Helping her patients look and feel their best is one of Dr. Shalini Gupta’s greatest joys. Utilizing the most up-to-date and proven procedures to achieve her patients’ goals, Dr. Gupta — among the most well-established cosmetic dermatology and laser practices in the Cincinnati, Dayton and Northern Kentucky area — is known for excelling in her artistic abilities and keen attention to detail in everything she does.
Venue Magazine recently asked Dr. Gupta to answer several questions regarding her practice, The Dermatology, Laser & Vein Center, and what state-of-the-art-and-science procedures she offers to help patients’ skin look firmer, smoother and healthier.
Q. Dr. Gupta, you began your practice, The Dermatology, Laser & Vein Center, in 2001 with two lasers. How has your practice changed since that time?
A. Great question! My practice has always kept the focus on delivering quality, evidence-based procedures and technologies to keep our patients looking and feeling their best. Scientific investigations have led to the development of new technologies that reverse aging less invasively, without surgery or recovery time, and are proven to work.
The first exciting new technology in 2002 was a procedure called Thermage, which for the first time showed that the skin could be tightened without the need to be cut. Rather, the skin could be healed and restructured with the right energy reaching the right tissues to be rejuvenated. Today our favorite procedure for skin lifting is Ultherapy, which is more targeted and gives more consistent results. Similarly, body sculpting has scaled new heights with noninvasive treatments such as Coolsculpting, Warmsculpting and Emsculpt.
With over 20 lasers/technologies, we now have some duplication of procedures that could work on the same problem. This allows us to consider specific nuances in deciding which procedure is truly best for the patient, rather than relying solely on what might be available. At our practice, we are always looking to do things better for our patients and continue to expand the breadth of problems we can treat.
Q. What new procedures are available for brown spots, sunspots and age spots?
A. Depending on the location and type of spot we are dealing with, we can customize treatment very easily. This customization is something I am very proud of and that no other practice can compete with, because you really need an army of various technologies to handle subtle differences. If age spots are raised, they will be treated differently than flat, textureless brown spots. If the pigmentation is deeper, such as melasma, that will require a different approach. Finally, the patient’s nascent pigmentation and ethnicity will play a major role in deciding which technology/procedure will most safely treat their spots and pigmentation without causing an undesired side effect. At my office, I can count at least 10 procedures that can treat brown spots, sunspots and age spots. I will help choose the best and safest procedure. Some pigmented spots disappear entirely in a single session, others may lighten significantly yet never entirely disappear, and others may require multiple ongoing treatments.
Q. Is Coolsculpting safe? How does it work?
A. Coolsculpting is a proven, safe, FDA-approved procedure for the noninvasive removal of excess fat cells. It works best on patients who have a lower BMI, with stubborn pinchable areas of fat. The procedure is based on the concept that cold temperatures cause damage to fat cells and force the cells into programmed cell death, or apoptosis. Coolsculpting uses a very specific protocol which protects the skin from freezing while effectively freezing the lower layers of fat. Some patients may need just one treatment to a given area, but most patients benefit from 2-3 treatments with six-week breaks between treatments for optimal results. Each session removes about 24% of the fat cells in the treatment area.
What’s unique at our office is that we have alternative noninvasive treatments, including Warmsculpting with Sculpsure laser, Vanquish ME, Exilis Ultra, Liposonix and Emsculpt. This way we can make sure to choose the procedure or combination of procedures that makes most sense for a patient, versus choosing the only available procedure. Combining procedures such as Vanquish ME with Coolsculpting for a “Fire and Ice” approach, for example, can yield more dramatic, quicker results.
Q. Tell us more about varicose vein therapy as well as spider vein therapy. Can varicose veins be a health threat? How long is the recovery period following the procedures?
