Cosmetic Dermatology in San Diego County (Located in Chula Vista and Coronado)

1. Topical Treatments:

• Retinoids (Tretinoin, Retinol): These Vitamin A derivatives promote skin cell turnover, helping to fade pigmentation and improve skin texture. Over time, they can help smooth out surface irregularities and reduce the appearance of scars, particularly for mild acne scars.
• Hydroquinone: Often used for pigmentation issues, hydroquinone lightens dark spots left behind by acne scars (post-inflammatory hyperpigmentation). This treatment is especially helpful for red or brown spots, but it may take several weeks to see noticeable improvement.
• Alpha Hydroxy Acids (AHAs) & Beta Hydroxy Acids (BHAs): These exfoliating acids help remove dead skin cells, allowing new, healthier skin to emerge. They can also reduce the appearance of shallow scars, improve texture, and even out skin tone. AHAs are generally better for dry or sun-damaged skin, while BHAs (such as salicylic acid) are ideal for oily or acne-prone skin.

2.  In-Office Treatments performed by Board Certified Dermatologists:

• Chemical Peels: A chemical solution is applied to exfoliate the outer layer of skin, which encourages the shedding of damaged skin cells and helps reduce pigmentation. For deeper scars, a stronger chemical peel (like a TCA peel) may be recommended to stimulate collagen production and promote healing.
• Microneedling (Collagen Induction Therapy): In this procedure, tiny needles are used to create controlled micro-injuries in the skin, stimulating collagen and elastin production. This helps to improve the texture and appearance of scars, especially rolling scars or shallow pitted acne scars. Microneedling is often combined with serums to enhance its effectiveness.
• Laser Treatments:
  • Fractional CO2 Laser: This laser resurfacing treatment targets both the surface and deeper layers of the skin, stimulating collagen and improving skin texture. It’s particularly effective for deep acne scars, such as ice-pick scars or boxcar scars.
  • Erbium Laser: A gentler alternative to CO2 laser, the erbium laser is ideal for more superficial acne scars, working to resurface the skin and promote collagen formation with less downtime.
  • Pulsed Dye Laser (PDL): Effective for treating redness and hyperpigmentation caused by acne scars, PDL targets blood vessels under the skin, helping to reduce the appearance of redness, while promoting skin healing.
• Dermal Fillers: Injectable fillers, like hyaluronic acid or poly-L-lactic acid, can be used to fill in deep acne scars, particularly rolling or boxcar scars. These fillers provide an immediate smoothing effect, though results may last from several months to a year, depending on the type of filler used.
• Subcision: For deeper scars, subcision involves using a needle to break up the fibrous bands beneath the skin that tether the scar to deeper tissue. This releases the scar and allows the skin to lift, improving its appearance.   Unique to our office, is that we perform subcision with a blunt canula and we use tumescent anesthesia for a more comfortable and safe experience.

3. Minimal Recovery Acne Scar Treatments:

• Platelet-Rich Plasma (PRP) Therapy (Vampire Facial): In PRP therapy, a small amount of your own blood is drawn, processed to concentrate platelets, and then applied or injected into the skin. The growth factors in the platelets stimulate collagen production, helping to improve the texture of acne scars and promote overall skin healing.
• Punch Excision or Punch Grafting: For very deep acne scars, such as ice-pick scars, punch excision is a surgical procedure where the scar tissue is excised, and the area is sutured closed. Punch grafting is similar but involves taking a small piece of skin (usually from behind the ear) to graft into the scar site, which can help smooth out the area.
• Radiofrequency (RF) Microneedling: This advanced treatment combines traditional microneedling with radiofrequency energy, which helps deliver heat to the deeper layers of the skin. The heat stimulates collagen production, and the microneedles create micro-channels for enhanced skin regeneration. It’s effective for treating both superficial and deeper acne scars.  We use the Morpheus8 and we only use superficial settings of 1-2 mm depth to avoid removal of fat.  This is very good for darker skin of color with acne scars in patients with limited down time.  Multiple sessions are needed.

