ADAS Dermatology

By David T. Harvey, MD, FAAD, FACP

Aging can often take us by suprise and can affect many locations of our skin. Many of my patients in Jacksonville, Ponte Vedra Beach and Palm Coast complain that they don’t like the look and feel of their hands. They complain that doctors can help them with their complexion and skin issues on their face and neck, but friends still notice their hands. Many are self conscious because they experience, easy bruising, skin laxity, discoloration and muscle tendon prominence.

What can I do for this doctor? is the normal question that I am asked. Can you help my hand appearance? Several years ago,  I would not have a good answer but with today’s technology, there are great solutions out there.

At our practice, we like to take a twofold approach to hand rejuvenation. first, we look at degree of 1.  hand atrophy and then assess 2. the hand skin color and laxity.  If skin fullness is an issue, we have some wonderful new fillers today. We love to use Radiesse, a hydroxyappetitie (calcium based) product that has excellent properties for filling natural skin depressions. One to two vials are administered painlessly into the back of thinned out hands. A numbing solution is mixed with the Radiesse, so this makes the procedure very tolerable.

After filler treatments,, we can perform either a Fractional CO2 or IPL (intense pulsed light) treatment to get improve skin discoloration and assit with age spot removal. Fractional CO2 is also a great way to tighten the skin. This a wonderful treatment option with one to two treatments being the norm.

So it time to ante up and show your hands at your next card game or ladies dinner. No longer do you have to worry about giving away your age…instead you will amaze.

By David T. Harvey, MD, FAAD, FACP

Eyelid Surgery is a standard therapeutic and cosmetic surgery procedure that is performed in the fields of plastic surgery and dermasurgery. We approach this procedure in a unique fashion…combining the best of cold steel surgery with “state of the art” CO2 laser instrumentation.

Traditionally, eyelid surgery involves the removal of the delicate fat pads by 1. identification of the fat pedicle with gentle skin dissection. 2. lifting of the fat pedicle 3. clamping with a forcep or “kelly” clamp 4. cutting the fat with tenotomy scissors and 5. intense coagulation (heating of the delicate eyelid tissue).

In our practice, with CO2 laser, we are able to eliminate steps 3 through 5. Once the fat is teased out, it can be genly ablated (evaporated) without the need for clamping or excessive heating. Fat which is still noted can be gently sculpted away  and the overlying skin muscle interface (septum) can be contracted without cutting using the CO2 laser in a defocused laser beam pattern.

I believe the technique minimizes the risk of the most serious side effect -retro orbital hematoma (bleeding behind the eye). It also lends itself to a much more precise type of surgery, one where the surgeon is more of an artist and less of a forger and pillager.

Check out the technique by clicking here… ah yes, the eyes ….they are indeed a beautiful sight to behold once again.

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After -7 weeks postop

By David T. Harvey, MD, FAAD, FACP

Fractional CO2 Technology

Recently, I had the pleasure of lecturing to fellow colleagues at the Advances in Dermatologic Surgery  Meeting in West Palm Beach and demonstrating what I  believe to be one of the greatest advancements in cosmetic laser surgery…..Fractional CO2 Laser Technology.

CO2 Laser has been around for many years. In fact, I remember that the technique was just coming out as I was  finishing my dermatology residency in 1995. It was a revolutionary laser but had many problems. First off, patients would complain of the pain and downtime. they had to have IV or general anesthesia. Another issue was that these patients would look disfigured and red for up to 14 days. Then we saw the complications (and did we!).  Poor utilization and technique as well as “off label” uses lead to unintended scarring and in some instances permanent disfigurement.

I have over 10 years experience with the CO2 laser and what I love about the fractional CO2 technology is that it finally offers us some unique advantages over traditional CO2 laser including…predictable results, off face uses, less downtime, requires topical anesthesia only, is minimally painful and very affordable. I can report from my own personal experience that this technology is pretty painless. I had my eyelids treated at low settings and found the experience to be very tolerable (reporting a 1 to 3 out of 10 pain scale.. in some areas I did not even require a topical anesthetic).

Fractional CO2 laser makes use of tiny dots which penetrate the skin and cause a disruption of the middle portion of the skin known as the dermis. Through a combination of selective tissue evaporation and heating, the dermis remodels and tightens.. This treatment is excellent for acne scars, wrinkles, oil gland enlargement, neck and hand laxity and much more. We can even use this laser in a unique way for our eyelid surgery cases. It is quite an awesome tool!

In short, I am blogging the Fractional CO2 laser because I am truly a believer of the technology. If you don’t believe me, check out our before and after pics and research the technology on your own. I am sure that you will be amazed like I was… in short order.

By David T. Harvey, MD, FAAD, FACP

Fraxel (re:store) treatment

ALA application

We then use a pulse dye laser to activate the ALA. This causes a mild redness  and induces shrinking of oil glands, blood vessels, pores and wrinkles. Down time is only a few days but redness can persist for up to a week.

before

after