Facial Fat Grafting

Facial Fat Grafting

For optimal results, facial rejuvenation procedures should address both the volume deflation associated with facial aging. Facial fat grafting, also known as fat transfer, is a natural, non-synthetic solution to restore volume and enhance facial contours. The procedure involves harvesting fat from one area of your body (such as the abdomen or thighs), purifying it, and then injecting it into areas of the face that have lost volume due to aging or other factors. This technique provides long-lasting, natural-looking results, as the body recognizes the fat as its own, offering a safe and effective way to restore a youthful appearance without relying on synthetic fillers. 

Why consider facial fat grafting?

• No risk of allergic reaction – Since the material is from your own body, there’s no risk of rejection or reaction.
• Fat grafting contains stem cells and growth factors that may improve skin quality and stimulate collagen production over time.
• A softer, more natural feel – Unlike fillers, which can sometimes feel firm or shift over time, fat integrates seamlessly with facial tissue.
• Long-term results – While dermal fillers require repeat treatments, a portion of transferred fat remains permanently, making it a more cost-effective solution in the long run.

In general, 40 to 50 percent of the injected fat volume goes away within several months. To compensate, your surgeon may choose to overcorrect a treatment area, anticipating that some of it will go away. Another approach is to inject until an immediate correction is achieved, wait to see how much goes away, and repeat the fat transfer several months later.

This is a safe approach in the rare event that an overcorrection of fat transfer unexpectedly does not go away. Also, if too much fat is injected, it can lead to hard bumps known as fat necrosis that may either get broken down and resorbed by your body over time or require surgical removal. Fat necrosis is more common when fat is injected into areas of poor blood flow, such as thin or radiated tissues.

Types of Facial Fat Grafting

Macrofat:

What It Is:

• Macrofat is the largest form of fat harvested and processed during liposuction. It contains relatively larger fat cells, typically around 2 to 5 millimeters in diameter.
• The fat is minimally processed, with most of the fat cells remaining intact.

Uses:

• Volume Restoration: Macrofat is mainly used to restore volume to areas of the face that have experienced significant fat loss due to aging or weight changes. Common areas include the cheeks, jawline, temples, and chin.
• Deep Structural Support: It provides more noticeable volume and is often injected into deeper layers of the skin or subcutaneous tissues. It helps in contouring the face, such as creating more defined cheekbones or lifting sagging areas.
• Longer-Term Results: Since macrofat contains intact fat cells, it tends to have longer-lasting results, as the fat cells can survive and thrive in their new location.

Benefits:

• Helps restore overall facial volume.
• Provides more dramatic results in areas with significant volume loss.
• Lasts longer compared to microfat and nanofat.

Microfat:

What It Is:

• Microfat is a more refined version of macrofat. The fat is processed to a finer consistency, typically using a smaller cannula or mechanical methods, resulting in fat cells that are around 1 to 2 millimeters in diameter.
• It is less chunky and more fluid than macrofat but still contains viable fat cells that can integrate into the surrounding tissue.

Uses:

• Subtle Volume Restoration: Microfat is ideal for areas that require more subtle volume enhancement. It is commonly used for the under-eye area, nasolabial folds, cheeks, and temples, where more delicate work is needed.
• Improving Skin Quality: Since the fat is finer, microfat can also be injected into the dermal layer to improve skin texture, tone, and smoothness, promoting collagen production.

Benefits:

• Provides a more subtle and natural enhancement compared to macrofat.
• Can be used in delicate areas like the under-eyes without causing lumps or uneven results.
• Helps improve the skin’s texture and elasticity.

Nanofat:

What It Is:

• Nanofat is the finest form of fat and is processed to a liquid consistency using advanced techniques like liposuction followed by emulsification, often with a nano-purification system. The fat cells are broken down into a fluid form containing tiny fat particles, making it ideal for skin rejuvenation.
• It is not used primarily for volume restoration but more for skin regeneration.

Uses:

• Skin Rejuvenation: Nanofat is primarily injected into the dermal layer to improve skin texture, tone, and elasticity. It’s ideal for fine lines, wrinkles, and skin laxity.
• Improving Skin Tone and Texture: Nanofat can be used to treat sun-damaged skin, acne scars, and stretch marks by stimulating collagen and elastin production.
• Face Brightening: Nanofat can help to give the skin a more radiant, glowing appearance by improving its overall health and appearance.

Benefits:

• Provides skin rejuvenation benefits by stimulating collagen and improving skin texture.
• Ideal for fine lines, wrinkles, and skin imperfections.
• Enhances skin health by improving elasticity and promoting skin regeneration.

Facial Fat Treatments

Fat grafting on the face is a highly versatile and effective technique, often used to improve scars, restore volume, and enhance skin quality. When combined with procedures like facelifts and laser resurfacing, fat grafting can provide even more dramatic and natural-looking results. Here’s a breakdown of its uses and benefits:

1. Fat Grafting for Scars

Fat grafting can be a powerful tool in improving the appearance of scars, especially those that are depressed, indented, or caused by previous surgeries or trauma.

