Tag Archives: Aesthetic Dermatology and Skin Cancer: Jeffrey H. Binstock M.D.

Don’t Ignore the Temples as Part of Your Comprehensive Facial Rejuvenation

Loss of volume in the temple areas of the face contributes to a gaunt and wasted appearance. Fortunately, dermal fillers such as hyaluronic acid (HA) can counteract this loss of volume to achieve a more balanced and youthful appearance.

For themples, only the most experienced aesthetic dermatologists can skillfully combine the best filler for you with the injection technique that will meet your expectations with this treatment. In this regard, both Restylane® and Restylane® Lyft (formerly known as Perlane-L®) have been studied.

Rejuvenation of the temples with Restylane

In this study, 20 people were treated with Restylane injections. The injection technique was based on the provider’s expertise and experience. Following treatment, responses were recorded by the doctor who did the injecting. In addition, a physician who wasn’t involved in treatment did an evaluation using the Hollowness Severity Rating Scale. This scale is designed specifically to evaluate the temples. It is a 4-point scale, ranging from absent (1), mild (2), moderate (3), and severe (4).

Importantly, the people who were treated also completed questionnaires.

Here’s what they found

At weeks 4, 12, and 24, and month 12, everyone reported improvement overall in hollowness.

One year later, no touch-ups were needed in anyone, and any side effects were judged mild or moderate and resolved within 2 weeks.

Rejuvenation of the temples with Restylane Lyft

In this second study, another HA filler, Restylane® Lyft, was used. Among 16 patients treated, 13 were “very” or “moderately satisfied” and requested repeat treatment; whereas three were only “mildly satisfied” or “ambivalent.”

The bottom line

Volume loss in the temples occurs because of three key factors: changes in the bone resulting in a concave appearance, wasting away of underlying muscle, and a reduction in the fat pad. The good news is that research tells us that fillers can be used effectively to treat sunken temples. Injecting facial filler(s) in the temple area can actually help you regain a more youthful look to the entire face.

Caution, like all the other areas of the face, lack of skill leading to improper injecting technique or injecting the wrong filler product may result in less than satisfactory outcomes.

Before you get treated, be sure your provider is experienced and expert in the procedure. Some doctors are not keen to even try to put injectable fillers in the temple area. So, it’s important to speak with a qualified and experienced aesthetic dermatologist.

At Aesthetic Dermatology and Skin Cancer: Jeffrey H. Binstock, M.D., we are experienced in providing our patients with this treatment as part of a comprehensive approach to facial rejuvenation. Call our San Francisco office at (415) 956-8686, or in Mill Valley call (415) 383-5475. Dr. Binstock, Dr. Layton, and Physician Assistant Stephanie Cullinane will answer your questions.

 

 

Satisfaction with Midface Volume Correction

The most important question for people considering midface volume correction is, “Have others been satisfied with the results, and would you agree to treatment again?”

In this study, researchers report that the answer, for a majority, is “yes.” However, one factor significantly affects the “yes” response. And it requires consideration by everyone thinking about facial rejuvenation with hyaluronic acid (HA) fillers.

Here’s what they did.

Researchers reviewed the records of 61 people who underwent treatment for facial volume loss correction using low-dose hyaluronic acid filler. Most (95%) were women.

Patients were treated with HA filler according to each doctor’s usual practice. Follow-up visits were made out to 12 months after treatment.

Here’s what we learned.

At 12 months after the procedure, 84% of patients were satisfaction with their treatment response.

Most (68% to100%) were willing to undergo HA treatment again.

How can we explain this wide spread of percentages?

One factor identified in these patients that was most likely to influence their willing to repeat the injections was the dose. For example, at 12 months, all 4 patients treated with greater than 2 mL of HA indicated they would undergo the procedure again.

The bottom line

Ultimately, the key to successful rejuvenation with HA filler goes beyond recognizing who can anatomically benefit. But it would be a mistake to conclude that if 2 mL were good, 5 mL will always be even better. Proper dosing is critical to satisfactory outcomes. And this is where the experience and expertise of a qualified board-certified aesthetic dermatologist are essential.

To see if you are a candidate for midface volume restoration with hyaluronic acid filler, contact Aesthetic Dermatology and Skin Cancer: Jeffrey H. Binstock, M.D. Dr. Binstock, Dr. Layton, and Stephanie Cullinane, PC-A will answer your questions. Call our San Francisco office at (415) 956-8686, or in Mill Valley call (415) 383-5475.

