David T. Harvey, MD FAAD, FACMS
Cosmetic Dermatologist & Mohs Surgeon

Today, we have many options for the cosmetic dermatology patient to explore. We are fortunate that in the Atlanta area, we have access to some really great technologies which are letting patients achieve their desired look in a safe and predictable manner.

Many of the cosmetic dermatology patients that we evaluate are in their 40s or 50s. During a consultation, I will give the cosmetic patient a chance to tell me their concerns in front of a mirror while simultaneously exam the aging changes that are clinically relevant.

Patients want treatments that are safe, effective and don’t require a lot of downtime. The following are some of the treatments that I will employ in a patient who has moderate photodamage, volume loss, and neck fullness.

1. Neurotoxins– Botox is my main treatment modality here. I will usually treat the glabellar “11 lines with 25 units and crow’s feet with 20 units or so. To reduce the chance of too much eyebrow elevation , I use 8 units in the frontalis muscle and, if jowls are prominent, will administer 20 -25 units in the platsymal bands to give a “Nefertiti” lift.

2. Fillers– I am a big fan of hyaluronic acid fillers, particularly in the cheek and lip regions. I like to use Voluma to augment the cheek area, Juvederm in the lip area, and Radiesse in the prejowl sulcus region. When combined with neurotoxins, this can give patients a new found freshness and help them to recreate the “inverse triangle” of the face that is lost with time.

3. Fractional CO2 Laser– This technology is one of my favorites. What use to instill fear in patients, the CO2 laser in a fractional application is now a standard for me to use in the face, neck, eyelid and décolleté area. Fractional CO2 laser eliminates brown spots, corrects wrinkles due to solar elastosis changes in the skin, and tightens pores. I will wait on performing this procedure until 2 weeks after Botox is used but before the benefit of this neurotoxin wears off, e.g., about 3 to 4 months.

4. Neck tightening – There are several ways to improve neck fullness and skin laxity in the neck. In our practice we love the Thermi- RF neck radiofrequency device. This procedure is performed under local anesthesia and minimal oral sedation. Thermi-RF heats the subcutaneous fat and platysmal bands to 60° C. We monitor the skin temp using infrared cameras. Non selective radiofrequency heating recreates a nice tight neckline. I sometimes will perform a little liposuction after the radiofrequency device is used but not always.

As you can see, combination therapies can be very effective for the cosmetic dermatology patient. It is truly an exciting time to be a cosmetic dermatologist in this field. Happy New Year Everyone. Blessings for a healthy, happy and prosperous 2015.