Acne is a chronic, inflammatory condition of the hair follicle. It is characterized by comedones (white and black heads), papules, pustules, nodules and cysts.

This is a common skin problem in adolescents as well as in adults. It affects 40-50 million people in the United States.

There are four major factors associated with the pathogens behind acne. These are, increased sebum production, increased keratinocyte proliferation, abnormal desquamation, and colonization by Propionibacterium acnes, resulting in inflammation.

Acne grading is based on the numbers, type, and extent of acne lesions. Depending on the severity of the condition, we prescribe treatments that will target the particular causative mechanisms causing an individual’s acne condition.

Routine endocrinologic testing is not necessary. Indicators of hyper-androgenism often include menstrual dysfunction, hyrsutism (excessive hair growth), or polycystic ovarian syndrome in adult women.

In all cases, we at Park Avenue Medical Spa recommend deep cleansing of the pores to eliminate the sebum and prevent infection. Exfoliation further helps to reduce hyperkeratosis. In addition, we often add light peels to a cleansing facial in my N.Y. practice.

Mild acne can be successfully treated with a topical retinoid with or without a topical antibiotic. Prolonged use of topical antibiotics can induce antibiotic resistance.

There are multiple topical retinoids, like adapalene or tazarotene which give excellent results.

Benzoyl peroxide is a bactericidal and is effective in treating acne to end the development of P. acne resistance. It is available alone or in combinations with topical retinoid or antibiotics.

Topical antibiotics, like clindamycin or erythromycin show efficiency and are available in gels or creams combined with retinoids or benzoyl peroxide. Studies indicate that they have comparative efficacy in reducing acne lesions.

Treatment of moderate acne will require a more aggressive approach. Systematic antibiotics are often added to a topical regimen. The most commonly used antibiotic is tetracycline and its derivatives.

Oral contraceptives containing estrogen and a progestin have also been effective in reducing acne in women.

I often incorporate spironolactone when treating acne patients in my Westchester practice. This medication inhibits biosynthesis of testosterone and blocks androgen receptors, thus eliminating the androgenic pathway of acne production.

Severe acne will need a combination of treatments, including synthetic antibiotics, topical retinoids, topical benzoyl peroxide and hormonal manipulation in women. Oral isotretinoin is indicated in severe nodulocystic acne or treatment-resistant moderate acne. Depression and suicidal behaviors have been reported in patients taking isotretinion. Other treatments include intralesional corticosteroid, injections, chemical peels, IPL treatments and photodynamic therapy.

At Park Avenue Medical Spa, we utilize both glycolic and salicylic acid peels. The salicylic acids have a strong comedolytic effect and penetrate deep into pores.

Photodynamic therapy utilizes a photosensitzing agent and used correctly shows positive results.

The face and neck are areas often neglected by many of our clients. They, however, are an easy give-away of one’s true age and should be treated as frequently as the face.

Some of the most common blemishes we see with the, hands, neck, and décolleté are “sun spots,” fine lines, creepiness , loss of elasticity and firmness, and loss of dermal and subcutaneous volume.

In my Armonk, Westchester N.Y., practice I start with close inspection of these areas and after assessment of the degree of damage we recommend single or combined therapies.

We immediately start a regimen including topical agents like retinoids or glycolics.  Other topicals often utilized are hydroquinone or kojic acid containing collagen stimulating peptides or growth factors. Antioxidants are also useful in treating hyper-pigmentation and preventing oxidative damage.

Park Avenue Medical Spa is equipped with the latest in state of the art technology for the treatment of aging.

The treatments are always customized to individual needs and may include microdermabrasion, peels and IPL treatments.

In all our Westchester centers we perform a variety of alfa and beta hydroxi acid peels of different strengths. We also utilize commonly trichloroacetic acid peels for those with more severe problems.  These treatments are complemented by at home use of appropriate creams and abundant use of the right sunscreen.

For patients with more advanced conditions we recommend IPL photo rejuvenation. The use of this device will improve texture, remove pigmentation and reduce fine lines and wrinkles.

Botox is frequently added for treatment of the neck to eliminate platysmal banding and provide a moderate lift.

Mesotherapy is another technique that I utilize in my NY locations (don’t you only have NY locations? In which case, you should just say “at all my locations”)  to improve texture and reduce wrinkling. This technique developed in France utilizes multiple superficial injections of hyaluronic acid combined with vitamins and retinoic acid.

The loss of volume can be corrected with fillers. Most commonly used fillers are Radiesse (Calcium Hydroxylapatite) and Sculptra (poly-L-lactic acid).

