Services
LASER SKIN ENHANCEMENT TREATMENTS
ProFractional™
ProFractional is a quick and comfortable laser procedure with little to no downtime, used for improving the overall appearance of the skin. ProFractional uses a laser microbeam to treat thousands of pinpoint areas of the skin. Improvement is visibly noticeable in a wide variety of skin conditions such as wrinkles and fine lines, post-traumatic and acne scars, age and sun spots, freckles, signs of aging and sun damage.
ProFractional uses laser energy to create thousands of microscopic channels in the skin which are surrounded by areas of healthy, untreated skin. The zones of untreated skin invigorate the body's natural healing process, and the treated areas stimulate production of new collagen, plumping up the skin and smoothing out the wrinkles, lines, scars and other irregularities.
Depending on your skin's needs, ProFractional is typically done in a series of 1-4 treatments spaced 3-6 weeks apart. Dr. Salzman will personalize the treatment plan for each patient based on the amount of improvement needed. A topical numbing cream is applied prior to the treatment to eliminate any discomfort. The actual ProFractional treatment last about 30 minutes.
Immediately following the procedure you will experience a redness resembling a sunburn which can last several days depending on the depth of the treatment performed. Most patients return to makeup and work 1-2 days following the treatment.
AFFIRM® Laser Treatments
Affirm laser treatments are for people whose skin shows signs of aging such as wrinkles, discoloration, coarse texture or laxity. These laser treatments can decrease the effects of sun damage and aged look to the skin. Wrinkles, fine lines and increased pore size can all be effectively diminished. It is also useful in reducing the irregularity of acne and surgical scars as well as improving the appearance of stretch marks.
The Affirm laser treatment is the next generation of fractionated laser skin resurfacing. The Combined Apex Pulse (CAP) technology in the Affirm® laser distributes light energy to create a more comfortable and effective procedure with lasting results. The treatment stimulates the patient's own collagen production and promotes tissue tightening through a coagulation effect. The remodeling of the collagen in the skin makes for a more youthful, vibrant and fresher appearance of the skin.
Affirm® uses a fractional approach to laser skin resurfacing. Instead of treating the entire surface area of the skin at one time, only 20% is treated in any one session. The Combined Apex Pulse (CAP) technology utilizes 1000 tiny micro thermal columns of treatment with higher energy. The rest of the 80% of the area receives a low level of laser energy. The fractional approach is more gentle with little or no downtime.
Patients will require a series of 3-5 treatments to expose all the skin to the higher energy micro thermal zones. Sessions last about 30 minutes and are spaced 2-3 weeks apart. The Procedure is performed in The Skin Spa by Salzman by our certified aestheticians and registered nurses.
Unlike some of the earlier methods of fractional skin resurfacing, Affirm® does not usually require any topical anesthesia. Because the Affirm® laser does not go any deeper than is necessary to correct skin imperfections, numbing cream is usually not necessary. If patients choose to have numbing cream applied, the Spa can supply it so that it can be placed on the treated area about one hour before treatment. Any redness, swelling or puffiness is usually gone within hours but not lasting more than a day.
This is where the Affirm is superior to all other fractional laser treatments. Most patients will be pink for less than a day. Swelling is minimal and most patients can apply makeup immediately post treatment.
Affirm Multiplex Laser
The Multiplex Laser adds an additional wavelength of laser light that goes deeper into the dermis and tightens the skin. Like the single wavelength alone, CAP technology is employed thereby lowering the energy level necessary to achieve the desired effect. This laser treatment is recommended if skin tightening in addition to skin texture, fine lines and discoloration are all problematic in the patient's skin quality.
LaserFacial™
The LaserFacial™ is a treatment for the face using a Yag laser in a "paintbrush" fashion to address photo aging. Over long periods of time, sun exposure can lead to changes in the facial skin of dilated capillaries, pigment irregularities and a rough texture to the skin. The 1064-wavelength laser is attracted to the red color of blood and produces a heat reaction causing a decrease in caliber of the vessels and shrinking of the oil glands openings into the skin. This will improve the texture and color of the skin to a more youthful appearance. The treatment is done at Skin Spa by an aesthetician and requires no preparation or aftercare. Most patients are pink for several hours and can apply make-up as soon as the treatment is finished. A series of treatments is recommended to get the most benefit.
