Paz Dermatology

BOTOX® 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. Applications For BOTOX Cosmetic Although 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 furrows Frown lines bunny lines Crow’s feet Skin bands on the neck Lip flip Chapstick lines According to Allergan, BOTOX Cosmetic has been “extensively researched, with approximately 2500 studies.” Using 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 Cosmetic Injection-site side effects of BOTOX Cosmetic are usually mild and temporary, and include the following: Pain Infection Inflammation Tenderness Swelling Redness Bleeding Bruising Normal activities may be resumed immediately after receiving injections.

Injectables And Fillers As we age, our skin changes. Over time, the volume of youthful skin begins to diminish as wrinkles and folds form. With injectables and fillers, you don’t have to just sit back and let it happen! Kybella™ For Fat Reduction Under The Chin At Fresno and Visalia Dermatology Specialists we help our cosmetic dermatology patients address a variety of aesthetic concerns, including facial wrinkles, acne, unwanted fat, and hair loss. But one area that has had few nonsurgical options for improvement is the chin. Many people are unhappy with excess fat in their chin area—a problem that can make one look heavier and older than they truly are. Fat in the chin is also notoriously difficult to get rid of, and can even affect people who maintain a healthy weight. Until recently, the only effective way to remove fat under the chin (also known as submental fat) was through liposuction, but a new product, Kybella™ offers an exciting non-surgical option. Dr. Carlos Paz is one of the first physicians in the Central California to be trained and certified in administering Kybella™. Kybella™ is a form of deoxycholic acid, a substance that occurs naturally in the body to aid in breaking down and absorbing fat. The procedure consists of a series of injections into the fat of the chin, which destroys the localized fat cells so that they can no longer store fat. While the number of necessary treatments varies from patient to patient, the result is a slimmer, younger-looking chin with minimal downtime. Botox® Cosmetic BOTOX® Cosmetic is a prescription medicine that is injected into muscles and used to improve the look of moderate to severe frown lines between the eyebrows, forehead wrinkles and crow’s feet for a temporary period. The lines that appear between your brows actually result from muscle movement and the passage of time. During the procedure, Dr. Paz will inject BOTOX directly into the muscle as a simple, nonsurgical treatment. Once injected, Botox works by blocking nerve impulses to the injected muscles, which reduces muscle activity that causes moderate to severe lines to form between the brows. Allergan Family Of Fillers Juvederm is a smooth consistency gel made of hyaluronic acid, a naturally occurring substance in your skin that helps to add volume and hydration. The smooth consistency gel helps to instantly restore your skin’s volume and smooth away facial wrinkles and folds. During the procedure, Dr. Paz will ease Juvederm injectable gel into the skin using a fine needle to temporarily fill in and augment the treatment area and smooth moderate to severe facial wrinkles and folds. The injection process takes about 15 minutes, the results are immediate and last approximately six months. JUVÉDERM VOLUMA® XC As you age, the cheeks may flatten and the skin may begin to sag. This is caused by natural loss of volume in the cheek area, or what the experts call age-related midface volume loss. JUVÉDERM VOLUMA® XC is designed to add volume beneath the skin’s surface, which provides lift and contour to the cheek area. The results are immediate and last approximately 2 years. JUVÉDERM VOLLURE™ XC Injected into the areas of facial tissue where moderate to severe facial wrinkles and folds occur, including the “parentheses lines” around the nose and mouth, designed to temporarily correct facial wrinkles for a smoother appearance to the face. The results are immediate and last approximately 18 months JUVÉDERM VOLBELLA® XC First approved by the FDA in 2006, JUVÉDERM® XC corrects moderate to severe facial wrinkles and folds, such as the parentheses lines or “smile lines” around the nose and mouth. JUVÉDERM® XC is injected into areas of facial tissue where moderate to severe facial wrinkles and folds occur to temporarily add volume to the skin, which may give the appearance of a smoother surface.The results are immediate and last approximately 1 year. JUVÉDERM VOLBELLA® XC Injectable gel is for injection into the lips for lip augmentation and for correction of perioral lines, often called “lipstick lines”. The results are immediate and last approximately 1 year. JUVÉDERM® Ultra XC An injectable gel that temporarily adds more fullness and plumps thin lips—whether your lips have thinned over time or you simply want fuller lips. JUVÉDERM® Ultra XC is also approved for smoothing and correcting moderate to severe parentheses lines, such as nasolabial folds (smile lines around the nose and mouth). The results are immediate and last approximately 1 year. Radiesse Radiesse is a synthetic dermal filler made of calcium hydroxyapatite that helps reconstruct the skin by stimulating collagen production. It is used for soft tissue augmentation and to treat skin folds and wrinkles. During the procedure, Dr. Paz will implant the Radiesse with a small needle.

