Cosmetic
Dermatology

Cosmetic Dermatology focuses on procedures and services that help patients soften signs of aging and maintain a youthful, natural appearance.

Scar Revision

Scars are a common cosmetic concern, especially on the face. Scarring is a natural part of wound healing. Any wound to the skin including an injury, a burn, surgery and acne can cause scarring. Once a scar forms it is permanent. Scar revision therapy is intended to improve the appearance of the scar, its tone and texture so that it blends in with the surrounding skin. Fortunately, there are many good options to minimize the appearance of a scar. The right treatment for you depends upon various factors like the type of scar, its location, thickness and age, as well as your skin type.

Scare institute

Laser Scar Revision

We specialize in laser scar revision. Our cases have been featured both nationally and internationally and our techniques have been shared around the world. At Hudson Dermatology and Laser Surgery, our focus is around healing you to the best of our abilities. It’s not an easy journey but we are in it together. We use cutting edge devices and depending on the type of scar and severity, also coordinate care with surgeon colleagues and other parts of the medical team. We specialize in complex traumatic scars, acne scars, and burns.

 

Dr. Dhaval Bhanusali and Dr. Kiran Mian of Hudson Dermatology & Laser Surgery are board-certified dermatologists. They are widely regarded as experts in scar revision.

Hudson Derm in the Press

Dr. Bhanusali x Bridger Walker

The hero brother who saved his sister from a dog attack and feels his face scar is "Something to be proud of".

To Read More About Bridger’s Inspiring Story:

People Magazine, NewswiseNew York Post

Dr. Bhanusali x Amanda Morris

Chealsea slashing victim makes amazing recovery thanks to dermatologist.

To Read More About Amanda’s Story: ABC News, Daily MailFox NY

Dermabrasion is a safe and effective method to treat scarring, particularly rough or elevated scars. Using a special tool, the procedure removes the upper most layer of skin. As the skin heals, new skin replaces the old to improve the appearance of the superficial scars, making them less visible. Typically, a 50% reduction in scarring is considered a good result.

Dermal fillers are valuable to fill in depressed or concave scars. The improvements can last for months or up to a year, depending on the filler chosen. Repeated treatments are necessary to maintain the results.

Steroid injections can be used to soften and shrink hard scars like keloids and hypertrophic scars. Treatments will improve the size, texture, and appearance of raised scars.

Fat transfer therapy involves injections of your own fat that is retrieved from your thighs, buttocks or abdomen, and injected to fill depressed scars. Because your own tissue is used, there is no risk of allergic reaction. A few treatments may be needed to achieve desired results.

Subcision is a minor surgical procedure designed to treat depressed scars by releasing hard and fibrous scar tissue, lifting the depression. A filer can be injected to raise any depression remaining.

Laser therapy treats thick, red, large, indented, raised scars with a special vascular laser (a pulsed dye laser) to reduce or eliminate hyperpigmentation. Usually pulsed dye laser treatment is done first, followed by CO2 laser treatment to reach the depth of the scar

An IPL Photofacial can treat hyperpigmented acne scars.

Chemical peels, especially TCA peels are good for pitted acne scars. Deep peels go deep into the skin and can take several weeks to heal. They treat the entire face and produce smoother, more youthful looking skin.

Laser skin resurfacing can penetrate and break down scar tissue without damaging healthy skin. An added benefit is the stimulation of collagen production which will naturally fill and recontour depressed acne scars. Laser skin resurfacing is good for pitted acne scars. Healing takes about 7-10 days but will produce smoother, more youthful looking skin. It cannot be used while you still have acne breakouts.

Deep severe acne scarring is best treated with surgical scar revision because these scars tend to be under tension and surgery can release the tension. Surgery will leave a scar, but it will be less visible and more acceptable than the scarring that was removed.

Acne Scarring

Acne affects close to 90% of adolescents. But acne isn’t just a teenage problem. Acne can persist long after adolescence, and its negative impact on patients is well documented. Studies report that many with acne feel embarrassed, self-conscious, less attractive, unhappy, more anxious and less confident.

Breakouts are tough enough, but many people are left with acne scarring, which is often permanent and disfiguring. Scarring is more common in people who have had severe inflammatory acne, and those whose family members have acne scarring. It is also more common when the sufferer has squeezed or picked at his or her acne bumps, which forces inflammation and bacteria deeper into the skin.

