Botox, botulinum type A, is a purified protein substance produced by the bacteria Clostridium Botulinum. There are seven types of botulinum toxins, A-G.
Botulinum toxin A weakens or paralyzes striated muscles by inhibiting the release of acetylcholine ( a neurotransmitter) at the neuromuscular junction. Once the treated muscles are weakened, the overlying skin flattens, minimizing dynamic facial skin creases. Onset of the paralytic effect typically occurs 2 – 3 days after injection and lasts between 3 – 6 months. Repeat injections will be required to maintain the paralytic effect.
Botox was FDA approved in April, 2002, for the treatment of glabellar wrinkles (frown lines between the eyebrows). Other FDA approved uses include the treatment of blepharospasm, strabismus, and cervical dystonia. It has also been used for many off-label indications (treatments that have been widely used, however, are not yet FDA approved), including the cosmetic treatment of lateral periocular rhytides (crow’s feet), brow ptosis (droop), central forehead wrinkles, perioral lipstick lines, and platysmal bands in the neck. Other off-label uses include the treatment of hyperhidrosis, headache, back pain, and limb spasticity.
The most common side effects include pain and bruising at the injection site. Other less common side effects include headache, blepharoptosis (eyelid droop), brow ptosis (brow droop), lack of expressivity, diplopia (double vision), ectropion (outward turning of the eyelids), temporary dysphagia (difficulty swallowing, can be seen after treatment of platysmal bands), an asymmetric smile, drooling, a Bell’s palsy – type appearance, flu-like symptoms, nausea, and rashes at sites distant from injection sites. Rare case reports have been described of patients who developed chronic, severe headaches lasting several months, as well as a prolonged chronic fatigue-like syndrome. There is potential for patients to develop resistance to Botox, however, this is very rare and has only been seen in patients treated with very high doses for conditions such as cervical dystonia.
Pregnant or nursing women, individuals with neuromuscular disorders such as Myasthenia Gravis or Eaton-Lambert Syndrome, and people taking the following medications: aminoglycoside antibiotics, penicillamine, quinine, and calcium channel blockers (a blood pressure medication).
Kybella is a new treatment aimed at reducing submental fullness (double chin). It is the first and only FDA-approved treatment for adults with moderate –to-severe double chins. Dr. Bickle is one of the first doctors in southern California to offer this treatment, and has the added benefit of working with Dr. Adam Rotunda, one of the co-creators of this product.
Kybella is identical to deoxycholic acid, a naturally occurring molecule in the body that aids in the absorption and break down of fat. When injected, Kybella disrupts the fat cell membrane and destroying the cell. The destroyed cells can no longer store fat and the fat gets dissolved.
People with submental fat or double chins, who do not wish to undergo a surgical option such as liposuction or a facelift.
Submental fullness, or a double chin, is due to again, genetics, and / or weight gain. It often does not respond to diet and exercise, therefore making it challenging for people to address on their own. Until now, surgery (liposuction and facelifts) were the only treatment option.
At the time of your procedure, the area to be treated will be anesthetized locally. This can be achieved with topical numbing cream or local injections, or a combination of both. A series of small injections will be performed into the area to be treated. The amount of Kybella needed to treat an area varies from person to person, and can be determined at the time of your consultation. Most people will use between 1-2 vials per treatment session. There will be some temporary burning and stinging, along with swelling.
The treated area will stay swollen for 1-2 weeks, and will likely be sensitive to touch during that time period as well. During this time, you may also feel small lumpy areas in the fat that was treated – this is a normal part of the body’s process to clear the destroyed fat cells.
Results can be seen within weeks of the first treatment as the body naturally processes and removes the destroyed fat cells. Most people, however, require between 2-4 treatment sessions before their ideal results are achieved. Up to 6 sessions can be done if necessary. Each session should be schedule at least 1 month apart. Other non-invasive treatments, such as Radiofrequency ( the Exilis) or ultrasound (Ultherapy) can be combined in conjunction with Kybella to enhance results and tighten skin.
The most common side effects include pain, bruising, swelling, numbness, redness and hardening of the treated areas. These side effects are all temporary. Less commonly, there are more serious side effects, including difficulty swallowing and nerve injury that may result in temporary weakness of facial muscles or an uneven smile. These side effects are temporary as well.