LASER TREATMENT OF SPIDER VEINS OF THE FACE AND LEGS
Spider's veins or (telangiectasias) are dilated reddish or bluish colored blood vessels that can appear on the legs or face. They are attributed to sun exposure, hormones, oral contraceptives, pregnancy or heredity. Using lasers that are attracted to the color in these vessels, light is converted to heat energy, which gently coagulates the vessel. After treatment, the vessel slowly and naturally disappears. Results may take one or two treatments to resolve the vessels. Two different lasers are used. The Diolite® laser is better for the red veins of the face. The Cynosure Elite® Yag is used for the more bluish vessels of the legs. No pre-treatment is required and cold air is added for comfort. You can resume all of your regular activities right away.
FOTOFACIAL™
Intense Pulse Light with Radiofrequency (IPL with RF) is a light source treatment for skin rejuvenation. It targets uneven skin tones, pigment irregularities, spider veins, redness, age spots, freckles and rough appearance of the skin.
Expectations are lightening of the skin tone, reducing the aged look from sun damage and clearing of red pigmentation issues. Fading of freckles, age spots, spider veins and generalized redness associated with rosacea. There is also some improvement in skin texture.
IPL with RF is approached in a 5 treatment series. Maintenance treatments are advised and available for patients completing their series. Using ELOS (electrical optical synergy) technology, the machine's applicator emits a filtered spectrum of light targeted at skin color. The pigment absorbs this energy and transforms it to heat. Lightening of the pigment usually occurs after 2-3 weeks after treatment. The RF component works on the skin texture as this energy is absorbed in the dermis and stimulates collagen production.
The procedure is performed in Skin Spa by a certified aesthetician. Most patients can tolerate their treatment well using no topical anesthetic. If needed, patients may place a topical agent on the area 45 minutes before the treatment. Treatments take 30-40 minutes and are spaced a month apart.
There is minimal downtime with this procedure. There may be some darkening of the pigment that will eventually fade. Patients can return to their normal activities right away. Makeup can be applied immediately after the procedure.
3T Laser Lift: Tone, Texture and Tightening
Skin Spa by Salzman has designed a special combination of layered light treatments to address the photo and environmental aging of the skin. Using a combination of the Fotofacial™, LaserFacial™ and Titan® treatments, we can effectively lessen sun damage, discoloration, rough texture and skin laxity. Each patient will have a custom designed protocol designed for them to address their particular needs. Several of the layered light treatments can be combined in one session and repeated over several weeks to obtain the best result.
PHOTODYNAMIC THERAPY
Photodynamic therapy (PDT) uses the same light source as the Fotofacial™. Prior to treating with the intense pulse light (IPL) we place a medication called Levulan™ on the skin. Levulan™ is a photosensitizing agent; it makes the skin more receptive to the light energy. The light is absorbed by the red and brown pigments of the skin. Sun damage, discolorations, rough texture of the skin are all improved.
PDT with Levulan™ is also used to treat the acne/oily skin patient. The light source energy reduces the oil producing glands and minimizes pores improving the look of acne prone skin. The blue light wavelengths in the light source have been shown to reduce the bacteria in the oil glands that cause acne thereby making new occurrences less likely.
Patients will experience mild stinging during the treatment. The skin following the treatment may be red or pink, slightly swollen and will remain sun sensitive for several days. Brown spots may darken first then gradually fade over 7-10 days. Some patients may peel similar to a mild sunburn. A series of treatments, spaced at 3-4 week intervals, may be necessary to achieve optimal results.
Blue Light Therapy
Blue Light Therapy involves the use of visible blue wavelengths of light that create a toxic environment inside the pore and kills the acne-causing bacteria. It is used to treat active lesions and help prevent dormant glands from becoming active lesions. Without the acne-causing bacteria present, and allowed to grow, inflammation diminishes and acne clears up.
MicroLaserPeel™
MicroLaserPeel is an intra-epidermal laser peel that precisely ablates the desired amounts of the outermost layer of the skin to achieve smoother, healthier and more vibrant skin.
Generally Microdermabrasion treatments remove only up to 10 microns of the stratum corneum. The MicroLaserPeel is a partial-to-full epidermal peel removing 20-50 microns. This treatment requires a topical numbing cream to eliminate any discomfort the patient would otherwise have.
As compared to Microdermabrasion, with MicroLaserPeel you will experience smoother, healthier, more vibrant skin with a significant and immediate change in skin texture and tightness. Although one treatment alone can provide a visible result, patients may have 2-4 peels to achieve maximum results by spacing the peels 6-8 weeks apart.