What causes acne scarring?

Actually, scarring is part of the normal healing process after an injury or wound, and this is also true for acne.

When a hair follicle or pore becomes clogged with dead skin cells and excess oil, and overrun with bacteria, it causes inflammation and what we call acne. Inflammation disrupts the lining of the pore or follicle and allows the bacteria to escape into the surrounding healthy tissue, causing significant inflammation and tissue destruction.

 

Damage to the epidermis, the top layer of skin, can result in post-acne hyperpigmentation, and shallow scars. When the damage penetrates more deeply to the dermis, the deeper skin layer that contains collagen and elastin, hair follicles and sweat glands, the resulting scars can be much deeper and more obvious. The more severe the inflammation, the worse the scar. Acne scars come in different types based on the conditions that caused the scar. Red inflamed pimples, nodules, and cysts can cause damage that the body cannot adequately repair.

Types of acne scars

Acne scars come in many colors, forms, and shapes. Discoloration of the scar may appear as pink, red, purple or brown spots. And acne scars also have different architectures. Atrophic scars sit below the rest of the skin and result from too little collagen deposition during healing.

Atrophic scars include: narrow, V-shaped ice pick scars that go deep into the skin; U shaped boxcar scars have sharp edges and are punched out in the middle; and rolling scars, which are wide depressions with irregular borders.

Then there are hypertrophic scars that sit above the surrounding skin and result from too much collagen deposition during healing.

Treatment of acne scars is a process that requires patience and motivation, but with the help of our dermatologists, you are in expert hands. Our dermatologists will listen to your concerns and create a treatment protocol specifically for you.

Acne scarring treatment options

There are many treatment options for acne scarring, including the use of vascular lasers, ablative lasers, microneedling, topical treatments, dermal fillers, subscision and even surgery in some cases. For optimal results Hudson Dermatology and Laser Surgery often recommend a combination of treatments and procedures.

 

Treating acne scars takes patience, and often requires a series of treatments over time. Persistence pays off and reduced scarring enhances your self-esteem and confidence.

Neurotransmitters

Neurotransmitters Cosmetic or “Neurotransmitters” is an FDA-approved injectable solution that acts to relax muscles and reduce wrinkles. As we animate our faces, our muscles contract to form forehead creases; smile, scowl, and squint lines. Neurotransmitters works by disrupting signals between nerves and muscles so that the muscles aren’t able to “flex.” This causes less muscle movement and prevents creases and wrinkles from becoming etched into the skin. Although Neurotransmitters is best for wrinkles that are formed when animating the face, it can be used to soften some deeper lines that are present at rest. Multiple Neurotransmitters treatments can improve these wrinkles over time, but lines may not completely disappear.

Neurotransmitters applications

Most often Neurotransmitters is used to target horizontal forehead lines, squint lines (crow’s feet), and scowl lines (“angry 11s”). With specialized techniques, it can also be used to increase eyebrow arch, smooth “sniff” or “bunny” lines, raise a down-turned smile, correct a pebbly chin, elongate the face, minimize a masculine jaw, soften vertical neck bands (“grimace” bands), and control excessive sweating on the palms, soles, & under the arms.

Neurotransmitters takes 2-7 days to reduce muscle movement, and it typically lasts between 3-4 months. Muscle movement gradually returns as its effects wane. Repeat treatments every 3-4 months help soften lines most effectively.

At Hudson Dermatology and Laser Surgery, our goal is to maximize your comfort during treatment sessions. Because we use very fine needles, most patients experience minimal discomfort. Topical numbing cream and ice packs are available if desired. Temporary bruising and swelling are possible, but other side effects are rare. Before treatment, your dermatologist will thoroughly discuss the procedure and answer any questions you may have.

Jeuveau

What is Jeuveau?

Jeuveau is a new drug approved by the FDA in February 2019 for the temporary improvement in the appearance of moderate to severe glabellar lines called the “elevens” – short, vertical parallel lines or wrinkles between the eyebrows. Jeuveau is first new Neurotransmitters alternative in ten years. It is made with the same botulinum toxin Type A that is in Neurotransmitters.

 

The safety and effectiveness are similar to Neurotransmitters. Treatment takes about 3-5 days to take effect and lasts about 3-6 months, but duration varies depending on each individual’s metabolism. It is projected to cost about 25% less than Neurotransmitters, and due to a new manufacturing process, it may last longer than Neurotransmitters.

