At Fine Arts Skin and Laser, Dr. Hartman believes in the importance of patient education and frequently answers patient questions on Real Self. Below are some of the questions and answers he has addressed:
Questions I’ve Answered
- Age Spots Treatment (4)
- Botox (1)
- Botox for Migraines (1)
- Brow Lift (8)
- Chin Implant (1)
- Chin Liposuction (1)
- CO2 Laser (4)
- Dysport (4)
- Ear Lobe Surgery (1)
- Ear Surgery (2)
- EndyMed 3DEEP (1)
- Eyelid Surgery (6)
- Facelift (1)
- IPL (1)
- Laser Hair Removal (1)
- Latisse (1)
- Lip Lift (1)
- MACS Facelift (1)
- Microdermabrasion (1)
- Microneedling (1)
- Mini Lift (1)
- Mole Removal (5)
- Neck Lift (9)
- Non Surgical Nose Job (1)
- Nordlys Hybrid System (2)
- Restylane Silk (1)
- Scars Treatment (4)
- SculpSure (2)
- Septoplasty (4)
- Smart Lipo (1)
- SmartLipo MPX (1)
- SMAS Facelift (1)
- TriPollar (1)
- Vampire Facelift (2)
- Wrinkle Treatment (2)
Q & As
- Q: The front of my brows sink in making me look angry even when I am not. Is there any way I can fix this?
A: Is there a permanent solution to an angry, tired-looking brow?
I believe the best, long-term solution to an angry, tired-looking brow is a browlift. Browlifts are wonderful for removing vertical and horizontal lines, giving a balanced, natural, and symmetric position to the eyebrows and providing a much more rested and youthful appearance to the eyes and entire upper face.
A: Rejuvenation options for the eyelids and brow.
Ongoing use of topical Retinols is certainly important. Dysport/Botox may help you with the dynamic wrinkles of your frown lines. Intensif Radio-Frequency Microneedling w/ PRP (platelet Rich Plasma) may be a first choice in the treatment of your skin texture. If, however, you are considering a more dramatic rejuvenation, a Browlift, conservative upper Eyelid Lift, and CO2 Fractional Laser treatment would deliver more dramatic results.
A: Correcting brow asymmetry
To a greater or lesser extent, asymmetry of the brows is actually quite common. The two most widely-used approaches (endoscopic vs open approach) to the browlift have varying potential for achieving eyebrow symmetry. The Transfollicular Browlift (an example of an open lift) is the best option in most people with brow asymmetry – excess forehead skin is trimmed, just behind the hairline – and the amount trimmed can be customized depending on the need of each individual side of the brow.
A: Aesthetic brow lifting
After all has settled, the elevation of the actual eye brow in a browlift does, in fact, typically end up in that range: about 2-9 mm. What matters most is the final shape of the brow – the curve and placement of eyebrow arch, the impact of the browlift on the upper lids, and finally the improvement of the texture of the forehead skin and lids – these are all critical concerns when designing and performing an aesthetic browlift. Many of us are now performing browlifts with local numbing and tumescent numbing only. Being awake during the procedure offers patients the opportunity during the “setting of the brow” to participate in the decisions of the final position and placement of the brow. In our practice, we sit the patient up and hand them a mirror to discuss the brow position and shape during the setting of the “keystone/important sutures”. We find that patient feedback is critical in creating a beautiful, natural-looking result that fits the client’s/patient’s desires.
- Q: I am considering an eyebrow lift with the incisions in the hair line. Will there be hair loss with this procedure?
A: Browlift incision placement and risk of hair loss
Browlifts are marvelous for improving a tired/angry look of the upper face. Upper eyelid appearance is also improved in a well-done brow lift. Position of the hairline is a very important consideration with a browlift. The Transfollicular Browlift with a “double beveled” incision placed 1/4″ behind the forehead hairline, maintains hair growth in front of the incision to further camouflage it – usually leaving incision sites invisible. Combining this procedure with a “brow advancement” can actually even bring the hairline down to shorten an overly long/high forehead/hairline.