Healing time generally takes 3-4 days with a sunburn like redness that gradually dissipates. Mild skin sloughing on day 2-3 may occur. Makeup can be applied on day 4.
SkinTyte™
The best way to tighten skin is SkinTyte, which utilizes infrared energy to deeply heat dermal collagen while protecting the entire treated area with sapphire contact cooling. This process promotes contraction of the collagen, initiating the body's natural healing process. Following treatment, a new foundation of collagen is created leading to increased skin firmness.
SkinTyte treatments are virtually painless and require no downtime, allowing patients to return to their busy schedules immediately. SkinTyte is safe for light and dark skinned patients and can treat most any area of the face and body to tighten skin. Some of the more popular treated areas are the Face, Neck, Hands, Abdomen, Arms, Knees and Thighs.
SkinTyte treatments can be done alone or in conjunction with a skin or fat reduction procedure for further skin tightening. Visible results can be seen after one treatment; however, most patients will need a series of treatments to achieve optimal results. Treatments are spaced 2-3 weeks apart.
Dermal Fillers
HYALURONIC ACID FILLERS
Restylane®
Restylane® is one of the first natural non-animal based hyaluronic acid filler substances. Hyaluronic acid is a natural building block material that exists in human skin to provide volume and fullness. Restylane® is used to fill moderate to severe facial wrinkles and folds such the crease that forms from the nose to the corner of the mouth (nasolabial fold). Because it is a naturally occurring substance, no prior skin test is required to see if you are allergic. Restylane® has been safely used by Dermatologists and Plastic Surgeons worldwide since 1996. Restylane® generally lasts about 6 months. It is injected in tiny amounts through an ultra fine needle. We use both a skin chilling device and topical anesthesia. If injected into the lips we will block the feeling in the lips with a local numbing injection prior to placing the Restylane®. Avoidance of aspirin, non- steroidal anti-inflammatories like Motrin®, Advil® and Aleve®, can minimize bruising. There is usually minimal swelling and bruising lasting several days at the most and easily concealable with make-up.
Perlane®
Perlane® is of a similar material to Restylane®. Its difference lies in the size of the hyaluronic acid particles. In Perlane®, the particles are of a larger size. The increased size allows for deeper placement of the material and fill of deeper folds like the nasolabial folds or back of the hands. It also may last a little longer than Restylane®. It is primarily used for lips and deep nasolabial folds.
Juvederm® The Next Generation Dermal Filler
Juvederm® is also a hyaluronic acid filler. It differs form the Restylane® family of fillers in that the injectable gel is produced by a Hylacross® technology, which creates a more stable and resistant gel to degradation by the body. Juvederm® is of a smoother consistency than Retylane® and creates a natural look and feel that lasts longer than Restylane® with persistence up to a year. As one of the top injectors in the nation, Dr. Salzman was chosen by Allergan inc. to be among the first physicians in the US to introduce this exiting new filler.
Juvederm® comes as Ultra and Ultra Plus size of particles and is used in similar locations that we would use Restylane® and Perlane®.
Click here to use the Juvederm® Treatment Visualizer
ARTEFILL® PERMANENT WRINKLE CORRECTION
Dr. Salzman is Louisville's exclusive provider of the first and only FDA approved non-resorbable injectable wrinkle filler with permanent result. Artefill® contains microscopic spheres of polymethyl-methacralate a glass like substance commonly used in medicine in a carrier of bovine (cow source) collagen matrix. The collagen allows for the body to anchor the tiny spheres and produce its own collagen. As the bovine collagen is absorbed, it is replaced by human collagen. The combination of your own collagen and these tiny beads that cannot be absorbed makes for a permanent correction of the wrinkle. Because Bovine collagen is used as a carrier for the microspheres, a skin test is needed prior to the placement of Artefill® to make sure you don't have an allergy to cow source protein. Depending on the degree of correction needed, some patients may need more than one treatment to build layers of Artefill® for optimal correction. Lidocaine numbing medicine is combined with the Artefill® to make the placement more comfortable.
