MEET DR. CREASMAN’S AESTHETIC NURSE SPECIALIST,
MARISHA HALLARCES R.N.
MEDICAL AESTHETIC TREATMENTS
Many aesthetic issues cannot be addressed surgically. We provide ancillary services to address these issues. Performed by Marisha Hallarces, R.N., our injection nurse, these less-invasive procedures can be performed in our office outpatient clinic with little to no recovery time.
- Neuromodulators – Botox Cosmetic® and Dysport® – FDA approved for use in the treatment of unwanted frown lines, these substances are injected into specific muscles in the forehead and crow’s feet lines to temporarily de-animate them so as to diminish the wrinkles these muscles create with frowning or squinting.
Injectable fillers – Hyaluronic acid in various degrees of viscosity is used as an injectable filler material for cheek augmentation, wrinkles, scars, and depressions in the face, lip enhancement, and general volume restoration in the face. Products we use include Juvederm™, Restylane Silk™, Voluma™, and Perlane™.
- Maintenance skin care– we use Teoxane™ skin care products exclusively because they are best in class products available only from select aesthetic physicians.
- LATISSE™ – eyelash growth treatment: makes eyelashes grow longer
- AlphaLash™– eyelash growth treatment: makes eyelashes grow thicker
What follows is a more in-depth overview of the treatments offered in our practice and information about our nurse injector. You may look at some examples of the effect of these treatments in our Photogallery, under Botox and Fillers.
Botox Cosmetic® is an FDA approved purified protein that is administered in a non-surgical procedure that temporarily improves the appearance of lines. The most common areas of treatment are the frown lines, between the brows, crow’s feet and forehead lines.
Botox Cosmetic® works by blocking the chemicals that cause muscle contraction. This results in relaxation of the muscles that are responsible for the lines. Results may last between 3-4 months. Learn more about BOTOX® Injections.
There are a number of FDA approved hyaluronic acid (HA) dermal fillers available. Our practice currently uses Juvederm®. Juvederm® Ultra and Juvederm® Ultra Plus for injection into the mid to deep dermis for correction of moderate to severe facial wrinkles and folds, such as nasolabial folds. Side effects are usually mild to moderate lasting 7 days or less and included temporary injection site reactions like redness, pain, firmness, swelling and bumps. These products last up to 12-15 months.
JuvedermVoluma® XC is the newest hyaluronic robust filler FDA approved for mid-face volume deficit. This is a structural product that should be viewed like an implant. The youthful effect of restoring volume and contour in the cheeks is visible immediately after treatment with Voluma®. The added volume offers support and lifting effects to the mid-face which minimizes the appearance of smile creases, supports the lower eyelid area and inflates the facial skin for a more natural youthful look and smile. An alternative structural filling material is Perlane® when large volumes of material are required.Voluma® and Perlane® are only used in the deeper planes of the face because of their bulk and firmness. These products last up to 24 months.
Starting in 2015, a new HA filler was introduced called Restylane Silk®. Restylane Silk® was approved by the FDA for injection in lips and perioral lines (also known as smoker’s lines or pucker lines). This is the first product approved for these fine wrinkles. The product’s softness is its defining feature. Fillers can be manufactured with different viscosities, and Restylane Silk® is composed of smaller and smoother particles than its siblings, which allows the injector to use of an ultrafine needle. The lip is perhaps the most sensitive area of the body, and the combination of the tiny needle and the inclusion of lidocaine in the formula provides a more comfortable patient experience. We have found that a little goes a long way and most patients only need one syringe.
Because the lips are in constant motion, longevity has always been a problem for fillers in the area. Previous products often lasted only three to four months in lips versus six months in smile lines. In the FDA trial of Restylane Silk®, which involved 221 mostly female patients, 98 percent had visible improvement 14 days after injection, and 76 percent still had lip improvement at six months. Silk is also a great product for injecting the ‘tear troughs’ of the lower eyelids. We have been very happy with this product. It is less likely to show through the skin or result in later lumps and bumps. This product lasts 6-9 months.
These various HA fillers are wonderful, safe and popular products. Wrinkle treatment and volume enhancement of the face has undergone major development in the last ten years and continues to improve. The safety and longevity of the HAs is impressive. One aspect of hyaluronic acid fillers is the ability to make corrections using an enzyme to break the material down if need be, or as we have seen with patients coming in with less than satisfactory results, the ability to completely dissolve the material and begin treatment from the beginning. Though we have seen some delayed inflammatory reactions to the longer acting products like Voluma®, this is in a minority of patients on the order of less than 1%.