• Depressed or Atrophic Scars: Scars that are indented or sunken (often seen after injury, surgery, or acne) can be treated by injecting fat into the scar tissue. The fat helps to lift the scar, filling in the depression and making the skin more even and smoother.
• Softening Scar Appearance: Fat grafting can also help soften the harsh edges of scars, making them less noticeable. This is particularly useful for hypertrophic (raised) or thick scars, as the fat graft can help integrate the scar into the surrounding tissue, reducing its prominence.
• Improving Skin Texture: In addition to filling in scar depressions, fat grafting stimulates collagen production in the skin, which enhances skin texture, tone, and elasticity. Over time, this can further improve the appearance of scars, making them look smoother and more integrated with the surrounding skin.
• Healing Process: The fat transfer itself contains stem cells and growth factors that promote healing and tissue regeneration, which can reduce the visibility of scars and encourage better overall skin recovery.

2. Fat Grafting for Volume Restoration

As we age, the face naturally loses volume, leading to a hollowed-out or gaunt appearance, particularly in areas like the cheeks, temples, under the eyes, and jawline. Fat grafting is an excellent solution for restoring volume to these areas, achieving a youthful and refreshed look.

• Cheeks and Temples: Fat can be transferred to the cheeks and temples to restore fullness. These areas lose volume with age, leading to a more sunken or tired appearance. Fat grafting can replace lost volume and give the face a more youthful, rounded, and lifted look.
• Under-eye Area (Tear Troughs): Hollowing under the eyes can make a person appear tired or aged. Fat grafting can be used to fill in these hollows, reducing the appearance of dark circles and puffiness and creating a more rested and refreshed appearance.
• Nasolabial Folds and Marionette Lines: Deep lines around the nose and mouth (nasolabial folds) and the lines that run from the corners of the mouth to the chin (marionette lines) can be softened with fat grafting. The added volume restores the skin’s youthful contours and smooths out these lines.
• Jawline and Chin: Fat grafting can be used to enhance the jawline or chin, adding definition and improving facial symmetry. This can be especially helpful for individuals who have lost volume or definition in these areas due to aging.

3. Fat Grafting in Conjunction with Facelifts

Facelifts are designed to tighten and lift the skin, but they don’t always address volume loss, which is a common concern with aging. Combining fat grafting with a facelift can provide a more comprehensive, natural-looking result by not only lifting the skin but also restoring lost volume and rejuvenating the overall facial appearance.

• Enhancing Lifted Areas: After a facelift, fat grafting can be used to enhance specific areas of the face, like the cheeks, under the eyes, and jawline, to restore volume and improve the overall contour of the face. The added volume helps complement the lift achieved with the facelift, creating a more youthful, balanced, and harmonious look.
• Restoring Youthful Proportions: As we age, the face loses volume in key areas like the cheeks, temples, and midface. Fat grafting can help restore youthful proportions, filling out areas that might appear hollow or deflated after a facelift, making the entire face look fuller, smoother, and more youthful.
• Non-Surgical Touch-Ups: For patients who have had a facelift in the past and are experiencing further volume loss or minor sagging, fat grafting can be an excellent non-surgical option for touch-ups. It helps keep the facelift results looking fresh and rejuvenated without needing a full revision.

4. Fat Grafting in Conjunction with Laser Resurfacing

Laser resurfacing is often used to improve the texture and tone of the skin, reducing wrinkles, fine lines, and pigmentation issues. When combined with fat grafting, the two procedures complement each other and enhance the overall rejuvenating effects.

• Improved Skin Texture: Laser resurfacing helps to smooth out skin texture, reduce pigmentation issues, and stimulate collagen production. After the skin is resurfaced, fat grafting can restore volume to areas that have lost fullness, giving the skin a smoother, plumper, and more youthful appearance.
• Collagen Stimulation: Both fat grafting and laser resurfacing stimulate collagen production. Fat grafting promotes collagen regeneration in the transplanted area, while laser resurfacing stimulates collagen in the skin’s surface. This dual approach helps to improve the texture, elasticity, and tightness of the skin.
• Minimizing Downtime: Combining fat grafting with laser resurfacing can reduce the need for multiple procedures over time. Instead of doing separate treatments months apart, performing both procedures at once allows for a more efficient treatment plan with less overall downtime for the patient.
• Even Skin Tone and Volume: After laser resurfacing, the skin may appear more even in tone, but volume loss may still be a concern. Fat grafting can address this by adding fullness to areas where volume has been lost, creating a more balanced, youthful appearance.

5. Enhancing Results of Facelift and Laser Resurfacing

Fat grafting can enhance the results of both facelifts and laser resurfacing by addressing concerns that the other procedures do not fully target.

