Dr. Rohrich offers several types of minimally and/or non-invasive cosmetic procedures that can treat different aspects of a patient’s appearance, in addition to advanced regimens and products that you use at home:
- Skin Resurfacing- (chemical peels, laser resurfacing)
- Neuromodulators (Botox, Dysport, Xeomin, and Jeuveu)
- Cosmetic Fillers (Restylane, Voluma, Juvederm, Vollure, and others)
- Microneedling with Platelet Rich Plasma
- Radiofrequency Microneedling – Morpheus8
Skin resurfacing is a medical-grade skin care technique that provides rapid results. Unlike the skin care products that can be used at home, these treatments require a professional. The process involves removing the old outer layer of skin through one of three general techniques:
- Dermabrasion, which involves abrading or sanding the outer layer of skin.
- Chemical Peel, the use of special chemicals to remove the outer layer of skin.
- Erbium laser peel, using a direct laser beam which removes the outer layer of skin without burning.
All of these methods work by the same basic mechanism: They injure and remove the outer layer of skin so that new skin can regenerate. “Injuring” the skin, put simply, is the process of removing old skin to make way for the new. The injury or effect needs to be confined to the dermis to have a visible effect on the skin. If the injury extends into the reticular (deeper) dermis, there is an increased risk of scarring. However, because deep wrinkles extend deeper into the skin, deeper treatments are sometimes necessary.
Each of the techniques offer their own advantages and some are better suited to for certain applications. There is a subtlety and finesse involved in administering these customized treatments safely and effectively, you will only want an expert to perform these treatments, especially the deep treatment types, in order to minimize the risk of scarring.
Fillers are used to add volume to your face when you have volume loss, but have not yet reached the point of sagging. Once sagging sets in, fillers will not be able to effectively provide treatment. One of the most common mistakes that inexperienced physicians and other practitioners make is in the excessive promotion of these products, believing fillers can lift and fill for an easy fix. They cannot. When overused, they create a very over-filled and fake appearance.
When it comes to FDA-approved fillers in the USA, you have many options. The most commonly used fillers are the following:
- RESTYLANE® and RESTYLANE LYFT ® are hyaluronic acids that occur naturally in our bodies and aid in regulating growth and cell renewal. These are excellent hyaluronic acid fillers that are great for filling the cheek, nasolabial folds, under the eyes (tear troughs), and the lower jaw (chin) areas. They usually last more than six months, depending on your metabolism and muscle movement in the treated area. There is minimal allergic or hypersensitivity risk with either one.
- JUVÉDERM ULTRA PLUS XC® is another excellent hyaluronic acid filler. Due to its water-solubility, JUVÉDERM ULTRA PLUS XC® a softer filler and is therefore ideal for areas that see more muscle movement, such as the lips and the corners of the mouth. JUVÉDERM ULTRA PLUS XC® can last more than six months, depending on the patient’s metabolism. It is injected only for correction and causes tissue to become fuller over time. It is also reversible with hyaluronidase (an enzyme that breaks down hyaluronic acid).
- JUVÉDERM VOLUMA® XC injectable gel is a smooth, colorless hyaluronic acid gel that contains a small quantity of local anesthetic (lidocaine). Hyaluronic acid is a naturally occurring sugar found in the human body. The role of hyaluronic acid in the skin is to deliver nutrients and help the skin retain its natural moisture and softness. The addition of lidocaine helps to improve the comfort of the injection. JUVÉDERM VOLUMA® XC injectable gel is manufactured using VYCROSS® technology to give a specialized smooth-gel filler that produces long-lasting results at the treatment site. JUVÉDERM VOLUMA® XC is delivered by an injection into the cheek and surrounding area of the mid-face to correct volume and fullness.