- Q: Blepharoplasty to correct genetically heavy upper eyelids (27y.o. female)?
A: Treating genetically heavy upper eyelids in a younger person
I recently treated a young woman (35 years old) with almost the same concern that you have – by doing a Mini Temporal Browlift only – no lid surgery (yet anyway); and her results are wonderful with no facial scars at all. We did it in the office with local and tumescent anesthesia only. The mini temporal lift consists of removing matching right and left crescent-shaped patches of high temporal scalp, then lifting and releasing the forehead and brows. Next, the outer brows are pulled up to close the crescent scalp gaps. She had mild bruising and swelling for a week.
A: Is general anesthesia needed for a facelift?
The trend for all cosmetic procedures is moving rapidly to non-general anesthesia. Better in many ways, is the use of local numbing combined with “tumescent” (larger volume, very dilute) numbing, with/without oral sedation (like a Xanax). The reasons are many, including: procedures are safer – in a multitude of ways, and less expensive – without general anesthesia. For most patients, a full facelift, browlift, and laser resurfacing without general anesthesia – is an all-around positive experience.
- Q: I’m 71 and I’m very concerned about looking surgically altered. Can lifts be performed without being over corrected?
A: Natural-looking facelifts
A well-done facelift is not “a single procedure”, but rather, it is a collection of 40 or so maneuvers each one customized to the address the goals chosen together by the patient and the facelift surgeon. For excellent results, each maneuver must be executed well – in its own right – as well as done in a way that it complements all the other components of the whole. You asked about “over correction”: actually, some maneuvers may, in fact, be intentionally slightly over-corrected at the time of surgery, understanding that certain aspects of the lift will “settle” predictably in the post-operative days and weeks. The artistic eye and technical experience of your surgeon are critical to precisely execute all the details – so that the final result is corrected just right. Choose your board-certified facelift surgeon carefully. Look at the before and after photos. Make sure that your goals are clearly understood and agreed upon.
A: Overnight stay after Face-Lifting?
From a pain management standpoint, after a facelift, staying in a hospital overnight would offer you minimal benefit. Pain after a facelift, is well managed with Tylenol/Motrin and occasionally judicial use of oral hydrocodone. If you have a companion who can stay with you the first night, the rest and comfort will be superior at home.
Radio Frequency Microneedling to improve skin quality
- Q: I hate the crepy skin under my eyes, but I’d rather not have any surgery yet. What is Microneedling?
Eye Lid Lift
A: 28 year old: eyelid droop/ bags
- Q: My lower face and jowls are in decent shape. I’ll be 52 next month. It’s mostly only my neck that has the thinner, lose, old-looking texture. What can be done for a neck like mine?
A: Neck lift without scars in front of ears
It is impossible to adequately access your needs and options without a face to face consultation. But, I would probably discuss with you a neck lift in which the incision scars would be hidden only in the crease behind the ear and then also just into the back hair line that sweeps back away from the top of the ear. It sounds like you could get a very nice result from that procedure alone.
Precision Smart Lipo for the under-the-chin area
- Q: What procedures, either surgical or non-surgical, can tighten loose / extra skin around chin area? I’m 37, and the skin of my neck and face is not wrinkly; my problem is I have this fatty double chin that I hate.
A: Solutions to fullness under/around the chin
In someone as young as you, I would say a facelift is too much, too soon. Precision Smart Lipo uses dual-direction lasers to melt fat and tighten dermis followed immediately by suction liposculpting to remove the fullness. The 3 tiny incisions are only 1/8″ long and will vanish into your skin creases. Down time and cost is less than half of that for a facelift.
In my experience, Smart Lipo is the smoothest method of liposculpting – as the initial laser application is done with hundreds of tiny-cannula passes with cross hatching from 5 directions to initially melt the fat – followed by tiny-cannula liposuction to suck out the melted fat. The final step, directs the laser up into the dermis of the skin from underneath to tighten the skin – and this also is done with hundreds of passes to smoothly deliver all the energy necessary. So, by design, Smart Lipo yields an extremely even, natural-looking fat reduction.
- Q: What are typical Anesthesiologist costs with Priecision Smart Lipo?
