+ Why should I get Botox?
If you feel your face has a tired or angry expression, especially between your eyebrows, or if you’re finding wrinkles between your brows, sides of your eyes (“crows feet”), forehead or lip lines, then Botox will help. Your face will appear smoother, more rested and brighter.
+ How does Botox work?
Botox is a protein that works by inhibiting our nerves from releasing another protein that would normally signal muscle contraction. When injected into specific muscle groups, it has a range of about 1 cm (fingertip width) so it will not travel far from there and affect more important muscles. It takes 2 weeks to see the effects and typically these last 14 weeks.
+ What are side effects of Botox?
Because Botox is a medication that reduces muscle contraction, if injected into an unintended muscle group, such as just above the inside of your eye, it could cause eyelid drooping. There are antidotes to help eyelid droop. Other areas to be aware of include around the mouth as loss of the ability to contract muscles can affect your smile or speech. Your forehead muscle may have several “compensitory” fibers and sometimes we see a dramatic rise in one or both sides of the brow (“Mr. Spock eyebrow”), but can be readily corrected.
+ When should I start doing Botox?
The age to begin using Botox has many variables, which include your comfort level, financial commitment to injections every 14 weeks, and the amount of wrinkles caused by muscle movement. We start to see the effects of wrinkling into our 30s, although some late 20-year olds may begin early if their muscles are especially strong and they feel they look angry or tired. However, we’ve had several 40 and 50-year olds who are beginning Botox for the first time, so there is really not a standard age, other than what you feel personally.
+ When will I see results?
It takes 2 weeks to see the full effect, but you may see results in as soon as 2 days.
+ What can I expect during my treatment?
Botox must be “injected” into the muscle groups. This means Dr. Tokarz will use a very fine needle to do this. It stings a little due to the needle, but most patients tell her they feel minimal pain during the procedure. There is some transient swelling at the injection sites (like a bug bite reaction) which lasts about 20 minutes.
+ How long does it take to get Botox?
We book 15 minute appointments for botox which includes: consent signing, cleansing your skin with alcohol wipes, and the injections.
+ What does Botox unit mean?
Botox and Dysport are measured by their amount of units, and therefore volume is irrelevant. There are standardized units required for the average person to see reduction of muscle movement. It’s also important to understand that a Botox unit is different than a Dysport unit.
+ Will I bruise?
Because we are living beings and have fine blood vessels all over our skin, so there is always a chance you could bruise. Dr. Tokarz will use fine needles and magnifier lenses when injecting in order to reduce your risk. If you take any NSAIDS (motrin, ibuprofen, aleve, apirin, excedrin), fish oil, or have consumed alcohol in the last 24 hours, then your risk of bruising does increase. If Dr. Tokarz anticipates a bruise, she’ll use a cold pack and pressure to reduce it. She may suggest you eat fresh pineapple which has a chemical in it that could make bruising go away fast.
+ How often do you need Botox/Dysport?
These medications last an average of 14 weeks.
+ Does Botox hurt?
Most patients do not feel discomfort from injections except for a minor needle stick. The medication itself does not feel painful.
+ What happens if I stop doing Botox?
If you stop Botox, your muscles will go back to the natural function of contracting and you’ll see those lines reappear. You will not have worsening of the lines.
+ What happens if I don’t like the way I look after Botox? Can it be reversed?
If you’re unhappy with your Botox treatment, Dr. Tokarz will examine you and determine if a “touch up” is needed for any unevenness. Botox cannot be reversed and effects take 14 weeks to wear off.
+ What areas can you treat with Botox?
Botox works the best between your eyebrows, but also for your forehead lines and the lines on the sides of your eyes. Other areas that can be treated include chin wrinkles, lip lines, nasal lines (“bunny lines”) and neck bands.
+ How long do fillers last?
Fillers typically last between 6-18 months depending on location and type of filler.
+ How much filler do I need?
Dr. Tokarz will determine the best amount depending on several factors such as your budget, age, and facial bone structure. She’ll ensure your appearance isn’t fake or overdone like so many non-dermatologists do.
