Dr. Binstock's Advanced Skincare Regime

There are many options now available for improving and rejuvenating sun damaged skin. This is fortunate, as eighty percent of what we perceive as "old skin" is due to sun exposure. This manifests as dulling and sallowing of the skin, irregular blotchy pigmentation, brown spots, wrinkles, furrows, and skin cancer.

In youth, the lips and the eyes are the focus and foreground of the face, with the rest of the face being essentially in the background. As we age, the background stands out and overpowers the appearance of the lips and eyes; we begin to focus on the texture of the skin.

Today, a combination of Non-Surgical Facial Rejuvenation procedures enables the reversal and rejuvenation of sun damaged skin to restore a healthier and a more youthful complexion. These treatments include Botox® Cosmetic, Collagen, fat transfer, peels, and lasering of vessels, pigment and hair. Dr. Binstock's personal selection of advanced skin care products formulated with glycolic acid, vitamin C, rich humectants, and most importantly, effective sunscreen agents.

What Products are Available?
Skin rejuvenating products include AHA (alpha hydroxy acids), notably Glycolic and Lactic acid, can help improve blotchy skin pigmentation, and diminish fine lines. They are skin toners, yet they act as moisturizers. These agents also open the spaces between skin cells and thus facilitate the penetration of many other substances into the skin, which can further aid in rejuvenation.

Retin-A® and Renova® are Vitamin A derivatives which impact the skin's organization and metabolism. These products improve pigmentation of the epidermis or upper layer of skin, and stimulate the deposition of new collagen and elastic tissue in the dermis, to yield a more evenly toned, less wrinkled skin. Retin-A® thus can be viewed as the facilitator for facial rejuvenation.

Vitamin C products are unique in that they not only improve the tone and texture of the skin, but are also antioxidants. With regular use they can prevent further sun damage and wrinkling. Vitamin C is however, not an effective sunscreen and must be used in conjunction with a sunscreen.

Sunscreens are rated by a SPF for sun protective factor of 15, 30, 50, etc. This factor applies only to Ultraviolet B radiation as UVB is responsible for sunburns, and is most intense mid-day. It is a measure of how long one can be out in the sun without burning. UVB is absorbed in the upper layers of the skin, and classically thought to be the agent responsible for sun damage and skin cancer. It is now understood that Ultraviolet (UVA) or long wave length violet light, is also very important as it is equally intense from dawn until dusk, and penetrates more deeply into the skin. UVA under normal circumstances does not cause sunburn, but does accelerate skin damage and skin cancer. It can disrupt the elastic and collagen tissue in the skin and promote wrinkles. There are now very effective sunscreens that block both UVA and UVB. Their active agents include translucent zinc oxide crystals, and avobenzone (parsol 1789).

An example of our Advanced Skin Rejuvenation Program that utilized our special formulations of the above agents is as follows:

• MORNING: one washes with our Glycolic Acid Facial cleanser following with our vitamin C cream, 10% or 15% is applied to the skin surface. Our sunscreen SPF 20 with translucent zinc oxide is then applied for sun protection. Vitamin K can be used in combination as needed if there is a marked presence of blood vessels or redness to the skin.
  
  

• EVENING: the make-up can be removed with Glycolic Facial cleanser, or a more gentle cleanser such as our Azulene cleanser, following which Retin-A R or Renova R is applied.

  Retin-A® is better for oily skin, and Renova® for drier skin, and each are found to be less irritating if applied to damp skin. A night cream can be applied over this product, and we recommend our Hydrating Cream for individuals with dry skin, and our Oil-Free Glycolic Acid moisturizer for those with oily skin. Vitamin K can also be applied if necessary.

ANCILLARY PROCEDURES:

Botox® Cosmetic: Botox® Cosmetic can be injected into frown lines, forehead lines, crow's feet, neck lines, and neck bands, to reduce and relax muscular activity, thus providing a more relaxed and natural appearance. These are simple office injections, and benefits last approximately 4 to 6 months. (Botox® Cosmetic can be used to reduce/eliminate under arm sweating for 6-12 months)

Sculptra® was recently approved by the FDA to restore, recontour and fill in volume of sunken facial areas and to smooth away wrinkles. This unique product actually stimulates the skin’s own fibroblasts to grow its own new collagen. Native poly-a-lactic acid, i.e. a safe material used in sutures for over 40 years. Sculptra® does not require skin testing. Sculptra’s® benefits are accrued over several sessions and lasts two years or longer

Restylane® is hyaluronic acid injectable filler that provides for longer lasting correction of facial wrinkles and grooves. Hyaluronic acid is a stabilized gel that occurs naturally in the body, and is used by cells to provide volume and fullness to the skin. There is no pretesting and immediate treatment is available. Most frequent side effects include swelling, redness, tenderness, pain, and bruising initially at the injection site. Restylane® is genetically engineered and not an animal product. It is currently available in 60 countries.

