# Paz Dermatology > Paz Dermatology is a dermatology practice in Fresno and Visalia, California, led by Harvard-trained, board-certified dermatologist and Mohs surgeon Dr. Carlos Paz, MD, PhD. It offers medical, surgical and cosmetic skin care for the whole family, from skin cancer screening and Mohs surgery to injectables, lasers and facials. - **Website:** https://www.pazderm.com/ - **Last updated:** 2026-10-16 - **Publisher:** Paz Dermatology - **Sitemap:** https://www.pazderm.com/wp-sitemap.xml - **Index version:** https://www.pazderm.com/llms.txt ## Key Information ### Contact Us ### Request an Appointment ## What happens next 1. We call you Our team reaches out to schedule at the office you chose. 2. Get ready Fill out your patient forms, or cosmetic forms for a cosmetic visit, and bring your insurance card and a photo ID. 3. Your visit Medical visits are billed to your insurance. Cosmetic consultations are complimentary. ## Have an HMO plan? HMO plans need a referral from your primary care provider before your visit. See [Insurance & Payment](/insurances-accepted/) for the plans we accept. ## Locations ### Fresno ## Care at our Fresno office ### Medical Dermatology Acne, eczema, psoriasis, rosacea, rashes, hair loss and more, for babies through grandparents. ### Surgical Dermatology Skin cancer screening, biopsies, excision and Mohs surgery, with Mohs layers checked the same day in our own lab. ### Cosmetic Injectables, lasers, facials and peels, cosmetic surgery and medical-grade skin care. Liz is the cosmetic consultant at this office. ## Your providers in Fresno Dr. Carlos Paz performs Mohs surgery and cosmetic surgery, and Melissa Manriques, FNP-C, and Gabriel Zapata, PA-C, see patients for general and cosmetic dermatology. Meet them on [Our Providers](/providers/). ## Se habla español Spanish-speaking staff are here to help. Call (559) 233-3376 and ask for someone who speaks Spanish, or visit our page in [Español](/es/). ### Visalia ## Care at our Visalia office ### Medical Dermatology Acne, eczema, psoriasis, rosacea, rashes, hair loss and more, for babies through grandparents. ### Surgical Dermatology Skin cancer screening, biopsies, excision and Mohs surgery, with Mohs layers checked the same day in our own lab. ### Cosmetic Injectables, lasers, facials and peels, cosmetic surgery and medical-grade skin care. Sonia and Lorena are the cosmetic consultants at this office. ## Your providers in Visalia Dr. Carlos Paz performs Mohs surgery here. Clarissa Alvarado, FNP-C, and Amal Muthana, FNP-C, see patients for medical and cosmetic dermatology, and Joanne Gloria, PA-C, for medical and surgical dermatology. Meet them on [Our Providers](/providers/). ![Paz Derma Spa](https://www.pazderm.com/wp-content/uploads/2026/09/pazderma-spa.png) ## Paz Derma Spa, a SkinCeuticals Flagship The cosmetic side of our Visalia office is the Paz Derma Spa, and it's a SkinCeuticals Flagship. That gives our team advanced training and expert education from SkinCeuticals, and access to some of its best products, so your treatments here and your routine at home work toward the same skin goals. See the full range of [medical-grade skin care](/skincare-products/) we carry, or book a [complimentary cosmetic consultation](/cosmetic/consultation/). ## Se habla español Spanish-speaking staff are here to help. Call (559) 385-2133 and ask for someone who speaks Spanish, or visit our page in [Español](/es/). ## Concerns ### Acne ## More common than you think, and very treatable Acne is the most common skin condition in the United States, affecting up to 50 million Americans a year. [1] About 85% of people between 12 and 24 have at least minor acne, [1] and plenty of adults get it too, some for the first time in adulthood. [2] It develops when pores become clogged. [2] Oil, dead skin cells and bacteria build up in the pore, and the result can be anything from a few blackheads to deep, painful cysts. ### Signs of acne - Blackheads and whiteheads - Red, tender pimples - Pus-filled bumps - Deep, painful cysts or nodules - Dark marks or scars left behind - 50 million Americans affected by acne each year, the most common skin condition in the country. [1] ## Why breakouts happen 1. Oil During puberty, hormones called androgens enlarge the skin's oil glands, which make more oil that can clog pores. [2] 2. Family history Your risk is higher if a parent or close relative had severe acne. [2] 3. Things that make it worse Too little sleep, certain foods and oily makeup or skin care can worsen acne. [2] Stress doesn't cause acne, but it can make existing acne worse. [2] 4. Smoking In women, research links more smoking with more severe acne. [2] - 6 to 8 weeks How long most acne treatment takes before you see fewer breakouts. [3] ## How we treat acne The goals are to clear the acne you have, stop new breakouts and prevent scars. [3] Most plans combine two kinds of care. Medical careProfessional skin treatmentsPrescription creams and gels you apply to your skin [3]VI Peel Purify, made for active and hormonal acneMedicine you take by mouth, when appropriate [3]The Acne HydraFacial for congested, breakout-prone skinSkin care recommendations for your skin typeSkinCeuticals peels and DiamondGlow for oil and textureFollow-up visits to adjust your planIPL for redness and marks Your prescription care is part of [medical dermatology](/medical-dermatology/). The skin treatments are cosmetic, and your plan can include both. ## Where acne shows up AreaWhat you might seeFaceBlackheads, whiteheads and pimples, especially on the forehead, nose and chinJawline and chinDeeper, tender bumps, common in adult womenChestRed bumps and pimplesBack and shouldersBreakouts that can leave dark marks ## Real results from patients - Clear skin With a dermatologist's help, virtually everyone can see clearer skin. [3] The Paz difference ## Prescription care and skin treatments under one roof Acne rarely clears with one product. Here, prescription treatment and professional skin care happen in the same practice, so your plan can combine a medicine that works from the inside with a peel or facial that clears pores and fades marks. And because treating acne early helps prevent scars, [3] we'd rather see you sooner than later. If [acne scars](/concerns/acne-scars/) have already formed, there are good treatments for those, too. ## When to see us ### Book an appointment if: - Store-bought products haven't helped after a couple of months - You have deep, painful bumps or cysts - Breakouts are leaving dark marks or scars - Acne is affecting how you feel about yourself - You started getting acne as an adult What looks like acne is sometimes a different condition, [3] which is another good reason to have it checked. ## Everyday habits that help - Wash your face gently, twice a day and after sweating - Choose makeup and skin care labeled non-comedogenic or oil-free [2] - Don't pick or squeeze pimples, which can cause scars - Get enough sleep [2] - Give each treatment 6 to 8 weeks before judging it [3] - If you smoke, stop [2] ## Services we offer Along with prescription care, these skin treatments help clear acne. Pick one to see how it works. ## What treatment costs Prescription acne care is medical care, and it's handled differently from the cosmetic treatments on this site. Our office walks you through what applies to you when you book. For peels and facials, your cosmetic consultation is free. How commonUp to 50 million Americans a year [1]CauseClogged pores [2]Who gets itTeens and adults [1] [2]ResultsUsually 6 to 8 weeks after starting treatment [3]WhereOur Fresno and Visalia offices ## Acne questions, answered **Q: How long until my skin clears?** It takes at least 6 to 8 weeks to see fewer breakouts. [3] Sticking with your plan is what gets results. **Q: Can adults get acne?** Yes. Some women get acne for the first time as adults. [2] **Q: Does stress cause acne?** No, but it can make acne you already have worse. [2] **Q: Do facials and peels help acne?** They can clear pores and reduce oil, and work best alongside medical care when acne is more than mild. **Q: Will my acne leave scars?** Treating acne early helps prevent scars. [3] If scars have formed, lasers and peels can make them less noticeable. **Q: Do I need a prescription?** Not always. Mild acne can respond to good skin care and professional treatments, while more stubborn acne usually needs prescription care. Your visit sorts out which you need. ## References [Skin conditions by the numbers](https://www.aad.org/media/stats-numbers) [What causes acne](https://www.aad.org/public/diseases/acne/causes/acne-causes) [Acne: Diagnosis and treatment](https://www.aad.org/public/diseases/acne/derm-treat/treat) Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Acne treatment is chosen for each person, and results vary. Some acne medicines have side effects and aren't safe during pregnancy; your provider reviews these with you. Individual results may vary. ### Acne Scars ## When acne leaves a mark As a breakout heals, your skin makes collagen to repair it. If it makes too little, a depressed scar forms; too much, and the scar is raised. [1] Most acne scars are depressed, and they come in three shapes. Knowing which you have helps choose the right treatment. ### Types of depressed scars - Ice pick: small but deep, the most common type [1] - Boxcar: round or oval dents, wider than ice pick scars [1] - Rolling: wide and shallow; many together make skin look wavy [1] - 3 types Ice pick, boxcar and rolling: the shapes depressed acne scars take. [1] ## Why some acne leaves scars 1. Deep breakouts The deeper acne goes into your skin, the more likely it is to cause a scar. [2] 2. Picking and squeezing Popping or picking at acne increases inflammation and the chance of scarring. [2] 3. Your genes If a close relative gets acne scars, your skin may be more likely to scar too. [2] - Fair to brown The range of skin tones PicoWay Resolve is FDA-cleared to treat for acne scars, from fair through brown. [3] ## Is it a scar, or a mark that will fade? Not every spot acne leaves behind is a scar. Flat dark or light marks usually fade on their own, while true scars need treatment. What you seeWhat it isWhat helpsFlat brown or gray-blue spotsDark marks, not scars; they usually fade over time [1]Peels and lasers can speed the fadingFlat red or pink marksMarks from healing breakoutsIPL can calm the rednessPits and dentsDepressed scars [1]PicoWay Resolve, VI PeelFirm, raised bumpsRaised scars, more common in darker skin [1]A visit to plan the right treatment Your [free consultation](/cosmetic/consultation/) looks closely at your skin and tells you which is which. ## Where acne scars show up AreaWhat you might seeCheeksRolling and boxcar scarsTemples and foreheadIce pick scarsJawlineScars from deeper, cystic breakoutsChest and backRaised scars and dark marks ## Real results from patients - New collagen Laser resurfacing and chemical peels help skin make collagen and elastin, which softens scars. [4] The Paz difference ## Clear the acne first, then smooth the scars Scar treatment works best on skin that isn't still breaking out, so the plan usually begins by getting [acne](/concerns/acne/) under control. [4] Because this is a dermatology practice, acne care and scar treatment happen in the same place, one plan from start to finish. Providers also use [Radiesse](/treatments/radiesse/) for scars that leave a dip in the skin. Ask at your consultation whether it suits you. ## When to talk to us ### It's a good time if: - Pits or dents from old breakouts bother you - Dark marks haven't faded after several months - You're still breaking out and want to prevent new scars - Your skin looks uneven or wavy in certain light Tell us about any acne treatments you've used in the last two years. [4] ## Preventing new scars - Treat breakouts early, before they go deep [2] - Apply acne medicine to a breakout instead of picking or squeezing it [2] - Wear sunscreen every day, which helps dark marks fade - Keep up with your acne plan between scar treatments ## Services we offer Each of these treats acne scars or the marks acne leaves. Pick one to see how it works. ## What treatment costs Cost depends on the treatment and how many sessions you need. Your consultation is free, and you'll know your plan and its cost before anything happens. TypesDepressed (ice pick, boxcar, rolling) and raised [1]CauseToo little or too much collagen as skin heals [1]TreatmentsPicoWay Resolve, VI Peel, IPLFirst stepClear active acne [4]WhereOur Fresno and Visalia offices ## Acne scar questions, answered **Q: Will my acne scars fade on their own?** Depressed scars and keloids won't fade on their own, but flat dark marks usually do. [1] Treatment can help both. **Q: What's the best treatment for acne scars?** It depends on the type of scar and your skin. Lasers and peels both help your skin rebuild collagen. [4] **Q: Can you treat acne scars on darker skin?** Yes. PicoWay Resolve is FDA-cleared for acne scars in fair through brown skin. [3] Your settings are chosen for your skin tone. **Q: How many treatments will I need?** Most people need a series. Your plan depends on how deep and how many scars you have. **Q: Should I treat my acne first?** Usually, yes. Stopping breakouts reduces inflammation and prevents new scars. [4] **Q: Are the dark spots scars?** Flat brown or gray-blue spots after acne are usually not scars, and they tend to fade over time. [1] ## References [Acne scars: Signs and symptoms](https://www.aad.org/public/diseases/acne/derm-treat/scars/symptoms) [Acne scars: Causes](https://www.aad.org/public/diseases/acne/derm-treat/scars/causes) [510(k) Premarket Notification K220853: PicoWay Laser System](https://www.accessdata.fda.gov/cdrh_docs/pdf22/K220853.pdf) [Acne scars: Consultation and treatment](https://www.aad.org/public/diseases/acne/derm-treat/scars/treatment) Content on this page is for educational purposes and is not a substitute for professional medical advice. Acne scar treatment is chosen for each person, and results vary; most scars soften rather than disappear completely. Each treatment has its own side effects and risks, explained on its page and at your consultation. Individual results may vary. ### Actinic Keratosis (Precancerous Lesions) ## A precancer you can often feel before you see An actinic keratosis, or AK, is a precancerous spot of skin damaged by years of sun or tanning. [1] It's one of the most common things dermatologists treat, with more than 40 million Americans developing them each year. [1] The reason to take one seriously is what it can become. Left untreated, some AKs turn into [squamous cell carcinoma](/concerns/squamous-cell-carcinoma/), a common skin cancer. [2] Treating the AK takes that possibility off the table, which is about as good a deal as skin care offers. ### Why it's worth a visit - A rough spot that won't go away is easy to check - Some AKs can turn into skin cancer if left alone [2] - Having one is a sign of sun damage worth keeping an eye on [2] - 40 million Americans who develop actinic keratoses each year. [1] If you've spent time in the sun, you're in good company. ## Where AKs come from 1. Years of sun AKs are caused by ultraviolet light from the sun and from tanning beds. [1] The damage builds over years, which is why AKs usually show up later in life. 2. Sunny places and outdoor days People who spend a lot of time outdoors, or who live where the sun is strong most of the year, are more likely to get them. In the Central Valley, that's a lot of us. 3. Your skin Fair skin that burns easily is the most prone. Once you've had one AK, you're more likely to get another, which is why regular checks help. - Sandpaper How many people describe an AK. You can often feel one before you can see it. [2] ## How to recognize an AK AKs come in more shapes and colors than people expect. Here's what they tend to be like. What it's likeFeelRough, dry or scaly, like a patch of sandpaper. Often easier to feel than to see. [2]LookA rough bump, a flat patch or a raised growth. [2]ColorRed or pink, skin-colored, gray, brown, tan or white. [2]SymptomsIt may itch, burn or sting, feel tender, bleed, or catch on clothing. [2] A spot that's rough, keeps coming back, or bleeds easily is worth showing us, even if it looks small. ## Where AKs show up AreaWhy it mattersFaceGets more sun than almost anywhere, year after year. [2]LipsA common place for AKs, and an easy one to overlook. [2]EarsOften forgotten when applying sunscreen.ScalpEspecially where hair has thinned.NeckSun-exposed every day. [2]Forearms and backs of the handsHours of driving and outdoor work add up here. The Paz difference ## Treat the spot, and keep an eye on the skin around it An AK means your skin has had a lot of sun. So we treat the spot you came in for, and we look at the rest of your skin too, because where there's one AK there are often others, and sometimes something that needs a closer look. Treatment is chosen by how many spots you have and where they are. Some are treated one at a time in the office with cryotherapy, which freezes the spot so it falls off after a few days. [4] Others do better with a prescription you apply at home. If a spot looks unusual, a biopsy settles it. And a yearly [total body exam](/treatments/skin-cancer-screening/) keeps new ones from getting ahead of you. - SPF 30+ The minimum sunscreen dermatologists recommend: broad-spectrum and water-resistant, reapplied every two hours outdoors. [3] ## When to have a spot checked ### Book an appointment if you notice: - A rough or scaly patch that doesn't go away [2] - A spot that itches, burns, stings or bleeds [2] - A rough spot on your lip that won't heal [2] - A spot that's growing, thickening or getting tender ### Worth a regular skin check if you: - Have fair skin that burns easily - Have spent years outdoors for work or fun - Have used tanning beds [1] - Have had AKs or skin cancer before AKs are common and very treatable. There's no downside to having one checked. ## Keeping AKs from coming back Treating AKs is half of it. The other half is slowing down the damage that causes them. ### Every day - Use a broad-spectrum, water-resistant sunscreen, SPF 30 or higher, and reapply every two hours outdoors [3] - Wear a wide-brimmed hat, sunglasses, long sleeves and pants when you can [3] - Seek shade, especially in the middle of the day [3] - Skip tanning beds entirely [1] ### Over time - Check your skin as often as your provider recommends [3] - Keep your follow-up visits, since new AKs and early skin cancers are easiest to treat when they're small [3] - Tell us about any spot that returns after treatment Much of what makes AKs likely is also behind [sun damage](/concerns/sun-damage/) you can see, like brown spots and fine lines. The same habits help with both. ## Services we offer A skin check is where AKs are found and treated. Pick it to see how it works. ## What treatment costs Treating AKs is medical care, and it's handled differently from the cosmetic treatments on this site. Our office walks you through what applies to you when you book. What it isA precancerous growth caused by sun or tanning [1]How it feelsRough and scaly, often before it's visible [2]Why treat itSome AKs turn into squamous cell carcinoma [2]How commonMore than 40 million Americans a year [1]WhereDiagnosed and treated at our Fresno and Visalia offices ## Actinic keratosis questions, answered **Q: Is an actinic keratosis cancer?** No. It's a precancer. Some AKs turn into squamous cell carcinoma if they're left alone, which is why they're treated. [2] **Q: Will it go away on its own?** Sometimes a spot fades and then comes back. Because some AKs can turn into skin cancer, it's better to have one checked than to wait it out. [2] **Q: Does treatment hurt?** Most treatments are quick, and any discomfort is brief. After cryotherapy, a crust or small blister on the treated skin is normal and expected. [4] **Q: Can I get more of them?** Yes. An AK is a sign of sun damage, and people who've had one often get others. Sun protection and regular skin checks keep new ones small and easy to treat. [3] **Q: I have a rough spot on my lip. Could that be an AK?** It could. The lips are a common place for AKs, [2] and a rough spot there that doesn't heal is worth having looked at. **Q: Is sunscreen really enough?** It's one part. Broad-spectrum SPF 30 or higher, reapplied every two hours outdoors, plus a hat, sunglasses, sleeves and shade, add up to real protection. [3] ## References [Actinic keratosis: Overview](https://www.aad.org/public/diseases/skin-cancer/actinic-keratosis-overview) [Actinic keratosis: Signs and symptoms](https://www.aad.org/public/diseases/skin-cancer/actinic-keratosis-symptoms) [Actinic keratosis: Self-care](https://www.aad.org/public/diseases/skin-cancer/actinic-keratosis-self-care) [Actinic keratosis: Diagnosis and treatment](https://www.aad.org/public/diseases/skin-cancer/actinic-keratosis-treatment) Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. A rough or scaly spot isn't always an actinic keratosis, and some skin cancers look similar; a biopsy may be needed to tell. Treatment choice depends on the number, size and location of spots. Actinic keratoses can recur, and new ones can appear, so regular skin checks are recommended. Individual results may vary. ### Alopecia Areata ## Hair loss in patches Alopecia areata is a disease that causes hair loss, [1] developing when the body's immune system attacks hair follicles. [2] It often causes patchy hair loss, [1] though some people lose more hair on the scalp or body. People of all skin tones and genders get it. It usually begins in children and young adults, but it can start at any age. [1] ### Signs of alopecia areata - Smooth, round patches of hair loss [1] - Patches in the beard, eyebrows or eyelashes - Hair that falls out quickly in one area - Small dents or pits in the nails - 6 weeks How soon some people see regrowth with treatment. [1] ## Why it happens 1. The immune system The body's immune system mistakenly attacks hair follicles. [2] The follicles aren't destroyed, which is why hair can grow back. 2. Family history It's more likely if a family member has alopecia areata or another autoimmune condition. 3. Triggers Stress or illness may set off an episode in some people, though often there's no clear trigger. - Not contagious Alopecia areata can't spread from person to person. [1] ## Regrowth is possible Alopecia areata can't be cured yet, but treatment can help people regrow their hair. [1] Hair can grow back, although not everyone sees the regrowth they hope for. [1] What you might noticeWhat it meansPatches that fill back inHair follicles are recovering [1]Regrowth that starts white or grayCommon; color often returnsNew patches while old ones regrowThe condition can come and go Your provider looks at how much hair is affected and how long it's been happening, then recommends a plan to encourage regrowth. ## Where it shows up AreaWhat you might seeScalpRound, smooth bald patches [1]BeardPatchy hair loss in the beardEyebrows and eyelashesThinning or small bare spotsNailsPits, ridges or rough texture The Paz difference ## Caring for the person, not just the patch Hair loss can be hard emotionally, especially for children and teens. Here, your provider confirms the diagnosis, since several [other kinds of hair loss](/concerns/hair-loss/) can look similar, and builds a plan with you, checking in as your hair responds. - All ages It usually begins in children and young adults but can start at any age. [1] ## When to see us ### Book an appointment if: - You or your child find a round bald patch - Hair is falling out quickly in one area - Patches are spreading or new ones appear - You're losing eyebrow, eyelash or beard hair The earlier you start treating hair loss, the more likely you are to see regrowth. [3] ## Taking care of yourself - Protect bare patches of scalp from the sun with a hat or sunscreen - Be gentle with your hair and scalp - Consider hats, scarves or hairpieces if they help you feel comfortable - Reach out to support groups; many people find them helpful - Keep your follow-up visits so your plan can be adjusted ## How we treat alopecia areata here Alopecia areata is diagnosed and treated in a regular medical visit, where your provider confirms the cause of your hair loss and recommends treatment to help your hair regrow. See [Medical Dermatology](/medical-dermatology/) for what a medical visit covers. ## What treatment costs Alopecia areata care is medical care, and it's handled differently from the cosmetic treatments on this site. Our office walks you through what applies to you when you book. What it isThe immune system attacks hair follicles [2]Who gets itAll skin tones and genders; often children and young adults [1]ContagiousNo [1]RegrowthPossible; sometimes seen in 6 weeks with treatment [1]WhereOur Fresno and Visalia offices ## Alopecia areata questions, answered **Q: Will my hair grow back?** It can. Treatment helps many people regrow their hair, though results vary. [1] **Q: Is alopecia areata contagious?** No. It can't spread from person to person. [1] **Q: How soon does treatment work?** Some people see regrowth in about 6 weeks. [1] **Q: Can children get it?** Yes. It often begins in childhood or young adulthood. [1] **Q: Is it caused by stress?** Stress may play a part for some people, but the root cause is the immune system attacking hair follicles. [2] **Q: Can it come back?** Yes. Alopecia areata can come and go, which is why follow-up care matters. ## References [Alopecia areata](https://www.aad.org/public/diseases/hair-loss/types/alopecia) [Hair loss: Who gets and causes](https://www.aad.org/public/diseases/hair-loss/causes/18-causes) [Hair loss: Diagnosis and treatment](https://www.aad.org/public/diseases/hair-loss/treatment/diagnosis-treat) Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Alopecia areata treatment is chosen for each person, and regrowth varies. Individual results may vary. ### Basal Cell Carcinoma ## The most common skin cancer, and a very treatable one Basal cell carcinoma, or BCC, is the skin cancer people are most likely to get. [1] It tends to grow slowly and rarely spreads to other parts of the body. [1] That's the reassuring part. The part to take seriously is that it keeps growing. Left alone, a BCC can reach into the muscle and bone beneath it, and the deeper it goes, the harder it is to remove completely. [2] Caught early, most are removed in a single visit, and many are cured that way. [2] ### Why it's worth a visit - Most BCCs are removed in one visit [2] - Found early, the treatment and the scar stay small - A sore that won't heal is one of its most common signs [1] - Most common Basal cell carcinoma is the most common type of skin cancer. [1] It's also one of the most treatable. ## Why it happens 1. Years of sun Most BCCs develop in people who spent years outdoors without protecting their skin, or who used tanning beds. [1] That's why they show up on the face, ears and scalp. 2. Your skin Fair skin that burns easily is the most prone, though BCC can develop in any skin color. In darker skin, it often looks like a brown or black raised growth rather than a pink one. [1] 3. A history of skin cancer Having had one BCC makes another more likely, which is why regular skin checks matter after treatment. - Head and neck Where most basal cell carcinomas develop, including the ears, nose, eyelids and scalp. [1] ## Five ways a BCC can look BCCs don't all look alike, which is why they're easy to dismiss. Any of these is worth showing us. It may look likeWhat to noticeA firm, round, raised growthOften pink and shiny in lighter skin, brown or black in darker skin. [1]A round spot that dips in the centerA raised edge around a small hollow. [1]A scaly spot or patchEasy to mistake for dry skin. [1]A sore that doesn't healOr one that heals and keeps coming back. [1]A new mark that looks like a scarWith no injury to explain it. [1] The common thread is that it's new, it doesn't go away, and it doesn't look like the rest of your skin. ## Where to look AreaWhy it mattersNoseOne of the most common spots, and one where saving healthy skin matters. [1]EarsEasy to miss, and exposed to sun every day. [1]EyelidsDelicate skin where careful removal counts. [1]ScalpHidden by hair, especially where hair has thinned. [1]Rest of the face and neckWhere most BCCs develop. [1] The Paz difference ## Every standard treatment, in one practice Most BCCs are [removed with an excision](/treatments/skin-cancer-excision/), the most common treatment, and many early ones are cured this way. [2] When a BCC sits on the nose, an eyelid, an ear or the scalp, or has come back after treatment, [Mohs surgery](/treatments/mohs-surgery/) is often the better choice, and it has the highest cure rate of any skin cancer treatment. [2] [3] Both are done here, and Mohs is done with our own lab, so each layer is checked the same day while you wait. You don't have to be sent elsewhere for the right treatment. - Highest Mohs surgery has the highest cure rate of all treatments for skin cancer. [2] ## When to have a spot checked ### Book an appointment if you notice: - A sore that won't heal, or heals and comes back [1] - A shiny, pink or darker bump that's new [1] - A scaly patch that doesn't respond to moisturizer - A scar-like mark where you never had an injury [1] ### Worth a regular skin check if you: - Have had a BCC or other skin cancer before - Have spent years in the sun or used tanning beds [1] - Have fair skin that burns easily BCC is slow, so there's time. That's not a reason to wait. Smaller means simpler. ## After a basal cell carcinoma Once a BCC is removed, the focus is on catching any new one early. People who've had one are more likely to get another, so regular [total body exams](/treatments/skin-cancer-screening/) are the habit that matters most. ### Going forward - Keep your follow-up skin checks, even when everything looks fine - Check your own skin monthly, especially your face, ears and scalp - Use a broad-spectrum sunscreen, SPF 30 or higher, and a wide-brimmed hat [4] - Tell us about any sore or bump that shows up near the old scar Much of the same sun damage can also lead to [squamous cell carcinoma](/concerns/squamous-cell-carcinoma/), so a skin check looks for both. ## Services we offer Finding, removing and following up on BCC all happen in this practice. Pick one to see how it works. ## What treatment costs Skin cancer care is medical care, and it's handled differently from the cosmetic treatments on this site. Our office walks you through what applies to you before your visit. How commonThe most common type of skin cancer [1]How it behavesGrows slowly and rarely spreads [1]Where it shows upMostly the head and neck [1]How it's treatedUsually excision, or Mohs surgery for delicate areas [2]WhereOur Fresno and Visalia offices ## Basal cell carcinoma questions, answered **Q: Is basal cell carcinoma serious?** It's a cancer, so it needs treatment, but it's one of the most treatable. It grows slowly and rarely spreads. [1] Left alone for a long time, though, it can grow deep and become harder to remove. [2] **Q: Will it go away on its own?** No. A BCC keeps growing until it's treated. [2] A spot that seems to heal and then returns is a classic sign. [1] **Q: How is it treated?** Most often with an excision, which removes the cancer and a margin of healthy skin. [2] For the nose, eyelids, ears, scalp or a BCC that's come back, Mohs surgery is often recommended. [3] **Q: Will I have a scar?** Yes, any removal leaves one. Treating a BCC early keeps it smaller, and on the face, Mohs saves as much healthy skin as possible. [3] **Q: Can it come back?** It can, and people who've had one are more likely to get another. That's why follow-up skin checks matter. **Q: Can people with darker skin get BCC?** Yes. In darker skin, a BCC often looks like a firm, raised growth that's brown or black. [1] ## References [Basal cell carcinoma: From symptoms to treatments (signs and symptoms)](https://www.aad.org/public/diseases/skin-cancer/types/common/bcc/symptoms) [Basal cell carcinoma: From symptoms to treatments (treatment)](https://www.aad.org/public/diseases/skin-cancer/types/common/bcc/treatment) [What is Mohs surgery?](https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma/mohs-surgery) [Actinic keratosis: Self-care](https://www.aad.org/public/diseases/skin-cancer/actinic-keratosis-self-care) Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. A spot's appearance alone doesn't establish what it is; a diagnosis comes from a biopsy examined under a microscope. Treatment depends on the cancer's type, size, depth and location. Every removal leaves a scar. A basal cell carcinoma can recur, and new ones can develop, so regular skin checks are recommended. Individual results may vary. ### Benign Growths ## Harmless spots that can look worrying As skin ages, new growths appear. Most are completely harmless. The catch is that a few of them can look like a wart, a precancerous spot or even skin cancer, [1] so it's worth having new growths checked. ### Common benign growths - Seborrheic keratoses: tan to brown growths that can look warty or like a dab of candle wax on the skin [1] - Skin tags: small, soft flaps of skin, often on the neck, underarms or eyelids - Cherry angiomas: small, bright red spots made up of blood vessels [2] - Dermatofibromas: firm, small bumps, often on the legs - Dermatosis papulosa nigra: small dark bumps, a form of seborrheic keratosis that's very common in darker skin [3] - Sebaceous hyperplasia: small bumps that form when oil glands in the skin get bigger [4] - Lipomas: soft, movable lumps of fat under the skin (for lumps filled with skin cells, see cysts) - Harmless Seborrheic keratoses may look worrisome, but they're harmless. [1] ## Why growths appear 1. Age Most people get seborrheic keratoses in middle age or later, [1] and cherry angiomas are most common after 30. [2] 2. Family traits Cherry angiomas tend to run in families. [2] 3. Friction Skin tags often form where skin rubs against skin or clothing. - After 30 When cherry angiomas become most common. [2] ## Harmless growth, or something to check? Usually harmlessWorth a closer lookLooks like your other spotsLooks different from the restStays the same over timeIs new, growing or changing [2]Waxy, "stuck-on" surfaceBleeds, itches or won't healSoft skin tag that movesA dark or multicolored spot with uneven edges If a growth is new or changing, have it checked. See [changing moles](/concerns/suspicious-moles/) for the warning signs, or book a [skin cancer screening](/treatments/skin-cancer-screening/). ## Where benign growths show up AreaCommon growthsChest and backSeborrheic keratoses, cherry angiomasNeck and underarmsSkin tagsFace and scalpSeborrheic keratosesLegsDermatofibromas ## Real results from patients The Paz difference ## Peace of mind comes first Because some harmless growths look like skin cancer, [1] an experienced eye matters. Here, your provider examines each growth, tells you plainly what it is, and checks the rest of your skin while you're there. - Not contagious Seborrheic keratoses can't spread to other people. [1] ## When to see us ### Book an appointment if: - You notice a new growth and aren't sure what it is - A growth catches on clothing, jewelry or a razor - A growth bothers you ### Book soon if a growth: - Is new, changing or growing [2] - Bleeds, itches or won't heal - Looks different from your other spots ## Keeping an eye on your skin - Check your skin once a month, front and back, with a mirror - Note any new or changing spots - Protect your skin from the sun every day - Don't try to cut off skin tags or growths at home ## How we care for growths here Benign growths are evaluated in a regular medical visit. Your provider confirms what each growth is. If one catches on clothing, gets irritated or bothers you, it can usually be removed right in the office by freezing it with cryotherapy, burning it off or shaving it off. [2] [5] [6] Small bumps like dermatosis papulosa nigra and sebaceous hyperplasia can be reduced the same way. [4] See [Medical Dermatology](/medical-dermatology/) for what a medical visit covers. ## What treatment costs Evaluating growths is medical care, and it's handled differently from the cosmetic treatments on this site. Our office walks you through what applies to you when you book. Common typesSeborrheic keratoses, skin tags, cherry angiomasCancerousNo, but some look like skin cancer [1]ContagiousNo [1]Most commonWith age [1] [2]WhereOur Fresno and Visalia offices ## Growth questions, answered **Q: Are seborrheic keratoses cancer?** No. They're harmless, even though they can look like skin cancer. [1] **Q: Do cherry angiomas need treatment?** Usually not. They're noncancerous and generally don't harm your health. [2] **Q: Can I remove a skin tag at home?** It's safer not to. Cutting it can cause bleeding and infection, and it's best to confirm it's really a skin tag. Your provider can remove it in the office instead. [6] **Q: Why do I keep getting more?** Most benign growths become more common with age, and some run in families. [1] [2] **Q: When should a growth worry me?** If it's new, changing or looks different from the rest, have it checked. [2] **Q: Are these growths contagious?** No. Seborrheic keratoses are not contagious. [1] ## References [Seborrheic keratoses: Overview](https://www.aad.org/public/diseases/a-z/seborrheic-keratoses-overview) [Cherry angioma](https://medlineplus.gov/ency/article/001441.htm) [Seborrheic Keratosis](https://my.clevelandclinic.org/health/diseases/21721-seborrheic-keratosis) [Sebaceous Hyperplasia](https://my.clevelandclinic.org/health/diseases/22670-sebaceous-hyperplasia) [Seborrheic keratoses: Diagnosis and treatment](https://www.aad.org/public/diseases/a-z/seborrheic-keratoses-treatment) [Skin Tags (Acrochordons)](https://my.clevelandclinic.org/health/diseases/21528-skin-tags-acrochordons) Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Any new, changing or unusual growth should be examined. Individual results may vary. ### Cysts ## A small sac under the skin The most common skin cyst is an epidermoid cyst: a closed sac under the skin filled with dead skin cells. [1] It usually feels like a small, non-painful lump that grows slowly, often with a tiny pit in the center. [1] Epidermoid cysts are not dangerous and don't need treatment unless they cause symptoms or become inflamed. [1] People sometimes call them "sebaceous cysts," but true sebaceous cysts are a different type. [1] ### What a cyst feels like - A round lump under the skin that moves slightly - Usually painless and slow-growing [1] - A tiny hole or pit in the middle [1] - Sometimes a thick, cheesy material if it leaks - Not dangerous Epidermoid cysts are harmless unless they cause symptoms or become inflamed. [1] ## How cysts form 1. Trapped skin Cysts form when surface skin gets beneath the skin and fills with dead skin cells that can't shed normally. [1] 2. Blocked hair follicles A blocked follicle or small injury can start the process. 3. Your skin type Some people are simply more prone to cysts, especially on the face, neck and trunk. [1] - Face, neck, trunk Where epidermoid cysts are usually found. [1] ## Leave it, or treat it? Usually fine to watchWorth a visitSmall and painlessRed, swollen or tender [1]Not changingGrowing or large [1]Not in the wayInfected [1]You're sure it's a cystYou're not sure what it is A warm, moist compress can help an irritated cyst at home. [1] Don't squeeze it, which can cause inflammation and infection. ## Where cysts show up AreaGood to knowFaceA common spot for cysts [1]Neck and behind the earsAnother common area [1]Chest, back and shouldersCommon on the trunk [1]ScalpFirm, round lumps under the hair The Paz difference ## Know what it is first Not every lump is a cyst. Some are fatty growths or other [benign growths](/concerns/benign-growths/), and occasionally something needs a closer look. Here, your provider examines the lump and tells you what it is and what, if anything, it needs. - Warm compress A simple home step that can soothe an irritated cyst. [1] ## When to see us ### Book an appointment if: - You have a new lump and aren't sure what it is [1] - A cyst becomes red, swollen or painful [1] - It's growing or getting in the way - It keeps coming back ### Call us promptly if: - The area is hot, very painful or draining pus, or you have a fever, which can mean infection ## Caring for a cyst at home - Leave it alone; don't squeeze or pop it - Use a warm, moist compress if it becomes irritated [1] - Keep the skin over it clean - Watch for redness, swelling or pain [1] ## How we care for cysts here Cysts are evaluated in a regular medical visit. Your provider confirms what the lump is. If a cyst is painful, inflamed or bothering you, it can be drained, or removed completely with its sac, right in the office. [2] See [Medical Dermatology](/medical-dermatology/) for what a medical visit covers. ## What treatment costs Cyst care is medical care, and it's handled differently from the cosmetic treatments on this site. Our office walks you through what applies to you when you book. What it isA closed sac under the skin filled with dead skin cells [1]UsuallySmall, slow-growing, painless [1]DangerousNo [1]Needs care whenInflamed, infected, large or tender [1]WhereOur Fresno and Visalia offices ## Cyst questions, answered **Q: Is a cyst dangerous?** Epidermoid cysts aren't dangerous, [1] and a quick check of any new lump confirms what it is. **Q: Should I pop my cyst?** No. Squeezing can push material deeper, causing inflammation and infection. Your provider can drain or remove it safely in the office. [2] **Q: Will a cyst go away on its own?