Kent Aftergut, M.D. was selected as a top dermatologists by D Magazine.
7777 Forest Lane
Building C Suite 724
Dallas, TX 75230
Fax: (972) 283-8988
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Cedar Hill, TX 75104
Fax: (972) 283-8988
click here for map
BOTOX ® Cosmetic Learn More
Many facial wrinkles are not related to underlying muscle motion. Rather, these "static" wrinkles result from sun damage and the natural aging process. Static wrinkles are effectively addressed by techniques that resurface the wrinkle (laser resurfacing, dermabrasion) or elevate it with respect to surrounding skin (Restylane injections). These techniques have proven less effective with dynamic wrinkles because they do not address the underlying muscle function.WHAT IS BOTOX ® Cosmetic?
BOTOX ® Cosmetic is the trade name for botulinum toxin. It selectively weakens tiny facial muscles by blocking the nerve impulses that cause them to contract. This relaxing of selected muscles allows overlying skin to remain smooth and unwrinkled, while untreated facial muscles contract in a normal fashion. BOTOX ® Cosmetic has been used since the early 1980's to treat spasms of the neck muscles and eyelids. In the early 1990's, an ophthalmologist and her dermatologist husband first noticed its beneficial effects on expression lines. Their pioneering research led to the use of BOTOX ® Cosmetic in cosmetic surgery.IS IT SAFE?
Please don't let the word "toxin" scare you. BOTOX ® Cosmetic is one of the safest products in medicine. There has never been a report of a serious side effect resulting from the use of BOTOX ® Cosmetic in cosmetic surgery. Furthermore, BOTOX ® Cosmetic will not cause botulism - a form of paralysis caused by natural exposure to large amounts of botulinum toxin.WHERE IS BOTOX ® Cosmetic PLACED?
BOTOX ® Cosmetic is precisely placed only into the muscles responsible for the unwanted wrinkles. For example, the frown line between the eyebrows results from contraction of the corrugator and procerus muscles. These small muscles can be felt during a purposeful frown as a thickening just below the inside aspect of your eyebrows. By carefully targeting only the offending muscles, the function of other facial muscles is preserved.DOES TREATMENT HURT?
A tiny needle is used to place the medicine. Because the needle is so fine and only a small amount of fluid is used, the pain associated with the injections is minimal. Many patients compare the sensation to a bug bite. No sedation or anesthetic is required, although a topical anesthetic is available if desired. You can resume your normal activities immediately, including driving.HOW LONG DO THE BENEFITS LAST?
Results are seen in 3-7 days, and generally last 3 months. The improvement is easy to maintain with touch-up sessions. With repeated treatments, many patients find that the desired results last even longer. You can stop BOTOX ® Cosmetic treatments at any time with the confidence that you will eventually return to your pre-treatment appearance.WHAT ARE THE POSSIBLE SIDE EFFECTS?
Temporary bruising occasionally occurs and can be covered with makeup. In very rare cases, BOTOX ® Cosmetic can cause temporary drooping of an eyelid or eyebrow, double vision, or decreased tear secretion. However, in treating hundreds of patients since 1996, Dr. Dhir has never witnessed any of these undesirable side effects. Because the effects of BOTOX ® Cosmetic are completely reversible, any side effects are temporary, lasting no more than a few weeks.WHAT OTHER CONDITIONS CAN BE TREATED WITH BOTOX ® Cosmetic?
BOTOX ® Cosmetic can effectively decrease excessive sweating of the palms or armpits for several months. It works by blocking the signals that "tell" glands to produce sweat. Two to three sessions are required annually to maintain results. Treatment of the palms requires nerve blocks by an anesthesiologist, making this a rather expensive procedure.IS THE TREATMENT FOR EVERYONE?
There are very few restrictions regarding BOTOX ® Cosmetic treatments. However, patients who are pregnant, nursing, or have a neurologic disease (for example, myasthenia gravis) should not be treated. Also, aminoglycoside antibiotics and other drugs that interfere with neuromuscular transmission should be avoided during BOTOX ® Cosmetic therapy.WHAT ARE THE LIMITATIONS OF BOTOX ® Cosmetic?
