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FAQs about Products & Procedures in Dermatology

Q. What is the best filler?

A. There is no best filler. Some fillers are better for people with thin skin whereas others are better for people with thick skin. Some are great at filling fine lines while others are wonderful for support and structure. Certain fillers (Restylane, Perlane, Radiesse and Evolence) have lifting properties that can help to resuspend the face and some are great for facial sculpting. Others such as Restylane and Juvederm have flow qualities that make them ideal for some types of lip injections, injections near the eyes and for patients with certain goals. Sculptra is not a filler but rather a volumizer - it stimulates the skin to produce collagen. While it may last for more than one year in many instances, it requires several injections (usually 3-4) with each injection spaced about a month apart. Prevelle is a hyaluronic acid filler with local anesthetic mixed in. This makes it more comfortable but it is relatively short lived.

Q. Why don't you use the filler that lasts the longest? Are you trying to make your patients come in more frequently?

A. There are fillers that last forever (silicone and Artefill among them). I do not use these because while the benefits of these fillers may be permanent, so are the complications. Some of these products are great but some have been known or may in the future be known to produce problems up to 15 years after the injection. If you have seen one of the people that has had a problem with a product that is permanent.(and would need to be cut out), you would hesitate to have them injected.

Q. Is Botox poison?

A. No, Botox and Reloxin (a newer form of botulinum type A toxin) are purified proteins that are made using biopharmaceutical production facilities that are among the best in the world. These products come to physicians as a freeze dried powder which is reconstituted with saline. Thus, no bacteria could survive the process and no bacteria is present in the bottles.

Q. Why do you charge more for a syringe of Botox or Reloxin?

A. There are a variety of reasons but the most simple is that you get what you pay for. When a patient buys Botox or Reloxin, they are depending on the integrity of the physician. While some may advertise discount products, the person getting injected may be getting diluted products or water. This is one of the reasons why some people say that �Botox doesn't work for me� or that �It only lasts for a few weeks�. When properly injected and dosed (the products are dosed based on muscle mass and require repeated injections over time for optimal results) the effect should last about 3-4 months. One other advantage of being treated by Dr. Beer he has different options for anesthetic to make the procedure more comfortable and it is included in the fee.

Q. What type of laser is good for me?

A. Not any single laser can do all things well so the answer depends on what skin type you have and what your goals, budget and tolerance for risk is. We use several lasers and light sources. For instance, our intense pulsed lights use broad spectrum (many colored) lights to treat brown spots, red spots and stimulate collagen. However, because it sends out broad light colors it compromises on the intensity of the energy. A laser, on the other hand, uses a single type of light or energy with very high intensity. Some of these lasers are great for brown spots, some for red spots, some for hair reduction and some for skin rejuvenation. The costs associated with these lasers and light sources varies and is associated with the type of device and the time involved in the treatments.

Q. What skin care products are the best?

A. This is perhaps the most personal type of question and one that requires a skin care consultation. If you have fair skin, prone to redness, we would try to keep you away from products with acid. If you are going to want to treat some lines, we may suggest products that have antioxidants and retinoids (vitamin A derivatives). Each problem requires a separate solution and at times we combine prescription with over the counter or lasers with topical products. This is really the strength that a board certified dermatologist brings to your care.

Q. What about skin cancer?

A. Drs. Beer and Waibel are both Board Certified by The American Board of Dermatology and Dr. Beer is also certified in Dermatopathology (the microscopic analysis of the skin). Dr. Beer utilizes his training to perform Mohs surgery and in many instances also reconstructs the skin after the cancer has been removed. At times, he will refer patients to plastic surgeons for their reconstruction and patients are welcome to discuss this with him. No matter who removes a skin cancer, there will be a scar. The type of scar depends on a host of factors including the physician's skill, the size of the cancer, the location of the cancer, the person's ability to heal and several other factors.

Q. What is Mohs surgery, when should it be used and who should perform the surgery?

A. Mohs surgery is a means to evaluate the margins of a skin cancer while the patient is in the office. According to guidelines issued by Medicare and other carriers, Mohs is recommended for the treatment of skin cancers located on the face, ears, lips, nose or hands. In addition, Mohs is recommended for lesions that are greater than 2 Cm, infiltrative or are recurrent skin cancers. Although Mohs theoretically could be performed for every skin cancer, Medicare policy dictates that it is not appropriate for most skin cancers. Many types of dermatologists perform Mohs surgery with differing degrees of training. Dr. Beer is not only board certified in dermatology but also in dermatopathology (both from the University of Chicago) so he is uniquely qualified to interpret the pathology of skin cancers during Mohs surgery.

Q. Why is there a wait?

A. Since I started this practice, I have tried to do what I could to help my patients. Sometimes this means that they need to have a biopsy that was done when there is no time for it. Sometimes it means that when someone calls because they fell and need some stitches or their doctor calls because they have a new rash, we need to fit them in. Occasionally, we need to call other physicians to deal with problems that we discover but are outside our specialty. Finally, there are occasions where someone simply needs to talk.

Q. Who can I speak with if I have an issue?

A. Barbara LaBounty runs our office and can help with logistic questions. Drs. Beer and Waibel can help with medical questions or issues. Many of our patients are also our friends and we would like to help when we can.

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