little bleeding points develop. And that’s very, that’s a very indicative of basal cell carcinoma. So this is a larger lesion. Uh, you could identify lesions that are half the size of this doing the same technique. So we’re looking for shininess and we’re looking for these little bleeding points to develop, and that’s all there is to it. So may is skin cancer awareness month. Go out and find yourself a skin cancer.

Diamond Glow – Orchard Park Dermatology

We are about to do a diamond glow on Ashley here, so Ashley has been struggling with the occasional breakout some uneven texture to her skin so what we chose for her today was the Pore Clarifying Serum.

Combination Peel – Phenol Jessner

This video demonstrates a combination peel, now a combination peel will include phenol, around the mouth the upper lip and the lower eye lids, and that is helpful for deeper problems such as, lines and Keratoses, crow’s feet and we use a milder solution either a Jessner solution or trichloroacetic acid on the cheeks and that is more of irregularities and pigmentation. More so than Keratoses or wrinkles so I never like to peel just a localized area it is always better to peel the entire face even if you use a combination of agents just to do it, so in this case we start on the upper lip with our Phenol solution and if you notice in the video that we are scrubbing it in and that is to really get to the base of some of these etched lines so we use a milder solution, on the upper lip – a heavier solution or a stronger solution on the thicker skin of the chin and this is applied slowly, our patient is under sedation so she is awake, but she is a little bit groggy but we have the conversation all through the procedure here. So you see the bright white frost on the chin that fades into a grey frost then we can see the area that we peeled first on the upper lip as a grey frost, so sometimes we will recoat when looking for a uniform frost and that is why we take our time, and we just watch and see how each patient’s skin reacts. So now we are moving to the lower eye lid and this is being much thinner skin, we are going to use a milder solution but we are still using thymol.  I like it because we get a nice tightening usually by using the thymol below the eyes and there is some stinging involved but as you can see our patient is really no in any significant discomfort so once we have done the perioral area of lips and chin. We are going to finish off this peel, with a milder solution and this milder solution we can apply much more quickly, so we are treating the nose, the central cheeks across the forehead, and when we get don our patient is pink she will remain pink for the next several days. The areas around the mouth and upper lip of course will of course peel for a longer period of time, that is a deeper peel. So the cheeks maybe for up to a week. The upper lip and around the mouth and she can plan on pealing for a good ten days or so.

Detailed video – Phenol Peel

Today we are demonstrating a full face phenol peel on a patient, who presents with a number of skin concerns, she has Dyschromia characterized by brown blotches on both cheek form chronic sun exposure, she has that mainly on the cheeks but also extending up on to the forehead. She is a patient that we have also treated for pre cancers in the past with liquid nitrogen so she has a long history of sun damage and also of concern to our patient are these vertical upper lip lines you can come in a little bit closer, that many women develop after menopause we commonly call them smokers lines but they occur in women who have never smoked and has more to do with estrogen levels and what we have done is we have pretreated her with a retinoid, a retinae for the past several weeks and that is the primary skin for the peel and this morning she took some sedatives, she is not asleep – say hello! Hi! She is groggy but she is not asleep and we will be able to talk to her throughout the procedure, we do monitor her vital signs with heart rate blood pressure and that way it is another way we can track and see how she is doing, so we administer the peel over about a 90 minute period, she will go home and because she took an ambient earlier today she will wind up sleeping the afternoon away. She is really not going to have significant discomfort after the procedure. We will see her back in the morning, checkup and she will have only a hazy memory of what happened here today. 

Ok now we are moving to the other side with some fresh peel solution, again we are going to go right up close to the eye lid margin, and we do that because this thin skin will tighten up nicely after the peel. Now we use different strength solutions, for different areas of the face, because of differences in skin thickness. Okay next we are moving to the upper li we are going to use a stronger solution here and I really want to stretch the sin out so I get down into those vertical lip lines and I am going to work on one half of the upper lip – it is okay to get the solution down on to the vermillion or what we call the red part of the lip, and we know she has had a lot of sun damage here – we have frozen pre cancers form this area so hopefully this is going to have a therapeutic effect on that as well. You see with the stronger solution we get a quicker and whiter frost than we did with the milder solution and to the other side, again I am going to stretch the skin, so we get our solution right in there. This is an area where I think patients achieve the most satisfaction, because these lines tighten up and disappear. If not if they don’t totally disappear they are marginally improved. Okay we are starting now on the chin! This is also an area that has a high concentration of sebaceous glands which allows us to use a stronger solution here. She has got some lines near the corner of her mouth and we are hoping to get those improved. 

