Bruce P.Robinson, MD

PRO-NOX Nitrous Oxide

Breeze through pain-free, anxiety free cosmetic treatments with ProNox.

We are pleased to introduce ProNox™ in our practice, a patient controlled, inhaled analgesia for in-office use. We want our patients to achieve their cosmetic goals worry-free. Patients say that it has made all the difference in moving forward with many cosmetic procedures.

The use of nitrous oxide in Medical, Cosmetic & Laser Dermatologic procedures is becoming more common. Our goal is to provide each patient with a pain-free experience and to work with their varied anxiety levels. While we have excellent topical numbing options for pain control, nitrous oxide can help calm the patient who is nervous or anxious and also help with pain relief.

Liquid Face Lift

What should you know about the procedure before finalizing your decision? We consider these the five most important distinctions.

Liquid Face Lifts Are Perfect For Long Lasting, But Impermanent Improvements

While a facelift lasts anywhere from 5 to 10 years, a liquid facelift typically lasts up to 4 - 6 months, for the best possible and longest-lasting results. This makes the procedure a good choice for patients who want apparent improvement, but aren’t quite ready for a surgical facelift or mini facelift—whether due to inhibitions about the surgery or because one’s signs of facial aging aren’t yet very dramatic.

Improvements Can Be Made In Increments

Results of a liquid facelift are evident almost immediately. But since the procedure has so much potential, it’s possible that more than one treatment session would be needed for the best results. This allows improvements to be made incrementally. Some patients appreciate the fact this allows their results to come in more gradually and thus look more natural.

All Areas Of The Face Can Be Improved

A liquid facelift has excellent potential, but it should be understood from the outset that since no incisions are made and no actual surgery is performed, its results will naturally fall shy of what a complete surgical facelift can accomplish. But let’s look at what a liquid facelift can achieve: 

  • Add volume to the cheeks, temples, and lip area
  • Smooth out wrinkles in all areas of the face
  • Lift and plump up the cheeks
  • Reduce the appearance of scars and other “imperfections”

They Are More Affordable Than Regular Face Lifts

A liquid facelift is cheaper and more affordable than a facelift or mini facelift, with the exact cost depending upon how much of what types of fillers are needed to help you reach your goals for the procedure. Health insurance does not cover the cost of a facelift or a liquid facelift.

Most Dermal Fillers Used Are Made Of Naturally Occurring Ingredients 

A liquid facelift is done with a combination of dermal fillers and neuromodulators. That means fillers like Radiesse®, Juvéderm®, Belotero®, Restylane® will be used to plump and add volume to the skin in deprived areas, while neuromodulators like Botox will be used to reduce the appearance of fine lines and facial wrinkles. 

The art of a liquid facelift lies in how it’s done precisely. How much of what fillers are applied in what portions of the face? Dr. Bruce Robinson has mastered this art and looks forward to helping you achieve your facial beauty goals—without surgery, without incisions, and with minimal downtime. 

Please contact our office today for more information or a personal consultation.

BOTOX® Cosmetic

Smile, laugh, frown, and make all the facial expression you want and stop worrying about wrinkles

After years of sun, squinting, laughing, frowning, smoking, and worrying, the skin around the eyes and on the forehead will often develop deep lines and wrinkles called “expression lines.” A frequent concern is that they often make you look older, tired, or stressed. Until recently, these advanced furrows have been difficult to treat. Now, by utilizing this FDA approved temporary muscle-relaxing agent, you can reduce "permanent expression lines". Botox® is a “neuromodulator,” an extremely popular agent used to treat the lines of motion that are accentuated with facial movement and expression. It is one of our favorite procedures to perform because of the extremely high patient satisfaction rate, and a great place to start if you are considering a cosmetic procedure for the first time.

Botox uses:

  • Wrinkles of the Face
  • Crow’s Feet
  • Frown and Worry Lines
  • Drooping Brow – Brow Lift
  • Bunny Lines of the Nose
  • Excessive Sweating

What age should you start Botox?

If you want to prevent the earliest fine lines from becoming full-blown wrinkles, preventative Botox can be the solution. Botox is approved for patients who are 18 years and older and most experts agree that patients in their mid to late 20s and early 30s are at a good age for preventative Botox treatment.

What is treatment like?

