Cosmetic Skin Institute

Botox, a neurotoxin, is injected into a muscle which blocks the nerve impulse that prevents contraction of the muscle. The muscle weakens, and eventually the wrinkles in the skin gradually soften and often disappear.

Some possible side affects are mild bruising and drooping. A bruise would last a few days and a droop can last one to two weeks. These side effects are not common and are temporary.

Now frown lines, crows feet, and forehead lines can be dramatically softened or eliminated. This procedure, known as a cosmetic denervation, uses Botox injections to improve the appearance of worry lines, frown lines, laugh lines, crows feet and other dynamic wrinkles.

Chronic Migraine is more than just frequent migraines. A migraine is a type of headache that may begin as a dull ache and then turn into a constant, throbbing pain, often felt on one side of the head. Botox is the first and only preventive treatment approved by the FDA for adults with Chronic Migraine (15 or more headache days a month, each lasting 4 hours or more) . If you suffer from chronic migraines, Botox may be able to help. Call or email us today to schedule an appointment.

No! Dysport has been available in Europe, Asia, and South America for over 10 years. Dysport is manufactured by Ipsen Pharmaceuticals (FRA) and is supported by over a decade of clinical experience. Dysport is distributed in the United States by Medicis, the manufacturers of the revolutionary Restylane dermal filler. Dysport was developed in the United Kingdom in the early 1990's to successfully treat a number of neurological and opthamalic conditions. It was further developed to treat a wide variety of neuromuscular disorders, for which it is licensed in over 60 countries. Since that time, with an increased understanding of the uses of Dysport, thousands of treatments have been safely and effectively performed for a variety of conditions ranging from facial wrinkles to axillary Hyperhidrosis (excessive sweating under the armpits) .

This topic is widely debated and heavily biased due to most comparative cosmetic studies being partially of fully funded by manufacturers of Botox (Allergan) and Dysport (Ipsen/Medicis) . Many cosmetic physicians outside the U.S. who have used Dysport report greater longevity when compared to Botox. In most unbiased neurological studies for the treatment of movement disorders, Dysport has provided equal or greater efficacy when used in a 2.5 to 4:1 ratio to Botox. In a double-blinded randomized crossover study in cervical dystonia (the most common use of neurotoxin in the world) , results showed Dysport to be more effective than Botox with a similar safety and side effect profile when used in a 3:1 dose relationship.

Restylane - is intended for wrinkle correction and lip enhancements. Restylane Silk - is used for subtle lip enhancement and the smoothing of wrinkles and lines around the mouth. Restylane Lyft - provides fullness to cheeks and adds volume to correct and smooth smile lines (nasolabial folds) .

No skin test is necessary. Allergic reactions are almost non-existent. Lasts up to 60% longer than collagen fillers. Clinical trials show that Restylane is effective for up to six months after lip augmentation.

With Juvéderm the injection process takes only about 15 minutes and results are immediate. Plus, there's minimal recovery or downtime. So you can step into your doctor's office for treatment and step right back into your life. Juvéderm is indicated for injection into the mid to deep dermis for correction of moderate to severe facial wrinkles and folds (such as nasolabial folds) . The other dermal filler used in this study was ZYPLAST dermal filler (bovine-based collagen) .

Because Juvéderm injectable gel is a simple, nonsurgical wrinkle treatment, there is minimal recovery or downtime. So you can make an appointment to stop by our office for treatment on the way home from work or the gym, or even while the kids are at soccer practice-and get right back to your life.

We will examine the soft tissue of your face to assess the depth of wrinkles and folds to determine your treatment. Juvéderm injectable gel is available in two formulations-Juvéderm Ultra for versatility in contouring and volumizing facial wrinkles and folds, and Juvéderm Ultra Plus, a robust formulation for volumizing and correcting deeper folds and wrinkles. This allows us to better tailor treatment to your unique needs. We will also take pre-treatment photographs so you can see the difference after treatment!

Over time, the natural fat surrounding the cheeks begins to deteriorate, resulting in a reduction of volume, sagging skin and more prominent wrinkles. Through nonsurgical injections, Restylane Lyft is specifically designed to add fullness to the cheeks and midface area, which can result in a natural-looking appearance.