A. This is one of my favorite procedures because it is so satisfying to watch the veins vanish as I inject them — I mostly use hypertonic saline or foam sclerotherapy. We also have lasers, such as the Nd:YAG laser for stubborn vessels, but sclerotherapy continues to remain the gold standard and my preferred treatment for varicose and spider veins of the legs. While the veins disappear as I treat them, they will initially look inflamed and red. Over the next few weeks, the veins collapse and dissipate as they disintegrate. Some vessels may survive this assault to them and require a second and occasionally a third treatment. I usually recommend waiting at least three weeks prior to retreatment to effectively assess which vessels need retreatment. It can also take 1-2 weeks for any bruising to subside.
Though not required, I continue to recommend that patients wear compression stockings for 48 hours after each treatment. With the larger vessels, they will sometimes feel hardened as the blood trapped in the dying vessel coagulates. This can sometimes be a little uncomfortable, in which we case I can release the trapped blood. There is no danger of emboli from treatment of superficial varicose or spider veins. The blood trapped in the vessels may also begin to oxidize and turn green and later, a brownish color. This also slowly dissipates. Overall, this is a much simpler, less expensive, and noninvasive way to treat varicose and spider veins. While not a threat, in most cases, varicose and spider veins are a sign of an inefficient or insufficient vascular system. Removing these less efficient vessels does improve the overall health of the legs. Some patients find the veins to be painful or the legs to feel achy. These symptoms improve significantly with treatment.
I also commonly treat hand veins. Large hand vessels can make the hands look harsh and aged. Shrinking these vessels away dramatically takes years off and makes the hands appear more delicate and youthful.
Q. Other than using a concealer, is there anything that can be done about the dark circles under my eyes?
A. Absolutely! Our eyelid skin is thinner than other areas of our face and it often shows our age first. We have some very nice procedures to tighten the skin with focused Ultrasound energy, lasers and radiofrequency procedures. Most of these procedures are entirely noninvasive, except laser skin resurfacing, which can take a week or so to heal but gives very dramatic, beautiful results.
The procedure chosen depends on the patient’s preferred healing time and my recommendation, based on safety of the procedure for that patient and extent of aging that needs to be reversed. Dark circles can be caused by several factors. Some patients have hereditary darkening, which is often due to extra pigmentation in the undereye area. For this, I can use lasers that help break up the pigmentation. In some cases, I find a lot of vascular congestion with the presence of bluish vessels in this area. These vessels can be leaky, and the blood may oxidize and turn brownish in color. Lasers work well in this situation, breaking up the oxidized hemoglobin. The visible vessels are also effectively treated to prevent continued leakage.
Fat pockets can begin to protrude in the undereye area, causing both puffiness and shadows that fall under the fat pockets, leading to the appearance of dark circles. The ligaments that hold our fat pockets back, weaken over time. We can try to re-strengthen this area and use methods to shrink away the fat pockets in more extreme cases. Fillers are a very important tool to use in undereye darkness. They can restore volume that is lost from structural changes as we age and help the puffy fat pockets blend in more seamlessly. Undereye fillers are an art that requires experience and an artistic eye. The depth and location of placing the filler is critical to achieving the best results as is choosing the filler or combination of fillers to use. This is a very satisfying procedure when done well.
Q. How do I know if liposuction is an option for me?
A. This is where a one-on-one consultation is worth the time investment rather than trying to figure out the answer via an internet search. Ideally, the best candidates are those who are in good health and close to their ideal weight, with stubborn fat pockets that are difficult to get rid of with regular exercise and healthy eating. However, larger areas that are stubborn can also be very effectively treated with satisfying results.
The most common area we treat is the stomach, followed by the love handles. Other areas we routinely treat are thighs, knees, buttocks, arms, back/bra fat, chin and chest. In men, we can use lipo-suction to also treat gynecomastia and, in women, we can help reduce the weight of enlarged breasts without major surgery using liposuction. In our office, liposuction is performed strictly with local anesthesia, with the patient awake. I like to use either laser (Smartlipo) or ultrasound (Vaserlipo) to liquefy the fatty tissue before suctioning. This is gentler, more effective, and yields greater skin tightening with a quicker recovery for the patient — a win-win situation.
