Sunless Tanners



Sunless Tanners

Get the Skinny on Sunless Tanners

Long gone are the days of slathering baby oil and iodine on your skin and baking in the sunshine like a chicken on a kebab.  Even though being pale was once considered a sign of health and beauty, present day media now perceives ‘the tan’ as in vogue.  Unfortunately, what the media and the general public do not understand is that tanning is evidence of skin damage.   Melanin is a pigment which lies in the skin and is responsible for the brown color of your tan.  Melanin production increases with sun exposure and dissipates UV radiation as a means to protect you from skin cancer formation.  With age, the amount of melanin decreases and this shift can leave you with more and more burns.

Fake Bake

Through the years, research has supported evidence that the sun’s rays contribute to skin cancers and premature aging.  More recently, you may have heard about sunscreen regulation changes and the importance of broad spectrum products.  With the growing body of knowledge we have regarding the purpose of melanin and the harmful effects of UVA and UVB rays, the general consensus of most dermatologists is to take a rain check on roasting in the sun.

So how can you get a bronzed glow without the risk of skin cancers?

We certainly do not condone tanning beds (aka cancer in a box), but we do support the use of many other products available over the counter.  Many people use cosmetic bronzers or spray tans.  Others prefer sunless tanners which work with the body’s natural processes to develop a tan.

How do sunless tanners work?

Sunless tanners contain a chemical called dihydroxyacetone (DHA).  DHA is a safe and nontoxic chemical that was once used as a sugar substitute but was accidentally found to have tanning properties. When DHA is applied to the skin, a chemical reaction occurs with proteins in which the end result is a chromophore known as melanoidin- this will give a brown color. The chemical reaction process known as the Maillard reaction typically takes a few hours and results in darkening of the skin.  Luckily, the Maillard reaction is only seen in the most superficial layer of the skin, and therefore, the ‘tan’ can be easily removed with exfoliation or allowed to fade over days.

What do I need to know about sunless tanners and their application?

Sunless tanners are a safe and effective way to achieve a sun kissed look without the price of skin cancer.  They are easy to apply with the use of gloves, and many are combined with a dye so that areas where the tanner has been applied can be seen.  When applying sunless tanner, be sure to rub less onto areas with thicker skin such as the knees or elbows.  Since DHA is absorbed into the superficial layers, these thicker areas will absorb more DHA and cause darker pigmentation.  Most importantly, sunless tanners will NOT protect you from the sun like natural tans from melanin do.  So be sure to still apply your broad spectrum sunscreen every time you are in the sun!

Does the USF Health Cosmetic & Laser Center carry any sunless tanners?

Yes we do! We carry Fake Bake® in our office.  It comes with a handy application glove and is a favorite amongst our staff! Come by our office and pick up a bottle to try for yourself!

By: Erika Dare, ARNP-C, Dermatology and Cosmetic Practitioner at the USF Health Cosmetic and Laser Center on Davis Islands

Erika Dare, ARNP-C

Erika Dare, ARNP-C


American Academy of Dermatology. (2010). Prepping for fall dances shouldn’t increase skin cancer risk. Retrieved from

Z.D., Draelos. (2013). Sunless tanning: An alternative to sun exposure. Best Practices in Cosmetic Dermatology, 0(2), 10-11. Retrieved from



At the USF Health Cosmetic & Laser Center, our scope of treatment is broad and not only includes laser, peels, Botox, and filler, but also suits the needs of our younger and older acne patients.

Thinking outside of the box

Acne can be a pesky situation to get rid of.  Many of our patients come to us after years of unsuccessful acne treatment in search of new hope. Treatment is based on patient age, the cause of the acne, as well as the type and severity of the acne present. Typically patients are started on topical medications, but some may need oral antibiotics or isotretinoin if their acne is moderate or severe.  Due to the long list of side effects and complications surrounding oral isotretinoin use (remember Accutane?), many patients seek a safer alternative.   At USF Health Cosmetic & Laser Center we use combinations of all treatment options, but when treatment resistant moderate to severe inflammatory or cystic acne presents, we offer our patients an alternative: Acne Dynamic Therapy (ADT).

