Peels stimulate a number of reactions by exfoliating the superficial layers of the epidermis. This in turn has consequences on fibroblastic synthesis and angiogenesis, which take place in the papillary dermis and renew and revive the skin. A peel can also directly penetrate and act on the dermis which is a unique property of peels.

The benefits of peels were first noticed years ago by Egyptian women who noticed that the byproducts of grapes improved their skin, due to their tartric acid. They also noticed that milk baths made their skin softer, because of its lactic acid. In the Antilles Islands, women noticed that the use of products obtained from sugar cane made their skin softer, which was a result of the glycolic acid found in the sugar.

Today, years of research have created an arsenal of peels, from those which act superficially to those which are deeply penetrating, which treat a number of conditions, with little to no downtime.

The superficial peels are: glycolic acid peels, lactic acid peels, salicylic acid peels, kojic acid and TCA of low concentration. These peels will cause no or minimal exfoliation and will improve the texture, brighten the complexion, hydrate, and decrease fine lines in the skin. These treatments will restore the equilibrium between different cell types.

The INTERMIDIATE peels are primarily the TCA peels. These peels will improve deeper wrinkles, eliminate actinc keratotic lesions which are precancerous lesions, and improve the skin’s overall tone. These peels will repair the skin and revive all of the skin’s functions.

The DEEP peels like TCA 40% and phenol peels cause a dramatic result by practically liquefying the epidermis and strongly stimulating the dermis. The skin becomes very smooth, and lines are completely eliminated.

These treatments are extremely rewarding, but not without potentially severe side effects and if practiced should only be done by very experienced physicians. The most common indication is very wrinkled, thin skin which can lose about 10 to 15 following the peel.

NO BRUISE FILLERS. The most valuable advancement I encountered is the blunt cannula, which allows one to inject filler without causing bruising. It is available in a variety of widths and lengths, which gives me tremendous versatility. I am now using them with all the HA fillers, such as Restylane, Perlane, Juvederm, Radiesse or Sculptra. This technique requires fewer punctures into the skin, making it less traumatic. Only 2-4 entry points are usually necessary to treat a whole face. The procedure is painless and permits injections not only in the face but also the décolletage, and hands.

NEW NEUROMODULATORS
Adding to the armamentarium of botulin toxins is Xeomin, recently approved by the FDA for use in the glabellar area. The new product contains the same chains of amino acids but without the complex proteins. Its purity makes it easier to conserve, while having the same therapeutic effects as Botox. Like Botox, it requires the same doses to achieve optimal results.

NEW TOPICAL TOXIN TYPE A
For those who shy away from needles, there will be a topical botulin toxin on the horizon. This product, Revance, is now in the latest stages of Phase 2 Trials. 11 studies involving over 500 patients, showed excellent efficacy in the crow’s feet area with no undesirable effects.
I would like to take the opportunity to once again remind everybody who is undergoing Botox to this particular area that studies show disappearance of lines at rest with this treatment. Even at the age of 20, when you smile, there will be wrinkling of the skin around your eyes, but, they will disappear at rest which is what we are hoping to achieve
with Botox to this area. The end goal of all our treatments is to allow our clients to continue to have a natural appearance and not to look like they’ve had “something done.”
As many have said before, the technique of injection is not particularly  difficult to learn, what is challenging is knowing where and how to utilize the technique to create a natural, aesthetically pleasing outcome.

In choosing a cosmetic doctor, I have learned, it is crucial to look for someone who is not only knowledgeable, but who truly understands aesthetics and facial anatomy. It is also extremely important to seek out someone who devotes his or her time exclusively to cosmetic medicine, whether surgical or nonsurgical. It is rare to find a first class injector who also devotes time to other specialties like gynecology, dentistry or even general dermatology.
Lastly, Revance shows promising results for those suffering from hyperhydrosis or extreme axillary sweating, simply by applying a gel.

