Patrick S. Carney, MD

Thank you for asking these good questions.

Botox, or the new Dysport product, will work to help relax the lines around the eyes and upper part of your face. These neurotoxins also works in small doses around the mouth and jawline, if your muscle activity is strong and is causing smile lines, lip lines, or a pull at the corners of your mouth.

Dermal fillers, ie. Restylane, Perlane, Sculptra, Juvederm, may all be considerations to soften and restore smile lines, however they are capable of much more than this.

We will more often address the whole face, choosing to lift the cheek, thereby softening the folds, and restoring volume in the areas that are lacking, which will not only improve a deep smile line or specific concern, but provide overall a more youthful and softened appearance. These products are being used in the cheek and temple area as well as the smile line, and lower portion of the face to achieve such results.

Schedule a consultation with a practice that comes highly recommended to you in your area to receive more information about these products, treatment options, and costs associated. The combination of Botox/dermal fillers is the right direction for a young 42 year old woman, and may provide exactly the results you're hoping to achieve.

Sincerely,

Dr. Carney

Hello and Thank you for asking this question.

Some of my Dermatology clinics see significant traffic of patients seeking this treatment for excessive sweating, however we are finding that few cases are being approved by insurance for coverage of treatment using Botox.

There are a series of other products available that my be less expensive and potentially helpful in providing relief. If you have tried several products and are not seeing significant changes in your excessive sweating, I do suggest Botox Therapeutic treatment.

We have recently implemented a program using CareCredit to help patients afford these treatments by making monthly payments to this finance company, and have proposed 2 treatment levels.

From our experience, we know that a vial (100 units) of Botox is maximum dosage used in each underarm, palm of hand, or sole of foot. However, we also recognize that 1/2 of this dosage (50 units) is quite effective as well.

Treatment pricing for Hyperhidrosis in our clinic is as follows: 100 unit treatment total (1/2 dosage): $850, and 200 unit treatment total (full dosage) is $1500.

I wish you success in finding a treatment to provide relief from sweating and understand how frustrating this can be for you.

Take care.

As a dermatologist who offers Fraxel Restore treatment and many other laser and chemical peel treatments, I appreciate your question.

Tretinoin usage in combination with these treatments is often controversial, but may be moreso than need be.

While I am not certain if you are treating melasma or acne scarring with Fraxel Restore, nor aware of your heritage or skin tone, my staff and I will often encourage our patients to refrain from tretinoin for 10 days (or so) prior to the Fraxel treatment, and resume 5-7 days post treatment.

It is certainly safe to continue Obagi Nu-Derm system steps (aside from Blender and Tretinoin) up to the day of treatment. It may be wise to stop all Obagi steps for a few days after treatment.

Obagi and Fraxel work very well together for obvious reasons, however the use of tretinoin can alter or "intensify" treatment. A conservative and cautious approach and suggestion by your Fraxel provider to temporarily discontinue tretinoin use is valid and admirable.

We will often recommend Cicaplast from La Roche Posay or MD Forte (or Vivite) Replenish Hydrating Cream to our patients following this treatment. Aquaphor or Vaseline will work if the dry skin is irritating and excessive.

Congratulations on choosing exceptional treatments and systems to improve your skin.

I hope to have helped in some way.

Latisse is the newest and only FDA approved eyelash enhancement treatment in the market. This product along with another product (non-FDA approved) is available in our practice.

Latisse was introduced late January of 2009, and while we have tremendous confidence and are seeing happy patients, the full effects of Latisse may result after 6-8 weeks of use.

We have introduced a special offer like many other physician offices to encourage a more affordable "first step" to fabulous lashes. The regular price of Latisse is $120. I believe this is consistent in physician's offices as well as when provided through the pharmacy by prescription.