• Facelift Alone: A facelift tightens and lifts sagging skin, but it may not restore lost facial volume or improve the skin texture in areas like the under-eye region or nasolabial folds. Fat grafting can be strategically used to restore volume and smooth out facial contours, giving a more natural and youthful look after a facelift.
• Laser Resurfacing Alone: While laser resurfacing improves skin texture, fine lines, and pigmentation, it does not address volume loss. Fat grafting can fill in areas where the skin is lax or hollow, improving the overall structure and balance of the face after laser treatment.

Key Considerations:

• Fat Survival: Not all of the fat injected into the face will survive, and fat may be reabsorbed by the body over time. Surgeons often overfill the treated area to account for this, but results may require a follow-up procedure to achieve the desired volume.
• Multiple Sessions: Depending on the amount of volume loss and the areas treated, multiple fat grafting sessions may be needed to achieve the desired results.
• Recovery: While fat grafting has relatively minimal downtime, combining it with other procedures (like facelifts or laser resurfacing) may increase recovery time. However, the benefits of combining these procedures often outweigh the longer recovery period.

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What is liposuction?

Liposuction, also known as lipoplasty, is a surgical procedure that involves the removal of excess fat from specific areas of the body. The procedure is typically used to contour the abdomen, hips, thighs, buttocks and other areas where diet and exercise alone have not been successful. Liposuction is a popular cosmetic surgery procedure that can help people achieve a slimmer and more proportional body shape.

What liposuction can treat

Liposuction techniques may be used to reduce localized fat deposits of the:

• Abdomen and waist
• Back
• Calves and ankles
• Chest area
• Face, cheeks, chin and neck
• Hips and buttocks
• Inner knee
• Thighs
• Upper arms

What liposuction cannot do:

• Liposuction is not a treatment for obesity or a substitute for proper diet and exercise. Liposuction works for people of normal weight who have some extra fat.
• If you have firm, elastic skin, you will have better results.
• Skin that is soft and thin from stretch marks, weight loss or natural aging will not reshape as well.
• You may need more surgeries to remove and tighten extra skin
• Lipoosuction is also not an effective treatment for cellulite.

Fat Grafting

Fat grafting, also known as fat transfer, is a three-step procedure that consists of using liposuction to remove unwanted fat (also called adipose tissue), processing the fat and then redistributing it into low volume areas. The most common areas for fat grafting include the hip dips, butt (Brazilian butt lift), breast, face, and hands.

Step 1: Liposuction

Liposuction can be performed anywhere there is excess fat, but most commonly, patients choose the abdomen, flanks and back.

Step 2: Filtering, cleaning and purification

Because the body is roughly 60% fluid, we need to isolate the harvested fat cells from the fluid to ensure the best results possible. We do this by sending the fat through a processing stage that includes filtering, cleaning and purification. Without purification, the resorption rate for the fat transfer goes up, which means more of the transferred fat will be absorbed by the body and diminish the result

Step 3: Injection

In the final stage of a fat transfer procedure, the purified fat is injected into the area needing improvement. This is done with the utmost attention to aesthetics and patient safety. When the fat is correctly purified and injected, it develops a new blood supply. This allows the cells to grow and thrive in their new home indefinitely as living tissue. Some fat cells are absorbed by the body (anywhere from 10-50%) no matter what, which is why we take precautions by transferring more fat than is needed to the area. This helps patients achieve the results they are looking for.

Medical Weight Loss

At Integrated Skin Institute, we are here to help you achieve your weight loss goals. When you join our injectable weight loss program, you are not only getting a “skinny shot” but a revamp in your lifestyle.

Beginning with your consultation, we go through your medical history, draw blood, review nutrition, and go over expectations to ensure you are a candidate. Once approved, you will visit us weekly for your skinny shot and we will monitor your progress. We additionally offer personalized training with our licensed nutritionist and certified fitness instructor to help you optimize your weight loss goals. Once you are ready to come off the medication, we hope that you have adopted healthier lifestyle habits to keep you healthy and happy. Whether you simply need to lose weight or you need to lower your BMI for cosmetic surgery (i.e.- liposuction), we are here to support you on your weight loss journey!

What is a “skinny shot”?

We utilize two different drugs: Semaglutide and Tirzepatide. Both medications are glucagon-like peptide 1 (GLP-1) receptor agonists which reduces cravings and makes you feel fuller quicker by delaying gastric emptying. Some patients do better with one or the other medication which is why we offer both. Semaglutide is the active ingredient in the diabetes drug Ozempic, and Wegovy is the brand name of a drug licensed for weight loss. Tirzepatide, branded as Zepbound, is the active ingredient in Mounjaro.