Hylaform® and Hylaform Plus® is another hyaluronic acid product which has been available overseas for many years. This product differs from the Restylane® in that it is made from the combs of roosters, a concentrated source of hyaluronic acid. (People who have an allergy to chicken should not undergo injection with hylaform). This products works similar to the other hyaluronic acid products in that it effectively corrects smile lines, frown lines, lip lines, and can be used to enhance lips, cheeks, etc. It seems to also last longer than Collagen and does not involve a skin test. The reactions that have occurred include temporary redness, and a little bruising like one would see with any injection. Rarely persistent redness or red spots follow the injection, but experience in Europe has shown that incidence of side effects is very low.

Captique® is the latest FDA approved hyluronic acid filler, an organic substance found within your skin. It helps restore the skin's natural look by reducing lines, wrinkles, acne scars, enhance lips, and add definition to chin and cheeks. Captique is a non-animal hyluronic acid filler and can be used immediately without skin testing.

CosmoDerm® and CosmoPlast® are human collagen products that offer an alternative to Zyderm® and Zyplast®. They can be used by those individuals allergic to bovine collagen, and do not require skin testing. CosmoDerm® and CosmoPlast® effect a smoothing of facial lines, and can create full lips and reduce acne scarring.

Collagen Injections: Zyderm® and Zyplast® Collagen are bovine products which can be injected into lines and furrows to fill them, thus diminishing lines and wrinkles. Collagen can also be used to augment and enlarge the lips. The duration of benefit is approximately 6 to 9 months and a skin test is necessary prior to collagen treatment.

Fat (Lipo)Transfers: This is the recycling of your own fat to fill in deeper lines and furrows, enhance cheek bones, full or hollow cheek, chin, and augment the lips and rejuvenate hands. This is a simple office procedure wherein several syringes of fat are removed from the stomach or hip, and then injected into the face. Generally fat grafting should be conducted in a series of three sessions, each of which usually results in some residual benefit that persists.

Lasers: Lasers can be used to eliminate and improve facial or leg vessels, skin discoloration and brown spots on the face and body, and wrinkles:

Facial Blood Vessels: The laser we use to treat blood vessels, rarely results in bruising, and generally all that is visible is some redness and fine crusting. This treatment is very effective and can result in the marked diminishment of most facial blood vessels, and finer leg veins. This is a simple, relatively painless office procedure.

Skin discolorations and brown spots are treated with a different wave length of laser light that is effective in removing liver spots, freckles, and other discrete skin discolorations of the face, back of hands, and other body areas. The treatment results in a temporary darkening of the pigmented area which heals in approximately two weeks. (These lasers are not used for the treatment of melasma, or mask of pregnancy).

Carbon Dioxide UltraPulse® Laser is used to erase facial lines and wrinkles and tighten facial skin. This laser can yield marked improvement of sun damage, and relief of wrinkles while tightening skin excess of the eyelids, cheeks, and jowls. This generally takes 7 to 10 days to heal, is used primarily on the face, and can result in residual redness that lasts for months.

Photodynamic Rejuvenation: PDT uses a technology of fotofacial™ intense pulse light therapy in combination with a photo sensitizer, ALA. This combination enhances the benefit beyond that of the standard fotofacial™ treatment. The number of sessions that are required to reduce the signs of sun damage are as little as 2-3 instead of 5 sessions with the standard package. In addition, to reducing the visible signs of sun damage, blood vessels, brown spots and fine wrinkling, Photodynamic Skin Rejuvenation also is effective in reducing precancerous growths (actinic keratoses).

Beta Lift® is a mild to moderate chemical exfoliation utilizing salicylic acid, a Beta-Hydroxy Acid, in an advanced formulation. This is usually administered in a series over time, and acts to decrease fine lines, improves skin texture and color, minimizes pore size, and helps exfoliate micro comedones, i.e. blackheads. Beta Lift® is applied to the skin, stings for a minute or so, and self neutralizes as it turns into a powder after a few minutes. Generally there is a fine crusting with possibly a temporary increase in skin pigmentation which peels off in 3 to 5 days on the average.

Derma Peel® Micro Dermabrasion
This is another variation of a lunch time peel. Micro Dermabrasion takes less than an hour to perform and most people return to work immediately. The Derma Peel® procedure uses a highly controlled vacuum and pressure system to move microscopic abrasive crystals across the skin's surface. This action causes little or no discomfort and gently removes and exfoliates the outer layer of skin. Derma Peels® are usually repeated every two weeks for an initial period of three months. With each successive exfoliation, younger skin moves to the surface, often revealing significant texture and color changes.

Please feel free to discuss our Advanced Skin Rejuvenation Program, and ancillary procedures with Dr. Binstock.

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