The choice of which dermal filler to use is individualized by the aesthetic nurse specialist under the supervision of the doctor. Factors that influence this are: Areas to be treated, depth of wrinkles, skin texture and cost. A combination of dermal fillers and Botox® treatments can be performed at the same time. These options are best determined during the consultation. This is a collaborative process between you, your aesthetic nurse, and Dr. Creasman.
SKIN MAINTENANCE WITH TEOXANE PRODUCTS
Teoxane® is the only topical skin care line that delivers the hydrating effects of Resilient Hyaluronic Acid (RHA)™, providing immediate and sustained skin HydroStasis™
We continuously lose water from the skin’s surface by evaporation, which worsens with age. Other topical products containing hyaluronic acid temporarily hydrate but quickly break down. The RHA technology is unique to this company founded in Switzerland. Dr. Creasman is one of a small number of doctors in the United States who have access to this state of the art technology. Patients who have used it have raved about how great their skin looks and feels.
TEOXANE® SKIN CARE PRODUCTS
This Resilient Hyaluronic Acid is crossed linked with antioxidants and is the highest percentage Topical Hyaluronic Acid on the market. This serum acts as a hydrator to the skin, allowing hydration without oil. As the skin ages, water is lost from the skin resulting in dehydration, dull look and lack of luster. RHA Serum acts like a blanket over the skin resulting in prevention of water loss and pushing water back into the skin. Skin looks brighter, tighter and plumper. This product compliments injectable dermal fillers.
This combination of RHA and Restructuring Complex helps combine hyaluronic acid and collagen deep inside the skin to recreate tissue from inside. This is designed for normal to dry skin. Skin is hydrated, smoothed and brightened. This is considered a day moisturizer and compliments the RHA Serum and enhances the effects of professional aesthetic procedures.
Perfect Skin Refiner
This combination of RHA and concentrated resurfacing ingredients helps increase the overall clarity of the skin. Complexion becomes more uniform and radiant, pores are refined and pigmented lesions are corrected. This is considered a night moisturizer and compliments the RHA Serum, Advanced Filler and enhances the effects of professional aesthetic procedures.
Deep Repair Balm
This combination of Arnica and anti-inflammatory ingredients is used after professional aesthetic procedure such as injections, laser treatments and chemical peels. Deep Repair Balm also helps with sensitive, dry, irritated skin. It helps in restoring the altered skin by moisturizing, reducing skin redness and bruising.
Sclerotherapy is a medical procedure used to eliminate spider veins. Sclerotherapy involves an injection of a solution (generally a salt solution) directly into the vein. The solution irritates the lining of the blood vessel, causing it to swell and stick together, and the blood to clot. This has no effect on the circulation because other veins take over for the clotted vein, which is no longer prominent.Sclerotherapy is a proven procedure that has been in use since the 1930s.
Frequently asked questions about Sclerotherapy:
–How does this treatment work?
Before the treatment begins, the skin is cleansed with an antiseptic solution. The skin is stretched and the sclerosing solution is administered into the chosen veins: one injection per inch. Generally, 5 to 40 injections are made per treatment. As each injection is completed, cotton ball and compression tape is placed on the area.
–How many treatments are required?
For maximum results, multiple treatments are required, although there will be visible results after one session. The original spider veins will be obliterated; however, the treatment does not stop new spider veins from appearing.
–Is Sclerotherapy safe?
Sclerotherapy is safe, and serious medical complications from the treatment are extremely rare.
–Will there be any downtime?
There is very little downtime. Support hose will be provided and placed over bandages to ensure proper healing. Although the legs are bandaged, you are encouraged to walk to prevent blood clots. Avoid prolonged sitting, standing, squatting, heavy weight lifting and jogging. Use of support hose is imperative to achieving a good result.
–What are the results?
Most clients are very pleased with the diminished appearance of their spider veins. The skin on the legs will appear younger, clearer and healthier. There is a dramatic difference between a treated leg and an untreated leg.
–How soon will results appear?
When the compression bandages are removed, there will be bruising and reddish areas at the injection sites. The bruises will diminish with time, and in some cases there is some residual brownish coloration which may a while to completely fade.