About the Program

• 6-month weight loss program but can be on medication indefinitely
• Once weekly injection done at home to lose weight.
• Personalized 1-on-1 nutrition/fitness instruction
• Medication (semaglutide or tirzepatide) regulates appetite, thereby reducing food intake by decreasing hunger and increasing feelings of fullness
• Secondary benefits: improving weight loss-related health issues such as cardiovascular factors, including hypertension, diabetes, and quality of life
• Most common symptoms: nausea, which is regulated by dose adjustments

Is it Right for You?

• Patients that have been unable to lose weight despite diet and lifestyle modifications or those looking to start eating better with healthier portion sizes and shed the extra pounds
• Use is not recommended if you or any family members have ever had thyroid cancer or thyroid tumors, history of pancreatitis, Medullary Thyroid Carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

Varicose Veins 101

Varicose Veins – Overview

• Half of all Americans over 50 suffer from the pain and swelling of large, “ropey” varicose veins.
• Many individuals are familiar with varicose veins, but only a small number truly grasp their root cause or the risk of them becoming a significant health issue. If you suffer from severe varicose veins, it can affect the skin’s nourishment and result in discomfort and swelling.
• Additional health complications that may arise include eczema, inflammation, and even ulceration in the lower leg. Therefore, it is crucial to address vein issues promptly.
• Fortunately, the diagnosis and treatment of varicose veins is a procedure that is typically covered by most insurance plans.

What causes varicose veins?

• The veins in your legs resemble a tree, with the trunk at the bottom dividing upward into various branches and leaves.
  • Blood flows from the leaves, known as superficial venous capillaries, into the branches (small tributary leg veins), and then finally into the trunk (larger saphenous veins). Eventually this blood returns to your heart.
  • Normally, there is a one-way valve allowing blood to flow from the saphenous vein into your deep veins (femoral vein). If this valve is not functioning properly, blood flows back into the saphenous vein, which then influences all of the superficial veins extending all the way down to the ankle.
• Varicose veins are a sign of venous reflux or “leaky valves” and is broadly known as the condition called Chronic Venous Insufficiency (CVI) which is a result of failing valves that inhibit the blood in your legs from returning to the heart as it normally should.
• Varicose veins represent the distended tributaries or “branches” coming off larger malfunctioning veins (“trunks”). They are most common in the calves, but can be seen anywhere in the lower leg, depending on what “feeder vein” is not functioning properly.

What are risk factors for varicose veins?

• Genetics
• Hormones
• Pregnancy
• Occupational (prolonged sitting/standing)

How does Varicose Vein Disease (Chronic Venous Insufficiency) present?

• Symptoms:
  • heaviness
  • aching
  • swelling
  • throbbing
  • itching
  • pain
  • burning
  • tiredness
  • numbness
  • cramping
  
  Visible clinical findings, ranging from the following (C1-C6):

Next Steps:

Our Approach:

The goal is to treat the underlying medical problem first, then to treat what is left, and finally any cosmetic issues. If there is no underlying problem, the cosmetic issue may be addressed directly.

The Diagnosis and Treatments for Varicose Vein Disease Are Covered By Most Insurance Plans!

Medicare and most commercial insurance companies cover the diagnosis and evaluation of varicose veins and chronic venous insufficiency.

Treatment coverage by Medicare and other insurance depends on an in office evaluation by our vein care specialist and what we find on your ultrasound exam of your legs. 93% of our medical patients have their treatments covered by insurance. Medicare and most insurance companies may first require you to try conservative treatments including the use of compression hose, prior to approving laser ablation treatment and other minimally-invasive procedures.

Our vein care specialists will happily walk you through a full benefit estimate prior to treatment.

Our Medical Protocol:

Vein Treatment Consultation

• Meet your Vein Care Specialist and receive a comprehensive medical and cosmetic vein evaluation.
• An ultrasound exam will be recommended if your issue is medical.

Ultrasound of Your Leg Veins

• An ultrasound exam of your legs is performed to evaluate your vein size and determine if you any leaky vein valves (reflux).

Ultrasound Follow Up Appointment

• Your custom vein map report is reviewed with your Vein Care Specialist.
• Conservative management and minimally-invasive treatment is discussed if your report is positive for vein disease.

Conservative Treatment – click to learn more

• Most insurance companies require a conservative trial of compression hose and other measures.
• Your treatment will not be covered by insurance without a conservative treatment lasting anywhere from 3-6 weeks (depending on your insurance provider).

Vein Treatment

• Endovenous Thermal Ablation and Ultrasound-Guided Foam Sclerotherapy (UGS) are performed following your compression trial. 
• Most patients need 1-2 thermal ablations and 2 UGS to complete treatment of one leg.
• You will need to wear a medical-graded, custom-fitted compression hose continuously for 1-2 weeks following each treatment. (This will be placed in the office after each treatment)
• There is NO downtime. You return to normal activities immediately following each treatment.
• Treatments are virtually pain free. 

Treatment Follow Up

• A follow-up ultrasound exam of your legs will be completed to document closure of your treated veins.

