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Injections or Surgery: When's the Right Time?

Injections or Surgery: When's the Right Time?

Perhaps you have been considering a procedure to address your aging skin. Do you opt for an injectable like Botox or Xeomin to stop muscle movement or a filler like Juvéderm or Radiesse to add volume? Or is it time for surgery in the form of an eyelift or blepharoplasty?

"I generally suggest that you give fillers a try if you have relatively good skin elasticity, but have lost some of the fullness in your face," says Dr. Jennifer Reichel, Founder & Director of Pacific Dermatology & Cosmetic Center. Fillers can plump up areas that are beginning to look a bit gaunt, but they cannot address excessively sagging skin. If wrinkles are bothering you, injectables like Botox or Xeomin may fit the bill to stop the facial movements (like squinting) that cause the lines.

If you have tried injectables or fillers and feel that you look "puffy" or "doughy," it may be time to move on to surgery. If you have sagging skin, surgery is the procedure that will fix it.

However, since some areas of your face may need more aggressive attention than others, don't be surprised if your doctor suggests injectables or fillers in conjunction with surgery to help you achieve the most natural, balanced look. Bottom line: Seek out a board-certified cosmetic surgeon to help determine the current condition of your skin and the best ways to improve it.  At Pacific Dermatology & Cosmetic Center, we offer cosmetic consultations for all of your cosmetic questions and needs, call 206.859.5777, to schedule an appointment today.

I would like a consultation for liver spots

Dear Dr. Reichel:

I am 67 years old, and have two liver spots on my face and would like them removed. Do you have "free" consultations? Thanks J.W.

Dear J.W.

Liver spots are a common name for any sort of pigmented lesion on the skin that develops with aging. They are usually “sun freckles”, or solar lentigines. However, someone might also be referring to seborrheic keratoses when they use the words “liver spots”. I like to call seborrheic keratoses “spots of much wisdom”. Often times, we think of Liver spots as being located on the hands. However, I am sure that some folks think of Liver Spots as any brown spot on the body that has come with age, and is not a mole.

 For treatment, the easiest and fastest is still use of liquid nitrogen, or freezing. When a patient has only a few brown spots, this is often my treatment of choice. However, there are several lasers here at PDCC that we can use to remove brown spots. And, of course, I am a huge proponent of Retin-A for anti-aging.  Our cosmetic consultations are $80, however if you decide to have treatment the same day we can credit the $80 toward that treatment.  Please call our office at your earliest convenience to schedule at appointment, 206-859-05777, either Melissa or Sara can set that up for you.  I look forward to working with you.

Thank you, Dr. Jennifer Reichel of Pacific Dermatology & Cosmetic Center in Seattle

Dear PDCC;

I have a couple of scars around my mouth that are getting deeper as I age. I'm wondering about fat injections vs. a dermal filler, both in terms of lasting effect and cost. Can you tell me how the two compare? K.

Dear K.
Thank you for your inquiry. The most important idea is for you to come in and we can do a consultation face to face to look at your scars. However, I can give you some information vial email. When working around the mouth (with wrinkles, or with scars), I am more likely to recommend a dermal filler (such as Restylane or Juvederm) over fat injections. Fat is a wonderful “volumizer” for the face. Non of the other fillers even come close to giving the results of a fat transfer when someone has lost volume in the upper face, or has dark circles or grooves under the eyes.
However, around the mouth, fat often is too bulky, and it does not have the ability to fill in fine lines or fine scars. The hyaluronic acid fillers, such as Restylane and Juvederm, can be placed very superficially under the skin to really fill in finer lines, or to fill in scar lines. There are other options for scar treatments – so we don’t want to rule those out until I see you in person. 
Please call my office at your earliest convenience, 206.859.5777, either Melissa or Sara can schedule an appointment for you.
Thank you for the email. I look forward to seeing you.
Dr. Jennifer Reichel Pacific Dermatology & Cosmetic Center in Seattle

Look Years Younger in Minutes with Liquid face lifts

Look Years Younger in Minutes

In the hands of a skilled, board-certified practitioner, injectables and fillers offer a fast route to a youthful makeover with zero downtime. The "liquid lift" utilizes fillers and injectables that can take off 10 years in mere minutes.

For instance, a hyaluronic filler like Perlane is used to define the cheeks and to address shadows under the eyes. Radiesse is a semi-permanent filler and can do wonders to improve a weak chin.  An injectable like Botox can help to smooth forehead lines by stopping the muscle contractions that create wrinkles. New fillers and injectables have recently been FDA-approved, so ask your doctor about the latest options.

Using injectables to rejuvenate the face is a customized procedure and the doctor may use different combinations of injectables to address individual concerns. It’s imperative that your physician knows the nuances of each product, where to inject them and how to manage potential complications.  The skilled physicians at Pacific Dermatology & Cosmetic Center have years of experience with the "Liquid Face Lift", call us today to schedule your consultation, 206-859-5777, we look forward to working with you.