–How long does Sclerotherapy last?
The veins affected by the session will be permanently obliterated. However, the treatment has no effect on newly appearing veins that grow over time.
–Who should avoid Sclerotherapy?
Individuals with hepatitis, blood-borne diseases, circulatory problems, heart conditions, or diabetes may be advised against this procedure.
–How does the treatment feel?
Some discomfort may be experienced. Each injection is given with a needle, and several injections are administered. Some clients experience a slight burning sensation as the solution is injected, but this fades in a couple minutes.
–Instructions before treatment:
Wash legs thoroughly, but do not use any type of moisturizer, sunblock or oil. Keep in mind that the legs will appear bruised, so you may want to plan your treatment during a time when it is possible for you to wear slacks for the next few weeks. Measurement for compression hose is completed during the consultation. The compression hose are put on after the first treatment.
–Instructions after treatment:
The compression tape and support hose will be in place for 1 to 2 weeks. Walking is recommended after treatment because it prevents deep blood clots. Jogging or any jarring exercises to the legs should be avoided. A one month healing period must be completed before a second series of injections can be administered to the same site.
Now, you can grow longer, fuller, darker lashes. LATISSE® is the first and only prescription treatment approved by the FDA for inadequate or insufficient eyelashes, growing them longer, fuller and darker. LATISSE® is now being dispensed in the office of Dr. Craig Creasman.
LATISSE® makes lash growth possible because of its active ingredient, bimatoprost. Although the precise mechanism of action is not known, research suggests that the growth of eyelashes occurs by increasing the percent of hairs in the anagen (or growth) phase of the eyelashes. Lashes can grow longer, thicker and darker because bimatoprost can also prolong the duration of this growth phase. LATISSE® offers clinically proven results you can see over time
LATISSE® is easy to use, FDA approved and effective. It is a once-a-day treatment you apply topically to the base of your upper eyelashes. Patients in one clinical trial saw results gradually, starting at 4 weeks with full results after 16 weeks.
While LATISSE® is a new treatment in eyelash growth and was developed through years of research by Allergan, a pharmaceutical leader with over 60 years of expertise in prescription eye care products.
What to Expect with LATISSE®
Great eyelashes don’t just happen overnight. That’s why it is important to note that LATISSE® (bimatoprost ophthalmic solution) 0.03% works gradually yet remarkably – starting at 4 weeks with full results after 16 weeks. Once you begin treatment, you could start to see results in as little as 4 weeks, but you must continue applying the topical treatment each night and follow the directions for best results. Remember: results are seen over time.
Your eyelashes will experience real measurable growth.
LATISSE® works from the inside out. As the treatment progresses, you’ll begin to see changes in length, thickness and darkness gradually. After week 16, you’ll see the full effect of LATISSE® – and so will others.
There are possible side effects.
Throughout clinical trials, some users did experience itchy eyes and eye redness. However, some users found that this irritation went away once they became accustomed to the product or began applying it properly. As with any prescription treatment, always consult with Dr. Creasman or one of his aesthetic nurses for information and proper usage of LATISSE® solution.
How to Apply
A few simple steps can lead to great lashes. Like every routine, applying LATISSE® is all about consistency and precision. Once you follow the basic guidelines, the results will come gradually over time. To see the full effect of your eyelash transformation, take a “before” picture before you start the treatment, and keep taking pictures every 4 weeks to chart your progress.
Step One – Before Applying
Before applying LATISSE® each night, ensure your face is clean, makeup and contact lenses are removed, and any other facial care products have already been applied.
Step Two – Prepare the Applicator
Remove an applicator from its tray. Then, holding the sterile applicator horizontally, place one drop of LATISSE® solution on the area of the applicator closest to the tip, but not on the tip.
Step Three – Apply to Skin using Applicator
Immediately draw the applicator carefully along the skin at the base of the upper eyelashes just as you would apply liquid eyeliner. This area should feel lightly moist without runoff.
Step Four – Blot Excess
The fourth step is to carefully blot any excess solution beyond the eyelid with a tissue, as shownin this image.
Step Five – Dispose of Applicator
Dispose of the applicator after one use. Repeat for opposite eyelid, using a new sterile applicator to help minimize any potential for contamination from one eyelid to another.