It is not uncommon to utilize multiple therapies for better and faster results. It then remains in one’s hands to protect and maintain the results achieved.

Protection with frequent application and generous amount of the right sunscreen remains one of the best ways to prevent future damage and maintain a healthy ageless skin.

In my practice, Facial Rejuvenation often includes a multitude of treatments, starting with a series of peels combined with microdermabrasion, to a more complex approach that incorporates Botox Fillers and IPL technology.
What determines the treatment selected is a detailed history and physical with a close analysis of the degree of photoaging. For a younger patient with Type I photoaging, I concentrate more on the pigmentary changes, the vascular aspect, and the pores. For Type II photoaging, where there is involvement of the entire dermis, the approach is more complex. Type 3 is characterized by lypoatrophy, muscle and bone re absorption, with deeper wrinkles and significant volume loss. This remains the biggest challenge for me. The majority of these patients have not had any aesthetic procedure and are often unwilling to accept surgical or ablative procedures and sometimes fillers, which could promote collagen or new bone formation, like Sculptra or Radiesse.

The IPL technology remains the gold standard for treatment of actinic keratoses, rosacea and acne. These technologies can increase collagen production, reduce pore size and improve overall texture of the skin. The equipment available to my Westchester patients gives me the versatility of different energies, IPL technology with bipolar RF, IPL alone or just RF which accomplishes volumetric heating and is used primarily for those patients who have important laxity.
In both my Armonk and Rye Brook, NY, pracices I offer my patients combining technologies based on their needs and primary goals. IPL devices can eliminate inflammation, decrease the numbers of Propionibacterium and Demodex organisms and reduce sebum production. These actions improve acne. Adding photodynamic therapy with the aminolevulinic acid (ALA) will further improve results and even reduce the number of treatments.

The Sciton technology using special filters allows me to treat pigmentation and vascularity more aggressively. Patients with Rosacea see faster and more impressive results after only one treatment.

The Refirm ST (Syneron) combines infrared with bipolar RFand penetrates to a depth of 1.5mm. to 2mm. This skin tightening treatment is used by itself or combined with other Elos technology to improve texture and tighten the skin.

These treatments can be successfully applied to the neck, chest and hands, areas that tend to be often neglected.

Used alone or in combination with chemical peels, microdermabrasion, mesolift, Botox and Fillers these treatments can turn back the clock.

Facial fillers are one of the most commonly used minimally invasive cosmetic treatments. Used in combination with Botox, the so called “Liquid lift” can take more than 10 years of your face. The challenge remains choosing the right filler. There are currently many fillers on the market, some permanent, others semi-permanent, and still others, temporary. Filler longevity varies substantially from patient to patient. It can be based on the amount injected, the location, and on individual patient characteristics.

One should utilize permanent fillers with caution since they are less versatile, can interact with certain drugs, or can result in inflammation. The underlying mechanisms are not yet understood. 

In my Westchester practice, I generally recommend that first time users start with temporary fillers. If the result is not that which was expected, at least we will know that in about six months time it will be completely gone and no permanent changes will have been made. Frequently my patients will ask “Will my face look worse once the filler is no longer present?” and the answer is NO.

At Park Avenue Medical Spa located in Armonk, Westchester we commonly use as temporary fillers   hyaluronic acids like Restylane, Perlane, Juvederm Ultra and Ultra Plus. These fillers are well tolerated, very versatile, and amongst the few that can be used successfully for lip augmentation.  Ideal for superficial defects, they are safe and offer instant gratification. Complications are limited to temporary bruising or swelling.

The semi-permanent facial fillers, like Radiesse, a calcium hydroxylapatite, are more viscous, require deeper placement, and are commonly used for large volume correction. Radiesse is used frequently for cheek or jaw line augmentation as well as correction  of nasolabial folds or marionette’s lines. It can be used with caution for correction of rhinoplasty defects involving the bridge or tip of the nose. Radiesse is also indicated to restore volume in aging hands.

Sculptra, a poly-L-lactic acid, is a semi- permanent filler and should be performed by an experienced injector. It works by stimulating collagen formation and requires multiple treatments spaced several weeks apart. The injections are deep and overcorrection must be avoided. 

Permanent fillers such as ArteFill (polymethylmethacrylate/bovine collagen) and silicone can offer certain advantages, like cost and convenience. The real concerns remain, patient satisfaction, delayed complications, allergic reactions, and bacterial or viral infections.

The use of facial fillers can have dramatic results. While fillers can wipe away all those unwanted wrinkles,  they can also result in complications.  Search carefully for a physician, do not be afraid to ask questions, and plan your treatment carefully.