Click here to learn more about our medical evaluation and treatments

Our Cosmetic Protocol:

“What about my spider veins?”

Spider veins are small, red, purple, or blue veins located just beneath the skin’s surface. These veins become visible because they are swollen with stagnant blood. While spider veins are smaller than varicose veins, they can be more noticeable due to their position just below the skin and their darker color, which makes them stand out. Additionally, spider veins are more prevalent in women than in men.

Although not typically a serious health issue, their appearance can indicate various vein disorders. Spider veins may also cause itching, minor discomfort, and pain.

Common causes of spider veins include:

• Genetics
• Gender
• Pregnancy
• Hormonal changes
• Aging
• Occupations that involve prolonged standing or sitting
• Obesity
• Injury

Most insurance companies consider treatment for these visible veins to be strictly cosmetic and do not cover treatment for spider and/or reticular veins.

The treatment options for spider veins include:

• Sclerotherapy: Used to treat both varicose and spider veins using an injectable.
• Vascular Laser: This is a 100% non-invasive treatment that allows your vein doctor to eliminate veins from the outside without incisions or injections.

Click here to learn more about our cosmetic treatments

Compression Therapy

What is compression therapy?

• Compression therapy is the use of medical-grade compression products along with other at home conservative therapies to improve the blood circulation in your legs and help relieve symptoms associated with varicose vein disease (aka Chronic Venous Insufficiency).
• Presently, five categories of compression therapy of the extremities are available: compression bandages, compression stockings, self-adjustable Velcro devices, compression pumps, and hybrid devices.
• Compression stockings are most commonly used for short-term application after varicose vein interventions.
• These over-the-knee stockings can be worn by themselves or beneath longer clothing, such as skirts and trousers.
• Medical-grade strength stockings range between 20-50 mmHg (the same unit used to measure blood pressure) and are prescribed by our vein specialists.
• Integrated Skin Institute is partnered with local specialty medical clinics and stores that can help with the custom fitting stocking appropriate to your comfort. 

How do compression stockings work?

• In healthy veins, blood flows up toward the heart. If you have varicose veins, weak vein walls or valves allow blood to flow backward and pool in the veins, which results in the typical blue bulging appearance of varicose veins.
• Compression stockings, also called compression hose, pressure stockings, or support stockings, work by providing consistent pressure to the leg, which helps blood move through the veins instead of pooling.
• Compression is graduated- compression pressure is strongest at the ankle and decreases higher up the leg, allowing for increased blood flow.
• Compression typically ranges from 8mmHg (mild) to 40mmHg (extra firm). 
• Patients should always consult their vein specialist to get information on the correct compression level – leave this to us!

• Our vein specialists recommend compression of at least 20 mmHg for the best possible results. We also recommend choosing compression socks that are fitted by height, and not by standard small/medium/large sizing.
• If possible, always opt for over-the-knee or thigh-high compression stockings, as these will provide maximum coverage (including additional UV protection in warmer months) and support both your calf and thigh with graduated compression. 
• Shorter styles are available, but do not compress the entire leg and may be less effective at relieving your symptoms.

How to wear compression stockings

Routine Daily Use: 

• When you are standing (in a vertical position), gravity causes the blood flow to become restricted due to compromised valves. For this reason, the calves and ankles typically feel fine in the morning but get inflamed and heavy during the course of the day.
• Wearing compression socks in the morning enables the valves to remain in the correct position to support proper blood circulation in the legs during the day.
• Compression stockings can help address symptoms such as:
  • heavy or painful legs
  • swollen ankles
  • night cramps
  • restless legs
  • tiredness and pain

Immediately after medical or cosmetic treatment:

• Post-operative care, especially involving compression therapy, remains crucial to improve outcomes, prevent varicose vein recurrence, and enhance overall recovery.
• Wearing compression stockings for approximately one week after endothermal ablation and and/or sclerotherapy can minimize bruising and early post-treatment pain.

Can compression alone treat my varicose veins?

• No. For existing varicose veins or spider veins, they will not disappear by simple conservative strategies.
• Vein diseases such as chronic venous insufficiency and varicose veins are progressive, which means they worsen over time the longer they go untreated. Compression, while beneficial, is not a permanent treatment for varicose veins. 
• Supporting good circulation and reducing swelling may help alleviate discomfort from painful symptoms of vein disease, but compression stockings will not make varicose veins fade or go away. 
• Regular use may help to keep symptoms mild while you pursue vein treatment, or help to postpone vein treatment.

What are some other conservative therapies for varicose vein disease?

Increasing Exercise, Especially Walking and Running:
Engaging in physical activities that strengthen the large muscles in your legs can significantly improve circulation. These activities help the muscles compress the veins in your legs, promoting better blood flow. Just thirty minutes of exercise focused on the lower body can not only help with vein health but also improve overall wellness.