People with a history of difficulty swallowing, bleeding abnormalities, and women who are pregnant or nursing should not undergo treatment with Kybella.
Microneedling is the use of multiple very small needles in a special, motorized device to cause tiny areas of injury to the skin, which in turn helps to stimulate the growth of new collagen and elastin. This helps to create a more youthful, refreshed appearance to your skin, improving skin texture and minimizing fine lines and wrinkles. The results are subtle, natural, and created over time as the skin repairs itself. This treatment may also be followed by the application of PRP (platelet rich plasma) to the skin to help speed healing and enhance results.
Microneedling is used to minimize wrinkles, reduces pore size, tighten skin, and improves scars. Vertical lip lines, crow’s feet, stretch marks, and scars from acne, trauma, and surgery can all be treated with this technique. Treating scars with microneedling generally takes 3-5 treatments at monthly intervals to see optimal results.
Microneedling can be performed as a one-time treatment, however, multiple treatments may be recommended depending on the desired results.
Mild swelling and redness, similar to that seen with sunburn, will be present for 2-3 days. Results will begin to show as new collagen is formed approximately 3-4 weeks after the procedure.
This procedure is safe for all skin types, and is safe to use on all areas of the body. It increases the penetration and thus the effectiveness of skin care products, and stimulates circulation as well as production of collagen and elastin. It is very cost effective compared to other skin resurfacing procedures.
PRP is the concentration of platelets and growth factors found in the blood. It is obtained by drawing the patient’s blood and spinning it down in a centrifuge to separate the red cells from the clear platelet-rich plasma. PRP can be rubbed into the skin after resurfacing procedures such as microneedling, ablative and non-ablative fractional laser resurfacing to enhance results and speed healing. It can also be injected into the skin to stimulate collagen production. It has also been shown to promote new hair growth, thicken thinning hair, and promote overall health of the scalp and hair. It can be applied to thinning hair via injections or after microneedling to the affected areas.
Sclerotherapy is the injection of FDA approved solutions to irritate and destroy unwanted spider and varicose veins, shifting blood flow to other healthy veins. It is often used in combination with laser therapy and typically takes several treatments to achieve best results.
Chemical peels have been used to rejuvenate skin for many years. Wrinkles, uneven skin coloration, sunspots and overall complexion can be improved with chemical peels. There are different types of peels that achieve different depths of penetration into the skin, and include superficial, medium, and deep chemical peels.
Chemical peels consist of application of various medical acids (common ones include glycolic acid, salicylic acid, and trichloracetic acid) to remove damaged layers of skin, leaving a refreshed, brighter appearance to the skin. They are most commonly performed on the face, but can be used to treat other areas including the neck, chest, back, shoulders, arms, legs, and hands as well.
It is best to schedule a consultation to discuss which chemical peel is most appropriate for your skin type and the conditions you wish to address.
The CO2RE laser is a fractional CO2 resurfacing laser with the capability to do conventional CO2 resurfacing as well. As we age and expose our skin to the sun, our skin will show signs of wear and tear, and may appear wrinkled and blotchy. Laser skin resurfacing can diminish the signs of this damage including wrinkling, sun damage, acne scars, and blotchiness, while evening out skin tone and texture. Fractionated CO2 delivery systems can selectively treat the skin without the prolonged recovery of traditional CO2 resurfacing.
Clear and Brilliant is a new category of laser treatments for patients who would like an in-office treatment with little to no recovery that refreshes the skin, providing a more youthful appearance while helping prevent the signs of premature aging. It is recommended for those who are starting to show the early signs of aging, such as large pores, fine lines and uneven skin tone, and for those patients wanting to get an early start on the skin rejuvenation process. It is best suited for patients who are not yet in need of more aggressive skin resurfacing procedures, or for patients who would like to maintain the results of a more aggressive resurfacing. This treatment will boost the effectiveness of topical medications applied to the skin as well, thus enhancing patient’s at-home skin care regimen. It gently refreshes your skin, giving it a more youthful appearance.
Clear and Brilliant is a gentle laser that refreshes your skin from the inside out. The laser energy creates millions of microscopic treatment zones in the upper layers of the skin, replacing damaged skin with healthy, younger looking tissue.
