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.

Before

  

 

 

 

 

After -7 weeks postop

By David T. Harvey, MD, FAAD, FACP

Fig 1. Evolence

I wanted to blog about a new state of the art filler that I was recently introduced to and one of the first to use in the Jacksonville, Florida  area… Evolence™. This product is the latest filler to be used by dermatologists and plastic surgeons and has quite a few advantages over others (as I pleasantly found out). First of all,  the material is very, very smooth and easy to place. I was pretty amazed when I treated a patient’s cutaneous upper lip on a smoker I was sure needed a CO2 laser procedure (Fig 2).

The material is derived from porcine (pig based) collagen. It is processed in a very unique way, which eliminates the need for pretesting. The process of ribosylation, evidently reduces some of the secondary post-op swelling that is seen with some of the other products that we commonly use (Restylane™ and Juvederm™).

Anecdotal reports have the material lasting from 15 to 24 months but I am not commenting until I see it for myself. To date, I am very impressed with how the material seems to finds the small lines and virtually erases them. Bruising is minimal. Cost is similar to the other products mentioned and varies from $600 to $800 dollars per vial.

Fig 2a. Before upper lip line treatment

Fig 2b. After treatment

A new filler, Evolence Breeze™, is set to hit the US market next year and this can be used in the lip region.

I will keep you posted of my personal experiences with this material but so far …so good.

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.