How does ADT work?

To understand how ADT works, we must first understand how acne starts. In our skin lies tiny sebaceous glands that are connected to hair follicles.  These glands secrete an oily/waxy substance called sebum.  When hormones are rampant in adolescence, sebum production increases. Eventually, the lining of hair follicles can become plugged with sebum and sloughed cells that are not removed properly.  This plugging leads to a collection of sebum and cells which dilates the lining around the follicle.  In time, the bacteria known as propionibacterium acnes contributes to rupture of the dilated follicle lining and resultant inflammation.

ADT uses blue and red lights as well as a topical lotion. 5-Aminolevulonic acid is the medicine applied to the skin before a light treatment.  The purpose of this medicine is to make acne prone areas more sensitive to light, a process that we call photosensitization. Lights have different wavelengths that when used on the skin, will travel to different depths.  The blue light wavelength ranges from 415-445 nm and travels superficially to the top layer of the skin.  Here the blue light will be absorbed by chemicals called porphyrins which will react to the light.  This reactivity will cause antibacterial activity against the nasty acne causing germ p. acnes.  In contrast, red light has a wavelength of 550-700 nm.  Since the sebaceous glands are located in the deeper dermis layer, red light will penetrate further to reach the glands and destroy them.  This destruction prevents sebum production and buildup.

Where can it be done?

ADT can be performed on the face, neck, chest, and back.

What does ADT involve?

Once all treatments options for acne have been exhausted without success, patients with moderate to severe inflammatory or cystic acne are candidates for ADT. Certain acne medications may be stopped before treatment. Patients will degrease their faces in office and apply a special lotion (Levulan) to the skin.  While the special lotion is on the face, a blue light will be on in the room. After an hour, the lotion will be washed off and the patient will proceed to sit in front of the red light for about 8-10 minutes with a fancy pair of goggles on.  During this time, the patient may feel some “ant bites” or heat on their face, but it will subside shortly. A cooling fan called a “Zimmer” can also be used to help deal with the temporary uncomfortable feelings.  After the red light has ended, patients will be coated with sunscreen and given post-treatment instructions.  Treatments are typically done 2-3 times at monthly intervals.

After all is said and done…

After treatment, patients must avoid the sun or excessive light exposure for 48 hours.  Patients can expect to have a range of responses to treatment including redness, swelling, crusting, peeling, or mild discomfort.  Most side effects will dissipate within a few days and can easily be tamed with gentle moisturizers and ice over a cloth.  Results of acne clearance or decreased acne breakouts can be expected for 6-9 months after treatment has been completed!


If your acne has been bothering you and you just can’t seem to get it under control… stop on by and see us at the USF Health Cosmetic & Laser Center!

Erika Dare, ARNP-C

Erika Dare, ARNP-C

By: Erika Dare, ARNP-C, Cosmetic Practitioner at the USF Health Cosmetic and Laser Center



As a cosmetic practitioner this question is common dialogue with patients in our practice on a daily basis. I am sure that other cosmetic providers can agree that we often hear “I’m not ready for Botox … I really don’t need it yet”. The truth of the matter is that most people that think they “aren’t ready” are the ones that can benefit from Botox the most. What do I mean by this? Let’s take a quick moment to learn the basics of Botox so that you too can make an education decision on whether or not Botox is right for you.Pre and Post Botox

Botox is actually a preventative measure used in combating wrinkles that form from making an expression. This is why you will hear providers call them dynamic wrinkle lines or wrinkles of motion. The idea behind Botox is that it temporarily weakens a muscle complex, therefore not allowing you to use that muscle to its full potential. When you are not able to use the maximum potential of that muscle it allows that area to rest. Over time, this will soften your expression lines. In younger patients these expression lines can easily resolve with one or two treatments of Botox. More mature patients have been making these expressions for much longer therefore their dynamic wrinkle lines can actually become etched in scars that are significantly more difficult to treat with Botox. So the key to Botox is starting early and not when those lines become obvious or pronounced at rest. With that being said, it is never too late to start Botox, even more mature patients can see a great benefit from using Botox. Most patients will start Botox in their late 20’s and 30’s. Unfortunately Botox gets bad press when it is “over done”, mostly by patient request, from those that suffer from what we call “wrinkle-rexia”. Bystanders should not know that you have received Botox, only that you look “soft, natural, well rested, and really good for your age”.

