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®, Juvederm®, and others), chemical peels, laser, and a comprehensive skin care program. Dr. Kirn, and nurse-injectors, Carrie Sanders RN, and Shirley Ramsey DNP perform neurotoxin and dermal filler treatments. 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. Working closely together, the same process is applied by nurse injectors, Carey Sanders RN and Shirley Ramsey DNP. Both nurses have surgical experience and have also performed thousands of injections using the same principles. Meticulous notes are maintained on each patient to allow duplication of treatments between the three providers.

Dermal Fillers

Tissue volume replacement has become a mainstay of anti-aging / facial rejuvenation. Kirn Plastic Surgery 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.

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. There is a vast and ever changing array of these products available. The trend over time has been for the manufacturers to target specific facial areas with a specific product. This has led to improved results and in many cases, better longevity of the effect.

VersaPulse® Laser

Dr. Kirn has been using the VersaPulse® laser since the device first entered the market in the late 1990's. He or Dr. Shirley Ramsey performs all the VersaPulse treatments. 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 of 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.

A skin rejuvenation treatment called Collagen Remodeling is also performed with the VersaPulse® laser. Here, a specific wavelength laser beam is painted over the face to stimulate the deep layers of the skin. A Zimmer chiller provides a continuous stream of super-cooled air to make this "laser facial" a comfortable reality for patients. This treatment is intended for both skin rejuvenation and healthy skin maintenance. The treatment is designed to improve skin tone and texture and also is useful for acne. Typically a series of treatments is performed, with each treatment requiring roughly 15 minutes. Because of this, a package of 3 or 5 treatments is offered.

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.


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. The practice only uses 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.


Kybella® is an FDA approved fat dissolving injection for use under the chin. The medication is injected into the fat under the chin. It breaks down the fat cells and the body removes the debris over the next several weeks. A minimum of two treatment sessions is usually required, but more may be necessary. Treatment sessions are performed about 6 weeks apart. The treatment may be performed with or without numbing medication. After treatment, patients can expect swelling and occasionally bruising. There is usually some minor discomfort for a few hours after treatment as well. Several weeks to months are required to see the final result.

Just like liposuction, when the fat cells have been destroyed or removed, they are gone permanently. However, as with liposuction, weight changes after treatment can have an impact on the contour of the area since not every fat cell in the treatment zone is removed or dissolved. Also, other factors can effect neck contour especially development of loose skin and muscle bands.

Neck contour is determined by several factors, specifically the amount and elasticity or "stretchiness" of the skin, the amount of fat, and the contour of the muscles. Kybella® only addresses the fat component and does not affect the skin or muscle. Therefore, an exam and discussion about the best options for you is important when selecting the best treatment. Other options to improve neck contour include liposuction as well as neck lift / face lift procedures.

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, one of the nurses, or with 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 and 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.