Radiesse®
Dr. Salzman was one of the first physicians to embrace Radiesse® as a choice for volume correction. Radiesse® is a calcium hydroxylapatite crystal in a carrier of mannitol and hydroxyl methylcellulose. The calcium salt is similar to that found in our bones and teeth and therefore does not require a skin test prior to its use. The mannitol and hydroxylmethylcellulose are sugars that suspend these calcium particles to allow for a smooth placement. Your body will degrade these sugars over several weeks and produce collagen to anchor the calcium crystals. The results of Radiesse® are long lasting approaching one and one half years in most cases. Radiesse® is a little thicker filler than those made of hyaluronic acid and therefore is placed deeper under the skin. It is commonly used in deeper nasolabial folds, marionette lines, back of the hands and to increase the fullness of the cheekbones. We mix it with a numbing medicine prior to its placement to make it more comfortable.
COSMODERM AND COSMOPLAST®
The Cosmoderm® and Cosmoplast® family of fillers are human based collagen replacement. They are formulated with a local anesthetic to make placement more comfortable. No pre-treatment skin tests are necessary as these are both made from human source. Cosmoderm® is thinner filler in consistency and therefore can be injected into very superficial layers of the skin. We will use it primarily in vertical lip lines and acne pockmarks. Cosmoplast® is cross-linked human collagen, which allows it to better resist degradation by the body. Its use is for folds such as the nasolabial and marionette lines. Both filler last on average 3 to 5 months.
COMBINATION TREATMENT: BOTOX® AND FILLERS
The combination of Botox® and fillers are often done to complement one and other. The Botox® will lessen the underlying muscle effect that creates the crease or wrinkle. Sometimes, despite inactivity of the muscle making or contributing to the wrinkle, the wrinkle may not completely disappear. It is then necessary to place a filler into the wrinkle to complete the correction. The lessening of the muscle effect by Botox® also may prolong the durability of the filler. With decreased muscle movement, there is less squeezing and mechanical compression of the filler allowing it to last longer. The two treatments can be done on the same day or staged such that the Botox® is placed first and allowed to work. In two weeks, we can then assess the need for additional treatment with a filler.
Evolence®
Evolence® is an all natural dermal filler that beautifully enhances the parenthesis lines on the face. Used in other countries for many years, Evolence® was just introduced and FDA approved in the US this year. There are absolutely no chemicals or additives in this product and it contains only two ingredients, which are collagen and sugar, making it the only all natural dermal filler available. Because of the advanced spinning technology used to make this product, there is no allergy skin test required.
Prevelle™ Silk
Prevelle Silk is a colorless HA gel with lidocaine that is injected into facial skin to reduce moderate to severe facial lines, folds, and wrinkles. No allergy test is required, and it's the first hyaluronic acid dermal filler that contains lidocaine for added patient comfort. Prevelle™ Silk is softer and thinner than other dermal fillers, which allows it to deliver fabulous results filling the vertical lip lines, and tear troughs where there skin is thinner. Results last 2 to 4 months, and treatments are fast and virtually pain free.
Botox®
Dr. Salzman's office has achieved Platinum status with Allergan, makers of Botox®. He is a member of the Botox® Cosmetic Physicians Network and The Botox® National Education Faculty responsible for training other doctors in the injection techniques of Botox® Cosmetic. His practice is in the top few percent of Botox ® providers in the United States. He was listed in the 2004 edition of Shop, etc. magazine as one of the best Botox® injectors in the US. Our certified nurse injectors utilize advanced techniques to place Botox® into areas of the face that are not considered "routine". Botox® is utilized to lessen the movement of the underlying muscles that may contribute to wrinkle and fold formation. Our certified nurse injectors have a wealth of experience in Botox® injections and can schedule your treatments at a moment's notice. We employ Botox Cosmetic® to treat lines of the crow's feet, smile, nose, lip, forehead and neck bands. To make the injections more comfortable, we use a skin-chilling device to freeze the area prior to Botox® injection Botox® Cosmetic injections are now the number one cosmetic enhancement procedure in the USA.
Skin Spa Peels
Microdermabrasion (Skinscape®)
Microdermabrasion uses aluminum oxide salt crystals and suction pressure to gently exfoliate the skin's surface. Environmentally damaged skin with large pores, fine wrinkles and uneven skin tone can all be improved. Skin of all parts of the body can be addressed. No anesthesia is required. The skin following treatment will be wind burned and chapped for 24 hours. No liquid make-up is allowed during this period of time. An approved mineral make-up may be applied immediately after. Healing occurs in 24 -48 hours; patients are required to follow a post healing protocol, resuming at home products within 48 hours. This procedure is recommended in a series to improve results. The skin's improvement is enhanced with the addition of a medically supervised skin care regimen.