- JUVÉDERM VOLLUREÔ XC injectable gel is a smooth, clear, colorless hyaluronic acid gel that contains a small quantity of local anesthetic (lidocaine). Hyaluronic acid is a naturally occurring sugar found in the human body. The role of hyaluronic acid in the skin is to help retain natural moisture and softness. The lidocaine helps to improve the comfort of the injection. JUVÉDERM VOLLUREÔ XC injectable gel is manufactured using VYCROSS® technology to give a specialized smooth-gel filler that produces long-lasting results for up to 18 months at the treatment site. JUVÉDERM VOLLURETM XC is injected with an ultrafine needle into areas of facial tissue where moderate to severe facial wrinkles and folds (such as nasolabial folds) occur.
- BELETERO® is a hyaluronic acid filler ideal for more superficial dermal filling. It works well on laugh and smile lines, especially around the mouth. It is also reversible. Its longevity is in the three to six-month range.
- RADIESSE® is used as a larger area volumizing filler. It is primarily used for filling the cheek areas and if a patient has deep nasolabial folds. It is not used for lips, eyelids, tear troughs, or nose. It is made from hydroxyapatite, which is made from sea coral. RADIESSE® is not reversible but does absorb over a twelve-to-eighteen-month period, so its effects are not permanent.
- SCULPTRA® is a volumizer that gives you great results over an extended period of time. It is gradual and requires two to four injection sessions spread over a three to four-week period. It is made from a poly-L-lactic acid and helps replace lost collagen, especially in the cheek areas. SCULPTRA® is not reversible but does absorb over an eighteen to twenty-four-month period, so its effects are not permanent.
Neuromodulators (Botox, Dysport, Xeomin, Jeuveau)
Botox® (onabotulinumtoxinA) is a brand name of a neuromodulator and is a well-recognized consumer word. When we use the word Botox herein, we use it in a general manner to refer to all other neuromodulators including Xeomin (incobotulinumtoxinA), Dysport® (abobotulinumtoxinA), and JeuveauÔ (prabotulinumtoxinA-xvfs). They are all excellent FDA-approved neuromodulators.
Botox is a botulinum toxin type A FDA-approved neuromodulator in the same class as Xeomin and Dysport, and Jeaveau which all work by temporarily weakening the muscles. This effect lasts about three to four months. Botox was first used to treat problems with the eye muscles, spasms, and tics, but physicians noted an interesting side effect: treated patients had fewer wrinkles in the skin overlying the treated muscles because of the reduction in movement. Its usage for cosmetic purposes grew, making it a popular and attractive alternative or complement to fillers.
Botox has been FDA-approved since 2002 to cosmetically soften wrinkles between the eyebrows. It can also be used “off-label” in many other areas of the face and body. (Off-label use simply means that the FDA has not yet specifically approved that particular drug, substance, or device for a certain area, indication, dosage, or population group).
Microneedling with PRP
The SkinPen FDA approved Microneedling device is used for Microneedling the skin also known as Collagen Induction Therapy. Microneedling is an elective procedure that is intended to allow for controlled induction of the skin’s self-repair mechanism by creating micro “injuries” in the skin which triggers new collagen synthesis. The intended result is smoother, firmer and younger looking skin. Skin needling procedures are performed in a safe and precise manner with the use of the sterile SkinPen FDA approved Microneedling needle head.
Platelet Rich plasma (PRP) is used in combination with Microneedling to trigger collagen synthesis. The procedure is normally completed within 30-60 minutes depending on the required treatment and anatomical site. PRP can be used as an injection to address specific wrinkles or scars or as a dermal filler. PRP injected or used topically with Microneedling works synergistically with microtrauma to trigger collagen synthesis in specific areas for the purpose of facial rejuvenation.