Satisfaction with CoolSculpting

Cryolipolysis (CoolSculpting®) is a proven method for body contouring. The mechanism behind the action of this procedure and its effectiveness have been discussed on this website. Essentially application of cold temperatures triggers fat cell death followed by slow digestion by white blood cells.

Of course, observable changes and the patient’s satisfaction with those changes are not necessarily the same thing. Fortunately, patent satisfaction has been studied, and the findings are encouraging, according to a survey of 518 treated patients in Belgium and France.

Here’s what they found.

The lower abdomen was most commonly treated (28%) along with the left and right flank (19% each).

Among those who responded to the survey, 89% had a positive perception of treatment, with 73% reporting satisfaction with the outcome. In line with these results, 82% of patients would recommend cryolipolysis to a friend.

It might be argued that these positive assessments are subjective. However, they are supported by caliper measurements demonstrating a 23% reduction in fat layer thickness at 3 months after treatment. Abdomen, back, and flank treatment sites were most effective, with 86% of patients showing improvement based on assessments by the researchers. Finally, the procedure was well-tolerated.

These finding in Europe are supported by a similar study of more than 500 people in California. In that group, CoolSculpting was also associated with “high patient satisfaction.”

The bottom line.

You might ask why satisfaction is not 100%, and is about 80% a good positive response? In fact, even after liposuction, patient satisfaction is about 80%.

In the field of aesthetic dermatology, no procedure can claim satisfaction by all those who receive it. Some patients inevitably have unrealistic expectations. In other cases, the person performing the procedure might not have the expertise and experience to maximize your benefit.

In California, the applicator may only be placed on the patient by a physician, physician assistant, or registered nurse, NOT by a medical assistant, licensed vocational nurse, or esthetician. Choose wisely the person treating you and be cautious about overly enthusiastic promises.

CoolSculpting at Aesthetic Dermatology and Skin Cancer: Jeffrey H. Binstock, M.D. follows a strict procedure that ensures you will enjoy the best results. For consultation and more information about our approach to CoolSculpting to achieve the best look for you, call our San Francisco office at (415) 956-8686, or in Mill Valley call (415) 383-5475. Dr. Binstock, Dr. Layton, and Stephanie Cullinane, PC-A will answer your questions.

Anxious About Your Mohs Surgery?

It’s not surprising that people scheduled for Mohs micrographic surgery experience anxiety. Today, Mohs surgery is accepted as the single most effective treatment for removing basal cell carcinoma and squamous cell carcinoma—the two most common skin cancers. So, not only are there issues with the physical procedure of skin surgery, one must also confront issues that accompany a cancer diagnosis.

Not surprisingly, the level of anxiety among Mohs surgery patients is higher than that experienced during a general dermatology visit or preceding biopsy for warts and skin tags.

Of course, the degree of distress varies. Not all people react the same to upcoming Mohs surgery. Some have trouble sleeping or shrink from social interaction, while others just find it nuisance.

What can be done?

There are lots of things dermatologists and their staff can do to help with psychological issues. It all starts with a conversation. The benefits of discussing your concerns with a medical professional—even just once—should never be underestimated.

At Aesthetic Dermatology and Skin Cancer: Jeffrey H. Binstock, M.D., we invite you to feel free to ask questions and share your concerns. Here are some suggested issues we can discuss.

  1. How does your skin disease make you feel?
  2. Are you having difficulty coping with the disease?
  3. Any changes in sleep or mood?
  4. Are you avoiding activities or social functions due to your condition.
  5. Do you find you are drinking or using medications or drugs before and during social events to help you relax?
  6. What are your expectations from treatment?
  7. Overall, how easy or hard is it to deal with anxiety, which is a natural part of the Mohs surgery experience?

For a consultation and more information about Mohs surgery and our approach to supporting you during this difficult time, contact Aesthetic Dermatology and Skin Cancer: Jeffrey H. Binstock, M.D. Dr. Binstock, USCF Fellowship Trained, will answer your questions. Call our San Francisco office at (415) 956-8686, or in Mill Valley call (415) 383-5475.

A Woman’s Lips and the Importance of First Impressions

A woman’s lips are the most attractive part of her body. During the first ten seconds after meeting a lady, the average man spends more than half his time gazing at her mouth.

