Dr. Angela Hutcheson

Note: Most of the procedures discussed in the article this month refer to the use of hyaluronic acid fillers, and are considered “off label.”  While they are approved and/or accepted practices in other countries, they are not FDA approved for these indications.

You are more than likely aware of the fantastic cosmetic results that can be achieved through the use of “volumizing” fillers, such as Restylane and Juvederm, in the face.  Fillers such as these are utilized to provide a more youthful appearance to the face by decreasing the appearance of nasolabial folds (the nose-to-mouth lines), improving lip volume, and diminishing the appearance of “sad mouth” (depression of the corners of the mouth), smoker’s lines, and smile lines.   A variety of fillers can be used for rejuvenation of the whole face, including enhancing the area around the eyes by treating sunken temples, accentuating cheeks, and improving the jawline.   If we are interested in turning back the clock, however, there are other areas of the body which are often neglected.

For example, the backs of the hands often demonstrate our age, and several fillers have been successfully utilized to make this skin appear more youthful.  Hand rejuvenation involves injecting a filler under the skin, ensuring that it is evenly distributed over the backside of the hand.  After anesthetizing the hands, this procedure lasts about 15-30 minutes.  While the results are instantaneous, there is continuous improvement for up to two weeks after the procedure.  With hyaluronic acid fillers (such as Juvederm and Restylane), the best results are often achieved by two to three treatment session (at least two weeks apart), and improvement can be expected to last up to 6-12 months, or sometimes longer.  Depending on the level of correction desired, most people can expect to have between four and six syringes of product injected.  The restoration of a youthful appearance to the backsides of the hands can be further improved if the affects of sun damage area also addressed (for example, with a laser procedure to lighten dark spots).

Fillers are also being used in other areas to mitigate the effects of aging.  Many people are bothered by a darkened, sunken appearance underneath the eyes (often known as tear troughs) which

can often be improved with the careful application of fillers.  Optimal correction usually requires only one syringe of product, is instantaneous, and there is minimal downtime with tear-trough injections (although there is occasionally bruising).

After age 40, foot padding starts to thin, which can be especially problematic in women who prefer to wear high heels, or who carry a little extra weight. Depending on the situation, the heels, balls and/or ankles can be injected with fillers to add “extra padding.”  This generally requires several injections, and results last for around 6 months.  For foot problems caused by the use of high heels, however, most podiatrists recommend improving the quality of footwear for a more permanent solution.  The off-label use of fillers (and occasionally fat transfer) in the feet is performed after podiatric/orthopedic evaluation.

It is important to remember that these are medical procedures, which do carry risks.  However, in a multi-faceted approach to rejuvenation, the less-common applications of fillers can be very useful in revitalizating one’s appearance.

Ashley Abercrombie, Medical Aesthetician

What is a chemical peel?  A lot of people hear the word chemical and automatically think it is something very abrasive and maybe even bad for the skin.  In reality, peels can be very beneficial and effective against anti-aging, acne scars, acne and hyperpigmentation.

 As a medical aesthetician I am frequently asked if chemical peels are organic and safe. I respond by telling clients that the chemicals used in most peels are derived from organic sources such as sugar, milk, plant bark  and various fruits.  The most commonly known acids used in peels are alpha hydroxy acids which are glycolic and lactic acid. These substances, derived from sugar and milk, are great for dry or mature skin. Beta hydroxy acid, commonly known as salicylic acid, comes from the bark of the willow plant (where aspirin comes from) and is ordinarily used for skin that is oily, acneac or has large pores. Malic acid comes from apples and various citric acids are derived from fruits like oranges and lemons. Sometimes, peels combine acids or other substances such as resorcinol, which is an antiseptic substance used to prevent infection, itching and inflammation.

 The chemicals used in treatments dissolve dead skin cells and promote cell turnover. They stimulate collagen and elastin production and smooth out the skin’s texture. The skin has many layers and chemical peels are designed to reach various depths in the skin. Very mild peels target the top layers; moderate peels are considered mid-depth and advanced peels, such as Jessners, reach the deepest layers of the skin. Mild to moderate peels may be administered by licensed aestheticians although deep peels should only be administered by a qualified physician. Carolina Aesthetic’s medical aestheticians can provide both mild and mid-depth peels.

 Different peels are also designed to treat different skin conditions such as wrinkles, large pores, acne, acne scarring and pigmentation. All skin types are candidates for some type of chemical peel but a physician or trained aesthetician should be consulted in order to customize these treatments specifically for your skin type and condition.

 What are the side effects of a chemical peel? Depending on the depth of the peel being used, you may or may not experience any peeling of the skin. With most treatments you can expect to see a little flushing in the cheek area and you may experience mild peeling for up to a week after treatment. With the mid depth peels, your skin will feel and look like it has a mild sunburn on the day of the treatment. On day 2, the skin will feel tight and look glossy like saran wrap. On days 3 – 7, you may experience heavier peeling of dead skin cells. There is no down time for mild to mid depth peels. The more advanced peels, performed by physicians, have more severe side effects which may interfere with your normal schedule.

