Restylane Silk

Brought to you by the trusted makers of the original hyaluronic gel Restylane, this new filler is used specifically for the delicate area around and in the lips. Only available to exclusively selected physicians, Dr. Jeffrey Rapaport, who is also the Physician trainer for Restylane SILK, is one of the first doctors offering this treatment in New Jersey.

What is it?

Restylane Silk is a transparent hyaluronic acid gel that is injected into patients’ lips and wrinkles around the mouth. Hyaluronic acid is a protective and lubricating gel that is produced naturally by the body. Restylane Silk is a new approved material that may increase the volume of patients’ lips and may smooth wrinkles around the mouth.

How does it work?

A doctor injects Restylane Silk in a patient’s lips and wrinkles around the mouth one or two times as needed over a period of two weeks. The product works by temporarily adding volume to the lips and smoothing wrinkles around the mouth. The effect lasts for about 6 months.

When is it used?

Restylane Silk is used in patients over the age of 21 with thin or very thin lips. The gel temporarily adds volume to the skin which may result in larger lips and may smooth wrinkles around the mouth.

What will it accomplish?

Restylane Silk may help increase the volume of patients’ lips and may smooth wrinkles around the mouth. Patients need one or two injections to achieve the best lip volume and wrinkle appearance. The effect lasts about six months.

Birthmark Treatments

What is a vascular birthmark?

 

  • Many babies have what are called “birthmarks” when they’re born. In some cases they may appear within the first few weeks of life. They can be brown, tan, blue, pink, or red. More than 10 in 100 babies have vascular birthmarks. These are made up of blood vessels bunched together in the skin. They can be flat or raised, pink, red or bluish discolorations.

 

What causes birthmarks?

 

  • As with many other birth defects, the exact causes are unknown. Most vascular birthmarks are not inherited, nor are they caused by anything that happens to the mother during pregnancy.

 

What are the different types of vascular birthmarks?

 

  • There are different kinds of vascular birthmarks. Sometimes, the birthmark must be watched for several weeks or months before the specific type can be identified. The most common types of vascular birthmarks are macular stains, hemangiomas, and port-wine stains. There are also many rare types of vascular birthmarks.

 

Macular Stains

 

Your physician will call faint, mild red marks macular stains. They are the most common type of vascular birthmarks. They are also called “angel’s kisses,” when they are located on the forehead or eyelids. When they’re found on the back of the neck, they’re called “stork bites.” They may also occur on the tip of the nose, upper lip or any other body location. They are pink and flat. Angel’s kisses almost always go away by age two, but stork bites usually last into adulthood. These birthmarks are harmless and require no treatment.

 

Hemangiomas

 

The term “hemangioma” is used to describe many different kinds of blood vessel growths. Most dermatologists prefer to use hemangioma to refer to a common type of vascular birthmark. These marks do not usually appear immediately after birth, but become visible within the first few weeks of life. Hemangiomas are usually divided into two types: strawberry hemangiomas and cavernous hemangiomas.  A strawberry hemangioma is slightly raised, and bright red because the abnormal blood vessels are very close to the surface of the skin.  Cavernous hemangiomas have a blue color. That’s because the abnormal vessels are deeper under the skin. Hemangiomas are more common in females and in premature babies. They can be anywhere on the face or body.  Usually, a child will have only one hemangioma, but sometimes there will be two or three. In rare cases, an infant may have many, or even some internally. Unlike other vascular birthmarks, hemangiomas can grow very rapidly. Growth generally begins during the first six weeks of life and continues for about one year. Most never get bigger than two or three inches in diameter, but some may be larger. After the first year, most hemangiomas will stop growing. They then begin to turn white and slowly shrink. Half of all hemangiomas are flat by age five; nine out of ten are flat by age nine. Many will completely go away, but often, a faint mark is left. It’s impossible to know how big any hemangioma will grow, or if it will completely disappear.

 

Complications of Hemangiomas

 

Occasionally, a hemangioma that’s growing or shrinking rapidly can form an open sore or ulcer. These sores can be painful, and can become infected. It’s very important to see your dermatologist and keep this sore clean and covered with antibiotic ointment and/or a dressing.

 

A hemangioma located over the genitals or rectum, or near an eye, the nose or mouth, can cause special problems. These hemangiomas should be watched closely by your dermatologist who will decide if further treatment is necessary.

 

Parents are often concerned that a hemangioma will bleed. These birthmarks do look as if they could bleed easily. However, this usually isn’t a problem. Bleeding usually occurs only after injury. If the hemangioma starts to bleed, it should be treated like any other injury – clean the area with soap and water or hydrogen peroxide and apply a gauze bandage. Apply firm, but not tight, pressure on the area for five to ten minutes. If the bleeding has not stopped, call your doctor.

