Nonsurgical Treatments Overview

While surgery remains the core of Kirn Plastic Surgery, nonsurgical treatments play a key role as well. We offer a full spectrum of nonsurgical treatments including neurotoxin (Botox® and Dysport®), dermal fillers (Restylane®, Perlane®, Juvederm®, Radiesse®, Sculptra®, Fat Grafting), chemical peels, laser, and a comprehensive skin care program. Both Dr. Kirn, and nurse-injector, Carrie Sanders, RN perform neurotoxin and dermal filler treatments. Dr. Kirn performs all of the laser procedures, and skin care is offered through the Aesthetic Skin Care Center located in the same building. For all of these interventions, the first step is to come in for consultation. Usually, neurotoxin and dermal filler treatment can be completed on the same visit. Our goal is to provide a wide array of options to meet the patient needs.

Neurotoxins (Botox® and Dysport®)

Dr. Kirn started using Botox® for cosmetic purposes in 1998, before it became popular to do so. Over the subsequent time period, he has performed thousands of treatments. All of his treatments are based on knowledge of the muscle locations obtained in surgery. A meticulous record keeping system is used for all treatments and has been a key component of success with neurotoxin treatment as well as dermal filler treatment. Now, with the addition of Carey Sanders, RN, nurse injector, these meticulous notes maintained over many years on established patients allow duplication of treatments between both Dr. Kirn and Carey. Dr. Kirn continues to perform his own Botox®, Dysport®, and dermal filler treatment, but the addition of Carey allows us to improve access to these useful treatments and lessen wait times.

Dermal Fillers

Tissue volume replacement has become a mainstay of anti-aging / facial rejuvenation. Throughout his career, Dr. Kirn has stressed the importance of these modalities. As technology has advanced, and new fillers have entered the market, a concerted effort has been placed to evaluate each new product, compare its advantages and disadvantages and make a determination as to what role, if any, it has in the treatment of patients. Therefore, we offer a very wide range of dermal filler options and make every effort to tailor them to the specific patient and indication.

By far, the most natural and useful filler is the patient's own fat. Dr. Kirn became interested in fat grafting / transfer when he was a resident. His interest continued into private practice and is maintained to this day. As time has gone by, he has adopted new instrumentation and technology as it has become available and shown to be scientifically valid. Fat grafting is routinely combined with surgical procedures, but also frequently performed as an office procedure. Grafted fat is your own tissue, so you cannot be allergic to it. It maintains a natural softness and appearance. As with any natural material, fat does not always behave in a predictable manner. When fat is transferred, some of the fat will survive in the new location and some will be absorbed by the body. The percentage which is absorbed varies from patient to patient and from area to area. The portion of fat which remains in the new location tends to stay for a very long period of time. Some authors have suggested that fat is a permanent filler. While that may be true to a certain degree, it is important to bear in mind that the aging process and natural loss of fat from certain areas will continue. For these reasons, it is best to consider that repeat fat grafting sessions may be useful over time.

In addition to fat, there are a variety of "off the shelf" dermal fillers, and Dr. Kirn as well as nurse-injector, Carey Sanders, RN have extensive experience with them. The most commonly utilized fillers in our practice are Restylane® Perlane®, Juvederm®, and Radiesse®. Sculptra® is also available and is typically used in circumstances where fat grafting is not possible or where fat grafting has been attempted and was unsuccessful. The choice of dermal filler is tailored to the patient's needs and goals. A consultation is the first step to selection of the treatment area and best filler option. Both Dr. Kirn and Carey Sanders RN treat patients with dermal fillers. For new patients, initial consultation with Dr. Kirn is the preferred method. Dr. Kirn and Carey work closely together to ensure each patient receives the care and attention they need.

VersaPulse® Laser

Dr. Kirn has been using the VersaPulse® laser since the device first entered the market in the late 1990's. Despite the long duration of time the machine has been available, it remains a premier instrument for treatment of small vessels on the face (spider veins, broken capillaries), for brown spots on the face and body, and for treatment of skin pigmentation problems / sun damage.

The VersaPulse® laser is brought to the office at a regular interval and patients are scheduled for treatment in 15 minute blocks. Most if the time, patients can expect to have some redness of the treated areas for a day or two after the session. Brown spots will usually flake off several days after the treatment revealing a pink area underneath. Depending on the number and type of lesions treated as well as the patient's response to treatment, one or multiple treatment sessions may be necessary.

Spider Veins, also called broken capillaries or telangiectasias may affect the face, neck or other body areas. They are one result of sun damage and are more common in individuals with a fair complexion. They typically respond well to VersaPulse® laser. The most commonly treated areas are the nose and cheeks.