A: Precision Smart Lipo
For the right patient, Precision Smart Lipo is a terrific procedure applied to the neck and jowls. As for the anesthesiologist, many cosmetic surgeons perform this procedure with local and tumescent (dilute local lidocaine) numbing only – no anesthesiologist required.
- Q: I recently received Dysport and am wondering if I got the proper amount? (29 year old female). I decided not to get the lifting injections in my horizontal forehead lines because mine weren’t too bad yet.
A: “Prejuvenation” w/ Dysport
Depending on how the face is aging, 29 years old is a very reasonable age to start using a Dysport or Botox. Softening the wrinkle-causing muscle actions early helps to prevent the “static wrinkles” (lines of the face that are present even when the underlying facial muscles are fully relaxed) from forming in the first place – “prejuvenation”. My goal with Dysport/Botox is to soften the muscle actions which are causing the undesired wrinkles, but, doing so in a measured way – so as to not over-treat – which leaves a frozen look. In fact, for a first-time patient, I will frequently use slightly less Dysport and see the first-time patient back for a check in a week or so – to further refine and balance the treatment as needed. You mentioned foregoing the “brow-lifting” injections. This concept may have been explained to you a little backwards. Treating the muscles that cause the horizontal lines of the forehead does not cause the brow to “lift”, but in fact, may actually, in certain people, cause the brow to lower. The Frontalis muscle is the muscle the raises the brow and causes the “bunching” (wrinkling) of the skin in the forehead, i.e., the horizontal lines. Treating the Frontalis muscle, softens the horizontal lines (the desired effect), but, also may “lower” the brow as the Frontalis is no longer pulling up the brow so hard. In contrast, it is the softening of the muscles that pull the brow down (the brow frown muscles), i.e., the muscles pulling “below” the brow: the Corrugator, the Depressor Supercilli, and the vertical segments of the Orbicularis Oculi muscles – when these frown muscles are weakened with Dysport/Botox – that allows the brow to drift upward (lift). This may be confusing at first read, but, I hope it helps a bit.
A: Treatment options for facial brown spots
Brown blemishes, commonly called age spots, are largely the result of ultraviolet radiation (UV) exposure. These brown spots can be dramatically improved with light-energy devices such as the Nordlys Hybrid. A single treatment often is all that is needed for a dramatic improvement. However, any odd-looking brown spot, that seem in any way suspicious, should be brought to the attention of a facial plastic surgeon/skin cancer specialist. Of course, it is also critical that further UV exposure be curtailed to prevent further proliferation of brown spots or recurrence of previously treated ones.
- Q: How can I get my face to look young again? I’m just 23, and my face has become littered with “age spots” over the last year. I have begun to be much more careful with sun exposure.
A: Treating brown dyschromia of the face, neck, and hands
Brown splotchy skin on the face and hands is a problem for many of us. Good for you for curtailing your sun exposure – that is the most important first step. Medical-grade retinol skin products are also essential in maintaining a more even skin tone. Daily sunscreen application will also be important. You may decide to look into Hybrid Nordlys treatments for more expedient results in removing those brown age spots.
A: Why choose the Nordlys Hybrid Experience?
What makes the Nordlys Hybrid more comfortable is that it delivers very, very effective treatments to the targeted treatment area, but with the absolute minimum amount of collateral damage to the non-targeted skin structures. The treatment wavelengths and intensities are precisely calculated and double filtered. Other laser devices, when turned on, run hot, noisy and vibratory, but, the Nordlys runs smooth and quiet like a Tesla. We have a dozen devices in our practice, and our Nordlys is our hardest working one. Downtime for 90% of treatments is less than an hour.
- Q: Help with mole biopsy pathology results. My dermatologist did a shave biopsy of a mole and the result came back saying, “mildly atypical junctional melanocytic nevus, deep and peripheral margins involved.” What does this mean; and what do I do now?
A: How to follow up on a shave biopsy result of “atypical junctional melanocytic nevus”?