NEW USE FOR BOTOX
Botox used in a technique called MesoBotox shows promising results in conditions like Rosacea, Acne, fine lines or crappie skin.
It is has added benefit to the mesolift and can be used together with the injections of hyaluronic acid or by itself to improve texture and tone.

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Medical Rolling

The Medical rolling, also known as percutaneous collagen induction is an alternative to laser resurfacing. The procedure can achieve similar results to the ablative laser procedures without the same down time.

It is performed with a roller which has fine protruding needles. These needles will puncture the skin, encouraging production of collagen and elastin.

The epidermis is a complex, highly specialized organ, about 0.2 mm in thickness. To appear rejuvenated, it needs to be evenly colored, hydrated and smooth.

The first step is proper home care with topicals, such as antioxidants, vitamins C and E, carotenoids, vitamin A. These alone cannot rebuild adequately lost collagen and elastin.

With the medical rolling technique, the needles will penetrate the epidermis, but will not remove it, so these small punctures will rapidly heal. The skin bleeds only for a few seconds. These punctures, automatically initiate a complex chemical cascade including numerous growth factors alpha and beta, which result in a fibroblastic response. This surge of activity leads to production of more collagen and elastin by the fibroblasts. Keratinocytes migrate across the epidermal defect and thicken the epidermis.

Five days after this procedure a fibronectin matrix is laid down and along it collagen will be deposited. Tissue remodeling continues for months after the injury and is primarily done by the fibroblast. Collagen type III is gradually replaced by collagen type I.

The procedure restores skin tightness in the early stages of facial aging. The neck, chest and hands can be successfully treated and any other body part like abdomen, thighs or buttocks.

It will diminish wrinkles, improve the appearance of scars and give white atrophic scars a healthier color. Telangiectasia may be eliminated. The recovery is minimal, and the procedure is a lot less expensive than any surgical, or laser ablative procedure.

In case you are all wondering why we so strongly advise getting facials on a regular basis, we thought we would explain some of the many benefits.

Facials are, as the name implies, skin treatments of the face, given by licensed aestheticians. The treatment starts with a detailed skin analysis, followed by cleaning, exfoliation, extractions, massage and, finally, a calming mask.

Facials benefit your skin in many ways. The deep cleansing removes build up and excessive sebum, preventing the clogging of pores and formation of comedones. This treatment is especially effective for acne-prone skin. Exfoliation, the removal of dead skin, will speed up the cell cycle and enhance collagen deposition. Black heads and white heads are removed during your treatment. Your skin will become more radiant and supple.

The massage stimulates blood circulation, brings more oxygen to the cell, and provides lymphatic drainage, reducing congestion and puffiness.

Our specialized facials have additional health benefits. Antioxidant facials contain free radical fighting products, which prevent free radical damage caused by daily polluants. Hydrating facials use products which penetrate deep into the skin providing moisture, while correcting the skin’s natural pH.

Facials can be combined with microdermabrasion, either ultrasonic or crystal, which will further add rejuvenating benefits to your treatment through exfoliation and mechanical stimulation. Alpha hydroxy or beta hydroxy acids have additional benefits and can be incorporated into any facial you may choose. These products can benefit acne- or rosacea-prone skin, in addition to aging skin.

Facials can regulate the immune system and aid in stress relief.

Our aestheticians can guide you in selecting the type of facial that will benefit your skin the most. They can also introduce you to more advanced treatments that our medical spa has to offer.

You may develop some redness, flakiness or even breakouts after a facial. This is a normal reaction and will resolve within a few days, leaving behind radiant, glowing skin. However, it is advisable not to schedule a facial close to a special event, particularly if you have clogged pores. Please call us with any questions you may have.

Your home skin care regimen is extremely important, it will compliment any in-office treatment you chose to have, so do not hesitate to discuss your regimen with your aesthetician. These treatments can be performed on your neck, décolleté or back. Please do not forget these areas as they can be prone to the same problems as the skin on your face!

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.

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.

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.

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.