+ When will I see results?
Results are immediate, however, there will be some swelling that can take up to 2 weeks to subside in order to appreciate the final result.
+ Does this procedure hurt?
Injection of filler can be uncomfortable, but Dr. Tokarz has a gentle hand, and unlike many other injectors, she uses small amounts of anesthetic and Micro-cannulas in order for you to have minimal pain and minimal bruising.
+ Do fillers make skin sag after you stop doing them?
Most filler will actually have what is referred to as a “bio-stimulatory effect”, meaning it can help stimulate the cells in your skin which produce collagen.
+ What are the side effects of facial fillers?
Fillers can cause pain, bruising and even bluish discoloration. Most importantly, if injected into a vessel they could cause significant damage to surrounding structures. You want a Board Certified Dermatologist who knows the anatomy, has spent thousands of hours in training, and understands what filler works best for your skin. Too many non-dermatologists and even non-physicians are using fillers without supervision which will put your health at risk. Fillers will cause temporary swelling which is worse the first 48 hours. It can take up to 2 weeks after filler to have all swelling resolved. Be aware that fillers can also have reaction to your body’s normal immune system and at times you may notice mild swelling recurring even months after filler, if you are ill. This can theoretically happen with ANY filler.
+ Will I look funny after fillers?
It is critical to choose a Board Certified Dermatologist, and one who specializes in cosmetic dermatology, to ensure the results you desire. Dr. Tokarz will choose the correct placement so that you’re natural and not overfilled. You can have swelling that lasts up to 2 weeks, but is most prominent the first 2 days. Lip fillers tend to have the most dramatic swelling but quickly goes down.
+ What can you not do after facial fillers?
You must protect your investment and not have any significant dental procedures or facial massages for 2 weeks after filler. For sport enthusiasts, please refrain from wearing ski or scuba masks for those 2 weeks as well as it can displace filler from your cheeks.
+ Can you reverse fillers?
Yes, the fillers which Dr. Tokarz uses are made of either Hyaluronic Acid or Micronized Calcium Hydroxylapetite. Both of these have “antidotes” of which Dr. Tokarz always has on hand as a precaution.
+ Will I bruise?
Because we are alive and have blood flowing throughout our skin, every single person has a risk to bruise. However, Dr. Tokarz has greatly reduced that risk using local anesthesia and Micro-cannulas for most areas of injection. If she anticipates significant bruising, use of pressure and cold packs will help. She will also offer complimentary post-filler laser spot treatment to make more severe bruising go away faster.
+ Where can I get fillers?
Dr. Tokarz provides all the major fillers on the market. It is recommended you only receive filler under the direction of a dermatologist or plastic surgeon, or other specialty physician who has advanced training on facial anatomy and a deep understanding for expectations and complications. Dr. Tokarz has over 10 years of injection experience, and is a Board Certified Dermatologist, which means she has thousands of hours in training and thoroughly understands your facial anatomy.
Laser Hair Removal
+ What are the Do’s and Don’ts before treatment?
You cannot pluck, wax or thread the areas for 3 weeks before your treatment. Doing so will remove the target: your hair and its pigment. However, you can’t have it too long either: shave 1-2 days in advance. No self tanners for at least 1 week before. You cannot be sunburned or excessively tanned during your treatment either.
+ Does it hurt?
The SplendorX has revolutionized the comfort of laser hair removal. It uses a medical grade cool air blower and is able to combine wavelengths at lower energies with amazing efficacy. You’ll feel the most discomfort in areas of highly dense, course, dark hairs. Most patients report it mild and transient.
+ When will I see results?
You’ll see that most of the hairs have been vaporized or will fall out over the next few days. After a month you’ll see approximately 20% reduction of the hair count. After a series of 6 treatments, expect an overall improvement of 80-90% reduction.
+ How many times do you need to go and how often?