** Some shrink, but many stay or come back. A small, painless cyst usually doesn't need treatment. [1] **Q: What if it gets red and painful?** That means it's inflamed or infected and needs care. [1] Book a visit, and use a warm compress in the meantime. [1] **Q: Is a sebaceous cyst the same thing?** Not quite. The name is often used for epidermoid cysts, but true sebaceous cysts are a different type. [1] **Q: Can a cyst come back?** Yes, especially if the sac remains under the skin. Your provider can explain your options. ## References [Epidermoid cyst](https://medlineplus.gov/ency/article/000842.htm) [Cyst Removal](https://my.clevelandclinic.org/health/procedures/cyst-removal) Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Any new or changing lump should be examined. Individual results may vary. ### Double Chin ## What's really under your chin A double chin is usually one of two things, or a mix of both: a pocket of fat under the chin, or skin that has loosened and sags. Each needs a different answer, which is why the first step is working out which one you have. Fat alone is the easiest to treat. When loose skin is part of the picture, lifting it gives the cleanest jawline. ### What you might notice - Fullness under the chin, even at a healthy weight - A jawline that blurs into the neck in photos - Softness that shows most when you look down - Loose skin under the chin that has crept in with age - 2 ways Kybella injections or a neck lift, matched to what's under your chin. ## Why the chin holds on 1. Where your body stores fat Some people naturally store fat under the chin, even when the rest of them is lean. Genetics decide a lot of this. 2. Skin that loosens with age Over time, skin under the chin and along the neck relaxes, and fat there sits lower. [1] 3. Weight changes Gaining weight can add fullness under the chin, and losing it may leave loose skin behind. - Up to 6 Kybella treatments you can have, spaced at least a month apart. [2] ## Two ways to a sharper jawline If what's under your chin isA good fitWhat it's likeA pocket of fat under the chin, with firm skinKybellaA series of injections in the office, no surgery [2]Fat plus loose neck skin or neck bandsA neck liftSurgery that removes fat and tightens skin and muscle [1] Most people can't tell which group they're in, and that's fine. At your [free consultation](/cosmetic/consultation/), your provider looks at your skin and the fat under your chin and tells you which approach will give you the result you want. ## Where it shows AreaWhat you noticeUnder the chinA soft pocket of fullness [2]JawlineA less defined line between jaw and neckUpper neckLoose skin or bands with age [1]In profileA softer angle from chin to neck ## Real results from patients - No surgery Kybella treats fat under the chin with a series of injections in the office. [2] The Paz difference ## Injections or surgery, whichever serves you Because injections and neck lifts are both offered here, the plan follows what's under your chin, not what's on the menu. If a few injections will do it, you'll hear that. If surgery will get you the result you want, you'll hear that too. ## When to talk to us ### It's a good time if: - Fullness under your chin has stayed despite diet and exercise - You avoid profile photos or angles that show your neck - Your jawline looks softer than it used to - Loose skin has joined the fullness under your chin A healthy, stable weight gives you the longest-lasting result with any of these. ## Keeping your jawline defined - Keep your weight steady after treatment - Protect the skin on your neck with sunscreen, just as you do your face - Good posture shows off a defined jawline in photos - Come back if you notice loose skin developing over time ## Services we offer Each of these treats a double chin in its own way. Pick one to see how it works. ## What treatment costs Cost depends on the approach and, for Kybella, how many treatments you need. Your consultation is free, and you'll know your plan and its cost before anything happens. CausesFat, loose skin or both [1]Non-surgicalKybella, up to 6 treatments a month or more apart [2]SurgicalA neck lift [1]WhereOur Fresno and Visalia offices ## Double chin questions, answered **Q: Can I get rid of a double chin without surgery?** Often, yes. Kybella is approved to improve moderate to severe fullness under the chin with injections, no surgery needed. [2] **Q: How many Kybella treatments will I need?** It varies. You can have up to six, at least a month apart, and many people need fewer. [2] **Q: What if my skin is loose too?** Removing fat alone won't tighten loose skin. A neck lift can address both. [1] **Q: Will losing weight fix it?** Sometimes it helps, but fat under the chin often stays even at a healthy weight. **Q: Is it permanent?** Skin keeps aging, so the neck can change over the years. Your provider can tell you what to expect from Kybella or a neck lift. ## References [Neck Lift](https://www.plasticsurgery.org/cosmetic-procedures/neck-lift) [KYBELLA (deoxycholic acid) injection: Prescribing Information](https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/206333s005lbl.pdf) Content on this page is for educational purposes and is not a substitute for professional medical advice. Kybella is a prescription medicine approved only for fat under the chin in adults. A neck lift is surgery. Whether any of these suits you depends on your consultation, and results vary from person to person. Each treatment has its own side effects and risks, explained on its page and at your consultation. Individual results may vary. ### Eczema ## The itch that rashes Eczema, also called atopic dermatitis, is a common condition that causes itchy, dry and inflamed skin. [1] It usually begins in childhood, often between 2 months and 5 years of age, but it can start at any age. [1] Many children outgrow it by their teens, while some people have it for life. [1] It isn't contagious, so it can't spread from person to person. [1] ### Signs of eczema - Intense itch, often worse at night - Very dry skin - On lighter skin, pink or red patches that may ooze or crust [1] - On darker skin, small bumps and dark brown, gray or purple patches [1] - Thickened skin where it's been scratched - Not contagious Eczema can't spread from person to person. [1] ## Why skin flares 1. A weaker skin barrier In eczema, the skin's outer layer doesn't hold in moisture or keep out irritants as well as it should, so it dries and flares easily. 2. Family history A child's risk is higher when a parent has or had eczema, asthma or hay fever. [1] 3. Triggers Finding and avoiding your triggers can reduce flare-ups, although not everyone can pin theirs down. [2] Common ones include harsh soaps, fragrances, sweat, stress and dry air. - Moisturize Dermatologists recommend moisturizer for everyone with eczema. It helps prevent cracks and fissures. [2] ## Control, not just relief A dermatologist's treatment plan can reduce flare-ups and ease symptoms such as itch and pain. [2] Most plans are built from three parts. Part of the planWhat it doesA skin care planBathing, moisturizing and being gentle with your skin [2]Medicine you apply to your skinCalms flares; many people control eczema this way [2]Medicine that works throughout the bodyFor widespread or severe eczema, FDA-approved options exist [2] Your provider builds the plan around your age, your skin and how much of it eczema affects, and adjusts it as your skin changes. ## Where eczema shows up WhoWhere it's commonBabiesFace, scalp and outer arms and legsChildrenCreases of the elbows and knees, wrists and anklesAdultsHands, feet, neck and around the eyesAnyoneAnywhere the skin is dry and irritated The Paz difference ## Care for the whole family, at every stage Eczema changes as people grow, and so should the plan. Here, babies, children and adults are all cared for in the same practice, so a family can see one team and a child's plan can grow with them. Some rashes that look like eczema are something else, such as [contact dermatitis](/concerns/rashes-dermatitis/) or an [infection](/concerns/skin-infections/). Getting the diagnosis right comes first. - 2 months to 5 years When eczema most often first appears, though it can start at any age. [1] ## When to see us ### Book an appointment if: - Itching keeps you or your child up at night - Moisturizers and over-the-counter creams aren't enough - Patches are spreading, cracking or bleeding - Eczema is affecting school, work or sleep ### Call us promptly if: - Skin becomes painful, weepy, crusted or has pus, which can mean infection - Your child has a fever along with a sudden, painful flare ## Everyday habits that help - Moisturize every day, [2] ideally right after bathing, with a mild, fragrance-free cream or ointment - Take short, lukewarm baths or showers - Choose fragrance-free soaps, detergents and skin care - Wear soft, breathable fabrics like cotton - Keep nails short to limit damage from scratching - Keep track of what seems to set off flares [2] ## How we treat eczema here Eczema is diagnosed and treated in a regular medical visit, where your provider examines your skin, finds your triggers where possible and builds your plan. See [Medical Dermatology](/medical-dermatology/) for what a medical visit covers. ## What treatment costs Eczema care is medical care, and it's handled differently from the cosmetic treatments on this site. Our office walks you through what applies to you when you book. Also calledAtopic dermatitis [1]Usually startsIn childhood, but can begin at any age [1]ContagiousNo [1]CureNone yet, but it can be controlled [1]WhereOur Fresno and Visalia offices ## Eczema questions, answered **Q: Can eczema be cured?** Not yet, but treatment can ease symptoms and lead to clearer, sometimes completely clear, skin. [1] **Q: Will my child outgrow it?** Many children do by their teenage years, though some people have eczema for life. [1] **Q: Is eczema contagious?** No. It can't spread from person to person. [1] **Q: What's the best moisturizer?** Dermatologists recommend moisturizer for everyone with eczema. [2] A mild, fragrance-free cream or ointment used every day is a good start, and your provider can suggest one for your skin. **Q: Is eczema an allergy?** Not exactly. It's linked to allergies, asthma and hay fever in families, [1] and some people's flares have allergy triggers. **Q: What if creams from the store aren't working?** That's a good time to book a visit. Prescription options can control eczema when over-the-counter care isn't enough. [2] ## References [Eczema types: Atopic dermatitis overview](https://www.aad.org/public/diseases/eczema/types/atopic-dermatitis) [Eczema types: Atopic dermatitis diagnosis and treatment](https://www.aad.org/public/diseases/eczema/types/atopic-dermatitis/treatment) Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Eczema treatment is chosen for each person, and results vary. Seek care promptly for signs of skin infection. Individual results may vary. ### Facial Volume Loss ## Why faces start to look tired With time, some of the fat that gives the face its fullness shrinks or shifts lower. [1] Cheeks flatten, temples hollow, and the area under the eyes can cast a shadow. The skin itself may be fine; it's the support underneath that has changed. That's why restoring volume can refresh a face more than any cream. It puts back the structure your features rest on. ### Signs of volume loss - Cheeks that look flatter or lower than they used to - Hollows at the temples - Shadows or a sunken look under the eyes - Deeper lines from nose to mouth - 4 options Juvéderm, Radiesse, Sculptra and Belotero, each suited to different areas. ## Where volume goes 1. Fat shrinks and shifts Facial fat that once kept cheeks full can fall or disappear with age. [1] 2. Skin loses support As skin relaxes, what's left sits lower, and folds from nose to mouth deepen. [1] 3. Sun and smoking speed it up Sun and smoking both age skin faster, which makes volume loss show sooner. [2] - Up to 2 years How long cheek results with Juvéderm Voluma XC can last with optimal treatment. [3] ## The right filler for each area Every area has fillers approved for it. Here's how they line up. AreaApproved options hereCheeksJuvéderm Voluma XC, and Sculptra for cheek wrinklesTemplesJuvéderm Voluma XCUnder the eyesJuvéderm Volbella XC or Belotero Balance (+)Nose to mouthJuvéderm, Radiesse, Sculptra or BeloteroBacks of the handsRadiesse You don't need to pick. Your [free consultation](/cosmetic/consultation/) looks at where your volume has changed and matches each area to the right product. ## Where volume loss shows AreaWhat you noticeCheeksFlatter, lower cheeks and a less lifted look. [1]TemplesHollowing at the sides of the forehead.Under the eyesA sunken look and shadow.Around the mouthDeeper folds from nose to mouth. [1]HandsVeins and tendons that show more. ## Real results from patients - Right away How soon you see volume with a hyaluronic acid filler. Sculptra builds gradually instead. The Paz difference ## Every filler, and the eye to use them well With four volume treatments offered here, your plan is built around your face, not one product. The art is in proportion: a little in the right places, placed so you look refreshed and never filled. ## When to talk to us ### It's a good time if: - You look more tired than you feel - Your cheeks look flatter or lower than in older photos - You notice hollows at your temples or under your eyes - Makeup no longer hides shadows under your eyes Volume loss is gradual, so small adjustments along the way keep results natural. ## Keeping your face fuller for longer - Wear a broad-spectrum sunscreen, SPF 30 or higher, every day [2] - If you smoke, stop [2] - Keep up with touch-ups on the schedule your provider suggests - Protect your skin's collagen with good daily skincare ## Services we offer Each of these restores volume in its own way. Pick one to see how it works. ## What treatment costs Cost depends on the areas and products in your plan. Your consultation is free, and you'll know your plan and its cost before anything happens. Common areasCheeks, temples, under-eyes, smile lines, handsMain causeFat that shrinks and shifts with age [1]TreatmentsHyaluronic acid fillers, Radiesse, SculptraResultsRight away with fillers; gradual with SculptraWhereOur Fresno and Visalia offices ## Volume loss questions, answered **Q: Will filler make my face look puffy?** Not when it's placed with restraint. The goal is structure and lift, not fullness for its own sake. **Q: Which filler is best for cheeks?** Juvéderm Voluma XC is approved for cheeks, and Sculptra for cheek wrinkles. Your consultation matches the product to your face. **Q: How long do results last?** It depends on the product and area. Cheek results with Voluma XC can last up to two years with optimal treatment. [3] **Q: Can I restore volume without looking done?** Yes. Small amounts in the right places read as rested, not treated. **Q: What about under-eye hollows?** Juvéderm Volbella XC and Belotero Balance (+) are both approved for under-eye hollows. **Q: Is Sculptra a filler?** It's a collagen stimulator. It rebuilds volume gradually over months rather than all at once. ## References [Facelift](https://www.plasticsurgery.org/cosmetic-procedures/facelift) [11 ways to reduce premature skin aging](https://www.aad.org/public/everyday-care/skin-care-secrets/anti-aging/reduce-premature-aging-skin) [Cheek Filler](https://www.juvederm.com/treatment-areas/cheek-filler) Content on this page is for educational purposes and is not a substitute for professional medical advice. Each filler is approved for specific uses, and whether one suits you depends on your consultation. Results are temporary and vary from person to person. Injectable treatments carry side effects and risks, including rare injection into a blood vessel, explained on each treatment's page and at your consultation. Individual results may vary. ### Fine Lines & Wrinkles ## Three kinds of lines, three kinds of answers A line between your brows that shows when you frown is a different thing from a crease that's there when your face is at rest, and both are different from the fine, crinkly texture that sun leaves on the skin. That's why one treatment rarely fixes every line. The good news is that every kind of line has a good answer. ### Three kinds of lines - Expression lines: they show when you move, like frown lines and crow's feet - Lines at rest: creases and folds that stay when your face is still - Surface lines: fine, crepey texture from sun and time - 3 kinds Expression lines, lines at rest and surface lines, each with its own best treatment. ## Where lines come from 1. Repeated expressions Contract the same muscles for years, like when you squint or frown, and those lines become permanent. [1] 2. Sun and tanning The sun plays a major role in aging skin early, and every tan adds to it. [1] 3. Smoking Smoking greatly speeds up how quickly skin ages. [1] 4. Time With the years, skin loses some of its firmness and fullness, and lines settle deeper, often alongside lost volume. - Permanent What expression lines become when the same muscles contract for years. [1] ## Which treatment for which line If the lineTryWhyShows when you frown, raise your brows or smileBotoxRelaxes the muscle behind it [2]Stays when your face is still, like smile linesA filler such as JuvédermAdds volume under the lineIs a smile line or fine line on the cheeks you'd like to soften graduallySculptraHelps rebuild collagen over timeIs fine, crepey surface textureA laser, light or peel treatmentWorks on the skin's surface Most faces have more than one kind, and many plans combine treatments. Your [free consultation](/cosmetic/consultation/) sorts out which lines you have and what will soften each. ## Where lines show up AreaWhat usually helpsBetween the browsBotox for the "11s" [2]ForeheadBotox for horizontal lines [2]Around the eyesBotox for crow's feet [2]Nose to mouthFiller for smile linesAround the lipsFiller for fine vertical linesCheeksSculptra or skin treatments for fine lines Providers also use Botox for bunny lines on the nose and fine lines around the lips, and Radiesse or Sculptra for marionette lines and chin wrinkles. Ask at your consultation whether one of these suits you. ## Real results from patients - SPF 30+ Daily broad-spectrum, water-resistant sunscreen is the first step in slowing new lines. [1] The Paz difference ## The right treatment for every kind of line Because injectables, lasers, light and peels are all offered here, your plan is built around your lines, not around one product. We'll tell you plainly what will make the biggest difference, and what won't. The goal is a softer, fresher version of your face, with expressions that still move naturally. ## When to talk to us ### It's a good time if: - Lines make you look tired, stressed or older than you feel - Makeup settles into lines you'd rather not see - A line bothers you even when your face is at rest - You'd like to slow new lines from forming Whenever lines start to bother you is the right time to ask. ## Everyday habits that slow new lines - Protect your skin every day with a broad-spectrum, water-resistant sunscreen, SPF 30 or higher [1] - Use self-tanner instead of tanning [1] - If you smoke, stop [1] - Wear sunglasses to cut down on squinting - Apply a facial moisturizer every day [1] - Skip skin products that sting or burn [1] None of this erases existing lines, and all of it helps the results of your treatments last. ## Services we offer Each of these treats a different kind of line. Pick one to see how it works. ## What treatment costs Cost depends on which treatments suit your lines and how many areas you treat. Your consultation is free, and you'll know your plan and its cost before anything happens. Main causesExpressions, sun, smoking, time [1]Expression linesBotox [2]Lines at restFillersSurface linesLaser, light and peel treatmentsWhereOur Fresno and Visalia offices ## Wrinkle questions, answered **Q: Botox or filler for my lines?** If the line shows when you move, Botox. If it's there when your face is still, filler. Many people use both. **Q: Can wrinkles be prevented?** You can slow them. Daily sunscreen, no tanning and not smoking make the biggest difference. [1] **Q: Will I look frozen?** Not with a light hand. The goal is softer lines with natural movement. **Q: Do creams work?** A daily moisturizer helps skin look its best, [1] and your provider can suggest skincare for your skin type. Deeper lines usually need an in-office treatment. **Q: How soon will I see results?** Filler shows right away, Botox within days, and Sculptra and skin treatments build gradually. **Q: What if I have several kinds of lines?** That's common. A combined plan treats each kind with what works best for it. ## References [11 ways to reduce premature skin aging](https://www.aad.org/public/everyday-care/skin-care-secrets/anti-aging/reduce-premature-aging-skin) [BOTOX® Cosmetic (onabotulinumtoxinA)](https://www.botoxcosmetic.com/) Content on this page is for educational purposes and is not a substitute for professional medical advice. The right treatment depends on the type of line, your skin and your goals, and results vary from person to person. Injectable and skin treatments have their own side effects and risks, explained on each treatment's page and at your consultation. Individual results may vary. ### Hair Loss ## Many causes, one first step Hair loss affects men and women. The most common cause is hereditary, which in men is called male pattern hair loss and in women female pattern hair loss. [1] Many other causes are temporary and improve once the trigger passes. Without an accurate diagnosis, treatment is often ineffective, [1] which is why finding the cause comes first. ### Signs to notice - A widening part or thinning on top - A receding hairline or thinning crown - Clumps of hair coming out when you brush or shower - Round, smooth bald patches - Hair breaking or thinning along the hairline - Most common Hereditary hair loss is the most common cause of hair loss worldwide. [1] ## Common causes of hair loss 1. Genetics Hereditary hair loss affects both men and women. [1] 2. Stress, illness or childbirth A few months after giving birth, recovering from an illness or having an operation, you may notice much more hair falling out. [1] 3. Tight hairstyles Wearing hair pulled back tightly, over time, can lead to permanent hair loss. [1] 4. Health and medicines Thyroid problems, too little biotin, iron, protein or zinc, and some medicines can all cause hair loss. [1] - Start early The earlier you start treatment, the more likely you are to see regrowth. [2] ## Finding what's behind your hair loss To pinpoint the cause, your provider will: [2] Hair can regrow on its own after things like pregnancy, major illness or surgery. [2] For other causes, treatment works best when it starts early. [2] ## Patterns of hair loss PatternOften points toReceding hairline or thinning crown (men)Male pattern hair loss [1]Widening part, thinning on top (women)Female pattern hair loss [1]Round, smooth patchesAlopecia areata [1]Thinning at the hairline or templesTight hairstyles [1]Shedding all overStress, illness, childbirth or medicines [1] The Paz difference ## A diagnosis before a plan Many hair loss products are sold without anyone looking at your scalp. Here, your provider finds the cause first, whether that's genetics, a medical condition, a [scalp condition](/concerns/scalp-conditions/) or something temporary, then recommends treatment that fits. - Can regrow After pregnancy, major illness or surgery, hair often regrows on its own. [2] ## When to see us ### Book an appointment if: - You're losing more hair than usual - Your part is widening or your hairline is receding - You have bald patches - Hair loss came on suddenly - You also have fatigue, weight changes or irregular periods The earlier you start, the more likely you are to see regrowth. [2] ## Everyday habits for healthier hair - Wear hairstyles that don't pull tightly on the scalp [1] - Be gentle when brushing and styling wet hair - Eat a balanced diet with enough protein and iron [1] - Limit harsh chemical treatments and high heat - Protect your scalp from the sun where hair is thin ## How we treat hair loss here Hair loss is evaluated and treated in a regular medical visit. Your provider finds the cause and recommends a plan to slow loss and encourage regrowth. See [Medical Dermatology](/medical-dermatology/) for what a medical visit covers. ## What treatment costs Hair loss evaluation is medical care, and it's handled differently from the cosmetic treatments on this site. Our office walks you through what applies to you when you book. Most common causeHereditary hair loss [1]Other causesAlopecia areata, stress, childbirth, hairstyles, thyroid, nutrition, medicines [1]Key to treatmentAn accurate diagnosis [1]TimingThe earlier, the better [2]WhereOur Fresno and Visalia offices ## Hair loss questions, answered **Q: Is hair loss permanent?** It depends on the cause. Hair lost after pregnancy, illness or surgery often regrows on its own. [2] Hereditary loss and damage from tight hairstyles can be permanent without treatment. [1] **Q: Do women get hereditary hair loss?** Yes. In women, it's called female pattern hair loss. [1] **Q: Can stress make my hair fall out?** Yes. Hair shedding can increase a few months after a stressful event, illness or operation. [1] **Q: What tests might I need?** Sometimes a blood test or scalp biopsy, if a disease, deficiency, hormone imbalance or infection is suspected. [2] **Q: Will vitamins help?** Only if you're low in something like biotin, iron, protein or zinc. [1] A blood test can tell. **Q: How soon should I be seen?** Sooner is better. Treatment started early is more likely to regrow hair. [2] ## References [Hair loss: Who gets and causes](https://www.aad.org/public/diseases/hair-loss/causes/18-causes) [Hair loss: Diagnosis and treatment](https://www.aad.org/public/diseases/hair-loss/treatment/diagnosis-treat) Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Hair loss treatment depends on the cause, and results vary. Individual results may vary. ### Hooded Upper Eyelids ## What makes eyelids look heavy Hooded lids come from loose, sagging skin that forms a fold and changes the natural shape of the upper eyelid. [1] Sometimes fat adds puffiness too. [1] The result is eyes that look smaller and more tired than you feel. When the fold is large, it can get in the way of your vision. [1] ### What you might notice - A fold of skin that hides your eyelid crease - Eyeshadow that smudges or disappears - Puffiness on the upper lids - A heavy feeling, or skin that crowds the edge of your view - In the crease Where the incision for upper eyelid surgery is placed, so it's well hidden. [1] ## Why lids start to droop 1. Skin relaxes with age Eyelid skin is some of the thinnest on the body, and as it loses firmness it stretches and folds. 2. Fat shifts Fat around the eyes can push forward and show as puffiness on the lids. [1] 3. Family traits Some people inherit heavier lids and notice hooding at a younger age. - Long-lasting How results from upper eyelid surgery are described. [1] ## Is it your eyelids or your brows? A brow that has dropped can push skin down onto the lid and look just like hooding. [Upper eyelid surgery](/treatments/upper-blepharoplasty/) treats the lid, not the brow, [1] so it's worth knowing which one is behind what you see. ### A quick check at home This is only a starting point. At your consultation, your surgeon examines your lids and brows together and tells you exactly what will help. ## What eyelid surgery can change ConcernWhat it doesLoose upper lid skinRemoves it [1]Puffy upper lidsReduces the fat behind the puffiness [1]A fold that crowds your visionClears it [1]Crow's feetNot treated by eyelid surgery; Botox helps these [1] ## Real results from patients - 1 procedure Upper eyelid surgery treats the skin and the fat together. [1] The Paz difference ## Eyes that look as awake as you feel Because this is a dermatology practice, your consultation looks at the skin around your eyes as well as the lids. If a non-surgical treatment would serve you better, you'll hear that. When surgery is the answer, the goal is a rested, natural look, never a surprised one. ## When to talk to us ### It's a good time if: - People tell you that you look tired when you're not - Your eyeshadow no longer shows - Skin on your upper lids feels heavy - The fold crowds your view [1] If hooding gets in the way of your vision, mention it when you book. ## Caring for the skin around your eyes - Wear sunglasses outdoors to protect the thin eyelid skin and cut down on squinting - Use a broad-spectrum sunscreen every day, carefully around the eyes [2] - If you smoke, stop [2] - Choose gentle eye products that don't sting or burn [2] ## Services we offer This is the treatment for hooded upper lids. Pick it to see how it works. ## What treatment costs Cost depends on your plan. The fairest number comes from your consultation, and you'll know your plan and its cost before you decide. What it isLoose, sagging upper lid skin, sometimes with fat [1]TreatmentUpper eyelid surgery (blepharoplasty)IncisionIn the natural crease of the lid [1]ResultsLong-lasting [1]WhereOur Fresno and Visalia offices ## Hooded eyelid questions, answered **Q: Can hooded eyelids be fixed without surgery?** Loose skin on the lid itself is best treated with surgery. Your consultation can tell you if a non-surgical option would help your particular eyes. **Q: Will I look different?** You'll look like yourself, rested. The goal is to open the eyes, not change their shape. **Q: Will there be a scar?** The incision sits in the natural crease of the lid, [1] so it's well hidden when your eyes are open. **Q: What if my brows are the problem?** Eyelid surgery won't raise the brow. [1] Your surgeon checks for this at your consultation. **Q: Do results last?** Yes, results are long-lasting, though your eyes keep aging naturally. [1] **Q: Can it help my vision?** When the fold crowds your view, removing it can clear it. [1] ## References [Eyelid Surgery](https://www.plasticsurgery.org/cosmetic-procedures/eyelid-surgery) [11 ways to reduce premature skin aging](https://www.aad.org/public/everyday-care/skin-care-secrets/anti-aging/reduce-premature-aging-skin) Content on this page is for educational purposes and is not a substitute for professional medical advice. Upper blepharoplasty is surgery, and whether it suits you depends on your consultation. Results vary from person to person, and eyes continue to age. Surgery has risks, explained on the treatment page and at your consultation. The home check on this page is not a diagnosis. Individual results may vary. ### Hyperpigmentation & Brown Spots ## Three kinds of dark spots Dark spots happen when skin makes extra pigment in one area. They're harmless in themselves, but they can make skin look older, tired or uneven, and they're one of the most common reasons people ask about their skin. ### The three you'll see most - Sun spots: flat brown spots on the face, hands and chest from years of sun damage - Melasma: patches darker than your natural skin tone, usually on the face [1] - Dark marks: flat spots left after a pimple, psoriasis patch, bug bite or cut heals [2] - 6 to 12 months How long a dark mark a few shades darker than your skin usually takes to fade on its own. Treatment can speed it up. [2] ## Where dark spots come from 1. Sun and visible light The sun's light, including visible light, can cause dark spots, and melasma often returns with unprotected time outdoors. [1] [2] 2. Hormones Many women first see melasma during pregnancy or after starting birth control pills. [1] 3. Healing skin A dark mark can appear after acne, psoriasis, a bug bite, cut or burn heals. [2] 4. Skin tone Women with medium to dark skin tones are most likely to develop melasma. [1] - Iron oxide The ingredient to look for in tinted sunscreen, because it helps block the visible light that causes dark spots. [2] ## The right treatment for each kind of spot Kind of spotOften responds toSun spots and age spotsIPL or PicoWay Resolve [3] [4]MelasmaPicoWay Resolve, VI Peel Precision Plus or the Pigment Balancing Peel, plus daily sun protection [4]Dark marks after acneVI Peel, SkinCeuticals peels or PicoWay ResolveUneven, dull toneHydraFacial or DiamondGlow for a brighter look Many plans combine treatments, and a dermatology team can combine them safely for the best results. [2] Your [free consultation](/cosmetic/consultation/) sorts out which kind of spot you have and what will fade it. ## Where dark spots show up AreaWhat you might seeCheeks, forehead and upper lipMelasma patches [1]Face and noseSun spots and frecklingHands and armsAge spots from years of sunChest and backDark marks after breakouts ## Real results from patients - SPF 30+ Broad-spectrum, water-resistant sunscreen every day protects the results of any treatment. [2] The Paz difference ## Every brown spot gets a proper look first Most brown spots are harmless, but a few that look similar aren't. Because this is a dermatology practice, spots are looked at with a trained eye before any cosmetic treatment, so you can fade what's cosmetic with confidence. And with lasers, IPL, peels and facials all here, your plan fits the kind of spot you have and your skin tone. ## When to talk to us ### It's a good time if: - Dark spots or patches bother you - Melasma keeps coming back - Marks from old breakouts haven't faded - Over-the-counter products haven't made a difference ### Have a spot checked soon if it: - Is new, changing or growing - Has uneven color or an irregular border - Itches, bleeds or looks different from your other spots A dark spot that's changing deserves a closer look. See our page on [changing moles](/concerns/suspicious-moles/). ## Keeping dark spots from coming back - Use a tinted sunscreen with iron oxide, SPF 30 or higher, every day [2] - Reapply every two hours outdoors - Wear a wide-brimmed hat in the sun - Don't pick at pimples, scabs or bug bites [2] - Keep up with maintenance treatments, especially for melasma [1] ## Services we offer Each of these helps fade dark spots in its own way. Pick one to see how it works. ## What treatment costs Cost depends on the treatment and how many sessions you need. Your consultation is free, and you'll know your plan and its cost before anything happens. KindsSun spots, melasma, dark marksCommon causesSun and visible light, hormones, healing skin [1] [2]Most at risk for melasmaWomen with medium to dark skin [1]Key preventionTinted sunscreen with iron oxide [2]WhereOur Fresno and Visalia offices ## Dark spot questions, answered **Q: Will dark spots fade on their own?** Dark marks after a pimple or cut often do, usually within 6 to 12 months. [2] Sun spots and melasma usually need treatment. **Q: Can melasma be cured?** It can be treated and controlled, but it can come back, especially with sun exposure. [1] Daily sun protection is part of every plan. **Q: What's the best sunscreen for dark spots?** A tinted, broad-spectrum sunscreen with iron oxide and SPF 30 or higher. [2] **Q: Are laser treatments safe for darker skin?** Many are, with the right settings. Your provider chooses treatments and settings for your skin tone. **Q: Why did my melasma start during pregnancy?** Hormone changes during pregnancy or from birth control pills commonly trigger it. [1] **Q: Is a brown spot ever something serious?** Occasionally. A spot that's new, changing or unlike your others should be checked before any cosmetic treatment. ## References [Melasma: Overview](https://www.aad.org/public/diseases/a-z/melasma-overview) [How to fade dark spots in darker skin tones](https://www.aad.org/public/everyday-care/skin-care-secrets/routine/fade-dark-spots) [How dermatologists treat sun-damaged skin](https://www.aad.org/public/everyday-care/sun-protection/sun-damage-skin/wrinkles-sun-damage-can-be-treated) [510(k) Premarket Notification K220853: PicoWay Laser System](https://www.accessdata.fda.gov/cdrh_docs/pdf22/K220853.pdf) Content on this page is for educational purposes and is not a substitute for professional medical advice. Dark spots should be examined before cosmetic treatment, and results vary from person to person. Melasma can return. Each treatment has its own side effects and risks, explained on its page and at your consultation. Individual results may vary. ### Melanoma ## What melanoma is, in plain terms Your skin's color comes from pigment cells. Melanoma starts when those cells begin to grow out of control. [1] It's much less common than the other skin cancers, and it gets the attention it does because it's more likely to spread if it isn't found and treated early. [1] That's also where the good news is. Nearly 8 in 10 melanomas are found before they spread. [2] At that stage, people's five-year survival is the same as for people who never had melanoma at all. [2] So the whole game is noticing. A skin check takes a few minutes, and most of the time the answer is reassuring. ### Why it's worth a look - Most are found before they've spread [2] - It can start anywhere, including skin that rarely sees the sun [1] - A quick check settles the question either way - Nearly 8 in 10 Melanomas found before they've spread, when they're most treatable. [2] ## What raises the odds One surprise for most people: melanoma usually doesn't start in an old mole. About 7 in 10 begin as a brand-new spot. [4] That's why a skin check looks at all of your skin, and why a new spot deserves as much attention as a familiar mole. 1. Sun and tanning beds Ultraviolet light from the sun and from indoor tanning can cause melanoma, and tanning-bed light tends to be stronger than sunlight. [3] Blistering sunburns, especially, add to the risk. [3] 2. Your skin and your moles Fair skin that burns easily, naturally blond or red hair, 50 or more moles, and moles that look atypical all raise the odds. [3] So does turning 50. [3] 3. Your history A parent, sibling or child who's had melanoma, a weakened immune system, or a skin cancer of your own in the past all make regular checks more worthwhile. [3] - 7 in 10 Melanomas that start as a new spot, not in an existing mole, across 38 studies. [4] ## The ABCDEs, and the spot that doesn't match Dermatologists use five letters to describe what to watch for. You don't need all five. Any one of them is enough reason to have a spot checked. LetterWhat to look forA · AsymmetryOne half of the spot looks unlike the other half. [5]B · BorderThe edge is irregular, scalloped or blurry. [5]C · ColorThe color varies across the spot: tan, brown or black, sometimes with white, red or blue. [5]D · DiameterUsually bigger than a pencil eraser by the time it's found, though melanomas can be smaller. [5]E · EvolvingIt looks different from the rest, or it's changing in size, shape or color. [5] Two more worth knowing. A spot that itches or bleeds should be checked. [5] And trust the one that stands out: if a spot doesn't look like any of your others, that alone is a good reason to come in. ## Where to look AreaWhy it mattersChest and backA common place for melanoma, especially in men, and hard to see yourself. [1]Arms and legsA common place for melanoma, especially in women. [1]Palms and soles of the feetMelanoma can start where the sun rarely reaches. [1]Under or around a nailA dark streak or spot here is worth a look, and it's easy to miss. [1]Darker skinIn people of African descent, melanoma tends to appear on the palms, soles or around a nail. [5] The Paz difference ## From the first look to the last stitch, one practice Everything melanoma care usually involves happens here. A [total body exam](/treatments/skin-cancer-screening/) to find what's new, [mole mapping](/treatments/mole-mapping/) to track what's changing, a biopsy when a spot needs a closer look, and removal when it's needed. If you've noticed [a spot that has changed](/concerns/suspicious-moles/), you don't have to piece together where to go next. An early melanoma is usually [removed with a margin of healthy skin](/treatments/skin-cancer-excision/), often right in the office, and that may be the only treatment needed. [6] For one kind of early melanoma that stays near the surface, [Mohs surgery](/treatments/mohs-surgery/) is sometimes used, done in a slower version where results come back the next day. [7] Your provider will talk you through which fits. - Every visit With mole mapping, your moles are photographed at each visit and compared with the last set, so a change shows up in the pictures. ## When to have a spot checked ### Book an appointment if you notice: - A new spot that doesn't look like your others [5] - A mole that's changing in size, shape or color [5] - A spot that itches, bleeds or won't heal [5] - A dark streak under a nail, or a new spot on a palm or sole [1] ### Worth a regular skin check if you have: - Fair skin that burns easily, or naturally blond or red hair [3] - 50 or more moles, or moles that look atypical [3] - A close family member who's had melanoma [3] - A history of blistering sunburns or tanning-bed use [3] - Had skin cancer before, or a weakened immune system [3] If you're not sure whether what you're seeing counts, book the visit anyway. That's exactly what it's for. ## After melanoma Once a melanoma is treated, the focus shifts to keeping watch. Regular skin exams are the backbone of that. For early melanomas, they're typically every 6 to 12 months, and for thicker ones every 3 to 6 months for a few years. [8] ### Between visits - Check your skin and the lymph nodes near the treated area about once a month [8] - Stay out of tanning beds and limit strong sun [8] - Keep your follow-up appointments, even when everything looks fine Having had one melanoma raises the chance of another skin cancer, which is why the follow-up schedule matters more than any single visit. [8] Mole mapping makes that easier: every visit adds a new set of photos to compare against. ## Services we offer Checking, tracking and treating melanoma all happen in this practice. Pick one to see how it works. ## What treatment costs Skin checks, biopsies and skin cancer treatment are medical care, and they're handled differently from the cosmetic treatments on this site. Our office walks you through what applies to you before your visit, so nothing about it comes as a surprise. What it isA skin cancer of the cells that give skin its color [1]How it often startsAs a new spot, more often than in an old mole [4]Warning signsThe ABCDEs, plus any spot that itches, bleeds or stands out [5]Found earlyNearly 8 in 10, when it's most treatable [2]WhereChecks and treatment at our Fresno and Visalia offices ## Melanoma questions, answered **Q: Is melanoma curable?