With a very fine needle, BOTOX is painlessly injected into the specific muscle that is contracting and causing the lines and wrinkles on the face. No anesthetic is required. Treatment is effective, safe, and takes approximately 10 minutes. Immediately following treatment you may resume regular activities.

How long does a BOTOX treatment last?

The effects usually last 3 to 4 months, and fade away gradually. Following several treatments, the results may last 4 to 8 months or longer. BOTOX offers extended relief over the course of long-term treatment.

Are there any possible side effects?

Side effects of BOTOX, if any, are usually mild and temporary. Botulinum toxins contain proteins, which in some circumstances may be naturally safeguarded against by the body?s ability to produce antibodies. If antibodies are formed, the therapy will generate a lesser response. Temporary bruising, mild pain and swelling are sometimes experienced, though these symptoms resolve on their own within 3 to 5 days. In rare cases, there can be a slight drooping of an eyelid or asymmetry of expression. If this should happen return to our office.

Here is a short guide of the do’s and don’ts after having Botox.

The do’s:

  • Frown repeatedly for about one hour immediately following the treatment. This will help the treatment to be more effective by increasing the uptake by the targeted muscle groups, then after this time try to avoid extreme facial expressions for the next 12 hours
  • Keep upright for the first 4 hours
  • You can gently apply light make-up after treatment but use a light dabbing motion instead of a rubbing or spreading motion

The don’ts :

  • Do not rub or massage the treated area and avoid make-up if possible.
  • Avoid sleeping on your face the first night
  • Do not exercise or partake in any strenuous activity for the next 12 hrs
  • Avoid excessive alcohol consumption for the next 24hrs
  • Do not have any beauty treatments on your face e.g. facials, facial massage for 2 weeks- this may cause the injected solution to spread to nearby muscles.
  • Avoid exposure to strong sunlight, very cold temperatures and saunas for the next 2 weeks

What type of results will I see?

Typically, the effect of BOTOX is visible within 5 -7 days. Maximum benefits are reached between 10 to 14 days. Once the muscle becomes dormant and the skin softens, you will have a more relaxed and youthful appearance. BOTOX treatments are not a substitute for the results achieved with a facelift. The optimum appearance may be achieved with BOTOX therapy in conjunction with a facelift, dermal fillers, laser resurfacing, and skin rejuvenation.

What is BOTOX?

BOTOX is a therapeutic muscle-relaxing agent derived from the bacterium, Clostridium Botulinum. For over a decade ophthalmologists have applied BOTOX for it's original intention, the treatment of blepharospasm. Physicians have utilized BOTOX for years as a cosmetic treatment to correct visible signs of stress and aging.

How does BOTOX work?

The contractions and movements of the facial muscles are controlled by signals from the brain. BOTOX simple prevents the muscle from allowing responses to these messages. As a result, the muscle relaxes and the overlying skin remains unwrinkled and smooth.

Botox for excessive sweating/hyperhidrosis:

Botox injections have been FDA approved to treat excessive sweating. In the skin, Botox selectively turns off the sweat glands resulting in a normal appearance without wetness. Treatment is performed during an outpatient clinic visit and no recuperative time or special care is needed afterward.

Before and After Images:

Wrinkles and Fine Lines

Wrinkles are caused by the natural aging process, expressions made by muscles and sun damage. Using Sunscreen daily is the Holy Grail Anti-Aging product. Today there are many treatments available to help reduce fine lines and wrinkles on the skin. For deeper creases, a person may require more aggressive technique. With the latest treatments such as Botox, Fillers, Ultherapy, TempSure, and Fraxel laser skin resurfacing, wrinkles can appear less noticeable and even be prevented. These treatments are easy in office procedures that require little to no social downtime. The results can be immediate or seen in just a few weeks. Say "Good-bye" to wrinkles and fine lines and hello to beautiful, younger, smoother looking skin.

Cosmetic Consultation Reimbursement Policy

Cosmetic Consultation Reimbursement policy offered to all patients. Come discuss your needs and goals with Dr. Robinson and the office visit cost will be applied to future costs for the discussed procedure. Procedure must be completed within 30 days of your consult visit.

Vitiligo

Vitiligo is a skin condition resulting from the loss of pigment which produces white patches. Any part of the body may be affected. Usually both sides of the body are affected. Common areas of involvement are the face, lips, hands, arms, legs, and genital areas.