Conclusion:

Texture Improvement for Smooth Glowing Skin

1. Medical Grade and Prescription Topical Treatments Sold in Our Office:

• Retinoids (Retinol, Tretinoin): Retinoids are some of the most powerful tools for improving skin texture. They speed up cell turnover, which encourages the growth of fresh, smooth skin and helps reduce the appearance of fine lines, acne scars, and enlarged pores. It’s often recommended to start with a lower concentration to minimize irritation, then gradually increase as your skin adapts.
• Exfoliating Acids (AHAs and BHAs): Alpha Hydroxy Acids (like glycolic acid) and Beta Hydroxy Acids (like salicylic acid) exfoliate the skin by breaking down the bonds that hold dead skin cells together, helping to reveal fresher, smoother skin underneath. AHAs are generally great for dry or sun-damaged skin, while BHAs penetrate pores more deeply, making them ideal for oily or acne-prone skin.
• Vitamin C: This powerful antioxidant not only brightens the skin but can also help improve overall skin texture by promoting collagen production. Regular use of Vitamin C can help fade dark spots and contribute to smoother, more radiant skin.  Effective vitamin C must be higher concentrations (not sold over the counter), the correct pH, and of newer technology so that it does irritate the skin or cause acne breakouts.
• Niacinamide: Niacinamide, or Vitamin B3, is excellent for improving skin’s elasticity, reducing fine lines, and smoothing out rough patches. It’s also beneficial for calming inflammation, which can be helpful for sensitive or acne-prone skin.  This is found in over 20 of our in office topical treatments.

2. In-Office Treatments:

• Chemical Peels: Chemical peels involve applying a solution to exfoliate the skin’s surface, promoting the shedding of dead skin cells and revealing a fresher, smoother complexion. The depth of the peel varies, with light peels targeting superficial issues like rough texture, and deeper peels addressing more stubborn concerns like acne scars and sun damage.
• Microneedling (Collagen Induction Therapy): Microneedling involves using tiny needles to create controlled micro-injuries in the skin. This stimulates the skin’s natural healing process and collagen production, improving texture, firmness, and tone. It’s particularly effective for reducing the appearance of scars and fine lines.
• Laser Resurfacing (Fractional CO2, Erbium, Clear & Brilliant Permea): Laser resurfacing uses focused laser energy to remove damaged skin layers and stimulate collagen production. This treatment can improve texture by smoothing out uneven surfaces, reducing the appearance of scars, and tightening the skin. It’s particularly effective for deep wrinkles, acne scars, and sun damage.
• Intense Pulsed Light (IPL): IPL therapy uses broad-spectrum light to target skin discoloration, sun spots, and redness. While it’s not directly focused on texture, IPL can improve overall skin tone and appearance, indirectly contributing to smoother-looking skin.

3. Skin Tightening and Firming Treatments:

• Sofwave is a non-invasive treatment that uses ultrasound energy to stimulate collagen production deep within the skin. Over time, this can improve skin’s elasticity and smooth out rough texture by tightening and lifting the skin.
• Radiofrequency (RF) Therapy: RF therapy uses heat to stimulate collagen and elastin production, improving the overall texture and tone of the skin. It’s often used to treat sagging skin and fine lines and can complement other treatments for a more youthful appearance.

4. Microneedling with Radiofrequency (RF Microneedling):

5. Platelet-Rich Plasma (PRP) Therapy (Vampire Facial):

6. Heavy Eyelid Correction

Upper Blepharoplasty
As we age, the delicate skin around our eyes often shows the earliest signs of aging. Drooping eyelids, excess skin, and puffiness can make us appear older and more fatigued than we feel. At The Dermatology Institute, we specialize in upper eyelid surgery (also known as upper blepharoplasty) to help you achieve a naturally youthful and refreshed appearance. Our highly skilled surgeon Dr.Peter Rullan is renowned for his ability to deliver beautiful, long-lasting results. He has been performing this surgery for over 30 years and he has a unique technique that also adds a deep chemical peel over the surgical site to cause the skin to also tighten and appear more youthful in those who would benefit from. Call us at 619-426-9600 to request a free consultation.

Conclusion:

WHEN TO CONSIDER UPPER EYELID SURGERY?
The eyes are often the focal point of the face and one of the first areas to show signs of aging. At Wave Plastic Surgery, our patients often experience comments about them looking tired or irritable. Upper eyelid surgery may be a good fit if this sounds like you. This cosmetic procedure is ideal for those who want to rejuvenate their appearance or address functional issues caused by drooping eyelids. Here are some key reasons people may consider an upper eyelid procedure:
Sagging Eyelids Aging can cause excess skin to droop over the eyelids, creating a hooded appearance. This can make you look older and tired, even if you feel energetic.
Puffiness Fat deposits in the upper eyelids can cause puffiness, giving a heavy or tired appearance. Upper eyelid surgery can remove or reposition this fat for a smoother look.
Impaired Vision Sometimes, sagging eyelids obstruct your vision, making everyday tasks like reading or driving more difficult. Surgery can improve both appearance and functionality.
Tired Facial Expression Drooping eyelids can give off a tired or even angry look, despite how you feel. Surgery helps refresh your appearance, making you look more alert and approachable.

