Fillers

As we age our face loses bone mass, especially along the jaw, and subcutaneous fat pads that create contour and suppleness shrink and migrate. These changes in our facial scaffold in addition to loss of collagen and elastin in the skin leads to excess laxity and drape in the skin, jowls, deeper shadows and loss of lip volume.

Fillers are injectable gels designed to help restore and correct these natural changes and, in some cases, to enhance contour. When used appropriately results will appear undetectable, natural and refreshed.

DLC uses fillers composed of hyaluronic acid and calcium hydroxyapatite which are both naturally occurring compounds in the body. We offer a select range of fillers including:

• Belotero®
• The Juvederm® product line
• Restylane Kysse® and
• Radiesse®

After a careful facial assessment, fillers are placed with a small needle or cannula into the desired areas. Topical numbing cream or lidocaine injections may be used for comfort during the procedure and afterwards some swelling, bruising and tenderness may occur but is temporary. For most results last on average 6-12 months or longer and injections are typically repeated once every 1-2 years as needed.

Because many factors contribute to the signs of aging fillers are often one element of a comprehensive plan.

Commonly treated concerns:

• Lip augmentation/restoration
• Restoration of lost cheek volume
• Smoothing of fine lip lines
• Smoothing of shadows in the nasolabial folds and marionette area

For first time visits a consultation is required to ensure patients are proper candidates for treatment and to counsel and plan thoughtfully. Due to the time it takes to administer filler carefully, treatment is typically not done on the same day as the initial consultation.

Dilute Radiesse®

Radiesse® is a calcium hydroxyapatite filler often used for volume restoration, however, when highly diluted it becomes an effective biostimulator activating the fibroblast cells in the skin to make new collagen. This newly formed collagen can increase skin thickness up to 50% resulting in natural looking fullness and improved skin quality.

Dilute Radiesse®

Radiesse® is a calcium hydroxyapatite filler often used for volume restoration, however, when highly diluted it becomes an effective biostimulator activating the fibroblast cells in the skin to make new collagen. This newly formed collagen can increase skin thickness up to 50% resulting in natural looking fullness and improved skin quality.

Dilute Radiesse® is administered with a cannula over the temples and lateral face where the signs of aging begin.

A series of 3 injection sessions are typically performed 2 months apart for optimal results. The body builds collagen slowly over 2-6 months following treatment with results lasting 2 years or longer. Periodic low dose injections may be used over time to maintain results.

Downtime is minimal lasting for most only several days and side effects may include temporary tenderness, bruising, swelling and bumps at the injection site.

This is a favorite technique for those looking to harness the body’s own collagen building properties and to generate a soft natural outcome.

For first time visits a consultation is required to ensure patients are proper candidates for treatment and to counsel and plan thoughtfully. Due to the time it takes to administer filler carefully, treatment is typically not done on the same day as the initial consultation.

Kybella®

Kybella® is an injection that offers a non-surgical option for removal of unwanted fat under the chin, called submental fullness or a “double chin”. Kybella® is composed of a synthetic form of deoxycholic acid, a chemical that permanently removes fat cells. The treatment consists of multiple small injections into the area of unwanted fat on the neck and under the chin once every four weeks for an average of 3-4 sessions. Swelling is expected after treatment and lasts for most an average 7-10 days, but bruising and occasionally numbness can occur as well and may persist for 2 weeks following injections.

Commonly treated concerns:
• Submental fat (double chin)

Clarity II

The Clarity II is a sophisticated dual wavelength 755 nm Alexandrite and 1064 nm Nd;YAG laser that is exceptional at permanent laser hair reduction. These light wavelengths absorb efficiently into melanin associated with hair follicles, destroying the hair follicle’s machinery without injuring surrounding healthy tissue. It is effective over multiple sites including the face, bikini, legs, underarms and back and across all skin tones.

Treatments must be repeated over time in order to fully target each hair in its growth phase. Consistency and commitment to the process is essential for success. For most, a series of 6 treatments spaced 4-8 weeks apart produce excellent results, however the number of treatments needed may vary depending on hormonal conditions or in those with particularly dense hair growth. Hair that is blonde, red, gray or white does not respond to laser hair removal and needs to be approached with other strategies such as shaving, waxing or electrolysis.

A consultation is required prior to treatment to ensure a patient is an appropriate candidate and to determine the optimal treatment schedule and protocol. This can be scheduled with our Master Esthetician or Nurse Practitioner.

Key Features:

Fast and Efficient Hair Reduction: The Clarity II produces more satisfying results in fewer treatments compared to light-based devices such as IPL and BBL. Its Intellitrak delivery system allows for a faster treatment session which is helpful for patients with busy schedules.

