The best way to prevent wrinkles from expression is with Botox. The administration of Botox is the most common cosmetic procedure performed in every developed nation.

When this derivative from food poisoning was first introduced in the 1980's, Dr. Degnan advised his listeners on his weekly Palm Springs radio show to hold off on using Botox until more time had passed to prove its safety. In fact, Dr. Degnan made a regular point of advising against most of the cosmetic procedures that were being performed in the 1980's and most of the 1990's.

While Dr. Degnan feels he was correct in advising listeners to shy away from the commonly used lasers and wrinkle fillers of that era, he admits he was wrong in his presumption that Botox would be hard on the human immune system. Dr. Degnan now feels that Botox, the second most prescribed drug behind Viagra, has been more than adequately time-proven to be safe. In fact, when used for wrinkles on the face as FDA approved, a Botox treatment is safer than swallowing a tablet of aspirin.

Botox has 2 main down-sides. It needs to be repeated about every 3 months and it is "addicting". Very few people that have received Botox want to ever go without it. Botox is best used for the frown lines above the nose, the wrinkles going across the forehead, and for crows feet. Botox should ideally be initiated in an individual at the age when these wrinkles are first starting to appear. Botox is superb at preventing the worsening of these wrinkles, but if a person waits until the wrinkles are already deep and well-established, then additional measures are needed to obtain ideal results.

Dermatologists have learned over the last 3 decades that the best way to improve the surface texture of skin is to frankly burn off the outer layers. This is akin to removing the dead wood out of a tree in that the new skin that re-grows will be healthier and totally replace the former outer layer. The new skin will have less wrinkles, smaller pore size, and less in the way of other manifestations of sun damage such as age spots and pre-cancerous changes (called actinic keratosis).

During his long career in Palm Springs, Dr. Degnan was adamantly opposed to most of the methods being used to burn off the outer layers of skin. The lasers, chemical peels, and mechanical devises being widely used by his skin colleagues were commonly scarring patients and even at best, required a long healing time. The reason these methods were troublesome and even dangerous had to do with the fact that they were not precise in targeting the outer layers of the skin and so the deeper layers would be injured. Injuring the deeper layers is what caused the disturbing long healing times, swelling, oozing, and too-often, scarring.

While these methods gave good results when nothing went wrong, Dr. Degnan wanted nothing to do with any procedure that might scar a person's face. Thus, despite his large multiple-office Palm Springs practice, he did not get into the field of "skin resurfacing" until the Sciton laser was invented in Palo Alto, California, that generated heat in a significantly faster fashion (chemical peels and the older lasers cause a "slow burn"), thus allowing for a more controlled burn that only affected the desired outer layers. With the deeper layers thus protected, there is much less chance of scarring. This remarkable Sciton laser is arguably the world's finest laser. Most importantly, Dr. Degnan has operated Sciton lasers at both his Palm Desert and Lake Tahoe offices, and has never scarred a single patient. Also, the healing time is much shorter and the entire experience is extremely improved upon relative to older lasers. Besides being known for its improved ability to rapidly generate heat, the Sciton is also revered for its ability to be precisely tuned or adjusted for different skin variables. Dr. Degnan will often laser deeper around advanced mouth wrinkles, for example, than around the sides of the face where the skin is thinner and less wrinkled.

After a Sciton laser peel, one needs to apply Vaseline and avoid the sun. Depending on the depth of the peel selected, this will vary from 2 to 7 days. You do not need stay home or avoid most activities. It is recommended that most patients have about 2 such peels yearly.

From what we can determine, Dr. Degnan's prices for Sciton laser peels are possibly the lowest in the United States. We keep the price very affordable because we want to encourage patients in every way we can to have these peels. Dr. Degnan feels laser peels are as imperative to the face as routine teeth cleaning is towards dental hygiene.

"Filler" is to the cosmetic dermatologist as putty is to a carpenter. Fillers are mainly used to enlarge lips and fill in wrinkles. The first filler to be widely used was bovine collagen derived from cow hide. Dr. Degnan refused to use this filler as it was not compatible enough with the human immune system. Now we have fillers which are extremely safe and last almost an ideal amount of time. (Dr. Degnan continues to refuse to use permanent fillers such as silicone and others as they are not compatible enough with the immune system and their permanency in the face will likely pose problems many years later).

Restylane was the first safe filler developed. While most physicians use it all over the face, Dr. Degnan mainly used it only in the lips because the results elsewhere were not very noticeable elsewhere (see Radiesse and Sculptra below). In February of 2007, Juvederm was FDA approved. Dr. Degnan now only uses Juvederm in the lips because this filler clearly lasts much longer and is much less likely to cause lumpiness and unwanted swelling afterwards. Dr. Degnan is so confident in his ability to enlarge lips that he frequently performs the procedure in front of live audiences (see photo of marquis for Tahoe's Mont Bleu Casino). Also, because he is so quick, no anesthetic injections around the mouth are needed. Instead, he uses nothing more than anesthetic cream and ice.

Another big improvement in the use of fillers was the advent of the so-called "deep fillers" such as Radiesse and Sculptra. These fillers were designed to be placed deep in the skin. Since advanced wrinkles reside deep in the skin, fillers meant to be used superficially such as Restylane or Juvederm are inadequate as they must be used in very high amounts to do the job, and at best, will not last as long as Radiesse or Sculptra. Dr. Degnan immediately became proficient in the use of these deep fillers during his years in Palm Springs as most of his older patients there had deep wrinkles for which Restylane was inadequate. There are very few physicians in northern California or northern Nevada using more of these modern fillers than Dr. Degnan at his Lake Tahoe office. This is because of his vast experience in the use of these fillers as well as providing them at very competitive prices.

Briefly, Radiesse is superb at treating the naso-labial folds or so-called "parenthesis" lines around the sides of the mouth, as well as the frown lines above the nose. Sculptra is the best "volumizing" filler, i.e. it is the best filler at large wide areas such as gaunt cheeks (as seen in thinner individuals) or hollow areas on the chin under the corners of the mouth (as seen in most older women). Sculptra can occasionally cause harmless lumps than can be treated with a few drops of injected cortisone. Both Radiesse and Sculptra last about a year and a half and are extremely safe.

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