Birem, MD Beauty & Wellness

UltraShape® System for Body ContouringThe UltraShape® System is U.S. Food and Drug Administration-approved for reducing abdominal fat (abdominal-circumference reduction). It uses pulsed, focused ultrasound to target and and destroy fat cells. Because no heat is involved and the ultrasound waves are so precisely targeted, blood vessels, nerves and connective tissue are not damaged. Undergoing UltraShape treatment to contour the abdominal area requires no downtime, and eliminates the complications that often result from surgical fat-removal procedures such as liposuction. A treatment takes about 45 to 60 minutes, and provides measurable results within only 2 to 4 weeks. The UltraShape System can also be used to reduce fat on the thighs and flanks ("love handle" areas).Candidates for UltraShape Body ContouringAlmost anyone who wants to remove localized pockets of fat in the abdomen, thighs and/or flanks is a candidate for UltraShape body contouring. A typical candidate is only moderately overweight, but has areas of fat that cannot be dieted or exercised away. Anyone who wants a significant amount of fat removed would benefit more from a treatment such as liposuction.The UltraShape System ProcedureThe UltraShape procedure is a simple one, with no anesthesia required. Before treatment begins, computer software is used to design an individualized treatment plan so that the the correct areas are targeted, and contouring is uniform. A handheld device (transducer) that converts electrical energy to ultrasound energy is run over the areas from which fat is to be removed. The pulsed energy, which contains no heat, destroys only fat cells; all other tissue is unaffected. The fat released by the destroyed cells is flushed naturally from the body via the liver. A typical treatment regimen consists of a total of 3 sessions, each performed 2 weeks apart. No recovery period is needed.Results from UltraShape Body ContouringResults from UltraShape treatment are visible within 2 to 4 weeks. Patients report seeing a decrease in fat and body circumference, and an improvement in body shape and skin tightness; overall patient satisfaction with the treatment is high. According to system manufacturers Syneron and Candela, in a randomized, controlled clinical study, "patients demonstrated an average reduction of 2.5 cm [per treatment session] in the treatment phase and 0.5 cm reduction in the control phase." To maintain results, a patient must not gain a significant amount of weight, and should continue to exercise.Risks of UltraShape Body ContouringBecause it is noninvasive, there are few documented risks associated with UltraShape body contouring. In rare instances, it causes mild bruising, redness and swelling.

BOTOX® CosmeticBOTOX® Cosmetic is a prescription drug that, when injected, temporarily paralyzes muscles. It contains a purified and safe form of botulinum toxin A, which is produced by the microbe that causes botulism. Manufactured by Allergan, Inc., it is used to treat permanent furrows and deep wrinkles in the skin that are formed by the continual contraction of facial muscles. In addition to its cosmetic applications, it is used to treat a number of medical problems, including excessive sweating, overactive bladder, neck spasms, crossed eyes, chronic back and jaw pain, and migraines.Applications for BOTOX CosmeticAlthough originally approved by the U.S. Food and Drug Administration for the treatment of eye and muscle spasms, BOTOX Cosmetic was quickly recognized for its cosmetic value. Properly placed injections of BOTOX Cosmetic block nerve impulses sent to muscles, weakening them to the point where they cannot contract, and temporarily eliminating moderately severe furrows and lines. BOTOX Cosmetic is used to treat the following:Forehead furrowsFrown linesCrow's feetSkin bands on the neckAccording to Allergan, BOTOX Cosmetic has been "extensively researched, with approximately 2500 studies."BOTOX Cosmetic Procedure and ResultsUsing a very fine needle, BOTOX Cosmetic is injected directly into facial muscles that are causing furrows and lines. Receiving the injections requires no anesthetic, but some doctors choose to numb the area to be injected with ice packs or a topical anesthetic cream. Results can usually be seen within a few days of treatment, and typically last up to four months, although areas that are treated on a regular basis may retain results longer. Injections should be given only by qualified medical professionals.Side Effects of BOTOX CosmeticInjection-site side effects of BOTOX Cosmetic are usually mild and temporary, and include the following:PainInfectionInflammationTendernessSwellingRednessBleedingBruisingNormal activities may be resumed immediately after receiving injections. BOTOX® Cosmetic FAQsBOTOX® Cosmetic is a prescription drug that, when injected, temporarily paralyzes muscles. BOTOX Cosmetic injections treat moderate-to-severe