Tanda Lane, MD

I have Fraxel Re:pair with nerve blocks, topical anesthetics, oral sedatives but it takes longer and the patient still has a degree of discomfort. Currently I use monitored anesthesia care with IV propfol +/- versed and patients do very well and the procedure is complete in much shorter time frame.

Botox to the mentalis can certainly correct the peau d'orange or "golfball" like texture of the chin. If the positioning of the lower lip is changing, it means the injector is also injecting fibers of the depressor labii inferioris. That should be correctable with a change in injection technique. The dimpling you dislike on your chin is due to the pull of the underlying muscles, and not because of volume loss so I think neurotoxins, and not fillers, are the best way to correct the problem.

Fraxel re:pair laser is a carbon dioxide (CO2) laser that
vaporizes microscopic columns of tissue deep within the skin. It is one of the
more aggressive resurfacing options and I find results highly satisfactory within
1-2 treatment sessions. I would recommend treating the full face rather than
sections to avoid demarcation lines post healing. You want the texture and tone
of your skin to be uniform. I think you’ll be pleased with the outcome.

Melasma certainly presents a treatment challenge and I find
the best approach to be a combined one.  A Combination of good sun protection, skin
care, supplements and procedural interventions are all typically needed. 4%
hydroquinone is the gold standard topical intervention and I typically have
patients prime the skin for at least 2 weeks with hydroquinone before any
procedure. The clear and brilliant (particularly the permea handpiece) is a
good minimally invasive option for melasma, but sadly there is no guarantee. I
also like the 1927nm thulium laser (Fraxel dual or Fraxel re:store) as it can
target dyschromia both in the epidermis and dermis.  I would also recommend supplementing with
oral pycnogenol during and after your therapies. This is a potent OTC anti-oxidant
and anti-inflammatory that decreases the pigment intensity of melasma and can
prevent rebound hyperpigmentation post laser. I would also recommend SkinMedica's total defense and repair post treatment as it blocks UVB, UVA and Infrared light...all which contribute to recurrences of pigmentation.