Important question. Melanocytes are the pigment-producing skin cells which are responsible for our skin tone and tan changes. However, melanocytes are also the cells involved in melanoma. “Mildly atypical” means that the pathologist sees subtle changes in the melanocytes which makes him/her suspicious that there is a chance that mole is on its way to becoming a melanoma. Because the mole was shaved off, some of the mole was most probably left behind below the level of the shave. The statement that: atypical changes extend to the “deep and peripheral margins” or extend to the surface edges of the mole, means that no “safety cuff” or border of normal skin was removed with the mole. Therefore, the recommendation is to re-excise the “mole” with a 5mm cuff of normal-looking skin all the way around it and have the pathologist examine that specimen again for completeness of the removal. For all of us: mid-day sun precautions/cover, routine sunscreen, and regular skin checks – are important for preventing/catching early skin cancer. Hope this is helpful.
- Q: I had two pre-melanoma moles; one punched, one just shaved off. Is it possible to get rid of it completely by shaving it off with razor?
A: Is shave biopsy recommended for a mole suspicious for melanoma
Melanoma is the #1 cause of cancer death in woman 20-30 years old. The very most critical staging component for a melanoma is: how “thick” is it? Once a suspicious skin lesion (mole, in your case) is “shave biopsied”, any attempt to evaluate the thickness, is forever lost. In my practice, if the skin lesion is slightly suspicious by initial microscope exam, a full-thickness, punch biopsy (3mm wide disc of the lesion) is obtained and evaluated by the pathologist. If, on the other hand, the lesion is deemed by me to be “quite” suspicious for melanoma at the initial visit, the lesion is promptly scheduled for a full thickness removal w/ appropriate margins of normal skin around it, and the wound is then closed carefully in the natural skin creases. We never do shave biopsies for suspicious skin lesions in my office. Quite frankly, your dermatologist should not have either.
SculpSure body contouring
A: discomfort with SculpSure?
SculpSure is effective at permanently removing about a quarter of the fat cells in a treated area. The experience of my patients, my staff, and me is that there is some discomfort during the treatment, but, that the discomfort is worth it. In my practice, our SculpSure medical esthetician is present with the patient at all times during the treatment and she is continuously monitoring and adjusting the treatment level, while checking in with the patient.
- Q: Who can legally perform Sculpsure? Can someone who is not certified or medically trained perform this treatment?
A: Who can legally perform SculpSure
SculpSure is a powerful fat sculpting device that uses special fat-targeting lasers to permanently destroy approximately 24% of the fat cells in the targeted area. Generally each treatment cycle uses all four of the specially cooled “paddles” or cups to target stubborn fat at the “muffin top”, love handles, saddlebag area, etc. In our state, all medical lasers require a physician trained in the laser devise to check the setup and the settings and to start the treatment. Each treatment cycle requires less than 30 minutes.
- Excess skin and persistent stretch marks after 100-pound weight loss: 19 years old. Can Tripollar Tightening RF help?
A: Tripollar for tightening
Congratulations on your dramatic weight loss and your commitment to continued improvement. TriPollar is one of many radiofrequency devices that can be quite effective in body sculpting and tissue tightening. But, like everything else, it has its limitations. While Tripollar works for fat sculpting and dermis tightening, I wouldn’t hold too high of an expectation that the stretch marks will improve much with Tripollar – stretch marks are indeed a challenging problem. One the one hand, Tripollar is not expensive, and you may well find it is useful. On the other hand, since you are having great success with the diet/exercise and that has gotten you this far, and I would certainly stay that course regardless. Again, congrats!
Torn Ear Lobe
- Q: My earlobe is torn, the piercing hole is close to the bottom, is there a home remedy to fix this?
A: Is there a nonsurgical repair for a torn earlobe?
Unfortunately, there is no nonsurgical repair available. The inside rim (the doughnut hole) has to be trimmed out to get freshened edges before the hole can be sewn closed again. Fortunately, however, this procedure is easily done in-office, with simple local numbing medicine and takes only a very short time. Hope this helps.
A: CO2 laser for breast scar improvement?