Who Gets Vitiligo?

Vitiligo affects one or two of every 100 people. About half the people who develop it do so before the age of 20; about 1/5 have a family member with this condition. It may be an autoimmune process (the body makes antibodies to its own pigment cells). Most people with vitiligo are in good general health, although vitiligo may occur with other autoimmune diseases such as thyroid disease

What Determines Skin Color?

Melanin, the pigment that determines color of skin, hair, and eyes, is produced in cells called melanocytes. If these cells die or cannot form melanin, the skin becomes lighter or completely white

How Does Vitiligo Develop?

Typical vitiligo shows areas of milky-white skin. However, the degree of pigment loss can vary within each vitiligo patch. There may be different shades of pigment in a patch, or a border of darker skin may circle an area of light skin.

Vitiligo often begins with a rapid loss of pigment. This may continue until, for unknown reasons, the process stops. Cycles of pigment loss, followed by times where the pigment doesn't change, may continue indefinitely.

It is rare for skin pigment in vitiligo patients to return on its own. Some people who believe they no longer have vitiligo actually have lost all their pigment and no longer have patches of contrasting skin color. Although their skin is all one color, they still have vitiligo.

The course and severity of pigment loss differ with each person. Light-skinned people usually notice the contrast between areas of vitiligo and suntanned skin in the summer. Year round, vitiligo is more obvious on people with darker skin. Individuals with severe cases can lose pigment all over the body. There is no way to predict how much pigment an individual will lose.

How is Vitiligo Treated?

Sometimes the best treatment for vitiligo is no treatment at all. In fair-skinned individuals, avoiding tanning of normal skin can make areas of vitiligo almost unnoticeable because the (no pigment) white skin, of vitiligo has no natural protection from sun. These areas are easily sunburned, and people with vitiligo have an increased risk to skin cancer. A sunscreen with a SPF of at least 30 should be used on all areas of vitiligo not covered by clothing. Avoid the sun when it is most intense to avoid burns.

Disguising vitiligo with make-up, self-tanning compounds or dyes is a safe, easy way to make it less noticeable. Waterproof cosmetics to match almost all skin colors are available. Stains that dye the skin can be used to color the white patches to more closely match normal skin color. These stains gradually wear off. Self-tanning compounds contain a chemical called dihydroxyacetone that does not need melanocytes to make the skin a tan color. The color from self-tanning creams also slowly wears off. None of these change the disease, but they can improve appearance. Micropigmentation tatooing of small areas may be helpful.

If sunscreens and cover-ups are not satisfactory, your doctor may recommend other treatment. Treatment can be aimed at returning normal pigment (repigmentation) or destroying remaining pigment (depigmentation). None of the repigmentation methods are permanent cures.

Treatment of Vitiligo in Children

Aggressive treatment is generally not used in children. Sunscreen and cover-up measures are usually the best treatments. Topical corticosteroids can also be used, but must be monitored. PUVA, an ulta-violet therapy, is usually not recommended until after age 12, and then the risks and benefits of this treatment must be carefully weighed.

Repigmentation Therapy

Topical Corticosteroids — Creams containing corticosteroid compounds can be effective in returning pigment to small areas of vitiligo. These can be used along with other treatments. These agents can thin the skin or even cause stretch marks in certain areas. They should be used under your dermatologist's care.

PUVA

PUVA is a form of repigmentation therapy where a type of medication known as psoralen is used. This chemical makes the skin very sensitive to light. Then the skin is treated with a special type of ultraviolet light call UVA. Sometimes, when vitiligo is limited to a few small areas, psoralens can be applied to the vitiligo areas before UVA treatments. Usually, however, psoralens are given in pill form. Treatment with PUVA has a 50 to 70% chance of returning color on the face, trunk, and upper arms and upper legs. Hands and feet respond very poorly. Usually at least a year of twice weekly treatments are required. PUVA must be given under close supervision by your dermatologist. Side effects of PUVA include sunburn-type reactions. When used long-term, freckling of the skin may result and there is an increased risk of skin cancer. Because psoralens also make the eyes more sensitive to light, UVA blocking eyeglasses must be worn from the time of exposure to psoralen until sunset that day to prevent an increased risk of cataracts. PUVA is not usually used in children under the age of 12, in pregnant or breast feeding women, or in individuals with certain medical conditions.