 

A hemangioma will rarely grow suddenly over one or two days. If this occurs, it’s important to call your dermatologist. Also, if a bruise begins to develop, your dermatologist should be notified.

 

Treatment of Hemangiomas

 

It’s very important that a baby with a vascular birthmark be examined by a dermatologist as early as possible, so that a correct diagnosis can be made and the need for treatment discussed. It’s not always easy for parents to watch a hemangioma grow, or wait for it to disappear, without doing anything. However, most hemangiomas do not require treatment. They eventually shrink by themselves, leaving very few signs.

 

There are several different types of treatments for hemangiomas that need care. No treatment is absolutely safe and effective. The potential benefits must be weighed against the possible risks.

 

The most widely used treatment for rapidly growing hemangiomas is corticosteroid and propranolol medication. This is either injected or given by mouth. Long-term or repeated treatment may be necessary. Some of the risks of therapy include poor growth, elevated blood sugar and blood pressure, cataracts and an increased chance of infection.

 

Lasers can be used to prevent growth of hemangiomas. Most lasers can only penetrate deep enough to treat surface hemangiomas. However, there is a laser that may treat deeper components but it’s not readily available.

 

Hemangiomas with sores that will not heal can also be treated with lasers. Laser treatment is costly and there are risks. They include pain, ulceration, and, in rare cases, scarring. There may be some risks and other costs if general anesthesia is needed.

 

Many other treatments have been tried and new experimental treatments are being studied. In most cases the best results are to let the hemangioma go away slowly on its own.

 

Port-Wine Stains

 

The port-wine stain is another type of vascular birthmark that occurs in 3 in 1,000 infants. It is sometimes called a nevusflammeus, or capillary hemangioma, but it should not be confused with a hemangioma.

 

Port-wine stains appear at birth. They are flat, pink, red or purplish discolorations, found most often on the face, neck, arms or legs. They can be any size. Unlike hemangiomas, port-wine stains grow only as the child grows. Over time, port-wine stains may become thick and develop small bumps or ridges. Port wine stains do not go away by themselves, but last a lifetime.

 

Complications of Port-Wine Stains

 

The most common complications from port wine stains, especially those on the face, are emotional, social, and economic. Even the smallest facial port-wine stains may influence how you feel about your appearance, may affect how others treat you and prevent you from getting certain jobs.

 

Port-wine stains on the forehead, eyelids or both sides of the face, can be associated with glaucoma, and/or seizures. Glaucoma is pressure within the eye that, left untreated, can cause blindness. These complications occur in less than one-fourth of those with port-wine stains of the forehead and eyelids. All infants with a port-wine stain in those areas should have a thorough ophthalmologic (eye) and neurologic examination.

 

Occasionally, there may be very gradual enlargement of tissues surrounding a port-wine stain. All children with large port-wine stains involving an arm or leg should be followed for any growth problems.

 

With time, port-wine stains can develop small blood vessel growths, called pyogenic granulomas. These can bleed easily, and should be removed.

 

Treatment of Port-Wine Stains

 

The use of cover-up makeup has been a common treatment for port-wine stains. Your doctor can provide you with more information about products that are made to cover up birthmarks.

 

Various methods have been tried in the past to remove port-wine stains, but none have worked well. New types of lasers have shown the best results with the least amount of risk and side effects.

 

Laser treatment of port-wine stains is FDA approved, and available at our center. For best results, treatment should begin as early as possible, even in infancy. Laser surgery is performed on an outpatient basis. Several treatments are usually required, given at two month intervals. Younger patients often require fewer treatments than adults. In about one-fourth of the patients, lasers can totally clear up the port-wine stain. Seventy percent will look much better. For reasons that are not understood, a small number of patients will not respond well to laser therapy.

 

There are several risks of laser therapy. An increase or decrease in skin color can occur, leaving patchy tanning or whitening of the skin. In most cases this is not permanent. Swelling, crusting or minor bleeding can occur. This is unusual and can be treated easily. Permanent scarring has happened, but is extremely rare. Laser therapy is uncomfortable, but not extremely painful. Anesthesia is not required for most adults. However, anesthesia is often important for toddlers and young children. If general anesthesia (putting the child to sleep) is required, there are some risks and higher costs. Most vascular birthmarks disappear without treatment or can be treated effectively. Through research, we’re learning more about the causes and treatments of all types of vascular birthmarks.

