Cosmetic Dermatology

Cosmetic Dermatology is the practice of improving the look and health of one’s skin through medical or surgical procedures, to help people look and feel their best. These procedures range from simple filler injections to help smooth wrinkles and firm sagging skin to laser and cosmetic surgeries that physically change the skin or alter its shape and elasticity.

Anyone who has looked in the mirror and thought of making some sort of improvement to their skin knows something about cosmetic dermatology. Wanting to look your best is a human trait, and there’s nothing wrong with taking advantage of the advanced and efficient treatments that are available in the field of cosmetic dermatology.

A qualified cosmetic dermatologist will be able to address all of your anti-aging and appearance improvement concerns. Patients should remember that although some of these treatments may be widely available, they are still medical procedures and do carry some risk. Expert counseling and the ability to confidently manage any complications that may arise are just two of the many reasons to seek out a board certified dermatologist for these treatments.

Cosmetic dermatology treatments are typically elective procedures and are not covered by insurance. At MidState Skin Institute, we work with you to create an individualized plan that will ensure that you get maximal results for your budget. To help make your cosmetic goals achievable, we are pleased to offer patient financing options, including low and even zero interest rate alternatives.


These are all brands of neurotoxins. They are injectable treatments used for the rejuvenation of the skin. A purified protein is injected into the skin in order to relax the muscles that form facial expression, and the results typically last for three to four months. The procedure is quick and very well tolerated. Botox®, Dysport® and Xeomin®, are FDA-approved for treating the glabellar area, which is the area between the eyes where wrinkles form. These injectables are also used off-label to treat other problem areas, like crow’s feet around the eyes, smoker’s lines around the mouth, a dimpled chin, creased forehead, and wrinkles on the neck.

Botox®, Dysport® and Xeomin® not only relax lines that are present, but can also help prevent new lines from getting “stuck” in the skin. These “aging” lines are formed by repetitive facial movements such as scowling and deep thinking.

These cosmetic injections provide great, non-surgical results.

Photodynamic Therapy

PDT is a light-based treatment used for photo rejuvenation, treatment of wrinkles, and acne. Itcan also selectively treat precancerous and cancerous lesions while causing minimal damage to the surrounding normal skin.

Sclerotherapy for Spider Veins

This is the treatment of choice for small yet unsightly clusters of red, blue, or purple veins that most commonly appear on thighs, calves, and ankles. This simple procedure involves injectingthe affected veins with a solution that causes them to fade away.

CO2RE Laser

Life leaves marks from wrinkles to scars. Transform your skin naturally with treatments from the CO2RE laser system.

What is CO2RE? 

From deep wrinkles to sun damage to scarring, skin concerns can undercut your confidence. They can even keep you from embracing life to the fullest. Still, not everyone wants the downtime associated with conventional resurfacing procedures. If that’s you, the answer may be CO2RE laser treatments for face. The CO2RE treatment is non-invasive and hormone-free, and can be done right in your doctor’s office. With the CO2RE treatment, younger, smoother skin is possible.

How does it work?

Lasers may sound futuristic, but CO2 laser resurfacing has been around for a long time. A treatment from the CO2RE fractional laser is fast with minimal downtime. The latest innovation in lasers is a big leap forward because it simultaneously works on the surface and beneath your skin. It treats a fraction of the skin at a time, making precise, microscopic wounds. As they heal, your body naturally produces collagen and healthy new skin cells.


CO2RE treatments are clinically proven to improve the appearance of:

  • Fine lines and deep wrinkles1
  • The effects of sun damage, including age spots
  • Skin tone and texture
  • Baggy eyes*

Lasting, noticeable results:

  • Surgical scars
  • Burn scars
  • Acne scars
  • Skin tags
  • Sebaceous Hyperplasia (small, skin-colored bumps)

Experience dramatic improvements in:

  • Milia (small, non-inflamed cysts)
  • Skin tags
  • Sebaceous Hyperplasia (small, skin-colored bumps)
  • Warts

*May require surgical blepharoplasty

Is CO2RE for me?

Ideal candidates for CO2RE treatments have fine lines, furrows and other types of deep wrinkles, discoloration, rough texture (acne scars), age spots, or skin damaged by exposure to the sun. It is ideal for anyone seeking younger-looking skin without the long downtime associated with conventional resurfacing procedures. You need to schedule a consult with our provider about your complete medical and skin history to minimize the potential for any negative reactions.

What is the CO2RE procedure like?

You can expect some moderate discomfort during the treatment, but the anesthetic applied before the procedure typically makes any discomfort tolerable. Pain and other prescription options can be reviewed in your consult.

How many treatments will I need?