facial lines and wrinkles that are formed by continual muscle contraction. Treatment with BOTOX Cosmetic is the most popular physician-performed nonsurgical cosmetic procedure in the United States.What does BOTOX Cosmetic do?According to its manufacturer, Allergan, Inc., "BOTOX Cosmetic is the first and only FDA-approved prescription product that temporarily improves the appearance of both moderate-to-severe frown lines between the brows and moderate-to-severe crow's feet in adults."How does BOTOX Cosmetic work?Properly placed injections of BOTOX Cosmetic, which contains a purified and safe form of botulinum toxin A, block nerve impulses sent to muscles, weakening them to the point where they cannot contract.When will I see results from BOTOX Cosmetic? How long does it last?Results from BOTOX injections are apparent within 24 to 48 hours, and are maximized by 30 days. Results often last between 3 and 4 months.Does BOTOX Cosmetic have medical applications?Yes; it is used to treat a number of medical problems, including excessive sweating, overactive bladder, neck spasms, crossed eyes, chronic back and jaw pain, and migraines.Who is qualified to give BOTOX Cosmetic injections?The manufacturer of BOTOX Cosmetic recommends that injections only be given by a doctor who has experience with BOTOX Cosmetic, and has a "medical practice that focuses on facial aesthetics and offers other facial aesthetic treatments."What are the possible side effects of BOTOX Cosmetic?Side effects of BOTOX Cosmetic are usually mild and temporary. Possible injection-site side effects include pain, infection, inflammation, tenderness, swelling, redness, bleeding and bruising.What are the possible cosmetic side effects of BOTOX Cosmetic?Depending on where they are given, cosmetic side effects of BOTOX injections include eyelid drooping and swelling.

JUVÉDERM® XC Injectable GelJUVÉDERM® XC injectable gel is a U.S. Food and Drug Administration-approved dermal filler that, according to its manufacturer, Allergan, Inc., is designed to "temporarily treat moderate to severe facial wrinkles and folds such as nasolabial folds" in people older than 21. Unlike the original JUVÉDERM injectable gel, JUVÉDERM XC is infused with lidocaine to make its injection more comfortable.JUVÉDERM XC is a smooth-consistency gel that restores volume to the skin, and smooths away moderate-to-severe facial wrinkles and folds. It is made of hyaluronic acid (HA), a sugar that occurs naturally in the body. In terms of the skin, HA's role is to deliver nutrients and hydration, and act as a cushioning agent. Young, healthy skin contains a lot of HA, but factors that include aging and sun exposure reduce the amount, causing skin to lose structure and volume. JUVÉDERM XC is most effective in improving the appearance of nasolabial folds, the lines that run from the bottom of the nose to the corner of the mouth on both sides of the face.JUVÉDERM XC Injectable Gel ProcedureJUVÉDERM XC injections take about 15 minutes to administer in a doctor's office. A fine needle is used for the injection, which is given under the skin in the targeted area to add volume or fill in wrinkles and folds. Because JUVÉDERM XC contains lidocaine to improve comfort, an anesthetic may not be needed. However, a doctor may still elect to use a topical anesthetic on the area to be treated before giving the injection. Afterword, the doctor may gently massage the treated area(s).Once treatment is completed, patients can return, with virtually no downtime, to their regular activities. For the first 24 hours after treatment, to reduce the risk of complications, patients should avoid strenuous exercise, excessive sun or heat exposure, and alcohol consumption.Results of JUVÉDERM XC Injectable GelThe results of JUVÉDERM XC are visible immediately after injection; any swelling and bruising, to which ice can be applied, should subside during the next few days. Results can last 6 to 9 months, and, in some cases, up to year. However, according to its manufacturer, "Results from injectable dermal filler vary and correction is temporary. Supplemental 'touch up' treatments may be required to achieve and maintain optimal correction of . . . wrinkles and folds."Risks of JUVÉDERM XC Injectable GelAlthough JUVÉDERM XC is considered safe, there is a risk of side effects. They are usually limited to the injection site, and include the following:RednessPain or tendernessFirmnessSwellingLumps or bumpsBruisingItchingDiscolorationInfectionFor customized treatment, Allergan, Inc., offers two types of JUVÉDERM XC: JUVÉDERM Ultra XC, which is suitable for superficial facial lines and folds, and JUVÉDERM Ultra Plus XC, a stronger formulation that is used for deeper facial folds and lines. JUVÉDERM XC is the first HA filler that is FDA-approved for use on people of color.Restylane® Injectable GelU.S. Food and Drug Administration (FDA)-approved Restylane® injectable gel is a