Cosmetic Eyelid Surgery (Blepharoplasty)

As we age, loose or puffy skin can develop around the eyes. This can be exceedingly frustrating in that the excess skin can make us appear more tired or older than we are. By surgically enhancing the areas around the eyes, our “windows to the soul,” the entire face is given a more youthful, rested appearance.

 

Dr. Boss’s surgical technique’s focus on removing fatty bulges above and below the eyes, as well as removing hanging skin from the upper or lower eyelids. Blepharoplasty is often done in conjunction with a face-lift, brow lift or laser skin resurfacing.

 

Are you a good candidate?

 

  • During your consultation, Dr. Boss will discuss your expectations and concerns, as well as post-operative care. He will also review your medical history to see if you have any opthalmolic condition that would be a contra indication to surgery. Pictures of patients who have been treated for similar problems will of course be available.

 

 

How is the surgery done?

 

  • Eyelid surgery is usually performed as an outpatient procedure, although you may request to have it done in a hospital. Dr. Boss usually uses local anesthesia alone. However, you can request to have an anesthesiologist administer intravenous anesthesia. When treating the upper eyelids, Dr. Boss uses microsurgery techniques and places a fine incision in the crease above each eye. He then removes excess skin and muscle, and very fine sutures are then carefully placed. To treat the lower lids, two approaches can be used. If excess skin needs to be removed a small incision is placed beneath the lower eyelash, then fat and excess skin are taken out and the incision is closed with very fine suture. If puffiness and fat are to be removed without excess skin, an incision can be made on the inside of the lower lid. Dr. Boss then gently removes the fat through this incision. He will often laser the lower lid to provide some tightening. Dr. Boss’s extensive experience in cosmetic surgery allows him to modify either of the above procedures and lift up the corner of the eyelid using a special suture technique.

 

What is recovery like?

 

  • The most common side effects are bruising and swelling. Dr. Boss recommends ice compresses aggressively for the first 24 hours. Oral antibiotics or antibiotic drops are prescribed for several days. Stitches are removed within 5 days and most patients return to work within a week. Makeup may be usually worn after 10 days, and contact lenses may be used within a few weeks.

Spider & Varicose Vein Therapy

Spider veins are small enlarged superficial blood vessels that appear red or blue. They commonly occur on the legs, but frequently occur on the face or elsewhere.

 

These dilated blood vessels may be short, unconnected lines each about the size of a large hair or connected in a matted, “sunburst” pattern. They may also look like a spider web or a tree with branches. Sometimes, they occur in a small area and aren’t very noticeable, or they can cover a large area of skin and be quite unattractive.

 

Larger dilated blood vessels called varicose veins may be raised above the skin surface. They may occur along with spider veins.

 

Patients can have pain, ranging from a dull throbbing pain to a burning sensation. The larger vessels are more likely to cause discomfort, although smaller blue veins have been shown to cause pain.

 

If spider veins are unsightly or uncomfortable, they can be treated with laser or by injection of a solution that will cause them to disappear or become much smaller. There is about a 50 – 90 percent chance for a greatly improved appearance.

 

What causes these blood vessels to become visible?

 

  • The cause of spider veins is not completely known. In many cases they seem to run in families. Identical twins can be affected in the same area of the body and to the same extent. The condition rarely occurs as part of an internal disease. Spider veins appear in both men and women, but more frequently in women. The female hormones may play a role in their development. Puberty, birth control pills, pregnancy or hormone replacement therapy often seem to bring them out. They may also appear after an injury or as a result of wearing tight girdles or hosiery held up with tight rubber bands. Spider veins may also occur in association with large varicose veins.  Spider veins on the nose or the cheeks of fair skinned persons may be related to sun exposure.

 

Can spider veins be prevented?

 

  • Spider veins can’t always be prevented. Wearing support hose may minimize unwanted blood vessels from developing. Keeping one’s weight at a normal level and exercising regularly may also be helpful. Eating a high-fiber diet and wearing low-heeled shoes may also help. Sun protection is important to limit the number of unwanted vessels on the face.

 

How are unwanted blood vessels on the legs treated?

 

  • The injection method, a procedure called sclerotherapy is used to treat unwanted blood vessels. One of several kinds of solutions, called sclerosing solution, is injected with a very fine needle directly into the blood vessel. This procedure has been used for spider veins since the 1930′s and before that for larger veins. The solution irritates the lining of the vessel, causing it to swell and stick together and the blood to thicken. Over a period of weeks, the vessel turns into scar tissue that is absorbed, eventually becoming barely noticeable or invisible.  A single blood vessel may have to be injected more than once, some weeks or months apart, depending on its size. In any one treatment session a number of vessels can be injected.  The solutions available are slightly different and the choice of which solution to use depends on several factors including the size of the vessel to be injected. our dermatologist will choose a solution that is best for your particular case.  Occasionally larger varicose veins are underneath or associated with the spider veins. In such cases, some physicians believe these vessels should be treated before the spider veins. This can be done by sclerotherapy, intravascular laser, or radiofrequency, followed by compression.