How does Jeuveau work?

Jeuveau blocks the nerve signals that cause muscles to contract, halting the muscle contractions that cause and deepen wrinkles, to smooth facial wrinkles. It is beneficial for dynamic wrinkles that gradually deepen with repeated facial expression.

Treatment with Jeuveau

Jeuveau is injected into the muscles in the forehead to improve the appearance of moderate to severe frown lines between the eyebrows. It works like Neurotransmitters, Dysport, and Zeominâ to block nerve signals to reduce muscle activity that causes deep grooves. It is also used at the corners of the eyes to temporarily halt muscle contractions that cause crow’s feet. It can be used for horizontal forehead lines, vertical lines between the eyebrows that make us look angry and tired, to soften crow’s feet, smooth the chin, lift the corners of the mouth and reduce the appearance of neck bands.

 

In addition to treating glabellar lines, our dermatologists have the skills and expertise to:

  • Create a mini brow lift using Jeuveau to elevate the brows and open the eyes.
  • Reduce the appearance of vertical neck bands
  • Reduce a gummy smile by weakening upper lip elevation for a more balanced smile
  • Lift the corners of the mouth to relax a frown and improve your smile.
  • Smooth chin dimpling
  • Reduce the appearance of vertical lip lines. 

Hudson Dermatology & Laser Surgery is located in Hudson Yards and near Hell’s Kitchen, easily accessible to New Yorkers. Dr. Bhanusali and Dr. Mian are leading dermatologists and researchers who are recognized healthcare innovators and the “go to” dermatologist for regular people and celebrities. Our dermatologists’ state-of-the-art, innovative and life-changing aesthetic services can transform your life. You will always receive first class treatment in a private professional environment.  Call us today to schedule a consultation to discover the hottest new product available to reduce the signs of aging, lift your spirits and treat sagging skin.

Juvederm

Youthful skin retains its tight, resilient, and flexible properties because of its water content. Aging, hormone changes, and sun exposure decrease the amount of hyaluronic acid in the skin, which results in collagen degradation, dryness, loss of elasticity and volume, and wrinkles.

What is hyaluronic acid?

Hyaluronic Acid (HA) is the main molecule associated with skin moisture, resilience and flexibility, and volume.  HA is a naturally occurring sugar found in the body and a key component of our soft tissues including the eyes, skin, connective tissues and joints. HA attracts and binds to water to provide volume, softness, smoothness and moisture to the skin which can fight the signs of aging. HA helps boost collagen production and hydrates the skin which reduces the appearance of wrinkles.

Because of their unique properties hyaluronic acid fillers are the most popular fillers in cosmetic dermatology for whole face restoration. HA fillers are an established treatment for correcting facial volume loss, lip augmentation, and smoothing of lines, folds and wrinkles with documented safety and efficacy.

What is Juvederm?

Juvederm is a collection of five different hyaluronic acid dermal fillers ideal for lifting, contouring, smoothing and plumping the skin. They work by attracting water to restore support structures like collagen and elastin, to reduce deep lines and wrinkles from the inside. All the Juvederm products contain lidocaine for your comfort during injection.

 

Juvederm Voluma is safe and effective to correct mild to severe facial volume loss in the mid-face, a common area that shows the signs of aging. Volume loss sharpens contours and hollows the cheek area. Voluma replenishes lost volume to the cheeks and recreates soft contours for significant rejuvenation. The enduring effects last up to 24 months after one or two treatments and imparts lifts and youthful restoration.

Juvederm XC and Juvederm Vollure XC

Juvederm XC smooths moderate and severe facial lines including lines and wrinkles around the mouth and nose. Its smooth consistency restores volume and hydration to improve skin elasticity. Vollure, a softer version of Voluma, is ideal to smooth fine lines and winkles. It lasts about 18 months.

Juvederm Volbella XC and Juvederm Ultra XC

Juvederm Ultra XC is an advanced dermal filler with a smooth consistency to improve the appearance of fine lines and wrinkles, and for lip augmentation. It will smooth away smile lines and wrinkles, restore contours and volume, and lasts up to a year.


Juvederm Volbella XC creates natural looking, fuller lips, restores lip symmetry and smooths vertical lip lines. It lasts about 12 months.