At Paz Dermatology, we are proud to provide a number of general dermatology services to address all of your dermatologic needs. Our professionals are extremely skilled at diagnosing skin, hair, and nail conditions and we are happy to work with our patients to devise treatment plans that take into account particular needs. Here are some of the conditions we handle: Skin Cancer Screenings, Detection and Treatment Actinic Keratosis Mole Checks and Mapping Rosacea Acne Psoriasis Sun Damage Alopecia Areata Rashes (Dermatitis) If you are considering your options for dermatology in the Central Valley, request a consultation with our office online or contact us at 559-233-3376 (DERM).

We Provide Several Treatment Options For Skin Cancer Dr. Paz specializes in the treatment of skin cancer. Below is an overview of the treatment options he uses to treat our patients. Mohs Micrographic Surgery The Mohs Micrographic Surgery technique combines surgical removal of the cancer with an immediate microscopic examination of the removed tissue to identify cancerous areas. Mohs surgery not only has the highest cure rate of all treatment methods, but it creates the smallest possible surgical defect, allowing for the best cosmetic results. This procedure is state-of-the-art treatment in which the physician serves as surgeon, pathologist and reconstructive surgeon. Mohs Surgery relies on the accuracy of a microscope to trace and ensure removal of skin cancer down to its roots. This procedure allows dermatologists trained in Mohs Surgery like Dr. Paz, to see beyond the visible disease, and to precisely identify and remove the entire tumor, leaving healthy tissue intact unharmed. Mohs Surgery is most often used in treating two of the most commons forms of skin cancer, basal cell and squamous cell carcinoma. Mohs surgery is an out-patient procedure performed under local anesthesia. The complete removal of the skin cancer and reconstruction can often be completed in a single day. Pre and post-operative instructions are posted on our website under the Patient Resources tab. Surgical Excision Surgical excision is used to treat all types of skin cancer. It offers results that are both medically and cosmetically excellent. During the procedure, Dr. Paz will outline the tumor with a marking pen. A safety margin of healthy-looking tissue will be included, because it is not possible to determine with the naked eye how far microscopic strands of tumor may have extended. An extended line of excision is drawn, so the skin may be sewn back together. The tissue sample will be sent to a lab, to see if any cancer cells appear in the safety margin excised. If cancer cells appear, it is assumed that the cancer is still present and additional surgery is required, typically Mohs Micrographic Surgery. Dr. Paz will administer local anesthesia, and then cut along the lines that were drawn. The entire procedure takes about thirty minutes for smaller lesions. Wounds heal rapidly, usually in a week or two. Scarring depends on many factors, including the placement of the tumor and the patient’s care of the wound after the procedure. Photodynamic Therapy Photodynamic therapy is a treatment that uses special drugs, called “photosensitizing agents,” along with light to kill precancerous cells. The drugs only work after they have been activated by certain kinds of light. Precancerous cells preferentially absorb photosensitizing agents. When light is applied, the photosensitizing agent combines with oxygen and forms a chemical that kills the cells. Photodynamic therapy is typically reserved for precancerous lesions.

