Tag Archives: facial rejuvenation

Here’s What to Look for in a Qualified Aesthetic Dermatologist

Frequently on the Aesthetic Dermatology and Skin Cancer: Jeffrey H. Binstock, M.D. website we caution readers to be careful when selecting the provider who will use fillers and other injectables on your face.

But how do you judge competency and experience?

Certainly, you can ask friends, but generally their experience is anecdotal—limited to just one or two people who treated them in the past. Or, perhaps they have a friend who has a friend.

The fact is that the best results from treatment depend on many factors, including the exact purpose for using a filler, its known limitations, any interaction between the filler and your skin, and, of course, proper placement of the filler under your skin.

Here’s what to look for during your initial consultation with the person doing the injecting.

First, meet with the provider who will do perform the treatment. Describe what you want done and that you know there are lots of fillers that could be used. Which one is best for you, and why? The FDA has posted a list of fillers with descriptions here.

The person doing the injecting must be thoroughly familiar with all filler option—one size does not fit all.

Second, training and experience count. Ask where the person doing the injection went to school. They should have a degree from an accredited medical school, preferably with a post-doctoral degree. For example, in addition to receiving his degree in medicine and years of experience in aesthetic dermatology, Dr. Binstock’s training includes a prestigious Fellowship at UCSF. Today, he is Clinical Professor of Dermatolgy [Volunteer] at the University California San Francisco.

Then, ask about for how long the person doing the injecting has been providing this service in an aesthetic dermatology practice.  Theoretical knowledge can be learned from books, but practical knowledge is best acquired through experience treating many patients over many years. How many people does he or she treat with fillers each week?

Finally, cost. We all look for the best price, that’s normal. But if the cost is too good to be true, be cautious. Ask about the source of the fillers. Sometimes, cheaper prices are charged because drugs being injected come from outside the U.S. and are not approved for use by the U.S. Food and Drug Administration (FDA).

Seek a board-certified aesthetic dermatologist who is experienced in facial rejuvenation. For consultation, 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.

Benefits of a Long-term Strategy for Facial Rejuvenation

Today we know that repeated treatments with Botox® lead to improved results long-term, while the response to fillers appears to continue beyond the initial treatment period. Both have implications for achieving the best response possible when applied as part of a strategy for facial rejuvenation.

“The greatest benefits,” according to international experts, “are obtained if patients return for treatment when the previous results start to diminish rather than after they disappear completely.”

Support for follow-up Botox injections comes from a review of 194 patients who received Botox treatments over an average of 9 years for the vertical wrinkles that developed between their eyebrows—commonly known as frown lines. Ongoing evaluation and treatments as needed lead to sustained improvement and, most importantly, “very high patient satisfaction!” Those treated for longer periods reported greater perceived benefits in terms of increased pliability and elastic recoil.

The long-term restorative potential of hyaluronic acid filler (Juvéderm® Ultra) was shown among more than 350 patients. Improvement persisted beyond the time that could be accounted for by space-filling effects alone! It is suggested that in these patients there was an up-regulation in collagen and elastin formation after injection of the filler—a response not seen when saline is injected.

The bottom line.

We keep learning more about facial fillers and Botox. Now more than ever, consultation with an expert aesthetic dermatologist is essential for anyone seeking to restore a youthful facial appearance. For a consultation and more information about the benefits of fillers and Botox for you, contact Aesthetic Dermatology and Skin Cancer: Jeffrey H. Binstock, M.D. Drs. BinstockLayton, 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.

One Person’s Experience with Treating Brown Spots

Facial appearance doesn’t always reflect chronological age; some people look younger or older than they really are. We all know that changes in skin such as wrinkles and sagging make us appear older than our years. Brown spots on your skin also make you appear older, particularly to younger people you meet every day.

When researchers in Paris looked at facial features of Caucasian women between 20 to 74 years old, they found that the presence of brown spots (aka age spots, liver spots, sun spots) caused younger people to overestimate the age of a women. In other words, brown spots influence your younger friends and business associates to conclude you are older than you really are.

Exposure to sunlight influences the number and locations of these spots. Higher exposure leads to more spots, whereas people with less exposure tend to have fewer of these blemishes. Fortunately, brown age spots can be removed by a qualified aesthetic dermatologist using Excel V™ laser treatment. This laser emits a tunable pinpoint beam of light that triggers elimination of melanin, which removes the brown spots.