cosmetic "filler" that contains hyaluronic acid (HA), a natural substance that is found in the body. HA gives volume and elasticity to the skin, but as the body ages, HA levels decrease, resulting in loose skin and wrinkling. When injected, Restylane gel is designed to plump the skin beneath lines and wrinkles, smoothing them out and making them less noticeable.The most common areas for Restylane treatment are the glabellar lines (which run between the eyebrows) and the nasolabial folds (which run from the sides of the nose to the corners of the mouth). Restylane injectable gel is also FDA-approved, for those 21 and older, for enhancing the lips. According to manufacturer Medicis, results can last for up to 6 months, at which point the hyaluronic acid is reabsorbed by the body.Benefits of Restylane Injectable GelWhen injected, Restylane gel plumps up glabellar lines and nasolabial folds, making skin appear younger and look smoother. When used for lip enhancement, it makes the lips fuller and gives them more definition.Advantages of Restylane Injectable GelOne significant advantage that Restylane injectable gel has over other facial fillers made with hyaluronic acid is that it contains nothing of animal origin. As a result, it does not require a potential user to undergo allergy testing, which can sometimes take weeks. Another advantage is that Restylane injections are performed in-office, usually by a dermatologist, in less than half an hour, and require little-to-no downtime for the patient.

Laser hair removal is a cosmetic procedure that uses pulsed laser energy to remove unwanted hair from a targeted area, while leaving surrounding skin unharmed. Common areas on which laser hair removal is performed are the chin, upper lip, chest, underarms, back, bikini line and legs. Although there are many temporary treatments, including tweezing, shaving, using depilatory creams and waxing, to remove unwanted hair, patients seeking more permanent and less irritating/painful methods are frequently good candidates for laser hair removal. Through what is a safe and usually painless procedure, hair can be removed from nearly any area of the body (the eye area is an exception because of the possibility of serious eye damage).Candidates for Laser Hair RemovalBecause the laser beams used to remove hair target its melanin (pigment), the best candidates have dark hair and light skin. Conversely, those with blond, red, gray or white hair and dark skin are usually not good candidates. Recent technological advances have made laser hair removal for those with dark skin more successful, while techniques for using lasers to effectively remove light-colored hair are being investigated.Benefits of Laser Hair RemovalThere are many benefits to having unwanted hair removed through the use of laser therapy. They include the following:Hair is precisely targetedProcedure is quickResults are permanent (for 90 percent of patients) or long-lastingFor many patients, laser hair removal is painless, although some experience minor discomfort, usually described as something like a rubber band's snapping against the skin.Laser Hair Removal ProcedureLaser hair removal is performed while the target area is numbed by a topical anesthetic. A handheld device that emits intense laser pulses is moved across the area, focusing on individual hair follicles. There are several different methods of laser hair removal, some of which combine laser impulses with radiofrequency. The appropriate method for each patient is decided in consultation with the physician administering treatment.Hair growth takes place cyclically, in three stages. The most effective laser hair removal takes place during the andogen (full-growth) stage, because the hair follicles in this stage are susceptible to laser energy. But, because all hair is not in the same stage of growth at any given time, several laser treatments, usually between three and five, spaced 4 to 8 weeks apart, are necessary. To some extent, the length of treatment depends on the texture of the patient's hair, and the location from which it is being removed.Recovery from Laser Hair RemovalSome redness, soreness or swelling may occur immediately after laser hair removal, but they almost always disappear within a few days. Cold compresses or ice packs, moisturizers, and anti-inflammatory creams may minimize discomfort. Sun exposure should be avoided as much as possible for some period of time.Complications of Laser Hair RemovalThe most common complication of laser hair removal is the regrowth of the unwanted hair. Frequently, however, the hair that regrows is finer and lighter than the hair that was removed. Usually, regrowth can be addressed with a few additional treatment sessions. Other complications that may arise after laser hair treatment include skin irritation such as blistering and crusting; changes in pigmentation or texture of the skin; and scarring at the removal site.