** Very often, yes, especially when it's found early. Most melanomas are caught before they spread, and at that stage five-year survival matches that of people who never had it. [2] **Q: Can melanoma start somewhere that wasn't a mole?** Yes, and it usually does. About 7 in 10 melanomas begin as a new spot rather than in an existing mole. [4] That's why a new spot deserves a look, even if your moles haven't changed. **Q: Can people with darker skin get melanoma?** Yes. Melanoma develops in people of every skin color. In darker skin it often shows up on the palms, the soles of the feet or under a nail, places that don't get much sun. [3] **Q: How is melanoma diagnosed?** By a biopsy. If a spot looks suspicious, your provider removes all or part of it, and the tissue is examined under a microscope. That's the only way to know for sure. **Q: How often should I have my skin checked?** It depends on your risk. People with many moles, a family history or a past skin cancer benefit from a regular schedule, and after a melanoma, checks are typically every 3 to 12 months. [8] Your provider will set a schedule that fits you. **Q: What happens if a melanoma has spread?** Then treatment goes beyond removing the spot, and care often includes cancer specialists alongside your dermatologist. That's the less common path, and it's why early checks matter so much. ## References [What Is Melanoma Skin Cancer?](https://www.cancer.org/cancer/types/melanoma-skin-cancer/about/what-is-melanoma.html) [Cancer Stat Facts: Melanoma of the Skin](https://seer.cancer.gov/statfacts/html/melan.html) [Skin cancer types: Melanoma causes](https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma/causes) [A meta-analysis of nevus-associated melanoma: Prevalence and practical implications](https://pubmed.ncbi.nlm.nih.gov/28864306/) [Skin cancer types: Melanoma signs and symptoms](https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma/symptoms) [Melanoma treatment](https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma/treatment) [What is Mohs surgery?](https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma/mohs-surgery) [After Treatment for Melanoma Skin Cancer](https://www.cancer.org/cancer/types/melanoma-skin-cancer/after-treatment/follow-up.html) Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. A spot's appearance alone doesn't establish what it is; a diagnosis comes from a biopsy examined under a microscope. Not every changing mole is melanoma, and not every melanoma matches the warning signs. Treatment depends on the melanoma's type, thickness and stage. Survival figures are national statistics and don't predict any one person's outcome. A skin exam can't guarantee that every problem will be found, so report any change between visits. Individual results may vary. ### Nail Disorders ## When nails change A change in a nail's color, texture or shape can be harmless, but it can also be a sign of disease. [2] A common cause is nail fungus, a fungal infection that can affect both toenails and fingernails. [1] Nail fungus almost never goes away on its own and can spread, [1] but it's treatable, especially when caught early. [1] ### Nail changes to notice - A different color on part of a nail [1] - A brittle nail that cracks or splits [1] - A nail lifting away from the skin [2] - Tiny dents or pits [2] - A new or changing dark streak [2] - Treatable Nail fungus is treatable, especially when caught early and mild. [1] ## What's behind most nail problems 1. Fungus The first sign of a fungal infection is usually a change in the nail, often its color. [1] 2. Bacteria and injury Redness and swelling around a nail may mean an infection, [2] and a bacterial infection can turn a nail greenish black. [2] 3. Skin conditions Pitting can be a sign of disease, [2] including psoriasis. 4. Your overall health Nails that turn yellow, thicken and seem to stop growing can signal something going on inside the body. [2] - Rarely clears Nail fungus almost never goes away on its own and can spread. [1] ## Changes worth a visit What you seeWhat it can meanA new or changing dark streakCould be melanoma, the most serious skin cancer [2]A discolored, brittle nail with buildup under itNail fungus [1]Redness and swelling around the nailInfection [2]Tiny dents or pitsA skin disease such as psoriasis [2]A nail lifting offMany causes, often with white discoloration [2]Deep grooves across the nailSomething slowed or stopped nail growth [2] Sometimes testing is needed to diagnose nail fungus and treat it effectively, [1] because many nail problems look alike. ## Where nail problems show up AreaCommon problemsToenailsFungus, thickening, ingrown nailsFingernailsPitting, lifting, infection around the nailAround the nailRedness, swelling, tenderness [2]Under the nailDark streaks or discoloration [2] The Paz difference ## A dermatologist's look at your nails Nails are part of your skin, and dermatologists treat them. Here, your provider looks closely at the nail and the skin around it to tell fungus from psoriasis, infection or something that needs a biopsy, then treats the actual cause. - Dark streak A new or changing dark streak under a nail needs a skin cancer check. [2] ## When to see us ### Book an appointment if: - A nail is thick, discolored or crumbling - A nail is lifting, pitted or grooved - Over-the-counter treatments haven't helped - You have diabetes and a nail problem on your foot ### Book soon if you notice: - A new or changing dark streak in a nail [2] - Swelling or pain around a nail [2] ## Keeping nails healthy - Keep feet clean and dry, and change socks when they're damp - Wear sandals in locker rooms and shared showers - Trim nails straight across - Don't share nail clippers or files - Choose salons that sterilize their tools ## How we treat nail problems here Nail problems are diagnosed and treated in a regular medical visit. Your provider finds the cause and recommends treatment that fits it. See [Medical Dermatology](/medical-dermatology/) for what a medical visit covers. ## What treatment costs Nail care is medical care, and it's handled differently from the cosmetic treatments on this site. Our office walks you through what applies to you when you book. A common problemNail fungus [1]Goes away on its ownAlmost never [1]Best outcomeTreated early, when mild [1]Warning signA new or changing dark streak [2]WhereOur Fresno and Visalia offices ## Nail questions, answered **Q: Will nail fungus go away by itself?** Almost never, and it can spread. [1] Early treatment gives the best chance of a cure. [1] **Q: Is a dark line in my nail serious?** It can be. A new or changing dark streak should be checked for melanoma. [2] **Q: Could my nail problem be psoriasis?** Possibly. Pitting and discoloration are common signs of nail psoriasis. **Q: Why are my nails yellow and thick?** Often fungus, but yellow, thick nails that stop growing can also signal a health issue. [2] **Q: Can nail salons cause infections?** They can if tools aren't cleaned properly. Choose salons that sterilize their instruments. **Q: How long does treatment take?** Nails grow slowly, so it can take months for a healthy nail to grow out. ## References [Nail fungus: FAQs](https://www.aad.org/public/diseases/a-z/nail-fungus-overview) [12 nail changes a dermatologist should examine](https://www.aad.org/public/everyday-care/nail-care-secrets/basics/nail-changes-dermatologist-should-examine) Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. A new or changing dark streak in a nail should be examined promptly. Individual results may vary. ### Neck Laxity ## What changes in an aging neck Three things tend to happen to the neck with time. The skin loosens and starts to hang. A thin sheet of muscle just under the skin, the platysma, can separate into vertical cords you see when you tense your neck. And fat under the chin can collect and sit lower. [1] Most necks show some mix of the three, and each responds to a different treatment. ### What you might notice - Loose skin under the chin or down the neck - Vertical cords that show when you speak or grimace - A jawline that blurs into the neck - Horizontal creases across the front of the neck - 3 changes Loose skin, neck bands and fat under the chin, the three things behind an aging neck. [1] ## Why the neck shows age early 1. Skin loses its spring Over time, skin makes less of the support that keeps it firm, and neck skin starts to hang. 2. Muscle bands separate The platysma muscle can separate into bands that create uneven contours along the neck. [1] 3. Sun and smoking Sun plays a major role in aging skin early, and smoking greatly speeds it up. [2] Necks often miss out on sunscreen. - Neck bands Botox is approved to improve the look of moderate to severe vertical bands between the jaw and neck. [3] ## Matching the treatment to your neck If your main concern isA good fitWhat it doesVertical bands, with skin that's still fairly firmBotoxRelaxes the muscle that forms the bands [3]Loose skin, with or without bands and fatA neck liftRemoves excess skin and fat and tightens the neck muscle [1]Mostly fullness under the chinSee our double chin optionsKybella or a neck lift Your [free consultation](/cosmetic/consultation/) shows you which of these is behind what you see, and what each option can realistically do. ## Where neck laxity shows AreaWhat you noticeUnder the chinLoose skin, sometimes with fullness [1]Front of the neckVertical bands [1]JawlineA softer line where jaw meets neck [1]Across the neckHorizontal creases ## Real results from patients - SPF 30+ Daily broad-spectrum, water-resistant sunscreen, on your neck as well as your face. [2] The Paz difference ## A quick fix or a lasting lift With both Botox and neck lift surgery offered here, you get the option that suits your neck, whether that's a short visit for the bands or a surgical plan for the whole neck. Either way, you'll know exactly what to expect before you decide. ## When to talk to us ### It's a good time if: - You notice your neck more than your face in photos - Vertical cords show when you talk or tense your neck - Loose skin under your chin bothers you - Scarves and high collars have become a habit ## Caring for your neck - Wear a broad-spectrum sunscreen, SPF 30 or higher, every day, [2] and take it down to your neck and chest - If you smoke, stop [2] - Use your facial moisturizer on your neck, too - Keep up Botox visits if you choose that route; results are temporary ## Services we offer Both treat an aging neck, in different ways. Pick one to see how it works. ## What treatment costs Cost depends on whether Botox or surgery suits your neck. Your consultation is free, and you'll know your plan and its cost before anything happens. What changesLoose skin, muscle bands, fat under the chin [1]For neck bandsBotox [3]For loose skinA neck lift [1]PreventionDaily sunscreen, no smoking [2]WhereOur Fresno and Visalia offices ## Neck questions, answered **Q: Can Botox help my neck?** Yes, for vertical neck bands. It's approved to improve moderate to severe bands between the jaw and neck. [3] **Q: Will Botox tighten loose skin?** Botox relaxes muscle, so it helps the bands. Loose skin is best addressed with a neck lift. **Q: What does a neck lift fix?** Loose neck skin, neck bands, fat under the chin and jowls. [1] **Q: Is a neck lift permanent?** It gives a lasting improvement, but it can't stop aging, so the neck keeps changing slowly. [1] **Q: Can I prevent a sagging neck?** You can slow it. Sunscreen on your neck and not smoking make a real difference. [2] **Q: Do creams work on neck skin?** Moisturizer keeps skin looking its best, but it won't tighten loose skin or relax neck bands. ## References [Neck Lift](https://www.plasticsurgery.org/cosmetic-procedures/neck-lift) [11 ways to reduce premature skin aging](https://www.aad.org/public/everyday-care/skin-care-secrets/anti-aging/reduce-premature-aging-skin) [BOTOX® Cosmetic (onabotulinumtoxinA)](https://www.botoxcosmetic.com/) Content on this page is for educational purposes and is not a substitute for professional medical advice. Botox Cosmetic is a prescription medicine with temporary results. A neck lift is surgery. Whether either suits you depends on your consultation, and results vary from person to person. Each treatment has its own side effects and risks, explained on its page and at your consultation. Individual results may vary. ### Psoriasis ## Skin that renews too fast In psoriasis, the body makes new skin cells in days rather than weeks. [1] They pile up on the surface as dry, thick, raised patches, often covered with a silvery-white scale, and they tend to itch. [2] Most people who get psoriasis have it for life, [1] but a good plan can bring real control and clearer, or even clear, skin. [1] ### Signs of psoriasis - Dry, thick, raised patches of skin [2] - Silvery-white scale on top [2] - Itch [2] - Tiny dents or discoloration in the nails [2] - Swollen, tender joints or heel pain [2] - 80 to 90% People with psoriasis who have the most common type, plaque psoriasis. [2] ## Why psoriasis flares 1. The immune system Psoriasis starts with an overactive immune system that speeds up the growth of skin cells. 2. Family history It often runs in families. 3. Triggers Flares can follow stress, an infection such as strep throat, an injury to the skin, smoking or alcohol, and some medicines. 4. Health links Psoriasis can raise the risk of certain diseases, such as psoriatic arthritis and diabetes. [1] - Days, not weeks How fast the body makes new skin cells in psoriasis. [1] ## More than one kind It's possible to have more than one type, and each looks a little different. TypeWhat it looks likePlaqueRaised, scaly patches, often on the scalp, elbows, knees or lower back; 80 to 90% of cases [2]GuttateMany small bumps that appear suddenly, often in children after strep throatInverseSmooth, shiny patches where skin touches skin, like the armpits or groinNailTiny dents or discoloration of the nails [2]Psoriatic arthritisSwollen, tender joints, often a finger or toe, or heel pain [2] Your provider identifies which types you have, because that shapes the plan. ## Where psoriasis shows up AreaWhat you might seeScalpThick scale that can look like severe dandruffElbows and kneesClassic raised, scaly plaques [2]Lower backPlaques that itch [2]NailsPits or discoloration [2]JointsSwelling and tenderness [2] ## Real results from patients The Paz difference ## A plan for the long run Psoriasis is a lifelong condition, so the relationship with your dermatology team matters. Here, your plan is built around how much of your skin is affected, where, and how it affects your life, then adjusted over time as your skin responds. Because joint pain can be an early sign of psoriatic arthritis, which can become disabling if it progresses, [2] your visits cover your joints too, not just your skin. - Clear skin With help from a dermatologist, many people gain control and see clearer, or clear, skin. [1] ## When to see us ### Book an appointment if: - You have patches that are thick, scaly or itchy - Over-the-counter creams aren't helping - Psoriasis is affecting your sleep, work or confidence - Your nails are pitted or discolored ### Tell us promptly about: - Joint pain, swelling or stiffness, especially in fingers, toes or heels [2] - A sudden, widespread flare ## Everyday habits that help - Try not to scratch; it can thicken the patches [2] - Moisturize every day - Take lukewarm, not hot, baths or showers - Manage stress where you can - If you smoke, consider quitting, and limit alcohol - Keep your follow-up visits so your plan keeps working ## How we treat psoriasis here Psoriasis is diagnosed and treated in a regular medical visit. Your provider builds a plan that may include medicine you apply to your skin and, for more extensive psoriasis, treatment that works throughout the body. See [Medical Dermatology](/medical-dermatology/) for what a medical visit covers. ## What treatment costs Psoriasis care is medical care, and it's handled differently from the cosmetic treatments on this site. Our office walks you through what applies to you when you book. What it isSkin cells made in days rather than weeks [1]Most common typePlaque psoriasis, 80 to 90% of cases [2]Can affectSkin, scalp, nails and joints [2]ContagiousNoWhereOur Fresno and Visalia offices ## Psoriasis questions, answered **Q: Is psoriasis contagious?** No. You can't catch psoriasis from someone or give it to anyone. **Q: Can psoriasis be cured?** Most people have it for life, [1] but treatment can bring it under control and clear the skin for many people. [1] **Q: Why do my joints hurt?** Psoriasis can affect the joints, a condition called psoriatic arthritis. [2] Tell your provider about joint pain early. **Q: Is it the same as eczema?** No. They can look similar, but they're different conditions with different treatments. A visit sorts out which you have. **Q: Can psoriasis affect my nails?** Yes. Look for tiny dents or discoloration under the nail. [2] **Q: What makes it flare?** Common triggers include stress, infections, skin injuries, smoking, alcohol and some medicines. ## References [Psoriasis: Overview](https://www.aad.org/public/diseases/psoriasis/what/overview) [Psoriasis: Signs and symptoms](https://www.aad.org/public/diseases/psoriasis/what/symptoms) Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Psoriasis treatment is chosen for each person, and results vary. Joint symptoms should be evaluated promptly. Individual results may vary. ### Rashes & Dermatitis ## When your skin reacts "Dermatitis" simply means inflamed skin. A rash can be red, pink, purple or darker than your skin tone; it can be flat, bumpy, scaly or blistered; and it can itch, sting or burn. Because so many rashes look similar, the right treatment depends on getting the cause right, which is what a skin exam is for. ### Common kinds of rashes - Contact dermatitis: a reaction to something that touched your skin [1] - Seborrheic dermatitis: a scaly rash on oily areas like the scalp and face [2] - Eczema: itchy, dry, inflamed skin that comes and goes - Psoriasis: thick, scaly patches - Skin infection: bacterial, viral or fungal rashes - 15,000+ Things that touch our skin that can cause an allergic reaction. [1] ## What sets off a rash 1. Something that touched your skin Contact dermatitis happens when something irritates your skin or causes an allergic reaction. [1] Fragrance and nickel are among the most common culprits. [1] 2. Oily areas and yeast Seborrheic dermatitis causes a scaly rash on oily areas like the scalp, face, ears, eyebrows and beard. [2] 3. An underlying condition Eczema, psoriasis and infections are common causes of rashes that keep returning. 4. Heat, sun or medicines Heat, sunlight and some medicines can also bring on a rash. - Hours or days How long after contact an allergic rash tends to appear, even from a brief touch. [1] ## Two of the most common rashes Contact dermatitisSeborrheic dermatitisCauseSomething touching your skin irritates it or causes an allergic reaction [1]A reaction on oily areas of skin [2]Looks likeItchy skin, then a rash, sometimes with blisters [1]Scaly patches; red on lighter skin, pink, purple or lighter on darker skin [2]WhereWherever the trigger touchedScalp, face, ears, eyebrows, beard, chest [2]ContagiousNo [1]No [2]Key to controlFinding and avoiding the cause [1]Treatment eases itch and can clear the rash [2] ## Where rashes show up AreaCommon causesHandsContact dermatitis from soaps, gloves or chemicalsFace and scalpSeborrheic dermatitis, contact dermatitis from productsWrists, neck and earlobesNickel in jewelry and watches [1]Body foldsIrritation, sweat and infections ## Real results from patients The Paz difference ## The right diagnosis, then the right treatment Treating a rash without knowing its cause often means it comes back. Here, your provider looks at the pattern, where it is and what you've been in contact with, and builds a plan to calm it now and prevent the next one. - Not contagious Contact and seborrheic dermatitis can't spread from person to person. [1] [2] ## When to see us ### Book an appointment if: - A rash lasts more than a couple of weeks - It keeps coming back - Itching disturbs your sleep - Over-the-counter creams haven't helped ### Get care right away if: - The rash spreads quickly, blisters widely or is very painful - You have a fever, or the rash looks infected - You have swelling of the face, lips or throat, or trouble breathing (call 911) ## Everyday habits that help - Choose fragrance-free soaps, detergents and skin care - Wear gloves for cleaning and wet work - Moisturize to keep your skin barrier strong - Note new products or exposures before a flare - Try not to scratch ## How we treat rashes here Rashes are diagnosed and treated in a regular medical visit. Your provider identifies the cause and builds a plan to calm the rash and prevent it from coming back. See [Medical Dermatology](/medical-dermatology/) for what a medical visit covers. ## What treatment costs Rash care is medical care, and it's handled differently from the cosmetic treatments on this site. Our office walks you through what applies to you when you book. Dermatitis meansInflamed skinCommon typesContact, seborrheic, eczema, psoriasis, infectionCommon allergensFragrance and nickel [1]ContagiousContact and seborrheic dermatitis: no [1] [2]WhereOur Fresno and Visalia offices ## Rash questions, answered **Q: Why did I get a rash from something I've used for years?** Allergies can develop over time, and an allergic rash can appear hours or days after contact. [1] **Q: Is my rash contagious?** Contact and seborrheic dermatitis are not. [1] [2] Some infections are, which is one reason to have a new rash checked. **Q: How do I get rid of contact dermatitis?** Only by avoiding what causes it. [1] Your provider helps you narrow down the cause and calms the rash in the meantime. **Q: Is dandruff a rash?** Dandruff may be the mildest form of seborrheic dermatitis. [2] **Q: Will it come back?** Some rashes clear for good once the cause is removed; others, like seborrheic dermatitis, can return and are managed over time. [2] **Q: When is a rash an emergency?** If it comes with swelling of the face or throat, trouble breathing, a high fever or rapid spreading, get care right away. ## References [Eczema types: Contact dermatitis overview](https://www.aad.org/public/diseases/eczema/types/contact-dermatitis) [Seborrheic dermatitis: Overview](https://www.aad.org/public/diseases/a-z/seborrheic-dermatitis-overview) Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. A rash with facial swelling, trouble breathing, high fever or rapid spread needs emergency care. Individual results may vary. ### Redness & Visible Blood Vessels ## Tiny vessels, visible color Small blood vessels sit just under the surface of your skin. When they widen or multiply, they show through as fine red lines, small red spots or an all-over flush. They're harmless, but they can make skin look irritated or older. Lasers are effective at reducing broken blood vessels, red birthmarks and other red spots on the skin. [1] ### What you might see - Fine red lines around the nose and cheeks - A lasting flush or blotchy redness - Small, bright red spots - Reddish-brown color on the sides of the neck from years of sun - A red birthmark - A few visits Many small facial vessels clear in a short series of laser or light treatments. ## Why redness shows up 1. Rosacea Rosacea often brings flushing, lasting color and visible blood vessels. [2] 2. Sun Years of sun can widen small vessels and leave redness, especially on the cheeks, nose and neck. See sun damage. 3. Your genes and skin type Some people are simply more prone to visible vessels, especially those with fair skin. 4. Heat, alcohol and other triggers Anything that makes you flush, like heat or alcohol, can make redness more noticeable over time. - FDA-cleared VBeam is cleared to treat facial vessels, rosacea, red birthmarks and redness on the neck from sun. [4] ## VBeam or IPL for your redness If your concern isConsiderWhyFine red lines or small red spotsVBeamTargets the vessels precisely, often in fewer sessions [3]Overall redness plus brown spotsIPLTreats red and brown together, gently [3]Rosacea flushingEither, with medical careBoth can calm rosacea's redness [3] [4]A red birthmarkVBeamCleared for port-wine stains and hemangiomas [4] Visible veins on your legs are treated differently. See [spider veins on your legs](/concerns/spider-veins/). Your [free consultation](/cosmetic/consultation/) helps you choose. ## Where redness shows up AreaWhat you might seeNoseFine red lines on the sides of the noseCheeksA flush or web of small vesselsNeck and chestReddish-brown sun-related color [4]AnywhereSmall, bright red spots or a red birthmark [4] ## Real results from patients - Two options VBeam laser and IPL, so your treatment fits your redness. The Paz difference ## Finding the cause of your redness Redness has many causes, from rosacea to sun to a medical skin condition. Because this is a dermatology practice, the cause is identified before treatment, so the laser or light treats what's really there, and any condition behind it gets the right care too. ## When to talk to us ### It's a good time if: - Red lines or spots on your face bother you - Makeup no longer hides redness - Your face flushes easily and stays red longer - You have a red birthmark you'd like lightened If redness comes with burning, itching, scaling or bumps, book a visit so the cause can be checked. ## Keeping redness down - Wear a gentle, broad-spectrum sunscreen, SPF 30 or higher, every day - Notice what makes you flush, and limit it when you can - Use gentle, fragrance-free skin care - Skip very hot showers and saunas on your face ## Services we offer Both treat facial redness and small vessels. Pick one to see how it works. ## What treatment costs Cost depends on the area and how many sessions you need. Your consultation is free, and you'll know your plan and its cost before anything happens. Also calledBroken capillaries, telangiectasiaCommon causesRosacea, sun, skin type, flushing triggers [2]TreatmentsVBeam laser, IPL [1] [4]SessionsOften a short seriesWhereOur Fresno and Visalia offices ## Redness questions, answered **Q: Can broken capillaries be removed?** Yes. Lasers are effective at reducing broken blood vessels and other red spots. [1] **Q: Will they come back?** Treated vessels are gone, but new ones can form over time, especially with sun and flushing. Sunscreen and upkeep visits help. **Q: Is facial redness always rosacea?** No. It can come from sun, skin type or other conditions. A visit sorts out the cause. **Q: Does treatment hurt?** Most people feel a quick snap with each pulse, softened by built-in cooling. **Q: Can you treat redness on darker skin?** Often, yes, with carefully chosen settings. Your consultation confirms what's safe for you. **Q: What about red birthmarks?** VBeam is FDA-cleared for port-wine stains and hemangiomas. [4] ## References [Skin conditions that lasers can treat](https://www.aad.org/public/diseases/a-z/skin-conditions-lasers-treat) [Rosacea: Overview](https://www.aad.org/public/diseases/rosacea/what-is/overview) [Rosacea: Diagnosis and treatment](https://www.aad.org/public/diseases/rosacea/treatment/diagnosis-treat) [510(k) Premarket Notification K230990: Candela Vbeam Family of Pulsed Dye Lasers](https://www.accessdata.fda.gov/cdrh_docs/pdf23/K230990.pdf) Content on this page is for educational purposes and is not a substitute for professional medical advice. Redness can have medical causes that need their own care, and results vary from person to person. Each treatment has its own side effects and risks, explained on its page and at your consultation. Individual results may vary. ### Rosacea ## More than blushing Rosacea is a skin condition that mainly affects the face. [1] It often starts as easy flushing, then settles into lasting color, and for some people brings bumps, visible blood vessels, irritated eyes or thickened skin. [1] It develops in people of all skin tones. People with lighter skin often see redness, while people with darker skin may see a brown or violet color. [1] ### Signs of rosacea - Flushing that comes and goes [1] - Lasting redness or color on the cheeks, nose, chin or forehead [1] - Acne-like bumps [1] - Visible blood vessels [1] - Irritated eyes [1] - All skin tones Rosacea develops in people of every skin tone, though it can look different on darker skin. [1] ## What sets off a flare The cause isn't fully understood, but most people with rosacea find that certain things set off a flare. 1. Sun Just a few minutes of sunlight on rosacea-prone skin can bring on flushing and redness. [2] 2. Heat and hot drinks Overheating and the heat of hot beverages can trigger flares. [2] 3. Stress Stress is a common trigger, and learning to manage it can help. [2] 4. Alcohol and spicy food Red wine and spicy dishes are common culprits for many people. [3] - SPF 30+ A gentle, broad-spectrum sunscreen every day, ideally with zinc oxide or titanium dioxide. [2] ## Calming rosacea, two ways [paz_instagram id="DXZk_SSBzyl" label="Watch: rosacea care at Paz"] Treatment can reduce flare-ups and help you feel more comfortable. [1] Most plans combine medical care with light or laser treatment for the color that lingers. Medical careLaser and lightPrescription creams, gels or medicines for bumps and rednessVBeam, a pulsed dye laser FDA-cleared for rosacea [4]A gentle skin care plan and product advice [2]IPL, which can reduce flushing and improve texture [5]Help finding your personal triggersFewer sessions with laser; gentler, more sessions with IPL [5] Prescription care is part of [medical dermatology](/medical-dermatology/). Laser and light treatments are cosmetic, and your plan can include both. ## Where rosacea shows up AreaWhat you might seeCheeksFlushing, lasting color and small vesselsNoseRedness, vessels and, over time, thickened skin [1]Chin and foreheadRedness and acne-like bumpsEyesIrritation [1] ## Real results from patients - Fewer flares Treatment can reduce flare-ups and help you feel more comfortable. [1] The Paz difference ## Medical care and lasers in one place Rosacea responds best to a plan that treats both the flare-ups and the color they leave behind. Here, prescription care and laser treatment are in the same practice, so one team manages the whole picture. Rosacea bumps are easy to mistake for [acne](/concerns/acne/), and acne treatments can make rosacea worse, so the right diagnosis matters. ## When to see us ### Book an appointment if: - Your face flushes easily and the redness is lasting longer - You have bumps that don't respond to acne products - Small blood vessels are showing on your cheeks or nose - Your eyes often feel irritated - Redness is affecting how you feel about your skin ## Everyday habits that help - Use a gentle, fragrance-free sunscreen, SPF 30 or higher, every day [2] - Keep a note of what seems to trigger your flares - Cool off quickly: a cold, wet cloth on your neck or a cold drink helps [2] - Let hot drinks cool before sipping [2] - If red wine or spicy food sets you off, try a milder choice - Ask for a skin care plan made for rosacea-prone skin [2] ## Services we offer Along with prescription care, these treatments calm rosacea's redness. Pick one to see how it works. ## What treatment costs Prescription rosacea care is medical care, and it's handled differently from the cosmetic treatments on this site. Our office walks you through what applies to you when you book. For VBeam and IPL, your cosmetic consultation is free. AffectsMainly the face [1]SignsFlushing, lasting color, bumps, visible vessels [1]CureNone yet, but treatment controls it [1]TreatmentsPrescription care, VBeam, IPL [4] [5]WhereOur Fresno and Visalia offices ## Rosacea questions, answered **Q: Can rosacea be cured?** Not yet, but treatment can reduce flare-ups and help you feel more comfortable. [1] **Q: Is it just sensitive skin?** Rosacea is a medical skin condition. It often starts with easy flushing and can progress, so it's worth having it diagnosed. **Q: Does laser help rosacea?** Yes. VBeam is FDA-cleared to treat rosacea, [4] and IPL can reduce flushing and improve texture. [5] **Q: Can people with darker skin get rosacea?** Yes. It develops in all skin tones and may look brown or violet rather than red. [1] **Q: What should I avoid?** Your own triggers. Sun, heat, hot drinks, stress, alcohol and spicy food are common ones. [2] [3] **Q: What sunscreen is best?** A gentle, broad-spectrum, fragrance-free sunscreen with zinc oxide, titanium dioxide or both, SPF 30 or higher. [2] ## References [Rosacea: Overview](https://www.aad.org/public/diseases/rosacea/what-is/overview) [How to prevent rosacea flare-ups](https://www.aad.org/public/diseases/rosacea/triggers/prevent) [Triggers could be causing your rosacea flare-ups](https://www.aad.org/public/diseases/acne-and-rosacea/rosacea/triggers-could-be-causing-your-rosacea-flare-ups) [510(k) Premarket Notification K230990: Candela Vbeam Family of Pulsed Dye Lasers](https://www.accessdata.fda.gov/cdrh_docs/pdf23/K230990.pdf) [Rosacea: Diagnosis and treatment](https://www.aad.org/public/diseases/rosacea/treatment/diagnosis-treat) Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Rosacea has no cure; treatment controls it, and results vary. Each treatment has its own side effects and risks, explained on its page and at your visit. Individual results may vary. ### Rough Texture & Dull Skin ## Why skin loses its glow Healthy skin sheds dead cells constantly. When they build up on the surface, light doesn't reflect as evenly, and skin looks dull and feels rough. Exfoliation removes those dead cells from the outer layer of your skin. [1] Texture can also come from sun damage, dryness, enlarged pores or old breakouts, which is why the best treatment depends on what's behind yours. ### Signs you might notice - A tired, flat or grayish look - Skin that feels rough or bumpy - Makeup that sits on top instead of blending in - Enlarged-looking pores - Uneven tone - 6 treatments From a gentle facial to laser, so your plan fits your skin and your schedule. ## What dulls your skin 1. Dead cell buildup As we age, skin sheds dead cells more slowly, and they collect on the surface. 2. Sun The sun plays a major role in aging skin early. [2] Over the years, that shows up as rougher texture and uneven tone. 3. Dryness Dry skin looks duller and feels rougher. A daily moisturizer helps. [2] 4. Smoking Smoking greatly speeds up how quickly skin ages. [2] - Moisturize daily A facial moisturizer every day helps skin look its best. [2] ## From a quick glow to deeper renewal If you wantConsiderWhat it doesAn instant glow with no downtimeHydraFacialCleans, exfoliates and hydrates in one visitA deeper polishDiamondGlowDiamond-tip exfoliation with a serum infusionSmoother skin and better makeupDermaplaningRemoves dead skin and peach fuzzBrighter tone over a few daysSkinCeuticals peelsLight chemical exfoliationA real resetVI PeelAbout a week of light peeling for fresh skinTexture from scars or deeper damagePicoWay ResolveLaser that helps skin rebuild collagen Your [free consultation](/cosmetic/consultation/) matches the treatment to your skin type. Dry, sensitive or acne-prone skin often does best with gentler options. [1] ## Where texture and dullness show up AreaWhat you might noticeCheeksRough patches or uneven textureNose and foreheadEnlarged-looking poresWhole faceA flat, tired lookNeck and chestCrepey, sun-worn texture ## Real results from patients - SPF daily Daily broad-spectrum sunscreen protects the fresh skin every treatment reveals. [2] The Paz difference ## A glow plan built on skin knowledge Rough texture can be dryness, sun damage, [acne scars](/concerns/acne-scars/) or a skin condition, and each needs a different approach. Because this is a dermatology practice, your plan starts with a look at what's behind the texture, then matches you to the treatment that will make the biggest difference. ## When to talk to us ### It's a good time if: - Your skin looks dull no matter what products you use - Makeup doesn't sit smoothly anymore - Rough patches or bumps bother you - You have an event coming up and want your skin at its best If rough, scaly patches don't go away, have them checked, since some are sun-related spots that need medical care. ## Everyday habits for smoother skin - Moisturize every day [2] - Wear broad-spectrum sunscreen, SPF 30 or higher [2] - Exfoliate gently at home, and less often with stronger methods [1] - Moisturize right after exfoliating [1] - Skip exfoliating on sunburned skin, cuts or while using strong retinoids [1] - If you smoke, stop [2] ## Services we offer Each of these smooths and brightens skin in its own way. Pick one to see how it works. ## What treatment costs Cost depends on the treatment and how many sessions you need. Your consultation is free, and you'll know your plan and its cost before anything happens. Common causesDead cell buildup, sun, dryness, smoking [2]No-downtime optionsHydraFacial, DiamondGlow, dermaplaningDeeper optionsVI Peel, PicoWay ResolveHome careMoisturizer and daily sunscreen [2]WhereOur Fresno and Visalia offices ## Texture questions, answered **Q: What's the quickest way to brighten dull skin?** A HydraFacial or dermaplaning gives an instant glow with no downtime. **Q: How often should I exfoliate at home?** It depends on your skin and method. The more aggressive the exfoliation, the less often you need it. [1] **Q: Can I combine treatments?** Often, yes. Dermaplaning before a facial or peel is a popular pairing. **Q: Why is my skin rough even though I moisturize?** Dead cells may be building up, or sun damage may be part of it. A professional treatment can reset the surface. **Q: What if I have sensitive skin?** Gentler options, like a HydraFacial or a mild chemical exfoliant, usually suit sensitive skin best. [1] **Q: How long do results last?** Facials give a glow that lasts days to weeks; peels and laser build longer-lasting change. Regular visits keep skin looking its best. ## References [How to safely exfoliate at home](https://www.aad.org/public/everyday-care/skin-care-secrets/routine/safely-exfoliate-at-home) [11 ways to reduce premature skin aging](https://www.aad.org/public/everyday-care/skin-care-secrets/anti-aging/reduce-premature-aging-skin) Content on this page is for educational purposes and is not a substitute for professional medical advice. The right treatment depends on your skin type, and results vary from person to person. Each treatment has its own side effects and risks, explained on its page and at your consultation. Individual results may vary. ### Sagging Skin & Jowls ## Why the jawline softens With age, the skin of the face relaxes and sags, facial fat falls or thins, and jowls develop along the cheeks and jaw. [1] The crisp line from ear to chin gets softer, and the lower face can look heavier than it feels. How far along those changes are decides what will help most, from a little filler to a surgical lift. ### What you might notice - Jowls along the jaw, even when you're smiling - A jawline that looks less defined in photos - Loose skin along the lower face - Deeper lines from nose to mouth [1] - Up to 1 year How long jawline results with Juvéderm Volux XC can last with optimal treatment. [2] ## Where the sag comes from 1. Skin relaxes Facial skin loses firmness over time and begins to sag. [1] 2. Volume moves Fat that once supported the cheeks falls or disappears, [1] so the skin above the jaw has less holding it up. That's often lost volume as much as loose skin. 3. Sun and smoking Sun plays a major role in aging skin early, and smoking greatly speeds it up. [3] - Up to 2 years How long results with Radiesse can last. [4] ## Matching the treatment to the stage Where you areA good fitWhat it doesA jawline starting to softenJuvéderm Volux XC or Radiesse (+)Redefines the jawline without surgery [2] [4]Cheek wrinkles and smile lines as skin thinsSculptraRebuilds the skin's support gradually, smoothing wrinkles [6]Early to moderate jowls and loose skinA mini faceliftLifts and firms the lower face and jawlineJowls plus loose neck skinA mini facelift with a neck liftAddresses the jaw and the neck together [5] Providers also use Radiesse for early jowls and marionette lines, and Sculptra for marionette lines. Ask at your consultation whether one of these suits you. Your [free consultation](/cosmetic/consultation/) looks at your skin, your volume and your jawline together, and tells you which approach will give you the result you're after. ## Where sagging shows AreaWhat you noticeJawlineJowls and a softer edge [1]CheeksA flatter, lower look [1]Nose to mouthDeeper folds [1]Upper neckLoose skin where jaw meets neck [5] ## Real results from patients - 2 fillers Juvéderm Volux XC and Radiesse (+), both approved to improve the jawline. [2] [4] The Paz difference ## From a little filler to a full lift Jawline fillers, Sculptra and lifting surgery are all offered here, so your plan fits where you are now. Many people start with filler and consider a lift later; some are ready for the lift today. Either way, you'll get a straight answer about what will make the biggest difference. ## When to talk to us ### It's a good time if: - Jowls have started to show along your jaw - Your jawline looks softer in photos than it used to - Your lower face looks heavier or more tired - Filler no longer gives you the lift you want ## Keeping your jawline defined - Wear a broad-spectrum sunscreen, SPF 30 or higher, every day [3] - If you smoke, stop [3] - Keep a steady weight, which helps any result last - Keep up filler touch-ups on the schedule your provider suggests ## Services we offer Each of these treats sagging skin and jowls in its own way. Pick one to see how it works. ## What treatment costs Cost depends on whether filler, Sculptra or surgery suits your face. Your consultation is free, and you'll know your plan and its cost before anything happens. CausesRelaxing skin, shifting fat, sun, smoking [1] [3]Without surgeryJuvéderm Volux XC, Radiesse (+), Sculptra [2] [4] [6]With surgeryMini facelift, neck liftFiller resultsUp to 1 to 2 years, by product [2] [4]WhereOur Fresno and Visalia offices ## Jowl questions, answered **Q: Can filler fix jowls?