Richard E. Stiefler, MD

Either one is fine, including Xeomin.  Occasionally, for unknown reasons, one product seems to work better in one individual than another.  One could only find this out, however, through experience being injected with each product.  One could not know this beforehand.  Most of the time, however, they would work equally well.  The real question is not which product you should have, but rather the skill and product preference of the injector.  Because the units vary and are not interchangeable, a given injector may prefer one product or another or may be more skilled injecting one or the other.  

Both the beauty and the downside of Botox is its limited duration.  The positive side is that any negative effects will eventually wear off.  Even the downside is not truly a limitation.  If the effects of Botox were to last indefinitely then it would be a much more powerful treatment with the possibility of permanently altering neuromuscular function causing atrophy and permanent facial changes over time that would not be desirable and may not  coincide with aging facial changes.  We are much better off having a "toxin" the effects of which diminish over time.  That said, it is possible that with repeated injections over a number of years, that the duration of the effect will last longer increasing the time interval between treatments because of "retraining" of the injected muscles to to contract less.

There is absolutely no contraindication to the use of Botox and Retin-A.  They have totally different mechanisms of action.  Botox addresses dynamic wrinkles caused by muslce contraction.  Retin-A addresses sun damage and static superficial wrinkles and etched lines caused by aging and sun exposure.  Theoretically, they will supplement each other.

If the first course of Accutane was beneficial, then a second course may be an excellent option. As my rule of thumb, roughly 50% of those treated with Accutane, no matter how good the response, may eventually have a recurrence severe enough to merit another course of treatment. And after a second course of treatment, roughly 50% of these people may flare to the point of needing a third course, etc. etc. Compared to any other therapy for this chronic persistent condition, this is still a phenomenally successful treatment.

The cost of mole removal will vary depending on the method used (shave vs cutting out and suturing). The size and the location of the mole will also influence the price. However, there is also a charge for the mole to be examined by pathologist.

I advise to call your dermatologist and find out the estimate of the mole removal and how much the pathology will cost you.

If you have insurance it will most likely to cover both charges but depending on your policy it might be applied to deductible that you will have to pay.

I hope it is helpful information.

I strongly do not recommend laser distraction of any mole because there is no specimen for pathology evaluation. Any mole that is removed should be evaluated by pathologist -- to make sure that it is an "OK mole".

As discussed earlier shaving or cutting both are great ways to remove the unwanted mole. Shaving is a less expensive option and scars usually look great. However, cutting is most likely method to insure that mole does not reoccur. Discuss with your dermatologist both options. The size of the mole and location would be very helpful in deciding which procedure to chose. In addition, dermabrasion can be done afterwords to improve appearance of the area.

Dryness is very common with Accutane; therefore, there is a greater chance of irritation with hair removal products. Vaniqa is a great topical cream and as mentioned above it decreases the hair growth (effectively) but you still need either to shave unwanted hair or remove with tweezers. Depilatory creams also can be used; however, irritation might be an issue. These creams are OTC and can be found in any drug store.