Comfortable: A cooling spray to protect the skin during treatment is used rather than an applied gel like other hair reduction lasers. This makes treatments more comfortable and mess free for patients and reduces the risk of skin injury.

Safe Treatment over a wide range of skin tones: Nearly all skin types can be treated with the Clarity II because of the dual wavelength options. Providers have the ability to select wavelengths safer for darker skin tones when needed.

Primary Use:

• Permanent reduction of of unwanted pigmented hair growth.

View DermaV® Examples

Pigmented Lesions

Sun exposure, genetics and underlying skin disorders can all contributed to various pigmented growths or areas of patchy pigmentation. Many varieties of unwanted pigmentation can be addressed successfully with laser treatments by targeting the melanin in the skin which creates the visible brown discoloration. When specific light wavelengths absorb selectively into melanin it is destroyed and the body clears away the fragmented pigment particles over 2-6 weeks.

A series of treatments is often needed (on average 3-4) to achieve optimal clearance for most patients and at times we will combine different laser wavelengths or technologies to customize care. A consultation is required before starting pigmented laser treatment to ensure an accurate diagnosis is made prior to treatment and that supportive therapies if needed are initiated to optimize results.

The various types of pigmented lesions that can be treated with laser at DLC include:

• Freckles
• Lentigo (sunspots)
• Sks (age spots, liver spots)
• Melasma
• Sun damage
• Post inflammatory hyperpigmentation

DLC has multiple lasers that have the capability to address pigmentation, but our most used platforms are:

• Hollywood Spectra (Ultra-fast pulse 532 and 1064 laser)
• Clarity II (755 nm Alexandrite and 1064 nm Nd;YAG laser)
• Lutronic Ultra (Thulium 1927 nm laser)

When treating lentigines, freckles and SKs lesions may appear dusky red, darker or scabbed for a temporary period of time before fading or sloughing to reveal clearer skin. In field treating broad areas of sun damage patients may experience generalize redness in the treatment area for several days, sensitivity and scaling.

In melasma management the treatment approach is gentle, so as not to worsen pigmentation. A series of 6 no downtime sessions spaced 2-4 weeks is typically done on low intensity settings with the Hollywood Spectra to reveal a more even clearer complexion. The Hollywood Spectra is FDA approved for this indication and when used in combination with topical melasma therapies or the Ultra Thulium laser as a drug delivery tool can yield beautiful results.

Maintaining results after treatment pigment laser involve consistent sun protection and skin care.

Lutronic Ultraâ

The Lutronic Ultra is a powerful Thulium 1927 nm laser and one of our favorite tools at the clinic because of its versatility, transformative results, low downtime and ability to treat patients year-round.

It is a nonablative fractional resurfacing laser that diminishes unwanted pigmentation (sun damage, age spots) and gives skin a brighter tone, improved luminosity, and smoother texture. The Ultra is usually administered in a series of 3 treatments spaced about 1 month apart and is fully customizable, allowing a range of light to intense treatments depending on the patient’s goals.

Key Features:

Nonablative Fractional laser technology, breaks or fractionates delivery of the laser beam to into thousands of microscopic treatment zones. This leaves areas of surrounding tissue intact to provide faster healing and recovery compared to traditional fully ablative lasers.

Drug delivery: Nonablative fractional resurfacing allows effective delivery of medications to the deeper layers of the skin often not accessible by topically applied products. This can be a useful way to deliver lightening agents such as tranexamic acid effectively in tough melasma or pigmentation cases.

Range of Power from light to Intense: The Ultra is superior to other nonablative Thulium lasers such as Clear and Brilliant and Moxi because of its capability to treat with higher power. While higher power and greater density are options for a more robust session, the Ultra can also be customized to deliver a light treatment for those looking for a gentle refresh.

Minimal downtime: Redness and occasionally light swelling are typically present for several hours to 1-2 days post procedure depending on intensity. This is followed by a coarse sand paper like texture for 5-7 days that sloughs naturally leaving refreshed smoother, clearer skin. Most resume their normal day to day activities immediately post procedure, but delay exercise for 48 hours.

All skin types and Year-round treatment: Ultra can be performed year-round and on all skin tones making it an option for most patients.

Primary Uses:

• Reduce uneven pigmentation from sun damage and lentigines
• Smooth texture and improve overall skin clarity and luminosity.
• Reduce the pigmentation of melasma
• Laser assisted drug delivery

View DermaV® Examples

Hollywood Spectra:

The Hollywood Spectra is an ultra-short pulse (1064 and 532 nm) laser platform designed to reduce unwanted skin pigmentation and tattoo ink.