Skin Cancer Screenings What Is A Skin Cancer Screening? A skin cancer screening is an inspection of your skin by a medical professional. Why Are Skin Cancer Screenings Necessary? Skin cancer is the most common cancer in the United States; in fact, 1 in 5 Americans will develop skin cancer in their lifetime. People of all colors and races can get skin cancer. There are many different types of skin cancer, including Basal Cell Carcinoma (BBC), Squamous Cell Carcinoma (SCC), and Melanoma. BCC and SCC are the most common forms of skin cancer, but melanoma is the most deadly form of skin cancer. With early detection and proper treatment, the cure rate for BCC and SCC is over 95 percent. When melanoma is detected before it spreads, it also has a high cure rate. Regular self-skin exams and a yearly examination by a dermatologist help people find early skin cancers. Our office recommends annual skin cancer screenings, and more for individuals with a history of skin cancer. Treatment For Precancerous Skin Lesions And Skin Cancer There are various treatments for pre-cancerous lesions, called Actinic Keratosis, including: Cryotherapy, or freezing Curettage, or scraping Application of cream or ointment Chemical peeling Photodynaminc therapy using laser light For skin cancer, our office offers a variety of effective treatments including: Mohs Micrographic Surgery Electronic Brachytherapy Surgical Excision Photodynamic Therapy Dr. Paz is one of the few fellowship-trained Mohs Surgeons in Central California. Our office is committed to offering Mohs Surgery expeditiously to our patients. Dr. Paz performs Mohs Surgery to our patients once a week in Fresno and once a week in Visalia.

Intense-Pulsed-Light (IPL) skin rejuvenation uses high-energy pulses of light to improve the skin's appearance. Also referred to as IPL photorejuvenation, photofacial therapy and pulsed-light therapy, IPL skin rejuvenation is a nonabrasive and noninvasive treatment option for removing red and brown pigment from the skin. IPL is used to treat age spots, birthmarks, freckles caused by the sun, symptoms of rosacea, spider veins, and scarring from acne; it is also an effective tool for hair removal. IPL penetrates below the surface of the skin, leaving the top layer of skin intact, which means that there is no post-treatment recovery period. The light is absorbed by the pigment in sunspots and the blood in the visible vessels, and converted to heat. The heat dissolves the cells that create the pigment and shrinks the vessels. The Intense-Pulsed-Light Skin Rejuvenation Procedure Prior to IPL treatment, a topical anesthetic gel is applied to the skin to reduce discomfort. The IPL machine is placed on the settings that best suit the patient's skin; among the factors considered are the condition being treated and, because IPL is absorbed differently by different skin colors, the amount of pigment in the skin. Protective coverings are placed over the patient's eyes, and the IPL handpiece is gently pressed to the skin as pulses of light are emitted. The light is absorbed by the skin's red or brown pigment and converted to heat, which dissolves the pigmented cells. After treatment, the topical anesthetic is removed with a warm cloth, and a moisturizer with sunscreen is usually applied. If there is any swelling, a cold pack is applied for 5 to 10 minutes. Three to six treatment sessions are usually required; sessions typically last from 30 to 90 minutes each, and are spaced approximately 3 weeks apart. Gradual improvement may be seen after each treatment, but optimal results appear only after several months. Recovery from Intense-Pulsed-Light Skin Rejuvenation There is no recuperation time following IPL treatment. A patient can return to work or resume normal activities on the same day. Although skin may be slightly reddened after the treatment, redness typically disappears within a day or two. As it heals in the days following treatment, skin often begins to flake. Over time, however, a gradual, natural-looking improvement in the skin becomes noticeable. Applying sunscreen regularly and avoiding sun exposure is recommended following IPL treatment. Risks of Intense-Pulsed-Light Skin Rejuvenation One possible contraindication for IPL treatment is taking medication that increases photosensitivity. A patient using a topical or oral medicine that increases sensitivity to light may not be a candidate for IPL treatment. And, although IPL skin rejuvenation is considered safe, there are some risks associated with its use. Although rare, IPL skin rejuvenation can cause skin discoloration, blisters, scars and burns. Interested in IPL Skin Rejuvenation in Visalia, CA? Ready to move forward? Don't hesitate to schedule your IPL treatment consultation now! Reach out to us at our Fresno office by dialing 559-233-3376 or our Visalia office at 559-385-2133. Keep in mind that our IPL Skin Rejuvenation treatment is exclusively available in Visalia. However, we're more than willing to accommodate your consultation at either of our locations. You can also fill out the form on our contact page, and our team will help you set up a personalized appointment with one of our providers. The Paz Dermatology team looks forward to serving you!