Many patients have a brown/red discoloration to the neck, medically known as Poikiloderma of Civatte. Although the name is unfamiliar to most folks, the condition is very common. It is again related to sun exposure. VersaPulse® laser provides one of the few effective treatments for this condition. Typically, multiple treatment sessions are necessary.

Brown spots and many other skin discolorations can be successfully treated with the VersaPulse® laser. Both individual, discrete brown spots as well as larger zones of discoloration may be treated. For the latter, a process known as pigment blending may be used. The laser beam is essentially "painted" over the affected skin in order to lighten up desired area.

VersaPulse® laser is used in the office and does not usually require any anesthesia. A consultation is required prior to treatment for all patients new to the VersaPulse® laser. Sun protection is essential after VersaPulse® laser treatment.

Sclerotherapy

Prominent leg veins may be treated by several methods according to the size of the vessels. Small vessels also called broken capillaries, spider veins, or telangiectasias may be treated with sclerotherapy. This process involves injecting a sclerosant medication into the undesired veins. The medication causes the vessel to clot off and then the body dissolves the vessel over the next few days or weeks. A very tiny needle is used to inject the medication. Dr. Kirn, and nurse-injector Carey Sanders, R.N., use the FDA approved sclerosant, Asclera®. The quantity of medication needed as well as the number of treatments both depend on the size and number of veins. Multiple treatment sessions are the norm for sclerotherapy.

Sclerotherapy is performed in the office and usually requires 15 minutes or more. The veins will look clotted or bruised for a few days to a few weeks after treatment. It is important to avoid sun exposure after the treatment as this can lead to a darkening of the treated areas. For this reason, most patients choose to have sclerotherapy performed in the fall and winter. Support pantyhose or compression stockings are advised for several days after each treatment to enhance the effectiveness. Kirn Plastic Surgery Center does not treat varicose veins. Facial veins / broken capillaries on the face are usually treated with VersaPulse® laser (hyperlink).

Skin Care

Kirn Plastic Surgery Center features a comprehensive skin care program within the facility. Our affiliate practice, Aesthetic Skin Care Center, LLC features two nurses and a cosmetic consultant with a combined experience of over 25 years. In addition to multiple prescription grade skin care products, they offer a full range of cosmetics. The office features a large skylight to allow clients to see the products under natural light. Dr. Kirn coordinates closely with all of the staff of Aesthetic Skin Care Center. More information is available at: www.kyskincarecenter.com

Chemical Peels

Kirn Plastic Surgery Center offers a variety of skin rejuvenation procedures, many of which are coordinated with our affiliate practice, Aesthetic Skin Care Center, LLC. The selection of a peel is customized to the patient's individual need and skin type. The deeper the peel, the longer the recovery time, but also the greater the improvement in the skin. Thus, selection of the right peel is the first, and perhaps the most important step. The deeper peels are performed by Dr. Kirn. Some peels are intended to be repeated over time. Frequently the effect of a chemical peel is improved by pre-treatment of the skin with specific topical skin care products. As with other surgical and non-surgical treatments, a consultation either with Dr. Kirn or one of the nurses at the Aesthetic Skin Care Center is the first step to determining if a chemical peel is right for you.

Laser Resurfacing

Many lasers have come gone for skin resurfacing, but one has stood the test of time. To date, the UltraPulse® CO2 laser remains the gold standard for skin resurfacing. Originally developed in the 1990's, Dr. Kirn became interested in this technology while he was a resident at UK and has remained involved with lasers ever since. His first patent was for a skin grafting device designed to work with the UltraPulse® CO2.

The UltraPulse® CO2 laser provides numerous benefits including smoothing skin wrinkles, treating sun damage, and tightening the skin. CO2 resurfacing makes lasting changes in the skin. However, to accomplish these desirable goals, a recovery time will be necessary. The patient will be responsible for caring for their skin after the treatment to ensure proper healing.

UltraPulse® CO2 resurfacing is performed in the operating room at Lexington Surgery Center using general anesthesia. Most patients require a 2 week healing time after the treatment during which meticulous skin care and adherence to the postoperative instructions is essential. Depending on the skin complexion, redness may remain for several weeks to months after the treatment. Most of the time, after-treatment redness may be camouflaged with makeup.

As with surgical treatments, a detailed consultation is essential to educate the patient on the benefits and risks of laser resurfacing. Many times, less invasive modalities may be used as an alternative to CO2 resurfacing if the patient cannot accept the recovery time required.

Minimally invasive laser skin rejuvenation is also possible using the VersaPulse® laser and is discussed in greater detail in that section. Similarly, chemical peels, topical skin care products, fat grafting, neurotoxins, and dermal fillers may serve very beneficial purposes for skin rejuvenation and maintenance of good skin health.