William P. Coleman III, M.D.

The key to choosing the appropriate facial rejuvenation procedure is to understand exactly what bothers you. Some individuals are quite sensitive about certain facial flaws, but are very comfortable with others.

Each person who is considering facial rejuvenation should look in the mirror and prioritize exactly what bothers them. Then they can address each problem separately. Often correcting just one problem can make a great difference in the facial appearance.

Most people think about the face when they talk about cosmetic surgery. With aging and exposure to the sun, facial tissues lose their elasticity and begin to sag. Wrinkles form around the eyes and mouth and later throughout the whole face. The skin becomes discolored and blotchy.

None of these problems can be solved with a single procedure. Many people assume incorrectly that a facelift is the ultimate in facial rejuvenation. However, a facelift only addresses one aspect of facial aging: drooping of tissues. We see patients every day who have had facelifts but still complain about wrinkles, blotchy skin, drooping eyelids, and other unattractive features. Below are some of the options we provide for rejuvenating the face:

Wrinkles, sun damage, and even pre-cancerous changes can be dramatically improved by resurfacing the skin. The main three forms of facial resurfacing are chemical peeling, laser resurfacing, and dermabrasion.

CHEMICAL PEELING

Chemical Peeling involves the applications of various strength acids to the face in order to peel away damaged skin. Superficial chemical peels are often performed monthly to gradually improve the appearance of skin over a period of time. The advantage of this that there is no down time and most people can resume their regular activities the day after these treatments because peeling is minimal.

Medium chemical peels involve a recovery of 5-7 days. During this time, most people will not want to be around others since the skin is peeling and there is usually mild swelling as well. Medium peels usually do not cause any postoperative discomfort and patients are able to exercise and work normally as long as they avoid the public for 5-7 days. The effects of medium peels last several years and this treatment can significantly improve sun damage and pigmentary problems. Wrinkles are improved as well.

Deep chemical peels involve 7-10 days of recovery. These peels are more aggressive and used for patients with severe skin problems. Deep peels result in significant peeling and swelling and moderate pain the first day of the procedure. Deep peels however, can dramatically improve even deeper wrinkles and tighten the skin..

Chemical peeling can also be performed on the neck, chest, back, arms, or legs for repair of sun damaged skin. Some patients prefer to have a "body peel" of all these areas. This is an effective way of restoring some of the softness and even out color caused by sun and aging.

Laser resurfacing is used to smooth out facial wrinkles, improve scarring, and tighten skin. Laser resurfacing is particularly effective for the wrinkles around the mouth and eyelids. Both Erbium YAG and CO2 lasers are used for this purpose. In order to obtain long lasting improvement of wrinkles the skin is usually lasered to a depth that results in 7 days of healing. During this time, most patients are comfortable to work and exercise but would not wish to be in public. When only the eyelids are lasered, most patients are able to do minor chores even the day after surgery, wearing sunglasses to hide the healing tissues. This is also a good chance to spend a week at home catching up on all those chores you have been ignoring. After a week the treated skin is still slightly red or pink, but this can be hidden with make-up.

Dermabrasion is a time proven procedure for improving sun damage and scars. Dermabrasion is the most effective approach for acne scars and rivals lasers for improvement of wrinkle lines around the mouth, cheeks, and forehead.

Dermabrasion can also be used to improve scars resulting from accidents or surgery. Dermabrasion involves sanding the skin, with a special surgical instrument, to a depth required to eliminate the scar or wrinkle. This procedure is performed using mild sedation and local anesthesia. Most patients are quite comfortable during the dermabrasion procedure itself. After dermabrasion there is mild discomfort for the first day or so and pain medications may be needed. The skin appears like a brush burn and is cared for with special ointments and frequent washing with soap and water. Normally patients heal from dermabrasion within one week and are able to disguise the residual redness with makeup. When dermabrasion is used to remove pre-cancerous skin damage it can provide protection against new skin cancers for many years.