I find that fractional CO2 laser treatments for scars are almost always quite helpful. We do a lot of facial reconstructions for skin cancer in my practice – and thus, I use my CO2 laser for scar improvements several times in a single day – it is very quick, very safe, and it works! I generally don’t charge my clients for this service, especially if we are already doing some other procedure. With my laser, I typically see a 20-30% improvement in scars with each application of the laser. Applying the laser 1 to 3 times, 3 or more weeks apart – generally achieves the desired results. Redness and tiny pinpoint scabbing might be present for a week or so. I hope this helps!
- Q: Would like to improve a deep facial scar above eyebrow. Which treatment would provide the best results?
A: deep facial scars
With deep (atrophic) scars, not only is skin/dermis scarred, but so is the underlying fat and muscle. In my view, the most reliable (and, in fact, the easiest) approach would be to use a microscope to cut out the defect – full thickness – and do a multilayer closure of the soft tissue and skin – this takes only 15- 20 minutes. Then early on in the healing, apply fractional CO2 laser to the wound site to further promote smooth, even, healing.
Hair Removal – the Nordlys Hybrid Experience
A: laser hair removal
Laser hair removal targets the pigment of the hair in the hair follicle. At any given time, approximately 70% of hair follicles will be in the active or “growth” phase – and these are the follicles that will be permanently destroyed by an excellent hair removal laser – without injuring the skin. 6-8 weeks later, of the remaining 30% of surviving hair follicles, approximately 70% of those can then also be destroyed to yield a total of 90% removal, and so on. With our system, the Nordlys Hybrid, it is best if the area is freshly shaven so that the energy absorption from the hair removal device is concentrated at the follicle. This type of device works best with darker hair on lighter skin. We are getting outstanding permanent hair removal from upper lip and chin, but also: underarms, bikini area, chest, legs, arms, back, hands, anywhere! And best of all, it is extremely economical.
Microdermabrasion for skin glow
- Q: I had microdermabrasion and chemical peel earlier today. I have this red rash on my face and forehead. What should I do?
A: microdermabrasion caused red rash and swelling
Most likely the treating esthetician slightly “over treated” that area when transitioning between the forehead and the cheek or vice versa. It is entirely possible that the redness, swelling and even slight scabbing will worsen for a few days before it improves, but, I would be very confident that you will have a full recovery. Moisturizers and sunscreens will be important this week.
Latisse for luxurious eye lashes
My patients and staff who use Latisse, love it. It is a nightly, but simple, application routine that will begin to show upper eyelash lengthening by the fourth week, and an increase in the number and darkness of the eyelashes by the eighth week; with continued improvement in overall lash length and fullness through 16 weeks.
Restylane Silk for sexy lips
- Q: Restylane silk swelling?
A: swollen lips the day after Silk
Swollen lips for a day or two are not a big deal UNLESS you have some important event that next day! Restylane Silk gives wonderful results, and only a small percentage (15% perhaps) of patients will have the transient swollen lips afterwards. In my practice, we find that a 10mg tab of oral prednisone at the time of treatment is very effective at preventing that annoying side effect. We offer that preventive treatment to our patients and about half of them decide to use the prednisone – we have yet to see one of those treated patients demonstrate the lip swelling. Of course, prednisone also has potential side effects, and that needs to be explained and understood before taking prednison.
Nose Surgery for function and appearance
A: 5 days after septoplasty – still tender; is this normal?
Any post-operative pain and swelling that is in excess of what you have been told to expect should be brought to the attention of your surgeon. I tell my septoplasty patients to expect some pain, numbness, and/or tingling of the nose, front teeth and/or roof of the mouth for a few hours to a few weeks. Many surgeons leave the soft, silicone stents in the nose for a week or so; I take my patients’ stents out the next afternoon – there are pros and cons to both practices. Almost never is there any outward bruising or swelling after a septoplasty alone, and I generally advise my patients they can resume normal activity (within reason) by the second or third day.
- Q: My nose was broken in high school sports and never fixed. Will a septoplasty straighten the outside appearance of my nose?
A: Septoplasty to straighten to nose?