The standard treatment protocol calls for 6 treatments spaced 4-6 weeks apart. This will vary depending on the area(s) being treated and if you have underlying hormonal affects on your hair growth, such as polycystic ovarian syndrome.
+ Is LHR permanent?
The hair loss is permanent. For men having their beard area treated, it means they cannot grow a beard years later in areas treated. Over time, some of our vellus hairs (peach fuzz) will convert to the darker terminal hairs.
+ Can you get LHR on all hair colors?
You can only treat hair that has pigment such as black or brown. It is much less effective for blond and will not work on grey or white hairs.
+ Are you able to get LHR during the summer?
Treatment in “summer” is allowed as long as you refrain from purposeful tanning or sunburns. Laser hair removal is performed all over the world, including in much more temperate climates. The key is to ensure good sun protection in order to minimize risks.
+ Do you need to shave before treatment?
Yes you must shave 1-2 days prior to your treatment. If your hair is too long, the energy will not transfer down the hair shaft to the hair follicle stem cells. We recommend having not more than a “5 O’Clock shadow” of hair growth.
+ Can I use self tanner before I get LHR?
No, you cannot use self tanner as the laser will target the pigment in your skin as well as hair and this puts you at risk for possible pigment changes.
+ Will the skin be red or sensitive after treatment?
Yes your skin will have some swelling, especially around the follicles as that is considered an endpoint. At no time do we ever want blistering or peeling of skin. If this occurs, call our office immediately. Your skin will be mildly sensitive for 1-2 days after your laser treatment.
+ What are possible complications from laser hair removal?
In some cases you may get transient increase or decrease of pigment after a treatment. This risk increases significantly when laser hair removal is performed by non-physicians in a medi-spa setting. In fact, a recent study found that 70% of all complications from any laser device were found in the setting of laser hair removal performed by a non-physician without specialist supervision and in a medi-spa or non-clinical setting. Rest assured that your treatment will ALWAYS be under the direction of a Board Certified Dermatologist and your treatment is at a medical clinic not a medi-spa. Most often, Dr. Tokarz will begin your treatment series, then once settings are established her nurse will complete the treatment. Either way, you’ll have her expertise on site for your safety.
Intense Pulse Light
+ What is IPL or IPL photorejuvenation?
IPL stands for “Intense Pulse Light”. This device uses a variety of bandwidths to target mostly reds and browns found superficially in the skin. Dr. Tokarz uses the Lumenis M-22 system and considers it one of the best on the market given it’s versatility and power. She will perform various “passes” on your skin depending on the target. For example, she may start out with treatment of sunspots, then go to another setting for fine vessels or a more broad setting for background redness such as that found in rosacea. The “photorejuvenation” designation comes from the use of light energy to provide a “rejuvenated” or brightened appearance as removing reds and browns leaves a clearer complexion.
+ What does it treat?
IPL works best for vessels, sunspots, background redness from rosacea, sun damage along neck and chest (called poikiloderma). It’s great for clearing up damage in the form of brown sunspots that have accumulated over many years on your face, neck, chest, arms, hands and shoulders.
+ Is it Summer Safe?
IPL is ideally performed on non-tanned skin, especially if you’re trying to target sunspots. However, this treatment is performed all over the world and in much more temperate climates. Dr. Tokarz will counsel you about the importance of sun protection during and after treatments to “protect your investment”. We have several patients who are very sun conscious and will have this done during summer months. It is best to schedule this at least 2 weeks before and 2 weeks after any sunny vacations where you suspect you’ll get tanned.
+ What is the down time after treatment?
There is very little downtime associated with IPL. This is one of the reasons Dr. Tokarz chose this device - because it is very effective for reds and browns. You should be able to return to normal activities by the following day with minimal swelling. Brown spots will darken and fade over 1-2 weeks for the face and 2-4 weeks for treatment of the face (such as chest, arms or hands). When this treatment is combined with ResurFX, then you can expect 1-2 days of redness and swelling.
+ Do you need more than one treatment?