One person’s experience

Sarah’s story is based a composite of patients who typically develop brown spots on their skin. She is an active native Southern Californian who loves playing beach volleyball. Sara applies sunscreen to her face but not on here body; and since turning 40, the spots “just keep appearing”.

Two 15-minute Excel V treatments done last year removed a large sunspot along her hair line and another on her left cheek. Smaller ones on the other cheek were successfully treated.

Sara continued to play beach volleyball, and over time the spot on her right cheek returned, despite using sunscreen. Additional treatments, targeted her face and proceeded down her body—legs, arms, and chest. The spots changed color and then “fell off” after a week or two.

Laser treatment for your brown spots

Brown spots are stubborn, and some people may require several treatment sessions. Immediately after treatment, the area becomes gray/purplish for up to a week. So, plan for some downtime. Soon the treated skin will regain the correct pigment, which matches surrounding skin. Following treatment, you must use SPF 30 and properly care for the skin.

Skillful use of the Excel V laser is a good treatment option for many people with brown spots. At Aesthetic Dermatology and Skin Cancer: Jeffrey H. Binstock, M.D. we have extensive experience using Excel V. You can read more about how it works here.

For a consultation and more information, 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.

The Basics of “Syringe Therapy” for Non-Surgical Facial Rejuvenation

Did anyone ever tell you that you have a baby face? A big part of a “baby face” is the presence of full, round cheeks. Over time, that baby face you enjoyed early in life is lost due to an ongoing complex process that involves two important factors.

First, there’s a loss and displacement of fat and collagen that cause volume loss throughout the face. The forehead, temples, cheeks, and areas around the eyes and mouth shift downward. Features that were round are now sunken, and you lose that full look. Meanwhile, other parts of the face get baggy, especially around the chin and jowls.

Second, repetitive facial muscle movements cause wrinkles and folds, which are sometimes referred to as expression or animation lines. One way to look at it is that the increasing wisdom and experience associated with age is “paid” for with hollow cheeks and wrinkles.

The good news is that it’s possible to design individualized treatment based on your special needs. The skillful use of dermal fillers, botulinum toxin, and Kybella® can rejuvenate that youthful appearance so many of us desire.


Dermal fillers work by providing support for facial structures. When used properly by an experienced aesthetic dermatologist, fillers can be used throughout the face. They can raise the eyebrows, fill the tear trough, reshape the nose, and lift the nose tip. They fill in “smile lines” or “laugh lines”, as well as the downturned lines at the corners of your mouth. Filler can be used to raise the cheekbones, reshape the jaw line, and rejuvenate the temple area.

Today, many different types of fillers are available. Each is unique. They differ in their ingredients, concentration, duration of effect, and more. Some include a local anesthetic. In addition, the Food and Drug Administration (FDA) approves fillers for use in specific areas of the face based on research in patients. Your provider can use these fillers “off label” to treat many facial areas not specifically FDA “approved”

Limiting yourself to one filler may give less than optimal outcomes. For many people, the skillful use of these drugs in combination with botulinum toxin (described below) yields the most satisfying results.

Botulinum toxin

Botulinum toxin injection is an effective treatment for fine lines and wrinkles on the face that appear because of contraction and relaxation of facial muscles. Examples include, crow’s feet around the eyes due to smiling, worry lines on the forehead due to raising the eyebrows, and frown lines between the eyebrows due to concentrating or grimacing when you’re angry.

Botox® was the first drug to use botulinum toxin. Now, three others are available. Each is a little different, particularly when it comes to dosing, so they aren’t interchangeable. We prefer to use BOTOX.


Kybella is the first FDA-approved non-surgical injectable treatment for adults with moderate or severe fat below the chin (double chin). It’s a synthetic form of deoxycholic acid, which is a bile salt naturally produced by the body.

Kybella works by breaking down the cell membrane, and once the fat cells dissolve, your body absorbs and metabolizes the fat in them.

The bottom line.

Skillful selection and use of these products (often in combination, and with regular maintenance treatments) offer an opportunity to restore your youthful appearance. More on fillers, Botox, Kybella  and combination treatments can be found throughout the Beauty Before Age™ website.

For a consultation and more information, 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.