** Filler can sharpen a softening jawline and make early jowls less noticeable. Juvéderm Volux XC and Radiesse (+) are both approved for the jawline. [2] [4] More advanced sagging usually needs a lift. **Q: How do I know if I need a facelift?** If filler no longer gives you the definition you want, or loose skin is the main issue, a lift is worth discussing. Your consultation will tell you. **Q: What's the difference between a mini facelift and a full facelift?** A mini facelift focuses on early to moderate changes in the lower face and jawline. A full facelift addresses more advanced aging across more of the face and neck. **Q: Does a facelift stop aging?** It turns back the clock, but the face keeps aging from there. [1] **Q: Can Sculptra help?** It's approved for smile lines and cheek wrinkles, and it works gradually, rebuilding the skin's support over a few months. [6] For jowls themselves, filler or a lift does more. **Q: Can I combine treatments?** Yes. Many people pair filler or Sculptra with a lift, or a mini facelift with a neck lift. ## References [Facelift](https://www.plasticsurgery.org/cosmetic-procedures/facelift) [Jawline Filler](https://www.juvederm.com/treatment-areas/jawline-filler) [11 ways to reduce premature skin aging](https://www.aad.org/public/everyday-care/skin-care-secrets/anti-aging/reduce-premature-aging-skin) [Merz Aesthetics Receives FDA Approval for RADIESSE® for the Treatment of Wrinkles in the Décolleté Area](https://merzaesthetics.com/news/fda-approval-radiesse-for-treatment-of-wrinkles-in-decollete-area/) [Neck Lift](https://www.plasticsurgery.org/cosmetic-procedures/neck-lift) [Galderma receives FDA approval for Sculptra® for cheek wrinkles](https://www.galderma.com/news/galderma-receives-fda-approval-sculptrar-cheek-wrinkles-0) Content on this page is for educational purposes and is not a substitute for professional medical advice. Fillers and Sculptra are approved for specific uses, and a mini facelift and neck lift are surgery. Whether any of these suits you depends on your consultation, and results vary from person to person. The face continues to age after any treatment. Each treatment has its own side effects and risks, explained on its page and at your consultation. Individual results may vary. ### Scalp Conditions ## More than dry skin Seborrheic dermatitis is a common condition that causes a scaly rash on oily areas like the scalp and face. [1] Dandruff may be its mildest form. [1] In babies, it shows up on the scalp as cradle cap. [1] Other scalp problems, like [psoriasis](/concerns/psoriasis/), infections and some kinds of [hair loss](/concerns/hair-loss/), can look similar, which is why a diagnosis matters. ### Common scalp conditions - Dandruff: white-to-yellowish flakes - Seborrheic dermatitis: scaly, sometimes greasy patches with inflammation [1] - Scalp psoriasis: thick, silvery scale that can extend past the hairline - Skin infection: itchy, scaly or sore patches, sometimes with hair loss - Cradle cap: crusty scalp patches in babies [1] - Not contagious Seborrheic dermatitis can't spread from person to person. [1] ## Why scalps flake and itch 1. Oil and yeast Seborrheic dermatitis appears on oily areas of the body. [1] 2. An overactive immune system Scalp psoriasis comes from skin cells growing too quickly. 3. Infection Fungal infections can cause scaly, itchy patches and patchy hair loss. 4. Products and irritation Hair dyes and styling products can irritate the scalp or cause an allergic rash. - Mildest form Dandruff may be the mildest form of seborrheic dermatitis. [1] ## Telling scalp conditions apart DandruffSeborrheic dermatitisScalp psoriasisScaleFine white or yellowish flakesGreasy or dry scale [1]Thick, silvery scaleInflammationUsually noneYes; red on lighter skin, pink, purple or lighter on darker skin [1]Raised, well-defined patchesBeyond the scalpRarelyEars, eyebrows, beard, around the nose, chest [1]Elbows, knees, nails Your provider can tell them apart, sometimes in a single look, and choose the treatment that fits. ## Where scalp conditions spread AreaWhat you might seeScalpFlaking, scale, itch or sorenessHairline and behind the earsScale that extends past the hairEyebrows and beardSeborrheic dermatitis scale [1]Sides of the noseRedness and flaking [1] ## Real results from patients The Paz difference ## Relief that starts with the right diagnosis A dandruff shampoo can handle mild dandruff and even mild seborrheic dermatitis, [2] but when it isn't enough, the cause may be something else. Here, your provider examines your scalp and hair to find the real cause, and treats babies, children and adults. - Can clear Treatment can ease itch and lessen, sometimes clear, seborrheic dermatitis. [1] ## When to see us ### Book an appointment if: - Dandruff shampoos haven't helped after a few weeks - Your scalp is very itchy, sore or bleeding from scratching - You have thick, scaly patches - You're losing hair along with scaling or itching - A baby's cradle cap is spreading or looks inflamed ## Caring for your scalp - Use a dandruff shampoo as directed; it may be all mild cases need [2] - Let the shampoo sit on the scalp for a few minutes before rinsing - Try not to scratch, which can worsen itch and irritation - Rinse hair products out well - Keep up with your plan, since scalp conditions often come and go ## How we treat scalp conditions here Scalp conditions are diagnosed and treated in a regular medical visit. Your provider finds the cause and recommends treatment to calm itch and clear scale. See [Medical Dermatology](/medical-dermatology/) for what a medical visit covers. ## What treatment costs Scalp care is medical care, and it's handled differently from the cosmetic treatments on this site. Our office walks you through what applies to you when you book. Most commonDandruff and seborrheic dermatitis [1]ContagiousSeborrheic dermatitis: no [1]In babiesCradle cap [1]First stepA dandruff shampoo for mild cases [2]WhereOur Fresno and Visalia offices ## Scalp questions, answered **Q: Is dandruff the same as seborrheic dermatitis?** Dandruff may be its mildest form. [1] Seborrheic dermatitis can also inflame the skin and appear beyond the scalp. [1] **Q: Can seborrheic dermatitis be cured?** Not yet, but treatment can ease itch and lessen, and sometimes clear, the rash. [1] **Q: Is it contagious?** Seborrheic dermatitis is not. [1] Some scalp infections are, which is one reason to have a new rash checked. **Q: Is cradle cap harmful?** It's seborrheic dermatitis on a baby's scalp [1] and is usually harmless. See us if it spreads or looks inflamed. **Q: Can scalp problems cause hair loss?** Some can, especially infections and scratching. Treating the scalp often helps hair recover. **Q: What if my shampoo isn't working?** Book a visit. Something other than dandruff may be causing your symptoms. ## References [Seborrheic dermatitis: Overview](https://www.aad.org/public/diseases/a-z/seborrheic-dermatitis-overview) [Seborrheic dermatitis: Diagnosis and treatment](https://www.aad.org/public/diseases/a-z/seborrheic-dermatitis-treatment) Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Scalp conditions are treated according to their cause, and results vary. Individual results may vary. ### Skin Infections ## Four kinds of germs, many kinds of infections Your skin is your body's largest organ, and it protects you from germs. [1] When bacteria, viruses, fungi or parasites get past that barrier, an infection can develop. ### Common skin infections - Bacterial: cellulitis, impetigo and staph infections [1] - Viral: shingles, warts and cold sores [1] - Fungal: athlete's foot, yeast infections, ringworm and nail fungus [1] - Parasitic: lice and scabies [1] - 4 causes Bacteria, viruses, fungi and parasites all cause skin infections. [1] ## How infections get in 1. Breaks in the skin Cuts, scrapes, bug bites and cracked skin let germs in. Impetigo often starts this way. 2. Close contact Some infections spread from person to person, such as impetigo when fluid from its blisters touches an open area of skin. [2] 3. Warm, moist skin Fungi thrive in sweaty areas like the feet, groin and skin folds. 4. Existing skin conditions Scratched eczema or other broken skin can become infected more easily. - Wash hands Washing your hands after touching infected skin helps stop the spread. [2] ## What you might be seeing InfectionWhat it looks likeContagiousImpetigoPus-filled blisters that ooze and crust with a honey-colored crust [2]Yes [2]CellulitisA red, warm, swollen, tender area that spreadsRarelyRingwormAn itchy, scaly ring with a clearer centerYesAthlete's footItchy, peeling skin between the toesYesCold soresClusters of small blisters around the lipsYes Many infections look alike and can mimic other rashes, which is why an exam matters before treatment. ## Where infections show up AreaCommon infectionsFaceImpetigo, cold soresFeetAthlete's foot, wartsLegs and armsCellulitis, ringwormScalpFungal infections, lice ## Real results from patients The Paz difference ## The right diagnosis means the right treatment A fungal cream won't clear a bacterial infection, and an antibiotic won't clear a fungal one. Here, your provider identifies what's causing the infection so the treatment actually works, and checks whether an underlying skin condition made you more prone to it. - Right diagnosis Treatment depends on the type of infection and how serious it is. [1] ## When to see us ### Book an appointment if: - A rash, sore or patch isn't healing - An itchy, scaly patch keeps spreading - Sores or blisters keep coming back - Over-the-counter creams haven't worked ### Get care the same day if: - A red, swollen area is spreading, hot or very painful - You have a fever, chills or red streaks from a wound - An infection is near the eye ## Preventing skin infections - Wash your hands often, especially after touching infected skin [2] - Keep cuts and scrapes clean and covered - Don't share towels, razors or clothing - Keep feet clean and dry, and wear sandals in shared showers - Treat eczema or dry, cracked skin so it stays intact ## How we treat skin infections here Skin infections are diagnosed and treated in a regular medical visit. Depending on the cause, treatment may be a cream or lotion, a medicine, or a procedure to drain pus. [1] See [Medical Dermatology](/medical-dermatology/) for what a medical visit covers. ## What treatment costs Treating infections is medical care, and it's handled differently from the cosmetic treatments on this site. Our office walks you through what applies to you when you book. CausesBacteria, viruses, fungi, parasites [1]Common signsRash, swelling, redness, pain, pus, itching [1]TreatmentDepends on the type and severity [1]PreventionHand washing, clean wounds [2]WhereOur Fresno and Visalia offices ## Skin infection questions, answered **Q: Do skin infections go away on their own?** Some do, but others need treatment, and some get worse without it. [1] **Q: Is impetigo contagious?** Yes. It can spread when fluid from the blisters touches open skin. [2] Keep sores covered and wash your hands. **Q: How do I know if it's bacterial or fungal?** They can look similar. An exam, and sometimes a simple test, tells them apart. **Q: When is a skin infection an emergency?** If redness spreads quickly, you have a fever or chills, or you see red streaks, get care the same day. **Q: Can children be treated?** Yes. Impetigo and other infections are common in children, and treatment is chosen for their age. **Q: Why do my infections keep coming back?** An underlying skin condition, sweat, or close contact at home or school can cause repeat infections. Your provider can help find the reason. ## References [Skin infections](https://medlineplus.gov/skininfections.html) [Impetigo](https://medlineplus.gov/ency/article/000860.htm) Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. A spreading, hot or very painful area, fever or red streaks need same-day care. Individual results may vary. ### Spider Veins ## Small veins you can see Spider veins are small versions of varicose veins. [2] They form when tiny one-way valves inside veins weaken, so some blood flows backward and pools, and the vein walls bulge. [1] They're usually a cosmetic concern, and they respond well to treatment. ### What they look like - Thin red, blue or purple lines - Web or branch-like clusters - Small starbursts around the knees or ankles - Fine red lines on the face - 3 to 6 weeks How long spider veins usually take to disappear after sclerotherapy. [1] ## Why spider veins appear 1. Family history If blood relatives have them, your risk is higher. [1] 2. Long hours on your feet or seated Standing or sitting for long periods puts extra pressure on leg veins. [1] 3. Hormones and pregnancy Pregnancy and hormonal changes are common triggers. [1] 4. Sun and injury Spider veins can also be caused by sunlight or an injury. [1] - 2 or 3 Sclerotherapy treatments many people need for the best results. [1] ## Matching the treatment to your veins If your veins areConsiderWhyOn your legsSclerotherapyThe most common treatment for leg veins; spider veins usually fade in 3 to 6 weeks [1]Very fine, or on your faceVBeamA laser FDA-cleared for facial and leg vessels [3]A mix of sizesOften bothEach size responds best to its own treatment Your [free consultation](/cosmetic/consultation/) looks at your veins and recommends the right approach. For [redness and small vessels on your face](/concerns/redness-blood-vessels/), see that page too. ## Where spider veins show up AreaWhat you might seeThighsWebs of red and blue linesBehind the kneesSmall clustersCalves and anklesFine veins and starburstsFaceFine red lines on the nose and cheeks ## Real results from patients - Next day When most people return to work and activities after sclerotherapy. [1] The Paz difference ## Two ways to clear veins, one careful look first With both sclerotherapy and VBeam here, you get the treatment that fits your veins. And because a physical exam helps decide whether leg vein treatment is safe for you, [1] your legs are examined before anything is planned. ## When to talk to us ### It's a good time if: - Spider veins make you self-conscious in shorts or swimsuits - New veins keep appearing - You'd like clearer legs for an event or season ### See a doctor promptly if you have: - Leg pain, swelling or heaviness - Skin changes or sores near a vein - A vein that is hard, warm or tender ## Helping prevent new spider veins - Move often if you sit or stand for long periods - Walk daily to keep blood flowing - Put your legs up when you rest - Wear sunscreen on exposed legs and face [1] - Wear compression stockings as directed after treatment [1] ## Services we offer Both clear spider veins, in different ways. Pick one to see how it works. ## What treatment costs Cost depends on how many veins you treat and how many sessions you need. Your consultation is free, and you'll know your plan and its cost before anything happens. What they areSmall widened veins near the surface [1] [2]CausesFamily history, long hours standing or sitting, pregnancy, hormones, sun [1]TreatmentsSclerotherapy, VBeam [1] [3]Fading timeAbout 3 to 6 weeks after sclerotherapy [1]WhereOur Fresno and Visalia offices ## Spider vein questions, answered **Q: Are spider veins dangerous?** Usually not. They're mainly a cosmetic concern. Leg pain, swelling or skin changes are worth a medical visit. **Q: Which works better, sclerotherapy or laser?** For leg veins, sclerotherapy is the most common treatment. [1] Laser suits very fine veins and those on the face. **Q: How many treatments will I need?** Many people need 2 or 3 sclerotherapy treatments. [1] **Q: Will they come back?** Treated veins close, but new ones can form over time, especially with family history or long hours on your feet. **Q: Can I treat spider veins during pregnancy?** It's best to wait. Pregnancy is a common cause, and many veins improve after delivery. **Q: Is there downtime?** Most people are back to work and activities the next day. [1] ## References [Leg veins: Why they appear and how dermatologists treat them](https://www.aad.org/public/cosmetic/younger-looking/how-dermatologists-treat-leg-veins) [Varicose vein: noninvasive treatment](https://medlineplus.gov/ency/article/007395.htm) [510(k) Premarket Notification K230990: Candela Vbeam Family of Pulsed Dye Lasers](https://www.accessdata.fda.gov/cdrh_docs/pdf23/K230990.pdf) Content on this page is for educational purposes and is not a substitute for professional medical advice. Leg symptoms such as pain, swelling or skin changes need a medical evaluation. Results vary from person to person, and new veins can form over time. Each treatment has its own side effects and risks, explained on its page and at your consultation. Individual results may vary. ### Squamous Cell Carcinoma ## A common skin cancer that's best caught early Squamous cell carcinoma, or SCC, is a common type of skin cancer. [1] It most often develops on skin that's had a lot of sun: the face, scalp, neck, arms, hands and lower legs. [1] When SCC is still confined to the skin, most people are treated successfully. [2] The reason not to wait is that, left untreated, an SCC can grow deep and spread. [1] ### Why it's worth a visit - Most SCCs are treated successfully when found early [2] - It can grow from a precancer you already have [1] - A quick check settles the question either way - Treated successfully Most people with squamous cell carcinoma that's confined to the skin. [2] ## What raises the odds 1. Sun and tanning beds Most SCC comes from ultraviolet light, from the sun and from indoor tanning. [1] 2. Precancers and past skin cancer Actinic keratoses, the rough, scaly precancers left by sun damage, can turn into SCC. A previous skin cancer raises the odds too. [1] 3. Your skin and your health Light skin, light-colored eyes and naturally red or blond hair make SCC more likely. [1] So does living with an organ transplant. [1] - Sun-exposed skin Where SCC most often develops: face, scalp, neck, arms, hands and lower legs. [1] ## Six ways an SCC can look SCC can be mistaken for a scab, a wart or a patch of dry skin. Any of these, especially one that won't go away, is worth showing us. It may look likeWhat to noticeA rough, scaly patchOften on skin that's had years of sun. [1]A firm, dome-shaped growthRaised and firm to the touch. [1]A sore surrounded by raised skinA crater with a firm edge. [1]A sore that doesn't healAnd may bleed. [1]A wart-like growthRough and raised. [1]A horn-like growthA hard spike of skin. [1] In darker skin, SCC is the most common skin cancer, and it can develop both on sunny skin and on skin that rarely sees the sun. [1] A sore that won't heal anywhere on the body deserves a look. ## Where to look AreaWhy it mattersFace, ears and lipsThe most sun-exposed skin on the body. [1]ScalpEspecially where hair has thinned. [1]Neck, arms and handsYears of sun add up here. [1]Lower legsA common spot that's easy to overlook. [1]Around or under a nailA less common spot, and worth checking. [1]Inside the mouth or on the genitalsLess common places, and worth mentioning at any skin check. [1] The Paz difference ## The right removal for where it sits Most SCCs are [removed with an excision](/treatments/skin-cancer-excision/): the cancer and some skin around it come out, and the tissue goes to the lab. [2] For an SCC on an ear, eyelid, scalp or hand, or near an eye, [Mohs surgery](/treatments/mohs-surgery/) is especially helpful. [2] Both are done here, with Mohs layers checked in our own lab the same day. And because precancers and SCC come from the same sun damage, we treat the spots that could become the next one while we're at it. - Same day With Mohs surgery here, each layer is checked in our own lab while you wait. ## When to have a spot checked ### Book an appointment if you notice: - A sore that doesn't heal, or bleeds easily [1] - A rough, scaly patch that's thickening or getting tender - A wart-like or horn-like growth that's new [1] - A firm bump with a crusty or hollow center [1] ### Worth a regular skin check if you have: - Actinic keratoses, or had skin cancer before [1] - Light skin and eyes, or naturally red or blond hair [1] - A history of lots of sun or tanning-bed use [1] - An organ transplant [1] A spot that's been there for weeks and isn't healing is worth a visit. That's all the reason you need. ## After a squamous cell carcinoma After treatment, the goal is catching anything new early. When an SCC returns, it tends to show up on or near the scar, so that's a spot to watch. [2] Regular [total body exams](/treatments/skin-cancer-screening/) do the rest. ### Going forward - Keep every follow-up skin check - Watch the scar and the skin around it, and tell us about any change [2] - Use a broad-spectrum sunscreen, SPF 30 or higher, and cover up outdoors [3] - Have new rough or scaly spots checked, since some precancers can become SCC [1] The same sun damage that leads to SCC can also lead to [basal cell carcinoma](/concerns/basal-cell-carcinoma/), so a skin check looks for both. ## Services we offer Finding, removing and following up on SCC all happen in this practice. Pick one to see how it works. ## What treatment costs Skin cancer care is medical care, and it's handled differently from the cosmetic treatments on this site. Our office walks you through what applies to you before your visit. What it isA common skin cancer [1]Where it shows upMostly sun-exposed skin [1]Why treat it earlyUntreated, it can grow deep and spread [1]OutlookMost treated successfully when confined to the skin [2]WhereOur Fresno and Visalia offices ## Squamous cell carcinoma questions, answered **Q: Is squamous cell carcinoma dangerous?** Caught early, most SCCs are treated successfully. [2] Left untreated, it can grow deep and spread, which is why it's worth treating promptly. [1] **Q: How is it different from basal cell carcinoma?** Both are common and both come mostly from sun. SCC is more likely to grow deep and spread if it's left untreated, so prompt treatment matters a little more. [1] **Q: Can an actinic keratosis turn into SCC?** Some can, which is why precancers are treated. [1] **Q: How is it treated?** Usually with an excision, which removes the cancer and some skin around it. [2] Mohs surgery is especially helpful on the ear, eyelid, scalp or hand, or near the eye. [2] **Q: Can it come back?** It can, most often on or near the scar. [2] Keep your follow-up visits, and tell us about any change there. **Q: Can people with darker skin get SCC?** Yes. It's the most common skin cancer in people with darker skin, and it can develop on skin that gets little or no sun. [1] ## References [Squamous cell carcinoma: From symptoms to treatments (signs and symptoms)](https://www.aad.org/public/diseases/skin-cancer/types/common/scc/symptoms) [Squamous cell carcinoma: From symptoms to treatments (treatment)](https://www.aad.org/public/diseases/skin-cancer/types/common/scc/treatment) [Actinic keratosis: Self-care](https://www.aad.org/public/diseases/skin-cancer/actinic-keratosis-self-care) Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. A spot's appearance alone doesn't establish what it is; a diagnosis comes from a biopsy examined under a microscope. Treatment depends on the cancer's type, size, depth and location, and more advanced cancers may need additional treatment. Every removal leaves a scar. A squamous cell carcinoma can recur, and new ones can develop, so regular skin checks are recommended. Individual results may vary. ### Sun Damage ## What years of sun leave behind The sun plays a major role in aging skin early, [1] and every tan adds to it. [1] Some of that damage is cosmetic. Some of it, like precancerous spots, needs medical care. ### Signs of sun damage - Brown spots and freckling on the face, hands and chest - Redness and small visible blood vessels - Rough, uneven texture - Fine lines and wrinkles - Rough, scaly patches that can be precancerous [2] - 1 in 5 Americans who will develop skin cancer in their lifetime, the most common cancer in the country. [3] ## How sun ages skin 1. Everyday exposure Sun damage builds up from daily life: driving, gardening, school pickup, weekends outdoors. 2. Tanning Every time you get a tan, you prematurely age your skin, and that includes tanning beds. [1] 3. Burns Blistering sunburns raise the risk of melanoma. [4] 4. Time The effects of sun often show up years later, which is why protection matters at every age. - 40 million Americans who develop precancerous actinic keratoses each year, a common sign of sun damage. [2] ## Treating what you see, checking what you can't What sun leftWhat helpsBrown spots and age spotsIPL, PicoWay Resolve or a VI Peel [5]Redness and small vesselsIPL or VBeamRough texture and dullnessSkinCeuticals peels, VI Peel or PicoWay ResolveFine linesPeels and laser treatments [5]Rough, scaly or changing spotsA skin check first Cosmetic treatments start with your [free consultation](/cosmetic/consultation/). Spots that could be precancerous or cancerous are checked and treated as medical care. ## Where sun damage shows up AreaWhat you might seeFaceBrown spots, redness, fine lines, rough patchesNeck and chestFreckling, uneven color, crepey textureHands and forearmsAge spots and thin, spotted skinLips, ears and scalpRough, scaly patches worth checking ## Real results from patients - SPF 30+ Broad-spectrum, water-resistant sunscreen every day, reapplied every two hours outdoors. [6] The Paz difference ## Look better, and stay safe Sun damage is both cosmetic and medical, and this practice handles both. Spots are checked with a dermatologist's eye before cosmetic treatment, and the same practice that fades your sun spots also does your skin cancer screenings, so important changes are caught early. ## When to see us ### Book a cosmetic consultation if: - Brown spots, redness or texture bother you - You'd like to look fresher and more even-toned ### Book a skin check soon if you notice: - A rough, scaly patch that doesn't go away - A spot that is new, changing, itching or bleeding - A sore that doesn't heal ## Protecting your skin from here on - Use broad-spectrum, water-resistant sunscreen, SPF 30 or higher, every day [6] - Reapply every two hours outdoors [6] - Wear a wide-brimmed hat, sunglasses and long sleeves when you can [6] - Seek shade, especially midday [6] - Use self-tanner instead of tanning [1] - Check your skin as often as your dermatologist recommends [6] ## Services we offer From skin checks to lasers and peels, these treat sun damage here. Pick one to see how it works. ## What treatment costs Skin checks and treatment of precancerous spots are medical care, handled differently from cosmetic treatments; our office walks you through what applies when you book. For cosmetic treatments, your consultation is free. Also calledPhotoagingSignsSpots, redness, texture, lines, precancers [2]Skin cancer1 in 5 Americans in their lifetime [3]Best preventionDaily SPF 30+, shade, clothing [6]WhereOur Fresno and Visalia offices ## Sun damage questions, answered **Q: Can sun damage be reversed?** Much of what you see can be improved. Lasers, IPL and peels can fade spots, calm redness and smooth texture. [5] **Q: Is a brown spot a sign of skin cancer?** Usually not, but some spots that look similar need a closer look. A skin check is the way to be sure. **Q: Does a tan protect my skin?** No. Every tan is a sign of damage and ages your skin early. [1] **Q: What are rough, scaly patches?** They may be actinic keratoses, precancerous spots caused by the sun that should be checked and treated. [2] **Q: How often should I have a skin check?** As often as your dermatologist recommends, based on your skin and history. [6] **Q: Is it too late to start sunscreen?** Never. Protecting your skin now helps your treatments last and lowers future damage. ## References [11 ways to reduce premature skin aging](https://www.aad.org/public/everyday-care/skin-care-secrets/anti-aging/reduce-premature-aging-skin) [Actinic keratosis: Overview](https://www.aad.org/public/diseases/skin-cancer/actinic-keratosis-overview) [Skin cancer statistics](https://www.aad.org/media/stats-skin-cancer) [Skin cancer types: Melanoma causes](https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma/causes) [How dermatologists treat sun-damaged skin](https://www.aad.org/public/everyday-care/sun-protection/sun-damage-skin/wrinkles-sun-damage-can-be-treated) [Actinic keratosis: Self-care](https://www.aad.org/public/diseases/skin-cancer/actinic-keratosis-self-care) Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Any new, changing or unusual spot should be examined. Cosmetic results vary from person to person, and each treatment has its own side effects and risks. Individual results may vary. ### Suspicious or Changing Moles ## Normal moles, and the ones worth a look Nearly every adult has a few moles, and most are common moles, which are harmless. [1] People with lighter skin tend to collect somewhere between 10 and 40 over a lifetime. [1] A normal mole has a steady look: one color, round, flat or slightly raised, and the same from month to month. [2] What earns a closer look is change, or a spot that simply doesn't look like your others. [2] Most of the time the answer is reassuring. Sometimes it's an early melanoma, and early is exactly when it's easiest to treat. ### Why it's worth a visit - A quick look answers a question that's easy to worry about - Changes are easier to judge with a trained eye and a lighted magnifier - If a mole needs to come off, it's done here - 10 to 40 Moles most people with lighter skin develop over a lifetime. [1] Having a lot is common, and a reason for regular checks, not worry. ## Why moles change, and why some matter And not every melanoma starts in a mole. About 7 in 10 begin as a new spot, [4] which is why a new mark that doesn't match your others deserves as much attention as an old mole that's changed. 1. Moles come and go with time Most moles appear in childhood and early adulthood, and how many you get runs in families. About 1 in 100 people is born with one. [1] 2. Some moles are atypical Atypical moles tend to be larger than a pencil eraser, oddly shaped and more than one color. [1] They aren't cancer, but having four or more raises the risk of melanoma. [1] 3. Sun and your history raise the stakes Sun exposure, fair skin, blistering sunburns, 50 or more moles and a family history of melanoma all make a changing mole more worth checking. [3] - 4 or more Atypical moles that raise the risk of melanoma, a reason to be on a regular checking schedule. [1] ## How to tell what kind of mole you're looking at Here's a simple way to sort what you're seeing. The third column is the one that says "come in." A common moleAn atypical moleA mole worth checking nowSizeUsually smallOften larger than a pencil eraser [1]Getting bigger [2]ShapeRound [2]Odd, not round [1]Changing shape [2]ColorOne color [2]More than one color [1]Changing color, or looks different from the rest [2]SurfaceFlat or slightly raised [2]Can varyItching, bleeding or crustingOver timeUnchanged month to month [2]Stable, but worth watchingEvolving [2] For the full list of the [warning signs of melanoma](/concerns/melanoma/), including the ABCDEs, see our melanoma page. ## Places moles hide AreaWhy it mattersScalpHair hides them completely. [2]Between the fingers and toesOne of the most routinely missed places. [2]Palms and solesMoles form here too, and few people think to check. [2]Under the nailsA dark streak or spot under a nail is worth a look. [2]Back and shouldersHard to see yourself, so a partner, a mirror or a skin check helps. The Paz difference ## A clear answer for every mole that has you wondering Most mole questions are settled in the exam room. Your provider looks closely with a lighted magnifier and tells you plainly whether it's fine. If you have many moles, [mole mapping](/treatments/mole-mapping/) photographs them so every future visit compares against a real picture instead of memory. When a mole needs a firmer answer, a biopsy settles it. When one needs to come off, it's [removed whole](/treatments/skin-cancer-excision/) and examined under a microscope, so the answer is certain. [5] Checking, tracking and removal all happen here. - Under a microscope Where every mole that's removed goes, so the answer comes from the lab, not a guess. [5] ## When to have a mole checked ### Book an appointment if a mole: - Is changing in size, shape or color [2] - Looks different from all your other moles [2] - Itches, bleeds or won't heal - Is new, especially if it doesn't match your other moles [2] ### Worth a regular skin check if you have: - 50 or more moles, or four or more atypical ones [1] - A family history of melanoma [3] - Fair skin, a history of blistering sunburns or tanning-bed use [3] If you're unsure whether what you're seeing counts as a change, come in. That's exactly what a mole check is for. ## Keeping an eye on your moles Most moles never need anything but an occasional look. A few habits make changes easy to spot. ### Between visits - Check your skin about once a month in good light, with a mirror for your back - Take a photo of any mole you're watching, with a ruler or coin for scale - Book a yearly total body exam, or more often if you're at higher risk - Never try to remove a mole at home. It can scar, cause infection, and delay a skin cancer diagnosis. [5] A mole that comes back after it's been removed should be seen right away. [5] ## Services we offer Checking, tracking and removing moles all happen in this practice. Pick one to see how it works. ## What treatment costs Mole checks, biopsies and medically needed removal are medical care, and they're handled differently from the cosmetic treatments on this site. Our office walks you through what applies to you when you book. How commonNearly every adult has a few moles [1]A normal moleOne color, round, and unchanged month to month [2]Worth checkingChanging, or different from your others [2]If one comes offIt's examined under a microscope [5]WhereOur Fresno and Visalia offices ## Mole questions, answered **Q: Are moles dangerous?** Almost never. Most are common moles and harmless. [1] The ones worth attention are the ones that change, and new spots that don't match the rest. **Q: Should I have my moles removed just in case?** Usually not. Most moles don't need treatment. [5] Removing a stable mole doesn't stop a melanoma from starting somewhere else, and most start as new spots. [4] Regular checks do more. **Q: Can I remove a mole at home?** Please don't. At-home removal and mole-removal products can scar, cause infection and delay a skin cancer diagnosis. [5] **Q: Is a new mole a bad sign?** Not necessarily, but a new spot that looks different from your others is worth showing us, since most melanomas start as new spots. [4] **Q: What happens if a mole looks suspicious?** A biopsy settles it. If the mole needs to come off, it's removed and examined under a microscope, and you'll hear the result. [5] **Q: I have a lot of moles. What should I do?** Get on a regular checking schedule. Mole mapping is especially useful, since it compares each visit's photos with the last. ## References [Moles: Who gets and types](https://www.aad.org/public/diseases/a-z/moles-types) [Moles: Signs and symptoms](https://www.aad.org/public/diseases/a-z/moles-symptoms) [Skin cancer types: Melanoma causes](https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma/causes) [A meta-analysis of nevus-associated melanoma: Prevalence and practical implications](https://pubmed.ncbi.nlm.nih.gov/28864306/) [Moles: Diagnosis and treatment](https://www.aad.org/public/diseases/a-z/moles-treatment) Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. A mole's appearance alone doesn't establish what it is; a diagnosis comes from tissue examined under a microscope. Not every changing mole is melanoma, and not every melanoma starts in a mole. Every removal leaves some mark, and healing varies by person and location. Report any new or changing spot between visits. Individual results may vary. ### Thin Lips ## Fuller lips, your way Lips can thin with age, and fine vertical lines can form above them, the ones lipstick likes to bleed into. And some people simply want more shape or fullness than they were born with. Both are common, and both are easy to address. Hyaluronic acid lip fillers add volume and shape, and some are also approved to soften the lines around the mouth. [1] ### What you can change - Lip fullness, subtle or noticeable - Lip shape and definition - Fine lines above the upper lip - Lips that have thinned over time - Up to 1 year How long results can last with Juvéderm Volbella XC or Juvéderm Ultra XC. [1] ## Why lips change 1. Natural shape Some lips are simply naturally thin. That's genetics, and a little filler can add the fullness you'd like. 2. Time With age, lips can lose some of their fullness and definition. 3. Sun and smoking Sun and smoking both speed up skin aging, including the fine lines around the mouth. [2] - Right away You see the change as soon as the treatment is done. ## Choosing your lip filler If you'd likeA good fitCan last up toA soft refresh and smoother lines above the lipJuvéderm Volbella XC1 year [1]More noticeable fullnessJuvéderm Ultra XC1 year [1] Providers also use [Botox](/treatments/botox/) for a "lip flip," relaxing the muscle above the upper lip so it turns out a little. Ask at your consultation whether it suits you. You don't have to choose before you come in. Tell us the look you want, and your [free consultation](/cosmetic/consultation/) matches it to the right gel. ## What lip filler can change AreaWhat changesUpper lipMore shape and a defined borderLower lipFuller, balanced with the upper lipAbove the lipFine vertical lines soften [1] ## Real results from patients - 2 fillers Juvéderm Volbella XC and Juvéderm Ultra XC, both approved for lips. [1] The Paz difference ## Lips that still look like yours Great lips come from proportion: how the upper and lower lip relate, and how they fit the rest of your face. We build a little at a time, and you can always add more at a follow-up. ## When to talk to us ### It's a good time if: - Your lips look thinner than they used to - Lipstick bleeds into fine lines above your lip - You'd like more shape or fullness - You're planning ahead for a wedding or event (give yourself at least a week) ## Keeping lips looking their best - Use a lip balm with sunscreen outdoors - If you smoke, stop [2] - Plan touch-ups before results fade completely - Book lip filler at least a week before a big event, so any swelling can settle ## Services we offer This is the most common treatment for this concern here. Pick it to see how it works. ## What treatment costs Cost depends on the filler and how much your lips need. Your consultation is free, and you'll know your plan and its cost before anything happens. TreatmentsJuvéderm Volbella XC, Ultra XC [1]ResultsRight awayLastsUp to 1 year [1]DowntimeLittle to none; swelling can last a few daysWhereOur Fresno and Visalia offices ## Lip filler questions, answered **Q: Will my lips look fake?** Not with a light hand. We build shape and fullness gradually, so your lips still look like yours. **Q: How long does lip filler last?** Up to a year with Juvéderm Volbella XC or Juvéderm Ultra XC. [1] **Q: Does it hurt?** These fillers contain a numbing medicine or are paired with numbing, so most people feel pressure more than pain. **Q: How swollen will I be?** Some swelling is normal for a few days. Book at least a week before any big event. **Q: Can it fix lipstick lines?** Yes. Juvéderm Volbella XC is approved to soften the lines around the mouth. [1] **Q: Can it be undone?