Juvederm products can restore symmetry, smooth nasolabial folds and marionette lines, augment the cheeks and lips, fill undereye hollows, enhance the jaw line, treat temple hollows and flaccid ear lobes.

Hudson Dermatology approach

When you are considering dermal fillers, contact Hudson Dermatology & Laser Surgery in Hudson Yards, NY to schedule a consultation. Our board-certified dermatologists are known to mix and match different fillers based on location, look, and feel.  No two people are the same and as such, no two procedures should be as well.

Kybella

A double chin or medically referred to as, submental fullness, is a common concern. Men view a strong jawline as a symbol of strength and masculinity. Women view a strong jawline as a symbol of youth and ideal weight. A double chin can create the appearance of being overweight or aged beyond one’s years. A significantly less invasive treatment than a facelift or necklift is an injectable called Kybella. Kybella can dramatically reduce the appearance of a double chin quickly and without surgery. Submental fat (a double chin) is fullness under the chin that is not caused by skin laxity (loose skin). Hormones, bone structure, and weight can all influence development or appearance of a double chin. No amount of dieting or chin exercises will get rid of a double chin. Until Kybella, the only available treatment for submental fatty deposits was invasive liposuction, fat excision, necklift, or facelift which all carry significant surgery and a long recovery.

What is Kybella?

Hyaluronic Acid (HA) is the main molecule associated with skin moisture, resilience and flexibility, and volume.  HA is a naturally occurring sugar found in the body and a key component of our soft tissues including the eyes, skin, connective tissues and joints. HA attracts and binds to water to provide volume, softness, smoothness and moisture to the skin which can fight the signs of aging. HA helps boost collagen production and hydrates the skin which reduces the appearance of wrinkles.

Because of their unique properties hyaluronic acid fillers are the most popular fillers in cosmetic dermatology for whole face restoration. HA fillers are an established treatment for correcting facial volume loss, lip augmentation, and smoothing of lines, folds and wrinkles with documented safety and efficacy.

Who is a good candidate?

The best candidates are younger and have pinchable, genetic submental fat, that is not weight related and good skin elasticity. The best way to know if you are a good candidate is to schedule a consultation with one of our dermatologists.

Your consultation

During your dermatologist will review your medical history, examine your skin, assess your submental fat and evaluate your skin elasticity. He may take before and after photos. Most people need 2-6 treatments for optimal results. Your dermatologist will recommend the number of treatments that will provide you with optimum results.

 

Kybella treatment is fully customizable to your needs. However, results are technique dependent which means you want an expert such as Dr. Bhanusali or Dr. Mian, who are trained in advance injection techniques, know face and neck anatomy and can sculpt the treated area to improve the contours of your jawline, and enhance your profile.

The procedure

Your face and neck will be cleaned, and a numbing gel applied. Your dermatologist will map out the injection sites and proceed to deliver the drug into the treatment area. Some patients feel a burning sensation which is calmed with an ice pack. After the procedure you may have a compression bandage around your head. Total treatment time is between 15 and 30 minutes.

Recovery

After the first treatment you will experience swelling and soreness that will improve within a few days to a week. Swelling indicates that the drug working to break down the fat cells. Swelling from subsequent treatments depends on the amount of fat that remains. There may be some temporary bruising and redness, and possibly some numbness, all of which will resolve within a few days.

 

Most patient see some noticeable improvement after the second treatment, but it takes time for the drug to kill the fat cells.  Tissue tightening requires several months.

 

At Hudson Dermatology & Laser in Hudson Yards, NYC you can count on personalized attention to your specific concerns and state of the art treatments to rejuvenate your appearance. Call us to schedule a consultation to discover the dramatic results achievable with Kybella.

Restylane

What is Restylane?

Restylane is a hyaluronic acid (HA) dermal filler that comes in various formulations for specific treatments. Thinner formulations are used to treat fine lines and wrinkles, and to plump the lips.

 

Thicker formulations are designed to restore volume lost due to age and to fill moderate to severe lines and wrinkles for a more youthful appearance. The Restylane family of fillers contains lidocaine to reduce injection discomfort.

Why hyaluronic acid fillers?