In most cases when treating areas of reds or brown, a series of 3 treatments are needed, with treatments spaced at 3-4 week intervals. For more severe sun damage or severe rosacea redness, a series of 5 treatments are necessary to achieve desired results. In many cases when treating dilated vessels, Dr. Tokarz is able to instantly clear those vessels after just one treatment. She’ll help you plan your treatments to fit your desired outcomes.
+ When will I see results?
You’ll see improvement after a few days, and for those dilated individual vessels (especially along the sides of your nose), you’ll see improvement immediately. For sunspots, it will take 1-2 weeks for them to fade on your face and 2-4 weeks for non-facial skin. As they fade or peel away, you’ll see either lightening of the pigment spots or regular appearing skin underneath.
+ How often should it be done?
When performing a series of treatments, these are spaced 3-4 weeks apart. Depending on your skin type, amount of sun damage history, sun exposure and sun protection habits, rosacea history and other genetic and environmental factors, you may want to continue with “touch-up” treatments every 6-12 months.
+ How long does treatment take?
Most IPL treatments are booked for 30 minutes when treating the face. If you’re including your neck and chest, then you’ll have a 45 minute appointment.
+ Does it hurt?
IPL treatment has some discomfort, or as Dr. Tokarz describes it, a “zing” when the beam of light fires. This is most sensitive around the nose and upper lip. After the treatment is over, you should feel little, if any pain. Sometimes you’ll feel some residual “sunburn” sensation for another hour or so.
+ Can you treat all body parts?
IPL works great for the face, neck, chest, arms, hands and shoulders.
+ Can you apply makeup after treatment?
Yes you can apply sunscreen, makeup, moisturizer and go about your daily routines. We recommend cleansing with a gentle cleanser and not trying to scrub or rub the treated areas for at least 3 days.
CO2 Skin Resurfacing
+ What is this treatment for?
This treatment helps all levels of sun damage from mild to severe and wrinkles. It causes dramatic improvement for wrinkles around the mouth and eyes. It is also excellent for acne scars, traumatic scars, congenital growths, xanthelasma and syringomas.
+ How does it work?
This is the most powerful laser available to dermatologists and uses fractioned ablative technology to laser fine deep and superficial broad beams into the skin. In deep passes (“DeepFX”) these microthermal zones of laser trigger a response from the skin cells to produce and remodel collagen. The superficial passes (“ActiveFX”) will have a more immediate effect of peeling away unwanted sun spots and rough texture.
+ Who is a candidate?
Most skin types can be treated with this laser depending on their level of damage or the type of treatment needed.
+ How many treatments?
For full face resurfacing, one treatment is typically needed. For acne scars, traumatic scars and some other less common indications, multiple treatments may be needed.
+ How much time will I need out of work?
This treatment does require more time for recovery because it is so effective. Most patients should plan for 1 full week away from work or their social activities.
+ What should I expect?
First you’ll have a pre-op visit one week prior where our nurse will review the procedure and required medications. On the day of your appointment, you’ll arrive one hour early for topical anesthesia. Once ready to go, the anesthesia is removed and eye protection placed. During the procedure the assistant with have both a vacuum assist device and a cold air blower to help with discomfort.
+ How much does it hurt?
This treatment has variable discomfort which is why we use the topical anesthesia and cold air blower. The pain is during the treatment only, and afterwards for the next hour you’ll feel like you have a sunburn. By the evening and the next day you should have no discomfort.
+ After care?
There is a detailed handout for you to follow after your treatment. You’ll be given a kit to get you started along with instructions for the medications which you received at the pre-op visit.
+ Will I need a ride to my appointment?
All patients are recommended to have a driver when performing full face or any treatment around their eyes.
+ Can I just treat my eyes, or around mouth?
Yes, if you are only bothered by one of these areas, then Dr. Tokarz can tailor the treatment and fee.
+ When will I see results?
You’ll see immediate improvement in the texture and tone of the skin following the one week healing. Most also see dramatic improvement around their mouth and eyes. But the best part of this treatment is that you’ve now stimulated collagen remodeling and your skin will continue to improve over the next several months for up to or more than a year. This is one of the only lasers where patients look better with more time span between their treatment.