Our patients see the difference they want after only one treatment. In the days after the treatment, your skin will gradually look softer and smoother, with less unwanted pigmentation. The fine lines, wrinkles, age spots, and uneven texture will start to show improvement.

What can I expect after my procedure? 

Immediately following the procedure, you can expect a sensation similar to a sunburn, lasting several hours. There is a possibility of redness and swelling post treatment. You can expect peeling of dead skin from the treatment area. This is a natural exfoliation process that may last 10-14 days.

Dermal Fillers

Dermal fillers are substances that are injected into the skin to replace lost volume. Typically, lost volume comes from aging. At MidState Skin Institute, we use products we feel are best engineered and give the best results. These products include Restylane, Juvederm, Perlane, Radiesse, and Sculptra.

Dermal fillers are used predominantly to fill lines around the mouth, but they are also used off label to treat cheeks, lips, tear troughs, marionette lines, temples, chest, forehead, ears, hands, and other locations. In general, a filler injection procedure results in no downtime and the changes are seen immediately after injection.

Hyaluronic acid fillers such as Juvederm, Restylane and Belotero are popular because they can be dissolved should a complication arise. When having a dermal filler injection procedure, it is important that the dermatologist evaluate the entire face and balance the outcome. If the filler is concentrated in one area, it may make the face look unnatural. Therefore, it is important to have
a filler injection performed by an experienced professional.

When fillers first came on the market, “line filling” was popular. Line filling was the practice of injecting fillers into visible line areas only. Over time, the standard of care has evolved and today professionals focus on “pan facial volumization”, or the injection of fillers into the face in a way that creates natural and balanced appearing volume. As we age, our temples become hollow, our cheeks become sunken, and our chins become less prominent. Replacing lost bone and fat with filler substances can create a more youthful contour to the face. Fillers are used in patients of all ages.

For younger patients, the focus of dermal fillers is often augmentation, which means enhancing a naturally occurring feature, like making lips fuller and thicker. Fillers can also be used to help minimize the visibility and contours of acne scars and to improve the contour of a patient’s profile. When a dermal filler is injected into the nose, it can change the shape of the nose and make it more aesthetically appealing.

For older patients, the focus of fillers is on correction and restoration of lost volume from aging.

Patients of all ages can benefit from the scientific advances in filling agents, which allow for comfortable, safe volume replacement or augmentation.

Filler FAQ

What is filler?

The facial fillers used at MidState Skin Institute are made from hyaluronic acid. The use of fillers can improve or even eliminate wrinkles, plump and hydrate lips, replace soft-tissue volume loss, raise scar depressions, and volumize creases and folds of the face. As we age, our skin becomes more susceptible to wrinkles and fine lines, especially due to sun damage and muscle movement. Facial fillers provide a solution to such wrinkles and folds through facial injections. Brands used at MidState include: Juvederm, Restylane, Revanesse, Radiesse (calcium hydroxylapetite).


When will I see results?

Results are visible immediately after treatment. The healing process then begins which involves swelling for about 3-14 days depending on the amount injected, area injected, and how your body reacts to the procedure. The product then settles and you’ll enjoy your final results about 2-3 weeks after injections. Please give yourself a minimum of 2 weeks before any events or vacations in case of residual bruising and swelling.


How long do results last?

Longevity differs from person to person and from treatment to treatment. Because the product is being injected into the body, some bodies may metabolize the product faster than others. Filler can last indefinitely as long as it is maintained. See below for average longevity based on treatment:

Cheek Filler: 9-18 months

Under Eye Filler: 9-18 months

Lip Filler: 6-12 months

Lower Face Filler: 12-18 months

Jawline Filler: 12-18 months

Chin Filler: 12-18 months

Non-Surgical Rhinoplasty: 9-18 months

Nasolabial Fold (Smile/Laugh Lines) Filler: 9-12 months

Temple Filler: 9-12 months

Sculptra: 2-3 years


How many treatments will I need?

Facial fillers are a temporary solution, and therefore to maintain results, treatments will need to be administered on a recurring basis (see longevity info above).

First session can be expected to result in ~40% improvement

Second session (3-6 months after first session) can result in ~80% improvement

Maintenance sessions every 9-12 months, budget $700-1400


Pricing varies based on areas treated and amount used. Below are ranges. Your in-person consult will determine the necessary amount of product needed in order to have a natural, lasting result.

Cheek Filler: $700-1400

Under Eye Filler: $700-$1400

Midface Cheek and Under Eye Filler Combination Treatment: $2200

Lip Filler: $700

Chin Filler: $700-$1400

Lower Face Filler Package: $2200

Jawline Filler: $1800-2200

Nasolabial Fold Filler: $700-1400

Marionette Line Filler: $700-1400

Nose Filler: $700

Perioral Line/Smoker Lines: $700-$1400

Temple Filler: $700-$1400

Full Facial Restoration/Balancing: $3600

Sculptra: $900-1800


Will I need time to recover?