Varying Activity to Avoid Prolonged Sitting or Standing:
Staying on your feet for extended periods increases pressure on your circulatory system. It’s important to take breaks, sit down, and stretch regularly. Similarly, long journeys, whether by plane or car, often require sitting for hours, which can cause blood to pool and irritate veins in your legs.

Elevating Your Legs While Resting or Working:
When standing, the veins in your legs face pressure from gravity. This is also true when lying down with your legs flat. Elevating your legs by six to twelve inches above heart level can help reduce swelling, pressure, and discomfort. Try propping up your legs with a pillow once a day to relieve the strain on your veins.

Losing Weight:
Carrying excess weight places significant strain on your veins and other vital organs. This added pressure can impair the veins’ ability to circulate blood effectively. Consider working with a healthcare professional to develop a personalized diet plan and achieve a healthy weight for improved overall health.

Varicose Vein Medical Treatment

Medical Treatment for Varicose Veins

The Diagnosis and Treatments for Varicose Vein Disease Are Covered By Most Insurance Plans!

Medicare and most commercial insurance companies cover the diagnosis and evaluation of varicose veins and chronic venous insufficiency.

Treatment coverage by Medicare and other insurance depends on an in office evaluation by our vein care specialist and what we find on your ultrasound exam of your legs. 93% of our medical patients have their treatments covered by insurance. Medicare and most insurance companies may first require you to try conservative treatments including the use of compression hose, prior to approving laser ablation treatment and other minimally-invasive procedures.

Our vein care specialists will happily walk you through a full benefit estimate prior to treatment.

Diagnosis: Ultrasound Evaluation

• During the initial consultation, your doctor and technician will use an ultrasound to visually map the relevant leg veins to identify the source of the problem.
• The source or “root cause” of your varicose veins is typically located in the superficial venous system, notably your saphenous veins (and/or its branches known as tributaries or perforators), as highlighted below in red.

Treatments for Varicose Veins

Integrated Skin Institute is pleased to offer minimally invasive treatments under ultrasound for Chronic Venous Insufficiency (as an alternative to the traditional, more invasive surgical vein stripping procedures). These include: 

• Endovenous Radiofrequency Ablation (VenClose RF)
• Foam Sclerotherapy (Varithena)

VenClose RF​

• VENCLOSE™ RF Ablation System is the latest treatment option using the current standard of care, endovenous radiofrequency (RF) ablation.
• During the procedure, your doctor will insert a small catheter into the diseased vein. The catheter will deliver heat, causing the diseased vein to shrink and close.
• Treatment takes roughly 20-30 minutes and is performed in an office setting under local anesthesia with minimal discomfort and no downtime.

Varithena​

• Radiofrequency ablation often treats only a segment of the diseased vein. The “downstream” portions of the saphenous vein and/or its branches are treated with ultrasound-guided foam sclerotherapy using Varithena.
• Varithena, a foam solution comprising of polidocanol 1%, is a sclerosing agent that is injected into the vein wall, which causes it to stop flowing, then eventually close down completely.
• Treatment takes roughly 5-10 minutes in the office with minimal discomfort and no downtime.

VenClose Radiofrequency (Endovenous Ablation) – click to see video

Varithena (Polidocanol 1% Foam Sclerotherapy)- click to see video

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Varicose Vein Cosmetic Treatment

Cosmetic Treatment for Varicose, Spider, Reticular Veins

Spider veins are small, damaged veins that can appear on the surface of the legs. They can be blue, purple, or red and may appear in the form of thin lines, webs, or branches. While usually not painful, many patients choose to treat them for cosmetic reasons – insurance will not cover this.

At Integrated Skin Institute, we treat surface-level spider, reticular, and varicose veins with:

• sclerotherapy
• vascular lasers

• Treatment sessions are typically 20-30 minutes each
• Each leg may require several (2-3) sessions until desired improvement

What is sclerotherapy?

Sclerotherapy is a procedure in which a small amount of medication is injected into the veins requiring treatment. The veins react to the medication by becoming inflamed and closing off, reabsorbing into the body over the following weeks.

This treatment takes about 30 minutes to complete and is performed in the office. Patients can expect to resume normal activities immediately after treatment,  but will require the use of compression stockings for one week following treatment.

Sclerotherapy – 1st line treatment

Vascular laser – 2nd line treatment

How to Prevent Spider Veins

You can’t change your genetics, but there are a few things you can do to lower the risk you’ll develop spider veins. Dr. Mudigonda recommends doing the following:

• Stay active and try to maintain a healthy weight
• Avoid sitting or standing in one position for too long
• Wear compression stockings or socks
• Protect your skin from the sun
• Avoid tight clothing that restricts blood flow

However, since spider veins are often caused by underlying chronic venous insufficiency, a formal medical consultation and ultrasound evaluation may be beneficial.  – click here to learn more.

Schedule An Appointment

To book a cosmetic or laser appointment please contact our friendly staff.