** Yes. Hyaluronic acid filler can be dissolved if needed, and we can dissolve filler you had placed here. Ask us about it at your consultation. ## References [Lip Filler](https://www.juvederm.com/treatment-areas/lip-filler) [11 ways to reduce premature skin aging](https://www.aad.org/public/everyday-care/skin-care-secrets/anti-aging/reduce-premature-aging-skin) Content on this page is for educational purposes and is not a substitute for professional medical advice. Lip fillers are approved for specific uses in adults over 21, and whether one suits you depends on your consultation. Results are temporary and vary from person to person. Common side effects include swelling, bruising, redness, tenderness and lumps. Rare but serious risks include injection into a blood vessel. Individual results may vary. ### Unwanted Hair ## Hair you'd rather not manage Everyone has some body and facial hair, and how much bothers you is a personal choice. For many people it's the daily routine, the razor burn or the ingrown hairs that make them want a longer-lasting answer. [Laser hair removal](/treatments/laser-hair-removal/) can remove unwanted hair from the face and body safely and effectively. [1] ### Common reasons people come in - Tired of daily shaving - Ingrown hairs and razor bumps - Irritation from waxing - Hair on the face, chin or upper lip - Wanting smooth skin for summer or an event - 2 to 6 The number of laser treatments most people need. [2] ## Why hair grows where you don't want it 1. Genetics How much hair you have, and where, is largely inherited. 2. Hormones Hormones influence hair growth, which is why facial hair in women can keep returning. [1] 3. Medical conditions New or excessive hair growth, especially in a male pattern in women, can signal a hormone condition worth a medical visit. - Months to years How long most people see no hair on treated skin after their series. [2] ## Shaving, waxing or laser? ShavingWaxingLaser hair removalHow long it lastsA day or twoA few weeksMonths or even years [2]Ingrown hairsCommonCommonFewer over timeUpkeepDailyEvery few weeksOccasional maintenance visits [2] Laser works best on dark hair and lighter skin. [2] Your [free consultation](/cosmetic/consultation/) looks at your hair and skin and tells you what to expect. ## Areas people treat most AreaNotesFace, upper lip and chinMaintenance visits often needed for women [1]UnderarmsNo more daily shaving or stubbleBikini areaLess irritation from shaving and waxingLegs, back, chest and shouldersLarger areas, treated in the same way [1] ## Real results from patients - 10 to 25% The reduction in hair after the very first treatment. [2] The Paz difference ## Hair removal in a dermatology practice Unwanted hair is usually cosmetic, but sometimes it points to something medical. Because this is a dermatology practice, your visit can cover both: laser for the hair you want gone, and a medical look if the pattern suggests something more. ## When to talk to us ### It's a good time if: - You're tired of shaving, waxing or ingrown hairs - You want long-lasting results before summer ### See a doctor if you notice: - Sudden new hair growth on the face, chest or back - Hair growth along with irregular periods, acne or weight changes ## Between visits - Shave the area as directed; don't pluck or wax during laser treatment - Stay out of the sun and avoid tanning, indoors and out [3] - Skip self-tanners before visits [3] - Plan occasional maintenance visits to stay smooth [2] ## Services we offer This is the treatment for unwanted hair here. Pick it to see how it works. ## What treatment costs Cost depends on the size of the area and how many visits you need. Your consultation is free, and you'll know your plan and its cost before anything happens. TreatmentLaser hair removalTreatments neededUsually 2 to 6 [2]ResultsMonths to years without hair [2]Best candidatesDark hair, lighter skin [2]WhereOur Fresno and Visalia offices ## Unwanted hair questions, answered **Q: Is laser hair removal permanent?** On most areas of the body, yes. On a woman's face, hormones mean hair can return, so maintenance visits help. [1] **Q: Does it work on blond or gray hair?** Usually not well, because light hair has little pigment for the laser to find. **Q: Can I remove facial hair with laser?** Yes. The upper lip and chin are common areas. [1] **Q: How many treatments will I need?** Most people need 2 to 6. [2] **Q: Is excess hair ever a medical problem?** Sometimes. Sudden or male-pattern hair growth in women can be a sign of a hormone condition and is worth a medical visit. **Q: Does it hurt?** Most people compare it to a rubber band snapping against the skin, with cooling to keep it comfortable. ## References [Laser hair removal: Overview](https://www.aad.org/public/cosmetic/hair-removal/laser-hair-removal-overview) [Laser hair removal: FAQs](https://www.aad.org/public/cosmetic/hair-removal/laser-hair-removal-faqs) [Laser hair removal: Preparation](https://www.aad.org/public/cosmetic/hair-removal/laser-hair-removal-preparation) Content on this page is for educational purposes and is not a substitute for professional medical advice. Sudden or unusual hair growth can have a medical cause and should be evaluated. Laser results vary, and maintenance treatments may be needed. Individual results may vary. ### Unwanted Tattoos ## You're far from alone Tattoo regret is common, and the reasons are personal: a relationship that ended, a new job, a design that no longer feels like you, or simply wanting fresh space for new art. [Laser tattoo removal](/treatments/laser-tattoo-removal/) has largely replaced older methods because it removes ink more safely and in fewer treatments. [1] ### Common goals - Removing a tattoo completely - Lightening a tattoo for a cover-up - Fading part of a design - Clearing an old, blurred tattoo - Lighter each visit After each treatment, a tattoo should look lighter. [1] ## Why some tattoos take longer 1. Layers of ink Tattoo artists layer ink, and a laser can't safely break down every layer in one session. [1] 2. Colors No single laser removes every ink color, [1] so some colors fade more slowly. 3. Healing time Your skin needs to heal and your body needs time to flush the ink between visits. [1] - Weeks apart Sessions are spaced so your skin heals and your body clears the ink. [1] ## Two paths, both start with laser Your goalWhat to expectFull removalA series of sessions until the ink is as faded as possibleLighten for a cover-upFewer sessions, just enough for your artist to work overFade part of a designOnly the area you want changed is treated Your [free consultation](/cosmetic/consultation/) looks at your tattoo's size, colors and age and gives you an honest estimate. ## Tattoos people remove most AreaGood to knowArms and wristsOften removed for workBack and shouldersLarger designs take more sessionsAnkles and feetCan take longer to clearNeck and handsVisible spots many people want gone ## Real results from patients - Fewer visits Lasers remove tattoo ink in fewer treatments than older methods. [1] The Paz difference ## Your skin comes first Tattoo removal goes best when your skin heals well between visits. Here, your skin is looked at along with the ink, and your sessions are paced so it recovers fully each time. ## When to talk to us ### It's a good time if: - A tattoo no longer fits your life - You're planning a cover-up and need the old ink lighter - A tattoo has blurred or faded unevenly If a tattoo becomes raised, itchy, painful or bumpy, have it checked, since ink reactions sometimes need medical care. ## Getting the best results - Keep the area out of the sun between sessions - Follow your aftercare instructions and don't pick at blisters - Keep every appointment in your series, since each one removes more ink [1] - Skip tattoo removal creams; there's no evidence they work, and they can burn or scar [1] ## Services we offer This is the treatment for unwanted tattoos here. Pick it to see how it works. ## What treatment costs Cost depends on the size of the tattoo and how many sessions it needs. Your consultation is free, and you'll know your plan and its cost before anything happens. TreatmentLaser tattoo removalHow it worksBreaks ink into particles your body clears [1]SessionsA series, weeks apart [1]GoalsFull removal or lightening for a cover-upWhereOur Fresno and Visalia offices ## Tattoo questions, answered **Q: Can any tattoo be removed?** Most can be faded significantly. Results depend on the ink colors, depth and your skin. [1] **Q: How many sessions will it take?** It varies by tattoo. Your consultation gives you an estimate. **Q: Do removal creams work?** There's no evidence they remove tattoos, and many contain strong acids that can burn or scar. [1] **Q: Can I lighten a tattoo for a cover-up?** Yes. Fewer sessions are usually needed than for full removal. **Q: Will it scar?** When done carefully and with good aftercare, scarring is uncommon. **Q: Does it hurt?** Most people compare it to a rubber band snap. Numbing or cooling helps. ## References [Tattoo removal: Lasers outshine other methods](https://www.aad.org/public/cosmetic/hair-removal/laser-tattoo-removal) Content on this page is for educational purposes and is not a substitute for professional medical advice. Results vary, and some tattoos may not clear completely. Laser tattoo removal has its own side effects and risks, explained on the treatment page and at your consultation. Individual results may vary. ### Warts ## A common growth caused by a virus A wart is a common, non-cancerous skin growth caused by the human papillomavirus, or HPV. [1] Warts often appear on the hands or feet, though they can develop anywhere on the skin. [1] Most warts are harmless and will go away on their own if you have a healthy immune system, but that can take months or even years. [1] ### Common kinds of warts - Common warts: rough, raised bumps, often on fingers and hands - Plantar warts: on the bottom of the foot, sometimes painful to walk on - Flat warts: small, smooth and often in clusters on the face or legs - A few visits How many office treatments it usually takes to clear a wart. [1] ## How warts spread 1. A virus Warts are caused by HPV. [1] 2. Contact Warts are contagious. You can spread the virus to other people and to other parts of your body. [1] 3. Small breaks in the skin The virus gets in more easily through cuts, scrapes or skin that's been picked or shaved. 4. Your immune system A healthy immune system often clears warts on its own over time. [1] - Months to years How long a wart can take to go away on its own. [1] ## When a wart is worth treating It's reasonable to wait ifIt's worth treating ifThe wart is small and doesn't bother youIt hurts, bleeds or catches on thingsIt isn't spreadingIt's spreading or new ones keep appearingIt's not on a visible spotIt's on your face, hands or feet and bothers youYou have a healthy immune system [1]You want it gone quickly [1] If you want a wart gone quickly, office treatment usually clears it in a few sessions. [1] ## Where warts show up AreaWhat you might seeFingers and handsRough, raised common warts [1]Bottoms of the feetPlantar warts, sometimes with tiny black dots [1]Around the nailsWarts that can be stubborn to treatFace and legsFlat warts, often in clusters The Paz difference ## Make sure it's a wart, then clear it Some growths that look like warts are something else, including skin cancers in rare cases. Here, your provider confirms what it is first, then treats it in the office, and a [skin cancer screening](/treatments/skin-cancer-screening/) can be done in the same practice if anything looks unusual. - Non-cancerous Warts are harmless skin growths, even when they're stubborn. [1] ## When to see us ### Book an appointment if: - A wart hurts, bleeds, itches or changes - Warts are spreading or keep coming back - A wart is on your face or genitals - At-home treatments haven't worked - You have diabetes or a weakened immune system and have a wart on your foot If you're not sure it's a wart, have it checked. ## Helping prevent warts - Don't pick at warts, which can spread them to other skin - Wear flip-flops in locker rooms and pool areas - Keep your feet clean and dry - Don't share towels, razors or nail tools - Cover warts to avoid spreading them to others ## How we treat warts here Warts are treated in a regular medical visit. Your provider confirms the diagnosis and treats the wart in the office, often with cryotherapy, which freezes the wart so it scabs up and falls off. [2] Most warts need a few sessions, spaced 2 to 4 weeks apart. [2] See [Medical Dermatology](/medical-dermatology/) for what a medical visit covers. ## What treatment costs Wart treatment is medical care, and it's handled differently from the cosmetic treatments on this site. Our office walks you through what applies to you when you book. CauseHuman papillomavirus (HPV) [1]ContagiousYes [1]HarmfulNo, warts are non-cancerous [1]Office treatmentUsually a few sessions [1]WhereOur Fresno and Visalia offices ## Wart questions, answered **Q: Will a wart go away on its own?** Often, if your immune system is healthy, but it can take months to years. [1] **Q: Are warts contagious?** Yes. You can spread the virus to others and to other parts of your body. [1] **Q: How quickly can a wart be treated?** In the office, usually over a few treatment sessions. [1] Cryotherapy can be repeated every 2 to 4 weeks until the wart is gone. [2] **Q: What happens after cryotherapy?** A crust or blister on the treated skin is expected, and the area usually heals in 4 to 7 days. [2] **Q: Why do warts come back?** The virus can linger in nearby skin, so a wart may return or new ones may appear. Follow-up visits help. **Q: Can children get warts treated?** Yes. Warts are common in children, and treatment is chosen to suit their age. **Q: Should I cut or file a wart myself?** No. That can spread the virus and cause infection. Let your provider treat it. ## References [Warts: FAQs](https://www.aad.org/public/diseases/a-z/warts-overview) [Warts: Diagnosis and treatment](https://www.aad.org/public/diseases/a-z/warts-treatment) Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Growths that look like warts should be examined, and results vary from person to person. Individual results may vary. ## Treatments ### Belotero ## Softer lines, less tired eyes Belotero Balance (+) is a smooth hyaluronic acid gel. It's approved for two things: smoothing moderate to severe facial wrinkles and folds, like [smile lines](/concerns/fine-lines-wrinkles/), and adding volume beneath the eyes to improve a hollow, sunken look. [1] [Hollow under-eyes](/concerns/facial-volume-loss/) can make you look exhausted even after a good night's sleep. Filling that hollow softens the shadow it casts, and you look like yourself on a well-rested day. ### What you can change - Hollows and shadows under the eyes - Smile lines from nose to mouth - Other moderate to severe facial lines - Up to 18 months How long Belotero Balance (+) results can last. [1] ## Your Belotero appointment 1. Look closely We look at the under-eye area and your lines in good light, and plan where a little gel will make the most difference. 2. Comfort Belotero Balance (+) contains lidocaine, a numbing medicine, so the treatment gets more comfortable as it goes. [1] 3. The treatment Your provider places small amounts, checking the result as they go. Under-eyes take a delicate, careful hand. 4. Out the door You'll see the difference right away. Swelling or bruising is common, and most side effects resolve within one to four weeks. [1] - 2 approvals Facial wrinkles and folds, and hollows beneath the eyes. [1] ## Why under-eyes need a light touch The skin under the eyes is thin, and too much filler there shows. That's why under-eye treatment is about restraint: a small amount, placed well, softens a hollow without puffiness. What it helpsWhat it doesn't changeUnder-eye hollowsThe sunken look and the shadow it casts [1]Dark color from pigment in the skinSmile linesDeep creases from nose to mouth [1]Lines that only show when you move Lines that show only when you move usually respond better to Botox. We'll tell you which treatment fits each concern. ## Where Belotero makes the biggest difference AreaWhat changesUnder the eyesHollows fill in, so you look more rested. [1]Smile linesThe creases from nose to mouth soften. [1]Other facial foldsModerate to severe lines smooth out. [1] ## Real results from patients - Right away You see the difference as soon as the treatment is done. The Paz difference ## Restraint, where it matters most Under-eyes reward a careful plan and a light hand. We place a little at a time, check the result in good light, and stop while it still looks natural. You can always add more at a follow-up. And because you're in a dermatology practice, your plan can include more than filler. If another treatment would do more for you, you'll hear about it at your [free consultation](/cosmetic/consultation/). ## Is Belotero right for you? ### You're likely a good fit if you: - Have hollows under your eyes that make you look tired - Have smile lines or other facial lines that bother you - Are over 21 [1] ### Tell us before your appointment if you: - Have severe allergies with a history of anaphylaxis [1] - Are allergic to lidocaine or similar numbing medicines [1] - Tend to form large scars or keloids [1] - Are pregnant or breastfeeding ## After your appointment Most people go straight back to their day. Swelling, bruising, redness, pain or tenderness, firmness, itching and small lumps are the common side effects, and most resolve within one to four weeks. [1] ### For the first day or two - Use a cold pack for swelling - Sleep with your head slightly raised the first night - Skip strenuous exercise until the next day Serious problems are rare. The one that matters most is filler entering a blood vessel, which can affect vision or cause scarring. [1] Call us right away if an area turns pale, dusky or very painful, or if your vision changes. ## Concerns treated These are some of the most common concerns Belotero helps with here. Pick one to see how we can help. ## What treatment costs Cost depends on the areas you treat and how much each needs, so the fairest number comes from seeing your face. Your consultation is free, and you'll know your plan and its cost before anything happens. You'll find our [current offers](/promotions/) on their own page. TreatsFacial wrinkles and folds, under-eye hollows [1]ComfortContains lidocaine [1]ResultsRight awayLastsUp to 18 months [1]WhereOur Fresno and Visalia offices ## Belotero questions, answered **Q: Can filler really help under-eye circles?** It helps when the darkness comes from a hollow that casts a shadow. It won't change dark color that comes from pigment in the skin. We'll tell you which you have. **Q: How long does Belotero last?** Results can last up to 18 months. [1] **Q: Will I look puffy under my eyes?** Not if it's done with restraint. We place a small amount and build carefully. **Q: Does it hurt?** Belotero Balance (+) contains lidocaine, so most people feel pressure more than pain. [1] **Q: How soon can I go out?** Right away for most people. Under-eye bruising is common, so give yourself a week before a big event. **Q: How is it different from other fillers?** It's one of several hyaluronic acid fillers, each suited to different areas. Belotero Balance (+) is approved for both under-eye hollows and facial lines. [1] ## References [BELOTERO BALANCE® (+)](https://www.belotero.com/) Content on this page is for educational purposes and is not a substitute for professional medical advice. Belotero Balance (+) is approved for specific uses in adults over 21, and whether it suits you depends on your consultation. Results are temporary and vary from person to person. Common side effects include swelling, bruising, redness, pain, firmness, itching and lumps. Rare but serious risks include injection into a blood vessel, which can cause vision problems, stroke or permanent scarring. Individual results may vary. ### Botox ## Soften the lines your expressions leave behind Every frown, squint and raised eyebrow folds your skin the same way, thousands of times. Over the years, those folds become [lines that settle in with time](/concerns/fine-lines-wrinkles/). [2] Botox gives the muscles behind them a rest, and the skin on top smooths out. It's approved for four areas: the frown lines between your brows, forehead lines, crow's feet, and the vertical bands that run from the jaw down the neck. [1] You still move and you still look like you, just less tired and less stern. ### What you can change - The "11s" between your eyebrows - Horizontal lines across your forehead - Crow's feet at the corners of your eyes - Vertical neck bands, for a smoother neck and jawline - 24 to 48 hours When you may start to see results. The full effect shows at about 30 days. [1] ## Your Botox appointment 1. Watch you move Your provider asks you to frown, raise your brows and smile, and maps where your lines come from. Everyone's muscles are a little different, so the plan is too. 2. A few quick injections A very fine needle places small amounts into the muscles that cause the lines. Most people describe it as quick pinches. 3. Back to your day There's no downtime. You can go right back to what you were doing. 4. Watch it settle in Results can start in 24 to 48 hours and reach their full effect around 30 days. [1] We'll check in to make sure you love how it looks. - Up to 4 months How long results can last before a touch-up. [1] ## Lines from movement, or lines at rest? This is the question that decides the treatment, and it's easy to answer in a mirror. BotoxFillerBest forLines that show when you make an expressionLines and hollows that are there even when your face is stillHow it worksRelaxes the muscle behind the line [1]Adds volume under the line or hollowCommon areasFrown lines, forehead lines, crow's feet, neck bands [1]Smile lines, lips, cheeks, under-eyesWhen you see itStarts in 24 to 48 hours, full at 30 days [1]Right away Plenty of people use both: Botox for the lines that come and go, and [filler](/treatments/juvederm/) for the ones that stay put. We'll tell you which one your lines need. ## Where Botox makes the biggest difference AreaWhat changesBetween the browsThe "11s" relax, so you look less stern or worried. [1]ForeheadHorizontal lines smooth out for a fresher look. [1]Crow's feetThe lines at the corners of your eyes soften when you smile. [1]NeckThe vertical bands, or cords, that stand out on the front of your neck relax, for a smoother neck and jawline. [1] Providers also use Botox for the "bunny lines" that crinkle the sides of the nose, for fine lines around the lips, for a subtle "lip flip" that turns the upper lip out a little, and for a gummy smile, where the upper lip lifts high enough to show a lot of gum. Ask at your consultation whether one of these suits you. ## Real results from patients - 4 areas Frown lines, forehead lines, crow's feet and neck bands: the uses Botox Cosmetic is approved for. [1] The Paz difference ## Natural movement, softer lines The goal is a face that still moves and still looks like you. That comes from careful placement and a light hand: enough to soften the lines, never so much that your expressions go flat. And because you're in a dermatology practice, your plan can reach past Botox. If filler, a peel or a laser would do more for a particular line, you'll hear about it at your [free consultation](/cosmetic/consultation/). ## Is Botox right for you? ### You're likely a good fit if you: - Have lines between your brows, across your forehead or at your eyes that bother you - Notice neck bands when you tense your jaw - Want results with no downtime - Are comfortable with a few quick injections ### Tell us before your appointment if you: - Have a skin infection where you'd be treated [1] - Have had an allergic reaction to Botox or a similar product [1] - Have a muscle or nerve condition, or trouble swallowing or breathing - Are pregnant, breastfeeding or planning to be ## After your appointment Most people go straight back to their day. Small red bumps or a little bruising where the needle went in usually fade quickly. ### For the rest of the day - Skip rubbing or massaging the treated areas - Hold off on strenuous exercise - Keep your head upright for a few hours Side effects can include discomfort at the injection site, headache, neck pain, tiredness, and eye effects such as drooping eyelids or brows, blurred vision or dry eyes. [1] Rarely, the effect can spread beyond the injection site. Call us right away, or get medical help, if you have trouble swallowing, speaking or breathing, or new muscle weakness. [1] ## Concerns treated These are some of the most common concerns Botox helps with here. Pick one to see how we can help. ## What treatment costs Cost depends on the areas you treat and how much each one needs, so the fairest number comes from seeing your face. Your consultation is free, and you'll know your plan and its cost before anything happens. You'll find our [current offers](/promotions/) on their own page. TreatsFrown lines, forehead lines, crow's feet, neck bands [1]AppointmentQuick, with no downtimeResults start24 to 48 hours, full at about 30 days [1]LastsUp to 4 months [1]WhereOur Fresno and Visalia offices ## Botox questions, answered **Q: Will I look frozen?** Not with us. A light hand keeps your expressions moving, just without the deep lines. If anything, people say you look rested. **Q: How long does Botox last?** Up to four months, and then a touch-up keeps the look going. [1] **Q: When will I see results?** Many people start noticing a difference in 24 to 48 hours, with the full effect around 30 days. [1] **Q: Does it hurt?** Most people feel a few quick pinches. It's over in minutes. **Q: Can Botox treat other areas?** Botox Cosmetic is FDA-approved for frown lines, forehead lines, crow's feet and neck bands. [1] Providers also use it for bunny lines, lip lines, a lip flip and a gummy smile. Ask at your consultation whether one of these suits you. **Q: Botox or filler, which do I need?** If the line shows when you move, Botox. If it's there when your face is still, filler. Many people use both, and your consultation sorts it out. ## References [BOTOX® Cosmetic (onabotulinumtoxinA)](https://www.botoxcosmetic.com/) [11 ways to reduce premature skin aging](https://www.aad.org/public/everyday-care/skin-care-secrets/anti-aging/reduce-premature-aging-skin) Content on this page is for educational purposes and is not a substitute for professional medical advice. Botox Cosmetic is a prescription medicine approved for specific uses in adults, and whether it suits you depends on your consultation. Results are temporary and vary from person to person. Common side effects include injection-site discomfort, headache, neck pain, tiredness, dry mouth and eye effects such as drooping eyelids or brows. The effect of botulinum toxin may spread beyond the injection site and cause serious symptoms, including trouble swallowing, speaking or breathing. Individual results may vary. ### Dermaplaning ## Smooth, bright skin in one gentle pass Dermaplaning removes the peach fuzz from the surface of your skin, an exfoliating process that leaves skin a little smoother and brighter. [1] Taking away that layer of dead cells helps perk up a [dull complexion](/concerns/texture-dull-skin/) and can keep pores from clogging. [1] With the surface clear, your skin care can absorb better, and makeup may go on more smoothly. [1] ### What you'll notice - Softer, smoother skin [1] - A brighter look [1] - Makeup that goes on more smoothly [1] - Skin care that sinks in better [1] - Peach fuzz Gone, along with the dead skin cells that make skin look dull. [1] ## Your dermaplaning appointment 1. Cleanse Your skin is cleansed and dried so the blade glides smoothly. 2. Dermaplane A sterile blade is drawn lightly across your skin at a shallow angle, lifting away dead cells and fine hair. It feels like a gentle stroke, not a shave. 3. Soothe and protect A calming serum, moisturizer and sunscreen finish the treatment. 4. Or pair it Dermaplaning is often done right before a HydraFacial or peel, so the next step works on freshly exfoliated skin. - No thicker hair Trimming fine hair at the surface has no effect on how it grows back. [1] ## Two ways to enjoy dermaplaning On its ownAs an add-onWhat you getA focused exfoliating treatmentDermaplaning before your facial or peelBest forA quick refresh before an eventGetting more from the treatment that followsTimeA short visitA few extra minutes Your [free consultation](/cosmetic/consultation/) helps you decide which suits your skin and schedule. ## Where dermaplaning makes the biggest difference AreaWhat changesCheeksSmoother skin, less fuzzForeheadA brighter, even lookUpper lip and chinFine hair removed for smoother makeupJawlineSofter-feeling skin ## Real results from patients - Smoother makeup With fuzz and dead skin gone, makeup may go on more smoothly. [1] The Paz difference ## Exfoliation that's right for your skin Your treatment starts with a look at your skin, so dermaplaning is done when it will help most. If you're in the middle of a breakout, which dermaplaning can aggravate, [1] you'll get a better option for that day, and your plan can include acne care in the same practice. ## Is dermaplaning right for you? ### You're likely a good fit if you: - Have dull skin or visible peach fuzz - Want makeup to go on more smoothly - Want a quick refresh before an event - Want your skin care to work harder ### Tell us before your appointment if you: - Have active acne or breakouts [1] [2] - Have eczema, psoriasis or another skin condition on your face [2] - Have moles, skin tags or other growths in the treatment area [2] - Use prescription retinoids or have had a recent peel or laser treatment ## After your dermaplaning Your skin may feel a little irritated for a day or so. [1] Most people go right back to their day. ### For the next few days - Wear sunscreen every day - Keep skin care gentle; skip scrubs and strong actives - Moisturize well - Avoid picking or touching your face Rarely, infection, scarring or skin discoloration can occur. [2] Call us if you notice anything that worries you. ## Concerns treated This is the most common concern dermaplaning helps with here. Pick it to see how we can help. ## What treatment costs Cost depends on whether dermaplaning is on its own or an add-on. Your consultation is free, and you'll know your plan and its cost before anything happens. You'll find our [current offers](/promotions/) on their own page. RemovesDead skin cells and peach fuzz [1]Feels likeA gentle stroke across the skinDowntimeNone for most peoplePairs withHydraFacial, peels and other facialsWhereOur Fresno and Visalia offices ## Dermaplaning questions, answered **Q: Will my hair grow back thicker?** No. Trimming the hair above the skin has no effect on how it grows. [1] It can feel coarser briefly because the cut ends are blunt. **Q: Does it hurt?** No. Most people find it relaxing. **Q: Can I have it if I have acne?** Not during an active breakout, which dermaplaning can aggravate. [1] We'll suggest a better treatment for acne-prone skin. **Q: How often can I have it?** Your skin needs time to recover between treatments, [2] so most people come in every few weeks. **Q: Is it the same as shaving?** It's more precise. A professional blade removes dead skin cells along with fine hair, for a smoother, brighter surface. [1] **Q: Can I wear makeup the same day?** Yes, and it may go on more smoothly than usual. [1] ## References [Dermaplaning at home: benefits and how it works](https://health.clevelandclinic.org/dermaplaning-at-home) [Dermaplaning: what it is, benefits and side effects](https://my.clevelandclinic.org/health/treatments/22680-dermaplaning) Content on this page is for educational purposes and is not a substitute for professional medical advice. Dermaplaning is a cosmetic treatment and isn't right for active acne or some skin conditions; whether it suits you depends on your consultation. Results vary from person to person. Side effects can include mild irritation. Rare risks include infection, scarring and skin discoloration. Individual results may vary. ### DiamondGlow ## Exfoliate, extract and infuse, all at once DiamondGlow is a dermabrasion treatment that does three things in one pass. [1] A diamond tip gently removes the top layer of dead skin, suction lifts dirt and debris from your pores, and a SkinMedica serum is infused while your pores are open. [2] The result is skin that looks cleaner, smoother and brighter, a lift for [dull, rough skin](/concerns/texture-dull-skin/) and a great reset before an event. ### What you'll notice - Smoother, softer skin - Brighter, more even-looking tone - Cleaner-looking pores - A healthy glow that makeup sits well on - 3 in 1 Exfoliation, extraction and serum infusion in one step. [2] ## Your DiamondGlow appointment 1. Choose your serum Your consultant looks at your skin and picks one of five SkinMedica Pro-Infusion serums for what you'd like to improve. [1] 2. Exfoliate A diamond tip provides controlled exfoliation to remove the top layer of dead skin. [2] The tip and suction are matched to your skin. 3. Extract Suction lifts dirt and debris from your skin and pores for a deeper clean. [2] 4. Infuse Your serum goes in while your pores are open and most receptive. [2] - Minimal downtime You can return to your daily activities right after treatment. [1] ## Choose your DiamondGlow Every DiamondGlow exfoliates, extracts and infuses in one pass. The difference is the SkinMedica Pro-Infusion serum, chosen for your skin and what you'd like to improve, along with the diamond tip. SerumBest forTNS Advanced+Visible signs of aging: fine lines, wrinkles, loss of firmness, and uneven tone or textureHA5 Hydra CollagenDry, rough or dehydrated skin, for a plumper, dewier lookEven & CorrectDark spots, hyperpigmentation and uneven skin tonePore PurifyingCongested skin, visible pores, redness and marks left after breakoutsVitamin CDullness and sun damage, with antioxidant support ### DiamondGlow or HydraFacial? Both clean, exfoliate and hydrate. The difference is how they exfoliate. DiamondGlowHydraFacialExfoliationDiamond tip, physical dermabrasion [1] [2]Gentle resurfacing plus a mild peelFeels likeA light scratchy, stinging sensation [1]Gentle suction, very relaxingBest forSkin that wants a deeper polishNearly all skin types, including sensitive Not sure which to choose? Your [free consultation](/cosmetic/consultation/) helps you pick, and either can be paired with [add-ons](/treatments/treatment-add-ons/). ## Where DiamondGlow makes the biggest difference AreaWhat changesFaceSmoother, brighter skinNose and chinCleaner-looking poresNeckSofter textureChestA more even, polished look ## Real results from patients - Every 2 weeks How often you can have DiamondGlow, or as your provider suggests. [1] The Paz difference ## A facial chosen for your skin Your facial starts with a look at your skin, so the diamond tip, the suction and the serum all suit you. And if breakouts, spots or texture need more than a facial, your plan can reach to peels, lasers or medical care in the same practice. ## Is DiamondGlow right for you? ### You're likely a good fit if you: - Have dull, rough or congested skin - Want a deeper exfoliation than a classic facial - Want to look your best before an event - Want a treatment you can repeat regularly ### Tell us before your appointment if you: - Are pregnant or nursing [1] - Have any medical conditions [1] - Have irritated, broken or sunburned skin - Use prescription retinoids or other strong skin care ## After your DiamondGlow Your skin may feel a little tight, look slightly red or be mildly swollen for a short time. [1] Most people go right back to their day. ### For the next day or two - Wear sunscreen every day - Skip scrubs and strong actives such as retinoids - Keep your skin moisturized - Use the home care your consultant recommends ## Concerns treated These are some of the most common concerns DiamondGlow helps with here. Pick one to see how we can help. ## What treatment costs Cost depends on the treatment and any add-ons. Your consultation is free, and you'll know your plan and its cost before anything happens. You'll find our [current offers](/promotions/) on their own page. TypeDermabrasion facial with serum infusion [1]StepsExfoliate, extract, infuse [2]SerumsTNS Advanced+, HA5 Hydra Collagen, Even & Correct, Pore Purifying, Vitamin CDowntimeMinimal [1]How oftenEvery two weeks, or as suggested [1]WhereOur Fresno and Visalia offices ## DiamondGlow questions, answered **Q: Does it hurt?** Most people feel a light scratchy, stinging sensation during treatment. [1] It passes quickly. **Q: What's the diamond for?** The diamond tip does the exfoliating, polishing away the top layer of dead skin. [2] **Q: Can I wear makeup afterward?** You can, though your skin looks its best if you give it the rest of the day. **Q: How often can I have it?** Every two weeks, or as your provider suggests. [1] **Q: Which serum will I get?** One of five SkinMedica Pro-Infusion serums, chosen for your skin: TNS Advanced+ for signs of aging, HA5 Hydra Collagen for dryness, Even & Correct for dark spots, Pore Purifying for congestion, or Vitamin C for dullness. [1] **Q: Is it the same as microdermabrasion?** It's a form of dermabrasion, like microdermabrasion, with extraction and serum infusion added in the same step. [1] [2] ## References [DiamondGlow FAQ](https://www.diamondglow.com/faq) [DiamondGlow: The treatment](https://www.diamondglow.com/the-treatment) Content on this page is for educational purposes and is not a substitute for professional medical advice. DiamondGlow is a cosmetic treatment and isn't right for compromised skin; whether it suits you depends on your consultation. Results vary from person to person. Side effects can include a scratchy, stinging feeling during treatment and temporary tightness, redness or slight swelling. Individual results may vary. ### HydraFacial ## Everything your skin needs, in one visit Many facials focus on one thing. A HydraFacial cleanses, exfoliates, extracts and hydrates in a single treatment. [1] Gentle suction clears out your pores while serums soak in, so your skin looks cleaner, smoother and brighter from the first visit. It's gentle and suitable for nearly all skin types, [2] and it's a favorite before weddings, photos and big nights out. ### What you'll notice - Pores that look cleaner and less congested [1] - Softer-looking fine lines [1] - Fewer breakouts and less oil [1] - Smoother texture and more radiance for dull, uneven skin [1] - No downtime Walk out glowing and go straight back to your day. ## Your HydraFacial, step by step 1. Cleanse and exfoliate A gentle resurfacing step lifts away dead skin cells to reveal fresh skin underneath. [1] 2. Peel A mild, customized peel helps loosen what's clogging your pores. [1] 3. Extract Painless vortex suction cleans out pores without squeezing. [1] 4. Hydrate and protect Serums with antioxidants and hyaluronic acid soak in for the signature HydraFacial glow. [1] - Once a month How often many people come in to keep their skin glowing. [2] ## Choose your HydraFacial Every HydraFacial includes the core steps. The difference is what's added on top. TreatmentWhat it includesSignature (Express)The foundational treatment: cleanse, exfoliate, extract and hydrate [3]DeluxeThe Signature, plus a targeted booster serum and LED light therapy [3]PlatinumThe Deluxe, plus lymphatic drainage to reduce puffiness [3]Acne HydraFacialThe Signature, plus acne-focused steps for congestion, oil and breakouts, blue LED light and extra extraction timeWet Diamond HydraFacialThe Deluxe, plus Wet Diamond exfoliation: a diamond tip with a wet solution for deeper resurfacing Boosters are targeted serums for concerns like dehydration, congestion, uneven tone, redness, dark spots and signs of aging. [3] You can also pair your facial with [add-ons](/treatments/treatment-add-ons/), or ask about [DiamondGlow](/treatments/diamondglow/) for a deeper exfoliation. ## Where a HydraFacial makes the biggest difference AreaWhat changesNose and chinClogged pores and blackheads clear outCheeksSkin looks smoother and more evenForeheadOil and congestion are reducedWhole faceHydrated, glowing skin ## Real results from patients - Nearly all skin types A HydraFacial is gentle enough for dry, oily and everything in between. [2] The Paz difference ## A facial with a dermatology practice behind it Your facial is planned around your skin, not a set menu. If breakouts, dark spots or redness need more than a facial can do, your plan can reach to peels, lasers or medical care in the same practice. You'll hear about it at your [free consultation](/cosmetic/consultation/). ## Is a HydraFacial right for you? ### You're likely a good fit if you: - Want cleaner pores and a healthy glow - Have dull, congested or oily skin - Want a facial with no downtime before an event - Want a regular treatment to keep skin at its best ### Tell us before your appointment if you: - Are pregnant or nursing - Have a rash, active cold sore or sunburn on your face - Use prescription retinoids or other strong skin care - Have had a reaction to skin care ingredients ## After your HydraFacial Your skin may look a little pink for an hour or so. Most people head straight back to their day. ### For the next day or two - Skip scrubs and strong actives such as retinoids - Wear sunscreen every day - Give your skin a day before heavy makeup, if you can - Keep up the glow with the home care your consultant recommends ## Concerns treated These are some of the most common concerns a HydraFacial helps with here. Pick one to see how we can help. ## What treatment costs Cost depends on which HydraFacial you choose and any add-ons. Your consultation is free, and you'll know your plan and its cost before anything happens. You'll find our [current offers](/promotions/) on their own page. StepsCleanse, exfoliate, extract, hydrate [1]OptionsSignature, Deluxe, Platinum, Acne, Wet DiamondDowntimeNoneHow oftenAbout once a month [2]WhereOur Fresno and Visalia offices ## HydraFacial questions, answered **Q: Does it hurt?