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Cosmetic dermatology gains in popularity

Jeanette McKennan

The desire to look younger is nothing new. But while historically plastic surgery has been perceived as something for the wealthy and celebrities, cosmetic dermatology has now entered the mainstream. In 2013, the American Society for Dermatologic Surgery reported significant growth in cosmetic dermatology over the previous year, with some procedures up by as much as one-third.

This week on “Take Care,” Dr. Emmy Graber, president and founder of the Dermatology Institute of Boston discusses the benefits and risks of some of the most common types of cosmetic dermatology procedures.

Botox injections

Botox is the brand name of a one of a class of products known as neuromodulators. The goal of neuromodulators is to stop muscles from moving. The main ingredient is botulinum toxin.

“When you hear botulinum toxin you obviously think of something toxic and very dangerous,” said Graber. “The way it’s done when it’s treating wrinkles, is that it’s injected, but just being absorbed very locally by the tiny nerve endings that are just underneath the skin. And it doesn’t spread throughout your body.”

Graber says Botox is particularly used in the upper half of the face, where there are wrinkles created over time by moving muscles in the area. Furrowing your brown or scrunching up your forehead may be expressive during conversation, but it also creates wrinkles.

“By using some of these products, you can soften the movement of the muscles so the lines don’t form,” said Graber. And, she adds, the lines that may already be there over time, start to go away

Graber says Botox injections work quite well, and the results last 3-4 months before the product wears off. Patients often do it again right away. And depending on the patient, Graber says he or she can see results right away. But if the wrinkles have been there for a long time, it can take weeks or months for the results to be noticeable.

Graber emphasizes that it is always important to make sure the botox or other product is injected by a physician who is a board-certified dermatologist or plastic surgeon. Graber says using these products does require a bit of training and things can go wrong. The most common side effect is tiny bruise at the site of injection.

The most common horror story is that the patient’s forehead might look lopsided or the eyebrows may look uneven. But Graber says that’s uncommon when the injection is done by someone who has been properly trained. The good news is that since Botox will wear off in 3-4 months, these side effects go away.

As far as any long-term side effects, Graber says the nerve will always regain movement after the injection wears off, no matter how long a patient has had treatments.


In general, filler is used for wrinkles and lines on the lower half of face. Fillers fill lines and wrinkles from the underside. They lift up a line’s folds so you don’t see them anymore, making them even with the surface of your skin.

Graber says fillers can be used on the lower half of face to give volume. When people age, sometimes cheeks become hollow. Thin lips can be injected with a filler to make them fuller.

Fillers are made of hyaluronic acid, a substance found naturally in the skin, which has the consistency of a gel. Graber says it’s injected with a very tiny needle and placed under skin.

Graber says in general, fillers are considered very safe. She says the most common complication is bruising, which will go away.

Fillers can be reversed. If there were a problem or the patient didn’t like the look of it, another kind of injection can be used to make the product go away in matter of days.

“They can look very natural. We see the pictures of the celebrities who have gone too far, they’ve done too many fillers; it doesn’t look natural. When fillers are done correctly the outside person doesn’t know someone has had fillers. They just look a bit more rested, and a little bit more refreshed,” said Graber.

Graber says fillers can last six months to two years. And, she says some filler products are coming out that can be permanent.

Laser treatments

Lasers treatments can be used for a lot of different purposes. Removing hair is probably the most common. But Graber says lasers can also be used to remove sun spots, broken blood vessels, redness, some types of birthmarks, tattoos removal and acne scars. Sometimes lasers are used to treat wrinkles.

There are different kinds of lasers used for different purposes -- some are infrared light, some visible spectrum of light.

As with Botox and fillers, Graber recommends that patients should do their research about who should perform their treatment, and recommends sticking with a physician.

The primary risk factor Graber says to watch out for is that many lasers should not be done in summer time. She says the slightest bit of suntan can bring on more complications, like a burn. Also, patients who have naturally darker skin must be more careful about what kind of laser is used.