It is not permanent and will require touch-up injections 2-3 times per year to maintain results. Also, BOTOX ® Cosmetic will not improve wrinkles due to sun damage or aging since they are unrelated to facial muscle contractions. There are rare reported cases of patients who possess a natural resistance to BOTOX ® Cosmetic and therefore do not respond to treatment. An alternative product called Myobloc is now available for these patients. Treatment of wrinkles is considered cosmetic and is not covered by insurance. Payment is expected at the time of scheduling. Costs vary from $325 to $650 per treatment session.BOTOX ® is a registered treademark of Allergan, Inc. Close
HOW CAN EARLOBE SURGERY BENEFIT ME?
Dr. Aftergut can restore the natural contour of your earlobe. Surgery is performed under local anesthesia in our comfortable procedure rooms. Postoperative pain is minimal and easily controlled with pain medications. Patients normally return to work the next day, and sutures are removed in 7 to 10 days.WILL INSURANCE PAY FOR THIS PROCEDURE?
Reconstruction of split earlobes is considered cosmetic and is not covered by insurance. The cost is usually around $400 depending of the size and severity of the tear. Keloid surgery is significantly more expensive, but insurance companies will often pay for surgical removal of keloids. Close
HOW DOES LASER HAIR REMOVAL WORK?
Hair removal lasers target the pigment located in the hair shaft and follicle. By targeting this pigment, the laser eliminates the hair itself. The laser can only access actively growing hairs. Since 20% of hairs are dormant and thus inaccessible at any one time, laser treatments must be repeated for the best results. Most patients undergo three to five total treatment sessions, typically scheduled every 1 to 2 months.HOW MUCH HAIR CAN BE PERMANENTLY REMOVED BY THE LASER?
Statistics suggest that the first laser session permanently removes about 30% of all the hairs in a treated area. The second session increases the total number of hairs permanently removed to 50%. With four total treatment sessions, most patients achieve a 80-90% permanent reduction. Although a few hairs remain, they are often finer and lighter in color, making the degree of improvement seem even greater. Improvement is limited to the treated area. For example, treatment of the upper lip and chin will not decrease the number of hairs present on the arms or bikini area.IS TREATMENT UNCOMFORTABLE?
Most patients feel that waxing and electrolysis cause more pain than the laser. However, patients may experience mild to moderate stinging or burning during the laser procedure. For smaller areas, such as the face or bikini area, a topical anesthetic can be prescribed. This is applied 90 minutes prior to the procedure. The first treatments are the most painful. With each treatment there is less and less hair and the laser becomes less painful. For larger treatment areas, local anesthetics are impractical. An oral pain reliever can be prescribed to be taken 1-2 hours prior to the procedure. In this case, you will need to have a friend or family member accompany you to the appointment.WHAT CAN I EXPECT AFTER THE PROCEDURE?
Most people experience mild redness and swelling of the skin immediately after the procedure. This typically resolves within several hours. A mild degree of crusting may be seen, especially with the first treatment session, or in those with darker and thicker hair.WHAT ARE THE POSSIBLE COMPLICATIONS OF LASER-ASSISTED HAIR REMOVAL?
Laser-assisted hair removal is very safe, with almost no risk of serious complications. Most patients return to their usual social and occupational schedules within several hours following treatment, or by the next day. Unlike electrolysis, scarring occurs in less than 0.1% of cases. Pigmentary changes are also rare, but can occur in patients with a strong tan or naturally dark skin. Therefore, it is important that you avoid tanning prior to your laser session. A strong tan may force us to reschedule your case, to ensure your safety.WILL MY INSURANCE COVER THE PROCEDURE?
Laser-assisted hair removal is considered cosmetic and is not covered by insurance companies. Payment is due at the time of scheduling. The cost varies from $75 to $1000 per treatment session based on the areas being treated. Close
WHAT CAUSES THESE LESIONS?
The most common causes in adults are sun, rosacea, and estrogen. Genetic factors also play a significant role – e.g. patients of Western European ancestry develop these lesions more easily. How do vascular lasers work?