** No. Most people find it relaxing. The suction feels like a gentle vacuum. **Q: How long will my glow last?** Many people see a difference right away. Regular visits, about once a month, keep it going. [2] **Q: Can I wear makeup afterward?** You can, but your skin will look its best if you give it the rest of the day. **Q: Which HydraFacial should I choose?** The Signature is a great start. Deluxe adds a booster and LED light, and Platinum adds lymphatic drainage. [3] The Acne HydraFacial adds blue LED light and extra extraction time for breakouts, and the Wet Diamond adds a deeper diamond-tip exfoliation to the Deluxe. Your consultant can help you choose. **Q: Is it good for acne?** It can help clear congested pores and reduce oil. [1] The Acne HydraFacial adds acne-focused steps, blue LED light and extra extraction time, and your plan can include other acne care if you need it. **Q: Is it safe for sensitive skin?** It's gentle and suits nearly all skin types. [2] Tell us about any sensitivity so your serums can be chosen with care. ## References [How Does Hydrafacial Work?](https://www.hydrafacial.com/pages/how-it-works) [Frequently Asked Questions](https://www.hydrafacial.com/pages/frequently-asked-questions) [Treatment types](https://www.hydrafacial.com/treatment-types/) Content on this page is for educational purposes and is not a substitute for professional medical advice. A HydraFacial is a cosmetic treatment, and results vary from person to person. It is not a treatment for skin disease; persistent acne or other skin conditions may need medical care. Individual results may vary. ### IPL Photofacial ## Clearer, more even skin, one session at a time IPL uses a broad band of light to treat everything from rosacea to [sun damage](/concerns/sun-damage/). [1] The light is drawn to brown pigment and to the tiny red blood vessels near the surface, and it breaks them down so your body can clear them away. The result is fewer [sun spots](/concerns/hyperpigmentation/), less [redness](/concerns/redness-blood-vessels/) and a smoother, brighter look. It can also reduce the flushing of [rosacea](/concerns/rosacea/) and improve your skin's texture. [2] ### What it can improve - Brown spots and freckling from the sun - Blotchy or ruddy color [3] - Redness and flushing - Small visible blood vessels on the face - Uneven texture - 2 to 3 The number of IPL sessions many people need, followed by a yearly touch-up. [1] ## Your IPL appointment 1. Your consultation We look at your spots, your redness and your skin tone, check the medicines you take, and set your plan. Consultations are offered in Fresno and Visalia. 2. Preparing your skin A cool gel goes on the treatment area, and you'll wear protective eyewear. 3. Treatment The handpiece rests on your skin and delivers quick flashes of light. Most people feel a warm snap, like a rubber band. 4. Afterward Skin may look a little pink for a day or two. Brown spots often darken slightly, then flake away over the following days. - Once a year How often a maintenance session helps keep results after your series. [1] ## Light or laser for your redness? Both treat redness and visible blood vessels. They just go about it differently. IPL photofacialVBeam laserWhat it isA broad band of light [1]A pulsed dye laser tuned to blood vessels [1]Best forBrown spots and redness togetherRedness, broken blood vessels, red birthmarks [1]SessionsMore sessions, gentler on the skin [2]Fewer sessions [2] If your main concern is sun spots with some redness, IPL treats both at once. If it's redness alone, VBeam may get you there in fewer visits. We'll help you choose at your [free consultation](/cosmetic/consultation/). ## Where IPL makes the biggest difference AreaWhat changesFaceFewer sun spots, calmer redness, a more even tone [3]NeckLess of the blotchy color sun leaves behindChestFewer freckles and spots from years of sunHandsBrown spots fade for a younger look ## Real results from patients - SPF daily Sun protection every day protects your results and your skin. [3] The Paz difference ## Light treatments, planned with care Light treatments give the best results when they're planned around your skin. Your plan starts with a look at your skin tone, your spots and any medicines that make you sensitive to light, so every session is set for you. And with both IPL and VBeam here, you get the tool that fits your skin rather than the only one on hand. ## Is an IPL photofacial right for you? ### You're likely a good fit if you: - Have sun spots, freckling or uneven color - Have redness, flushing or small visible blood vessels - Want improvement with little downtime - Can protect your skin from the sun during and after your series ### Tell us before your appointment if you: - Take any medicine, cream or supplement that makes you sensitive to light - Have a tan or have recently used a self-tanner - Have darker skin, so your settings can be chosen with extra care - Are pregnant ## After your appointment Most people go right back to their day. Some pinkness, mild swelling or darkening of spots is normal and settles on its own. ### For the next few days - Use sunscreen every day, even when it's cloudy [3] - Let darkened spots flake off on their own - Skip scrubs and harsh products until your skin settles - Use a cool compress if your skin feels warm Light treatments can cause burns, lasting changes in skin color or scars, which is why careful settings matter. [2] Call us if you notice blistering or anything that worries you. ## Concerns treated These are some of the most common concerns IPL helps with here. Pick one to see how we can help. ## What treatment costs Cost depends on the area and how many sessions you need. Your consultation is free, and you'll know your plan and its cost before anything happens. You'll find our [current offers](/promotions/) on their own page. TreatsSun spots, redness, rosacea, visible blood vessels [1] [3]SessionsAbout 2 to 3, then yearly [1]DowntimeLittle to noneTreatmentOur Visalia officeConsultationsFresno or Visalia ## IPL questions, answered **Q: Is IPL a laser?** No. It uses a broad band of light rather than a single laser wavelength, [1] which lets it treat brown spots and redness in the same session. **Q: How many sessions will I need?** Many people need about two to three, then a yearly touch-up to keep results. [1] **Q: Does it hurt?** Most people feel a quick, warm snap with each flash. It's very manageable. **Q: Will my spots get darker first?** Often, yes. Treated spots can darken for a few days, then flake away. **Q: Can IPL help rosacea?** Yes. It can reduce flushing and improve your skin's texture. [2] **Q: Where can I have IPL?** Treatments are done at our Visalia office. You can have your consultation at either office. ## References [Skin conditions that lasers can treat](https://www.aad.org/public/diseases/a-z/skin-conditions-lasers-treat) [Rosacea: Diagnosis and treatment](https://www.aad.org/public/diseases/rosacea/treatment/diagnosis-treat) [How dermatologists treat sun-damaged skin](https://www.aad.org/public/everyday-care/sun-protection/sun-damage-skin/wrinkles-sun-damage-can-be-treated) Content on this page is for educational purposes and is not a substitute for professional medical advice. Whether IPL suits you depends on your skin and your consultation. Results vary from person to person, and maintenance sessions may be needed. Side effects can include redness, swelling and temporary darkening of spots. Rare risks include blistering, burns, lasting changes in skin color and scarring. Individual results may vary. ### Juvéderm ## Put a little back exactly where you want it Over the years, faces lose a little volume. Lips get thinner, cheeks sit a bit flatter, and the lines from your nose to the corners of your mouth settle in deeper. Juvéderm gives some of that back. It's a smooth gel made of hyaluronic acid, a substance your skin already makes, placed with a fine needle right where you'd like more fullness or a softer line. [4] Most people see the difference before they're out the door. [2] The collection covers [lips that have thinned](/concerns/thin-lips/), [cheeks that have flattened](/concerns/facial-volume-loss/), hollows under the eyes and at the temples, a chin that could use more shape, the smile lines around your nose and mouth, and a jawline that's lost its edge. [3] Each area gets the gel designed for it, which is why the results look like you and never like filler. ### What you can change - Lip fullness, from a soft refresh to a more noticeable pout - The little vertical lines above the lip that lipstick bleeds into - Cheek volume and lift - Hollows under the eyes or at the temples - The shape of your chin in profile - Smile lines from the nose to the corners of the mouth - A softer, less defined jawline - Right away You see the difference as soon as the treatment is done. Most swelling settles over the next few days. [2] ## Your Juvéderm appointment, start to finish 1. A real conversation first You tell us what's been bothering you in the mirror, and we look at your face together. Then we agree on a plan: which areas, which gels and how much. Holding back is always an option. 2. Comfort built in Every Juvéderm gel we use contains lidocaine, a numbing medicine, so the treatment gets more comfortable as it goes. [3] 3. The treatment itself Most filler appointments take 15 to 30 minutes. [2] Your provider places small amounts, checks the balance from every angle and adjusts before you're done. 4. Out the door Your new look is there right away. Some redness, swelling or bruising is normal, and it clears within 7 to 14 days, often sooner. [2] 5. Keeping it Juvéderm is temporary, so a touch-up keeps the look going. [2] How often depends on the area and the gel, and we'll give you a realistic timeline for yours. - 15 to 30 minutes The usual length of a filler appointment, done in one visit. [2] ## Pick the look, and we'll pick the gel Juvéderm is a family of gels, each made for a different part of the face, and that's why lips come out soft and a jawline comes out crisp. Here's how they line up with what you might want. You'd likeThe Juvéderm we useResults can last up toSoftly fuller lips and smoother lines around themVolbella XC1 year [3]More noticeable lip fullnessUltra XC1 year [3]Fuller, lifted cheeksVoluma XC2 years [3]Softer smile lines from nose to mouthVollure XC18 months [3]Deeper creases and folds, like smile linesUltra Plus XCVaries by person [3]A sharper, more defined jawlineVolux XC1 year [3]Brighter, less hollow under-eyesVolbella XC1 year [3]A stronger chin profileVoluma XC1 year [3]Fuller templesVoluma XC13 months [3] You don't have to know any of these names before you come in. That's our job, and it's a big part of why the results look natural. ## Where Juvéderm makes the biggest difference AreaWhat changesLipsMore shape and fullness, from barely there to noticeably plumper. [3]Around the mouthFine vertical lines soften, so lipstick stays put. [3]CheeksVolume returns high on the cheek, which lifts the whole midface. [3]Smile linesThe creases from nose to mouth relax, and you look less tired. [3]JawlineA crisper edge from ear to chin, in photos from every angle. [3]Under the eyesHollows soften, so you look more rested. [3]TemplesA smoother curve at the side of the forehead. [3]ChinBetter balance with your nose and jaw in profile. [3] ## Real results from patients - Up to 2 years How long cheek results with Voluma XC can last with optimal treatment. [3] The Paz difference ## An eye for natural Great filler is part anatomy and part eye for proportion. Before anyone treats one spot, we look at your whole face, because a little in the right place does more than a lot in the wrong one. Our taste runs natural. A conservative hand gives the most natural-looking result, and you can always add a little more at a follow-up. [2] Taking some away is harder. And because you're in a dermatology practice, your plan can reach past filler: if Botox or another treatment would do more for you, you'll hear about it. ## Is Juvéderm right for you? ### You're likely a good fit if you: - Want fuller lips or cheeks, softer smile lines, less hollow under-eyes or temples, or more shape at the chin or jawline - Want a change you can see the same day, with no surgery - Are 22 or older [1] - Like the idea of starting subtle and building from there ### Tell us before your appointment if you: - Have had a severe allergic reaction to anything, including lidocaine or a previous filler [3] - Are pregnant or breastfeeding, since filler's safety hasn't been established then [1] - Take a blood thinner or aspirin, or have an event coming up soon Not sure yet? A [free consultation](/cosmetic/consultation/) is the easiest way to find out, and there's no pressure to book anything. ## After your appointment Most people go straight back to their day. Expect some redness, swelling, tenderness or small bumps where the gel went in, and possibly a bruise. [3] These fade on their own within 7 to 14 days, often sooner. [2] ### For the first few days, do - Use a cold pack if you're swollen - Wait until the next day to exercise [2] - Book your follow-up so we can see how everything settled ### For the first few days, don't - Touch, press or massage the area for three days unless we've told you to [2] - Spend the first day in strong sun or heat, or drink alcohol Serious problems are rare. The one that matters most is filler entering a blood vessel, which is a big part of why training and anatomy matter so much. [1] Call us right away if an area turns pale, dusky or very painful, or if your vision changes. ## Concerns treated These are some of the most common concerns Juvéderm helps with here. Pick one to see how we can help. ## What treatment costs Cost depends on the areas you treat and how much gel each one needs, so the fairest number comes from seeing your face. Your consultation is free, and you'll know your plan and its cost before anything happens. You'll find our [current offers](/promotions/) on their own page. WhereOur Fresno and Visalia officesTreatsLips, cheeks, under-eyes, temples, chin, jawline, smile lines, lines around the mouthAppointment15 to 30 minutes [2]ComfortNumbing medicine built into the gel [3]ResultsRight away [2]LastsUp to 1 year or 2 years, by product [3] ## Juvéderm questions, answered **Q: How long does Juvéderm last?** It depends on the gel and the spot. Lip results can last up to a year, smile lines up to 18 months and cheeks up to two years with optimal treatment. [3] **Q: Does it hurt?** Most people describe pinches and pressure more than pain. The gel contains lidocaine to numb the area as the treatment goes. [3] **Q: Will I look overdone?** Not with us. We start conservatively, since a light hand looks most natural, and you can always add more at a follow-up. [2] **Q: Can Juvéderm be undone?** Yes. Because it's made of hyaluronic acid, it can be dissolved with an enzyme called hyaluronidase, which starts working almost immediately. [4] It's rarely needed, and we can do it for filler you had placed here. **Q: When can I go back to work?** Right away, for most people. You might see some swelling or a small bruise for a few days, and makeup can cover it. Wait until the next day to exercise. [2] **Q: Can I combine Juvéderm with Botox?** Yes, and many people do. Botox softens lines that come from movement, like frown lines, while Juvéderm adds volume and fills lines that stay put when your face is at rest. Your consultation will map out which one fits which area. ## References [Dermal Fillers (Soft Tissue Fillers)](https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/dermal-fillers-soft-tissue-fillers) [Fillers: FAQs](https://www.aad.org/public/cosmetic/wrinkles/fillers-faqs) [JUVÉDERM® Collection of Fillers: Important Safety Information and treatment-area pages](https://www.juvederm.com/) [Risks and rewards: What to know about dissolving filler](https://www.plasticsurgery.org/news/articles/risks-and-rewards-what-to-know-about-dissolving-filler) Content on this page is for educational purposes and is not a substitute for professional medical advice. Juvéderm fillers are FDA-approved for specific uses in adults over 21, and whether they suit you depends on your consultation. Results are temporary and vary from person to person, and touch-up treatments are needed to maintain them. Common side effects include redness, swelling, pain, tenderness, firmness, lumps or bumps, bruising, discoloration and itching. Rare but serious risks include injection into a blood vessel, which can cause skin damage, vision problems including blindness, or stroke. Individual results may vary. ### Kybella ## A smoother profile, without surgery Kybella is a prescription injection of deoxycholic acid. [1] Placed into the fat under the chin, it destroys fat cells there, which gradually softens [a double chin](/concerns/double-chin/). [1] It's approved only for fat under the chin. [1] That focus is the point: a cleaner jawline and profile, with no incisions. ### What you can change - Fullness under the chin - A profile that looks heavier than the rest of you - A softer line between the chin and neck - Up to 6 Treatments in a Kybella series, spaced at least a month apart. [1] Your plan may need fewer. ## How a Kybella series works 1. Map the area Your provider marks a grid on the fat under your chin so every injection lands in the right spot. 2. A series of small injections Small amounts go into the fat under the chin, spaced evenly across the marked area. [1] 3. Swelling, then change Swelling is the most common side effect and is expected after each session. [1] Results build gradually between visits. 4. Space it out Sessions are at least a month apart, up to six in total, until you're happy with your profile. [1] - 1 month The minimum time between Kybella treatments. [1] ## Two ways to a slimmer chin Fat under the chin can be treated a few ways here. Which fits depends on how much fat there is and whether loose skin is part of the picture. KybellaNeck liftBest forModerate to severe fullness from fat under the chin [1]Fat plus loose skin or neck bandsIncisionsNoneYesVisitsA series, a month apart [1]One procedureDowntimeSwelling after each session [1]Longer recovery If loose skin is what bothers you most, a [neck lift](/treatments/neck-lift/) may do more than Kybella. Your consultation sorts out which fits. ## What Kybella treats AreaWhat changesUnder the chinFat cells are destroyed, and fullness gradually decreases. [1] Kybella is approved only for the area under the chin. [1] ## Real results from patients - No incisions Kybella is a series of injections, with no surgery. The Paz difference ## The right approach for your chin A double chin can be fat, loose skin or both, and the best treatment depends on which. We look closely and tell you plainly whether Kybella is the right tool, or whether a neck lift would serve you better. Both are offered here. That honesty is the best part of a [free consultation](/cosmetic/consultation/). You leave knowing what will actually work. ## Is Kybella right for you? ### You're likely a good fit if you: - Have fullness under the chin that doesn't budge with diet or exercise - Prefer a nonsurgical option - Are an adult [1] - Have fairly firm skin under the chin, since Kybella treats fat, not loose skin ### Tell us before your appointment if you: - Have an infection in the treatment area [1] - Have had trouble swallowing [1] - Take a blood thinner or aspirin [1] - Have had surgery or treatment on your face, neck or chin ## After each session Swelling, bruising, pain, numbness, redness and firmness under the chin are the most common side effects, and they're expected after each session. [1] ### For the first few days - Use a cold pack for swelling and tenderness - Sleep with your head slightly raised - Plan around a few days of visible swelling Less commonly, Kybella can injure a nerve in the jaw, causing an uneven smile, or cause trouble swallowing. [1] Call us if you notice either, or if swelling makes it hard to swallow. ## Concerns treated Kybella is one of two ways we treat this concern. Pick it to see how we can help. ## What treatment costs Kybella is planned as a series, so cost depends on how many sessions you need. Your consultation is free, and you'll know your full plan and its cost before anything happens. You'll find our [current offers](/promotions/) on their own page. What it isA prescription injectable of deoxycholic acid [1]TreatsFat under the chin only [1]SeriesUp to 6 treatments, at least a month apart [1]DowntimeSwelling after each session [1]WhereOur Fresno and Visalia offices ## Kybella questions, answered **Q: How many treatments will I need?** Up to six, spaced at least a month apart. [1] Your provider will tell you how many you're likely to need. **Q: Is the swelling bad?** Swelling is the most common side effect after each session. [1] Plan around a few days of it before events. **Q: Can Kybella treat other areas?** No. It's approved only for fat under the chin. [1] **Q: Will it tighten loose skin?** Kybella treats fat, not skin. If loose skin is the main concern, a neck lift may be the better choice. **Q: Does it hurt?** Most people feel some burning and tenderness during and after. A cold pack helps. ## References [KYBELLA (deoxycholic acid) injection: Prescribing Information](https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/206333s005lbl.pdf) Content on this page is for educational purposes and is not a substitute for professional medical advice. Kybella is a prescription medicine approved only for fat under the chin in adults, and whether it suits you depends on your consultation. Results vary from person to person. Common side effects include swelling, bruising, pain, numbness, redness and firmness. Less common risks include nerve injury in the jaw causing an uneven smile, and trouble swallowing. Individual results may vary. ### Laser Hair Removal ## Smooth skin, without the daily routine Shaving lasts a day. Waxing lasts a few weeks. Laser hair removal works on the follicle itself, and most people see no hair on the treated skin for several months or even years. [1] When a little grows back, it's usually finer and lighter. It's a quick, practical way to take [unwanted hair](/concerns/unwanted-hair/) off your to-do list, with almost no downtime. [1] ### Popular areas - Upper lip, chin and face - Underarms - Bikini area - Legs - Back, chest and shoulders - Neck - 10 to 25% The reduction in hair you can expect after your very first treatment. [1] ## Your laser hair removal plan 1. Your consultation We look at your skin tone and hair color, talk through the areas you want treated, and set your plan. 2. Treatment The laser's light is drawn to the pigment in the hair and travels down to the follicle. Each pulse covers a small area, and a cooling burst of air or spray keeps your skin comfortable. 3. A series of visits Hair grows in cycles, and the laser works best on hair in its active growth stage. That's why it takes a series of visits, spaced weeks apart, to catch every follicle. 4. Upkeep Once you've finished your series, an occasional maintenance visit keeps the area smooth. [1] - 2 to 6 The number of treatments most people need. [1] ## Two wavelengths, one laser We use the GentleMax Pro, which combines two laser wavelengths in one device: a 755 nm Alexandrite laser and a 1064 nm Nd:YAG laser. Having both lets your provider match the settings to your skin tone and hair, so more people can be treated safely and effectively. What it means for youTwo wavelengthsSettings matched to your skin tone and hairBuilt-in coolingMore comfortable pulsesLarge treatment area per pulseQuicker visits for legs and backs Your consultation confirms which setting suits you. If laser isn't the best choice for your hair color, you'll hear that up front. ## Where laser hair removal works best AreaWhat changesFaceSmoother upper lip and chin. On a woman's face, hormones mean upkeep visits are often needed. [2]UnderarmsNo more daily shaving or stubbleBikini areaFewer ingrown hairs and less irritationLegsSmooth legs through every seasonBack, chest and shouldersLess hair across larger areasNeckA cleaner neckline ## Real results from patients - No downtime Most people go straight back to their day after treatment. [1] The Paz difference ## A laser practice inside a dermatology practice Great laser results start with understanding your skin. Here, your plan starts with a careful look at your skin tone, your hair and any medicines you take, so the settings fit you and your skin stays comfortable from the first pulse to the last. And if something else would serve you better, you'll hear about it at your [free consultation](/cosmetic/consultation/). ## Is laser hair removal right for you? ### You're likely a good fit if you: - Have dark hair; laser works best on dark hair and lighter skin [1] - Are tired of shaving, waxing or ingrown hairs - Can keep the area out of the sun during your series - Are happy to come back for a series of visits ### Tell us before your appointment if you: - Have taken isotretinoin for acne, or take any other medicine, including aspirin [3] - Get cold sores, if you're treating near the mouth - Have a tan, or have recently used a self-tanner - Are pregnant Blond, red, gray and white hair has little pigment for the laser to find, so it usually responds poorly. Your consultation will tell you where you stand. ## Before and after your visits ### Before - Don't tan, outdoors or indoors [3] - Skip self-tanners [3] - Wear broad-spectrum, water-resistant sunscreen, SPF 30 or higher, every day [3] - Shave the area as instructed, but don't pluck or wax, so the root is there for the laser ### After - Keep the treated skin out of direct sun [1] - No tanning beds or sun lamps [1] - Use a cool compress if the area feels warm Discomfort, swelling and redness are the common side effects, and they usually last 1 to 3 days. [1] Rarely, blistering, cold sore outbreaks, infection, scarring, or lightening or darkening of the skin can occur. [1] Call us if you notice any of these. ## Concerns treated This is the most common concern laser hair removal treats here. Pick it to see how we can help. ## What treatment costs Cost depends on the size of the area and how many visits you need. Your consultation is free, and you'll know your plan and its cost before anything happens. You'll find our [current offers](/promotions/) on their own page. Our laserGentleMax Pro (755 nm and 1064 nm)TreatmentsUsually 2 to 6 [1]First visit10 to 25% less hair [1]DowntimeGenerally none [1]WhereOur Fresno and Visalia offices ## Laser hair removal questions, answered **Q: Is laser hair removal permanent?** On most areas of the body, yes. On a woman's face, hormones mean hair can return, so upkeep visits help. [2] **Q: How many treatments will I need?** Most people need 2 to 6, [1] spaced weeks apart. Your plan depends on the area and your hair. **Q: Does it hurt?** Most people compare it to a quick snap of a rubber band. Built-in cooling keeps each pulse comfortable. **Q: Can I shave between visits?** Yes. Shaving is fine. Skip plucking and waxing, which remove the root the laser needs. **Q: Does it work on darker skin?** Laser works best on light skin and dark hair. [1] With two wavelengths, our laser can be set for a wider range of skin tones. Your consultation confirms what's safe for you. **Q: Is there downtime?** Generally no. [1] Some redness and swelling can last a day or so. ## References [Laser hair removal: FAQs](https://www.aad.org/public/cosmetic/hair-removal/laser-hair-removal-faqs) [Laser hair removal: Overview](https://www.aad.org/public/cosmetic/hair-removal/laser-hair-removal-overview) [Laser hair removal: Preparation](https://www.aad.org/public/cosmetic/hair-removal/laser-hair-removal-preparation) Content on this page is for educational purposes and is not a substitute for professional medical advice. Whether laser hair removal suits you depends on your skin, your hair and your consultation. Results vary from person to person, and maintenance treatments may be needed. Common side effects include discomfort, swelling and redness. Rare risks include blistering, cold sore outbreaks, infection, scarring and changes in skin color. Individual results may vary. ### Laser Tattoo Removal ## Fade the ink, one visit at a time When the laser's light hits the ink, it shatters it into tiny particles, and your body gradually flushes them away. [1] After each treatment, the tattoo should look lighter. [1] Lasers have largely replaced older methods such as sanding or cutting the tattoo out, because they remove ink more safely and in fewer treatments. [1] Whether you want [a tattoo you've outgrown](/concerns/unwanted-tattoos/) gone completely or faded enough for a cover-up, laser is the place to start. Here, that laser is the Candela PicoWay, a picosecond laser FDA-cleared to remove tattoos in black, brown, blue, green, purple, red, orange and yellow ink. [2] It's the same laser behind our [PicoWay Resolve](/treatments/picoway-resolve/) skin treatments. ### Good reasons to come in - Removing a tattoo completely - Fading a tattoo before a cover-up - Lightening part of a design - Clearing an old or blurred tattoo - Lighter each visit After each treatment, your tattoo should look lighter. [1] ## Your tattoo removal plan 1. Your consultation We look at the tattoo's size, colors and age, and your skin, and give you a realistic plan. 2. Treatment You'll wear eye protection, and the area can be numbed or cooled first. The laser moves across the tattoo in quick pulses. Each session takes only minutes. 3. Healing between visits Your skin needs time to heal, and your body needs time to flush out the ink. [1] That's why sessions are spaced weeks apart. 4. Repeat until you're happy Tattoo artists layer ink, and a laser can't safely break down every layer in one session, [1] so the tattoo fades over a series of visits. - Weeks apart Sessions are spaced to let your skin heal and your body clear the ink. [1] ## Why every tattoo fades differently No two tattoos respond the same way. These are the things that shape how many visits you'll need. FactorHow it mattersInk colorsNo single wavelength removes every color, [1] so the PicoWay uses different wavelengths for different inks [2]Size and densityLarger, more heavily inked designs need more sessionsAmateur or professionalProfessional tattoos are usually inked deeper and more denselyAge of the tattooOlder tattoos have often faded some alreadyWhere it is on your bodyAreas with good circulation tend to clear ink faster Your [free consultation](/cosmetic/consultation/) looks at your tattoo and gives you an honest estimate. ## Where tattoos can be treated AreaGood to knowArms and shouldersAmong the most common areas treatedBack and chestLarger designs take more sessionsLegs and anklesAreas farther from the heart can take longer to clearHands, wrists and neckVisible spots, often removed for work ## Real results from patients - Fewer visits Lasers remove tattoo ink in fewer treatments than older methods. [1] The Paz difference ## Tattoo removal in a dermatology practice Tattoo removal goes best when your skin is part of the plan. Here, your plan starts with a careful look at your skin as well as the ink, and the whole series is planned so your skin heals well between visits. ## Is laser tattoo removal right for you? ### You're likely a good fit if you: - Want a tattoo removed or faded for a cover-up - Can come in for a series of visits, weeks apart - Can keep the area out of the sun during treatment - Have realistic expectations about the time it takes ### Tell us before your appointment if you: - Have a tan, or have recently used a self-tanner - Take any medicine that makes you sensitive to light - Have had a reaction to your tattoo ink - Tend to form thick or raised scars - Are pregnant ## After your appointment The area will look and feel like a mild sunburn. Some swelling, redness or blistering is normal as your skin heals. ### While you heal - Keep the area clean and covered as instructed - Use ice to soothe swelling - Apply the ointment we recommend - Don't pick or pop blisters - Keep the area out of the sun Some people get light or dark spots on the skin, which tend to fade within 6 to 12 months. [1] Rarely, scarring, texture changes, burns or infection can occur. [1] Call us if the area becomes very painful, hot or swollen. ## Concerns treated This is the most common concern laser tattoo removal treats here. Pick it to see how we can help. ## What treatment costs Cost depends on the size of the tattoo and how many sessions it needs. Your consultation is free, and you'll know your plan and its cost before anything happens. You'll find our [current offers](/promotions/) on their own page. LaserCandela PicoWay, a picosecond laser [2]How it worksShatters ink into particles your body clears [1]SessionsA series, weeks apart [1]Each visitOnly minutesHealingLike a mild sunburnWhereOur Fresno and Visalia offices ## Tattoo removal questions, answered **Q: How many sessions will I need?** It depends on the tattoo's size, colors and depth. Most tattoos need many sessions, [1] and your consultation gives you an estimate. **Q: Can every tattoo be removed completely?** Results vary with the ink and your skin. Some colors are more stubborn, [1] and your consultation will tell you what to expect. **Q: Does it hurt?** Most people compare it to a rubber band snapping against the skin. Numbing or cooling makes it more comfortable. **Q: Do tattoo removal creams work?** There's no evidence they can remove a tattoo, and many contain strong acids that can burn or scar your skin. [1] **Q: Will it leave a scar?** When done carefully, scarring is uncommon. Following your aftercare instructions helps your skin heal well. **Q: Can I fade a tattoo for a cover-up?** Yes. A few sessions can lighten the ink enough for your artist to work with. ## References [Tattoo removal: Lasers outshine other methods](https://www.aad.org/public/cosmetic/hair-removal/laser-tattoo-removal) [510(k) Premarket Notification K220853: PicoWay Laser System](https://www.accessdata.fda.gov/cdrh_docs/pdf22/K220853.pdf) Content on this page is for educational purposes and is not a substitute for professional medical advice. Whether laser tattoo removal suits you depends on your skin, your tattoo and your consultation. Results vary, and some tattoos may not clear completely. Side effects can include redness, swelling, blistering and temporary light or dark spots. Rare risks include scarring, texture changes, burns and infection. Individual results may vary. ### Mini Facelift ## A firmer jawline, a fresher face As the years add up, facial skin relaxes and sags, and jowls form along the cheeks and jaw. [1] A mini facelift focuses on those early to moderate changes in the lower face, lifting and firming so the jawline looks defined again. It won't change who you are. A facelift doesn't alter your fundamental appearance or stop the aging process, and it isn't meant for fine lines or sun damage on the surface of the skin. [1] What it does is take the heaviness out of the lower face. ### What you can change - Early jowls along the jaw - A jawline that's lost its definition - Mild to moderate loose skin in the lower face - Sagging skin and early jowls that make you look tired - Early to moderate The stage of lower-face aging a mini facelift is designed for. ## How a mini facelift works 1. Your consultation Your surgeon looks at your face, your skin and your goals, and talks you through whether a mini facelift is the right tool, or whether something else would serve you better. 2. A plan made for your face The procedure is customized to your anatomy, so the lift looks natural from every angle. 3. The surgery Loose tissue in the lower face is lifted and firmed, and extra skin is trimmed, with incisions planned to heal as discreetly as possible. 4. Recovery A bandage may be placed to reduce swelling and bruising, and you'll go home with specific instructions for care and follow-up. [3] - Customized Every mini facelift is planned around your own anatomy and goals. ## Choosing the right lift Lower-face aging can be skin, fat, volume or all three. The right plan depends on which. If your main concern isA good fit may beEarly jowls and a softening jawlineMini faceliftLoose neck skin, fullness under the chin or neck bandsNeck lift, alone or with a mini faceliftLost volume in the cheeksA filler like JuvédermFine lines or sun damage on the skin's surfaceSkin treatments, since a facelift doesn't change skin texture [1] Many people combine approaches. Your consultation maps out what will make the biggest difference for you. ## What a mini facelift improves AreaWhat changesJawlineA crisper line from ear to chin.JowlsEarly jowls are lifted back up. [1]Lower cheeksRelaxed skin is firmed. [1]Overall contourA fresher, more balanced lower face. ## Real results from patients - Still you A facelift doesn't change your fundamental appearance. It refreshes it. [1] The Paz difference ## Natural results, planned with care The best facelift is the one nobody can spot. Our approach is built around natural-looking results that keep your own features, planned for your face rather than from a template. And because this is a dermatology practice, your plan can include the skin itself. A lift repositions tissue; skin treatments take care of texture and tone. Together, they do more than either alone. ## Is a mini facelift right for you? ### You're likely a good fit if you: - Have early jowls or a softening jawline - Have mild to moderate loose skin in the lower face - Are in good overall health and don't smoke - Want a natural refresh rather than a dramatic change ### Tell us at your consultation if you: - Take blood thinners, aspirin or supplements that affect bleeding - Smoke or vape - Have high blood pressure, diabetes or a bleeding disorder - Have had facial surgery before ## Recovery and risks After surgery, a bandage may be placed to reduce swelling and bruising, and small tubes may drain fluid for a short time. You'll get specific instructions for care, medicines and follow-up. [3] Bruising and swelling usually last two to three weeks. After a less invasive procedure like a mini facelift, most people return to work in five to seven days, and strenuous exercise waits at least three weeks. [4] ### While you heal - Keep your head raised when resting - Follow your care and medication instructions closely - Avoid strenuous activity until your surgeon clears you - Keep every follow-up visit Like any surgery, a facelift has risks, including anesthesia risks, bleeding, infection, fluid collection, facial nerve injury with weakness, numbness, poor wound healing, prolonged swelling, hair loss at the incisions, skin irregularities, unfavorable scarring and results that may need revision. [2] Your surgeon will go through each of these with you. ## Concerns treated This is the most common concern a mini facelift treats here. Pick it to see how we can help. ## What treatment costs Cost depends on your plan, so the fairest number comes from your consultation. You'll know your full plan and its cost before you decide. A consultation with a medical provider is $80, and it goes toward your surgery if you go ahead. You'll find our [current offers](/promotions/) on their own page. What it treatsEarly to moderate lower-face agingFocusJawline, jowls, loose lower-face skinTime off workUsually five to seven days [4]ApproachCustomized to your anatomyWhat it won't changeFine lines or sun damage on the skin [1]WhereOur Fresno and Visalia offices ## Mini facelift questions, answered **Q: What's the difference between a mini facelift and a full facelift?** A mini facelift focuses on early to moderate changes in the lower face and jawline. A full facelift addresses more advanced aging across more of the face and neck. **Q: Will I look different?** You'll look refreshed, not like someone else. A facelift doesn't change your fundamental appearance. [1] **Q: Does it get rid of wrinkles?** It lifts sagging skin and jowls. Fine lines and sun damage on the surface respond to skin treatments, which can be part of your plan. [1] **Q: How long is recovery?** Most people are back at work in five to seven days. Bruising and swelling fade over two to three weeks, and it can take a few months for your face to feel fully back to normal. Your surgeon sets your exact timeline. [4] **Q: Can I combine it with a neck lift?** Yes. When the neck is part of the picture, the two are often planned together. **Q: How long do results last?