Now understanding the importance of starting Botox early, let’s dive a little deeper into the science behind Botox. Botox is a protein derived from the bacterium clostridium botulinum that has qualities of a neurotoxin. Botox decreases muscle activity by blocking overactive nerve impulses that trigger excessive muscle contractions. It was FDA approved in 2002 to use in between the brows but we often use it off-label to soften crow’s feet, forehead lines, and in the lower face to achieve the best outcomes for our patients. The results of Botox last about 3-4 months and can vary between patients and areas of the face. It takes anywhere from 2 days to 2 weeks to see the initial results post injection. The Botox injection procedure is very quick and can easily be done during lunch hour or in between errands. Some practitioners will use ice or numbing cream prior to injection, to minimize discomfort. Common side effects include headache and pinpoint bruising. Other less common side effects are flu like symptoms, droopy eyelid, and heaviness in the brows. All side effects of Botox are transient meaning they go away in a few weeks following the procedure. Most would consider Botox and safe and effective cosmetic procedure.

So the next time you ask yourself “Do I need Botox yet?” I encourage you to reference this post and inform yourself on the benefits of starting Botox early and often to maximize your anti-aging potential.

Nicole Nations, ARNP-C

Nicole Nations, ARNP-C

By: Nicole Nations, ARNP-C, Cosmetic Practitioner at the USF Health Cosmetic and Laser Center

Laser Nail Fungus Treatment


Clinicians using laser technology have made great strides in the treatment of nail fungus. Due to the risks associated with oral medications and the disappointing results from prescription creams and polishes to treat nail fungus, these therapies are quickly becoming treatments of the past. Clinical trials show laser treatment for nail fungus success being as high as 70-90% with multiple treatments where as current prescription therapies are about 50% effective. The laser works by heating up the nail layers specific to the fungus and attempts to destroy the genetic material responsible for the growth and survival of the fungus.  Treating nail fungus with laser is a safe and easy procedure.



  • Safe and effective
  • Treatments are quick (approximately 30 min)
  • Painless (although it is not uncommon to feel heat from the laser)
  • Excellent alternative to potentially harmful oral medication

What to expect

  • A minimum of two treatments are recommended
  • Laser nail fungus treatments are 5-6 weeks apart
  • All nails in the area of the fungus will be treated
  • Laser nail fungus treatment is used in conjunction with creams
  • Fingernails require 3 to 6 months to re-grow completely and toenails 12 to 18 months
  • Results will not be seen at least 2 months from your initial laser treatment

Laser Tattoo Removal


Who says you can’t erase the past?

Whether it is an old boyfriend or teenage craze, you actually can remove the past … that is as long as it’s in the form of a tattoo. What seemed like a good idea at the time might be a permanent reminder of something worth forgetting. It is estimated that 10 million Americans have at least one tattoo and of those, 50% of them wish they did not have them and would get them removed. With recent advances in laser technology, patients now have an option to either remove the tattoo or lighten it with hopes of getting another.

There are several ways to remove tattoos such as dermabrasion, surgical excision, or cryosurgery. Unfortunately, the older technologies always leave a significant scar. Newer light based technologies, specifically lasers, now make it possible to remove or lighten your tattoo. The gold standard for tattoo removal is the Q-switched laser. The laser light delivers a bolus of light creating a photoacoustic affect to break up the ink particles. These particles are then absorbed by the body’s macrophages, tiny cells that scavenge the skin for unwanted materials. The laser selectively targets the pigment of the tattoo without damaging the surrounding skin.  Different color tattoos actually take different wavelengths of light to be destroyed. With this in mind, the three q-switched lasers available on the market today are the ruby, alexandrite and the Nd:YAG.

