On June 19, TMD Medi-Spa had its first official Botox party.  Botox was discounted to only $9/unit!  Lots of people came for treatments and to find out more about what TMD offers.  Jeannine, our physician assistant won praise from patients for her technique and gentle touch.  Here are some of the testimonials:

I just had to tell you again how very pleased I am with the Radiesse injections I had yesterday.  I inspected your work again as soon as I got in my car and later in the evening when I got home and I can’t believe what a flawless job you did.  I usually leave the office looking swollen and blotchy but I was good to go the moment I left your office.  You are simply THE BEST!!!!!!!  Thank you so much for taking the time to do the job right.  I’ll see you again in a year or so when I need a touch up. - N. H.

Just wanted to let you know that I saw Jeannine for botox this afternoon.  While I was extremely nervous, she put me at ease and explained everything really well.  She was great!  I am very excited to have been introduced to your clinic.
I actually asked Jeannine about a couple other things and didn’t realize that today there were specials for Juvederm as well.  I am thinking I would love to try that too at some point in the future.  Just wondering if you guys have these “parties” periodically.?.? Hope to meet you next time.  I will definitely be recommending your clinic and Jeannine.  Thanks!!!  - M. B.

Botox and Juvederm are names that are often heard in discussions of cosmetic dermatology and beauty treatments. What they actually are may be mysterious for some people. This post will try to clarify what they are and what they are used for.

Botox is a chemical derived from bacteria that works by blocking the responsiveness of muscles to nerve impulses. In tiny doses, as in standard medical practice, when botox is injected into facial muscles, it causes them to relax and stop working for an average of 3 months. So, if someone has overactive facial muscles that are causing wrinkles, such as between the eyebrows and around the eyes, Botox can be injected in a pinpoint fashion to relax these. It targets those muscles only, producing a specific and predictable improvement in frown lines, crow’s feet and forehead lines. Such wrinkles are all caused by overactive muscles that are not necessary for a happy, normal appearance. They can be treated to produce a relaxed, youthful look. Obviously, you would not want to immobilize all the muscles of facial expression, as this would look unnatural. Some muscles in the face are essential for function, such as the lips and eyelids, and these are not typically treated either.

Juvederm is very different from Botox. It is not an active biochemical. Although it is made by bioengineered bacteria, it is consists of hyaluronic acid. This is a structural molecule within the skin that has no chemical activity on nerves or muscles. Juvederm acts by filling a depression in the skin where it is injected. Thus it can be injected under and within wrinkles to make them flatten out and to make them disappear. It can also be injected into lips to make them plumper. Juvederm is FDA-approved to last up to 1 year in the nasolabial folds. It can be used anywhere there are deep wrinkles, such as a very deep furrow between the eyebrows, deep lines around the corners of the mouth, and anywhere else.

Juvederm and Botox are often used together since they work on different aspects of lines and wrinkles. It is common to get Botox for upper face wrinkles, such as crow’s feet and forehead lines and Juvederm for lips or nasolabial folds. At Tattoo MD, a custom solution that addresses your specific needs will be tailored for you. Whether it is for Juvederm, Botox, or tattoo removal, consults are always free! Contact us for an appoinment.

The art of laser tattoo removal involves not just selecting the right laser and wavelength to treat a tattoo. In the last blog entry, we went over the fundamentals of the laser and the importance of using the appropriate wavelength to treat different tattoo ink colors. In this entry, we’ll go over some subtler points.

The amount of energy in a laser shot can be varied from low to high. Most patients think that the higher the energy, also called fluence, the faster their tattoos will come off. This is not quite true. There is a maximum amount of energy that a tattoo can absorb. If additional energy is applied, then it is converted to heat which can injure the skin. As there is less and less remaining ink to absorb the laser energy, the fluence can be increased. The majority of the energy does not encounter tattoo ink and is reflected away. Less heat is generated and thus a higher energy can be safely used. There is of course a limit to how high the energy can be set.

Another aspect is beam profile. The laser beam that hits the skin is ideally completely uniform in energy from outer edge to the middle of the beam. This is not necessarily so. Laser manufacturers have continued making improvements in beam uniformity but this used to be more of a problem. Older lasers sometimes had higher energy in the center of the beam which could cause hot spots and non-uniform tattoo removal.

Some colors of ink absorb the available laser wavelengths very poorly. This makes them more difficult to fade with a laser. Colors such as yellow, pink, and purple are more difficult to remove than colors such as black, blue, red, and green. This does not mean that those colors cannot be removed at all, but that removal is more difficult and expectations should be lower.

Some inks may contain metal pigments, such as iron and titanium, that are much harder to remove than other inks. India ink, for instance, is much easier to remove by comparison. Since patients (and even tattoo artists) almost never know what the inks in their tattoos are composed of, there is no way to predict when this will be a problem.

The current state of the art in laser tattoo removal involves the use of q-switched lasers. The concept is based on “selective photothermolysis” and “photoacoustic effects.”
The ink from a tattoo is generally located within the dermis layer of the skin. The ink may be black, red, or almost any color. A laser light of a particular wavelength, such as 1064 nanometers, is differently absorbed by the particular ink in the tattoo than by the surrounding skin. Thus, the ink particles within a tattoo absorb much more laser energy than the surrounding normal skin. This is referred to as selective photothermolysis.
This difference in absorption though, is not enough to perform successful tattoo removal. The energy must be delivered so fast that it “shatters” the ink particles rather than just heating them up slowly. This is where “q-switching” comes in. The q-switch is like a super-fast shutter on the laser that allows only brief shots of laser light to come out at a time. When something is heated or cooled extremely quickly, it doesn’t have time to expand or contract properly, and so it cracks. This is the photoacoustic effect. If a non-q-switched laser of the proper wavelength were used to treat the tattoo, it would typically cause a burn in the area of the tattoo. This is why laser hair removal is not safe over a tattoo.
These are the two main elements of the mechanism of laser tattoo removal. There are other subtleties that are also important, such as the wavelength of the laser light, the size of the spot, the uniformity of the beam, and the amount of total energy applied to each burst of the laser.