Combining resurfacing procedures

For many individuals one resurfacing procedure is not perfect for all areas of the face. Some patients can benefit from laser resurfacing of the eyelids, but do not need this deep treatment over the rest of the face. Others can benefit from dermabrasion of acne scars of the cheeks but do not need a lighter treatment for the forehead or eyelids. In these cases, Dr. Coleman prefers to combine resurfacing procedures. This involves using each resurfacing approach for its best effect. A common combination includes laser resurfacing of the lower eyelids and chemical peeling of the rest of the face. When Dr. Coleman performs dermabrasion for acne scars, he often uses lasers for tightening the tissues of the lower eyelids and chemical peeling for irregular pigmentation of the forehead and neck. This custom approach to facial resurfacing is important because it allows each procedure to be used where it is needed most. Also it spares patients the longer recovery associated with deeper procedures in areas of the face where this is not required. Finally it reduces the expense of facial resurfacing.

Before laser resurfacing of the upper lip, chemical peeling of the rest of the face and fat transplantation of the cheeks was performed. After, the combined approach has rejuvenated the following woman nicely:

Why choose us for resurfacing?

Dr. Coleman is known widely for his teaching on skin resurfacing. He has lectured on this subject as an invited guest professor in South America, Europe, Asia, Africa, and Australia.

He is the lead author of a popular textbook on Skin Resurfacing and has written numerous chapters in other medical textbooks on this subject. Dr. Coleman served as the director of the full day course on skin resurfacing at the annual meeting of the American Academy of Dermatology for several years. He is listed for his work on skin resurfacing in every edition of Best Doctors in America.

BOTOX is an extremely popular material employed to weaken the facial muscles of expression and soften wrinkles. The benefits of BOTOX are unique. Nothing else can provide such quick and predictable improvement of wrinkles. BOTOX is particularly useful for the frown lines and horizontal forehead lines of the upper face. It is also quite effective in softening the crow's feet lines. BOTOX can also be used to lift up the drooping corners of the mouth, and relax folds in the neck. BOTOX can also be used for reduction of excess sweating in the underarms and palms of the hands. This is a wonderful treatment for patients whose lifestyles are compromised by consistently wet underarms or hands.

BOTOX is derived from botulinum toxin, which is produced by bacteria. This potent toxin is then purified and diluted so that it is safe for human use. Numerous studies using BOTOX in humans have demonstrated that it is extremely safe and side effects are rare. When side effects do occur, they are usually temporary and minor. The most common side effect is bruising. Rarely (less than 1%) patients develop weakness in a nearby muscle causing temporary minor problems such as a drooping eyelid for one to two weeks. In the hands of a dermatologist experienced in using BOTOX this is quite rare and can be treated with eye drops.

BOTOX treatments should always be given in a doctors office by a physician properly trained in it use, such as a Dermatologist. Recent publicity about BOTOX parties in hotels has been highly criticized by several major medical societies. The treatment is performed under local anesthesia with little or no discomfort. Most patients can resume normal activities within a few hours.

Two other forms of botulinum toxin are also available for treating facial wrinkles. Myobloc, which is Botulinum B has been used successfully for wrinkles of the upper face. Dysport (Botulinum A) has been used in Europe in a similar fashion to Botox. This agent is now in FDA clinical trials for approval for use in the United States.

Why choose us for Botox?

Dr. Coleman has been using BOTOX since it was originally pioneered for treatment of wrinkles. He was one of a small group of physicians chosen to perform the clinical trials for the FDA approval for BOTOX for treatment of wrinkles of frown lines. He also was a lead researcher on the FDA trials for the use of BOTOX in treating excessive sweating .He has served as a consultant to the Elan Corporation and has assisted in the development of clinical uses of Myobloc. He has also served as a consultant to the Iomed Corporation which is seeking FDA approval of Dysport for use in facial wrinkles. Dr. Coleman is a member of the BOTOX National Education Faculty and his office is designated as a BOTOX National Training Center where Dermatologists and Plastic Surgeons are trained in the proper use of this material.