RECOVERY AND RESULTS
Recovery after upper eyelid surgery is typically smooth, but following your surgeon’s specific aftercare instructions is important to ensure the best outcome. Since this is an outpatient procedure, you’ll be able to return home the same day, although you’ll need someone to drive you as the anesthesia and sedation wear off. A successful recovery depends on the procedure itself and how well you care for your eyes in the days and weeks that follow.

• First Few Days: In the initial days following surgery, it’s normal to experience mild discomfort, swelling, and bruising around the eyes. These side effects are temporary and can be managed with cold compresses, keeping your head elevated, and prescribed pain medications. Some patients may also experience sensitivity to light or slight dryness in the eyes, which can be relieved with lubricating eye drops.
• First Week: Most patients can resume daily activities and return to work within 10 days post-surgery. However, avoiding strenuous activities, including heavy lifting and vigorous exercise, is recommended for at least two weeks to allow your eyelids ample time to heal without putting unnecessary strain on them. You may also need to avoid wearing contact lenses during this time to prevent irritation.
• Final Results: While the initial swelling and bruising will subside within a few weeks, it can take several months for the final results to settle fully. As your eyelids continue to heal, the improvements in the appearance of your eyes will become more pronounced. Your eyes will look brighter, youthful, and alert, with the excess skin and puffiness significantly reduced or eliminated 2-4 weeks after surgery. Results very from person to person and you will always need to consult with your doctor.

BLEPHAROPEEL
The blepharopeel is also known as a micropunch blepharopeel. It consists of a deep chemical peel of the upper eyelids to tighten the skin. Then, superimposed on this immediately peeled skin, small tiny pieces of skin are removed and then left open to heal. This leads to skin contraction or tightening without scarring. It is a fast procedure that does not require anesthesia. The skin takes 2 weeks to heal. The eyes are swollen for up to 5 days. Dr. Peter Rullan and Dr. Jennifer Rullan are experts in this procedure and train other board certified dermatologists this procedure in live workshops and international conferences.

When to perform blepharopeel or a blepharoplasty?

Micropunch blepharopeeling versus blepharoplasty; what is the best procedure for upper eyelid rejuvenation?
Introduction: Periocular rejuvenation is the most common aesthetic plastic surgery. The aim of this study was to determine effects of micropunch blepharopeeling (MBP) approach vs blepharoplasty (BP) in periocular rejuvenation.
Methods and materials: This is a clinical trial study on 22 patients who underwent periorbital rejuvenation referred to University Skin Clinics. Patients were randomly divided into two groups of blepharoplasty or micropunch blepharopeeling. After procedure, all patients were followed in 2 weeks and 2 months and were asked about complications. Patients’ satisfaction was scored based on 5-grade scale. Physician satisfaction was assessed based on patients’ photographs taken before and 2 months after surgery based on 4-grade scale.
Results: The mean age of group MBP was 48.45 ± 7.71 and group BP was 45.45 ± 7.20 (P-value = .36) and Fitzpatrick skin type was not significantly different. Scar was significantly different between groups that 4 (36.4%) patients of BP complained from scars, while none of MBP had significant scar (P-value = .04). Patients were statistically more satisfied with MBP in terms of symmetry, pain, and scar (P-value = .048, .040, and<.001, respectively). Also, MBP was significantly more satisfying for physicians in terms of symmetry and scar (P-value = .047 and <.001, respectively).

Conclusion:

Micropunch blepharopeeling can be considered as an acceptable procedure of upper eyelid rejuvenation mentioned by patients and physicians. Micropunch blepharopeeling causes fewer scars, better symmetry, and less pain.

Neurotoxin for Eyebrow Lifting
By injecting botulinum toxin into the lateral part of the orbicularis oculi muscle, the brow can be raised and arched. As a result, the brow can appear more lifted; the eyes may appear more open. This is because you’re relaxing the orbicularis oculi which are responsible for pulling the eyebrows downward.There are also other techniques where we stimulate the forehead to lift more.

The brow lift takes up to 2 weeks to take effect and lasts on average 3 months. This is a very affordable and non-surgical option for those who are beginning to notice the eyebrow is lower or heavier or some hooding of eyelids.