You can see her upper lip the frost has already completely faded. Nice contrast white frost, and as we look at the other side grey frost!

Okay – so I want to point out that we are moving out to the cheek and this is the driver’s side – Margaret’s driver’s side and she has got lots of solo antigens or what you may call brown spots and she has more on this side than she does on the other side and this peel is going to do a terrific job in removing those so I want to make sure we get a nice close up of what these look like before we start. Okay starting on her cheek, and gain we are looking for that same white frost, and we are just going to change direction and go right up to her cheek bone, we have to work a little bit harder to get that frost here – now I am just going to spot treat on some of the darker areas.

As I move from area to area we will note little areas of imperfections that require extra attention whether they be brown spots or pre-cancerous Keratoses or fine lines around the eyes we, we address each of these in turn, the entire peel experience takes about 0 minutes and when the patient goes home today as I said earlier. She will just sleep the afternoon away she will have a lot of redness and swelling over the next few days and she will peel for a full ten days sometimes 12 days. Now after that point the skin will be very pink but she wil be able to use make up and cover up and these before and after photos that I am going to show now are taken probably a month or more after the people experience, But as you can see overall the complexion is brighter and the brown spots are no longer present and she has nice improvement around the mouth area – those vertical lip lines. Overall it is a very satisfying procedure for the right patient, the patient who has the downtime that this requires this is our deepest chemical peel but also it is the most effective one.

Orchard Park Dermatology – Adult skin care and surgery

Kybella Treatment 

Today I am demonstrating Kybella treatment – Kybella is Allergen’s new product for dissolving the fat pad below the chin often called double chin. Our patient is Joe, Joe has had one treatment already and she is an ideal candidate because for this treatment we like patients at a normal weight or at least within 20 pounds of normal weight. People with larger necks, larger patients might do better with liposuction – or one of the cryo treatments that are available so the way this works is we start by prepping her neck which we have done already and next I am going to apply a decal which will be my guide on locations to inject.

So I am going to center this decal right where I want to give the product and we are just going to wet it. The treatment is relatively quick, I am going to administer 20 injections and hopefully a period under 30 seconds and then we are going to ice her neck, and we are ready.

The Kybella gets injected directly into the fat pad and we are doing okay? Mhmm, and that is it – we are done, it is a quick easy procedure, she will experience some swelling this evening and tomorrow maybe wear a scarf around her neck for a day or two, but by the weekend she will be back to normal – and that fat will dissolve over a period of about 6 weeks, that is why our 2 treatments are about 8 weeks  apart and it is a very satisfying procedure for the right patient and that is somebody with just a small pocket of fat below the chin.

Vobella – Lip Filler

This is a short video demonstrating the use of Vobella for lip injection. Vobella is a very soft hyaluronic acid product and it is an ideal choice for someone who has never had filler before or has some apprehension about having a filler done. Because it is so soft it is not really a lip plumper it is more of a lip enhancer, and in this case our patient was concerned with a very thin upper lip, but in order to keep things in balance we need to add some filler to the lower lip and we do that first and once we are sure that it is nice and smooth and balanced, then we move to the upper lip – and our goal is to create just a bit more red show without really altering the size or the appearance of her lips.

So our patient is numbed up with some cream and some ice before this, and the Vobella itself as some local anesthetic – built into it so it is not a very uncomfortable procedure, and here are some before and after’s that is just a subtle improvement. Everyone will notice but no one will know!

Orchard Park Dermatology – Adult skin care and surgery

Botox Treatment.

Today we are going to demonstrate Botox injections. Botox is far and away the most common cosmetic procedure performed by dermatologists in the Unites States. It is estimated that more than 14 million American have tried Botox. It is a quick in and out procedure. Many men and women will come by on their lunch hour to get these injections and there is absolutely no down time, you can go right back to work. So we are going to inject Susan’s forehead we can show – raise your eye brows for us, and she has all of these lines and we can soften those up considerably without freezing her forehead. She is still going to have some motion but she won’t be able to make those lines, and we will show you some before and after. Ready? Mum

(Injects Botox) quick and easy! And that is it! We are going to remove our little markers! She has these small welts but by the time she gets to where she is going those will have dissipated and she can put makeup on right away! And that is Botox injections!