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Post Surgical Scars Treatment

Post-Surgical Scars

A post-surgical scar is a mark left on the skin after a surgical procedure mostly happens due to the body’s natural healing process. While they natural, many people opt for treatment to fade scar appearance. When the skin is cut during surgery, the body generates new tissue to close the wound, which may naturally cause to scarring. The look of surgical scar depends on multiple factors, including the surgical procedure, incision location, the patient’s healing process, and their skin type. While scars may initially appear red, swollen, or raised, they typically become less noticeable and flatten over time, especially with the help of dermatological treatment.

Features of a Scar:

At Integrated Skin Institute, our providers use innovative treatments to minimize the appearance of post-surgical scars, promoting faster healing.. Whether your scars are fresh or have been there for some time, we offer individualized treatment plans to help you feel confident again.

There are multiple components and characteristics to  a post-surgical scar:

• Thickness/elevation as seen in hypertrophic/keloid scars
• Depression as seen in atrophic scars
• Texture irregularities
• Color changes (white, red, pigmentary)
• Width and Length of a scar 
• Distortion of adjacent facial skin structures (i.e.- eyelid, lip, nostril margin) 

Our personalized treatment protocols are designed to address one or more of the above issues to help improve your scar appearance.

Types of Treatments

• Topical: Silicone gel sheets are a non-invasive treatment option used to reduce the appearance of post-surgery scars. They may work work by hydrating the skin and creating a barrier that helps soften, flatten, and lighten the scar over time. 

• For red/inflammatory scars, first and foremost, the best treatment to minimize redness is a vascular laser/device (intense pulse light, PDL laser, KTP laser)

• For hypertrophic scars, the goal is to flatten the scar treatment involves initially intralesional injections with steroids +/ fluorouracil and may involve multiple sessions. Adjunctive resurfacing lasers (CO2, erbium) are also beneficial.

• For irregularly textured, uneven scars, energy-based modalities may help, ranging from the following:
  • Fractional resurfacing lasers (CO2, erbium) – safe for all lighter (Fitzpatrick I-III) skin types; ablates the skin surface and uses heat to stimulate new collagen development
  • Radiofrequency with Microneedling (RFMN) – safe for all skin types; help break up/soften scar and stimulate collagen production
  • Microneedling – safe for all skin types; uses a needling device to stimulate the formation of new collagen and improve the texture of all acne scar types

• For depressed scars, the goal is to elevate the scar, typically by increasing volume
  • • Injectable Filler(s)
      • 1. Injectable hyaluronic acid (HA) filler – temporary filler, lasts 6 to 12 months; can be dissolved
      • 2. Polymethylmethacrylate (Belafill, PMMA) – semi- permanent filler; cannot be dissolved
      • 3. Biostimulatory filler – Hyperdilute Calcium Hydroxylapatite (Radiesse) or poly-L-lactic acid (Sculptra); stimulate collagen production
      • 4. Autologous Stem-Cell Rich Fat Grafting

• Lastly, for all scars, they can be surgically excised. While this leads to another scar, the goal is to shrink a conspicuous, wide scar with less visible & improved linear scar that can further be refined with laser resurfacing

Post-reconstruction (i.e.- after Mohs repair, facial plastic surgery)

• Most facial surgeons will wait six months to a year from the initial development of the scar prior to intervention as scars gradually improve
• However, some post-surgical scar contractures can lead to distortion of sensitive cosmetic subunits (nose, eyelids) that can be unsightly for patients
• At Integrated Skin Institute, we specialize in improving scars after facial surgery (i.e.- skin cancer reconstruction, facelift, eyelid lift, lip lift)
• These techniques include:
  • Injectables
    • Dermal Fillers to elevate depressed or atrophic scars
    • 5’Fluorouracil/Steroids to flatten elevated scars
  • Laser Scar Revision 
    • Fractional CO₂ or Erbium:YAG Lasers for texture irregularities, atrophic scars, and discoloration.
    • Vascular Lasers to reduce redness
  • Surgical Scar Revision
    • i.e.- Elliptical Excision, Z Plasty, Serial Excisions

Schedule An Appointment

To book a cosmetic or laser appointment please contact our friendly staff.

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Keloids And Hypertrophic Scars Treatment

Keloids And Hypertrophic Scars

Scarring is a natural part of the body’s healing process, but trauma, infection, injury, or surgery can sometimes result in large or unsightly scars. A scar forms as the body heals and replaces lost or damaged skin, typically composed of fibrous tissue. Scars can appear anywhere on the body and may vary in composition, appearing flat, hypertrophic (elevated), atrophic (sunken), or discolored (dark, red, or white). They may also be painful or itchy. The final appearance of a scar depends on several factors, including skin type, location on the body, the direction of the wound, the type of injury, the age of the individual, and their nutritional status.