Medical lasers operate on the principle of "selective photothermolysis." This refers to the ability of a laser to selectively heat and damage a specific target while ignoring the remainder of the skin. To treat vascular lesions, the laser's wavelength is tuned to precisely match red blood cells. Since red blood cells are confined to blood vessels, the laser deposits its energy into the unwanted vascular lesions without damaging the surrounding skin. This is quite different than older methods of treatment, such as electrocautery, which cause nonspecific damage.ISN'T LASER THERAPY ALSO THE LATEST TREATMENT FOR UNWANTED VEINS ON THE LEGS?
Actually, sclerotherapy (leg vein injections) remains the most effective treatment for spider and varicose veins of the legs. Simply put, lasers often fail to cause enough damage to unwanted leg vessels to effectively remove them. The diminished effectiveness of lasers on leg veins is due to the higher degree of blood flow through these veins, coupled with their deeper location.On occasion, lasers are effectively used following sclerotherapy to treat tiny blood vessels that are either too small for sclerotherapy or that have failed to respond to previous injections.HOW MANY TREATMENT SESSIONS ARE REQUIRED?
Most patients need two to three sessions to achieve significant clearing. While some patients achieve their results with one treatment, this is not typical. This is due to the body's remarkable ability to heal damage. Your health and safety are important to us, and we cannot speed up the process by "over-treating" areas. Treatment sessions are scheduled every 4 weeks, so that the body has adequate time between sessions to eliminate damaged vessels.
Vascular birthmarks in children often require numerous treatment sessions. Some adults with particularly severe or widespread involvement may benefit from additional treatment sessions as well. We regret that we cannot give you a guarantee as to the total number of sessions needed. However, we can promise you that we will do our best to achieve your goals safely in the fewest sessions possible.DOES TREATMENT HURT?
Most patients complain of mild stinging or burning during the procedure. Unfortunately, local anesthetics are impractical because they cause blanching of the skin. This blanching removes the target of therapy and makes treatment less effective. The vast majority of patients tolerate the discomfort well and are pleasantly surprised by the lack of pain immediately following the procedure. If desired, we can prescribe a pain medication to be taken two hours prior to treatment. In this case, you will need to be accompanied by a companion who will drive you to and from your appointment.WHAT ARE THE POSSIBLE COMPLICATIONS OF LASER THERAPY?
Laser therapy is very safe, with very few risks of serious complications. Most patients return to their usual social and occupational schedules within several hours following treatment, or by the next day. With the laser, almost all patients experience facial flushing that lasts a few hours. Treatment of the cheeks or neck often results in small, mosquito-bite-like red bumps, due to histamine release. These bumps typically last only 24-36 hours, but can persist for several days in rare cases. Approximately 2% of patients, typically those with sensitive skin (e.g. rosacea), may also notice mild-to-moderate "puffiness" or swelling of the lower eyelids and/or cheeks. Although this swelling is not dangerous, it can take a few days to resolve. Some patients may have bruising following the procedure that can last seven to ten days.
In a minority of patients, areas of treated skin may develop small crusts similar to scratches. However, scarring occurs in less than 0.1% of cases. Pigmentary changes are also rare but can occur in patients with a strong tan or naturally dark skin.WILL MY INSURANCE COVER THE PROCEDURE?
Laser treatment of vascular lesions is considered cosmetic and is not covered by insurance companies. Prices vary from $200 to $600 per treatment session, depending on the size of the area to be treated.WILL MY LESIONS EVER RETURN?
Rarely, treated areas may fail to clear completely or may even recur following successful therapy. Of course, new lesions may develop with time; the risk factors (rosacea, sun, estrogen, genetics) are difficult to avoid. Fortunately, new vessels can be effectively treated with touch-up procedures if necessary. No reputable surgeon can guarantee the elimination of every unwanted blood vessel, but most patients achieve a 70 - 100% improvement and are very satisfied with their treatment. Close
HOW CAN A LIGHT PEEL BENEFIT ME?