Wrinkles develop for a variety of reasons including aging, sun damage, and facial expressions. Special fillers are available to plump up the dermal layer of the skin. Wrinkles around the mouth are particularly well suited to improvement with injectable fillers. Acne scars can also be smoothed out with fillers.

COLLAGEN wrinkle and scar fillers have been safely used by Dr. Coleman for over 25 years. Several collagen fillers are FDA approved including Zyderm, Zyplast, Cosmoderm, Cosmoplast, Dermologen, Alloderm, and Cymetra.
Collagen derived from cow or human skin is purified and injected into the skin to replace natural collagen lost with aging. This procedure is quite simple to undergo and can be performed under local anesthesia. Collagen injections usually cause only minor swelling for a few hours and most people are able to appear in public within 24 hours.
A variety of other wrinkle and scar fillers have been introduced into the United States over the last few years. Many of these have been in use for many years in Europe and Canada. Of these the most popular is RESTYLANE. Restylane is composed of hyaluronic acid, a substance found in all mammals. It is extremely well tolerated in humans and skin testing is not required. Restylane is especially useful in improving deep wrinkles around the mouth and grooves under the eyelids. Dr. Coleman often layers Restylane beneath collagen to achieve a two-layered improvement in wrinkles. Dr. Coleman also frequently uses Restylane to improve flat lip borders or to enlarge thin lips. Other hyaluronic acid fillers we use include Captique, Hylaform, and Hyalaform Plus.

The FDA has approved poly-l-lactic acid (SCULPTRA) for deep tissue augmentation in patients with HIV facial atophy. It may also be used “off label” for improvement of sunken cheeks due to aging changes. Sculptra is generally well tolerated, especially when used with new dilution methods and gradually deposited in small droplets over several treatment sessions.

Other substances previously approved by the FDA for non-wrinkle uses have been employed “off label” for soft tissue augmentation. The best known of these is calcium hydroxyapatite (Radiesse, also known as Radiance). Since this material was approved by the FDA as a bone cement and for vocal cord problems, and not as a wrinkle filler, it has not been rigorously tested for use in human skin. Not surprisingly there have been a large number of reports of complications with the off label use of this substance as a wrinkle filler. Dr. Coleman currently discourages the use of Radiance or Radiesse as a wrinkle filler until it has been properly approved by the FDA for this indication.

Currently, the FDA is in the process of deciding whether to approve Perlane, a thicker form of Restylane and a form of collagen mixed with tiny plexiglass (PMMA) beads (Artecoll, also known as Artefill). Medical grade silicone, which has not been used widely for many years, has now been reformulated (SILIKON 1000) and may also be approved by the FDA for treatment of atrophy in HIV patients.. Once these fillers are approved by the FDA they may improve the longevity of wrinkle correction. Although some physicians are illegally importing wrinkle fillers that have not been approved by the FDA, Dr. Coleman only uses FDA approved substances to be sure that his patients receive treatments that are proven safe.

Why choose us for dermal filling agents?
Dr. Coleman has over 25 years experience using fillers for wrinkle improvement. He has served as a consultant to a variety of companies who produce wrinkle fillers. Dr. Coleman has participated in FDA trials on the safety of a number of wrinkle fillers. He has written articles in the medical literature on these procedures. He has also served as a guest lecturer, teaching other physicians how to use wrinkle fillers at medical meetings in the United States and abroad. Since the proper use of dermal filler substances requires significant experience, it is best to choose a physician like Dr. Coleman who has performed this technique for many years.

SKIN TIGHTENING

Aging produces sagging skin. We all know it and we all hate it! Until recently the only option for tightening sagging skin was face lifting. Recently a number of innovations allow cosmetic dermatologic surgeons to tighten skin without surgery. The most recent advance is a laser-like instrument called TITAN. This device allows gradual skin tightening without surgery. Titan works by heating the deep layers of the skin to a temperature that causes shrinkage of collagen fibers. Meanwhile the outer layers are protected by a cooling device. This technique is nearly painless and appears to be an advance over older approaches such as ThermaCool (Thermage). Dr Coleman has been performing Titan treatments all over the body and his studies have found it is most effective for tightening wrinkled abdomens and knees, as well as sagging jowls and necks.