HA fillers are the most popular fillers because they are safe and versatile. They are used to temporarily volumize and contour soft tissues. HA fillers are ideal to rejuvenate the aging face. HA is a naturally occurring sugar compound that is essential to youthful skin. It attracts and binds to water to restore volume and provide a natural look and feel.

The Restylane family

  • Restylane corrects nasolabial folds, marionette lines, undereye hollows and frown lines. Adds natural volume as it integrates into the tissues and attracts water to volumize.
  • Restylane Lyft is suitable to correct moderate to severe lines and wrinkles and for cheek augmentation. Effects last 6-12 months.
  • Restylane Silk is valuable to correct lip lines and for lip augmentation
  • Refyne is specially formulated to treat mild to moderate marionette lines that run from the corners of the mouth to the chin.
  • Defyne is specially formulated to correct moderate to severe marionette lines.

Who is a good candidate?

During your consultation with one of our dermatologists, they will listen to and discuss your concerns and expectations with you. They will carefully review your medical history and evaluate your skin. Then they will make a recommendation as to which filler is best for you and explain the course of treatment, the expected results, the need for maintenance treatments and how long the effects can be expected to last. Our dermatologists often like to mix and match fillers for optimal appearance and satisfaction. No two people are the same and so, no two treatments are the same.

 

Injectable hyaluronic acid fillers are safe and effective for all skin types and colors.

The Procedure

Your skin will be cleaned and mapped to focus on your areas of concern. Your dermatologist will inject the filler and massage the areas to distribute the product, smooth any lumps and bumps and recontour the treated areas. Side effects from injection may include temporary tenderness, swelling, bruising, and redness that will resolve quickly. 

Why you want an expert injector

Part of the beauty of fillers is that they can be molded to create symmetry and sculpted to restore contours. While complications from are very rare, an expert must know anatomy to decrease risk of intravascular occlusion, and to provide you with the best your results are technique dependent. An experienced and skilled injector has an artistic eye and can sculpt and recontour the treated areas based on appreciation of facial harmony and bone structure.

 

Contact Hudson Dermatology & Laser Surgery to schedule a cosmetic dermatology consultation. A consultation with one of our dermatologists can help you find the best options for face and skin rejuvenation to restore your natural beauty. Dr. Bhanusali has served as a consultant with Galderma, Allergan, and other aesthetic brands where he’s called on for his scientific expertise.  Additionally, he is a cosmetic and reconstructive surgeon who offers minimally invasive techniques and advanced procedures to help you reclaim and enhance beauty at any age. Often a combination of fillers and minimally invasive procedures will provide the most optimal outcome.

Sculptra

Facial aging – The Benjamin Button Injection

Collagen is a natural protein and the key structural component of youthful, smooth and wrinkle-free skin. Elastin is also a protein that depends on collagen to keep the skin firm, plump and toned. With age collagen and elastin production naturally decline, and existing collagen and elastin degrades with sun exposure and environmental damage caused by pollution, smoking, and stress.

 

Beginning at about age 20, collagen and elastin degradation is faster than new collagen and elastin production. Starting at age 20 we lose approximately 1% of our collagen each year. The skin’s tone and texture change leading to fine lines and wrinkles. By age 50 there is about a 30% decrease in collagen and reduced elastin and hyaluronic acid (HA). HA keeps the skin hydrated. The result is a loss of fullness, hollowed out temples and cheeks, shallow and deep wrinkles and folds, and jowling.

What is Sculptra Aesthetic?

Sculptra Aesthetic is a filler that restores youthful fullness to reduce hollows and lose and deflated skin. It is made of micro particles of Poly-L-Lactic Acid (PLLC), a synthetic form of lactic acid that is biocompatible with your body.

How does Sculptra work?

Sculptra works by stimulating the body to synthesize new collagen and elastin to gradually restore structure and volume, skin firmness and plumpness for a more youthful appearance. Unlike hyaluronic acid fillers that provide temporary improvement in the appearance of lines and wrinkles, Sculptra is an anti-aging treatment that tackles volume loss and lost elasticity that underlie facial aging.

 

Sculptra provides immediate improvement in volume and reduces deep wrinkles. Within a week the skin begins to create the new collagen and after a series of 2-4 treatments full volumization is restored. Think of it as slowly reversing the signs of aging over months instead of any drastic change, a trick used often in Hollywood. Sculptra effects are retained for up to 25 months. Periodic maintenance injections can help to retain the desired results.

