Dr. Raminder Saluja injects BOTOX® with a very small, 31-gauge insulin needle to minimize discomfort. Most patients hardly feel the injection; however, for patients that would like to numb, topical numbing is applied prior to injecting to truly make it pain free.
The dynamic wrinkles (wrinkles occurring through expression) begin to relax and clinical results are seen as early as five days post-injection and up to two weeks after.
Typically, BOTOX® lasts between three to four months, although in a small subset of patients, it can last up to five to six months.
When a deep wrinkle is present at rest, we typically do a combination of either filler or laser along with BOTOX® to improve the cosmetic appearance.
The small needles used with BOTOX® diminish the risk of bruising, but please note that we all have vessels under our skin, therefore minimal bruising may rarely occur.
Dr. Saluja primarily uses Juvéderm® Voluma, Juvéderm® Ultra Plus, and Juvéderm® Ultra to fill areas of volume loss. Each Juvéderm® type has different particle sizes and different durations of longevity (up to one to two years!). The specific Juvéderm® that she will recommend depends on the area of the face that needs the volume. For the tear trough area, she typically uses Belotero®.
After baseline photographs are taken, Dr. Saluja applies topical numbing to the area. She uses small microcannulas that have blunt tips to inject the fillers. This greatly diminishes bruising and swelling, however aspirin, ibuprofen, fish oil, and ginkgo should be stopped (if not medically indicated) 10 days prior to the injection day if possible. Arnica montana can also be taken (you can buy it from a local drugstore and it is found under the arthritis section). This is a homeopathic medication that diminishes bruising and swelling.
First, it is important to wear sunscreen during the day whether it is winter and snowing or classically in the summer sun. It is also important to distinguish that the pigmentation is benign and not a suspicious lesion. If indeed it is benign pigmentation, then either an IPL (Intense Pulsed Light) or laser such as Picosure Focus Lens or Erbium can be utilized to minimize the pigmentation. Oftentimes, several treatments are recommended depending on the level of pigmentation. Other times, combination treatments with several lasers are recommended to achieve the best clinical result.
When vessels (telangiectasia) become prominent, IPL and pulsed dye laser treatment can improve the appearance of rosacea. Dr. Saluja utilizes the Max G IPL or Pulsed Dye Laser to target the hemoglobin within the vessels. Oftentimes, a series of treatments are needed every six weeks. It is important to wear sunscreen, especially since rosacea patients are even more susceptible to photodamage.
We recommend Sculpsure® for patients with "pinchable" fat. The laser procedure takes 25 minutes, where laser energy is delivered deep to the fat to injure the fat cell. Over the next two to three months, the body then clears away the fat and reduction is visualized.
Typically, one or two treatments spaced six weeks apart are recommended for the abdomen and flanks. We have found that distal areas like the legs and arms have more stubborn fat and may need two to three treatments.
We have a large variety of laser platforms to effectively target blood vessels, pigmentation, collagen, and elastin for skin tightening, hair removal, fat, and tattoos. The best option is to schedule a cosmetic consultation to discuss your concerns.