MicroPeel®
MicroPeel® is a three-step process done in our Skin Spa for patients with environmentally damaged, discolored, acne prone or hypersensitive skin. A micro thin portion of the top layer of the skin is removed to lessen the clogged pores and smooth the surface of the skin. The treatment is similar to a facial however; most people will notice a change in the skin's appearance right away. You can safely apply make-up immediately after a MicroPeel®.
MicroPeel Plus® (Acne Treatment)
Similar to a MicroPeel®, Salicylic Acid is added to the regimen to slightly deepen the depth of the peel. This peel is better suited for the patient with oily acne prone skin quality. Healing is like a mild sunburn: the skin will feel tight and start to chafe. Healing is complete in a few days.
Obagi Blue Peel®
The Blue Peel® is a combination of trichloracetic acid, a proprietary peeling agent and blue food color. It is painted on the skin of the face, neck, chest or hands and allowed to work. The color is then removed with skin soothing agents. Peeling is variable depending on the strength of the solution and number of applications. We customize each peel to achieve the best results with the least amount of down time. This peel is appropriate for patients with discolored, coarse, mild to moderately wrinkled skin. It is usually done in a series of three treatments spaced several weeks apart. The treated areas will peel and heal an outside layer of skin in about a week at the most. The skin may then by pink and sun sensitive for several days after that. During the pink phase of healing, you should either avoid direct sun exposure or use an SPF 12 or more sunscreen.
Anti-Aging Peel®
The Anti-Aging Peel® incorporates the combination of several fruit acids with salicylic acid to peel of the outside layer of the skin. This peel solution contains no dyes or coloring agents thereby reducing the down time associated with colored indicators. This peel removes the epidermis or outer layer of skin leaving the newly formed skin smoother, more even in skin tone with less visible pore size. The skin after the peel will feel tight, look darker in color and begin to peel within 2 days. The entire process takes 3-4 days to resolve. A good skin preparation supervised by our aestheticians can optimize the result. A series of Anti-Aging® peels are recommended to improve the outcome.
Dermaplaning (Mechanical Exfoliation)
In Dermaplaning, a scalpel is used to scrape off the top skin layer consisting of mostly dead skin. The underlying skin is then stimulated to replace this loss with a healthier more plump outside layer. The skin will feel softer and look smoother. There is no pain and no downtime associated with this treatment.
SKIN SPA BY SALZMAN SIGNATURE FACIALS
Foot Peel
When feet are extremely dry and callused this is an excellent option as it works to remove the dead skin build up on the bottom of the feet and cuticles. A high concentration peel, manual exfoliation, and hydrating mask are guaranteed to minimize unwanted rough spots while hydrating and repairing cracked dry skin.
Non-Acid Enzyme Facial
A non irritating exfoliation using natural enzymes from papayas (papain) and bromelain to safely dissolve surface skin debris leaving the skin soft, cleansed and refreshed. The perfect facial for sensitive skin.
Gentlemen's Facial
An age defying treatment specifically tailored to a man's need. The treatment includes a deep pore cleansing facial using steam and soft brushes. Exfoliation is done with enzymes. Age defying antioxidants and green tea extracts are then infused into the skin to defend the skin against environmental damage. The facial is relaxing yet effective for reversing the signs of skin aging.
Ultrasound Facial
Low frequency ultrasound is used to loosen and remove dead skin cells and debris from the skin's surface. Thorough and consistent exfoliation, perfect for sensitive skin or anyone who needs superficial resurfacing for common photo aging of the skin.
Iontophoresis Facial
Galvanic frequency waves are use to help penetrate cosmoceuticals, such as Vitamin C, into the skin to help protect it against environmental damage.
Enzymes such as papain, bromelain, papaya and pumpkin are custom blended for a particular skin type.
Anti-Aging Facial
Combines exfoliation with enzymes to slough off dead skin cells and soften the skin's surface. Antioxidants are driven in to the skin by ultrasound to protect the skin from free radical damage and improve the appearance of fine lines and wrinkles. This facial is finished with a warm green tea mask that calms the skin.
Deep Pore Facial
Each Deep Poor Facial is customized to the patient's skin type and condition. Based on the initial skin analysis, the correct products are chosen and then a series of steps are performed. A thorough cleansing is done, followed by exfoliation, steam, masque, extractions when needed, and then finished with a moisturizer/sunscreen.