Sue Leeson, who is marketing director of QVC, tell us, “It seems that no matter what your lips are like naturally, there is a solution for everybody.” So, it’s not surprising to learn that lip enhancement is one of the most frequently requested cosmetic procedures. It’s also technically demanding. To achieve the most aesthetically pleasing lips, the aesthetic dermatologist weaves art with science.

Getting Started

The goal for lip augmentation with dermal fillers like Restylane® Silk and Boletro® is to harmonize the appearance of the lips with other facial features. The process begins by applying the basic artistic principle known as DaVinci’s classic proportions—defined as PHI or the golden ratio.

Treatment targets as many as six anatomic areas: the philtrum columns, Cupid’s Bow, the vermilion-cutaneous junction, lower lip “pillows”, oral commissures, and the nasolabial creases. Each is shown in the photo.

Philtrum Columns 

Sculpted philtrum columns are in style. Yet, with age, these well-defined vertical columns are lost, leading to a flattened, unattractive upper lip. In such patients, it’s important to re-create them.

Cupid’s Bow

The pouty, Cupid’s Bow appearance of the central portion of the upper lip is considered sexy, desirable, and very much in fashion. Skilled placement of filler supports the projection of this area.

Vermillion Border

Precise injection technique is critical if this area is to be treated properly.

Careful! A common error that results from a poor understanding of the delicate features of the lip occurs when filler is placed too far along the border, leading to “sausage” or a “duck” lip.

Lower Lip “Pillows”

Adding volume to the areas has a sexy effect.

Oral Commissures

Proper injection technique here creates a natural looking pout.

Nasolabial Creases

Filling the nasolabial creases makes the upper lip turn outward for a natural looking pout.

The Bottom Line

Lips are one of the most sensual parts of a woman’s body and play a critical role in human sexual attraction, according to researcher, Dr. Geoff Beattie. Yet, each person has special needs and expectations—Caucasian women differ from African-American women, and from men, for that matter. There is no single prescription for a “perfect” lip, nor a “one size fits all” approach for lip augmentation.

In addition to a lip assessment, expect that your consultation with a member of our staff will include a discussion of treatment options, downtime after treatment, and medications you take and other conditions you may have. Photographs will aid before and after treatment assessments.

For a satisfactory aesthetic outcome, seek a board-certified aesthetic dermatologist who is experienced in evaluating and treating this complex soft tissue area. For consultation and more information about our approach to lip augmentation, contact Aesthetic Dermatology and Skin Cancer: Jeffrey H. Binstock, M.D. Drs. Binstock, Layton, and Physician Assistant Cullinane will answer your questions. Call our San Francisco office at (415) 956-8686, or in Mill Valley call (415) 383-5475.

Treating Age-Related Volume Loss in the Cheeks

Juvéderm Voluma® XC is a facial filler that uses a unique formulation of hyaluronic acid. It is designed to correct “age-related midface volume deficit.” In other words, it plumps up the cheeks! “XC” means there is a small amount of lidocaine in the product, which numbs the area during treatment.

Voluma XC differs from other hyaluronic acid fillers in several ways. First, it feels soft and natural in the skin. Second, Voluma XC may be less painful than other fillers because it is injected deeper into the skin where there are fewer nerves. Third, injecting deeper may also cause less bruising because it is injected under blood vessels. Fourth, the results typically last 9 to 12 months—some report up to 2 years. The duration of response is related to the area of the cheek treated and the dose. Follow-up treatments extend the duration of response.

Response to Initial Treatment

Immediately after treatment, 96% of 115 people treated with Voluma XC reported being “delighted” or “happy” with the results. Satisfaction was maintained by day 21.

Response to Initial Plus Follow-up Treatments

The volume of Voluma XC injected and the number of treatments extend the duration of satisfaction.

Table 1. Responders were those who achieved at least a 1-point improvement on the Mid-Face Volume Deficit Scale.

Table 1. Responders were those who achieved at least a 1-point improvement on the Mid-Face Volume Deficit Scale.

In a study of 235 adults initially treated with Juvéderm Voluma XC plus touch-up treatment available 30 days later, responders were those who achieved at least a 1-point improvement on the Mid-Face Volume Deficit Scale (Table 1). Six months after treatment, 76% to 83% of patients responded depending on the area of the cheek evaluated (Figure 1). Higher responder rates, up to 24 months, were achieved as the volume of Voluma XC injected and the number of treatments increased.

