FAQs about Products & Procedures in Dermatology
Q. What is the best filler?
A. There is no best filler. Some fillers are better for people withthin skin whereas others are better for people with thick skin.Some are great at filling fine lines while others are wonderful forsupport and structure. Certain fillers (Restylane, Perlane,Radiesse and Evolence) have lifting properties that can help toresuspend the face and some are great for facial sculpting. Otherssuch as Restylane and Juvederm have flow qualities that make themideal for some types of lip injections, injections near the eyesand for patients with certain goals. Sculptra is not a filler butrather a volumizer - it stimulates the skin to producecollagen. While it may last for more than one year in manyinstances, it requires several injections (usually 3-4) with eachinjection spaced about a month apart. Prevelle is a hyaluronic acidfiller with local anesthetic mixed in. This makes it morecomfortable 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 Dysport (a newer form of botulinum type A toxin)are purified proteins that are made using biopharmaceuticalproduction facilities that are among the best in the world. Theseproducts come to physicians as a freeze dried powder which isreconstituted with saline. Thus, no bacteria could survive theprocess and no bacteria is present in the bottles.
Q. Why do you charge more for a syringe of Botox orDysport?
A. There are a variety of reasons but the most simple is that youget what you pay for. When a patient buys Botox or Dysport, theyare depending on the integrity of the physician. While somemay advertise discount products, the person getting injected may begetting diluted products or water. This is one of the reasons whysome people say that "Botox doesn't work for me" or that "It onlylasts for a few weeks". When properly injected and dosed (theproducts are dosed based on muscle mass and require repeatedinjections over time for optimal results) the effect should lastabout 3-4 months. One other advantage of being treated by Dr. Beerhe has different options for anesthetic to make the procedure morecomfortable 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 answerdepends on what skin type you have and what your goals, budget andtolerance for risk is. We use several lasers and light sources. Forinstance, our intense pulsed lights use broad spectrum (manycolored) lights to treat brown spots, red spots and stimulatecollagen. However, because it sends out broad light colors itcompromises on the intensity of the energy. A laser, on the otherhand, uses a single type of light or energy with very highintensity. Some of these lasers are great for brown spots, some forred spots, some for hair reduction and some for skin rejuvenation. The costs associated with these lasers and light sourcesvaries and is associated with the type of device and the timeinvolved in the treatments.
Q. What skin care products are the best?
A. This is perhaps the most personal type of question and one thatrequires a skin care consultation. If you have fair skin, prone toredness, we would try to keep you away from products with acid. Ifyou are going to want to treat some lines, we may suggest productsthat have antioxidants and retinoids (vitamin A derivatives). Eachproblem requires a separate solution and at times we combineprescription with over the counter or lasers with topical products.This is really the strength that a board certified dermatologistbrings to your care.
Q. What about skin cancer?
A. Drs. Beer are both Board Certified by The AmericanBoard of Dermatology and Dr. Beer is also certified inDermatopathology (the microscopic analysis of the skin). Dr. Beerutilizes his training to perform Mohs surgery and in many instancesalso reconstructs the skin after the cancer has been removed.At times, he will refer patients to plastic surgeons for theirreconstruction and patients are welcome to discuss this with him.No matter who removes a skin cancer, there will be a scar. The typeof scar depends on a host of factors including the physician'sskill, the size of the cancer, the location of the cancer, theperson's ability to heal and several other factors.
Q. What is Mohs surgery, when should it be used and whoshould perform the surgery?
A. Mohs surgery is a means to evaluate the margins of a skincancer while the patient is in the office. According to guidelinesissued by Medicare and other carriers, Mohs is recommended for thetreatment of skin cancers located on the face, ears, lips, nose orhands. In addition, Mohs is recommended for lesions that aregreater than 2 Cm, infiltrative or are recurrent skin cancers.Although Mohs theoretically could be performed for every skincancer, Medicare policy dictates that it is not appropriate formost skin cancers. Many types of dermatologists perform Mohssurgery with differing degrees of training. Dr. Beer is not onlyboard certified in dermatology but also in dermatopathology (bothfrom the University of Chicago) so he is uniquely qualified tointerpret the pathology of skin cancers during Mohssurgery.
Q. Why is there a wait?
A. Since I started this practice, I have tried to do what I couldto help my patients. Sometimes this means that they need to have abiopsy that was done when there is no time for it. Sometimes itmeans that when someone calls because they fell and need somestitches or their doctor calls because they have a new rash, weneed to fit them in. Occasionally, we need to call other physiciansto deal with problems that we discover but are outside ourspecialty. Finally, there are occasions where someone simply needsto talk.
Q. Who can I speak with if I have an issue?
A. Tracy Laird runs our office and can help with logisticquestions. Dr. Beer can help with medical questions orissues. Many of our patients are also our friends and we would liketo help when we can.