** A lift sets the clock back, and your face keeps aging naturally from there. [1] ## References [Facelift](https://www.plasticsurgery.org/cosmetic-procedures/facelift) [Facelift safety](https://www.plasticsurgery.org/cosmetic-procedures/facelift/safety) [Facelift recovery](https://www.plasticsurgery.org/cosmetic-procedures/facelift/recovery) [Facelift (rhytidectomy): what is it, recovery and what to expect](https://my.clevelandclinic.org/health/treatments/11023-facelift) Content on this page is for educational purposes and is not a substitute for professional medical advice. A mini facelift is surgery, and whether it suits you depends on your consultation. Results vary from person to person, and the face continues to age. Risks include anesthesia risks, bleeding, infection, fluid collection, facial nerve injury, numbness, poor wound healing, prolonged swelling, hair loss at the incisions, skin irregularities, scarring and the possible need for revision. Individual results may vary. ### Mohs Surgery ## The smallest wound that still gets all of it Most skin cancers are found after [a biopsy](/treatments/skin-cancer-screening/) confirms what a spot really is. From there, the question is how to remove every cancer cell while keeping as much healthy skin as you can. On your face, that difference is measured in millimeters. Mohs answers it by working in thin layers. Your surgeon removes the visible cancer and a thin rim around it, then examines that tissue under the microscope before deciding whether to take any more. [1] Only skin that still shows cancer comes out. Everything else stays. [1] Most people who have Mohs are being treated for [basal cell carcinoma](/concerns/basal-cell-carcinoma/) or squamous cell carcinoma. It's recommended most when the cancer is large or aggressive, has come back after treatment, or sits where there's little tissue beneath the skin, like the eyelid, nose, ear, scalp, hand or foot. [1] A slower version is also used for one kind of [early melanoma](/concerns/melanoma/). [1] ### What this covers - Removal of basal cell and squamous cell cancers, one checked layer at a time - Same-day processing of every layer in our own lab - Repair of the wound, usually the same day [2] - A follow-up visit booked before you leave - Skin checks afterward, because one skin cancer makes the next check more important - Up to 99% The success rate reported for Mohs surgery, the highest of any skin cancer treatment. [2] ## How a Mohs surgery unfolds ![Dr. Paz and a medical assistant at work during a Mohs procedure](https://www.pazderm.com/wp-content/uploads/2026/09/mohs-surgery-close.webp) 1. Numbing and the first layer The area is numbed with local anesthetic, so you're awake and comfortable. Your surgeon removes the visible cancer along with a thin layer of surrounding skin. [1] 2. Into the lab, down the hall That layer goes straight to our in-house lab, where it's prepared for the microscope the same day. You're bandaged and wait comfortably in the meantime. [1] 3. Reading the edges The layer is examined under the microscope, and any cancer cells left at the edges are mapped to the exact spot. [1] 4. Another layer, only where needed If cancer is still there, a thin layer is taken from that spot alone. The cycle repeats until no cancer cells are seen. [1] 5. Repair Once the edges are clear, the wound is repaired, in most cases that same day. [2] Some heal nicely on their own, some need stitches, and a few need a graft or flap. [1] - Layer by layer Each layer is checked under the microscope while you wait, and your surgeon stops as soon as no cancer cells remain. [1] ## Know the edges are clear before you go home With [a standard excision](/treatments/skin-cancer-excision/), the cancer comes out along with some of the skin around it, and the tissue is sent to a lab. If the lab finds cancer cells at the edges, you may need more treatment. [4] With Mohs, you don't go home until each layer has been checked, so that answer comes during the same visit. [4] Standard excisionMohs surgeryWhen the edges are checkedAfter you go home, once the lab reports back [4]While you wait, before any more skin is taken [1]How much skin is removedThe cancer plus some skin around it [5]Only skin that still shows cancer [1]If cancer remains at the edgeMore treatment, often another excision or Mohs [4]Another thin layer, the same day [1] Standard excision is the most common treatment for basal cell carcinoma, and many early ones are cured with it. [4] Your surgeon will tell you which approach fits yours. ## Where Mohs makes the biggest difference AreaWhy Mohs is often the choiceNoseLittle tissue to spare, and every millimeter shows. [1]EyelidsThin skin that has to keep working as well as look right. [1]EarsThin skin over cartilage, where saving tissue protects the ear's shape. [1]ScalpLittle tissue between the skin and the skull. [1]Hands and feetLittle tissue beneath the skin, and a scar there has to bend and move. [1]Cancers that came backA cancer that returned after treatment is one of the main reasons Mohs is recommended. [1] The Paz difference ## Fellowship-trained, with the lab under the same roof Mohs is its own specialty. A Mohs fellowship adds one to two years of training after dermatology residency, with at least 500 Mohs cases done under supervision. [3] Our surgeon completed that fellowship and is board-certified in dermatology. The lab is part of the practice, not an outside service. That keeps the day moving: a layer comes out, it's prepared down the hall, and the answer is back while you wait. And because Mohs is offered at both offices, a Visalia patient doesn't have to drive to Fresno for it. ## When Mohs is the right call ### Mohs is often recommended when a skin cancer: - Is a basal cell or squamous cell carcinoma in an area with little tissue beneath it, like the eyelid, nose, ear, scalp, hand or foot [1] - Is large or aggressive [1] - Was treated before and has come back [1] - Is lentigo maligna, an early melanoma that stays near the surface of the skin [1] Mohs works on one skin cancer at a time, or a few that sit close together. [1] ### Worth telling us before surgery: - Any blood thinner, including aspirin, at least a week ahead - Any allergies or sensitivities, including to anesthetics or tape - Any over-the-counter medicines or supplements you take - Whether the site is near your eyes or mouth, so you can bring a case for contacts or dentures None of this needs sorting out before you call. Your consultation covers it, and you'll leave with written instructions. ## The day of surgery, and the days after Plan to spend a good part of the day with us, since each layer takes time to process. Eat a meal beforehand, bring your usual medicines, and wear a shirt that buttons in front. Refreshments are on hand while you wait. Bring a friend or family member, and arrange a ride home. A bulky pressure bandage stays on for the first 24 to 48 hours, and on the face it can block part of your view. ![Dr. Paz checking a patient's hand during a follow-up visit in the Fresno office](https://www.pazderm.com/wp-content/uploads/2026/09/mohs-aftercare-exam.webp) ### For the first few days, do - Leave the first dressing in place for 24 to 48 hours - Use an ice pack and keep the area raised on the first day, which cuts down swelling - Sleep with your head up on extra pillows if the site is on your head or face - Keep the follow-up visit we book for you before you leave ### For the first week, don't - Lift anything heavy, bend over, or do anything strenuous - Rub or bump the site - Take aspirin unless your doctor has told you to Discomfort is usually mild. Call us if the site becomes more tender over several days, or if you notice fever or yellow drainage. Everything you need is in [the full pre-op and post-op instructions](/pre-op-and-post-op-mohs-surgery-instructions/). ## Concerns treated These are the skin cancers Mohs is most often used for here. Pick one to see how we approach it. ## What treatment costs Mohs surgery is medical care, and it's handled differently from the cosmetic treatments on this site. Our office walks you through what applies to you well before your surgery date, so nothing about it comes as a surprise. WhereOur Fresno and Visalia officesAnestheticLocal. You're awake and comfortableLabIn-house, with each layer checked the same dayRepairUsually the same day [2]Plan forA good part of the day, with a driverFollow-upBooked before you leave ## Mohs surgery questions, answered **Q: Will I be awake?** Yes. An injection numbs only the area being treated, so you're awake and comfortable, and most people go home the same day. [1] **Q: How long will I be at the office?** Plan on a good part of the day. Each layer is processed and examined before the next step, and you wait comfortably between rounds. Bring your medicines and something to pass the time. **Q: Can I drive myself home?** Please don't. The pressure bandage can block part of your view if the site is on your face, so bring a driver. **Q: Will it leave a scar?** Any surgery on skin leaves a mark. Because Mohs takes only the skin that still shows cancer, the wound is usually smaller than with other methods, and repairs are planned to follow your skin's natural lines. [1] **Q: Is Mohs used for melanoma?** Sometimes. It's used for one kind of early melanoma, lentigo maligna, which stays near the surface of the skin for a while. The version used is called slow Mohs: the tissue needs more time in the lab, so you go home bandaged, and most people come back the next day to learn whether more skin needs to come out. [1] Your surgeon will tell you whether it's the right approach for yours. **Q: What happens after?** A follow-up visit, booked before you leave, then regular skin checks. Having had one skin cancer is the best reason to keep being checked. - Same day In most cases, the wound is repaired the same day the cancer comes out. [2] ## References [What is Mohs surgery?](https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma/mohs-surgery) [Overview of Mohs Micrographic Surgery](https://www.mohscollege.org/for-patients/about-mohs-surgery/overview-of-mohs-micrographic-surgery) [About ACMS](https://www.mohscollege.org/about-acms) [Basal cell carcinoma: From symptoms to treatments](https://www.aad.org/public/diseases/skin-cancer/types/common/bcc/treatment) [Squamous cell carcinoma: From symptoms to treatments](https://www.aad.org/public/diseases/skin-cancer/types/common/scc/treatment) Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Whether Mohs surgery is right for a skin cancer depends on its type, size, location and pathology, and the approach described here may not apply to your case. Surgery on skin leaves a scar. Discomfort, bleeding, bruising and swelling are expected after surgery. Less common effects include temporary or permanent numbness or weakness at the site, skin discoloration, itching, shooting pain, infection and raised or keloid scarring. A skin cancer can recur and may need further treatment, and regular skin checks are recommended afterward. Individual results may vary. ### Mole Checks & Mapping ## A record of your skin, so change is easy to see Nearly every adult has a few moles, and most are harmless for life. [1] The ones that matter are the ones that change, and change is exactly what's hardest to notice on your own back. Mole mapping gives your skin a baseline. Your moles are located, photographed and saved in your record. At your next visit, they're photographed again and compared with the last set. A mole that grows, darkens or changes shape stands out in the pictures, long before anyone would notice it in a mirror. ### What mapping gives you - A photo record of your moles, kept in your chart - A side-by-side comparison at every visit - A clear answer on which moles are stable - Early notice of a mole that's changing - A schedule set to your own level of risk - Every visit Your moles are photographed at each visit and compared with the last set. ## How mole mapping works 1. Your history We start with your health and family history, including any melanoma in the family, and show you how to check your own moles between visits. 2. The exam Your provider examines your skin, looking closely at your moles, and marks where each one sits. 3. The photos Your moles are photographed and saved to your record, so there's a clear picture of each one to compare against. 4. The follow-up At each visit, new photos are compared with the old ones. A mole that has changed gets a closer look, and if it needs a firmer answer, a biopsy. - 1 to 2 years How often mapping is usually repeated, and every 3 to 6 months for people at higher risk. ## Most melanomas aren't the mole you've been watching Here's the part that surprises people. About 7 in 10 melanomas start as a brand-new spot, not in an existing mole. [2] So mapping covers more than the moles you already have: it's about knowing your skin well enough that a new arrival can't hide among them. Checking from memoryMole mappingA mole that slowly growsEasy to miss over monthsMeasured against last visit's photoA new spot among many molesBlends inStands out, because it isn't in the recordA mole you're unsure about"I think it's always looked like that"A photo that settles itYour back and scalpHard to see at allPhotographed like everywhere else And a mole that stays the same in the photos can simply be left alone. ## Who mapping helps most If you haveWhy mapping helps50 or more molesMore moles means more to keep track of, and a higher chance of melanoma. [1]Four or more atypical molesAtypical moles raise melanoma risk and are worth watching closely. [1]Fair skin or light hairSkin that burns easily is at higher risk. [3]A family history of melanomaA close relative's melanoma raises your own risk. [3]Had melanoma beforeRegular checks are how a new one is caught early. [3]Lots of sun or blistering sunburnsPast sun exposure adds up. [3] The Paz difference ## Your photos, in your record, compared by people who know your skin Your mole photos are kept in your electronic record here and pulled up at each visit, so every comparison is against your own history, not a guess. When a mole does need attention, the biopsy and, if needed, the removal happen here too. With offices in Fresno and Visalia, keeping to a mapping schedule is easy, and your record follows you to either office. - 3 to 6 months How often mapping is repeated for people at higher risk of melanoma. ## Is mole mapping right for you? ### Mapping is especially worth it if you: - Have a lot of moles, or several that look unusual [1] - Have a close relative who's had melanoma [3] - Have had melanoma or another skin cancer before [3] - Have fair skin, or a history of blistering sunburns [3] - Find it hard to tell whether a mole has changed ### A regular mole check may be enough if you: - Have only a few moles, all similar to one another - Have no personal or family history of melanoma Not sure which fits? Book a [total body exam](/treatments/skin-cancer-screening/), and we'll tell you whether mapping makes sense for you. ## Between mapping visits Mapping works best alongside your own monthly look. Use a mirror, check the places you can't easily see, and compare what you notice with how your moles usually look. [4] ### Call us before your next visit if you notice - A new spot that doesn't look like your others [4] - A mole that's changing in size, shape or color [4] - A mole that itches, bleeds or won't heal [4] You don't need to wait for your next mapping appointment. The photos will still be there to compare against. ## Concerns treated Mole mapping is how these are caught early. Pick one to learn more. ## What treatment costs Mole checks and mapping are medical care, and they're handled differently from the cosmetic treatments on this site. Our office walks you through what applies to you when you book. What it isPhotos of your moles, compared visit to visitHow oftenEvery 1 to 2 years, or every 3 to 6 months at higher riskWho it helps mostMany or atypical moles, or a melanoma history [1] [3]If something changesA closer look, and a biopsy if neededWhereOur Fresno and Visalia offices ## Mole mapping questions, answered **Q: What's the difference between a mole check and mole mapping?** A mole check is a careful look at your moles at one visit. Mole mapping adds photos saved to your record and compared at every visit, so changes can be measured instead of remembered. **Q: Does it hurt?** No. It's an exam and photographs. The only needle involved is for a biopsy, if one's ever needed, and that starts with a numbing injection. **Q: How often will I need it?** Usually every one to two years. If you're at higher risk, every three to six months. Your provider will set the schedule with you. **Q: Should I just have my moles removed instead?** Most moles don't need treatment. [5] Removing a mole that's stable doesn't stop a new melanoma from starting elsewhere, and most start as new spots. [2] Watching your skin over time is what catches them. **Q: What happens if a mole has changed?** It gets a closer look, and if it needs a firmer answer, a biopsy. If it needs to come off, it's removed here and sent to the lab. **Q: What should I look for between visits?** Anything new, changing, itchy or bleeding. The warning signs of melanoma are a good guide. [4] ## References [Moles: Who gets and types](https://www.aad.org/public/diseases/a-z/moles-types) [A meta-analysis of nevus-associated melanoma: Prevalence and practical implications](https://pubmed.ncbi.nlm.nih.gov/28864306/) [Skin cancer types: Melanoma causes](https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma/causes) [Moles: Signs and symptoms](https://www.aad.org/public/diseases/a-z/moles-symptoms) [Moles: Diagnosis and treatment](https://www.aad.org/public/diseases/a-z/moles-treatment) Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Mole mapping helps track change over time; it doesn't diagnose a spot, and a diagnosis comes from a biopsy examined under a microscope. No exam or photograph can guarantee that every melanoma will be found, so report any new or changing spot between visits. Individual results may vary. ### Neck Lift ## A cleaner neck and jawline The neck shows age in its own ways. Skin loosens, fat collects under the chin, jowls form along the jaw, and bands appear in the neck muscles. [1] A neck lift addresses those changes together, for a smoother, more defined line from chin to collarbone. It won't make you look like someone else. A neck lift doesn't change your fundamental appearance or stop the aging process. [1] What it does is bring back the jawline you remember. ### What you can change - Loose neck skin - Fullness under the chin - Jowls along the jaw - Bands in the neck - An aged or undefined neck contour - 4 concerns Loose skin, fat under the chin, jowls and neck bands: what a neck lift can address. [1] ## How a neck lift works 1. Your consultation Your surgeon looks at your skin, the fat under your chin and your neck muscles, and talks through which of them are behind what you see. 2. A plan for your neck Depending on your anatomy and goals, a neck lift may be done alone or combined with other facial procedures, such as a mini facelift. 3. The surgery Loose skin is tightened and, where needed, excess tissue under the chin is removed and neck muscles are tightened. 4. Recovery A bandage may be placed around your face and neck to reduce swelling and bruising. Keeping your head raised and straight helps as you heal. [3] - Head up Keeping your head above your heart and straight helps swelling go down after a neck lift. [3] ## Skin, fat or muscle? Neck concerns come from different sources, and the right treatment depends on which one is behind yours. If the main issue isA good fit may beLoose skin, with or without neck bandsNeck lift [1]Fat under the chin, with good skinKybellaJowls and a softening jawlineNeck lift, often with a mini facelift [1]Neck bands without much loose skinBotox, which is approved for neck bands Your consultation sorts out which applies to you, and many people combine approaches. ## What a neck lift improves AreaWhat changesNeck skinLoose skin is tightened. [1]Under the chinExcess fat is reduced. [1]JawlineJowls are lifted for a crisper edge. [1]Neck musclesBands are smoothed. [1] ## Real results from patients - Still you A neck lift doesn't change your fundamental appearance. It refreshes it. [1] The Paz difference ## Surgical and nonsurgical options for the neck, in one practice Neck lift, Kybella and Botox are all offered here, so your plan is built around what your neck actually needs, not the one procedure a practice happens to offer. The goal is always the same: a cleaner, more defined neck and jawline that still looks natural. ## Is a neck lift right for you? ### You're likely a good fit if you: - Have loose skin under the chin or along the jaw - Have fullness under the chin, jowls or neck bands - Are in good overall health and don't smoke - Want a natural result rather than a dramatic change ### Tell us at your consultation if you: - Take blood thinners, aspirin or supplements that affect bleeding - Smoke or vape - Have high blood pressure, diabetes or a bleeding disorder - Have had neck or facial surgery before ## Recovery and risks After surgery, a bandage may be placed around your face and neck to minimize swelling and bruising. Keep your head raised above your heart and straight, without much twisting or bending of the neck. [3] A compression wrap is usually worn day and night for five to seven days, then at night for a while longer. Most people return to work in seven to 14 days, and sports or hard workouts wait at least two to three weeks. [4] ### While you heal - Keep your head raised and straight [3] - Follow your care and medication instructions - Avoid strenuous activity until your surgeon clears you - Keep every follow-up visit Like any surgery, a neck lift has risks, including anesthesia risks, bleeding, fluid collection, infection, numbness, persistent pain, poor wound healing, prolonged swelling, facial asymmetry, rare nerve injury that can weaken the lower lip, hair loss along the incisions, unfavorable scarring and results that may need revision. [2] Your surgeon will go through each of these with you. ## Concerns treated These are some of the most common concerns a neck lift helps with here. Pick one to see how we can help. ## What treatment costs Cost depends on your plan, so the fairest number comes from your consultation. You'll know your full plan and its cost before you decide. A consultation with a medical provider is $80, and it goes toward your surgery if you go ahead. You'll find our [current offers](/promotions/) on their own page. What it treatsLoose neck skin, fat under the chin, jowls, neck bands [1]Often paired withA mini faceliftRecoveryHead raised and straight as you heal [3]Time off workUsually seven to 14 days [4]What it won't changeYour fundamental appearance [1]WhereOur Fresno and Visalia offices ## Neck lift questions, answered **Q: What does a neck lift fix?** Loose neck skin, excess fat under the chin, jowls and muscle bands in the neck. [1] **Q: Is a neck lift the same as a facelift?** No. A neck lift focuses on the neck and jawline. It can be done alone or combined with a facelift when the lower face is part of the picture. **Q: Do I need surgery for a double chin?** Not always. If the issue is mostly fat with good skin, Kybella may be enough. Loose skin usually needs a neck lift. **Q: How long is recovery?** Most people are back at work in seven to 14 days, and back to sports or hard workouts after two to three weeks. Subtle swelling can take several months to settle fully. Your surgeon sets your exact timeline. [4] **Q: Will I look different?** You'll look refreshed. A neck lift doesn't change your fundamental appearance. [1] **Q: Can Botox help my neck?** Botox is approved to soften neck bands, which can help when bands are the main concern and skin is still firm. ## References [Neck Lift](https://www.plasticsurgery.org/cosmetic-procedures/neck-lift) [Neck lift safety](https://www.plasticsurgery.org/cosmetic-procedures/neck-lift/safety) [Neck lift recovery](https://www.plasticsurgery.org/cosmetic-procedures/neck-lift/recovery) [Neck lift](https://my.clevelandclinic.org/cosmetic-plastic-surgery/procedures/neck-lift) Content on this page is for educational purposes and is not a substitute for professional medical advice. A neck lift is surgery, and whether it suits you depends on your consultation. Results vary from person to person, and the neck continues to age. Risks include anesthesia risks, bleeding, fluid collection, infection, numbness, persistent pain, poor wound healing, prolonged swelling, asymmetry, rare nerve injury, hair loss along the incisions, scarring and the possible need for revision. Individual results may vary. ### PicoWay Resolve ## Smoother, more even skin from within Some resurfacing lasers work by removing the top layer of skin. PicoWay Resolve takes a gentler route: it splits its beam into tiny points of energy that reach below the surface, where your skin responds by building new collagen and elastin. Over a series of visits, that renewal shows up as smoother texture and a more even tone. It's cleared by the FDA for [wrinkles](/concerns/fine-lines-wrinkles/), [acne scars](/concerns/acne-scars/), melasma and benign pigmented spots such as sun spots. [1] ### What it can improve - Acne scars [1] - Fine lines and wrinkles [1] - Melasma [1] - Dark spots and sun spots [1] - Rough or dull texture - 4 uses Wrinkles, acne scars, melasma and benign pigmented spots: the uses PicoWay Resolve is FDA-cleared for. [1] ## Your PicoWay Resolve plan 1. Your consultation We look at your scars, spots or lines and your skin tone, and set a plan for how many visits you'll need. 2. Treatment A numbing cream can make you more comfortable. The handpiece glides over the area, delivering quick pulses. Most visits take 15 to 20 minutes. 3. A short series Visits are spaced a few weeks apart so your skin has time to rebuild between them. 4. Results build Texture and tone keep improving for weeks after each visit as new collagen forms. - 15 to 20 min A typical PicoWay Resolve visit, start to finish. ## Cleared uses, matched to your skin tone Each PicoWay Resolve use is cleared for a range of skin tones. Acne scar treatment is cleared for the widest range, from fair through brown skin. [1] UseCleared skin tones [1]Acne scarsFair through brown (types II to V)WrinklesVery fair through olive (types I to IV)MelasmaVery fair through olive (types I to IV)Benign pigmented spotsVery fair through olive (types I to IV) Your provider matches the settings to your skin at your [free consultation](/cosmetic/consultation/). Darker skin is more prone to burns and dark marks after laser treatment, so careful settings matter. [2] ## Where PicoWay Resolve makes the biggest difference AreaWhat changesCheeksAcne scars soften and texture smoothsAround the eyesFine lines look softerForehead and upper lipMelasma patches fadeFace, neck and chestSun spots and dark spots lightenHandsBrown spots fade ## Real results from patients - Low downtime Most people go back to their day with some redness that settles quickly. The Paz difference ## A laser plan built around your skin Melasma, scars and sun spots each respond differently, and so do different skin tones. Your plan starts with a close look at what's behind the concern, so every session is set for your skin. And because you're in a dermatology practice, your plan can combine PicoWay with skin care, peels or other treatments when that will do more. You'll hear about it at your consultation. ## Is PicoWay Resolve right for you? ### You're likely a good fit if you: - Have acne scars, fine lines, dark spots or melasma - Want a laser with little downtime - Can come in for a short series of visits - Can protect your skin from the sun between visits ### Tell us before your appointment if you: - Have a tan, or have recently used a self-tanner - Take any medicine that makes you sensitive to light - Have taken isotretinoin for acne - Get cold sores - Are pregnant ## After your appointment Most people have some redness and a warm, sunburned feeling for a few hours to a day. Tiny pinpoint marks can appear and fade within days. ### For the next week - Use a gentle cleanser and moisturizer - Wear sunscreen every day and stay out of strong sun [3] - Skip scrubs, retinoids and acids until your skin settles - Hold off on tanning, indoors and out Rarely, laser treatment can cause burns, lasting changes in skin color or scars. [4] Call us if anything worries you. ## Concerns treated These are some of the most common concerns PicoWay Resolve helps with here. Pick one to see how we can help. ## What treatment costs Cost depends on the area and how many visits you need. Your consultation is free, and you'll know your plan and its cost before anything happens. You'll find our [current offers](/promotions/) on their own page. FDA-cleared forWrinkles, acne scars, melasma, benign pigmented spots [1]Visit lengthAbout 15 to 20 minutesPlanA short series, weeks apartDowntimeLowWhereOur Fresno and Visalia offices ## PicoWay Resolve questions, answered **Q: How is PicoWay Resolve different from other lasers?** It uses extremely short picosecond pulses split into tiny beams that work below the surface, so the top layer of skin stays largely intact and downtime stays low. **Q: Can it treat acne scars on darker skin?** Acne scar treatment is cleared for a wide range of skin tones, from fair through brown. [1] Your consultation confirms the right settings for you. **Q: Does it help melasma?** Yes. It's FDA-cleared for melasma. [1] Melasma often comes back, so daily sun protection and skin care are part of the plan. **Q: How many treatments will I need?** Most people need a short series spaced a few weeks apart. Your plan depends on what you're treating. **Q: Does it hurt?** Most people describe a warm snapping feeling. A numbing cream can make it more comfortable. **Q: When will I see results?** Skin often looks brighter within days. Changes in scars and lines build over the weeks after each visit. ## References [510(k) Premarket Notification K220853: PicoWay Laser System](https://www.accessdata.fda.gov/cdrh_docs/pdf22/K220853.pdf) [Skin conditions that lasers can treat](https://www.aad.org/public/diseases/a-z/skin-conditions-lasers-treat) [How dermatologists treat sun-damaged skin](https://www.aad.org/public/everyday-care/sun-protection/sun-damage-skin/wrinkles-sun-damage-can-be-treated) [Rosacea: Diagnosis and treatment](https://www.aad.org/public/diseases/rosacea/treatment/diagnosis-treat) Content on this page is for educational purposes and is not a substitute for professional medical advice. PicoWay Resolve is FDA-cleared for specific uses and skin types, and whether it suits you depends on your consultation. Results vary from person to person, and melasma can return. Side effects can include redness, swelling and pinpoint marks. Rare risks include burns, changes in skin color and scarring. Individual results may vary. ### Radiesse ## Volume now, and collagen that keeps building Most fillers work by filling. Radiesse fills too, and it also helps your skin produce more of its own collagen and elastin, the proteins that keep skin firm. [1] And its results can last up to two years. [1] It's approved for [smile lines that have deepened](/concerns/fine-lines-wrinkles/) and other facial folds, the backs of the hands, fine wrinkles on the chest, and, in its Radiesse (+) form, a [softer jawline](/concerns/sagging-skin-jowls/) that's lost its edge. [1] ### What you can change - Smile lines and other deep facial folds - Thin backs of the hands, where veins and tendons show - Crepey lines on the chest - A jawline that's lost its definition - Up to 2 years How long Radiesse results can last. [1] ## Your Radiesse appointment 1. Plan the areas We look at your face, hands or chest together and decide where Radiesse will make the most difference. 2. Comfort Radiesse (+) contains a numbing medicine, so the treatment gets more comfortable as it goes. 3. The treatment Your provider places the gel with a fine needle, shaping as they go. Most appointments are quick. 4. Now and later You see added volume right away. Over the following months, your own collagen keeps building. [1] - 4 areas Face, hands, chest and jawline: the uses Radiesse is approved for. [1] ## A filler that works two ways What happensWhenRight awayThe gel adds volume under lines and hollowsAs soon as you're doneOver timeYour skin makes more collagen and elastin around it [1]Over the following monthsFor how longResults can last up to two years [1]With the right plan If you'd like a treatment that builds collagen more gradually, over a series of visits, [Sculptra](/treatments/sculptra/) is another option. We'll help you choose. ## Where Radiesse makes the biggest difference AreaWhat changesSmile linesDeep creases from nose to mouth soften. [1]Backs of the handsFuller, so veins and tendons show less. [1]ChestFine, crepey lines smooth out, when Radiesse is diluted for this use. [1]JawlineA crisper edge from ear to chin, with Radiesse (+). [1] Providers also use Radiesse for marionette lines, corners of the mouth that turn down, chin wrinkles, early jowls and scars that leave a dip in the skin. Ask at your consultation whether one of these suits you. ## Real results from patients - Collagen Radiesse helps your skin make more of it, along with elastin, the protein that keeps skin springy. [1] The Paz difference ## Structure, placed with care Radiesse is a structural filler, so where it goes matters. We plan each area carefully and build a little at a time, so the result looks like firmer, fresher skin, not added volume. And because you're in a dermatology practice, the whole face is part of the plan. If another filler or treatment suits you better, you'll hear about it at your [free consultation](/cosmetic/consultation/). ## Is Radiesse right for you? ### You're likely a good fit if you: - Want softer smile lines, fuller hands, a smoother chest or a sharper jawline - Like the idea of results that can last up to two years [1] - Are 22 or older for chest treatment [1] ### Tell us before your appointment if you: - Have a history of severe allergies [1] - Have a bleeding disorder [1] - Are allergic to any part of the product [1] - Are pregnant or breastfeeding ## After your appointment Most people go straight back to their day. Common side effects include bruising, redness, swelling, pain, itching and small lumps, and they usually fade on their own. [1] ### For the first day or two - Use a cold pack for swelling - Skip strenuous exercise until the next day - Follow any massage instructions we give you Serious problems are rare. The one that matters most is filler entering a blood vessel, which can be serious. [1] Call us right away if an area turns pale, dusky or very painful, or if your vision changes. ## Concerns treated These are some of the most common concerns Radiesse helps with here. Pick one to see how we can help. ## What treatment costs Cost depends on the areas you treat and how much each one needs, so the fairest number comes from seeing you. Your consultation is free, and you'll know your plan and its cost before anything happens. You'll find our [current offers](/promotions/) on their own page. TreatsFacial folds, hands, chest, jawline [1]How it worksAdds volume and stimulates collagen [1]LastsUp to 2 years [1]DowntimeLittle to noneWhereOur Fresno and Visalia offices ## Radiesse questions, answered **Q: How is Radiesse different from other fillers?** It adds volume right away and also helps your skin make more collagen and elastin over time. [1] **Q: How long does it last?** Results can last up to two years. [1] **Q: Can Radiesse treat my hands?** Yes. It's approved to restore volume to the backs of the hands. [1] **Q: What about my chest?** Radiesse is approved to smooth chest wrinkles when it's diluted for that use, for adults 22 and older. [1] **Q: Can it define my jawline?** Yes. Radiesse (+) is approved to improve jawline contour in adults over 21. [1] **Q: Does it hurt?** Most people feel pressure and a few pinches. Radiesse (+) contains a numbing medicine. ## References [Merz Aesthetics Receives FDA Approval for RADIESSE® for the Treatment of Wrinkles in the Décolleté Area](https://merzaesthetics.com/news/fda-approval-radiesse-for-treatment-of-wrinkles-in-decollete-area/) Content on this page is for educational purposes and is not a substitute for professional medical advice. Radiesse and Radiesse (+) are approved for specific uses in adults, and whether they suit you depends on your consultation. Results vary from person to person. Common side effects include bruising, redness, swelling, pain, itching and lumps. Rare but serious risks include injection into a blood vessel, which can cause lasting complications. Individual results may vary. ### Sclerotherapy ## Clearer legs, one small injection at a time Sclerotherapy is the most common treatment for leg veins. [1] A solution injected into the vein irritates its wall, the walls stick together, and blood can no longer flow through it. [1] Your body reroutes the blood through healthy veins and gradually clears the closed one away. [Spider veins](/concerns/spider-veins/) usually disappear in 3 to 6 weeks, and small varicose veins in 3 to 4 months. [1] ### What it treats - Spider veins on the thighs, calves and ankles [2] - Small varicose veins [1] - Clusters of fine red and blue veins - 3 to 6 weeks How long treated spider veins usually take to disappear. [1] ## Your sclerotherapy appointment 1. Your consultation Your legs are examined to make sure treatment is safe for you and to map which veins to treat. [1] 2. Treatment A very fine needle places the solution into each vein. No anesthesia is needed. [1] Most people feel small pinches. 3. Compression You'll wear compression stockings as directed afterward. Most people wear them for 2 to 3 weeks. [1] 4. Back to your day You can return to work and most activities the next day. [1] Walking helps. - 2 or 3 The number of treatments many people need for the best results. [1] ## Sclerotherapy or laser for your veins? Both can clear leg veins. Which one fits depends on the size of your veins. SclerotherapyLaser, such as VBeamHow it worksSolution closes the vein from inside [1]Light destroys the vein without harming the skin [1]Best forSpider veins and small varicose veins [1] [2]Very small veins, especially on the faceTreatmentsOften 2 or 3 [1]Often 3 or more [1] Your [free consultation](/cosmetic/consultation/) looks at your veins and recommends the right approach. If a vein needs a different kind of care, you'll hear that too. ## Where sclerotherapy makes the biggest difference AreaWhat changesThighsFine red and blue webs fadeBehind the kneesClusters of small veins clearCalvesSpider veins and small varicose veins closeAnklesFine veins around the ankle fade ## Real results from patients - Next day When you can return to work and most activities. [1] The Paz difference ## A careful look before any injection Veins that show on the surface can sometimes point to a problem deeper down. Here, your legs are examined before treatment, so what you get is safe, suited to your veins and likely to last. And with both sclerotherapy and laser available, you get the approach that fits your veins. ## Is sclerotherapy right for you? ### You're likely a good fit if you: - Have spider veins or small varicose veins on your legs - Want clearer legs for shorts, skirts or swimsuits - Can wear compression stockings for a couple of weeks - Can walk and stay active after treatment ### Tell us before your appointment if you: - Are pregnant or breastfeeding - Have had a blood clot in your legs or lungs - Take a blood thinner or hormones - Have leg pain, swelling or skin changes around your veins ## After your appointment Most people go back to work and their usual activities the next day. [1] Treated veins can look darker or bruised at first before they fade. ### For the next few weeks - Wear your compression stockings as directed [1] - Walk every day - Skip hot baths, saunas and heavy workouts for a few days - Keep treated areas out of strong sun while they heal Risks include bruising, scarring, failure to close the vein, nerve damage and blood clots. [2] Some people notice brown streaks or tiny new vessels near the treated area, which usually fade with time. Call us right away if you have new leg pain, swelling or shortness of breath. ## Concerns treated This is the most common concern sclerotherapy treats here. Pick it to see how we can help. ## What treatment costs Cost depends on how many veins you treat and how many sessions you need. Your consultation is free, and you'll know your plan and its cost before anything happens. You'll find our [current offers](/promotions/) on their own page. TreatsSpider veins and small varicose veins [1] [2]AnesthesiaNone needed [1]TreatmentsOften 2 or 3 [1]Back to workThe next day [1]WhereOur Fresno and Visalia offices ## Sclerotherapy questions, answered **Q: How long until my veins fade?** Spider veins usually disappear in 3 to 6 weeks; small varicose veins in 3 to 4 months. [1] **Q: Does it hurt?** Most people feel small pinches from the fine needle. No anesthesia is needed. [1] **Q: Why do I need compression stockings?** They help the treated veins stay closed and reduce bruising and swelling. Most people wear them for 2 to 3 weeks. [1] **Q: Can new veins appear?** Yes, over time. The things that cause spider veins, such as family history, hormones and long hours on your feet, [1] can lead to new ones. Touch-up treatments clear them. **Q: How many treatments will I need?** Many people need 2 or 3 for the best results. [1] **Q: Can I exercise afterward?