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A How To: Practicing Cosmetic Dermatology


Dr. Christine Lopez shared her expertise on cosmetic dermatology during a lecture at the SDPA Fall 2014 Conference. 


Dr. Christine Lopez shared her expertise on cosmetic dermatology during a lecture at the SDPA Fall 2014 Conference.  She began by sharing this pearl: Before performing cosmetic dermatological procedures, it is best to have an extensive consult with your patient.


Cosmetic Consult

Hear the patient’s chief complaint

Prioritize their complaint list



           Understanding of concerns & procedures



Thorough Physical Exam


Educate & have a thorough discussion

Collaborative plan—often with written notes of what was discussed in the consult so that if they come back with a complaint, you have proof of what was discussed.


Dr. Lopez will typically advise on a skin care regimen before the procedure is scheduled.  This improves the texture, pigmentation, prominent pores, acne, and fine wrinkles of the patient.  It also compliments the cosmetic procedures.  If the patient is consistent with the regimen, it typically shows that they are truly committed to the procedure.  This involves sunblock, retinoids, Alpha hydroxyl acids and antioxidants.

The most common reasons for derm cosmetic consults, reported Dr. Lopez, tend to be telangiectasias, skin tecture irregularities, lentigines, excess hair, acne scars, facial folds, or dynamic and static rhytides.  Minimally invasive cosmetic procedures for these concerns are botulinum toxin type A injection, hyaluronic acid injection, laser hair removal, laser skin resurfacing, and chemical peels.

Dr. Lopez listed treatments for various conditions, touching on the target muscles involved, the number of injection points, and the starting dosage.


Glabellar Wrinkles

Target your toxin into the glabellar complex.

Injection dose guided by the level of activity


Target muscles



Depressor supercilli

Orbicularis oculi


Usual # of injection points

Women: 5-7

Men: require more sites

Starting dose

Women: 20-30 u

Men: 30-40 u


Horizontal forehead lines

Target Muscles




Orbicularis oculi

Usual # of injection points


Total starting dose

            Women: 15 u; 10-20 u

            Men: 20-30 u

* Start your injections high up so that you do not restrict the ability to raise the eyebrows.


Crows feet

Target Muscles:

            Lateral portions of the orbicularis

Usual # of injection points

            2-5; more in some cases

Total starting dose

            12-30 units

* Multiple small injections


Bunny lines

Target Muscles:



Usual # of injection points

            1 per side

            1 in midline

Total starting dose

            2-5 u divided evenly

            1 u if needed

*It’s a pretty big muscle.  Start slowly, but increase as needed.


Throughout her talk, Dr. Lopez shared wisdom she has learned in years of cosmetic derm.

+ Start a good skin regimen

+ Listen to your patients

+ Assess their understanding of their concerns and what they are seeking.

+ Educate! Botox vs. Fillers

+ Warn them. 

When you stretch the skin and you see etch wrinkles, let them know that toxins cannot help those.

+ Get photos for before and after.  Schedule follow-up visits.

+ Don’t completely erase wrinkles. 

You don’t want your name attached to something that looks so unnatural.

+ Don’t feel the need to treat, even if the patient says it’s needed.

+ Recommend the best possible option, don’t undertreat

+ Underpromise … overdeliver


Image: mybulldog


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