The Bottom Line

Figure 1. Month-6 response rates were 76% for zygomaticomalar, 83% for anteromedial cheek, and 77% for submalar regions.

Figure 1. Month-6 response rates were 76% for zygomaticomalar, 83% for anteromedial cheek, and 77% for submalar regions.

The development of newer hyaluronic acid fillers has created many products with subtle but important differences. Voluma XC requires special training and experience to use it correctly. If the person injecting your face doesn’t appreciate how Voluma XC differs from other fillers and lacks experience injecting Voluma WC, you will not get the full benefit for the money spent.

Further, if your doctor doesn’t have an artistic eye and an understanding of how Voluma XC can bring harmony to the anatomical changes that accompany aging, you could leave the office looking really fake.

Don’t look really fake. For consultation and more information about our approach to using facial fillers, including Juvéderm Voluma XC, to achieve the best look for you, contact Aesthetic Dermatology and Skin Cancer: Jeffrey H. Binstock, M.D. Drs. Binstock and Layton will answer your questions. Call our San Francisco office at (415) 956-8686, or in Mill Valley call (415) 383-5475.

Mohs Surgery for People 75 and Older

Mohs micrographic surgery, named for Frederic Mohs, the surgeon who invented it, is the single most effective technique for removing basal cell carcinoma and squamous cell carcinoma, the two most common skin cancers. It’s also used to treat melanoma, a potentially deadly skin cancer.

At Aesthetic Dermatology and Skin Cancer: Jeffrey H. Binstock, M.D., we have extensive experience in performing Mohs micrographic surgery.

What We Know About Mohs and the Older Patient

Mohs surgery is performed on over 800,000 tumors per year in the United States, with approximately half performed on Medicare beneficiaries. A just published study of patients 75 years and older who underwent Mohs surgery reveals encouraging findings, as well as important takeaways for older people.

First, the clear majority (90%) of patients in this age group with skin cancer are highly functional and care for themselves. On average, they carry on normal activity, with minor or no signs or symptoms of disease. For people in their 8th decade of life, they do quite well.

However, lower functioning patients—disabled or require occasional of frequent assistance in performing daily activities—are likely to have larger, tumors with symptoms that negatively impact their lives.

The Bottom Line

Skin cancer is a common occurrence. Each year there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung, and colon! Between 40% and 50% of Americans who live to age 65 will have either basal cell carcinoma or squamous cell carcinoma at least once. And yes, one type of skin cancer, melanoma, can be deadly if it spreads throughout the body.

Photos. Most common skin cancers

Photos. Most common skin cancers

Effective Mohs surgery is available. So, there’s no reason to allow skin cancer to slow you down. Most people in their 70s today are living active lives. An important part of their activity should include self-examination for odd-looking moles and spots on the skin (Photos). You should also see a dermatologist to determine if annual examinations in the doctor’s office are right for you.

For people who are disabled or require occasional of frequent assistance in performing daily activities, evaluation by a caregiver or doctor is even more important to ensure that tumors are detected before they grow large and further impair quality of life.

For more information about self-examination and treatment by experienced Mohs surgeons, contact Aesthetic Dermatology and Skin Cancer: Jeffrey H. Binstock, M.D. Dr. Binstock, USCF Fellowship Trained, and Dr. Layton will answer your questions. Call our San Francisco office at (415) 956-8686, or in Mill Valley call (415) 383-5475.

Body Contouring Using CoolSculpting

Did you know that body contouring is among the most common cosmetic surgical procedures performed in the United States? The American Society for Aesthetic Plastic Surgery reports that it is more popular than breast augmentation.

CoolSculpting® (technically known as cryolipolysis) involves placement of a CoolSculpting device that combines vacuum suction with regulated cooling to impede blood flow in just the area being treated. This results in crystallization and removal of the targeted fat tissue. Importantly, at the temperatures used, cryolipolysis is limited to fat cells and has have no permanent effect on overlying dermis and epidermis tissues.

Not for Weight Loss

Cryolipolysis is not used to help people lose weight; and it is not an alternative to diet and exercise. Rather, Coolsculpting is replacing liposuction as the go-to procedure for body contouring. Our office has been doing this procedure for over 4 years.

CoolSculpting achieves body contouring by targeting stubborn localized areas of fat. Areas of treatment include “love handles,” the upper and lower abdomen, upper arm, and inner and outer thigh. Men also find CoolSculpting useful to sculpt the chest.