Q. What are the latest methods for cellulite treatment?
A. Cellulite is one of the most frustrating problems men and women deal with. You can be at an ideal weight and still suffer from the unsightly lumpiness and unevenness of cellulite. It is thought to be caused by a combination of factors, including skin collagen laxity, excess bundles of fat pro-truding through the thinned skin, bands that stiffen and shrink from the pressure of the protruding pockets. Some home treatments that may help include hydration, exercise and massage.
In the office, we have several treatments that can help. We can use externally applied monopolar or multipolar radiofrequency, which help shrink the fat pockets and stimulate collagen production in the skin at the same time. ThermiRF is a minimally invasive procedure using a small probe that travels under the skin. popping the fat cells, breaking up the fibrous bands and stimulating skin tightening. Mesotherapy using Kybella is also an interesting option.
The good news is that we can get an effective hold over cellulite with the latest procedures, especially when combining technologies (a recurring theme in our office). The key with cellulite is that it can, in many cases, require some ongoing maintenance to keep it all smooth.
Q. Is there a procedure that mimics a facelift but not as invasive?
A. Yes, absolutely. The best completely noninvasive approach is Ultherapy. Some patients also respond well to Thermage, but our preferred choice for the face is Ultherapy. It uses high intensity focused ultrasound (HIFU) to selectively deliver energy to the superficial musculoaponeurotic system (SMAS). This is the tissue that is accessed during a facelift and sutured to achieve a lift. We can now get to this deep tissue in a very selective manner using Ultherapy. No cutting, no recovery time, no scars. It’s a powerful tool to keep aging at bay. We have had wonderful success using it to lift the eyebrows, tighten the jowls, tighten the under-eye area, lips and neck.
If there is more skin laxity, I like to recommend Thermitight as an option for the lower face/neck. Using a small probe under the skin, the tissue is selectively heated and shrinks while forcing the skin to make new collagen fibers. As an aside, we have tremendous success achieving a nice breast lift using Thermitight as well.
Q. Is there a procedure that can improve my appearance during a lunch break appointment, and I can go right back to work?
A. I would highly recommend hydrafacials, Skin Tyte, RF tightening, Thermage, Ultherapy and Exilis Ultra for a lunchtime rejuvenation, tightening of the pores and a lift. These procedures do not cause any swelling or untoward redness, allowing one to easily get back to work with a more refreshed appearance. Fillers are also great for an immediate lift, though there can be some bruising that follows — usually the next day. Lip fillers instantly take 10 years off one’s age and can be done at lunch time as long as one is OK with the immediate change it makes and the initial swelling. Botox can also easily be done at lunch time, though the results take a few days to be seen. There is so much we can do to rejuvenate you in your lunchtime window! That gets us excited!
Q. How does technology impact what you do?
A. In a way, we are a technology practice because every procedure I do relies on research and a physical tool to achieve results, whether it is a fancy machine or a new injectable product or even a thread that gives an instant lift. The thought behind how a problem can be solved and how the technology can be developed to achieve that goal is very exciting. In practice, I can then use that technology to find new applications to solve various other problems. That is where creativity, science and art collide, and I can problem solve for my patients in their very best interest. That is what I truly love about my job!
Q. What would you like our readers to know about your practice?
A. We are established. We are not a medspa. We are truly a cosmetic dermatology center with the focus on science and art. We are progressive and love to introduce the best procedures and technologies to our patients. We are serious about education and making sure we put our best 200% effort and intention into every single patient. Each patient is unique, so there is no cookie-cutter consultation or answer. We like to think deeply and give the best solutions to our patients. Establishing trust is what we are about, and each patient is truly important to us. We are confident we have a solution to just about any cosmetic skin or body concern our patients have
The Dermatology, Laser & Vein Center is located at 9505 Montgomery Road, #201, Cincinnati, OH 45242. For more information, call 513.985.9885 or visit www.cincinnatiskinandlaser.com