aesthetic surgery laser surgery - skin treatmentsinvestigations have consistently proven that laser...

D e r m a t o l o g y

A e s t h e t i c S u r g e r y

L a s e r S u r g e r y

50 year old female before and one week after liposuction of the chin and jowls .

Patient of Dr. Berman

50 year old female before and 2 weeks after liposuction of the hips,outer thighs and buttocks.


Completely by Local Anesthetic

Body Sculpture by liposuction can be a dream come true.Localized accumulations of fat may be the result of a geneticallyinherited body type. These difficult areas that are often impos-sible to eliminate by exercise or dieting can now be removedpermanently by liposuction, never to plague you again.

Liposuction is a technique that improves the body’s contourby removing excess fat from fatty deposits located between theskin and muscle. The basic concept of liposuction is surprisinglysimple. A small stainless steel tube, called a cannula, is connectedto a suction pump and the removal of fat is accomplished asthe cannula creates tiny tunnels through the fat, which collapse,resulting in an improved body contour. Fat cells that are removedby liposuction do not grow back. As long as the patient doesnot gain excessive amounts of weight, the new, more pleasingsilhouette is permanent. The most frequently treated areas inwomen are the abdomen, hips, thighs, knees, neck and chin. Inmen, the most commonly treated areas are the love handles,abdomen, breasts, neck and chin.

Different techniques of liposuction differ dramatically ineffectiveness and risk. One possible risk factor is the risk ofcombining liposuction with general anesthesia, which maypromote blood vessel dilation and blood loss. Dr. Bermanreduces this risk by utilizing the Tumescent Technique. TheTumescent Technique, pioneered by dermatologic surgeons inthe late 1980’s, was developed so that the surgeon couldperform liposuction without general anesthesia, thus greatlyreducing the risk of blood loss. Though many practitionersclaim to use the Tumescent Technique, they surprisingly combineit with general anesthesia for convenience and speed of theprocedure. Dr. Berman will exclusively perform this procedureunder local anesthesia, most often with a mild “twilight” sedation.

The safety of the Tumescent Technique is what makes it standapart from the general anesthetic approach. The TumescentTechnique results in virtually no blood loss, and to the best ofour knowledge there have never been any reported seriouscomplications using the Tumescent Technique for liposuctionby using the proper local anesthetic approach. Over the years,Dr. Berman has treated numerous patients who previously hadliposuction with general anesthesia. Virtually every one of thesepatients has found the Tumescent Technique to provide betterand smoother results, and a more rapid healing and recovery.

LIPOSUCTION AND BODYSCULPTURE

47 year old Rosacea patient after partial cheek treated with pulse dye laser.

Treated Area

PhotoFacial vs . Lasers vs . Chemical Peels

Broken capillaries or redness of the face, neck and chest, aswell as brown spots of the skin are the result of excessive sunexposure, genetics, smoking, and hormones. Today, we havemany approaches to eliminate such problems, including theremarkable new PhotoFacial procedure, laser procedures,microdermabrasion and even chemical peels. The PhotoFacialprocedure, also known as Intense Pulsed Light (IPL), can removesuch skin imperfections with no down time, creating smootherlooking skin through a process called Photo-Rejuvenation.Depending on the conditions you are treating and the severityof the individual problem, a series of four to six treatmentsessions may be recommended. You can return to work thesame day and resume all your regular activities. By dividing thefull program into several treatments, the procedure providesgradual improvement with very low risk - and, it preservesthe wonderful “no down time” feature that people appreciate somuch. A more aggressive approach to treat the red componentof the skin would include a V Beam laser treatment, thoughthis procedure may result in bruising which may last 3-10 daysor more. Similarly, our YAG laser is a wonderful treatment toclear brown spots, however patients can expect slight skinirritation for a few days. Other laser available at our centerinclude the Aura KTP and CoolGlide lasers which both workto clear individual red or blue spider veins.

Lastly, chemical peels can rejuvenate skin. Alpha and BetaHydroxy Acids are skin smoothing agents derived from fruitand sugar cane, which even Cleopatra used for beautification!Medical studies prove that these agents work in two ways:

first, by gently dissolving the natural “glue” holding deadepidermal cells together, inducing an exfoliation process, andsecondly, by regenerating collagen in the deeper dermis.Patients have no down time, and should see a reduction inmottled brown discoloration, fine lines, and acne.TCA(Trichloroacetic Acid) is a stronger peeling agent which candeliver excellent results, though down time is possible,depending on the strength of acid used.