Like other areas of the face, the lips and skin surrounding the mouth show signs of aging as an individual gets older. This often results in lip thinning, lost shape and an increase in vertical lines above the lip. Restylane Silk is designed specifically to provide natural-looking results in these areas. That's why it's made of smaller, smoother particles than those used in other Restylane products. In a clinical study of patients treated with Restylane Silk or no treatment, clinical investigators reported: 77% of patients treated with Restylane Silk showed at least a one-point improvement in lip fullness (measured on on a 5-point scale) eight weeks after treatment. 59% of patients treated with Restylane Silk maintained lip fullness six months after treatment Restylane Silk's unique particle gel formula, along with an ultrafine needle designed for improved accuracy, helps give you softer, more precise results - just what you need for a natural-looking smile.

The Collagen P.I.N. Safety Micro-Needle provides "flawless" results on the following: Face, Neck, Decolletage, Hands, Arms, Legs, Abdomen, Back.

Fraxel treatments are mildly to moderately uncomfortable. A topical or local anesthetic in addition to using a cold air blower simultaneously with the laser, can lessen the discomfort dramatically.

Patients will likely experience redness, swelling, and possible peeling post treatment. Redness can typically last 1-2 weeks and can be covered with makeup. Swelling is usually 1-3 days. Most Fraxel patients report the sensation of a "light sunburn" immediately after treatment. Patients usually drive to and from their own Fraxel appointments.

Patients may feel slight stinging, commonly likened to the snapping of a small rubber band on the skin. We offer a topical numbing cream to alleviate the minimal pain of the treatment. The numbing cream is normally applied 30 to 60 minutes before the treatment.

Typically, 1 to 5 treatments are recommended every three to four weeks. Once a patient is evaluated by one of our medical professionals, they will have a better idea of how many treatments are necessary.

Larger areas may be treated using lasers as opposed to electrolysis, waxing or tweezing. Laser Hair Removal is effective on almost any area of the body where smoother, younger, hair-free skin is desired. The LightSheer Diode ET is the first system to provide permanent hair reduction using state-of-the-art, high-power diode technology.

The IPL Hair Removal system involves selective photothermolysis. In other words, the IPL Hair Removal is directed specifically for hair in that it selectively targets the melanin (color) of the hair and the texture. In this process, it ultimately destroys the hair follicle. The energy emitted through the IPL system is delivered to the area and the hair follicles are destroyed.

In terms of a single treatment, depending on the area to be treated, the chin and upper lip may take five minutes and both legs could take an hour and a half. To achieve permanent hair reduction, an average of three to five treatments may be necessary depending on skin type and body area. The frequency between treatments is about six to eight weeks.

The IPL Hair Removal system is effective on all skin types and hair color except white hair, grey hair, and blonde fuzz. Most systems target the pigment inside the hair. No pigment - no results.

The area that is being treated will be numbed with xylocaine so most patients feel little to no pain. There are normal side effects after a tattoo laser removal treatment such as redness, blistering and crusting. This usually lasts for about 1 week.

Call our office today to schedule a consultation and find out if Tattoo Removal is a good treatment for you. Our expert providers, who have over 15 years of experience, will be able to answer your questions.

Larger veins are usually treated first. A scalloping solution is injected into the vein with a micro-needle. The solution causes the vein to turn white (blanch) and then gradually disappear. A typical treatment lasts 30 minutes to an hour depending on the severity.

Complete correction is not expected on the first treatment. Only about 50% - 70% of the treated vessels will be permanently gone. Three to four sessions are generally required, spaced out six weeks apart for optimal results. Patients may be asked initially to wear heavy duty stockings to help keep treated veins closed and reduce bruising. It is recommended to have treatments done during colder months as the appearance of the veins will look worse before they get better. On occasion, small clots can develop at the site of the injection. Color changes can occur in the skin where the Sclerotherapy has been performed. If there is an underlying problem with the venous system, the veins will recur.

It gives you a subtle lift, helping to restore contour and a more youthful profile, for up to 2 years.

Enjoy mattifiers that tame the shine while they help your skin to become more balanced.

While BELOTERO BALANCE Dermal Filler is made of the same material (hyaluronic acid) as some other dermal fillers, BELOTERO BALANCE Dermal Filler has unique properties that allow it to adapt within the skin for soft and even correction. The versatility of the product makes it strong enough to handle deep treatment areas such as nasolabial folds (smile lines around the mouth) , yet soft enough to treat more delicate areas such as vertical lip lines (thin lines that appear above the lip line) .