 

Sculptra results look so natural because they come from the body’s natural collagen production. Minimal side effects include bruising, pain at injection sites, and swelling and redness, which typically resolve within a few days to a week after injections.

Sculptra applications

  • For facial rejuvenation restoring volume, tightening and lifting the skin, and smoothing lines and creases.
  • Elevate the jowls with added volume in the cheek area.
  • Fill and volumizes temple hollows.
  • Tighten and restore the jawline for a cleaner profile.
  • Enhance skin tone and texture to improve the appearance of décolleté.
  • De-age the hands softening the appearance of bulging tendons and veins.
  • Restore youthful balance and facial symmetry.

Our dermatologists have an artist’s eye and can visualize how to help you achieve your appearance goals. They can use it for scar revisions, reverse aging, or dilute it for superficial collagen stimulation.  Contact Hudson Dermatology & Laser Surgery in Hudson Yards, NY to schedule a consultation.

Vein Treatment

What are spider veins (telangiectasias)?

Spider veins are dilated small blood vessels that are just below the surface of the skin. Visible spider veins are frequently found on the cheeks, nose, chin and legs. They appear as thin red lines or web-like patterns of blood vessels. Facial spider veins are common with age, due to broken vessels but some medical conditions such as Rosacea cause visible facial veins. They are usually harmless but are unattractive. When spider veins appear on the ankles it may be an indication of a more serious health problem.

What are Varicose veins?

Varicose veins are enlarged blood vessels that are causes by damaged veins with weak vein walls. Varicose veins may be an indication of or create a risk for a more serious condition, such as a blood clot in the veins or phlebitis. Veins have valves that are designed to prevent blood in the legs from flowing backward and pooling in the veins. Varicose veins develop when the valves in the veins are damaged, and the blood that was to circulate back to the heart instead pools in the leg veins (venous reflux).

 

Most varicose veins cause no symptom and do not require treatment. However, if you have symptoms such as discomfort, leg ulcers, swelling and discoloration, treatment will be recommended. When your main concern is cosmetic, treatment will remove the offending veins.

What causes visible veins?

There are multiple causes of visible veins:

  • Age
  • Sun damage
  • Heredity
  • Unbalance of hormones due to pregnancy, birth control pills and hormone replacement

Vein treatments

Sclerotherapy is the gold standard treatment to eliminate spider veins and varicose veins. Using a very fine needle, sclerotherapy involves the injection of a prescription medication into the offending vein which causes the vein walls to collapse and seal off the abnormal vein. The treated vein disappears over the course of a few weeks. Some veins may require more than one treatment. Sclerotherapy is an office procedure performed under local anesthetic. Activities may be limited for several days after treatment.

Laser vein treatments use advanced laser technology (laser and intense pulsed light (IPL)) to destroy visible blood vessels. The heat from the laser or IPL targets the blood vessels, seals the abnormal vessels and does not damage the skin.

Laser treatment is a preferred treatment for facial veins because it requires no incisions and doesn’t injure healthy skin. The laser targets the red color and eliminates the vein without bruising. The body reabsorbs the unwanted blood vessels during healing. There is no downtime and normal activities can be resumed almost immediately.

RFA is a minimally invasive outpatient treatment. Under ultrasound guidance, radiofrequency energy is used to seal off the disease varicose vein with only minimal damage to the surrounding tissues.  Treatment removes the veins and their symptoms. There is no need for sutures and there are no scars. It can be performed under local anesthetic. This procedure may be covered insurance.

The procedure involves the insertion of a small catheter into the diseased vein. The laser emits head which seals the vein shut. With time, the vein shrinks and disappears. After treatment some patients experience tenderness and bruising which can be treated with over the counter pain medications and should resolve within a week.  RFA has been proven 99% effective for large varicose veins. For smaller dilated veins in the legs, sclerotherapy may be the best option.

These procedures have been replaced by laser or radiofrequency ablation.

This procedure removes the abnormal vein through small slits in the skin. It is reserved for large various veins close to the skin. It is performed using local anesthesia.  After treatment, there will be temporary bruising and swelling which will respond to over the counter pain medications. The patient will wear compression stockings for a week.

Contact Hudson Dermatology & Laser Surgery for more information about vein treatments. Our dermatologists are board-certified experts who provide medical and cosmetic dermatological services.