REDNESS / BROWN SPOTS /SUN DAMAGE

43 year old male before and minutes after KTP laser treatment of facial capillaries.




52 year old before and after one TCA peel

84 year old female before and one month after laser skin resurfacing of the upper lip.

Wrinkle , Scar and Precancer Removal

Laser skin resurfacing has revolutionized the treatment of aged,sun-damaged and scarred skin. It provides a safe and effectivetechnique to erase wrinkles, precancers and sun damage ofthe face, neck, chest, back and hands. Laser treatments can alsobe used to reduce scars resulting from severe acne, previoussurgical procedures or trauma. Dr. Berman utilizes two differentresurfacing lasers to deliver “state-of-the-art” laser resurfacing— the Sciton Contour Erbium laser and the CoherentUltrapulse CO2 laser. The on-site availability of two resurfacinglasers allows us to further individualize the treatment to apatient’s very specific requirements. Today, most patients returnto their usual activity after only 5-7 days with our uniqueapproach. For those who prefer no down time, we may out-line a series of more gradual lunchtime laser procedures,allowing patients to return to their usual activity immediately.

History of Laser Skin Resurfacing

In the mid 90’s, a Palo Alto, California company pioneered theprocess of laser skin resurfacing by developing the first laserused for this purpose, the Ultrapulse CO2 laser. Although thislaser was initially intended to remove sun damage and pre-cancerous growths of the skin, the inventors were

LASER SKIN RESURFACING

73 year old female before and one month after full face laser skin resurfacing.



happily surprised that it also reduced or eliminated wrinklesand scars! The CO2 laser treatments however were oftenassociated with longer than desired healing times, and somepatients noted a skin lightening effect from the laser. Toovercome some of these disadvantages, a cooler Erbium laserwas developed. Most Erbium lasers however were limited by their depth of penetration into the skin and by theirinsufficient skin-tightening effect. Another Palo Alto, Californiabased company responded to this issue by developing a moreadvanced Erbium laser, the “Sciton Contour” laser, with itsproprietary “Optical DiaThermy Technology.” With this laser,the surgeon could precisely “dial-in” the desired depth ofpenetration of laser light in microns (millionth of a meter),while at the same time dial-in the amount of heat necessaryto tighten skin. With this technology, healing time is reducedand side effects are rare. In order to satisfy patients’ variousrequirements, Dr. Berman will often combine the Ultrapulselaser and the Sciton Contour Laser on the same patientduring one treatment, delivering the most state of the art,individualized laser procedure possible.

What is Laser Skin Resurfacing?

In order to remove aged, sun-damaged and scarred skin, a laserbeam is passed over the surface of the skin, gently and preciselypainting away unwanted cells, one layer at a time. Clinicalinvestigations have consistently proven that laser skin resurfacing

38 year old female before and 5 years after laser skin resurfacing for acne scars.


See Dr. Berman performing laser skin resurfacing on The Learning Channel in 2002-2003.Visit www.tlc.discovery.com for theprogramming schedule for the show titled A Personal Story.

induces new collagen formation in the skin, resulting in thereduction or complete elimination of wrinkles and scars.Importantly, the process of eliminating sun-damaged cellsgreatly reduces the chance of developing pre-cancers and skincancers in later years.

The Day of the Procedure

All procedures are performed within our state-accreditedoutpatient surgery center. A topical anesthetic cream may beapplied to the treatment areas prior to the procedure. Smallregional areas are easily numbed up, while a full face procedurewould require twilight local sedation, administered by ourboard-certified anesthetists. The length of the proceduredepends on the amount of the surface area treated. Smallareas may take 15 minutes, while the entire face is completedin approximately 40 minutes. After a short recovery period,patients return home. For full face resurfacing, a soothingfacial mask is often applied which remains on the skin for 3 days, enhancing the healing process. After 3 days, patientsreturn to our center. At that time, a clear dressing is usuallyapplied to the skin, which remains on for 2 more days. Withour latest techniques, most patients are healed in 5-6 days.Any pink areas may then be covered up with a powder ormakeup. We encourage all patients to use a sunscreen andavoid excessive, direct sun exposure for many weeksfollowing this procedure.