In chemical peeling, a solution is applied to the skin to remove damaged skin cells and stimulate production of new, healthier skin cells. Light peels are used to "freshen" the skin in patients who cannot afford a great deal of down-time. They rejuvenate rough, sun-damaged skin. Peels can also improve acne, melasma, and other forms of uneven facial pigmentation. Usually multiple light peels one month apart are needed to see significant improvement. Chemical peels can also open up comedones (whiteheads and blackheads) and be helpful for patients with acne.HOW IS THE TREATMENT PERFORMED?
We use several solutions for light peeling, including glycolic acid, salicylic acid, trichloracetic acid, and Jessner's solution. We will help you select the peel that is best for you. Light peels take ten to fifteen minutes. The solution is carefully applied to the skin for a specific length of time and then neutralized or washed off. Any discomfort is mild and very brief - lasting no more than 2-4 minutes. No anesthesia is required, and the pain is gone before you leave the office.What can I expect after the peel?
A mild sunburn-like reaction - without the pain. The skin usually peels or flakes without blistering for 3-5 days. Swelling is minimal, and you can continue your normal activities uninterrupted. The first peel may produce very little reaction. Please inform us if you have a history of unusual scarring tendencies, X-rays to the face, cold sores, or Accutane (isotretinoin) therapy.What are the limitations of light chemical peels?
Typically, several monthly peels are necessary to achieve the maximum benefit. Heavily sun-damaged skin may benefit from a stronger, medium-depth peel – but healing will take a little longer. Lax skin and deeper wrinkles do not respond to peels. Also, chemical peels cannot change pore size, improve deep scarring, or remove broken blood vessels on the face. Light peels are considered cosmetic. Therefore, the cost of treatment is not covered by your insurance. Payment is expected at the time of scheduling. Costs vary from $150 to 200 per treatment session. Close
HOW CAN A MEDIUM-DEPTH PEEL BENEFIT ME?
In chemical peeling, a solution is applied to the skin to remove damaged skin cells and stimulate production of new, healthier skin cells. The greatest benefit of a medium-depth peel is the removal of severely sun-damaged skin and precancerous lesions (actinic keratoses). Studies demonstrate a 75% reduction in actinic keratoses post-peel. These peels also improve irregular or splotchy pigmentation and reduce fine wrinkling. In other words, medium-depth peels have significant therapeutic as well as cosmetic benefits for patients with photodamaged skin. A medium depth peel can help even out pigmentation and improve fine lines and wrinkles. It also can be open open and closed comedones and be of benefit to patients who suffer from acne.HOW IS THE TREATMENT PERFORMED?
The entire procedure takes approximately 45 minutes. After cleaning the face, a light coat of Jessner's solution or glycolic acid is applied to prepare the skin. After several minutes, the second agent – trichloracetic acid – is carefully applied. Most patients experience moderate discomfort for 3-5 minutes, but this quickly subsides with cool compresses. Medication is available to both ease the pain and help you relax. The pain is gone before you leave the office.WHAT CAN I EXPECT AFTER THE PEEL?
A severe sunburn-like reaction. Surprisingly, most patients report very little pain at all during the healing process. Water blisters form and subsequently break, crust, turn brown, and peel over the next 5-14 days. Some patients experience some swelling for a few days. Fortunately, with good wound care, most patients heal completely within 7-10 days. Some pinkness may be present for a few weeks, but this can be covered with makeup.WHAT ARE THE LIMITATIONS OF CHEMICAL PEELS?
Lax skin and deep wrinkles do not respond to peels. Also, chemical peels cannot change pore size, improve deep scarring, or remove broken blood vessels on the face. A medium-depth chemical peel is considered a cosmetic procedure and is not covered by insurance. Payment is due at the time of scheduling. The cost is $200 to $300. Close
In recent years, insurance companies have stopped paying for the removal of skin tags. Removal is usually termed a "medically unnecessary" or "non-covered" procedure. Therefore, removal of skin tags is considered a cosmetic procedure.