Laser lipolysis is an advanced, FDA-approved cosmetic procedure used to remove fatty tissue from localized areas of the body, and to contour those areas by tightening the affected skin. Designed specifically to target fat in parts of the body resistant to diet and exercise, lipolysis is a minimally invasive procedure, and represents a technological advance over liposuction, the original treatment for removal of localized fat.Benefits of Laser LipolysisAlthough effective, liposuction is an invasive procedure that requires a lengthy recovery time. Laser lipolysis, on the other hand, offers effective results with minimal downtime. Just as there are several types of liposuction, there are several types of laser lipolysis. All are derived from conventional liposuction, during which unwanted fatty tissue is suctioned out of the body through small tubes called cannulas. In laser lipolysis, laser energy melts the fatty tissue before its removal, and smaller cannulas, which cause less tissue trauma, are used.Laser lipolysis, when performed as an isolated procedure, treats only small areas of the body. It is sometimes referred to as "lunchtime lipo" because it takes only an hour or two to produce effective results. When a more significant reduction of fatty tissue is required, laser lipolysis is often performed along with traditional liposuction, helping patients to achieve maximum results in just one treatment.After treatment, a patient can expect significant circumferential reduction and skin-tightening in the targeted area. Common areas treated with laser lipolysis include the waist, abdomen, back, hips, buttocks, knees, ankles, face and neck.Laser lipolysis has a number of benefits over traditional liposuction. They include:Less traumaShorter procedure timeLess scarringLess downtimeEffective fat removalSkin-tighteningFewer risks and complicationsThe Laser Lipolysis ProcedureThe laser lipolysis procedure works along the same lines as the conventional liposuction procedure, except that it uses laser technology. Laser energy heats the fat cells, liquefying them and making them easy to remove through the smaller cannulas. This significantly reduces the trauma of the procedure. The laser also improves the treatment-area skin, causing it to tighten and conform to the body's new contours. Conventional liposuction often leaves skin loose and hanging.When performed on its own, laser lipolysis requires only local anesthesia, and is generally well tolerated. Depending on the size of the area treated, the procedure can last from less than an hour to several hours. Because the incision is small, no sutures are needed, and scarring is minimal. In some cases, scarring is not visible at all. A patient can return home shortly after treatment.Risks of Laser LipolysisAlthough laser lipolysis is considered safe, it is not appropriate for patients who are pregnant or regularly take certain medications. Because of the minimally invasive nature of the treatment, there is a lower risk of side effects, which include bruising, soreness, bleeding and swelling, than with conventional liposuction. Small lumps may be palpable at the treatment site, but will disappear in a short time. More serious complications are rare, but may include nausea, vomiting, fever, infection or prolonged bruising. If these symptoms are present, immediate medical intervention is required.Recovery from Laser LipolysisAfter laser lipolysis, patients can often return to work and other regular activities the next day. The positive effects of the procedure are immediately apparent, and the treated area, as it heals, continues to improve for several months. As with conventional liposuction, results of laser lipolysis are considered permanent unless a significant amount of weight is gained after treatment.