Bruising and swelling is possible, plan 2 weeks ahead of any events/vacations. In effort to decrease bruising consider OTC Arnica bruise supplements (available on Amazon or health stores – take as label directs, can be started 2 weeks prior to filler appointment) and OTC Arnicare Gel can be applied 3-4 times a day.


Any other reasons I should not get filler?

Dental work within 2 weeks of filler. Recent vaccination (2 weeks). Recent surgery (6 weeks). Recent illness (2 weeks). Uncontrolled autoimmune disease. Bleeding disorders. Pregnancy. Lactation.


“Filler looks fake.” “My friend got filler and now she has duck lips.” “I read a story that filler can stretch out your skin”

All of the above are common filler misconceptions! Filler can be used to make you appear more rested and rejuvenated. It can be used to remove the shadows on our face that make us look sad or angry or tired. Well placed filler will have your friends asking you what moisturizer you are using or if you got your hair done – not if you got filler. You will look like yourself – but better! Filler in the right hands will never make you look “done” or “pillow face”. Poor results from filler is not because of the filler – it was the technique used by the practitioner. Do your research to make sure you are putting your face in the right hands.

Neuromodulator FAQ

(Botox, Dysport, Xeomin, Jeuveau, Daxxify)

What is a neuromodulator?

Botulinum toxin is a neuromodulator, which is the fancy name for a class of chemicals that interrupt the signals between nerves and muscles causing muscles to relax and wrinkles to subside. Injections of botulinum toxin temporarily inhibit the nerve cells that signal specific muscles to contract, therefore weakening facial movements that cause fine lines and wrinkles.


Which lines of the face does neuromodulator work well?

The injections are most commonly used to relax:

  • Glabellar muscles between the brows (often referred to as 11 lines or frown lines)
  • Horizontal forehead lines
  • Lateral canthal lines (aka crow’s feet: lines radiating out from eyes)


Are neuromodulators safe?

Botox has been used safely for cosmetic purposes for over 20 years. Over 5 million neuromodulator procedures are performed every year in the United States alone. Therefore, there is significant data proving both safety and effectiveness.


Who cannot have neuromodulator injections?

Patients who are pregnant or breastfeeding.


How long does it take to see results?

You will begin to see improvement by day 7 post treatment. However, it takes 2 weeks for the neuromodulator to fully set it. Different muscles relax at different speeds. Relaxation can occur asymmetrically. Therefore, no adjustments can be made until the 2 week mark. As the muscles are relaxed, the lines at rest will improve over the next 6 weeks. With continued use, even deeper lines at rest can be improved.


What about after treatment?

You may apply makeup and use regular skincare a few hours after your treatment. Do not have any facials or laser procedures for 10 days post treatment. Do not exercise for 6 hours after treatment. No hats for rest of treatment day.


How long does the result last?

Typically with adequate amount of neuromodulator units used you can expect to last 10-12 weeks. That being said neuromodulator effects peak at week 2 through week 6 and then begin to taper off. An analogy for this is gas in your car; you start with a full tank and as time goes by it slowly decreases to empty. At this point you need to fill up your tank again. With neuromodulators, dose equals duration. This means is that if you don’t put enough units in, you will not last 10-12 weeks. If you are not lasting long enough more units are needed for subsequent visits. More units only means you have stronger muscles in that area. It can look unnatural if an area is not fully treated with the appropriate amount of units.



Cost depends on units used. The units necessary are specific to you and your muscle strength/facial anatomy. Below are averages needed for optimal treatment:

Glabella (11’s between eyebrows): 16-26 units

Forehead (horizontal forehead lines): 6-20 units

Crow’s Feet (lateral lines extending from eyes): 12-28 units (total for both eyes)

Brow Lift (treats the muscle that pulls the tail of the brow down): 6-10 units (total for both brows)

Lip Flip (lips perioral lines, increases upper lip show when smiling): 4-8 units

Gummy Smile (if desired less upper gum show when smiling): 2-6 units

Bunny Lines (lines that run diagonally across nose): 6-10 units

Chin (treats the orange peel texture of the chin): 6 units

DAO (up turns the corner of the mouth): 6 units

Neck lift (treat the vertical bands from your jawline to collarbone that contribute to a “turkey neck”): 6-10 units per neck band, average 4-6 bands

Masseter (helps with TMJ, teeth grinding,): 15-30 units per side