I had acne since 8th grade, and now I’m 20. You name a treatment and I probably tried it, so I finally wanted to go for Accutane. I went to my dermatologist and after evaluating my skin, he agreed to prescribe me, but made me understand about the tedious journey that I was about to start. I went to see him sometime in the 2nd week of February and he told me that I had to wait a month to actually start on the medicine. That day he did my pregnancy test and gave me a blood test requisition form that I would need right before I came next time. Basically, in order to get the Accutane, I need to to do a routine blood test, then follow up to the dermatologist who checks the blood results to make sure I’m not pregnant, then prescribes it, then I need to go online to iPLEDGE system to answer comprehensive questions swearing that I’m taking two forms of birth control and I will not get pregnant, finally when I’m done with those, the system will automatically send the prescription to the pharmacy. This cycle has to b followed every month for the entire course of the medication. Here’s the craziest part: there’s a deadline for the medicine to be picked up from the pharmacy. The day I do the routine blood test, that counts as the first day, so from that day to next seventh day, I MUST pick up the medicine from the pharmacy. If I miss for any reason like let’s say, my insurance took longer to authorize the medicine, then I’ll have to wait twelve days to start the cycle all over again! The authorization of insurance actually took longer for me, but fortunately my dermatologist was excellent and made sure that I was able to pick it up last minute before my deadline. Usually the lab results take two days to be ready, so from now on I will make sure to make advanced appointments first at the Quest Diagnostics, then I’ll go to the dermatologist two days later that way I’ll still have three days in my hands to pick up the medicine. I was given Claravis for 40 mg per day for now and I started on it on the 21st March. I’m giving my cheeks pictures for better understanding. I had a lot of scars on my cheeks, one of the issues that we are targeting to fix, so hopefully that improves. I’m breaking out a little bit with red pimples that has white nodule inside. However, other than that I had no side effects like body/muscle aches or rash or severe dryness. I’ve had terrible skin before, so these little pimples are bearable and I’m trying to be positive and hopeful that these will disappear very soon. I will try to update every month, so hopefully it’ll be helpful to you.
I was greeted warmly when I first walked in, then treated with wonderful bedside manner. Knowledgeable staff answered all of my questions so clearly and kindly. I was hesitant at first to try the CO2 laser, but the results were amazing. My acne scars have diminished by at least 50%. The aftermath wasn't too long of a recovery. I was a good reason to have a little R and R from work. I will be going back in 3 months for another treatment. Thank you Dr. Buka and staff, you guys are amazing.
Doctor Buka has helped me with multiple skin issues. Acne, skin tag removal, eczema, etc. I trust him completely and have always had great results with every visit. He is always on time and explains everything as he treats you. His staff at all the offices are great. I use all his F.A.B. products and love them.
When I had Botox for the first time with Dr Buka we discussed in depth the outcome I was looking for. My goal was to look as natural as possible therefore he would just concentrate on the frown line area between my brows which had started to made me look constantly angry. We kept the crows feet that were just beginning to show for" character", but he assured me it wasn't a big deal if I changed my mind to do it at a later point. It is a virtually painless procedure as the numbing gel and lots of ice both before and after help a lot. The outcome was and has always been excellent. Going to see Dr Buka is a treat for me. He is smart and charming all in one and his staff is very professional and kind. I see him for any skin situation I have and he is johnny on the spot to fix it.
When I hit my thirties, the lines started appearing. I wanted to do something about it, but I also didn't want to have anything done that would be obvious. After consulting a few dermatologists, I decided that Juvederm would be a great first start, but looking at their before and after pictures, I didn't feel comfortable. Those faces staring back at me obviously had work done. I wanted to look natural. That's when a friend suggested I see Dr. Buka. He had such a great bedside manner and really listened to what I wanted. He even asked what result I was looking for - when I told him I wanted to fill those lines but I wanted it to be a subtle change, he said he thought that was a great idea. He became my full-time dermatologist after that, and I consult him for everything that comes up and he always solves my problems with ease and with a smile. There was even a time when I was traveling, and I suspected that I might have shingles based on a couple bumps on my face. I texted him a photo, and he diagnosed it right away. I was able to get medication immediately, which saved me from a much worse fate. My eye doctor said that if I hadn't gotten diagnosed right away, the shingles would have likely affected my eyesight. Dr. Buka saved the day again!