One of its strongest capabilities is in treating tattoo ink either aiming for complete removal or in preparation for a coverup. The unique beam design of the Spectra allows for more even and consistent delivery of energy shattering tattoo ink particles and leading to more effective tattoo removal.

With its 2 wavelengths (532 and 1064 nm) it is most efficient with black, brown, red and purple inks. Green and turquoise inks often need a different wavelength (785 nm) for optimal removal, although they can be partially removed by the Spectra and yellow ink responds best to a Picosecond laser.

Treatments are typically spaced 4-8 weeks apart depending on the location of the tattoo and other factors.

A consultation before treatment is required for planning and to ensure patients are appropriate candidates and know how to best optimize their results.

Primary use:

• Tattoo removal (best for black, brown, red and purple ink)

Chemical peels have been used since the early 20th century to improve skin texture, reduce discoloration and fine lines and generate a brighter complexion by exfoliating the skin at different depths. Over time advances in safety and combinations of acids have led to peel formulations with less downtime and greater comfort.

DLC offers a spectrum of peels ranging from superficial “no peel peels” to medium depth peels administered by a medical provider that can be tailored to a patient’s tolerance for downtime and goals.

Our chemical peel lines include:

• Linder HealthÒ (Polite Peel, Hero Peel, Spotless Peel)
• SkinBetter ScienceÒ Professional Peel 30 and 50
• SkinCeuticals Ò (Smart TCA Peel)
• Glytone Ò (Triple Bright, Jessner’s Peel)
• Jessners + 30% TCA Peel (MD /ARNP only)

Professional facials with a Master esthetician can be done in preparation for special occasions, as part of a more regular skin care ritual or for active skin concerns such as acne extractions.

Two levels of customized facials are offered at DLC:

• Express Facial (45 min)
• Customized Full Facial (60 min)

Milia are very small cysts in the superficial layer of skin that appear as tiny (1-3 mm) white or yellow bumps. These occur when sloughed skin cells become trapped leading to accumulation of keratin and other debris in the follicle like a small pearl in the skin. Milia can also occur in tattoos or after chemical peels, dermabrasion and skin trauma. Heavy occlusive moisturizers can worsen the development of milia as well by plugging the follicle openings.

Some patients find that light exfoliation such as with glycolic or salicylic acid products or topical retinoids help reduce the formation of milia.

Milia do not have a dilated opening to the skin surface allowing them to be expressed with squeezing alone. They often require a small incision (“nick”) be made over the surface with a blade in order to extract the material. This procedure is done by our skilled master esthetician who can ensure the skin is clean, appropriately prepped and use a sterile instrument to perform the extraction. You may schedule directly with our master esthetician for milia extraction.

Comedones are a variety of acne lesion that develop when debris blocks the sebaceous duct and hair follicle leading to dilation of the follicle. When the follicle opening of a comedone is enlarged and visible it may be termed a blackhead. Blackheads are different from sebaceous filaments. Comedones may be extracted as well by our master esthetician and this procedure may be combined with a facial or light salicylic acid chemical peel for those with more active acne.

A daily at home skin care routine is an essential foundation to caring for healthy skin and maintaining results following in office procedures.

Basic routines include cleansing, moisturizing, and sun protection. Beyond the foundations, prescription medications and targeted corrective and preventative ingredients can be added to address active skin concerns such as acne, aging, and pigmentation, as well as maintaining and enhancing healthy, normal skin.

Personalized recommendations for skin care products and Makeup consultations can be provided through a visit with our Master esthetician.

Dermatology and Laser Center NW offers the following product lines:

• SkinBetter Science
• EltaMD
• SkinCeuticals
• MD Solar Science
• Jane Iredale Cosmetics

Skincare product and Makeup Consultations are complementary.

Cosmetic Mole Removal

Nevi, commonly called moles can be congenital (present at birth or within the first few years of life) or acquired later on. They are growths composed of pigment producing cells in the skin called melanocytes. Patients often seek cosmetic removal of moles when they are bothered by their appearance or when they are in inconvenient locations such as those that rub on clothing. Removal of benign moles is not covered by insurance.

Different techniques may be used to remove a mole including:

• Shave removal
• Punch removal
• Elliptical excision

The location, size and shape will influence the best option for removal.

It is important to recognize that mole removal involves cutting the skin and in some cases sutures . Mole removal will always leave a scar in its place and some patients are more prone to visible scarring than others. Guidance will be given to optimize wound healing and scar appearance. The goal is to leave a scar that has a more cosmetically acceptable appearance than the mole and at DLC cosmetic mole removals are done with precision and care.