Acne Facial
Gentle cleansing of the skin is done followed by the use of a "High Frequency" electrical stimulation to combat blemishes and bacteria.
Pumpkin Facial
This facial uses a blend of pumpkin derived enzymes that will effectively exfoliate the skin without irritation. Depending on the needs of the patient's skin, mechanical exfoliation may be used, followed by a second cleansing to effectively remove all the exfoliated skin and the pumpkin blend. The facial is finished with a moisturizer/sunscreen. This facial is excellent for sensitive or acne prone skin.
Pomegranate and Cranberry Mask
Try Skin Spa's delightfully fragrant Pomegranate and Cranberry Mask. The enzymes derived from both Pomegranates and Cranberries contain powerful antioxidants that are strengthening and anti-bacterial. Combined with Salicylic Acid this treatment will freshen the skin by removing its dead cells and revealing a more radiant glow. Recommended for dull, dehydrated, oily and acne skin.
Permanent Make-up
Permanent make-up is for those wishing to spend less time applying makeup and tending to it throughout the day and evening. It may also be beneficial to people with sensitive skin or allergies, arthritic hands, alopecia, scars or burns Areas that can be treated are the lips, eyeliner and eyebrows. Permanent makeup may also be used to camouflage scars.
Permanent make-up or Micropigmentation takes a few treatment sessions using state of the art equipment that is digitally computerized to deliver tint at the same depth throughout the treatment area. This insures a more even result. The correct color and depth are selected by our aestheticians that do all of the treatments.
Some swelling is common post treatment and can last a few hours. It is usually managed well with cold packs and Tylenol. The color may initially appear deeper than your eventual result as both the epidermis and dermis have been treated. Once the epidermis sheds, the true lighter color will emerge.
Hair Removal Laser
Lasers use a single wavelength of light over a broad surface area to disable the growth of hairs from all parts of the body. Different wavelengths are better for the whole spectrum of possible hair and skin color combinations. Multiple lasers have been used in the past to treat hair. We use the Cynosure Apogee Elite®, considered to be the "Rolls Royce" of hair removal lasers. It is actually two lasers in one. It contains both a long pulse Yag and Alexandrite lasers. The best candidates for hair removal with lasers have dark hair and light skin colors. Darker skin colors, because they have more pigment in the upper layers of the skin are more difficult to undergo laser hair reduction. For these patients, a long pulse Yag laser works better and is less likely to remove skin color including a suntan. Another advantage of the Apogee Elite® is the ability to change the pulsewidth or length of the pulse. Unlike fixed pulsewidth lasers such as the Gentlelase®, we can customize the treatment to the color and thickness of the hair by changing the type of laser, its pulsewidth and its energy level. All laser hair removal systems require some type of skin cooling. The Apogee Elite® has a Smartcool® advanced skin cooling jet of super cold air. It not only protects the skin from unwanted heat, it also makes the procedure less painful. Laser Hair Removal requires a series of treatments. Hair on the body is constantly going thru 3 phases of growth: active, resting and dormant. The laser can only disable growth of the hair while in the growing phase. We want to "catch" the hair while it's susceptible to laser. Anywhere from 3 to 8 treatments at 4 to 8 week intervals may be necessary to achieve a satisfactory reduction. Most patients can expect an 85% permanent hair reduction after the recommended treatment series.
LipoDissolve®
LipoDissolve® is a compound pharmacy made combination of several agents. The active ingredients include phosphotidylcholine (PPC) and deoxycholate (DC) along with some B vitamins and Trental (pentoxyfline). The PPC is known as lecithin a soy derivative that appears in the labels of many foods we consume daily. DC is a bile salt produced by our liver to aid in digestion of fat. The Trental causes the vessels nearby to dilate to carry more blood. Very tiny amounts of this mixture are injected spaced about a half inch apart to melt fat. This combination has been extensively studied in Europe for over 10 years and is found to be very safe and effective in thinning the fat layer just beneath the skin. Its main uses are for smaller fatty areas like the neck, back rolls, lower abdomen and arms. Because it works slowly, a series of treatments spaced some 4-6 weeks apart are necessary to achieve the optimum result. We also will use external ultrasound in the healing phase of the injections to speed recovery and soften the result. The immediate response is a few hours of itching and a mild burning sensation. Some swelling usually maximizes over the ensuing 2-3 days and then dissipates. The area may become firm until it all resolves over a 4-6 week period. Usually 4-5 treatments will be necessary to get the best result.