Removal can be performed using "liquid nitrogen cryotherapy" (freezing) or "snip excision" (delicate scissors after achieving local anesthesia). The cost for either procedure depends on the number of skin tags that need to be removed. Close
Wrinkle correction in the the lower two thirds of the face
Correcting nasolabial folds and puppet lines
Shaping the cheeks and chin for facial contour
Improve the appearance of acne scars
No skin test is necessary
Allergic reactions are almost non-existent
Lasts up to 60% longer than collagen fillers
Clinical trials show that Restylane is effective for up to six months after lip augmentation and up to twelve months after facial contouring Close
Radiesse can be used for:
Smile lines (nasolabial folds from edge of nostril to corner of mouth)
Marionette lines (from angles of mouth down)
Jaw Line contouring
Facial fat loss (lipoatrophy)
Step 1: Consultation with an experienced Radiesse provider
During your consultation, Dr. Aftergut will examine your skin and discuss how Radiesse treatment can enhance the contour and shape of your face to restore a vital and youthful appearance. Since no skin testing is needed, you can have your treatment the same day.
Step 2: Cleanse and fill
After a thorough cleansing of the area to be treated, Radiesse is injected in a narrow, continuous stream in the proper skin plane to achieve the desired facial augmentation and contouring. A combination of topical measures and local numbing will be used so treatment is comfortable and relaxing
Radiesse injection is a non-surgical approach that involves a simple in-office procedure. Treatment is convenient and quick. Usually, mild swelling and redness occcur at the injection sites that may last 1-2 days. Sometimes, a bruise may be noticable. In most cases, you may resume your routine activities immediately following the procedure. You will be provided with specific instructions.
Step 4: See immediate results
Radiesse can be placed to provide volume and correction without the need to over correct, an advantage over many other filler products. Therefore, your doctor can mold, shape and contour the areas of your face to provide immediate and optimal improvement.
Step 5: Long lasting correction You have successfully completed your Radiesse contouring treatment. In most facial applications, Radiesse should provide a correction that last one to two years. Sometimes, an occasional touch-up is needed. Close
Finally there’s a non-invasive solution that delivers safe, effective wrinkle treatment without surgery. ReFirme is ideal for patients who want to resolve mild to moderate wrinkles, and is especially effective in conjunction with ReFirme™ Skin Tightening.TREAT DEEP AND FINE WRINKLES
Unique Matrix Heating of Elos™ produces results at both the epidermal and deep dermal levels. The intersection of RF current and diode fluence — the Matrix — creates a controlled, focused energy at a depth of 1.5 to 2.0 mm, exactly the area where collagen stimulation should occur.
The power of the RF — which does not rely on a chromophore for absorption — means that energy is sent precisely and effectively to the treatment zone. Light creates higher temperatures in the epidermis while the combination of the light and RF penetrate into the deep dermis. The combination of controllable energies treating at multiple levels makes it possible to treat fine wrinkles at the surface, while penetrating into the dermis to treat deeper wrinkles - all in the same procedure.INCREASED SAFETY AND COMFORT
Elos™ requires lower overall energy levels for superior results and maximum safety. Most people experience no side effects at all, though a few exhibit some short-term local reddening of the surrounding skin. Treatments require no patient downtime.HOW IT WORKS
Powered by the revolutionary Elos™ Technology, ReFirme™ treatments generate results with its precision matrix heating. The intersection of radio frequency (RF) current and diode fluence creates a controlled, focused thermal energy at a depth of 1.5 to 2.5 mm.
Contact cooling protects the epidermis and directs the RF energy precisely at the treatment zone, the area thought to promote collagen production. The light and RF energies work synergistically at multiple levels creating a combined thermal effect, which enables the simultaneous resolution of fine surface wrinkles and deeper wrinkles in the dermis.
Juvéderm™ injectable gel is a “next-generation” smooth consistency gel dermal filler that helps restore skin's volume and smooth away facial wrinkles and folds like your “smile lines,” "puppet lines,"or “parentheses” (nasolabial folds—the creases that run from the bottom of your nose to the corners of your mouth). Juvéderm™ comes in two formulations—Juvéderm™ Ultra and Juvéderm™ Ultra Plus.What is JUVÉDERM™ used for?
Juvéderm™ Ultra and Juvéderm™ Ultra Plus are indicated for injection into the mid to deep dermis (below the outer layer of skin) for the correction of moderate to severe facial wrinkles and folds, such as nasolabial folds (the creases running from the bottom of your nose to the corners of your mouth, aka smile lines or parentheses).Why does JUVÉDERM™ come in two formulations?