 

How successful is sclerotherapy?

 

  • After several treatments, most patients can expect a 50 percent to 90 percent improvement. However, fading is gradual, usually over months. Disappearance of spider veins is usually achieved, but similar veins may appear in the same general area.

 

Can sclerotherapy be used on all skin types?

 

  • Yes. All skin types and skin colors respond equally well.

 

Will insurance cover the treatment of unwanted blood vessels?

 

  • Insurance rarely covers treatment of spider veins but may sometimes cover larger vein treatment. If the treatment is solely for cosmetic reasons, it may not be covered. Sometimes a second opinion, laboratory studies or photographs are required by insurance companies before treatment is started to get the procedure covered for larger varicose veins.

 

Are there side effects to spider vein treatments?

 

  • Even with a highly experienced physician performing the treatment, there are some possible side effects. They include: Stinging or pain at the sites of injection, swelling of the ankles or feet or muscle cramps – Most solutions for injection are relatively pain-free.  Red, raised areas at the sites of injection – These should disappear within a day or so and are like hives.  Brown lines or spots on the skin at the sites of treated blood vessels – Probably made up of a form of iron in the blood, these darkened areas may result when blood escapes from treated veins. These dark areas occur more often in patients who have larger veins treated. In most cases, they disappear within 6 months to a year, but in a small percent of patients they may last longer. Laser treatment may cause skin discoloration.  Development of groups of fine red blood vessels near the sites of injection of larger vessels, especially on the thighs – About a third of patients develop these; most disappear by themselves, some go away with additional injection treatment or laser therapy, a few may last.  Small, painful ulcers at treatment sites either immediately or within a few days of injection – These occur when some of the solution escapes into the surrounding skin or enters a tiny artery at the treatment site. These can be successfully treated, but it is necessary to inform the physician of them immediately. Lasers may cause small areas of skin breakdown.  Bruises at the site where the needle went into the skin – These will disappear in a few weeks and are probably related to the thinness of blood vessel walls.

 

 

Allergic reactions to certain sclerosing solutions – Although such reactions can be serious, they are extremely rare and can be treated by your dermatologist. Minor reactions can be treated with antihistamines.

 

  • Inflammation of treated blood vessels – This is very unusual but when it occurs it is treated with medications such as aspirin, compression, antibiotics or heat. Lumps in injected vessels, particularly larger ones, may develop – This is coagulated blood, similar to a bruise within the vein, but is not dangerous. The dermatologist may drain the blood out of these areas a few weeks after injection.

 

Will treated veins recur?

 

  • Larger veins may recur even after surgical procedures. Spider veins may also recur. It may seem that a previously injected vessel has recurred, when, in fact, a new spider vein has appeared in the same area.

 

Are there other treatment methods?

 

  • For larger varicose veins, radiofrequency may be used instead of stripping. Great advances have been made in the use of ultrasound to guide injection of varicose veins not visible at the skin surface.  Surgically tying veins off (ligation) or pulling them out (ambulatory phlebectomy) are other procedures for treating unwanted blood vessels. These methods are usually reserved for larger varicose veins.

 

How are spider veins on the face treated?

 

  • There are several ways to treat spider veins on the face. Many different lasers and intense pulsed light have been used quite successfully.

 

What do I do after treatments?

 

  • Physicians may differ in their after-treatment instructions to patients. Most advise their patients to “pump” the sclerosing solution out of the circulation by walking following the procedure.  Some physicians bandage the injected areas and instruct patients to “compress” the treated vessels by wearing support hose. This may help seal the treated vessels, keep the blood from collecting under the skin and reduce the development of dark spots. It also may reduce the number of treatments necessary, and the possibility of recurrence. Others put tape dressings on the areas and do not use compression unless the veins are large or in special locations.  Between treatments, many physicians recommend the use of compression or support hose. This may be particularly recommended for people who spend a lot of time on their feet or work in a standing occupation.

 

 

The treatment of spider and varicose veins can be successful. Treatment methods vary depending on the size and location of the abnormal veins. The injection method is presently most commonly used but great advances have been made in other techniques such as lasers.

 

Dr. Rapaport can advise you as to the likelihood of the need for additional treatments, depending on the specific condition of your skin.