The Skin Specialist Centre

Blepharoplasty - Eyelid Surgery

With the progression of years; age, heredity and sun combine to damage your skin and create unwanted folds of skin, manifest as loose skin over the top of the upper eyelid, creating a hood look, and bags of skin that contain fat under the lower eyelid.  Sagging or drooping upper eyelids tend to make us look and feel older or more tired than we are.  Blepharoplasty is an operation where we remove excess skin and remove fatty tissue to eliminate the tired, puffy look around your eyes which, in turn, restores a more youthful appearance to your eyes, creating more self-confidence.  The results can be a refreshened appearance, with a firmer, younger eye region.  Under certain conditions, upper eyelid surgery will be fully reimbursed by medical insurance companies.

Acne

Acne scarring management requires a dermatologist's "reservoir" of treatment options, which need to be "taylorized" to the individual's needs.  A specialist dermatologic surgeon is the most suitable individual to assess your needs, and recommend what treatment might be appropriate for you.

Treatment of acne scarring cannot begin until all active acne has been treated and observed for at least six months following initial total clearance.  Your acne scarred skin will never be restored to totally normal appearance, but with a combination of treatments specific to your requirements, significant improvement can definitely be achieved at the Skin Specialist Centre clinic.

Types of Acne Scars

There are a number of different-looking scars caused by acne:

• Ice-pick scars (deep pits).  Ice-pick scars are narrow, sharp scars that make the skin appear as if it has been punctured with an ice-pick.  They are narrow and less than 2mm and extend into the deep dermal subcutaneous layer.  They respond well to TCA technique (see below);  and surgical removal.
• Box car scars - these are angular scars that usually occur on the temples and the cheeks and can be either superficial or deep and are similar to chickenpox scars. They are oval depressions that have sharp, vertical edges.  Unlike ice-pick scars, they do not taper.  They are usually 0.1 - 0.5mm in depth and can be treated with conventional skin resurfacing techniques.
• Rolling scars (scars that give the skin a wave-like appearance).  These occur as a result of tethering of otherwise normal appearing skin to the subcutaneous tissue below.  Conventional skin resurfacing techniques do not work on rolling scars and they must be corrected by breaking up the subcutaneous fibrous bands.
• Hypertrophic scars - these are thickened scars.
• Macular scarring - this is characterized by flat areas of decreased and increased pigmentation as a result of acne.  No indentations are associated with this.

Treatment of Acne Scarring

The treatments listed below (either alone or in combination) should achieve significant improvement in your acne scarring, but will be dependent on the individual:-

1. Fraxel Laser System

This newly introduced technology stimulates collagen regeneration.  Usually five treatments with the Fraxel laser at four weekly intervals are required for this.  This laser significantly helps to smooth all acne scars.

2. Subcision

Subcision is used to break up fibrous bands that cause rolling scars.  This technique is performed under local anaesthesia by inserting a needle under the skin that is parallel to the skin surface.  It is essential that a dermatologic surgeon performs this procedure as the needle must stay in the plane between the dermis and subcutaneous tissue.  The needle is gently advanced or retracted in a piston-like motion, cutting the tethering bands.  The procedure causes bruising which fades within seven days.  This approach, where appropriate, achieves significant improvement, usually within two to three sessions.  Rolling acne scars respond particularly well to this technique.

3. TCA Cross

With this procedure, high-strength trichloroacetic acid is placed into the ice-pick scar area, resulting in the production of new collagen and re-modelling of existing collagen to fill the scar.  The treatment is localized to the ice-pick scar only and not the unaffected skin.

4. Dermal Filler Injections

Dermal fillers such as Restylane can be injected into acne scars to raise the surface of the skin and give a smoother look.  The injection of such materials does not permanently correct acne scars, so further injections are necessary.   This would need to be repeated regularly every six to twelve months depending on the site of the lesions.  Consideration can also be given to fat transfer into the areas.  Rolling acne scars respond well to dermal fillers.

5. Punch Excision

This can be used for deep scars, such as ice-pick or deep box-car scars.  A punch biopsy is used, which is like a cookie cutter tool that has varying diameters from 1.5 - 4mm.  The size of the punch biopsy is matched to the size of the scar to include the walls of the scar.  Following local anaesthesia, the scar is excised with the punch and the skin is sutured together.  If it is noticeable following this procedure, the area can be treated by various resurfacing techniques.