Tattoos no longer have to be permanent. Intense, fast-pulse Q-switched lasers can remove or significantly lighten a tattoo by training pulsing light on the tattoo's ink particles, which convert the energy to heat and break up into tiny pieces that are absorbed harmlessly by the body, without any damage to surrounding tissue. Ideal candidates for laser tattoo removal are typically fair-skinned, and have tattoos that are on areas, such as the arms, legs, buttocks or chest, that have a greater concentration of body fat. Prior to laser, techniques for removing tattoos included dermabrasion, cryosurgery and surgical excision. The Laser Tattoo Removal Procedure A few hours before the laser tattoo removal procedure begins, it is recommended that acetaminophen be taken to help minimize discomfort. Just before the procedure begins, one of our providers will provide the patient with a shield to protect his or her eyes from the laser. A topical anesthetic is applied to the skin; in some instances, a cooling system is used before, during and after the procedure to help with discomfort. The tattoo removal specialist then tests the skin's response to the laser to determine the most effective approach, and intense nanosecond pulses are sent from the Q-switched laser to the skin. Each laser tattoo removal session lasts only a few minutes and, at the end of each session, the tattoo is iced for about 30 minutes. A topical antibiotic and a bandage are then applied. Patients are advised to keep the skin around the tattooed area dry, and to treat it as if it were sunburned. Results and Risks of Laser Tattoo Removal Depending on the complexity of the tattoo, removal results vary. Simple tattoos may be eliminated within four treatment sessions, while more complicated tattoos might require ten or more. Although they rarely occur, there are certain side effects associated with laser tattoo removal. They include hyperpigmentation, hypopigmentation, infection and permanent scarring. Interested in Laser Tattoo Removal in Fresno or Visalia, CA? Ready to move forward? Don't hesitate to schedule your Laser Tattoo Removal consultation now! Reach out to us at our Fresno office by dialing 559-233-3376 or our Visalia office at 559-385-2133. You can also fill out the form on our contact page, and our team will help you set up a personalized appointment with one of our providers. The Paz Dermatology team looks forward to serving you!

Blepharoplasty (eyelid surgery) is a plastic surgery procedure for correcting sagging or drooping eyelids. The eyelid, because its skin is much thinner than that in other parts of the face, is often one of the first facial areas to exhibit signs of aging. Eyelids that sag or droop can affect peripheral vision, making daily activities such as driving more difficult. Blepharoplasty may become necessary when various factors, which include aging, sun damage, smoking and obesity, cause the muscles and tissue that support the eyelids to weaken. What can a blepharoplasty do? A blepharoplasty is ideal for correction of the following: Loose, sagging and/or folded upper eyelids that may interfere with vision Puffy fat deposits in the eyelids Undereye bags Sagging lower eyelids that may show the whites of the eyes below the irises Excess skin in the lower eyelids Fine wrinkles in the lower eyelids A blepharoplasty cannot raise the eyebrows, or treat deep wrinkles, dark circles under the eyes, or crow's feet. Reasons for Blepharoplasty Blepharoplasty tightens the eyelid's muscles and tissue, and removes excess fat and skin. Blepharoplasty eliminates the drooping of skin into the visual field, greatly improving peripheral vision. It is also performed for strictly cosmetic reasons. Functional Blepharoplasty If the eyelids begin sagging into the field of vision, a functional blepharoplasty may be required. The procedure may be covered by medical insurance if it is deemed medically necessary. A determination of how much vision is affected is done by checking the peripheral visual field with an instrument called the Humphrey Visual Field (HVF) Analyzer. Cosmetic Blepharoplasty Dr. Carlos Paz can perform Blepharoplasty on either the upper or lower eyelid, or on both, for cosmetic purposes. For a lower eyelid that needs fat rather than skin removed, a transconjunctival blepharoplasty is performed. During transconjunctival blepharoplasty, an incision is made inside the lower eyelid, so there are no visible scars, and the fat is removed. This procedure has no effect on vision, but results in a person's looking younger and more refreshed. It is important for a patient to have realistic expectations before undergoing cosmetic blepharoplasty. Although the procedure can enhance appearance and improve self-confidence, it does not radically alter the face. The Blepharoplasty Procedure Blepharoplasty is typically performed as an inpatient procedure requiring local anesthesia and sedation. General anesthesia may be used for anxious patients. Patients can choose to have this procedure on their upper or lower eyelids, or both. The procedure can take anywhere from 45 minutes to 2 hours, depending on whether both the upper and lower eyelids are operated on. If the upper eyelid is being operated on, Dr. Carlos Paz will typically make an incision along its natural crease. Once the incision is made, fat deposits are repositioned or removed, muscles and tissue are tightened, and excess skin is removed. For the lower eyelid, an incision is usually made just below the lash line so that excess skin can be removed. After the procedure, the incisions are closed with sutures, tissue glue or surgical tape, and usually loosely covered with gauze so the area can heal. What is recovery from a Blepharoplasty like ? After blepharoplasty, patients may be advised to apply lubricating drops/ointment and cold compresses to aid in healing and minimize side effects. Most patients return to work within a few days to a week, but should avoid exercise and strenuous activities for at least 2 weeks. Stitches are usually removed 3 or 4days after the procedure. Most of the swelling and other side effects typically subside within 2 weeks. Contact lenses and eye makeup may not be worn for 2 weeks after surgery. Patients are typically advised to wear dark sunglasses outside or in bright light for 2 weeks to protect their eyes from sun and wind. Risks of Blepharoplasty Although there may be swelling and bruising around the surgical site, they will subside on their own, and the eyelids will improve in appearance for up to a year. Uncommon side effects include infection, reaction to anesthesia, and double or blurred vision. Eyes may be irritated and dry due to a temporary change in tear distribution. Side effects such as uneven healing and permanent scarring are rare but, if they occur, may require surgical correction. The scars from blepharoplasty are well-concealed, and usually fade with time until they are virtually undetectable. Although the eyelids are still subject to aging, blepharoplasty produces long-lasting results.