Today, there are several injectable substances used to correctwrinkles, depressions and scarring, including collagen, newerfiller agents, and one’s own fat. Used appropriately, and oftenin combination with other techniques for facial restoration,results from these injections can be enormously satisfying.Collagen is a filler agent used to plump up a variety of cosmeticconcerns, including thin lips, marionette lines around the mouth,wrinkles, atrophic acne scars and traumatic scars. Collagen is asafe and effective treatment for such areas, having been aroundfor 2 decades. Collagen is usually injected twice a year througha tiny needle into the skin. An immediate correction is seenwithout the healing time associated with laser skin resurfacing

Fat transfer or microlipoinjection is a century-old technique oftransferring fat from one body area to another. The advantagesof using one’s own fat combined with the ability to correctlarge defects make the procedure a popular option for manypatients who choose to recontour their skin. Fat transfer ishelpful for both cosmetic and reconstructive purposes. Oftenreferred to as surgical “sculpting,” the process is used toreplace the loss of fat which occurs underneath the skin inassociation with the aging process. Fat transplant is performedmost commonly to the face and hands, although cer taintypes of scars and deformities may be improved with thisskin-sculpting technique. Microlipoinjection is considered asafe and effective procedure. Since one’s own fat is used,there is virtually no risk of allergic reaction or rejection of thefat tissue. Thus, microlipoinjection is an excellent alternative

for people who are allergic to collagen.The donor site (area fromwhich fat is to be removed) and the recipient site (area in whichfat is to be injected) are cleansed, surgically prepared andnumbed with a local anesthetic. Using a very tiny needle andsyringe, the fat is extracted through a small incision from theabdomen, buttocks or thighs. Once removed, the fat is reinjectedinto the recipient site. Favored recipient areas on the faceinclude the crease that extends from the nose to the mouth,the chin, and around the mouth and eyes. “Hollow cheeks”that have lost fat due to aging can also be filled out with fattransfer. Swelling, soreness and bruising is possible, but unusual.Patients can usually resume normal activity the day of surgery.The duration of the contour correction varies from patient to patient. While improvement is most often long lasting andpermanent, follow-up injections may be necessary or desiredfor maintenance and possibly to extend the longevity andpermanence of the fat transfer.

FAT TRANSFER ANDCOLLAGEN INJECTIONS

Before and after Collagen injections to naso-labial folds and lips.

Blue cosmetic tattoos have been found on Egyptian mummiesdating back to 1300 B.C. Tattoos are more popular than ever,though today’s enthusiasm can become tomorrow’s embar-rassment! Fortunately, we can now remove cosmetic, traumaticand permanent make-up tattoos (those resulting from perm-anent eyeliner or brow application) by using lasers. Tattoopigment is broken up into smaller particles by the laser, and isnaturally eliminated from the body. Multiple sessions areusually required, and most patients return to normal activityimmediately.

TATTOO REMOVAL

Only faint pigment remains after several treatments.


Botox is used at our center to treat hyperdynamic wrinkles,excessive sweating of the palms and underarms, migraine head-aches, and vertical platysmal neck bands. Hyperdynamic wrinklesare the most common indication for Botox treatments, andare caused by repeated contractions of the delicate underlyingfacial muscles every time you smile, laugh, or frown. A veryanimated individual who contracts these facial musclesfrequently will have greater facial muscle tone, and deepeningof unwanted lines of the face. Botox is injected into the small

facial muscles through a tiny needle, and it works in 2 ways.First, Botox relaxes hyperdynamic muscles, dramatically soft-ening or eliminating wrinkles within 3-10 days. Secondly, overthe ensuing months the relaxed muscle slowly thins down toa more normal state, providing further cosmetic benefit forunwanted wrinkles. This secondary effect has been seen in ourcenter to last as long as 2 years! With more than 2.0 milliontreatments performed last year and a superb safety trackrecord, Botox has rapidly become one of the most popularcosmetic procedures performed in the United States. Theareas most commonly treated include forehead lines, furrowsbetween the brows, crow’s feet, and upper lip lines. Patientsundergoing laser skin resurfacing may obtain an indirectlypermanent benefit from Botox; the administration of Botoxbefore and after laser resurfacing permits the underlyingfoundation of muscle to be more relaxed and flat.This resultsin the optimal alignment of the collagen fiber network into a permanent, horizontal pattern.