Platelet Rich Plasma (PRP) comes from your body’s own blood. It contains growth factors which aid your body in healing and stimulating your own collagen production. PRP has been used for over 20 years for its wound healing properties. PRP has been used in multiple medical specialties including, but not limited to, orthopedics, sports medicine, dermatological-wound healing and cosmetic surgery and in the past 14 years used for facial rejuvenation. Areas typically treated for aesthetic purposes and skin rejuvenation include acne, scars, skin discoloration, fine lines and wrinkles around the eyes, cheeks, mid-face, neck, lips, jaw-line, chest, décolletage, surgical scar improvement, back of hands and arms. Patients have reported improvement in skin overall color, texture and tone following treatment.
Hair Rejuvenation with Platelet Rich Plasma
Platelet Rich Plasma Hair Restoration is backed by years of research and science that proves it can dramatically increase hair growth. Dr. Rohrich has carefully selected scientifically proven equipment and protocols necessary to achieve higher platelet concentration which provides the best results. He uses a minimum of 5 X platelet concentration to achieve maximum results as recommended by experts.
Blood is drawn and through a special concentration process the Platelet Rich Plasma is separated from red blood cells and then injected into the scalp. Growth factors found within Platelet Rich Plasma aid in increasing nutrient delivery to the thinning areas of hair. A thorough hair and health history is required to customize a treatment option for you.
A thorough hair and health history is required to customize a treatment option for you. This customized treatment plan may include Platelet Rich Plasma Injections, prescription topical or oral medication, and a specially formulated scalp cleanser.
Platelet Rich Plasma (PRP) hair restoration is thought to stimulate and strengthen existing hair follicles but it does not create new hair follicles or restore follicles that have already died. Thinning hair is believed to benefit from PRP treatments, but PRP is not believed to treat complete baldness.
Results are generally visible at three weeks and continue to improve gradually over the next three to six months. Generally, three to four initial treatments are advised, however, more may be indicated for some individuals. Current data shows results may last 18-24 months. Once your results are achieved maintenance treatments may be required to maintain your results.
Morpheus8 Radiofrequency Microneedling
The Morpheus8 is a new subdermal adipose remodeling device (SARD) that fractionally remodels and contours the face and body. By penetrating deep into the skin and fat, this morphs the aging face or body into a more desired smooth and sleek appearance, for all skin tones.
The Morpheus8 delivers positively charged, silicone coated probe-needles through the skin into the superficial fat. Next, strong RF energy is emitted from the needle tip that heats and tightens fat and overlying skin.
Morpheus8 releases RF energy from the positively charged tip, embedded in the fat, leading to coagulation of the superficial fat and tightening of the bands that determine skin tautness. The RF also flows back up the probe-needle, heating the dermis and skin, leading to new collagen and elastin formation.
The Morpheus8 tightens the deeper soft tissue connections as well as the skin itself, resulting in significant soft tissue contraction and reduction in wrinkles and textural concerns. The Morpheus8 has long-lasting results.
Morpheus8 remodels deep structures of skin and fat to smooth and tighten treatment area Morpheus8 increases collagen production resulting in reduced wrinkles, faded stretch marks, improved acne scars, and overall skin rejuvenation. Morpheus8 is an in-office procedure with little to no down time that is safe and effective for all skin types.
Fat Transfers—Using Your Own Fat as a Filler
Fat transfers is the process of using your own fat as a cosmetic filler. Fat transfers have taken on a growing importance in facial rejuvenation and modern body contouring. Fat makes a wonderful natural filler for the face. In some specific instances, it works well for augmenting breasts and/or buttocks either alone or with implants to create a more natural look.
The development and use of fat transfers have made a tremendous difference in facial rejuvenation, as the first sign of aging is loss of facial fat in the central face areas. Injections of fat into the deep malar (cheek areas) compartments of the face, along with other fat compartments, addresses this issue in a way that facelifts alone do not. This was accomplished by groundbreaking anatomic research done by Dr. Rohrich and his team at UT Southwestern. Although they are an excellent filler, fat transfers are more labor-intensive and usually must be done in a procedure room or operating room.
Fat transfers work best when they are injected into the deeper compartments rather than superficially, and last much longer than other cosmetic fillers.