Hypertrophic Scars

• These thick, red scars usually protrude above
  the surface of the skin and can become quite
  obtrusive.

• They are, however, usually confined to the borders of the original wound, which means their growth is somewhat limited.

Keloid Scars

• Keloid scars can be some of the most
  challenging to treat since they tend to grow
  quite large and have a high recurrence rate.

• The most common places to see keloids
  develop include visible spots like the ears, face
  or neck.

• They may be painful, itch or become puckered,
  pulling in other tissue from the sides,
  extending outside the boundaries of the
  original wound. treat.

Treatment Options

• Steroids/Fluorouracil (injectable) – intralesional injections may impact the production of collagen, which will change the appearance and amount of scar tissue, especially beneficial for raised scars.
• Radiation Therapy – Superficial external beam radiotherapy is a low-dose radiation treatment that uses highly focused beams of light called superficial X-rays to destroy collagen-producing cells and limit the growth of new ones. These specialized X-rays do not penetrate deep layers of skin, so they don’t affect healthy tissue.
• Laser Treatments (vascular, resurfacing) – may be used to remove redness, uneven tone, and differing textures, including thickening and contracture, from scar tissue formation
• Surgical Excision – Typically not first-line option given high chance of scar recurrence; often combined with above treatment modalities

Schedule An Appointment

To book a cosmetic or laser appointment please contact our friendly staff.

Acne Scars Treatment

Acne Scars

Acne scars are permanent textural changes or indentations that occur on the skin as a result of severe acne. When acne penetrates the skin deeply and damages the tissue beneath it, the body attempts to repair this damage. If the body produces too much or too little collagen during this healing process, scars can form.

Acne scars are typically classified into two main types:

• atrophic (depressed) scars such as ice pick, boxcar, and rolling scars
• hypertrophic (raised) scars

They commonly appear on the face but can also affect the back, chest, and other areas. Treatment options include topical medications, chemical peels, microneedling, laser therapy, dermal fillers, and in some cases, surgery. Prevention focuses on early acne treatment and avoiding skin picking or squeezing.

Integrated Skin Institute

• At Integrated Skin Institute, our experts offer you a comprehensive of effective, acne scar treatments that can be tailored to meet the needs of your acne scars and help achieve your aesthetic goals.
• Depending on the type of scarring, many patients need a combination of treatments, including laser resurfacing, for best results. Multiple sessions may be required.

Acne Scar Treatment Options

• Topical retinoids like Retin-A® can be very effective for reducing uneven texture and pigmentation.

• For red/inflammatory scars, first and foremost, the best treatment to minimize redness is a vascular laser/device (intense pulse light, PDL laser, KTP laser)

• For hypertrophic scars, the goal is to flatten the scar treatment involves initially intralesional injections with steroids +/ fluorouracil and may involve multiple sessions. Adjunctive resurfacing lasers (CO2, erbium) are also beneficial.

• For depressed scars, the goal is to elevate the scar
  • For ice pick scars, we utilize chemical reconstruction of skin scars (CROSS) in which TCA or carbolic acid is applied directly into each scar to induce inflammation and stimulate new collagen formation, causing gradual reduction of scar depth.
  • For boxcar and rolling scars, multiple modalities are employed:
    • CROSS – chemical reconstruction of skin scars
    • Subcision – uses a needle or cannula underneath the surface of rolling or boxcar scars to release bands of fibrous scar tissue, freeing the skin from being tethered to deeper tissue layers
    • Adding volume:
      • 1. Injectable hyaluronic acid (HA) filler – temporary filler, lasts 6 to 12 months; can be dissolved
      • 2. Polymethylmethacrylate (Belafill, PMMA) – semi- permanent filler; cannot be dissolved
      • 3. Biostimulatory filler – Hyperdilute Calcium Hydroxylapatite (Radiesse) or poly-L-lactic acid (Sculptra); stimulate collagen production
      • 4. Autologous Fat Grafting
    • Energy-based modalities
      • Fractional resurfacing lasers (CO2, erbium) – safe for all lighter (Fitzpatrick I-III) skin types; ablates the skin surface and uses heat to stimulate new collagen development
      • Radiofrequency with Microneedling (RFMN) – safe for all skin types; help break up/soften scar and stimulate collagen production
      • Microneedling – safe for all skin types; uses a needling device to stimulate the formation of new collagen and improve the texture of all acne scar types.
    • Chemical Peel Resurfacing – full face chemical peel often with trichloroacetic acid (TCA) or phenol-croton oil peel; controlled abrasion of the skin, relying on the skin’s natural healing capacity to heal the treated area in a smooth manner.

• Lastly, for all scars, they can be surgically excised (punch/local excision). While this leads to another scar, the goal is to shrink a conspicuous scar with less visible & improved linear scar that can further be refined with resurfacing

Schedule An Appointment

To book a cosmetic or laser appointment please contact our friendly staff.

CONTACT US