BOTOX

After : Botox allows muscle to relax and lines dissipate away.

Before Botox: 32 year old male patient relaxed, not actively raising brow,with thick and tight muscle.


7 days after Botox: Patient trying to frown.

Before Botox: 59 year old female, frowning.

Before Botox: Patient raising forehead. After Botox: Trying to raise forehead.



Thinning hair and receding hairlines are commonplace, affectingboth men and women. Today, hair transplantation can naturallycorrect thinning hair, permanently. Though hair transplantationhas been performed since the 1950’s, technological advancesin recent years have permitted the cosmetic benefits to beenhanced substantially. The result of such advances has madehair transplantation the number one, most commonly performedcosmetic procedure for men in the United States. One maynot be aware of the staggering number of people who havehad a hair transplant because a good hair transplant is notnoticeable. Certainly, most everyone has viewed an obviouslybad transplant, one that was done with large plugs, resulting in a “pluggy,” “dolls head,” or “corn stalk” effect. These pooroutcomes were due to older techniques, using large, roundpunch devices to take out and move 15-20 hairs per punchgraft. Today, by moving only 1 hair at a time to the frontalhairline, it is vir tually impossible to obtain a “pluggy” look.Because these results are so much more superior to thetraditional technique, Dr. Berman exclusively relies on thenewer approach, as opposed to the punch graft technique still used by others. Done properly, using this micrograftingtechnology, our team can move thousands of hairs from theback of the head quickly, painlessly, and with natural results.

Hair transplantation is a medical procedure which really onlyredistributes your naturally growing hair. Hair which is growingin great density on the back of your head can be moved toareas where there is a shortage or thinning of the hair, suchas the balding areas in front or on top of the scalp. Becauseof the abundance of hair on the back of the scalp, removingsome hair from this area does not cause any cosmetic problem.Additionally, these hairs are genetically programmed to growthroughout your lifetime, thus transplanting them to a differentarea on the scalp allows them to still grow well, throughoutyour lifetime.

The following will lead you through a typical hair transplantationprocedure. While the patient watches a video, Dr. Bermananesthetizes the back of the scalp and harvests strips of hair-bearing skin, using the latest multi-bladed instrument. Eachstrip is meticulously dissected down to individual grafts; somegrafts containing 1 hair follicle each (micrografts), while otherscontain 2 or 3 hair follicles each (minigrafts). Next, Dr. Bermanfollows his pre-designed graft placement, planting the smallestsingle-hair grafts into the frontal hairline to give a purposeful,somewhat random and natural distribution of hair. The 2-to-3hair grafts are placed behind this hairline to fill in and enhancehair density. Dr. Berman takes into consideration the pattern

HAIR TRANSPLANTATION

Before (above) and after follicular unit hair transplantation.

of expected change of hairline and future hair loss, so that thetransplanted hairs, now permanent, will sit naturally as thepre-destined baldness pattern of the non-transplanted hairevolves. Further, in an attempt to create the desired distributionof future gray hairs, Dr. Berman will assess present day color-ation and mix or separate follicles that may gray in order topreserve the desired, natural appearance as the patient ages.Dr. Berman has published on hair transplantation in medicaljournals and remains acutely aware of the subtle nuances thatgo into the “good transplant.”

Not everyone is a candidate for hair transplantation. At yourinitial consultation, Dr. Berman will examine the density of hairon the back of the scalp in order to determine if there isenough hair for transplantation to the balding area. Multiplesessions may be required for optimal benefit, and patientsshould have realistic expectations prior to undergoing hairtransplantation, or any other cosmetic procedure.

34 year old female, before and after LightSheer Diode laser hairremoval of upper lip.