Response to CoolSculpting

While some patients may see results as early as 3 weeks after initial treatment, the most dramatic results are usually seen between 1 and 3 months following treatment.

Among 19 studies of cryolipolysis, each reported a significant reduction in fat volume in treated areas. The average 2- to 6-month reduction in fat volume ranged from 15% to 29%. The researchers concluded, “Cryolipolysis is a promising procedure for nonsurgical fat reduction and body contouring and presents a compelling alternative to liposuction and other, more invasive methods.”

Following two treatments in the hip and thigh area, the average fat layer reduction was 29% compared with 20% for patients receiving only one treatment.

Most, importantly, it was possible for people not involved in the treatment to see improvement in 79% to 89% of patients. And, most people can return to their normal activities immediately after CoolSculpting.

Importance of a Qualified Professional When CoolSculpting

When performed by a qualified and experienced aesthetic dermatologist, CoolSculpting has a low risk of side effects. During the 2 weeks following cryolipolysis there is minimal discomfort, with less than 1% of patients experiencing pain, which goes away without treatment. Other side effects are temporary redness, bruising, and short-lived numbness.

But like any medical procedure, inexperience can lead to unwanted results.  For example, earlier this year a patient experienced frostbite following CoolSculpting treatment for love handles performed in a beauty salon. It appears that the person performing cryolysis didn’t recognize the early signs. In fact, medical attention was not sought until one week later.

In California, the applicator may only be placed on the patient, by a Physician, Physician Assistant, Registered Nurse, NOT by a Medical Assistant, Licensed Vocational Nurse, nor an Esthetician.

The authors rightly concluded, “Emphasis must be placed on increasing patient awareness of the potential hazards of seeking cosmetic treatment from unregulated providers.”

CoolSculpting at Aesthetic Dermatology and Skin Cancer: Jeffrey H. Binstock, M.D. follows a strict procedure that ensures you will enjoy the best results. For consultation and more information about our approach to CoolSculpting to achieve the best look for you, call our San Francisco office at (415) 956-8686, or in Mill Valley call (415) 383-5475.

Two New Treatments for Laugh Lines

Two new facial fillers—Restylane® Refyne and Restylane® Defyne—are now approved by the U.S. Food and Drug Administration and are offered as treatment options by Aesthetic Dermatology and Skin Cancer: Jeffrey H. Binstock, M.D.

Photo. The nasolabial folds commonly known as "smile lines" or "laugh lines", are the two skin folds that run from each side of the nose to the corners of the mouth.

Photo. The nasolabial folds commonly known as “smile lines” or “laugh lines”, are the two skin folds that run from each side of the nose to the corners of the mouth.

Both fillers target moderate-to-severe “laugh lines” in adults. This is the area known as nasolabial folds (NLF), which extend from the nose to corners of the mouth, as shown in the photo. Restylane Refyne is designed to treat moderate wrinkles and folds, while Restylane Defyne is meant to plump and fill deep-set lines.

Refyne is the softer of the two, better for thinner skin, Defyne is the thicker product with more  up lift and better for thicker skin. Both products can be used off label in other facial areas such as the oral commissures, marionette lines, cheeks etc.

Here’s What We Know about Refyne and Defyne

Both injectable products are based on hyaluronic acid—the most commonly used injectable for facial rejuvenation. They differ from other products in the class because of a unique manufacturing process called XpresHAn Technology, which gives a more natural-looking appearance due to “cohesiveness”—the ability of a filler to “stick to itself” and blend with the surrounding tissues.

Although new to patients in the U.S., both fillers were approved for use in Europe back in 2010. So, there’s lots of experience with them; and this positive experience has been confirmed in two studies in the U.S. These studies are referred to as “Natural Expression” and “Dynamic Strain.”

Natural Expression Study

In this study, the product selected (Restylane Refyne or Restylane Defyne) and the amount injected in each of 63 women was based on the assessment by an expert in facial aesthetic procedures. Following correction of wrinkles and folds along the NLF in the lower face, each woman rated the naturalness of their appearance of facial contractions during movement and at rest (natural expression).

There was broad agreement among 95% (60/63) of the women treated that attractiveness was enhanced. In addition, 89% (56/63) of women reported that attractiveness was enhanced, while 79% (50/63) agreed they looked younger.