Individual results may vary, but BELOTERO BALANCE Dermal Filler may last about 6 months or more.

There is very little to no downtime associated with a BELOTERO BALANCE Dermal Filler procedure. In fact, most patients return to their normal daily activities right after their visit. Every patient is unique, so be sure to discuss your plans with one of our nurse practitioners during your consultation.

The Collagen P.I.N. Safety Micro-Needle provides "flawless" results on the following: Face, Neck, Decolletage, Hands, Arms, Legs, Abdomen, Back.

RADIESSE dermal filler works with your own body in a remarkable way. Upon injection, it immediately adds volume to safely contour, correct, and beautify facial features. And unlike other fillers, RADIESSE dermal filler continues to work over time. With its patented microsphere technology, it starts a process called collagenesis, stimulating your body to produce new collagen and encouraging collagen to grow around the injection area. RADIESSE dermal filler actually helps your body create its own naturally younger look, setting a new standard in facial contouring and augmentation.

Radiesse dermal filler is made of unique, patented, calcium hydroxylapatite (CaHA) microspheres suspended in a water-based gel carrier. When injected into the skin, these microspheres initially perform as a filler - they immediately provide facial volume for a soft, natural look. The transformation is noticeable right away. Over time, your body will gradually absorb the gel carrier, but the very tiny, smooth microspheres remain. Upon injection, RADIESSE dermal filler immediately adds volume to facial features. Macrophages continue to dissolve the gel carrier. Fibroblasts form new collagen. New resident tissue (collagen) surrounds the CaHA microspheres. The CaHA microspheres degrade and are phagocytized and metabolized by macrophages. Even the small fragments of CaHA are decomposed at the implant site, without evidence of migration.

Radiesse is used for hand augmentation to correct volume loss in the dorsum of the hands. Radiesse provides an immediate volumizing effect and can help to reduce the prominence of tendons and veins in the hands, delivering smooth, natural-looking results that can last up to one year.

Until the development of fractional skin resurfacing, there were only two types of laser treatments available - ablative and non-ablative. Ablative laser treatment is effective but requires some recovery time. Non-ablative laser treatment has little or no side effects and almost no healing time, but requires multiple treatments within a extended period of time. The Palomar fractional skin resurfacing laser offers the same effectiveness as the ablative laser treatment, but with the speedy healing time associated with the gentler, non-ablative lasers.

The Palomar laser and Fraxel laser are part of a new generation of laser treatments called fractional skin resurfacing. These lasers are similar in that they only treat a portion of the skin, 20 - 25 percent, during each session. However, there are subtle differences in the lasers manufactured by Palomar and Fraxel, which is why it is important to schedule a one-on-one consultation to determine which laser would be most effective in treating your skin condition. With the Palomar laser, no tinted guide lotion or topical anesthetic is required, making the treatment session very pleasant and easy for the patient. The Palomar laser contains a unique sapphire cooling tip, which cools the skin and minimizes discomfort during treatment.

The number of sessions will depend upon the condition treated. On average, an effective treatment regimen is 3 or 4 sessions, spaced 2 to 4 weeks apart. Depending on the severity of the condition being treated, it could take up to six treatments. Results are immediate and progressive. Over the course of two or three months, new collagen begins to form, creating healthy, more youthful skin.

A small amount of discomfort is involved but most people find that a Palomar laser session is comfortable. The Palomar laser has a unique sapphire cooling tip that cools the skin before, during and after each pulse light, making the treatment comfortable to most people. Most patients describe the treatment as having a mild "snapping" sensation or sunburn sensation.

Following treatment, it is important to apply a sunscreen of SPF 30 at least twice a day. Also, avoid direct sun exposure during the healing process and for at least three months following treatment.

Nevus of Ota is a blue hyperpigmented birthmark, caused by the entrapment of melanocytes in the upper third of the dermis. It is found on the face unilaterally and involves the first two branches of the trigeminal nerve. Nevus of Ota or blue-black facial birthmarks can be treated with the Q-Switched Lasers. Significant improvement (lightening of the birthmark) is noted after laser treatments.

The area that is being treated will be numbed with xylocaine so most patients feel little to no pain. There are normal side effects after a tattoo laser removal treatment such as redness, blistering and crusting. This usually lasts for about 1 week.

