Mary Ann Martinez, MD

While on Accutane or isotretinoin, your liver enzymes my elevate.  Many meds can do this.Infections such as viral hepatitis can do this as well.   If you consume excessive or chronic alcohol your liver may also become inflamed and your liver enzymes my subsequently elevate.  Therefore, while on any med that can potentially inflame your liver ,it is a good idea to avoid excessive alochol.  If your liver enzymes are within normal limits, you can drink some alcohol just be responsible.  After you complete isotretinoin and if you have a normal liver and if you are of age, you may drink alcohol-just do so responsibly.   

The "kits" are caustic chemicals that basically "eat away " the mole and can leave horrible scars.   The appropriate thing to do is to see a dermatologist - the mole will be cleansed with alcohol and numbed with lidocaine.  Usually the mole can be easily removed with a shave excision (like a scrape ) that will heal in 1 week.  The mole should be sent for pathology to verify that the mole is ok The  risk is minimal - there is a possibility of a small scar ,pain of the needle injection  and infection if the site is not cared for properly.   Call a dermatologist  in you area and they should be able to give you  a price range .  It should be very affordable . 

Latisse is applied every night 1 drop per upper eyelid rim only.  After about 8-12 weeks most patients will experience significant growth.  To maintain the effect you must continue to use it.  However, you may find that every other night or every 2nd night application will maintain the growth of the lashes.  If you stop it for any reason the lashes will return to their "pre Latisse " lenght.  That is ok just start over and apply nightly until you get the length you want then back off as above.

   Isotretinoin  is more commonly used for acne but can be used in severe refractory rosacea and rhinophyma.   During the initial phases of treatment you may become worse before better.  It is very important to use mild cleansers, moisturizers and plenty of sunscreen .  Rosacea can flare with heat, sun exposure, alcohol ingestion, spicy food and stress.   If you are having problems your doctor may prescribe a topical such as Metrogel or even a mild topical steroid to soothe  the inflammation while on isotretinoin.   Your rosacea should get better the longer you are on the medication as it works in a cumulative fashion.   The normal course is 5 months.  Try to be patient and hang in there but definitely consult your doctor if you are worried with your progress.

Botox works best for hyperfunctional facial lines. These lines are caused by the repetitive contraction of the underlying muscle which causes the wrinkles or creases in the skin.  Most common areas of treatment are:  the glabella (frown lines or "11) horizontal forehead lines (from raising your brows), crow's feet (from smiling or squinting) bunny lines on the sides of the nose (from squinting).  Less common sites are:  perioral lip lines (from pursing ,drinking through a straw or smoking) , labiomental crease and peau d'orange (the wrinkle below the lip in the chin and the orange peel look to the chin) , mouth frown ( the down turned corners of the mouth), wrinkles in the neck.   It is best to start Botox earlier rather than later because Botox will also prevent the lines from deepening.  It is important to keep up with your Botox and have repeated injections done when it wears off (usually 3-4 months) .  This will  maintain the smooth non-wrinkled appearance and keep the treated areas smooth.  Very deep lines may also require filler in addition to the Botox.

I do not recommend Botox while pregnant or breastfeeding. However, as soon as you stop breastfeeding you may be injected. Or, as soon as you deliver if you are going to use formula and not breast feed you may be injected.    I will say from personal experience that if you are pregnant and undergo Botox and you have not realized you are pregnant , the chances are great that the baby will be fine.  So don't worry, enjoy the pregancy and breastfeeding then when all is done and the time is right  treat yourself !