Studies show that nearly every woman and most men have atleast some hair on their body that they consider undesirable,whether it is on the face, back, bikini line, neck, legs, underarms,eyebrow area, abdomen, breasts, or arms. Previously, treatmentsfor unwanted body hair included shaving, waxing, tweezing,and chemical depilatories. These treatments provided onlytemporary results, and were often painful and difficult toperform. Even electrolysis, which uses an electric current todestroy one hair at a time is slow, requiring years of treatmentand carries a risk of scarring, pitting and infection. Today, lasersprovide a better, more rapid method of hair removal. Thelaser is passed over the skin, and light energy is absorbed bydark pigment in hair follicles beneath the skin, disabling hundredsof hairs at a time. The end result is either elimination or significantreduction of any regrowth of hair. It is important to performtest spots with increasing energy settings on every individualconsidering laser hair removal at the time of the initialconsultation. In this way, we can later start the treatments atthe highest energy to destroy the greatest number of hairfollicles, while knowing that the overlying skin should not beirritated. Test spots will thus allow the patient to undergo the fewest number of sessions possible.

The proper selection of the optimal laser, depending upon hairand skin type is imperative. Our hair removal lasers include fourLightSheer diode lasers, 2 CoolGlide lasers, and the Quantumintense pulsed light device. With these devices we are able totreat white, black, and even tanned skin. Additionally, patientswith pseudofolliculitis barbae or “hair bumps” — ingrown hairsof the face, beard and bikini line, commonly seen in African-American patients — can now be treated. Our center hastested older systems, such as the Softlight laser, the long pulseRuby lasers (Epilaser™, Palomar E2000), and the Alexandritelasers (GentleLASE™). None of these systems were adequatefor all skin types. The significant technological advantages ofthe LightSheer and CoolGlide lasers over older laser systemsare: 1) a longer wavelength of light (LightSheer: 810 nanometers,CoolGlide: 1064 nanometers) which allows for deeper pene-tration, permitting the light to preferentially by-pass theoverlying skin and target the hair follicles below, 2) the longerpulse duration (up to 100 milliseconds) which also permitsdeeper penetration while sparing the skin surface, 3) whitesapphire, direct, contact cooling, which efficiently dissipatesheat on the skin surface, compared to spray cooling in othersystems, and 4) a quicker treatment, important for largerareas such as the back or entire leg.

Patients will require multiple sessions, however the number oftreatments needed is dependent on the laser energy setting,and the patient’s skin and hair type. The laser treatmentswork by actually disabling the hair that is in the active growthphase at the time of the treatment. Not all of an individuals’hair follicles are producing hair at the same time, but actuallygo through 3 different phases: growth, regression and resting.Since other hairs will eventually enter into the active growthphase at different times, additional treatments will be neces-sary to eliminate other hair follicles in a given area. Theprocedure is well tolerated, though sensitive areas require atopical anesthetic cream. Following the treatment, mostpatients return to their normal activity immediately.

LASER HAIR REMOVAL


Microdermabrasion is a revolutionary, non-invasive treatmentinvented in Italy for skin rejuvenation. This procedure utilizescrystals to finely resurface superficial layers of the skin. Publishedmedical studies prove that microdermabrasion exfoliates theouter dead layers of the skin and stimulates new collagenformation in the deeper dermal layers, revealing younger,fresher skin. Microdermabrasion is right for all skin types andfor anyone interested in improving the appearance of fine linesand wrinkles, acne prone skin, black heads and white heads,mild acne scarring, pigmentation problems, uneven skin tones,and dull, lifeless sun-damaged skin. Microdermabrasion caneven treat the neck, chest, and the hands. Individuals return toregular activities the same day. During your consultation, youmay request a sample of the treatment on the back or yourhand to sample its benefits and painlessness.

MICRODERMABRASION

26 year old undergoing Microdermabrasion.


Fine crystals sprayedand suctioned

veins remains sclerotherapy injections. Certainly, lasers areused in our center to enhance the results. Many patients mayneed to repeat these procedures to achieve the desiredresult. After the procedure, patients may return to normalactivity immediately, avoiding strenuous exercise forapproximately 10-14 days.

Most women develop unattractive red and blue spider veinson their legs as a result of genetic predisposition, pregnancyand the aging process.These unsightly veins are not neededby the circulatory system, and can be removed withoutcreating a health problem.Though our center has 8lasers/light sources, which are FDA approved to treat legveins, we still feel that the gold standard for treating spider

65 year old before and after laser vein treatment.