Fraxel re:pair vs CO2 laser

Dear Dr. Reichel:

I'm in my early 40's and am not happy with how my skin looks.  I pride myself on wearing good sunscreen and taking care of my skin, however I feel as though the fine lines and brown spots are getting the better of me.  I have looked into lasers and read about both the fractional Co2 and traditional Co2.  A friend of mine had a great experience with you and suggested I come see you.  Can you tell me what the difference is between the two lasers?

Thank you. K.C

Dear K.C.

I very much love the Fraxel, as I have the new Fraxel dual re:store; but what I can tell you about the Fraxel re:pair is that compared to the traditional CO2 it has less versatility.  It can only do fractional, meaning only to one depth, vs my Lumenis CO2 that has two depths, deep and active, which I can use to treat the really deep wrinkles.  I would really like to see you in consultation to determine what would be best for you.  I can tell you that my patients who have been treated with the CO2 love their results and I have some great before/afters to show you.

Please call my office to schedule an appointment for a cosmetic consultation, 206.859.5777, I look forward to meeting you.

Thank you,

Dr. Jennifer Reichel

Is CO2 the best laser to remove wrinkles around my eyes?

Dear Dr. Reichel,
I am not happy about the wrinkles around my eyes.  I am very interested in the fractional CO2, but would like to know how much it would cost, and more importantly, what would I be getting myself into as far as downtime after the procedure?
Dear Katie,
Thank you for your inquiry about cost and recovery time for fractional CO2 laser around the eyes.
It is a great procedure and can give long lasting improvement for wrinkles, pigment, and loose skin around the eyes. Here at Pacific Dermatology & Cosmetic Center, we have the Lumenis Total FX CO2 laser. I believe strongly that it is the best fractional CO2 laser on the market. Remember that not all “fractional” CO2 lasers are made the same, and results will vary based on who the practitioner is that is performing the laser treatment. I have done hundreds of Fractional CO2 treatments, and trained in traditional CO2 resurfacing prior to that. I absolutely LOVE the results.
The cost to have a treatment done around the eyes is around $1900.00. Most patients have about 4 full days of down-time. On the fifth day, you should be able to put on make-up and go out into public, but you may still have bruising and redness. A small subset of patients will need more down-time. Keep in mind, that you won’t be ready for any special events for at least 4 weeks after your treatment.
I see all patients in consultation prior to treatment. At the consult, we sit down and evaluate what is best for each individual patients. We then go over all aspects of the treatment including pre-op and post-op expectations. We will look at my before and after images, and discuss cost. I try to be very informative and give you an honest assessment that is tailored to you. You will leave with a written cost estimate and a written description of what we discussed at your consultation.
I look forward to seeing you.

Dr Reichel.

Fraxel on Good Morning America Health

  During the *online segment of ABC's Good Morning America Health, Dr. Cameron Rokhsar features Fraxel as an excellent treatment allowing patients to look younger in as quickly as 15 minutes, as well as reverse sun damage, scaring, melasma and diminish wrinkles. Watch as he explains how Fraxel, unlike other laser systems, resurfaces skin effectively, reducing average recovery time to only two to three days!

 Click here to view the segment.

Call Pacific Dermatology & Cosmetic Center today to schedule your cosmetic consultation for Fraxel, 206.859.5777.

Aging skin, Sun Damage and Leg Veins

 Hello~ I am 33 years old (female) with considerable sun damage, some facial scarring and other skin issues as well as leg veins. I am interested in getting some procedures done now to correct or improve my issues so they will be more easily managed as I continue to age. Botox/Radiesse, laser treatments and Juvederm are all very intriguing to me and I would like to learn more about them. I am interested in a consult to see what Dr Reichel would recommend. Thank you. 

 MG, Seattle Washington

 Dear MG,  

 I like that you are looking into the future as a young female and wanting to address issues so they are more easy to manage as you age. For sun damage and facial (?acne) scarring, we have several laser or chemical peel options. We have added the new FRAXEL DUAL to our laser suite – and can now treat lines, scarring, and pigmentation better than ever before. For young women, it may also be the right time to start thinking about using Botox Cosmetic. Botox Cosmetic is the best way to prevent and improve wrinkles on the forehead, and around the eyes. We also carry Dysport, a newly approved agent for lines that is similar to Botox. 

 For leg veins, the FDA has now approved ASCLERA, a sclerotherapy agent that works really well for small and medium sized leg veins. Sclerotherapy is an injection treatment that may permanently shut down the unwanted broken vessels on your legs.  Remember that it is never to late to protect your skin from sun damage. Always wear sunscreen on your face, neck and chest if you are going to be out in the sun, and cover these areas with hats and light clothing.

 Thanks for your great questions, I look forward to meeting with you. 

Jennifer Reichel MD


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