Depending on the type of ink and whether the tattoo was done professionally or by an amateur will depend on the amount treatments it will take to lighten the tattoo. Black and other darker pigments of tattoos are more easily lightened or removed where as yellow are green are more difficult. Typically, for the removal of professional tattoos it can take between six to eighteen treatments to get a desired outcome. The most important aspect of getting your tattoo removed is having realistic expectations.

Laser tattoo removal can take anywhere from 30 minutes to an hour for treatment. A topical numbing cream is usually applied prior to the procedure to minimize discomfort. Immediately after the treatment, ointment and a non-stick bandage is applied to the tattoo. It is important to keep the tattoo dressed with ointment for about 1 week post procedure. Most patients experience redness, mild swelling and crusting or blistering at the site. Treatments are done 6-8 weeks apart in order to let the tissue heal properly and the ink particles to be absorbed.

Risks associated with tattoo removal include a change in pigmentation, either lightening (hypopigmentation) or darkening (hyperpigmentation) of the surrounding tissue, and scarring. These risks can be minimized by avoiding sun exposure during the length of your treatment times and not picking or rubbing the treatment area. There is a phenomenon referred to as paradoxical ink darkening, although rare, has been seen in some cases of tattoo removal where the tattoo will darken. These colors often contain iron and titanium dioxide that when heated to a certain temperature will oxidize and actually become darker. It is more commonly seen with lighter colored tattoos such as red, pink, white and skin tone colors. The cost of treatment depends on the size of the tattoo and can range from $150 to $1000 per treatment.

As with any cosmetic procedure it is critical to be an educated consumer and put your skin in the hands of those expertly trained in the field of laser science and cosmetic dermatology.


Book for Laser Tattoo Removal at:

USF Health Cosmetic and Laser Center on Davis Islands 813-259-8694


Laser Hair Removal


As the upcoming beach season approaches there is nothing worse than struggling with unsightly razor bumps from constantly shaving. This might be why approximately 1.1 million Americans were treated in 2011 with laser hair removal, a 15% increase from 2010. Laser hair removal has been studied for many years and proves to be effective in achieving permanent hair reduction.

This hair reduction occurs when laser light is absorbed by melanin, the dark color of the hair, which is primarily found in the hair shaft. The heat from the laser is then absorbed by the follicle while preserving the surrounding skin. This essentially disables the hair at its root which prevents it from growing back. Typically patients with red, gray, or blonde hair cannot achieve successful hair reduction with lasers based on the principle that the laser is attracted to the dark pigment (melanin), therefore lighter hair does not respond as well. Since the laser is attracted to the hair shaft it is important not to pluck, wax, or have electrolysis prior to treatments. Laser hair removal should be done in a series of treatments for optimum results to capture several growth cycles of the hair.

There are many lasers available on the market today for hair removal. It is important to recognize that different wavelengths of laser light are necessary to treat people with darker skin types since melanin (dark pigment) is the target of the laser. Here at the USF Cosmetic and Laser Center we have several lasers we use for hair removal and are able to treat all skin types.

Now is a great time to get laser hair removal in time for the beach weather!! It is essential to be a savvy consumer and chose a trusted provider for laser hair removal.

Nicole Nations, MSN, ARNP-C, Cosmetic Practitioner at the USF Health Cosmetic and Laser Center on Davis Islands. 813-259-8694

eMatrix Skin Treatment


For decades cosmetic practitioners have relied on laser and light based devices to turn back the hands of time and battle against fine lines, wrinkles, irregular pigmentation and textural issues. The idea of skin rejuvenation with heat and energy based devices has evolved significantly in the last ten years. Facial resurfacing, specifically fractional resurfacing procedures, have gained popularity in the last ten years. Fractional ablative procedures involve a week or two of downtime and come with potential complications yet achieve a great cosmetic benefit. However, these procedures are not recommended for all skin-types due to possible complications. Non-ablative fractional procedures typically involve heating the tissue with hopes of stimulating collagen over time. These procedures have minimal downtime yet do not yield the same impressive results as the fractional ablative procedures. For years there has been a large gap in terms of results from an aggressive ablative fractionated procedure and a less aggressive non-ablative procedure. The answer now lies within “sublative technology”. This non –laser technology allows us to achieve the aggressive results we desire but with less downtime than the traditional fractional ablative laser procedures.
We are very excited to be introducing the eMatrix into our practice!!eMatrix_3
Things you should know about eMatrix skin treatment:
• Bi-Polar Radiofrequency treatment that delivers energy deep into the dermis in order to elicit a wound healing response leading to a smoother, brighter appearance of the skin
• eMatrix skin treatment stimulates both collagen and elastin, which helps to tighten the skin, giving it a more youthful appearance
• Great for improvement of mild to moderate wrinkles, acne scarring, mild skin laxity, red/brown spots and textural irregularities
• Can treat within the orbital rim therefore great for fine lines around the eyes such as CROWS FEET
• eMatrix skin treatment is safe and effective for ALL SKINTYPES
• Short procedure with minimal downtime as it is a closed wound
• 3 treatments recommended at monthly intervals