Liposuction is a minimally invasive cosmetic procedure that uses a thin, hollow tube called a cannula toremove localized areas of body fat. The cannula is inserted through extremely small incisions, and thenmoved back and forth to loosen excess fat, which is suctioned out using a vacuum or a cannula-attachedsyringe. Treated areas look slimmer and more contoured, and in better overall proportion to the rest of thebody. However, liposuction is not a method for losing weight, and is not effective in eliminating cellulite,or tightening loose and sagging skin. The ideal candidate for liposuction is in good overall health, but has one or more areas of fat that do notrespond to diet or exercise. Areas that are often treated with liposuction include the thighs, abdomen,arms, back, hips, buttocks, chest, face, calves and ankles. Liposuction can be performed alone, or inconjunction with other cosmetic procedures, such as thighplasty and abdominoplasty. The Liposuction Procedure With over 10 years of experience, Dr. Carlos Paz often employs tumescent liposuction techniques in his practice, harnessing the benefits of ultrasound and laser assistance to ensure optimal results for his patients. During tumescent liposuction, a solution comprising saline solution, lidocaine (an anesthetic) and epinephrine (a blood-vessel contractor) is injected into the area being treated. The solution causes the targeted tissue swell and become firm, which makes it easier to remove via the cannula. The advantages to this technique are that the anesthetic is built in, so there is no need for general or IV sedation, and blood loss is minimized because the epinephrine constricts blood vessels. In laser-assisted tumescent liposuction, a laser is used to liquefy the fat, which makes removing it easier. The laser can also be used to tighten treatment-area skin after fat is removed. Similarly, ultrasound-assisted liposuction uses ultrasound energy to liquefy fat. Recovery from Liposuction After liposuction, patients experience mild swelling, bruising and discomfort in the treated area. Compression garments or elastic bandages are typically worn to help reduce these symptoms as the area heals. Patients can return to work and other regular activities as soon as they feel comfortable, which is usually after a few days. Exercise and other strenuous activities should be avoided for a few weeks. Risks of Liposuction In addition to the usual risks associated with surgery, risks associated with liposuction include the following: Loose or rippled skin Worsening of cellulite Asymmetry Contour irregularities Pigmentation irregularities When large amounts of fat are removed, surgery to remove excess skin may be necessary. Results of Liposuction Results of the liposuction procedure may not be apparent until swelling and bruising subside, which usually takes a week; swelling should completely subside within a few months. Incisions are rarely sutured, and scarring is almost nonexistent, because the incisions used for the cannula are so small. The results of liposuction are long-lasting, unless a substantial amount of weight is gained. Call to Schedule Your Liposuction Consultation in Fresno or Visalia, CA! Interested in learning more about liposuction? Call our Fresno office at 559-233-3376 or the Visalia office at 559-385-2133 to schedule your consultation today. You can also fill out the form on our contact page, and our team will help you set up a personalized appointment with one of our providers. Dr. Carlos Paz looks forward to serving you!