(This page is in progress and will forever be growing)


Botox is made from a neurotoxin called botulinum toxin. Dysport and Xeomin are other brands of botulinum toxin that are used just like Botox. They all work by temporarily paralyzing muscles that when moved repeatedly lead to expression lines and wrinkles. The forehead and around the eyes are the most common places to have Botox injected for cosmetic purposes. (Botox also has numerous medical applications treating muscular conditions.)

Courtesy of Botox Cosmetic—Before and after treatment with Botox

Botox is the most popular non-surgical cosmetic treatment, with more than 6 million treatments administered each year.

Botox is administered by injecting it directly into neuromuscular tissue. There are chemical synapses formed by contact between a motor neuron and a muscle fiber underneath the skin. This motor neuron transmits a signal to the muscle fiber, causing muscle contraction. (The Botox’s job is to prevent that signal.) Your injector knows right where these connections occur. You will receive a few pokes with a needle, depending upon the area being treated.

Areas where botulinum toxin is commonly injected

It can take 3-4 days for Botox to begin to work, with full effect observed at two weeks. The smooth results from Botox last anywhere from three to six months. Xeomin has a similar onset and longevity, though it varies from person to person somewhat for any botulinum toxin.
Dysport has a quicker onset of 2-5 days but may not last quite as long as Botox. (This last point is up for argument—some people report just the opposite to be true)


Clear + Brilliant

Clear + Brilliant is a skin resurfacing laser that removes old, damaged skin cells and age spots, diminishes pores and fine lines, and improves skin tone and texture. It’s different than other resurfacing lasers because there isn’t an extended downtime (where you look scaly, peeling or

discolored). Your skin may feel a bit rough for a day or two, but no one will notice you’ve had anything done, and by day three or four, new, fresh, “clear and brilliant” skin will be revealed. Multiple treatments are recommended for best results. The laser also has the effect of stimulating

collagen, so while you’ll see quick results, you’ll notice your complexion continue to improve over the next few months.



Collagen is the most abundant protein in the human body and provides structure to everything from bones, skin, muscles, tendons and ligaments. Collagen forms a scaffold to provide structure and strength. When you picture that in terms of your skin, that makes it seems quite important, doesn’t it?

Younger skin versus older skin and the role of collagen

Unfortunately, with age the body begins to produce less collagen. This means that the structural integrity of the skin becomes compromised. After menopause especially, women will experience a dramatic reduction in collagen synthesis.

There are certain things we can do to increase collagen, however—as well as behaviors that contribute to its decline. UV exposure is the number one enemy of collagen. Smoking will also cause it to deteriorate, as well as the consumption of sugar and other high-glycemic carbohydrates.

A lot of the treatments and procedures we talk about in this blog help “build collagen.” Collagen is what gives skin that youthful, plump look.



Dermal Fillers

Dermal fillers, or simply, “fillers” help to restore volume to the face. As we age, our faces naturally lose subcutaneous fat. Dermal fillers can enhance shallow contours (think cheeks, temples), plump thinning lips, fill out recessed scars, and even decrease or remove dark shadows under the eye.

Dermal fillers are injected underneath the skin using either a needle or microcannula, and the result is an instant fullness.

Courtesy of Juvederm/Allergen

There are several different types of fillers. Depending on the type used, where it is being injected, and the individual, most last from about six to eighteen months. (Over time the filler is absorbed by your body and this process happens at a slightly different rate for everyone.)
There are a couple of products on the market that last up to two years, and a filler known as Bellafill that lasts five years or longer.

The most popular category of filler is made from hyaluronic acid. Hyaluronic acid (HA) is a sugary substance that already occurs throughout our skin’s structure and connective tissue. It lubricates joints and keeps things moist. It has the ability to hold almost 1000 times its weight in water!

HA fillers can be dissolved if you are unhappy with the result. There is an enzyme that can be injected into the area where the filler was injected, causing the unwanted or “too much for your tastes” filler to dissolve within 24 hours.

Courtesy of The American Board of Cosmetic Surgery

Brand names of HA dermal fillers you may see include Juvederm, Belotero, Voluma, Restylane, Vollure, Volbella, and Revanesse. Revanesse Versa is a brand-new filler that was just approved by the FDA, actually.

The fillers Radiesse, Sculptra and Bellafill aren’t made from hyaluronic acid and promise slightly longer-lasting results, with Bellafill being the longest.