7. JAWLINE CONTOURING

Jawline contouring treatments can be either non-surgical or surgical, depending on the desired results and level of invasiveness. Here are some common options:

Non-Surgical Options

• Dermal Fillers – Hyaluronic acid or calcium-based fillers add volume and definition to and sculpt the jawline.
• Botox (Masseter Reduction) – Botox injections relax the masseter muscles to slim the lower face and create a more contoured appearance.
• Kybella (Deoxycholic Acid) – An injectable treatment that dissolves excess fat under the chin for a more defined jawline.
• Radiofrequency (RF) & Ultrasound Therapy – Technologies like Sofwave (newest on the market) or Morpheus 8 microneedling radiofrequency tighten skin by stimulating collagen production and can also be used at deeper settings to dissolve fat under the chin and in the jowls.
• Thread Lift – Dissolvable threads lift sagging skin along the jawline for a subtle, non-surgical lift. We use Mint PDO threads and charge per thread making each treatment customizable. We prefer less and add more at a different time as needed. These only last a year or less, however, the material of the suture does begin a process of collagen stimulation.
• Liposuction – Removes excess fat from the chin and jawline to enhance contour. It is performed under tumescent anesthesia in our office by Dr. Peter Rullan.

8. Hair Growth Options

Medical Treatments

A board-certified dermatologist can diagnose the underlying cause of hair loss and tailor a treatment plan accordingly. Common medical treatments include:

• Topical Minoxidil (Rogaine) – FDA-approved for androgenetic alopecia; increases blood flow and prolongs the hair growth phase.
• Oral Finasteride (Propecia) – Blocks DHT, the hormone responsible for hair follicle shrinkage in male pattern baldness.
• Oral Dutasteride – A stronger DHT-blocker than finasteride, sometimes used off-label for hair loss.
• Spironolactone – A hormonal treatment for female pattern hair loss that reduces androgens.
• Low-Level Laser Therapy (LLLT) – FDA-cleared devices that stimulate hair follicles to promote regrowth.
• PRP/PRF Therapy – Uses growth factors from the patient’s blood to enhance hair follicle health and regeneration.
• Steroid Injections – Used for autoimmune hair loss conditions like alopecia areata to reduce inflammation.
• Oral Immunosuppressants – For severe autoimmune-related hair loss, such as JAK inhibitors for alopecia areata.

Why You Should See a Board-Certified Dermatologist

• Accurate Diagnosis: Hair loss can be caused by genetics, hormones, autoimmune conditions, nutritional deficiencies, or underlying diseases. A dermatologist can pinpoint the exact cause.
• Personalized Treatment: Over-the-counter solutions may not work for all types of hair loss. A dermatologist can create a customized plan.
• Advanced Therapies: Dermatologists have access to prescription medications, in-office procedures, and clinical trials.
• Prevent Progression: Early intervention can stop hair loss before it becomes severe and difficult to reverse.

PRF vs. PRP for Hair Growth

Both Platelet-Rich Plasma (PRP) and Platelet-Rich Fibrin (PRF) are autologous blood-derived treatments used to promote hair growth by stimulating hair follicles, improving blood supply, and increasing cell regeneration. However, they differ in their preparation, composition, and potential effectiveness.

• Platelet-Rich Plasma (PRP)
• Preparation: Blood is drawn, centrifuged at high speeds to separate plasma from red blood cells, and then injected into the scalp.
• Key Components: Contains platelets, growth factors (PDGF, VEGF, TGF-β), and plasma, but minimal white blood cells and fibrin.
• Effectiveness: Studies suggest PRP can increase hair count and thickness by prolonging the growth (anagen) phase of hair follicles.
• Drawbacks: Shorter activation period, requiring multiple sessions (usually 3-6) for optimal results.
• Platelet-Rich Fibrin (PRF)
• Preparation: Uses a slower centrifugation process without anticoagulants, preserving more platelets, white blood cells, and fibrin.
• Key Components: Higher concentration of growth factors, white blood cells, and a fibrin matrix, which acts as a natural scaffold for sustained release.
• Effectiveness: Thought to offer longer-lasting growth factor release compared to PRP, potentially leading to better hair regrowth results.
• Drawbacks: PRF is newer than PRP, and research is still evolving to determine its superiority.
• Scientific Support for PRP and PRF in Hair Growth

PRP Studies:

• A 2019 meta-analysis (Garg & Manchanda) found PRP significantly increased hair density and thickness in androgenetic alopecia (AGA) patients.
• A 2022 systematic review in Dermatologic Surgery concluded PRP is a promising treatment, though protocols vary.
• PRF Studies:
• Emerging research suggests PRF might provide longer-lasting growth factor release than PRP, improving follicular survival.
• A 2023 study in the Journal of Cosmetic Dermatology found PRF led to sustained hair regrowth over six months compared to PRP.
• Which Is Better?
• PRF may have an advantage due to sustained growth factor release and lack of anticoagulants.
• PRP has more established research and is widely available.