Being Brazilian, where beauty is fundamental and home of the top doctors in the area, I can say that it is hard to find a dermatologist that you can trust and really feel 100% safe. I did a great deal of research to find someone that I could not only trust due to competency and experience, but someone who had the ability to maintain the integrity of my appearance and luckily Dr Buka was referred to me by a “guru” on cosmetic dermatology. He has been taking care of me for years now and all of my gorgeous friends as well. He is always up to date with the best medical and cosmetic dermatology out there including the most advanced lasers. The staff is always friendly and courteous. What can I say? If you have any doubt about where to go trust me you cannot go wrong with Dr Bobby Buka!
Dr. Buka and staff genuinely cared for me and my skin. I've been struggling with skin issues for many years now. They gave me options and we finally came to a decision about what it is I should start doing. My skin is clearing up, it feels nice to have a normal simple regime. The offices are warm and welcoming, and conveniently located all over Manhattan and in Brooklyn as well. Thank you Dr. Buka for your knowledge and your help.
Dr. Buka treated me for some adult acne that I was recently experiencing. As an adult female who never suffered from acne as a child or teenager, I'm sure you can imagine how emotionally stressed and upset I was to now be dealing with it at age 27. Dr. Buka was compassionate and understanding of my frustration and put together a regime for me that rapidly cleared up my adult issues, ultimately restoring my confidence! Dr. Buka also consulted me on a treatment for Botox. Although I am only 27, I do have a few forehead wrinkles which bothered me. Given my age, Dr. Buka recommended a conservative approach and we gave it a try! I absolutely LOVE my results and the procedure was painless! Overall, I would Highly Recommend Dr. Buka as he is extremely compassionate, professional, welcoming and knows what works best! It's also a nice plus to visit such cool offices! Updated on 14 Jan 2014: Thanks to Dr. Buka my skin is now flawless! Updated on 15 Jan 2014: Eva- I had a laser treatment that prevented and new blemishes from appearing. I was really nervous because I was always told lasers hurt. But I didn't have any discomfort at all, so I was really happy! I also started using a medicated face wash and topical treatment for my already surfaced blemishes! I did go ahead and receive a treatment of Botox. I only did my forehead, but let's just say... I am Hooked! I loveee my results!
- Appointment was made easily (plus) - insurance did not cover this treatment, which I found out 20 minutes before my appointment was to start. Wtf. Still decided to keep the appointment, and pay out of pocket. Rushed to make this appointment. - I was not informed beforehand that I would be seeing a PA. I have a Curology subscription for the past 4 years so I’ve talked to lots of PAs, I’ve already done that and it’s not working. That’s why I’m here to see a real dermatologist. - I insisted on seeing an MD. There was no MD at that location, and I had to make the trip to their office at 220 Front St. That’s a 30min train ride from Brooklyn to Manhattan. - I met with Dr. Dina Began. Finally, an MD. I understand wanting to look at things with a beginner’s mindset, but when a patient is telling you they’ve had acne for 18 years, and they’ve tried everything except Accutane, you might wanna take them seriously??? I’m not an idiot. I have a PhD in molecular biology, I’m the person who researches this stuff that pharma companies then produce and doctors prescribe. I have diligently studied the primary literature and I’m current with it. - Did not clarify treatment expectations and goals with me. - She asked me about spironolactone and doxycycline use. I was just on a doxycycline course for a week. In her opinion, doxycycline takes a month to work. I have not read this anywhere. She wanted to put me on doxycycline for a month! I’ve been on 100mg, 2x a day, 7 days; and no improvement. Spironolactone 50mg daily and it’s been 4 months now. Again, no improvement. Which again was in my history. - She asked me about PCOS, depression, etc. She didn’t read my file, because she would see it all in the notes that I’m being treated for depression. I don’t have a PCOS diagnosis. - My BMI and Hb1Ac is normal, I weigh 120lbs and I’m 5’4”. Again in my file, and didn’t use HIPAA to pull my records, otherwise we would have seen that number. - I have eliminated dairy, eggs, soy, meat because of increased breakouts. I limit my carbohydrate and simple sugar intake to no more than 50g. - Wanted to put me on Bactrim, which is a hard NO when on spironolactone because they both increase blood potassium levels. That’s dangerous. - Kept prescribing me things but did not narrow down the underlying reasons behind my hormonal acne. Obviously something’s not going right. The suggested treatments would not get to the root of the problem, so the acne is just going to keep on happening. What is the point fixing a leak in the system when you don’t know where it’s leaking? - Recommended Epiduo Forte, which is a problem for me as it increases scaliness and dryness, and it’s the wintertime, so more broken skin. It’s bad enough with 2.5% benzoyl peroxide and 0.012% tretinoin individually, how much worse is it going to get with a combination of the two??? (Adapalene is a third generation derivative