Call our office today to schedule a consultation and find out if Permanent Makeup Tattoo Removal is a good treatment for you. Our expert providers with over 10 years of experience will be able to answer your questions.

The basis of this technology comes from the idea behind dental ablation. By utilizing a piezoelectric mechanism, the dental ablator transmits high frequency vibrations to the teeth. The vibrations are helpful in disintegrating and removing tartar that accumulates on the surface of the teeth. The same principle is used with SkinBella Bi-Elastic Blade by adapting it to the skin and tissue. One of the most intersting aspects of the action produced by the blade is the cavitation phenomenon. The stress wave created by the rapid movement of the blade, along with a thin layer of fluid on the skin's surface, generates small microscopic gaseous bubbles that not only generate convective movement, but also provoke a depolarizing and a superficial catalyzing effect. The very rapid sequence of mechanical stress to the treated areas brings about the detachment of cells from the superficial layer of the epidermis. The gentle exfoliation employed by SkinBella System causes no injury to cells in deeper layers where the stress waves produce an effective micro-massage as a result of its characteristically stimulating action. The high-frequency micro-vibrations produced by the Bi-Elastic Blade also help reduce surface bacteria, which is a primary cause of blemishes. SkinBella has a "stress wave" generator, suitable for the following: Exfoliation Exogenous and endogenous moisturizing Heightened blood circulation Diminished discolorations

SkinBella treatments are non-invasive, removing the stratum corneum. The Bi-Elastic Blade produces an even exfoliation of all areas. Clean, consistent exfoliation revitalizes the skin. It does not use particulates or harsh chemicals. There is minimal redness and no down time following treatment. Visible results are immediate. Skin is left with a youthful, radiant glow. SkinBella's ultrasonic actuator kills surface bacteria, the primary cause of blemishes and acne. Inflamed blemishes can be exfoliated without risk of breakthrough bleeding. Extractions are minimized and can be easily performed. SkinBella is a wet peel. Suitable for multiple skin types. The original medical grade crystal free treatment that can reduce the effects of aging on your skin. Using the patented DiamondTome wand the treatment is a safe, clinically proven therapeutic approach to superior skin care results. Skin Resurfacing is an exfoliation technique for removing the topmost layer of skin, leaving it more supple and vibrant. The DiamondTome Skin Resurfacing System removes this layer by gently exfoliating the skin with natural diamond chips bonded to the tip of the wand, while vacuuming the exfoliated skin cells away in a controlled manner. Removing this outer layer leaves a smoother texture and promotes the growth of healthy new skin. Unlike other exfoliation treatments, the DiamondTome Skin Resurfacing System uses no loose abrasives to contaminate you or the environment.

Call our office today to schedule a consultation and find out if BELOTERO BALANCE is a good treatment for you.

Certified Nurse Practitioner and Laser Specialist. Johanna has been practicing cosmetic dermatology since 2001 and has treated hundreds of patients. She graduated from the University of Maryland with a BS in Nursing in 1999. She worked as a surgical nurse at Holy Cross Hospital in Silver Spring, Maryland for five years, after which she returned to the University of Maryland to pursue a Masters Degree in Science as an Adult Nurse Practitioner, graduating in December 2001. In addition, she obtained her post master's certificate as a Family Nurse Practitioner in May 2010. She specializes in providing cosmetic treatments, such as Fractional Laser Resurfacing and is a certified expert in Botox® and Restylane® administration, as well as Sclerotherapy for treatment of unwanted leg veins. Through her years in practice, she has performed hundreds of aesthetic laser procedures and has also participated in clinical trials of investigational procedures. She has also trained many nurses and physicians in many different cosmetic dermatology procedures such as Botox, Dysport, dermal fillers and several different lasers. In addition, she is a member of the Association of Medical Esthetic Nurses, the American Society for Laser Medicine and Surgery and the Dermatology Nurse Practitioner Society. Johanna enjoys helping her patients feel good about achieving their desired aesthetic goals. She prides herself in the expertise she has mastered with cosmetic dermatology and enjoys offering non surgical rejuvenation to all of her patients.

We believe that treating each client as an individual with separate and distinct needs is of utmost importance to achieving the client's goal and trust.

Our mission is to maintain trusting relationships with our clients in order to help them achieve their personal skin care goals.