Over the last few years a number of materials have been developed for lifting skin with barbed sutures implanted in facial skin. The so called “thread lift” can be performed under local anesthesia and gives immediate results. This is an evolving area of cosmetic surgery and long term results are not yet known.

To learn more, visit http://www.TightenMySkin.com

As we age, our upper eyelids begin to sag eventually obliterating the natural fold in the upper lid. Lower eyelids develop wrinkles and may bulge as fat pushes its way up from beneath the orbit. Aging eyelids can be rejuvenated by blepharoplasty, which involves removing excess skin and fat in the upper and/or lower eyelids. This simple outpatient surgery can be performed under local anesthesia with mild sedation. Most patient's feel good the day after surgery and are able to drive and do minor chores with their healing eyelids hidden by sunglasses.

An upper lid blepharoplasty involves removal of the sagging skin and suturing it to form a new upper lid crease. Because the incision is placed in the natural crease it is barely perceptible. Often excess fat, particularly on the nose edge of the eyelid, is also removed to improve the contours.

Lower eyelid blepharoplasty is performed either from an incision just under the lashes or inside the eyelid. Each procedure has its own advantages. The goal of lower lid blepharoplasty is to remove excess fat from beneath the lower lid or reposition it to give an improved contour. Some patients also benefit a canthopexy, which involves tightening the lids where they join together at the corner of the eye. In recent years, Dr. Coleman has been removing less fat from the lower lids and emphasizing laser resurfacing to tighten the skin instead. This thickens the skin, smoothes out wrinkles, and pushes the fat back where it belongs. A common combination is upper lid blepharoplasty combined with lower lid laser resurfacing. Also, Dr. Coleman frequently uses Botox to smooth the wrinkles of the crow's feet area and to lift the brow upward. Each patient however, requires a custom approach to suit his or her own particular eyelid problems.

Why choose us for blepharoplasty?

Dr. Coleman has been performing rejuvenative eyelid surgery for over 25 years. He has published articles and served as a guest professor lecturing about this technique at national and international meetings. As an expert in blepharoplasty, laser resurfacing, fat transplantation, and Botox he prefers a multidimensional approach to rejuvenating aging eyelids.

As people age they loose thickness in the fatty layer of the skin. This causes the skin to sag and the face becomes unbalanced. If you look at your high school graduation picture will see that your face was fuller, not tighter. Many patients choose to have facelifts, which removes skin, when what they really need is to simply fill out the skin that they already have.

Fat transplantation involves extracting fat from the abdomen or hip and reinjecting this tissue into various parts of the face. The most common areas for fat transplantation are the cheekbones, lower cheeks, the tissues around the mouth, and the lower forehead. Filling these areas resupports the structure of the face and provides a more youthful appearance. Fat transplantation is quite easy to go through especially if a conservative approach is used. While some surgeons transplant massive amounts of fat at a time, which requires a prolonged recovery, we have found, after 15 years of performing fat transplantation, that patients instead prefer a series of several small procedures. During each of the procedures, a small amount of fat is injected in all the needed areas. Normally there is moderate swelling the first day and slight swelling the day after this procedure. Most patients are able to appear in public within two days.

The fat is obtained from an area of excess fat, such as the abdomen or hips, thus giving a mini-liposuction. This benefits not only the face, but also the abdomen or hips as well. Enough fat is usually harvested during the first procedure for several additional procedures. The unused fat is frozen and simply thawed out when needed for additional facial transplantation sessions. Fat can be safely frozen and stored for at least one year.

Why choose us for fat transplantation?

Dr. Coleman is a pioneer in fat transplantation, performing this procedure since 1985. He has been invited to lecture on this procedure all over the world. After performing thousands of fat transplantation procedures he has developed the breath of experience that is needed to obtain the best aesthetic results from this procedure.