 Is getting a chemical peel painful? With a mild or mid depth peel, your treatment may sting a little bit as the liquid is applied but the stinging will gradually subside and this brief discomfort is well worth the results that are produced. Deep peels may be more uncomfortable but your physician can prepare you for what to expect prior to, during and after such a treatment.

Chemical peels are not as scary as they sound. They produce healthier, smoother, younger looking skin and can improve various skin conditions like acne and melasma. At Carolina Aesthetics, we love answering client questions and consultations are always free. Call and schedule your free consultation  with one of our trained aestheticians who can help you decide which treatments are best for your skin.

Dr. John Kuhl

Do you have a tattoo that you wish would disappear?  Your best chance for removal is with laser treatments.  Tattoos are created by placing ink deep into the skin below the level where new skin cells are generated.  This deep placement of ink makes the tattoo permanent.  Your body detects the ink as something foreign and tries to remove it; however, the ink particles are too large for your immune cells to carry them away.  Over decades, these immune cells can chip away at the tattoo giving it a blurry appearance.  Laser tattoo removal helps your immune system remove the tattoo by breaking the ink particles into smaller pieces that can more easily be carried away.

Some tattoos are easier to remove than others.  Amateur, or homemade tattoos, are usually easier to remove than professional tattoos.  Professional tattoos have more ink delivered into the skin, so it takes more treatments to remove them.  Larger tattoos and multicolored tattoos also require more treatments to remove.  Black and dark blue pigments respond the best to the laser light and are more easily removed.  All colors are generally improved with laser treatments, but some pigments, such as green and yellow, are more resistant to laser therapy.  Older tattoos are easier to remove than new ones.  Laser removal also works great for incidental tattoos such as pencil injuries that leave graphite under the skin.

Laser tattoo removal can be uncomfortable, but often just applying a cold pack prior to the treatment is all that is needed to make it tolerable.  Others options for numbing include topical anesthetic creams and injected local anesthetics.  We use a Q-switched Nd-Yag laser for removal of tattoos.  This laser is one of the best and most commonly used for tattoos.  Treatments are typically scheduled every 2 months to give your skin’s immune cells time to remove the pigment after each treatment.  An amateur tattoo may only take 3 sessions to remove; however, professional tattoos can take 6-8 treatments or more.  Even after multiple treatments there may be faint residual tattoo pigment, however, it is typically much less noticeable than the original tattoo.

Other methods of tattoo removal include surgical excision, dermabrasion (sanding), and chemical treatments; however, these methods often cause considerable scarring at the site of the tattoo.  Laser tattoo removal generally yields the best cosmetic outcome for tattoo removal.  We recommend that it only be performed by a qualified physician.  If you are interested in laser tattoo removal, please call Carolina Dermatology at (864) 233-6338 to schedule a consultation.

Catherine Martin, Clinical Aesthetician

Daily cleansing has a huge influence on the health of your skin. So what is the best way to cleanse the skin on your face?  A good soapy lathering, a scrub with an old washcloth and a quick towel dry are cleaning steps more suited to your car than to the delicate skin on your face. Here are a few things to consider:

First of all, it is important to clean your face every day. Dirt, makeup and excess oil should be removed before bedtime in order to keep your skin healthy.

When washing your face, grabbing whatever soap is close at hand is not a good idea. Soaps may contain perfumes or antibacterial agents that are too harsh for facial skin. The best choice is a soap free cleanser that is ph-balanced.

Your skin type, whether oily, dry, normal or combination, should guide the choice of your cleanser.

Other issues to consider include the sensitivity of your skin and/or how prone you are to breakouts.

You do not necessarily need a washcloth or abrasive applicator when washing your face. In fact, if you have sensitive skin, a washcloth can cause irritation or make you more prone to breakout. Applying the cleanser with clean fingertips in a gentle circular motion may be a better option.

Water temperature also makes a difference. Use warm, not hot water, when cleansing.

Always dry your face with a clean towel to avoid transferring dirt or bacteria to your cleaned skin.

There are hundreds of facial cleansers on the market. It is important to recognize the key ingredients of facial cleansers in order to determine which is best for your skin. Products that contain salicylic acid encourage skin cells to slough quickly in attempt to keep pores from becoming clogged with dirt and oil. These cleansers are typically used for acneic or oily skin. Other cleansers contain alpha-hydroxy acids (glycolic and/or lactic acid) which target the bond that holds dead skin cells together, encouraging cell turnover. Most skin types can tolerate these ingredients. Finally, there are cleansers that have a more creamy consistency and are typically created for dry or sensitive skin. These products may contain glycerin or hyaluronic acid and usually do not contain any perfumes which could irritate the skin.

Everyone’s skin is unique due to the combination of skin type, lifestyle choices and environmental influences. It is best to discuss your skin care with a dermatologist or skin care professional that can evaluate your skin and help you choose products that are right for you.

For a free skin care consultation with one of our aestheticians, call Carolina Aesthetics at 864-233-8088.