David E. Kent, MD

Mohs surgery is a tested and proven method for removing skin cancers often on the face. The two distinct advantages include maximal conservation of normal tissue and obtaining the highest cure rate possible. Reviewing your photos your skin cancer has indistinct edges and it is very difficult to identify the margins. In these cases, Mohs surgery is ideal as one does not consider closure options until 100% of the tumor is removed. We leave all the normal tissue undisturbed. The procedures are performed in the office under local anesthesia, This option will likely result in the smallest surgical defect and as a result, the smallest surgical scar too.

Upper lip reconstruction following Mohs surgery as we all know depends heavily on the horizontal diameter of the defect. Smaller defect that measure less than 25% of the horizontal lip length sometimes can be closed directly with a lip wedge or a partial lip wedge. Defects that are larger may require a flap from the lower lip (referred to as a lip switch), or other considerations. The fact that it extends down to the vermillion really doesn't matter as that part is often the easiest to fix. It is not uncommon to extend the incision inside the mouth on the inside lip to hid ethe incision. Sometimes combinations of more than flap are best again depending upon the specific dimensions of the surgical defect following Mohs surgery.

Skin peels for patients with skin of color demands careful consideration of which peeling agent to select. Additional options for safe peeling agents for unwanted hyperpigmentation other than a Cosmelan peel would include a Melanage peel that is highly effective or a peel with salicylic acid. One should avoid peeling agents with trichloroacetic acid.

Thank you for submitting your photos. Your photos highlight a common problem many patients face: neck fullness and skin laxity. Unfortunately, liposuction alone will only remove some excess fat. One excellent option to improve the contours of your neck and define your jawline would be to use radiofrequency combined with your tumescent liposuction- a procedure commonly referred to as Radiofrequency assisted liposuction (RFAL). This uses an amazing technology- Face Tite by InBody. The procedure is safe, performed in our office surgical suite under tumescent anesthesia and is virtually painless. The procedure involves initially and meticulously placing tumescent anesthesia in the subcutaneous tissues of the neck. next Face Tite radiofrequency is used to tighten the skin and melt fat. Finally, the unwanted fat is removed via liposuction. Patients continue to improve for over 6 months. So, you will see both skin tightening, combined with fat reduction and improved neck contours.

There are several key points you should be aware of before you come in for your Emsella treatment. First, each treatment lasts 28 minutes. You simply walk in, sit down with your knees bent at 90 degrees. Next an aiming pulse helps the patient center themselves. This will be felt between the rectum and the genital area. Once this location is confirmed, the treatment begins. The patient will feel a series of pelvic floor contractions that are intense. While the contractions are intense, they are NOT painful whatsoever. It is like doing 9000, high intensity pelvic floor contractions in 28 minutes. Wow. There are two protocols: one is primarily for helping urinary incontinence, the other (2) is to improve personal intimacy. the latter is more intense than protocol 1.