of tretinoin). That increases the risk of secondary infection, and more acne. - Gave me a pamphlet on Epiduo Forte. Pretty pictures from 3 people, but no statistics! C’mon Galderma (manufacturer of Epiduo Forte), you have to do a better job. I cracked open Pubmed, started looking for primary literature on Epiduo Forte. Dryness, itching, scaling reported in over a third of the population. Confirmed what I already knew would happen, because this happens to me all the time when I use a harsh treatment. Can’t get rid of the flakiness by moisturizing, can’t wear foundation over it either. - Just said it was different from Differin, but didn’t say how. Why would I want to spend $500 on Epiduo Forte if I can buy Differin for $15-25? It has the same ingredients as Epiduo Forte. She gave me a tiny sample of it to see if it is being tolerated. - asked her for fourth-generation retinoids, such as Seleinoid G. They’ve been around since 2005. Clinical trial data shows faster treatment, plus significant advantages over Adapalene for the same concerns I listed above. She didn’t say anything about that. - suggested Altreno but no samples to try for the next two weeks or more till the medical rep visits because they were all out of samples. She said it had alitretinoin, but it doesn’t. It has tretinoin, again, at 0.05%. If I couldn’t handle tretinoin at 0.012%, how can I do so at 0.05%? I was happy to see an MD after all the running around from Williamsburg, but she was dismissive of my experience with acne over 18 years with my own face and the products I had tried. She was insensitive about my depression, and I felt that she couldn’t understand where I was coming from. That was triggering, and I just broke down into tears in her office. She had barely inspected my face, and didn’t take any pictures. I had to ask her repeatedly if she was going to come back and take a look at certain areas. At the end of my appointment, she said “well, we have other patients to treat” . And walked out. No formal diagnosis in hand. A day and 250 dollars wasted. My acne is old enough to vote, and at this rate it’s going to be old enough to drink.
Hypopigmentation, or decreased pigment in a certain area, is really tough for us. If it's secondary to a condition like vitiligo, there are specific treatments for returning pigment to that area. However, if it's hypopigmentation from post-inflammatory, or inflamed skin, it has the possibility to hypo-pigment after the inflammation resolves. This issue is really a challenge for us as dermatologists. Usually, just tincture of time, or letting pigment homogenize from the surrounding areas is our best option for re-pigmentation in that area. Lasers don't work well for hypopigmentation, but they can be a nice viable option for hyperpigmentation.
There are a lot of ways for us to remove facial brown spots. The least invasive and inexpensive technique is a topical cream known as hydroquinone. Available in concentrations of 4% to 8%, this can be prescribed for you by your board certified dermatologist. In a month’s time, the brown spots will lighten. Alternatively, we have various chemical peels, most commonly trichloroacetic acid and glycolic acid, that can lighten brown spots. The final option for removing brown spots is through a laser technique. There are a variety of lasers available, such as a non-ablative, less intense laser that includes the pulsed dye laser and the alexandrite laser. There are more intense lasers that tend to have better efficacy include the CO2, or carbon dioxide, lasers that are ablative. However, we cannot forget to mention a more old-school conventional method. With this technique, your dermatologist will take a very light electric current called a hyfrecator to tap the top of those brown spots. This allows the spots to crust and then fall off.
If you are showing uneven results from a Dysport injection after five days, you many have had an anti-dynamic injected into your crow's feet. One side of the crow's feet, or the orbicularis oculi muscle, seems to have been deactivated more prominently than the other. The onset for Botulinum toxin is five to seven days, so at this point is when you will be able to notice any asymmetry. Your board-certified dermatologist can easily correct this by putting a more hyper-dynamic injection in the area to deactivate the musculature in that area.
Aftercare for tattoo removal is focused on excellent hydration of the healing site, protection from the sun, and prevention of infection. These three things should be your focus:
As dermatologists and plastic surgeons, we do our best to ensure that the scarring following mole removal is the least noticeable, the faintest, and the best shape so as to bring optimal cosmesis to the area. Due to some factors beyond our control, whether that be a local infection or inherited healing ability, these scars don't always look great. It sounds like your "hole" is one of those instances, where the cosmetic outcome is not ideal. You have options to treat this hole in your cheek. We can resurface the scar with ablative lasers and chemical peels, but perhaps the most successful option, depending upon the size of the scar on your cheek, is removal of the scarred tissue with re-suturing. Recreation of that scar in a controlled setting can result in vastly improved cosmesis. This second option may seem severe, but it oftentimes can undo 10 years of bad cosmesis in one session, in which we recreate the scar in a preferred fashion.