By: Nicole Nations, ARNP-C, Cosmetic Practitioner, USF Health Cosmetic and Laser Center on Davis Islands. University of South Florida

Nicole Nations, ARNP-C

Nicole Nations, ARNP-C

The Winter Itch of Dry Skin


The winter itch  of dry skin.

Winter weather comes with dry, itchy skin that may start to crack and possibly become painful. Several factors contribute to dry compromised skin including but not limited to cold weather, low humidity, overuse of soap, and genetics. Some of these factors we can control and others we cannot control, like genetics. However, there are things we can do, avoid, and apply to aid in minimizing dry itchy skin.

#1 Drink Plenty of Water. Drink at least 8 glasses of water a day to stay hydrated to keep your skin soft and less dehydrated from the environmental changes.

#2 Use a Small Amount of a Gentle Soap. Use a gentle soap with minimal ingredients and a small amount. The more soap you use and the more ingredients the soap has the drier you are more likely to be. Very dry people may consider only using soap on the really dirty or stinky parts. Our office recommends for the face SkinMedica® Sensitive Skin Cleanser and for the body Cetaphil® Skin Restoring Body Wash.

#3 Avoid Long Hot Showers or Baths. The hotter the water and the longer you are exposed the more dry your skin will become.

#4 Use a Moisturizer. After bathing pat dry with a towel and while your skin is still moist apply a moisturizer. Our office recommends a facial moisturizer specifically tailored for your skin type. And for those with really dry compromised skin we suggest a moisturizer that contains ceramides and other lipids to aid in restoring and protecting the skin barrier. We recommend SkinMedica® TNS Ceramide Cream for the face and Ceratopic Replenishing Cream for the body.  For really dry, red, painful cracked skin one should use a healing ointment, such as SkinMedica® Restorative Ointment.  

#5 Wear Gloves and other Protective Clothing. Wearing gloves and other protective clothing protects your skin from the environmental conditions that cause compromised skin. When washing dishes, preparing food or cleaning bathrooms we recommend you keep your hands as dry as possible. One technique you can use is the double glove technique. First, put on thin cotton gloves and then put rubber gloves over the cotton gloves. Also, wear hats, gloves, jackets, etc to protect your skin when going outside during the cold months.

#6 Hand Washing and Antibacterial Gels. Washing your hands is a must. Just make sure that you thoroughly and completely dry your hands and then immediately apply a moisturizer to help lock in the moisture from washing your hands. If this is not feasible consider using a barrier type moisturizer. Remember lotions in soaps do not moisturize, they rinse away like the soap. Also, antibacterial gels are good at getting rid of bacteria, but they have a very high percentage of alcohol that tends to dry the skin.

If you continue to have winter itch and dry compromised skin after trying the suggestions above see the dermatologist for more intensive treatment and detailed education for your unique skin.

Dr. Neil Alan Fenske, MD

Neil Alan Fenkse, MD is the Professor and Chairman, University of South Florida Morsani College of Medicine.

Physician Spotlight on Neil Alan Fenske, MD


PHYSICIAN SPOTLIGHT: Neil A. Fenske, MD Chairman, Department of Dermatology & Cutaneous Surgery, USFCOM, Tampa

Some might think that growing up “dirt poor” on a farm in Blue Earth, Minn. would be a liability. But Neil Fenske treasures it as a character-building experience that allows him to appreciate how far he has come in life.