Narrow Band UVB (NBUVB)

This is a form of phototherapy that requires the skin to be treated two, sometimes three, times a week for a few months. At this time this form of treatment is not widely available. It may be especially useful in treating children with vitiligo.

Grafting

Transfer of skin from normal to white areas is a treatment available only in certain areas of the country and is useful for only a small group of vitiligo patients. It does not generally result in total return of pigment in treated areas.

Other Treatment Options

Other treatment options include a new topical class of drugs called immunomodulators. Due to their safety profile they may be useful in treating eyelids and children. Excimer lasers may be tried as well.

Depigmentation Therapy

For some patients with extensive involvement, the most practical treatment for vitiligo is to remove remaining pigment from normal skin and make the whole body an even white color. This is done with a chemical called monobenzylether of hydroquinone. This therapy takes about a year to complete. The pigment removal is permanent.

Is Vitiligo Curable?

At this time, the exact cause of vitiligo is not known, however, there may be an inherited component. Although treatment is available, there is no single cure. Research is ongoing in vitiligo and it is hoped that new treatments will be developed.

Venous Lake

Time To Smile Again ... A venous lake is a benign, soft, compressible blue bump usually found on or around the lips caused by a dilated vein. While it is benign it can be cosmetically unsightly. With the use of the Nd:YAG laser a venous lake can be treated within seconds and resolved without scarring.

What To Expect:

  • Procedure Time: Literally Seconds
  • Back To Work: Immediately
  • Anaesthetic: Not Required
  • Sensitivity Period: One Week +
  • Visible Results: 4 - 6 weeks
  • Number of Treatments: 1 -2 
  • Possible Side Effects: Soreness, Blistering, Swelling
  • Duration of Results: Permanent

FAQ's:

Is It Safe? The Nd:YAG laser is clinically proven to be both safe and effective.

How Does It Work? Treatments target the blood in the venous Lake lesion, causing it to regress.

Is The Treatment Suitable For Me? This procedure can be used on all skin types and treatment is suitable for most people.  However, prior to treatment please review our cosmetic reimbursement policy. 

Tinea Versicolor

Tinea versicolor is a common skin condition due to overgrowth of a skin surface yeast. This overgrowth results in uneven skin color and scaling that can be unsightly and sometimes itch. The yeast normally lives in the pores of the skin and thrives in oily areas such as the neck, upper chest, and back. Tinea versicolor has small, scaly white-to-pink or tan-to-dark spots which can be scattered over the upper arms, chest and back. They may sometimes appear on the neck and the face. On light skin, Tinea versicolor may be faint or can appear as tan-to-pink spots, while on dark skin Tinea versicolor may be light or dark. The fungus grows slowly and prevents the skin from tanning normally. As the rest of the skin tans in the sun, the pale spots, which are affected by the yeast, become more noticeable, especially on dark skin.

What does Tinea Versicolor look like and how do you recognize it?

Tinea versicolor has small, scaly white-to-pink or tan-to-dark spots which can be scattered over the upper arms, chest and back. They may sometimes appear on the neck and the face. On light skin, Tinea versicolor may be faint or can appear as tan-to-pink spots, while on dark skin Tinea Versicolor may be light or dark. The fungus grows slowly and prevents the skin from tanning normally.

What are the symptoms?

Tinea Versicolor usually produces few symptoms. Occasionally, there is some slight itching that is more intense when a person gets hot.

Who may get this rash?

Most people get tinea versicolor when they are teenagers or young adults. It is rare in the elderly and children, except in tropical climates where it can occur at any age. Both dark and light skinned people are equally prone to its development. People with oily skin may be more susceptible than those with naturally dry skin.

The yeast is normally present in small numbers on everyone's skin. Anyone can develop an overgrowth of yeast. During the summer months when the temperature and humidity are high, the yeast can increase. The excess yeast on the skin prevents the normal pigmentation process, resulting in light and dark spots. In tropical countries with continuous high heat and high humidity, people can have these spots year round. In other climates, the spots generally fade in the cooler and drier months of the year. Why some people get tinea versicolor and others do not is unclear.