LEG VEIN TREATMENTS

As we age, our body changes, and eventually our claims of youthare undermined by the physical evidence which our agingbody displays. Often, the first part of the body that belies ourclaimed age is the eyes. Worse yet, the eyes of some individualsforce the world to believe that they are even older than theyactually are. For tunately, this can be corrected throughblepharoplasty procedures. The upper eyelid blepharoplastyprocedure yields dramatic results. The patient may choose to be lightly sedated or completely awake throughout theprocedure.The upper blepharoplasty procedure involves anincision that is mostly hidden in the crease of the eyelid. Dr.Berman utilizes the Ultrapulse laser for eyelid lifts to enhanceresults. Sometimes it may seem like an upper blepharoplasty is needed when in actuality the brow, or forehead has “fallen.”In this case, a forehead lift alone may correct the hooding ofthe upper eyelid. Eyelid skin heals extraordinarily fast, thoughmost patients take 4-6 days off from work. Camouflagecosmetics can cover any minor swelling or bruising after thefirst few days. Patients must avoid bending over, exercise orheavy lifting for 10 days. It is very important in eyelid surgerythat all sutures be removed at 4-5 days from the surgery date to reduce the chance of healing with suture tracks. If the lower lids are bagging or wrinkled, a lower blepharoplastymay be in order. For lower lid procedures, an incision is madein the pink, inner part of the lid and a similar procedure isfollowed. No incision is made in the skin, thus no sutures arenecessary. Patients enjoy permanent results from these proce-dures, and are pleased with their decidedly younger appearance.

LASER EYELIDLIFT /BLEPHAROPLASTY

39 year old female before and 1 month after laser upper eyelid lift.


40 year old before and after laser upper eyelid lift


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David A. Berman, M.D.

Medical Director

After being raised in Palo Alto, California, Dr. Berman attended theUniversity of California, Berkeley, where he received his Bachelor ofArts degree with honors. He then earned his medical degree from

Baylor College of Medicine in Houston,Texasand completed an internship in Internal Medicineat UCLA. He went on to become the ChiefResident of Dermatology at NorthwesternUniversity School of Medicine in Chicago. Dr.Berman is on the affiliated Medical Staff atStanford University Hospital and is past Chief ofDermatology and Dermatologic Surgery at SanMateo County General Hospital. He is boardcertified by the American Board of Dermatology,and is a Fellow of the American Academy ofDermatology, a Fellow of the American Academyof Cosmetic Surgery, a Fellow of the American

Society for Laser Medicine and Surgery, and a member of theAmerican Society of Liposuction Surgery.

Dr. Berman lectures to physician groups and medical associationsworld wide, conducts scientific investigations, and has been featuredon television for his work in laser and cosmetic surgery, includingmultiple Discovery Channel programs,The Learning Channel, ABCNews, NBC’s weekly “The Next Step,” and Bay TV. He lives with hiswife and enjoys music, travel, reading, biking, swimming and playingthe piano.

CONSULTATION INFORMATION

The Berman Skin Institute’s friendly and knowledgeable staff is happyto assist you in scheduling a consultation appointment, Monday throughSaturday, with evening hours available. A consultation appointmentgives you the opportunity to learn how one of the Institute’s manyservices may be of benefit to you.When scheduling your consultationappointment, be sure to ask for a complimentary video/DVD to besent to your home in order to learn more about the latest advancesin the fields of Dermatology, Cosmetic and Laser Surgery. Dr. Bermanand his staff look forward to helping you achieve your goals for self-improvement.

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©2002 Berman Skin Institute Medical Group, Inc. All rights reserved.

AESTHETIC SERVICES AND PROCEDURESBLEPHAROPLASTY (EYELID LIFT)

BOTOX BROWN AGE OR LIVER SPOTS

COLLAGEN TREATMENTSDARK RINGS/CIRCLES UNDER THE EYES

FACIAL CAPILLARIESFAT TRANSFER (MICROLIPOINJECTION)

HAIR TRANSPLANTATIONLASER HAIR REMOVAL

LASER SKIN RESURFACINGLEG VEIN TREATMENTS

LIPOSUCTION AND BODY SCULPTINGPEELS

PHOTOFACIAL / IPLREDNESS OF THE FACE, NECK AND CHEST

TATTOO REMOVAL

aesthetic surgery laser surgery - skin treatmentsinvestigations have consistently proven that laser...

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