Dynamic Strain Study

As in the Natural Expression Study, this study evaluated the naturalness of facial expressions following correction of wrinkles and folds along the NLF. It differs in that facial expressions were measured three dimensionally to objectively (and dynamically) record surface strain on the skin.

The results from 30 women (40 to 65 years old) showed a statistically significant reduction in the average peak dynamic strain for various standardized expressions one-month after treatment compared to before treatment.

Importantly, the women agreed. More than 8 out of 10 reported enhanced attractiveness. They thought they looked younger, with a naturalness of their expressions.

Both Restylane Refyne and Restylane Defyne were well-tolerated by the women taking part in the studies. Initial treatment injection site responses (redness, swelling, bruising, lump/bump formation, pain/tenderness) were predominantly mild-to-moderate in intensity and resolved in one to two weeks.

Which Treatment Is Right for You?

These products offer the latest advances in the ongoing effort to provide improved treatment for aging skin. But which treatment is right for you?

As treatments improve and become specialized, the role of an expert board-certified aesthetic dermatologist to recognize the best option and then to achieve the best results becomes ever more important.

For consultation and more information about our approach to using facial fillers to achieve the best look for you, contact Aesthetic Dermatology and Skin Cancer: Jeffrey H. Binstock, M.D. Drs. Binstock, Layton, and Physician Assistant Cullinane will answer your questions. Call our San Francisco office at (415) 956-8686, or in Mill Valley call (415) 383-5475.

 

 

A Woman’s Lips and the Importance of First Impressions

A woman’s lips are the most attractive part of her body. During the first ten seconds after meeting a lady for the first time, the average man spends more than half his time gazing at her mouth.

Sue Leeson, who is marketing director of QVC, tell us, “It seems that no matter what your lips are like naturally, there is a solution for everybody.” So, it’s not surprising to learn that lip enhancement is one of the most frequently requested cosmetic procedures. It’s also technically demanding. To achieve the most aesthetically pleasing lips, the aesthetic dermatologist must weave art with science.

Getting Started

The goal for lip augmentation with dermal fillers like Restylane® Silk and Boletro® is to harmonize the appearance of the lips with other facial features. The process begins by applying the basic artistic principle known as DaVinci’s classic proportions—defined as PHI or the golden ratio.

Treatment targets as many as six anatomic areas: the philtrum columns, Cupid’s Bow, the vermilion-cutaneous junction, lower lip “pillows”, oral commissures, and the nasolabial creases. Each is shown in the photo.

Philtrum Columns 

Sculpted philtrum columns are in style. Yet, with age, these well-defined vertical columns are lost, leading to a flattened, unattractive upper lip. In such patients, it’s important to re-create them.

Cupid’s Bow

The pouty, Cupid’s Bow appearance of the central portion of the upper lip is considered sexy, desirable, and very much in fashion. Skilled placement of filler supports the projection of this area.

Vermillion Border

Precise injection technique is critical if this area is to be treated properly. Careful! A common error that results from a poor understanding of the delicate features of the lip occurs when filler is placed too far along the border, leading to a “sausage” or “duck” lip.

Lower Lip “Pillows”

Adding volume to the areas has a sexy effect.

Oral Commissures

Proper injection technique here creates a natural looking pout.

Nasolabial Creases

Filling the nasolabial creases makes the upper lip turn outward for a natural looking pout.

The Bottom Line

Lips are one of the most sensual part of a woman’s body and play a critical role in human sexual attraction, according to researcher, Dr. Geoff Beattie. Yet, each person has special needs and expectations—Caucasian women differ from African-American women and from men, for that matter. There is no single prescription for a “perfect” lip, nor a “one size fits all” approach for lip augmentation.

In addition to a lip assessment, expect that your consultation with the aesthetic dermatologist will include a discussion of treatment options, downtime after treatment, and medications and other conditions you may have. Photographs will aid before and after treatment assessments.

For a satisfactory aesthetic outcome, seek a board-certified aesthetic dermatologist who is experienced in evaluating and treating this complex soft tissue area. For consultation and more information about our approach to lip augmentation, contact Aesthetic Dermatology and Skin Cancer: Jeffrey H. Binstock, M.D. Drs. Binstock, Layton, and Physician Assistant Cullinane will answer your questions. Call our San Francisco office at (415) 956-8686, or in Mill Valley call (415) 383-5475.