The number of treatments is tailored to your concerns and skincare desires. In recent studies, consumers reported visible improvements after 4-6 treatments, though many patients choose to have routine treatments as part of their overall skin care regimen. Your skin care provider will discuss a personalized treatment regimen with you.
Clear + Brilliant is a beneficial treatment for women and men of all ages and skin types who want to be proactive in their skin care- addressing the early signs of aging or maintaining the look of their skin.
The skin will feel softer and have improved tone, texture and radiance. Other benefits of the treatment may include:
The results of treatment are both immediate and progressive. A few days after the treatment, the skin will start to feel softer, look brighter and show more even tone. Results can last for months depending on age, skin condition and how well the skin is protected from the sun.
No matter how old you are, sun exposure, environmental conditions and lifestyle can contribute to lackluster skin. Whether you want to extend the younger look of your skin or address these early signs of aging, Clear + Brilliant can help.
Clear + Brilliant treatment is often used in conjunction with other cosmetic procedures like Botox, fillers, microneedling, radiofrequency devices and other lasers. Combination treatments are a great way to enhance clinical effect and save time.
Clear + Brilliant is a great way to protect the investment you have made in your skin, maintaining, extending and helping to continually improve upon the results already accomplished.
On the day of your procedure, most patients will numb with a topical anesthetic for approximately 30 minutes. The procedure itself takes between 20-40 minutes, depending on the areas to be treated. Most often the face, or face, neck and chest are treated. Hands, arms and legs are also areas that can be treated. You may experience a temporary warm or stinging sensation to the skin, and temporary redness and swelling lasting from a few hours up to a day. While this procedure does not carry the same risks as a traditional fractionated resurfacing, strict daily photoprotection after the procedure is still recommended. Over the next few days, your skin will have a “sandpaper-like” texture, indicative of the “micropeeling” response.
Most skin care routines can be resumed shortly after treatment, but Dr. Bickle will help you to determine the most appropriate skin care regimen based on your individual skin care needs. For best results, it is generally recommended that Clear and Brilliant be performed in a series of 6 monthly treatments, with individual treatments to maintain thereafter. It can also be combined with other procedures such as botox, fillers, and microneedling to enhance results.
To find out which resurfacing laser treatment is best for you, schedule a consultation with Dr. Bickle for evaluation.
Photodynamic Therapy consists of the use of a photosensitive drug (most often Levulinic Acid) applied topically to the skin, followed by the use of a laser or light source, most often blue and red LED lights or a pulsed dye laser (V-beam), to activate the topical medication. Once activated, the drug attacks the abnormal cells, including pre-cancerous cells and sun-damaged skin cells. This results in improved skin tone, smoother texture, and reduced appearance of pores.
Depending on your particular skin condition, your doctor will determine how long the topical solution needs to sit on the skin prior to your laser or light therapy, usually a couple of hours. Your skin will then be exposed to whatever light source you and your doctor have decided upon. You will likely experience a burning sensation during the treatment. After your treatment, while the PDT drug is still active, you MUST AVOID SUN EXPOSURE for two days. Redness and peeling can be expected for several days following treatment, however, it may be more or less depending upon the severity of sun damage and amount of pre-cancerous lesions.
The Vbeam Perfecta uses Pulsed Dye Laser technology to treat primarily vascular abnormalities of the skin. It can also be used to treat solar lentigines, also known as sunspots. Common vascular birthmarks include hemangiomas and port wine stains, both of which are due to abnormal development of blood vessels. Hemangiomas occur in one of every 10 infants, and tend to develop rapidly early in life. However, over the first 5 years of life, 50% of these go away on their own. Some, however, do persist and require medical and laser intervention. Port Wine stains are less common, affecting approximately 3-5 out of every 1,000 children born in North America. 90% of these are located on the head and neck, and typical appear as pink patches on the skin, which, in time will become a red or purple color, and may become thickened with time. They will not spontaneously resolve and do require laser intervention should treatment be desired. The V beam laser safely and effectively treats the above mentioned birthmarks, in individuals of all ages, including infants. Other vascular abnormalities that are successfully treated by the V-beam include the following: