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.

Emculpt Neo is a first in class technology that builds muscle, burns fat, and reduces abdominal muscle separation. While different aesthetic offices may suggest different treatment schedules, the clinical studies performed support the following: Because Emsculpt Neo is a combination of Radiofrequency and HIFEM technology (magnetic energy) one treatment per week (every 7 days) is recommended. This is to allow your muscles to recover from the radiofrequency. If only Emsculpt is performed, then one can safely do two (2) treatments per week separated by 3 days ideally.

While skin texture issues can be approached with both laser treatments such as the fractional CO2 or fractional Erbium, and radiofrequency micro-needling (RF micro-needling), RF micro-needling actually offers advantages when there is concern for patients with unwanted pigmentation changes. Here is why: Laser or light-based treatments have the risk of post inflammatory darkening or lightening following treatments. RF micro-needling treatments are actually "color blind" in terms of causing unwanted changes in pigmentation. This has to do with the fact that fractional ablative lasers (CO2& Erbium) both remove the outer layer of skin (epidermis) while RF micro-needling does not. While patients then go outdoors and are exposed to the sun's UV rays, discoloration can potentially occur.

Great question. This depends primarily on the location, depth, size of the defect, and the patient's overall health status. Generally, surgical wounds on convex surfaces (cheek, chin, etc.) heal better with stitches while wounds on concave surfaces (inner eyelid area, temple) actually have an excellent chance to heal with a very nice cosmetic result. While these generalities hold true, each patient is unique, and one must consider all the above factors before as well as the patient's preferences.

Fortunately, there are many published studies looking at what is the preferred schedule to receive PRP injections for your scalp to help new hair growth. These studies document the effectiveness for injecting a patient's scalp monthly for either three (3) or four (4) months. Many patients elect to have follow up injections perhaps one or two every 3-4 months as a maintenance however this is up to each patient. There is no scientific evidence to suggest that having a PRP scalp treatment more often than once a month is beneficial.

Many patients present who desire liposuction and have some abdominal wall separation who do NOT want surgery. Fortunately, we have an excellent option for these patients. We can perform tumescent liposuction without or with radiofrequency (BodyTite) to remove fat and tighten the skin. Following this we can use Emsculpt Neo. Multiple clinical studies document that four (4) Emsculpt Neo treatments one a week will increase abdominal muscle by 25%, and reduce abdominal muscle separation by 20%. Our patients love the combination of treatments.