Juvéderm™ injectable gel is available in two formulations to allow your physician to tailor treatment to your unique needs. Juvéderm™ Ultra provides versatility in contouring and volumizing facial wrinkles and folds. Juvéderm™ Ultra Plus is a more robust formulation for volumizing and correcting deeper folds and wrinkles.How is JUVÉDERM™ injectable gel different from BOTOX® Cosmetic?
Juvéderm™ injectable gel is a “next-generation” hyaluronic acid dermal filler that provides volume and is used to treat wrinkles and folds resulting from a loss of volume beneath the surface of the skin such as perioral lines and nasolabial folds (lines around your mouth and nose). Juvéderm™ restores your skin's volume for a smooth, natural look and feel. BOTOX® Cosmetic is not a filler. BOTOX® Cosmetic relaxes muscle activity and is used to treat moderate to severe lines caused by the dominant frown muscles between the eyebrows (the glabellar area). This allows the two vertical lines between the brows, often referred to as the “11,” to temporarily diminish for a smoother appearance.What is hyaluronic acid?
“Uncross-linked” hyaluronic acid in its natural form is in a liquid state. “Cross-linking” is the process through which hyaluronic acid is made into a gel product that can be injected into the skin for long-lasting results.How is JUVÉDERM™ injectable gel used in treatment?
Your physician eases Juvéderm™ 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 such as “smile lines” or “parentheses” (nasolabial folds) and “marionette lines” (oral commissures). Juvéderm™ temporarily adds volume to the skin and may give the appearance of a smoother surface. Ask your doctor what you should expect from your initial treatment and when they would recommend rescheduling another appointment.Is treatment with JUVÉDERM™ injectable gel painful?
Injections may cause some discomfort during and after the injection. The smooth consistency gel of Juvéderm™ allows your doctor to administer it easily and smoothly. And, Juvéderm™ is injected directly into the skin using a fine needle to reduce injection discomfort. Your doctor may choose to numb (anesthetize) the treatment area to further minimize discomfort. Some patients may get some bruising and swelling following treatment.How long does treatment usually take?
The injection process takes only about 15 minutes. You'll also need to allow time to consult with your doctor prior to treatment and for the application of numbing cream if necessary.Does the correction last forever?
No. Correction is temporary; therefore, touch-up injections as well as repeat injections are usually needed to maintain optimal corrections. However Juvéderm™ is the ONLY hyaluronic acid (HA) filler FDA approved to last up to 1 year.What are the possible side effects of JUVÉDERM™ injectable gel?
Most side effects are mild or moderate in nature, and their duration is short lasting (7 days or less). The most common side effects include, but are not limited to, temporary injections site reactions such as redness, pain/tenderness, firmness, swelling, lumps/bumps, bruising, itching, and discoloration. As with all skin injection procedures there is a risk of infection.Can people with different skin tones/colors be treated with JUVÉDERM™?
Yes. In fact, Juvéderm™ injectable gel is the first FDA-approved hyaluronic acid dermal filler that has proven its safety and effectiveness in persons of color. Studies with Juvéderm™ showed no increased risk of hyperpigmentation or hypertrophic scarring in patients of color. Close
CO2RE is the versatile fractional CO2 system that enables you to precisely target and effectively treat the skin’s surface, middle, and deep dermal levels. Then seamlessly perform traditional CO2 resurfacing and laser excision of lesions.
CO2RE gives you the ability to treat both superficial and deep skin layers simultaneously with precision-control over the intensity, pattern, and depth of ablation.CO2RE System Features
The Next Generation of CO2
Intuitive touch-screen interface – displays treatment geometries & selections
- Coherent gem series digital super pulsed Laser
- Over 16,000 pulses per second
- Fusion mode delivers deep and superficial energy in one pass
- Versatile: control depth from 10 to 750 microns and density from 1% to 100%
- Featherweight delivery system minimizes operator fatigue
- Small footprint and quiet operation made for the aesthetic practice