6. Punch Excision with Skin Graft Replacement

With this approach the scar is excised with the punch biopsy instrument as above.  Instead of suturing the skin edges together, a punch graft is usually taken from behind the ear and placed in the resulting punched out defect.

Botox Treatment

About

Botox is a natural, purified protein that relaxes wrinkle-causing muscles, creating a rejuvenated appearance. 

• Eyebrow lift
• Reduces frown lines between the brows (glabella)
• Reduces crows feet (lines at the lateral corners of the eye)
• Reduces forehead wrinkles
• Reduces lip lines
• Reduces gummy smile
• Reduces nasal flaring
• Reduces muscle bulkiness at the angle of the jaw (masseter muscle)
• Reduces chin wrinkling
• Reduces neck rhytids
• Reduces turned down corners of the mouth
• Reduces excessive sweating of the underarms and palms
• No downtime
• Minimal risk

Alternatives

Dermal fillers, fat transfer, skin rejuvenation

How Does it Work?

Dynamic wrinkles (smile lines) are caused by contractions of underlying facial muscles as you laugh or smile.  Botox blocks impulses from the nerve to the muscles that cause these lines, so that the muscles do not contract.  Consequently as the muscles are unable to contract, the areas appear relaxed, creating a softer, more youthful appearance.  The nerve endings which have been blocked usually grow new connections to the muscles in about three to five months, and muscle movement and activity returns.  Therefore, treatment must be repeated at least twice a year.

Who is a Candidate?

All skin types can have Botox, but patients who are pregnant or have neuro-muscular disorders such as myasthenia gravis should not undergo this procedure.  The key to successful Botox treatment is precise injection into the muscles.  This depends on the skill of the injector.

What Can I Expect?

Reduction or complete elimination of wrinkles and excessive sweating.  The full effects may not be seen until 5 - 10 days, and the results vary depending upon the amount of botox and the site. 

Safety and Side-Effects

Botox has a very safe track record and has become one of the most popular procedures performed in New Zealand.  While infrequent, mild, temporary bruising is the commonest side-effect.  Very rarely there can be drooping of an eyelid or asymmetry of facial expression.  Such risks depend upon the muscles injected.

Recovery Time

Nil.  Patients can return to work the same day and resume most of their regular activities.

Does it Hurt?

We use a 33 gauge insulin syringe and also bacteriostatic saline for dilution, which minimises discomfort at the time of injection.

Before Treatment Instructions

Avoid blood thinners such as Aspirin and anti-inflammatory pills for two weeks prior to treatment.

After Treatment Instructions

Patients are encouraged to frown as much as possible for three hours after injection of Botox into the frown lines. 

Who Performs the Treatment?

Dr McKerrow

Juvederm

Juvederm^tm is a non-animal dermal (skin) filler which is carefully injected beneath the skin surface to diminish the depth of facial folds and wrinkles and provide definition and volume to the lips.  Juvederm^tm injectable gel is made from a natural complex sugar.  The injectable gel acts as a skin filler to gently restore structure and volume to the skin.  Juvederm^tm filler lasts longer because it is the only dermal filler currently available with the highest concentration of hyaluronic acid in a special formulation process.

Restylane & Perlane

About

Restylane and Perlane are dermal fillers.  The popularity of such fillers is increasing as they work well, produce immediate results and there is essentially no recovery.  Hyaluronic acid is a naturally occurring substance in your skin, providing fullness and elasticity.  Over time, skin loses hyaluronic acid and as it diminishes, skin loses volume, increasing the chances for wrinkles and folds to appear.  Restylane^tm and Perlane^tm provide rejuvenating cosmetic beauty treatments for a natural, younger-looking you.  Restylane^tm and Perlane^tm are both composed of hyaluronic acid.  Perlane^tm has larger gel particles and tends to be injected deeper within the skin.  These products are non-animal, biotechnology produced.  Each is injected through a tiny needle to produce a long-lasting, safe and natural enhancement.

Benefits

• Instant results
• No skin test
• No animal ingredients
• Restoration of facial volume
• Reduces acne scars
• Reduces depressions in the skin
• Fuller lips
• Reduces wrinkles and fine lines
• Minor facial re-shaping
• Long-lasting up to 12 months

Alternatives

How Does it Work?