“I’m a guy who came up the hard way,” said Fenske, chairman of the Department of Dermatology & Cutaneous Surgery at the University of South Florida College of Medicine in Tampa. “I had to carve, scratch, dig and cajole. That’s not a complaint. It has made me stronger, Fenske said.Dr. Neil Alan Fenske, MD

How poor was his family? Fenske, the eldest of five children, wore only used clothes and one winter his only jacket was a girl’s. “I had to wear it to school because that was all (his parents) could afford for $1.50,” he remembered.

Fenske was driving a tractor and plowing fields at 10 years of age. His parents eventually purchased a small grocery store in nearby Winnebago, where he and his siblings worked at night and weekends. Fenske credits the long hours and hard work to forging his work ethic. “It was working behind the cash register where I learned to interact and communicate will people of all ages and personalities, which has served me well as a physician,” he said.

The family’s diet was low-budget and high-cholesterol. “SPAM® was a staple … and hot dogs and hamburgers were served on thin white bread because buns were ‘too expensive,’” he said, adding that an experience with a hamburger at age 12 was a turning point in his young life. “A friend’s mom took him and me for my first restaurant experience – a hamburger on a bun, French fries and a Coke. What a treat! It was at that point that I decided I was not going to be poor when I grew up. I committed myself to academic and athletic excellence throughout my high school years,” Fenske recalled.

He earned a basketball scholarship to Gustavus Adolphus College, becoming the first Fenske to attend college. He already knew he wanted to study medicine because of his teenage admiration for two family physicians. After college he enrolled in medical school at St. Louis University, where he took an elective course in dermatology and “fell in love with it,” Fenske said. He completed his internship at St. Mary’s Hospital in Duluth, and residency at the University of Wisconsin, where he met and married his wife Robyn, and soon realized “an academic career was my calling,” he said. Fenske was recruited to USF to start a residency training program in dermatology and he has been there since 1977.

But in many ways that is just the beginning of a career in which he has influenced the lives of countless patients, students and the institution he has served for 34 years. Along the way Fenske has left his mark in many ways, including being president of seven dermatologic organizations and being named the 1999 practitioner of the year by the Florida Society of Dermatology. In addition, he was chosen by his peers in the Castle Connolly Medical Ltd., directory as one of America’s top cancer doctors for five of the past seven years.

But the professional accomplishments that Fenske treasures most are his relationships with students and patients.

“I have had the privilege to educate and mentor many bright young men and women, many of whom practice in the greater Tampa Bay area,” he said. “All our grads are reputable and very highly sought-after. (Tampa-area) docs scoop up my residents all the time. I’m proud of all of them.”

Fenske said he still spends about 50 to 60 percent of his time seeing patients, which is unusual for a department chair, and that he still thrives on that interaction. “I have not lost my zeal,” he said. “I have as much enthusiasm today as when I started here 35 years ago. … I’m very motivated and high-energy.”

Others confirm Fenske’s self-evaluation. Stephen Klasko, MD, MBA, is senior vice president of USF Health and dean of the College of Medicine. “He is very well thought of by me and others,” Klasko said, pointing out his work with Fenske to transform the Dermatology Division into a full-fledged department. Klasko also noted that Fenske was instrumental in securing the endowment of the Dermatology Department Chair. It was Fenske’s relationship with a patient that made it possible.

Tampa resident Chris Sullivan is co-founder and CEO of Outback Steakhouse, and a patient of Fenske’s for about 15 years. “I’ve dealt with a lot of skin cancer issues personally and in my family. Over time I observed how he was teaching young doctors and how innovative he was in his practice and teaching,” said Sullivan. “They did not have a dermatology chair at USF and I knew he had done a fantastic job of building that department. The idea of endowing that chair became available to me and I thought it was the right thing to do because Neil had earned that opportunity. Personally, he has impacted me very positively and I like the way he goes about his business. He’s an outstanding educator and an outstanding doctor,” Sullivan said.