Only on rare occasion will a septoplasty alone have an impact on the straightness of the outer nose as seen from front view. However, septoplasty might impact the look of the nose when viewed from below – looking up the nose. In most cases, when the appearance of nasal “straightness” is altered by a trauma, most of the crookedness occurs due to an alteration of the two “nasal bones” which comprise the bridge area – upper 1/2 of the nose. This so-called “acquired nasal deformity” would best be improved by a rhinoplasty or at least, an “open reduction of a nasal fracture” (and possible septoplasty) to realign the nasal bones shifted by the sports accident. An open reduction requires special tiny curved bone chisels (applied up the nose while under general anesthesia) to separate the nasal bones from the cheek bones (and sometimes frontal bones and septum. Good luck.
Alternate Q & As:
Q: Help-advice needed! Neck lipo, neck lift or chin implant?
A: Treatment of fullness under the chin
Thank you for your question and the accompanying photos. From those photos, I would rule out neck lift – right off the top. Your neck and face are much too smooth and youthful to justify so much procedure. Necks like yours make perfect candidates for Precision Smart Lipo – an in-office procedure that will precisely target the fullness under your chin and provide a laser-induced tightening of the dermis/skin. The three tiny cannula incisions are inconspicuous; and the downtime is a few days to a week. As for a possible chin implant…that is something you will want to discuss with your board-certified cosmetic surgeon at the time of consultation; without seeing more views of your face (especially how your chin looks in relation to your nose), it is impossible to say whether a chin implant might be a good option for you…or not. I hope you find this helpful.
A: Minimally invasive rejuvenation
A: What can be done for crepy neck skin?
A: eyelid uneveness 5 days after lid surgery
Great question. Photos are very helpful.
It is important to photo document the healing process, and, indeed, I see that there is some difference between the two eye lids. At 5 days out from surgery, it is entirely common to have some unevenness in the healing. Depending on the level of scrutiny, all of us have some unevenness of our upper lids before and after lid surgery. At this point, I would inform your surgeon of your concern, perhaps even forward your photos to your surgeon, and follow his/her advice for the next few weeks and see if, in fact, the problem resolves to an acceptable level. If not, sometimes a simple, in-office mini-revision can get you the improvement you need. I hope this is helpful.
A: brow lift?
Great photos; thanks for sharing them!
For the right patient, I find that a brow/lid lift is a very reliable procedure to produce wonderful rejuvenation of the upper face. To your credit, your photos demonstrate a nice retention of beauty for a person of your still rather young age, so good for you! It appears that you take very good care of yourself. I would say that a judicious lifting might well make sense for you, but, I would also recommend being conservative, especially with lower lid work.
Q: Best treatment for eyebrow that droops downward and inward ? I’ve had Botox to the forehead.
A: Is a brow lift right for me?
Great question; thanks for sharing your photos.
Botox is a solution for softening “angry 11’s”. In your case, from the photos, you do appear to have gotten a pretty nice improvement of that concern. Botox generally lasts 3-4 months and then needs to be repeated to maintain the results – which is fine for many people in many situations. To get an actual lift, and a far more lasting improvement, you might want to consider a brow lift. In some brow lifts, not only is brow position lifted and balanced, but, the small frown muscles can also be partially uncoupled from the dermis of the brow to give additional smoothing and longevity to the results. I hope you find this helpful.
A: under chin looseness
Great question. So, you are only 40, and from the photos, it doesn’t appear that the lower half of your face or your neck has any other strong reasons for a facelift or a neck lift except for this looseness directly under your chin. The advantages of Precision Smart Lipo compared to a face lift or neck lift are: the tiny scars are negligible, the downtime is much less, the expense is less, and in your particular case, the results may be just as good or better. Smart Lipo liquefies the excess fat w/ dual beam laser (initially with the laser beams firing straight ahead and also down), then the liquefied fat is sucked out, finally, a second redirected use of the laser cannula under the skin in the loose skin area – will use up-firing lasers to tighten the skin from the inside out. Hope this helps.
Q: What is the best and most successful non-surgical procedure for sagging neckline and jowls on face? I am 63 years old.
A: Treating sagging neckline and jowls