Restylane^tm and Perlane^tm are cosmetic dermal fillers that add volume within the skin.  They consist of non-animal, stabilized hyaluronic acid (NASHA).  In the human body, natural hyaluronic acid provides volume and fullness to the skin.  After treatment with Restylane^tm and Perlane^tm, the hydrophilic (or "water loving") nature of the hyaluronic acid molecules allows them to bind many times their own weight in water as they slowly break down.  This process helps maintain volume for many months.  As the gel breaks down, water takes its place.  Consequently, the less concentrated the gel becomes, the more water is able to bind.  When totally absorbed, the gel disappears unnoticed from the body.

Who is a Candidate?

No allergy testing is required before use.

What Can I Expect?

Results are immediate following treatment and can last for six months or longer depending on the area treated.  As Perlane^tm is a larger molecule than Restylane^tm, it can result in even more enhancement for a longer time duration.

Safety and Side-Effects

Restylane^tm is the world's most studied cosmetic dermal filler, with more than a decade of use.  Restylane^tm and Perlane^tm have well-defined profiles and are approved for the treatment of moderate to severe facial wrinkles and folds, such as the lines from your nose to the corners of your mouth (naso-labial folds).  Restylane^tm has been used in over 1.4 million treatments in the United States and is available in more than seventy countries, with numerous studies published in the medical literature.  Clinical studies have shown no significant differences in the safety of Restylane^tm and Perlane^tm.  Restylane^tm and Perlane^tm contain no animal ingredients.  After the treatment, some common injection-related reactions may occur, such as swelling, redness, pain, itching, discoloration and tenderness at the implant site.  These typically resolve spontaneously within one to two days after injection into the skin, and within a week after injection into the lips.  One in two thousand treated patients have experienced localized reactions thought to be of a hypersensitivity nature.  These have usually consisted of swelling at the implant site, sometimes affecting the surrounding tissues.  Redness, tenderness and (rarely) acne-like formations have also been reported.  These reactions have either started a few days after injection, or after a delay of 2 - 4 weeks, and have generally been described as mild to moderate and self-limiting with an average duration of two weeks.  Both products contain trace amounts of gram positive bacterial proteins and are contra-indicated for patients with a history of allergies to such material.  The product should not be used by people with a known allergy to Lignocaine.

Recovery Time

Down-time is minimal for most patients.  Others may be over-corrected for the first couple of days.  One is usually able to return to normal activities the same day as the treatment.

Does it Hurt?

Restylane^tm Lidocaine, Perlane^tm Lidocaine were introduced at the beginning of 2009.  Lidocaine is an effective local anaesthetic.  In more than 90% of patients treated with Restylane^tm and Perlane^tmLidocaine this was more pleasant compared with the injection without Lidocaine.

Before Treatment Instructions

If possible, it is advisable to stop Aspirin and non-steroidal anti-inflammatories seven days prior to injection, and avoid alochol for twenty-four hours prior to injection.

After Treatment Instructions

None

Who Performs the Treatments?

All treatments are performed by Dr McKerrow, specialist dermatologist.  Dr McKerrow believes that this product should be administered by a qualified healthcare professional and this is the standard of care that every patient should always seek.  Dermatologists have an in-depth knowledge of facial anatomy and are versed in all different injectable products available.  Following consultation with you, Dr McKerrow will determine the best injectable product to meet your concerns, and administer the injections as well.  His medical experience and knowledge will benefit you, so you can be assured of the best possible outcome.

Acne Scars - Punch Grafts

Punch grafts are one of the treatment options we provide for patients for removal of deep acne scars.  Following this procedure, patients usually undergo laser resurfacing for smoother results.

Punch gratfs  can be used for deep scars, such as ice-pick or deep box-car scars.  A punch biopsy is used, which is like a cookie cutter tool that has varying diameters from 1.5 - 4mm.  The size of the punch biopsy is matched to the size of the scar to include the walls of the scar.  Following local anaesthesia, the scar is excised with the punch and the skin is sutured together.  If it is noticeable following this procedure, the area can be treated by various resurfacing techniques.

Punch Excision with Skin Graft Replacement

With this approach the scar is exc

Acne Scars - Subcision

Subcision is one of several methods used for the treatment of depressed scars. 

Subcision is used to break up fibrous bands that cause rolling scars.  This technique is performed under local anaesthesia by inserting a needle under the skin that is parallel to the skin surface.  It is essential that a dermatologic surgeon performs this procedure as the needle must stay in the plane between the dermis and subcutaneous tissue.  The needle is gently advanced or retracted in a piston-like motion, cutting the tethering bands.  The procedure causes bruising which fades within seven days.  This approach, where appropriate, achieves significant improvement, usually within two to three sessions.  Rolling acne scars respond particularly well to this technique.