Fenske said that when he and Klasko met with Sullivan to discuss a fundraising effort, Sullivan volunteered not only to endow the chair for $2 million, but he insisted on putting it in Fenske’s name. “I was caught off guard” by Sullivan’s generosity,” Fenske said. “I literally had tears welling in my eyes. Most people (who make a donation of that size) would want their name on the chair.”

But Sullivan saw it differently. “Neil’s the one who did all the work. It should be named after him,” he said.

And, Fenske said, his work is nowhere near done. Several area dermatologists and philanthropists have contributed, and one of his goals before retirement is to endow the entire Dermatology Department, which will require raising several million dollars. “It would be a great legacy for this great university,” he said.

But that doesn’t mean Fenske is eyeing retirement. “I still love going to work on Monday mornings. … Other than my grandkids and my immediate family, my work is my life and it’s a labor of love. God willing, and my health holds up, I’m here several more years,” he said.

Fenske has three children and four grandchildren and he savors the time he and Robyn spend together with them, especially during autumn at “our mountain house in the Smokies,” he said.

Reflecting on his humble beginnings, Fenske takes heart in the fact that “in America, you can still overcome it. … You’ll have to work harder than the average bear,” he said, but adhering to a simple set of principles has served him well: “Always work hard, do your best, and always do what’s right.”

Making Sense of Botox and Fillers


Published: April 10, 2010

Many of my patients have expressed confusion regarding the role of Botox and fillers for treatment of skin wrinkles.

Specifically, they often don’t realize that these very popular cosmetic procedures serve two very different purposes.

As we age, repetitive muscle movement results in dynamic wrinkles, such as those that occur around the eyes (crow’s feet) and between the eyes (frown lines). Botox, the brand name for OnabotulinumtoxinA, is injected into the muscles responsible for causing these wrinkles. By temporarily paralyzing these tiny facial muscles, the wrinkle is softened, making the face look younger and refreshed. It generally takes two to three weeks before the full benefit is seen. The effects of Botox only last three to four months.
Botox injections will not work for static wrinkles – wrinkles that are present all the time, even when the face is not animated. And Botox won’t eliminate the tiny creases already etched into the skin from many years of repeated movement – a good reason to commence with injections sooner, rather than later.
Botox injections are the most commonly performed nonsurgical cosmetic procedure performed in North America. They have an excellent safety profile. The only significant adverse events have been when large doses (many times that used for treating facial wrinkles) have been used “off label” in non-facial sites.

Newer varieties of botulinum toxins, such as Dysport, are becoming available. Whether these prove to be superior is yet to be determined.

I recommend that you purchase Botox by the unit, not by the area – it is the only way to accurately compare prices. Keep in mind that cost alone should not drive your selection of a provider. Experience and skill are necessary for a successful outcome!

Before Fillers

Before Fillers

Immediately Post Fillers

Immediately Post Fillers

Fillers, in contradistinction, are used primarily to restore volume to the aging face. As we age, our facial skin becomes thinner, fat diminishes, muscles atrophy and bone loss occurs, resulting in a face reminiscent of a deflated balloon. As the skin sags we develop unsightly furrows along the nose (naso-labial folds) and on the chin (marionette lines). These furrows can be safely filled with many different materials, and the results are immediate.

I generally prefer nonpermanent fillers, especially those containing hyaluronic acid (e.g. Restylane, Juvederm), a natural component of normal skin. These fillers last six to nine months, so if you don’t like the results, the skin will eventually return to baseline. Even better, if you hate the results, you can inject hyaluronidase and immediately reverse the effect.

Fillers are also used to enhance the lips, which also lose volume as we age. This is a case where less is more; if they end up being too big, it doesn’t look normal (restoration, not over-inflation, is the rule).

Remember, Botox and fillers are temporary “fixes” that have an excellent safety profile.

Injection is both a science and an art. It is foolhardy to just shop price – a lesson many have learned the hard way. Experience and an artistic eye are paramount to a successful outcome!

Neil Alan Fenske, MD

Neil Alan Fenske is the Professor and Chairman of the University of South Florida Morsani College of Medicine and the Medical Director of the USF HEalth Cosmetic and Laser Center on Davis Islands