ResurFX Photo-Fractional Treatment
+ How does this treatment work and what will it do?
ResurFx is an infrared laser which targets the water found in your collagen. It is fractionated, meaning it passes several micro-columns of laser energy at a given density and depth for each pass. Fractionating laser energy means your skin will tolerate deeper passes with fast recovery. When the dermis of your skin has this laser energy affect it, the tissue responds to the minor injury by producing more collagen. Therefore, this laser has a biostimulatory and remodeling effect.
+ Is everyone a candidate?
ResurFx laser is safe for all skin types. However, if combining it with IPL treatment, then it is best for medium to lighter skin colors. African American and dark Asian skin may not be able to tolerate IPL.
+ What can I expect during the treatment?
This is one of our lasers where we recommend coming early for topical anesthesia. This will sit on your skin for an hour and make the passes more comfortable. We also use a cold air blower, called the Zimmer. This will greatly reduce discomfort from the treatment. Your skin will be cleansed with alcohol prior to starting.
+ How many treatments do I need?
Most patients need a series of 3 treatments, but may require a series of 5 for more severe wrinkles and sun damage.
+ When will I see results?
It takes several months to see the results of the series of treatments. Most can expect to see improvement after 3 months.
+ What results will I see?
Depending on what was treated, you’ll see a smoothing of scars, and overall skin texture and tone.
+ What age should I start this treatment?
Most patients begin this treatment into their 40s or above. However, if you have acne scars or stretch marks, you can start much earlier.
+ Does it hurt?
This treatment does have significant discomfort during the passes, but afterwards you’ll find this to mostly resolved with a slight sun burn feeling for the next hour. We have you come in early for topical anesthesia (“numbing cream”) and also use a powerful cold air blower during the procedure to help diminish the pain.
+ How does a chemical peel work?
These are medications which have an effect of peeling through various layers of skin. After applied, the reaction takes place then the skin will exfoliate depending on the depth of peel.
+ What type of peels do you do?
We have a few different peels including those specific for acne, melasma, and general chemical peels for sun damage.
+ When will I peel and can I go back to work?
Most peels including the acne and melasma peels take a few days to see light exfoliation. In these cases you can return to work or school immediately. These peels take about 2- 3 days to start of skin exfoliation which can last about a week. Having a good moisturizer and reapplying throughout the day will help heal faster. For medium depth peels, you’ll have a similar time to peel, but the peeling is much more robust and you’ll need to have 5-7 days away from work.
+ What are the risks?
These peels can trigger cold sores, so if you have a history of these, let your doctor know and you should be started on antivirals. Given the strength of medium depth peels, you’ll have to be on these medications as a precaution.
+ Do chemical peels hurt?
Chemical peels can have some associated discomfort depending on the level of peel. Dr. Tokarz and her team will give you a handheld fan to reduce this. The deeper the peel, the more benefit, but the more discomfort you’ll feel.
+ What is Microdermabrasion and how will it help my skin?
Microdermabrasion is the use of a textured wand with a vacuum attached. Dr. Tokarz’s assistant or nurse will perform the treatment to gently remove dead skin cells leaving behind fresh glowing texture.
+ What does it feel like/Does it hurt?
There is minimal if any discomfort and most patients find the treatment to be very relaxing.
+ What is this thing called “Dermaplaning”?
Dermaplaning uses a flat blunt blade to physically exfoliate dead skin cells and remove fine vellus hairs (peach fuzz) from your cheeks, temples and upper lip.
+ How much time does it take to recover?
There is little if any recovery and you can apply makeup or sunscreen right after your treatment. Dr. Tokarz’s assistant and/or nurse will apply very nice moisturizers to your face following your treatment.
+ How often can I get this done?
You can have Microdermabrasion or Dermaplaning performed monthly or just before an important event where you want to give your skin a special, bright glow.