ASK THE DOCTORS

How long until final result after mole removal?

Thursday, June 13th, 2013

Hi Dr, I was wondering how long does it take to reach the final result after mole removal? I saw pictures of mole removals on the realself website and it look like you did good work. The scars of the patient were small thin almost unrecognizable lines. I had one removed 3 months ago and it is still red and stands out. I just want it to reach its final result so I can stop thinking about it cause it bothers me and stresses me out. I wanted to know how long after were the after mole removal pictures taken? It would help ease my mind a lot thank you

-M

Hi M,

Thank you for commenting on my “good work”. I do a lot of cosmetic mole removals and I always have a long discussion with the patient about healing time BEFORE we do the removal. It can take months for the redness and scar to resolve and look good. The photos on RealSelf that you saw were taken at 12 months and 3 years after the surgery. I comment to patients that at 2 months, you may very well be saying “why did I do this, it looks worse than the mole”. BUT, let me reassure you. In 90% of cases, the redness clears and the scar improves greatly and the cosmetic result is nice. It can take 4-12 months for that good end-point. So I hope this eases your mind.

I would give it another month, and then if the redness is still present, or the scar is not looking good, I would recommend that you 1. Talk to the doctor that removed the mole and see if they will see you – it is always good to let the physician that did the work know how things are going. He/She may have a laser or other options to improve scars. After you do that, you can 2. Always make an appointment here at Pacific Dermatology & Cosmetic Center and I would be happy to look at the scar and see if we can improve it, or at least reassure you that it will get better. I have many lasers (Vbeam, Fraxel, CO2) that can improve scars.

Thanks for the inquiry – and I hope this helps.

Dr Reichel

Jennifer Reichel MD

Director, Pacific Dermatology & Cosmetic Center

11011 Meridian Ave N Ste 102

Seattle WA, 98133

206-859-5777

www.pacificdermcenter.com

Botox for Teeth Grinding

Thursday, June 13th, 2013

Will Botox for jaw reudction help with teeth grinding?

-S

Dear S,

This is a very good question.
There is evidence that botox injections into the muscles used to cause teeth grinding (the Masseter and possibly Temporalis muscles) can help with this condition. In 2012, there was a small study done that involved 23 patients. The patients with nighttime teeth grinding, or nocturnal bruxism, who were given Botox injections reported greater improvement in their condition compared to those given a placebo. The findings suggest Botox could be used to treat nighttime teeth grinding, a common condition for which there is no established treatment. Although dental guards are used to prevent damage to teeth, they do not prevent the grinding itself.
In the study, 23 patients with nocturnal bruxism were randomly assigned to receive a Botox injection or a placebo injection. To be included in the study, patients were tested in an overnight sleep study to confirm they had nocturnal bruxism. Thirteen people received botox in the temple and jaw, and 10 received the placebo. Four weeks later, participants rated the severity of their condition – whether they felt better, worse or about the same as before the study. The ones who received botox felt significantly better.

So, YES, botox injections in the jaw and temple muscles may improve teeth grinding.
But, botox injections into the jaw muscle are also used to lengthen and thin a very round face. It can look really nice on certain patients. I have patients that come to me for this treatment. If you already have a longer face, then botox in the jaw muscle might not be the right treatment for you. Please call our office at 206.859.5777 to schedule a consultation.

Jennifer Reichel, MD
Pacific Dermatology & Cosmetic Center
11011 Meridian Ave N Suite 102
Seattle, WA 98133
206.859.5777

Dr. Jacobson talks to KOMO news on Skin Cancer Awareness

Tuesday, May 14th, 2013



Am I a good candidate for Total FX CO2 laser?

Sunday, May 12th, 2013

Younger Looking Hands: Filler vs. Fat Grafting

Friday, May 10th, 2013

Taken from a RealSelf interview with Dr. Jennifer Reichel

Dr. Jennifer Reichel who practices in Seattle says she believes that patients get better results if they use fat injections.

RS: What is your preferred method of adding volume back to aging hands?

Dr. Reichel: If the patient is willing to undergo the fat transfer, I certainly prefer it as a filling agent. I do use a lot of radiesse in the back of the hands because it’s very easy to do, the patient just comes in and you don’t have to worry about doing the liposuction procedure. It can look nice as well, but I personally prefer the fat.

RS: How is it done?

Dr. Reichel: For fat transfer in the hands you do a mini liposuction procedure where you remove the fat from the individual that you’re going to treat. Usually I remove it from the abdomen, it’s an easy place to get really nice fat for transfers. You insert a large volume of local anesthetic to numb the area, and you remove the fat using a very small canula and a syringe. Then you take the fat cells, and we have a special process where we spin them down and so it gets just the fat and you don’t have all the extra fluids. We store can store the fat in a freezer system for up to two years, and then for injecting it into hands it’s really easy to undergo.

I numb the back of the hand with a little bit of lidocaine, and then I attach the syringe with the fat in it to a small canula and insert the fat. The fat moves really easily through the tissues, and you can spread it throughout the hand. It’s a really great filler for hands, because unlike some of the other fillers it’s very malleable. Fat is the same viscosity as our underlining tissues, whereas the other fillers are a little more thicker and don’t move around quite as easily. You just inject it in there and it’s pretty instant. You may get a little swelling for about three or four days and that’s as far as side effects go.

RS: How long do they last?