Sculptra is unique because the effect of the injection is not immediately noticeable. Sculptra works by stimulating one’s own collagen in and around the treated area(s), and the overall filling out effect is gradual. Often people require two or three injections spaced months apart, and the effect lasts about two years.

A good physician will know exactly which product is right for the part of your face that concerns you. Some are created for areas where they will sit close to the skin, like your lips. In this case they must be very smooth and fluid. Others are thicker as they are meant to be placed deeper and fill out more pronounced grooves in the face.


Hyaluronic Acid

See “Dermal Fillers”



Melasma is a fairly common patchy brown, tan, or blue-gray discoloration on the face, often seen in women in their reproductive years. It usually will appear on the upper cheeks, upper lip, forehead, and chin. Melasma is uncommon in males but not unheard of. It is thought to be primarily related to UV exposure, birth control pills, and natural hormonal changes such as those seen in pregnancy. It is most often seen in pregnant women, especially those of Latin and Asian descent. You will sometimes hear it referred to as “the mask of pregnancy.”

The best way to prevent melasma is to always wear sun protection and practice sun avoidance. Treatment requires regular sunscreen application, medications such as hydroquinone, and other fading creams.

If topical medications do not get rid of the melasma, a procedure may succeed. Procedures for melasma include chemical peels, microdermabrasion, and/or laser or light-based procedures.



A microcannula is a thin, flexible tool that resembles a needle. The main difference between needles (that some 80% of injectors are still using exclusively) and microcannulas are the tips: needles are obviously quite sharp while a microcannula is blunt.

Just like the needled syringe would, the microcannula dispenses the chosen filler through a hole. The hole on the microcannula is near the top and on the side rather than at the tip like on a needle.

A needle is still used to make the initial entry point into the skin, but from there the microcannula takes over and has a good number of advantages over the sharper tipped needle.

Because the microcannula is flexible, the injector can make one needle entry point and using the cannula fill an area that would’ve required 4-5 needle punctures to fill using only a needle.
Because the tip is blunt, it will not nick any of the underlying blood vessels as it weaves its way around the area being filled. This type of maneuver would be impossible with a needle.

Bruising and pain is greatly reduced using a microcannula.


Retinoids is the name of the general category for all forms of vitamin A (also called retinol). They are FDA approved to treat acne and wrinkles. Prescription topical options include tretinoin (Retin-A, Avita, Atralin, and generics) and other vitamin A derivatives, such as tazarotene (Tazorac, Avage) and adapalene (Differin, also available combined with benzoyl peroxide as Epiduo). All of these come in different strengths, which your dermatologist can discuss with you. (Differin Gel is also sold over-the-counter in its lowest concentration, 0.1%, perfect for those who don’t have medical insurance) 


 Prescription retinoids are typically the first line of defense against acne your dermatologist will offer because they often work so well! Retinoids change the way skin cells are formed and how they move through the layers of skin on their way to the surface. This reduces clogged pores, restores a normal flow of oil through the pore lining, and calms inflammatory factors in skin that trigger acne. 

Retinoids are also a highly effective anti-aging product. Since they prompt surface skin cells to turn over and die rapidly,they make way for new cell growth underneath. They hamper the breakdown of collagen and thicken the deeper layer of skin where wrinkles get their start. (Also see this post)



Rosacea is a common skin condition that causes redness and visible blood vessels in the face. It can also produce small, red, pus-filled bumps. These symptoms can flare up for weeks to months and then diminish for a while. Rosacea is sometimes mistaken for acne, an allergic reaction, or some other skin problem.

Rosacea: Courtesy of The American Academy of Dermatology

Rosacea can occur in anyone, but it commonly affects middle-aged women who have fair skin. While there’s no cure for rosacea, treatments can control and reduce the signs and symptoms.

Unfortunately, there’s no treatment to cure rosacea. Instead, dermatologists aim to reduce or eliminate the signs of rosacea, ease the discomfort, and prevent it from worsening.

It’s important to find out what causes an individual’s rosacea to flare, so that they can avoid those triggers. People who have rosacea are usually quite sensitive to the sun. Sun protection is a huge part of preventing the condition from worsening. Also, many skin care products and habits can irritate skin with rosacea, causing it to flare. Using mild skin care and being gentle with the skin can help prevent such irritation.



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