In tropical countries with continuous high heat and high humidity, people can have these spots year round. In other climates, the spots generally fade in the cooler and drier months of the year.

How is Tinea Versicolor diagnosed?

Although the light or dark colored spots can resemble other skin conditions, tinea versicolor can be easily recognized by a dermatologist. In most cases, the appearance of the skin is diagnostic, but a simple examination of the fine scales scraped from the skin can confirm the diagnosis. Scales are lightly scraped onto a slide and examined under a microscope for the presence of the yeast. A special light may help to make the diagnosis by showing a yellow green color where the skin is affected.

How is it treated?

Tinea versicolor is treated with topical or oral medications. Topical treatment includes special cleansers including some shampoos, creams, or lotions applied directly to the skin.

Several oral medications have been used successfully to treat tinea versicolor. Because of possible side effects, or interactions with other medications, the use of these prescription medicines should be supervised by a dermatologist. After any form of treatment, the uneven color of the skin may remain for several months after the yeast has been eliminated until the skin repigments normally.

Tinea versicolor may recur. Special cleansers may decrease episodes when used once or twice a month, especially during warm humid months of the year.

Each patient is treated by the dermatologist according to the severity and location of the disease, the climate, and the desire of the patient. It's important to remember that the yeast is easy to kill, but it can take weeks or months for the skin to regain its normal color.

Telangectasias | Dilated Blood Vessels

Telangectasias (commonly known as spider veins) are dilated or broken blood vessels located near the surface of the skin. They often occur on the face and particularly on the sides of the nose. They often look like small red or pink lines, which temporarily whiten when pressed.

Some Symptoms Of Spider Veins Include:

  • Swollen legs and/or ankles
  • Fatigue of the legs
  • A burning, itching, or throbbing sensation around the legs
  • Muscle cramps in the legs

Common Causes of Spider Veins

Spider veins are generally caused by weak or damaged valves. The following causes can contribute to weaker blood flow in certain areas of your body. 

  • Weight Gain
  • Sun Damage
  • Rosacea
  • Stress
  • Pregnancy
  • Hormonal Imbalance
  • Age
  • Genetics
  • Trauma

Treatment(s):

Thankfully, laser therapy is safe and efficacious treatment. It is an easy in-office treatment that can be performed during ones lunch break. In 10 minutes those red lines are gone and you can go right back to work. No wound care or dressings needed.

Sclerotherapy is also a treatment option. A special solution is injected directly into the affected veins, forcing the veins to close and the blood to redirect into healthier veins. The old vein turns into scar tissue that your body will eventually absorb, causing it to fade.

Tattoos

Lately, the decision to obtain a tattoo has become increasingly popular, and so has the decision to remove them! DON'T REGRET IT ... REMOVE IT! An estimated 20 million Americans have tattoos, and many of them now feel that having a tattoo does not fit their image. Those remorseful about their tattoos are consulting with cosmetic laser physicians to determine if the removal of their tattoo is possible. Today's advanced laser technology provides the means for tattoo removal safely and quickly and, in most cases, without leaving a scar. Complete removal of all types of tattoos, on all skin types, in up to half the treatments.

How does the treatment work?

Cosmetic medical lasers designed to eradicate tattoos range from a single wavelength of light to a broad spectrum of light, the varieties of which are intended to obliterate the ink in the tattoo without damaging the skin. Certain colors of light are absorbed by specific corresponding colors of the tattoo ink. The light energy vaporizes or fragments the ink particles. Your body then absorbs these ink fragments naturally and the color fades over the next couple of weeks. This treatment is very similar to methods used for years to treat birthmarks.

Ask us about our "Cosmetic Consultation Reimbursement" policy offered to all patients. Come discuss your needs and goals with Dr. Robinson and the office visit cost will be applied to future costs for the discussed procedure. Procedure must be completed within 30 days of your consult visit.

Subcission Scar Treatment

Subcission is a treatment used to correct a type of scar called a valley scar. A valley scar simply means there is a defect in the volume of the skin at the site of the scar. The goal of subcission is to improve this decreased volume. This then allows a depressed scar to regain its smooth appearance. This treatment may be combined with other scar treatments to yield the best cosmetic results.

Copyright © 2023 Bruce Robinson, MD • All Rights Reserved
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