Dr. Reichel: It depends on the individual. So the first time I usually do it I tell people they are going to need to return for a second transfer done somewhere between 3 and 6 months later, and then maybe a third at the same interval. Then at the end of the two year period of time we contact the patient before their fat expires and ask them how they’re doing and invite them back in for a final transfer. So usually people undergo somewhere between 2 and 4 treatments in that two year period of time. If you look at the text books they say that fat can last anywhere between 2 and 8 years. I’ve seen it where it’s been 10 years later and that patient still has really nice filled hands, then some other patients it only lasts about a year or so before they need to undergo the process again.

Before and after photos of Dr. Reichel’s patients who used fat transfer to restore volume to their hands.

Dr. Jacobson on KOMO radio

Friday, May 10th, 2013

It's skin cancer awareness month and KOMO's Art Sanders talks to leading dermatologist Dr. Laurie Jacobson about the danger even here in Seattle

Surgical treatments for excessive sweating

Thursday, April 4th, 2013

The website suggested that for excessive sweating, there are some surgical treatments that could be applied. What exactly are these surgical treatments and what are there success rates? Thank you. JM

Hi JM. Thank you for sending your inquiry.

Yes, there are surgical treatments for excessive sweating. The treatment options may vary depending on which areas of your body you are having excess sweating.

In the armpits (axillae), you can have Botox or Dysport injections done. This is not permanent. Most patients respond well to the injections and will have decreased sweating for 6 to 9 months. This is the most popular treatment right now. It wouldn’t be considered surgical.

Another option for the armpits is to have a procedure done called retro-dermal curettage (axillary suction curettage). Retro-dermal curettage is a liposuction type procedure where you inject a large volume of a dilute anesthetic into the armpit area. You then take a liposuction cannula and insert it through tiny ports (little incisions made in the skin) and scrape the underside of the skin where the sweat glands live. The cannula is a small hollow metal tube. It has holes at the end and the edge of the hole is a little bit sharp. For liposuction, you point the “hole” on the cannula downward to suck out fatty tissue. For sweating, you point the cannula up toward the skin and basically scar the sweat glands down so that you no longer sweat. This is really a pretty easy procedure to undergo, and is very safe. It is effective for most patients and can give a permanent decrease in sweating of 50 to 90% or so. This would be considered a surgical procedure.

The other procedure that we offer for excess sweating can be performed in the armpits, and on the palms and soles of the feet. It is called Ultherapy. Ultherapy is an ultrasound device that sends high frequency ultrasound waves below the skin. It is most often used to tighten the skin of the neck, jawline, and face. However, when Ultherapy is done for sweating, the ultrasound waves penetrate the skin to the depth of the sweat glands and actually destroy the sweat glands. The preliminary studies done with this procedure showed a 70% reduction in the amount of sweating after 2 treatments. We believe it should have permanent, or very long-standing effects. It is NOT invasive, and is a great option for sweat reduction.

Finally, you can have the nerves that are associated with sweating cut. Depending on where you are sweating will change where the nerves should be cut. This procedure is called a sympathectomy. It is usually performed by a thoracic surgeon.

I hope this helps. I would be happy to see you in consultation to discuss the treatments further and pick the one that is right for you.
Thank you for your inquiry.

Sincerely,

Jennifer Reichel MD

Director, Pacific Dermatology & Cosmetic Center

11011 Meridian Ave N Ste 102

Seattle WA, 98133

206-859-5777

www.pacificdermcenter.com

Lip augmentation

Tuesday, March 19th, 2013

Hi Dr. Reichel,

I am interested in lip augmentation. Is this something you can do?

A

I love doing lip augmentation. I would be happy to see you for this. I usually use either Restylane, or Juvederm (fillers) to plump the lips. It is one of my favorite procedures to do. There is also a brand new ultrasound device called Jenu, that can be used at home to maintain plumped lips. You have to wait one week after having  fillers to use it, but it is great.

Please call 206-859-5777 to set up an appointment for a consultation. Mention RealSelf and the consult is free. Also, we can do your treatment on the same day if you would like. You will have about 2-3 days of very puffy lips, so be sure that you don?t have any big events in the days right after treatment. Other possible reactions include bruising. This is uncommon, but can happen. The fillers usually last about 6 months the first treatment, and then can last even 18 months with a second treatment.

I look forward to seeing you.

Dr Reichel

Treatment for older white stretch marks

Tuesday, March 19th, 2013

Filler for nasal correction

Tuesday, March 19th, 2013

Dr R, I am interested in Botox to reduce the width of my nostril flare when I smile and possibly Radiesse to enhance the tip, and make my broad asian nose look longer and slimmer. Can u give me an estimate, pictures, have u done it before?

F

Hi F,

I have done this before, probably about 10 times for Asian noses, and 20 times for Caucasian noses. The cost for the botox is $30 and the cost for the Radiesse is $450. It is about a 20 minute procedure. The botox lasts about 4-6 months. The first time, the Radiesse lasts about the same amount of time. After you have done the Radiesse a couple of times, it lasts a lot longer. It is amazing how you can make a nose look less flat and more slim by adding a bit of filler product along the bridge of the nose. There are few big risks. You may get bruising, and you will have temporary redness and swelling. Sadly, there have been some cases (very very few) in which the filler caused the skin to break down and develop a sore at the injection site. This is very rare and I have never seen it in person.

This is one of my favorite treatments. Please call to make an appointment for a consultation. I can show you photos then. The consultation fee is waived when you mention realself. Also, we can do the treatment on the same day if you want.

Thank you.

Sincerely,

Dr Reichel