** Walking is encouraged. Save heavy workouts for a few days after treatment. ## References [Leg veins: Why they appear and how dermatologists treat them](https://www.aad.org/public/cosmetic/younger-looking/how-dermatologists-treat-leg-veins) [Varicose vein: noninvasive treatment](https://medlineplus.gov/ency/article/007395.htm) Content on this page is for educational purposes and is not a substitute for professional medical advice. Whether sclerotherapy suits you depends on an exam and your consultation. Results vary, and new veins can form over time. Side effects can include bruising, darkening along the treated vein and small new vessels. Rare risks include blood clots, nerve damage and scarring. Individual results may vary. ### Sculptra ## Your own collagen, rebuilt a little at a time With age, skin loses collagen, and with it some of its firmness and [lost volume](/concerns/facial-volume-loss/). Sculptra works on the cause. Its tiny particles of poly-L-lactic acid help your skin gradually rebuild its structure, which smooths wrinkles from within. [1] It's approved for smile lines from nose to mouth and for [fine lines on the cheeks](/concerns/fine-lines-wrinkles/). [1] Because the change happens slowly, it looks like better skin, not added filler, and results can last up to two years. [1] ### What you can change - Smile lines from nose to mouth - Fine lines and wrinkles on the cheeks - Lines that have deepened gradually with time - Up to 2 years How long Sculptra results can last. [1] ## How a Sculptra plan works 1. A plan, not a one-off Sculptra works best as a short series. We map the areas and set a schedule, usually two to three visits at least three to four weeks apart. [2] 2. Each visit Your provider places Sculptra with a fine needle. It's quick, and you can get back to your day. 3. Massage at home Afterward, you'll massage the area five minutes at a time, five times a day, for five days. It helps the product settle evenly. [2] 4. Watch it build Results appear gradually as your collagen builds. In clinical study, most people still showed improvement at three months, one year and two years. [1] - 94% Of people in the clinical study still showed improvement two years after treatment. [1] ## Sculptra or a classic filler? Both soften lines. They just get there differently, and some people use both. SculptraHyaluronic acid fillerHow it worksHelps your skin rebuild collagen [1]Adds volume where it's placedWhen you see itGradually, over monthsRight awayNumber of visitsTwo to three, on average [2]Usually oneHow long it lastsUp to two years [1]Months to two years, by productBest if you wantSubtle change nobody can pin downA visible difference today If you'd like to see a change right away, a hyaluronic acid filler like [Juvéderm](/treatments/juvederm/) may suit you better. Your consultation sorts out which fits. ## Where Sculptra makes the biggest difference AreaWhat changesSmile linesDeep creases from nose to mouth soften over time. [1]CheeksFine lines and wrinkles smooth out as collagen rebuilds. [1] Providers also use Sculptra for marionette lines and chin wrinkles. Ask at your consultation whether one of these suits you. ## Real results from patients - Gradual Results build over months as your collagen does, so the change looks natural. The Paz difference ## Patience, planned well Sculptra rewards a good plan: the right areas, the right number of visits, and time for your skin to respond. We set that plan with you and check in along the way, so the result arrives the way you hoped. And because you're in a dermatology practice, the whole face is part of the conversation. If another treatment suits you better, you'll hear about it at your [free consultation](/cosmetic/consultation/). ## Is Sculptra right for you? ### You're likely a good fit if you: - Want softer smile lines or smoother cheeks - Prefer a gradual, natural-looking change - Have a healthy immune system [1] - Are happy to come in for a short series ### Tell us before your appointment if you: - Are allergic to any of its ingredients [1] - Tend to form keloids or thick, raised scars [1] - Are pregnant or breastfeeding [1] ## After each visit Most people get right back to their day. Swelling, tenderness, redness, pain, bruising, bleeding, itching and small lumps at the injection sites are the common side effects. [1] ### For the first few days - Massage five minutes, five times a day, for five days [2] - Use a cold pack if you're swollen - Keep your follow-up visits in the series Serious problems are rare. Like any injectable, Sculptra must stay out of blood vessels, which is why training matters. [1] Call us right away if an area turns pale, dusky or very painful. ## Concerns treated These are some of the most common concerns Sculptra helps with here. Pick one to see how we can help. ## What treatment costs Sculptra is planned as a series, so cost depends on the areas and how many visits you need. Your consultation is free, and you'll know your full plan and its cost before anything happens. You'll find our [current offers](/promotions/) on their own page. What it isPoly-L-lactic acid that helps rebuild collagen [1]TreatsSmile lines and cheek wrinkles [1]VisitsTwo to three, 3 to 4 weeks apart [2]ResultsGradual, lasting up to 2 years [1]WhereOur Fresno and Visalia offices ## Sculptra questions, answered **Q: How long until I see results?** Results build gradually as your collagen rebuilds, over the months after your series. [1] **Q: How long does Sculptra last?** Up to two years. In clinical study, 94% of people still showed improvement at two years. [1] **Q: How many treatments will I need?** Two to three on average, spaced at least three to four weeks apart. We'll set the number with you based on the areas and how much change you want. [2] **Q: Why do I need to massage it?** It spreads the product evenly under the skin. The rule of thumb is five minutes, five times a day, for five days after each visit. [2] **Q: Is Sculptra a filler?** It's a collagen stimulator. Instead of filling the line directly, it helps your skin rebuild what's under it. [1] **Q: Can I combine it with other fillers?** Yes. Many people pair Sculptra's gradual rebuild with a hyaluronic acid filler for an area they want to change right away. ## References [Galderma receives FDA approval for Sculptra® for cheek wrinkles](https://www.galderma.com/news/galderma-receives-fda-approval-sculptrar-cheek-wrinkles-0) [FAQs | Sculptra®](https://www.sculptrausa.com/faqs) Content on this page is for educational purposes and is not a substitute for professional medical advice. Sculptra is approved for specific uses in people with healthy immune systems, and whether it suits you depends on your consultation. Results develop gradually and vary from person to person. Common side effects include swelling, tenderness, redness, pain, bruising, bleeding, itching and lumps; lumps under the skin can appear later. Rare but serious risks include injection into a blood vessel. Individual results may vary. ### Skin Cancer Excision ## Take it out, check the edges, close it neatly Once [a biopsy](/treatments/skin-cancer-screening/) confirms a skin cancer, the next step is usually removing it. An excision does that in one visit. The cancer comes out with a little healthy skin around it, and the tissue goes to a lab so the edges can be checked. [1] When the edges are clear, treatment is complete. [1] It's the most common treatment for [basal cell carcinoma](/concerns/basal-cell-carcinoma/), and many early ones are cured this way. [1] It's used for squamous cell carcinoma and for early melanoma too, and for an early melanoma it may be the only treatment you need. [2] [3] ### What this covers - Removal of the skin cancer with a margin of healthy skin - Numbing, so you're comfortable throughout - Closing the wound with care for how it heals - A lab check of the removed tissue [1] - A follow-up visit to check healing and go over results - Most common Excision is the most common treatment for basal cell carcinoma, and many early ones are cured with it. [1] ## How an excision goes [paz_instagram id="DY2yAs7y6DK" label="Watch: patient experiences"] 1. Planning the removal Your provider outlines the spot and a margin of normal-looking skin around it. The margin is there because cancer cells can reach a little past what the eye can see. 2. Numbing A local anesthetic numbs the area, so you're awake and comfortable. 3. Removal The cancer and its margin are removed. [2] For a smaller spot, this part usually takes about half an hour. 4. Closing The skin is stitched closed, placed along natural lines where possible so the scar settles well. 5. The lab The tissue goes to a laboratory, where the edges are examined under a microscope. [1] If they're clear, you're done. If cancer cells reach an edge, more treatment follows, often Mohs surgery. [1] - About 30 minutes The usual time for a smaller excision, done in the office. ## When an excision is the right call, and when Mohs is Both remove skin cancer, and both are done here. The difference is where the cancer sits and how much healthy skin can be spared. Standard excisionMohs surgeryBest suited toMost basal cell carcinomas, and many other skin cancers where there's room for a margin [1]Cancers on the nose, eyelids, ears, scalp, hands and feet, or ones that are large, aggressive or have come back [4]How the edges are checkedBy the lab, after you go home [1]During your visit, before any more skin is taken [4]How much skin comes outThe cancer plus a margin of healthy skin [2]Only skin that still shows cancer [4]Visit lengthUsually under an hour for a smaller spotA good part of the day Your provider recommends one or the other based on your cancer's type, size and location. If you'd like to understand the choice, ask. It's a good question. ## What an excision is used for GrowthHow excision helpsBasal cell carcinomaThe most common treatment, and many early ones are cured with it. [1]Squamous cell carcinomaRemoves the cancer and some skin around it, with the tissue sent to the lab. [2]Early melanomaOften done during an office visit, and may be the only treatment needed. [3]A suspicious growthRemoves all of it so the lab can give a complete answer, including for a mole that's changed. The Paz difference ## Careful removal, with an eye on how it heals Removing the cancer completely comes first. How the scar looks comes a close second, especially on the face, neck and other places people see. Excisions here are planned with both in mind: the right margin, and a closure that follows your skin's natural lines. And because this practice also performs Mohs surgery, if your cancer turns out to need it, the next step is here too, with the same team that treated you the first time. - 1 to 2 weeks How long most excision wounds take to heal. ## Is an excision right for you? ### An excision is often recommended for: - An early basal cell carcinoma [1] - A squamous cell carcinoma confined to the skin [2] - An early melanoma [3] - A growth that needs to come out whole so the lab can read it ### Mohs may suit you better if the cancer: - Sits on the nose, eyelid, ear, scalp, hand or foot [4] - Is large or aggressive, or has come back after treatment [4] ### Tell us before your procedure if you: - Take a blood thinner or aspirin - Have any allergies, including to anesthetics or tape - Have a pacemaker or other implanted device ## Healing well You'll leave with a pressure dressing and written instructions, and your follow-up visit is scheduled before you go. ### What you'll need at home - Vaseline or Aquaphor - Telfa dressings, paper tape or bandages - An ice pack ### Caring for the wound - Leave the first dressing on, and dry, for 24 to 48 hours, then remove it - Clean the incision gently with mild soap and water. Skip rubbing alcohol and hydrogen peroxide unless we tell you otherwise - Pat it dry, apply Vaseline or Aquaphor and cover it with a Telfa dressing or bandage, every day until your follow-up visit - Ice the area for 15 minutes every other hour for the first 24 hours, or as needed, to ease swelling and bruising ### While you heal - For soreness, Extra Strength Tylenol and ibuprofen work best staggered; we can prescribe something stronger if you need it - Avoid aspirin and anything that contains it for one week - No strenuous activity for 4 weeks. For a site on your arms, legs or back, lift nothing heavier than 10 pounds - For a site on an arm or leg, wrap it daily with a Coban or ACE bandage for 30 days - No smoking or alcohol for 48 hours - Don't rub or massage the site, and wait 6 months before using scar creams or gels - After surgery on your head, sleep with your head raised on several pillows - If you were prescribed an antibiotic, take it with food ### If it bleeds A little bleeding is normal. Press firmly on the dressing for 15 minutes, and repeat once if it doesn't stop. If it's still bleeding after 30 minutes of pressure, call our office at (559) 233-3376. ### Call us if you notice signs of infection - Tenderness that gets worse over several days - Fever - Yellow discharge Every excision leaves a scar. How it looks depends on the spot's size and location and how your skin heals, and it keeps fading for months. ## Concerns treated These are some of the growths excision is used for here. Pick one to learn more. ## What treatment costs Skin cancer removal is medical care, and it's handled differently from the cosmetic treatments on this site. Our office walks you through what applies to you before your procedure date. What it isRemoval of a skin cancer with a margin of healthy skin [2]AnestheticLocal. You're awake and comfortableHow longAbout 30 minutes for a smaller spotHealingUsually a week or twoLab checkThe removed tissue's edges are examined [1]WhereOur Fresno and Visalia offices ## Excision questions, answered **Q: Will I be awake?** Yes. A local anesthetic numbs the area, and most people go straight home afterward. **Q: Will it leave a scar?** Yes, every excision does. It's placed along natural skin lines where possible, and it softens and fades over the following months. **Q: How will I know it got all the cancer?** The lab checks the edges of what was removed. If they're clear, treatment is complete. If not, you'll hear about the next step, which is often Mohs surgery. [1] **Q: Why not just freeze or burn it off?** Removing it whole means the lab can confirm the edges are clear. That confirmation is the point. **Q: How soon can I go back to work?** Usually the same or next day, depending on your job and where the excision is. Heavy lifting and strenuous exercise wait a little longer. **Q: Do I need someone to drive me?** Usually not for a small excision under local anesthetic. If yours is near your eye or you'd feel more comfortable with a ride, bring someone. ## References [Basal cell carcinoma: From symptoms to treatments](https://www.aad.org/public/diseases/skin-cancer/types/common/bcc/treatment) [Squamous cell carcinoma: From symptoms to treatments](https://www.aad.org/public/diseases/skin-cancer/types/common/scc/treatment) [Melanoma treatment](https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma/treatment) [What is Mohs surgery?](https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma/mohs-surgery) Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. The right treatment depends on a skin cancer's type, size, location and pathology. Every excision leaves a scar, and healing varies by person and location. Bleeding, bruising, swelling, infection, numbness and a raised or widened scar are possible. A skin cancer can recur and may need further treatment, and regular skin checks are recommended afterward. Individual results may vary. ### Skin Cancer Screening & Total Body Exams ## The easiest way to catch skin cancer early Skin cancer is the most common cancer in the United States, and about one in five Americans will have it at some point. [1] The encouraging part is that it grows where it can be seen. Found early, it's usually simple to treat. A total body exam is a careful look at all of your skin by someone trained to tell the ordinary from the unusual. There's no blood work and nothing to prepare. [2] Your provider checks each spot, notes anything worth watching, and answers the question you came in with. ### What we look for - New moles, and moles that have changed - Spots that look different from the rest, or that itch or bleed - Rough, scaly patches that can come before skin cancer - Early warning signs of melanoma and other skin cancers - Sun damage that shapes how often you should be checked - 1 in 5 Americans who will develop skin cancer in their lifetime, which makes it the most common cancer in the country. [1] ## What happens at your exam 1. A quick conversation We ask about sunburns, tanning, family history and any spot that's been on your mind. If there's one you're worried about, tell us first. 2. Scalp to soles You change into a gown, and your provider works through your skin section by section, including the scalp, behind the ears, between the toes, the soles of your feet and your nails. [3] Spots of interest get a closer look through a lighted magnifier. 3. The answer, in plain words Most of the time, everything looks as it should, and you'll hear that directly. Anything worth watching gets noted or photographed so it can be compared next time. 4. A next step, if one's needed A spot that needs a firmer answer gets a biopsy, where a small sample goes to the lab. If it's precancerous or a skin cancer, you'll leave knowing the plan. - About 10 minutes How long a skin check itself takes. [2] It's one of the quickest appointments you'll ever have that can matter this much. ## Every finding has a next step The point of a skin check is a clear answer for each spot. Here's how it usually goes. What we seeWhat happens nextA normal, stable moleNothing. It's noted, and you get your next check date.A spot to keep an eye onIt's photographed and compared at your next visit, and mole mapping can track many spots at once.A precancerous patchIt's treated, usually in the office or with a prescription, before it can become a skin cancer.A suspicious spotA biopsy settles it, and the lab result tells us what it is.A skin cancerIt's removed here, and for some cancers on the face or other delicate areas, with Mohs surgery. Having all of those steps in one practice means nothing gets lost between offices, and the provider who saw the spot can follow it through. ## Places people forget to check AreaWhy we lookScalpHair hides spots completely, so a part-by-part look matters. [3]Back and shouldersHard to see yourself, and a common place for spots to change unnoticed. [3]Between the toes and on the solesEasy to miss, and skin cancer can start where the sun rarely reaches. [3]Fingernails and toenailsA dark streak or spot under a nail is worth a look. [3]Behind the ears and back of the neckTwo of the most overlooked sun-exposed spots. [3] The Paz difference ## A skin check that doesn't end at "come back later" Checking skin is the everyday work of this practice, and so is everything that follows it. A spot that needs watching can be photographed and tracked here, a biopsy can be done here, and if something needs removing, that happens here too, including Mohs surgery with our own lab. With offices in Fresno and Visalia, your yearly check is close to home, and the notes and photos from last year are right there to compare against. - Every year How often we recommend a total body exam, and more often if you've had skin cancer. ## Who should book a total body exam ### It's especially worth it if you have: - A history of skin cancer, or a close relative with melanoma [4] - 50 or more moles, or moles that look atypical [5] - Fair skin that burns easily, or a history of blistering sunburns [4] - Years of time outdoors, or any tanning-bed use [4] - A spot that's new, changing, itchy or bleeding [3] ### Good to know: - There's no blood work and nothing to prepare [2] - You choose how much the exam covers, and you can ask to skip any area - Bring a list of spots you've been watching, or photos of them If you're not sure whether you need one, that's a good reason to book one. Early checks are how small problems stay small. ## Between visits A yearly exam works best alongside a quick look of your own. Once a month is a good rhythm. [3] ### How to check yourself - Use a full-length mirror for the front and back, then raise your arms and check each side [3] - Look at your forearms, underarms, palms and fingernails [3] - Check the backs of your legs, your feet, between your toes and your soles [3] - Use a hand mirror for your scalp, the back of your neck and your back [3] If you notice a spot that's different from the others, or one that changes, itches or bleeds, don't wait for your yearly visit. Call us. [3] ## Concerns treated These are some of the concerns a total body exam looks for. Pick one to learn more about it. ## What treatment costs A total body exam is medical care, and it's handled differently from the cosmetic treatments on this site. Our office walks you through what applies to you when you book, so nothing about it comes as a surprise. What it isA visual check of your skin from scalp to soles [2]How longA skin check itself takes about 10 minutes [2]PreparationNone, and no blood work [2]How oftenEvery year, more often after a skin cancerWhereOur Fresno and Visalia offices ## Skin check questions, answered **Q: How often should I have a total body exam?** We recommend once a year for most adults, and more often if you've had skin cancer before. If you have many moles or a strong family history, your provider may suggest a different schedule. **Q: Do I have to undress completely?** You'll change into a gown so we can see all of your skin, and you can ask us to skip any area you'd rather not have checked. It's your exam. **Q: Does a skin check hurt?** No. It's a visual exam. A biopsy, if you need one, starts with a numbing injection, and that's the only needle involved. **Q: What if you find something?** Then you'll know what it is and what comes next. Many spots only need watching. A suspicious one gets a biopsy, and if it's a skin cancer, treatment happens here. **Q: I already check my own skin. Do I still need this?** Self-checks are worth doing, and they work best alongside a professional look. Your back, scalp and the soles of your feet are hard to see yourself. [3] **Q: Can people with darker skin get skin cancer?** Yes. Skin cancer develops in every skin color, and in darker skin it often shows up in places that get little sun, like the palms, soles or under a nail. [4] ## References [Skin cancer statistics](https://www.aad.org/media/stats-skin-cancer) [What to expect at a skin cancer check](https://www.aad.org/public/public-health/skin-cancer-screenings/what-to-expect) [Find skin cancer: How to perform a skin self-exam](https://www.aad.org/public/diseases/skin-cancer/find/check-skin) [Skin cancer types: Melanoma causes](https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma/causes) [Moles: Who gets and types](https://www.aad.org/public/diseases/a-z/moles-types) Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. A skin exam is a visual check; a diagnosis comes from a biopsy examined under a microscope. No exam can guarantee that every skin cancer will be found, so report any new or changing spot between visits. Recommended exam frequency varies by person. Individual results may vary. ### SkinCeuticals Peels ## Brighter, smoother skin, peel by peel A chemical peel uses a professional solution to lift away the dull outer layers of skin, so fresher skin shows through. Light peels heal in 1 to 7 days, [1] which makes them easy to fit into a busy life. SkinCeuticals peels range from gentle and hydrating to more corrective, so there's an option whether you want a pre-event glow or a plan for [dark spots](/concerns/hyperpigmentation/) and [dull skin](/concerns/texture-dull-skin/). ### What they can improve - Dull, tired-looking skin - Uneven tone and dark spots - Rough texture - Fine lines from sun damage [2] - 1 to 7 days Healing time for a light chemical peel. [1] ## Your SkinCeuticals peel 1. Choose your peel Your consultant looks at your skin and goals and picks the peel, and the strength, that fits. 2. Prep Some people start a simple skin care routine 2 to 4 weeks before a peel. [1] Your skin is cleansed thoroughly the day of your peel. [1] 3. The peel The solution goes on for a few minutes. You may feel warmth or tingling while it works. 4. Heal and glow Once your skin heals, you'll see the results. [1] - 3 to 5 peels A typical series of light peels, repeated every 2 to 5 weeks. [1] ## Four SkinCeuticals peels, four goals Each peel is built for a different goal. Your consultant matches it to your skin. PeelBest forMicroPeelA quick refresh: exfoliation, a light peel and a cooling finish in one visit, customizable for all skin types [2]Gel PeelSmoothing sun-damaged skin and fine lines with glycolic and lactic acids, gently [2]Pigment Balancing PeelBrightening dark spots and uneven tone [2]Advanced Corrective PeelA more corrective option for discoloration, texture and the look of pores For deeper change, ask about the [VI Peel](/treatments/vi-peel/). For a no-peel glow, a [HydraFacial](/treatments/hydrafacial/) may suit you. Your [free consultation](/cosmetic/consultation/) helps you choose. ## Where a peel makes the biggest difference AreaWhat changesFaceBrighter, smoother, more even skinNeckSofter texture and more even toneChestSun spots and uneven color fadeHandsBrown spots look lighter ## Real results from patients - All skin tones People with skin of color can safely have a chemical peel with an experienced team. [1] The Paz difference ## The right peel at the right strength With four SkinCeuticals peels and the full VI Peel line offered here, your peel is matched to your skin and goals, from a gentle refresh to a corrective series. And if spots or acne need more than a peel, your plan can include lasers or medical care in the same practice. ## Is a SkinCeuticals peel right for you? ### You're likely a good fit if you: - Have dull skin, uneven tone or dark spots - Want smoother texture and fewer fine lines - Want a treatment with little downtime - Can wear sunscreen every day afterward [1] ### Tell us before your appointment if you: - Are pregnant or breastfeeding - Have taken isotretinoin (Accutane) in the past 6 months - Get cold sores - Have used retinoids, had waxing or had a laser treatment recently ## After your peel Your skin may look pink and flake lightly for a few days, depending on the peel. ### While you heal - Don't rub or scratch treated skin, which can cause an infection [1] - Keep skin care gentle and moisturize well - Stay out of strong sun - Once your skin heals, use sunscreen every day to keep your results [1] Temporary darkening or lasting redness can occasionally occur. [1] Call us if your skin becomes very red, painful or blistered. ## Concerns treated These are some of the most common concerns SkinCeuticals peels help with here. Pick one to see how we can help. ## What treatment costs Cost depends on the peel and how many are in your plan. Your consultation is free, and you'll know your plan and its cost before anything happens. You'll find our [current offers](/promotions/) on their own page. PeelsMicroPeel, Gel Peel, Pigment Balancing, Advanced CorrectiveHealing1 to 7 days for light peels [1]SeriesOften 3 to 5, every 2 to 5 weeks [1]AftercareDaily sunscreen once healed [1]WhereOur Fresno and Visalia offices ## Peel questions, answered **Q: Will I peel a lot?** Most SkinCeuticals peels cause light flaking at most. Healing takes 1 to 7 days for a light peel. [1] **Q: How many peels will I need?** A series of 3 to 5 light peels, every 2 to 5 weeks, is common. [1] Your consultant sets your plan. **Q: Is a peel safe for darker skin?** Yes. People with skin of color can safely have a chemical peel with a team experienced in treating darker skin tones. [1] **Q: What's the difference between these and a VI Peel?** SkinCeuticals peels offer lighter, highly customizable options. The VI Peel is a medium-depth peel with about a week of peeling. Your consultant can help you choose. **Q: Can I combine a peel with a facial?** Often, yes. Your consultant can tell you which peels pair well with a HydraFacial or dermaplaning. **Q: When will I see results?** Once your skin heals. [1] A series builds on each peel's results. ## References [Chemical peels: FAQs](https://www.aad.org/public/cosmetic/younger-looking/chemical-peels-faqs) [Professional protocols](https://www.lorealdermatologicalbeauty.us/protocols) Content on this page is for educational purposes and is not a substitute for professional medical advice. Whether a chemical peel suits you depends on your skin and your consultation. Results vary from person to person, and a series may be needed. Side effects can include redness, flaking and temporary darkening of the skin. Individual results may vary. ### Treatment Add-Ons ## Your treatment, customized Every skin is different, and so is every occasion. Add-ons let you focus your visit on the areas and goals that matter most to you, whether that's a smoother surface, a brighter neck and chest, or hands ready for close-up photos. Our cosmetic consultants can help you combine services when that makes sense, and tell you which treatments work best on their own. ### Popular add-ons - Dermaplaning - A chemical peel - Specialty HydraFacial enhancements - Neck and décolletage treatments - Back facial - Hand facial - 6 ways To customize your facial or peel, from dermaplaning to a hand facial. ## How add-ons work 1. Pick your main treatment Start with a HydraFacial, DiamondGlow or peel. 2. Talk through your goals A cosmetic consultant helps you choose add-ons that suit your skin and your event. 3. Customize Your add-ons are built into the same visit whenever they can be. 4. Or stand alone Some treatments work better as their own appointment. Your consultant will tell you which. - One visit Most add-ons fit right into your facial or peel appointment. ## Choose your add-ons Add-onWhat it doesDermaplaningRemoves dead skin and peach fuzz for a smoother surface before your facial or peelChemical peelA light peel layered into your treatment, such as a VI Peel or one of our SkinCeuticals peelsSpecialty HydraFacial enhancementsTargeted boosters and upgrades for a specific concernNeck and décolletageExtends your treatment to the neck and chest, where sun often shows firstBack facialCleanses, exfoliates and refreshes the skin on your backHand facialHydrates, smooths and brightens hands, perfect for special occasions and wedding-day photosAdditional targeted treatmentsExtra care for the areas that matter most to you Not sure what to add? Your [free consultation](/cosmetic/consultation/) helps you build the right visit. ## Areas you can add AreaAdd-onFaceDermaplaning, peels, HydraFacial enhancementsNeck and chestNeck and décolletage treatmentBackBack facialHandsHand facial The Paz difference ## Customized by people who know skin care Our cosmetic consultants help you put together a visit that fits your skin, your goals and your calendar. Tell them the date you're getting ready for, and they'll plan backward from it. - Wedding ready Hand facials and neck and chest care are favorites before the big day. ## When to add something extra ### Add-ons are a great fit if you: - Have a wedding, vacation or event coming up - Want to treat your neck, chest, back or hands as well as your face - Want more from your regular facial or peel - Want a visit built around your own goals ### Tell us before your appointment if you: - Are pregnant or nursing - Use prescription retinoids or other strong skin care - Have any rash, sunburn or irritated skin in the area ## After your treatment Aftercare follows your main treatment. Your consultant will go over it before you leave, including sunscreen for any area that was exfoliated or peeled. ## What add-ons cost Cost depends on the add-ons you choose. Your consultation is free, and you'll know your plan and its cost before anything happens. You'll find our [current offers](/promotions/) on their own page. Add toHydraFacial, DiamondGlow or peelsOptionsDermaplaning, peels, HydraFacial enhancements, neck and chest, back, handsGreat forWeddings, vacations and special eventsWhereOur Fresno and Visalia offices ## Add-on questions, answered **Q: Can I add more than one?** Often, yes. Your consultant will tell you which add-ons pair well. **Q: How far ahead of a wedding should I book?** Give yourself a few weeks, especially if you're adding a peel, so your skin has time to settle before the day. **Q: Can I book an add-on on its own?** Some, like dermaplaning, can be booked on their own. Your consultant can help. **Q: What's a back facial?** A customized treatment that cleanses, exfoliates and refreshes the skin on your back. **Q: What's a hand facial?** A special treatment that hydrates, smooths and brightens your hands, perfect for wedding-day photos. **Q: Who helps me choose?** Our cosmetic consultants, at either office. Your consultation is free. ### Upper Blepharoplasty ## Open, rested eyes again Eyelid skin is thin, so it's often one of the first places time shows. Loose skin can fold over the upper lid, and small fat pads can make it look puffy. Sometimes the fold droops far enough to get in the way of your vision. [1] Upper blepharoplasty removes the extra skin and, where needed, excess fat, through an incision hidden in the natural crease of the eyelid. [1] The result is a fresher, more open look that still looks like you. ### What you can change - Hooded upper eyelids and folds of extra skin - Puffiness from fat in the upper lids - A heavy, tired look around the eyes - A fold that crowds your upper view - Natural crease Where the incision goes. [1] That keeps the scar well hidden when your eyes are open. ## How upper eyelid surgery works 1. Your consultation Your surgeon examines your eyelids and brows, talks through what's bothering you, and makes sure the lids, not the brows, are the source. 2. Numbing and comfort The procedure is usually done under local anesthesia, often with sedation to help you relax. 3. The surgery Through an incision in the natural crease, excess skin is removed and fat is trimmed or repositioned where needed. [1] The incision is closed with fine stitches. 4. Healing You'll go home with instructions for cold compresses and eye drops or ointment. Stitches come out within days, and most swelling settles in about two weeks. - About 2 weeks How long most swelling and bruising take to settle after upper eyelid surgery. ## The right procedure for the right concern Upper eyelid surgery does one job very well. Knowing exactly what that job is makes for the best result. Upper blepharoplasty canIt can'tRemove loose, sagging upper eyelid skin [1]Raise a low brow [1]Reduce puffiness from fat in the lids [1]Smooth crow's feet [1]Open up the eyes and freshen the lookFix dark circles under the eyes [1]Clear a fold that crowds your vision [1]Stop the eyes from aging over time Crow's feet usually respond better to [Botox](/treatments/botox/). If a low brow is part of the picture, your surgeon will tell you. ## What upper eyelid surgery treats ConcernWhat changesHooded lidsThe fold of extra skin is removed. [1]Puffy lidsExcess fat is trimmed or repositioned. [1]A tired lookEyes look open and rested.Crowded visionA drooping fold is lifted out of the way. [1] ## Real results from patients - Long-lasting Blepharoplasty results last, though your eyes continue to age naturally. [1] The Paz difference ## A refreshed look that's still you The best eyelid surgery doesn't change who you are. It takes away the heaviness and leaves the character of your eyes. That starts with careful planning: how much skin to remove, where the crease should sit, and how both eyes will match. Because this is a dermatology practice, your surgeon also looks at the skin around your eyes, and will tell you if a non-surgical treatment would serve you better. ## Is upper eyelid surgery right for you? ### You're likely a good fit if you: - Have extra skin or puffiness on your upper lids - Look tired even when you're rested - Are in good overall health and don't smoke - Have realistic expectations about the result ### Tell us at your consultation if you have: - Dry eye or another eye condition - Thyroid disease, diabetes, high blood pressure or heart disease - A blood thinner or aspirin in your routine - Had eye surgery before, including LASIK ## Recovery and risks Expect swelling and bruising around the eyes, eased with cold compresses and lubricating drops. [1] Most people go back to work within a few days to a week, and most swelling fades in about two weeks. ### While you heal - Use cold compresses and eye drops or ointment as directed [1] - Skip contact lenses and eye makeup for about two weeks - Hold off on exercise and strenuous activity for about two weeks - Keep your head raised when resting Like any surgery, eyelid surgery has risks, including anesthesia risks, bleeding, infection, dry eyes, difficulty closing the eyes, changes in sensation, sensitivity to light, unfavorable scarring, the possible need for revision and, very rarely, changes in vision. [2] Your surgeon will go through each of these with you. ## Concerns treated This is the most common concern upper eyelid surgery treats here. Pick it to see how we can help. ## What treatment costs Cost depends on what your eyelids need, so the fairest number comes from your consultation. You'll know your plan and its cost before you decide. A consultation with a medical provider is $80, and it goes toward your surgery if you go ahead. You'll find our [current offers](/promotions/) on their own page. What it treatsLoose upper eyelid skin and puffiness [1]IncisionIn the natural crease [1]AnesthesiaUsually local, often with sedationBack to workA few days to a weekSwellingMostly settled in about 2 weeksWhereOur Fresno and Visalia offices ## Eyelid surgery questions, answered **Q: Will people be able to tell?** The incision sits in the natural crease, [1] so it's well hidden when your eyes are open, and it fades with time. Most people just look more rested. **Q: Does it hurt?** The area is numbed, often with sedation to help you relax. Afterward, most people describe soreness more than pain. **Q: How long is recovery?** Most people return to work in a few days to a week. Swelling and bruising mostly settle in about two weeks. **Q: Can it fix crow's feet or dark circles?** No. Eyelid surgery treats extra skin and fat on the lids. [1] Crow's feet respond to Botox, and your consultation will cover options for dark circles. **Q: Do the results last?** Yes, the results are long-lasting, though your eyes keep aging naturally over time. [1] **Q: What if my brows are low?** A low brow can look like hooded lids. Your surgeon checks for this at your consultation, since eyelid surgery won't raise the brow. [1] ## References [Eyelid Surgery](https://www.plasticsurgery.org/cosmetic-procedures/eyelid-surgery) [Eyelid surgery safety](https://www.plasticsurgery.org/cosmetic-procedures/eyelid-surgery/safety) Content on this page is for educational purposes and is not a substitute for professional medical advice. Upper blepharoplasty is surgery, and whether it suits you depends on your consultation. Results vary from person to person, and eyes continue to age. Risks include anesthesia risks, bleeding, infection, dry eyes, difficulty closing the eyes, changes in sensation, light sensitivity, scarring, the possible need for revision and, very rarely, changes in vision. Individual results may vary. ### VBeam Laser ## Calmer, clearer skin VBeam is a pulsed dye laser, a type of laser that's especially good at reducing [rosacea](/concerns/rosacea/), red birthmarks, [broken blood vessels](/concerns/redness-blood-vessels/) and other red spots. [1] Its light is absorbed by the blood inside small vessels, which heat up and close, and your body clears them away over the following weeks. VBeam is also cleared to treat scars, stretch marks and benign brown spots. [2] ### What it can treat - Rosacea and facial redness [2] - Broken blood vessels on the face and legs [2] - Spider veins [2] - Port-wine stains and hemangiomas [2] - Red scars and stretch marks [2] - Sun spots and other benign brown spots [2] - 595 nm The wavelength VBeam uses, chosen because blood vessels absorb it so well. ## Your VBeam appointment 1. Your consultation We look at your redness, vessels or marks, check your skin tone and medicines, and set your plan. 2. Treatment You'll wear protective eyewear. With each pulse, a burst of cooling spray protects and soothes the skin. Most people feel a quick snap. 3. Afterward Skin is usually pink or a little swollen for a few hours to a day. Depending on the settings, some people have temporary bruising. 4. A short series Many concerns clear in a few sessions spaced several weeks apart. - Fewer sessions Lasers typically need fewer sessions than light treatments for redness. [3] ## Laser or light for your redness? Both treat redness. The right one depends on what else you'd like to change. VBeam laserIPL photofacialBest forRedness, broken vessels, red birthmarks, red scars [2]Redness and sun spots togetherSessionsFewer [3]More, but gentler [3]WhereFresno and VisaliaVisalia Not sure which fits? Your [free consultation](/cosmetic/consultation/) will sort it out. ## Where VBeam makes the biggest difference AreaWhat changesCheeks and noseRedness and tiny vessels fade [2]Face and neckRosacea flushing and color calm [2]LegsSmall spider veins clear [2]Scars and stretch marksRed or pink color softens [2]BirthmarksPort-wine stains and hemangiomas lighten [2] ## Real results from patients - Built-in cooling A cooling burst with every pulse keeps treatment comfortable. The Paz difference ## Redness, understood before it's treated Redness can come from rosacea, sun damage, broken vessels or a medical skin condition, and the right treatment depends on which. Because you're in a dermatology practice, your plan starts by finding the cause, so the laser treats what's really there. ## Is VBeam right for you? ### You're likely a good fit if you: - Have rosacea, facial redness or small visible vessels - Have spider veins on your face or legs - Have a red birthmark, red scar or stretch marks - Can protect your skin from the sun during treatment ### Tell us before your appointment if you: - Have a tan, or have recently used a self-tanner - Take a blood thinner or any medicine that makes you sensitive to light - Have darker skin, so your settings can be chosen with extra care [1] - Are pregnant ## After your appointment Most people go back to their day. Some redness and swelling is normal and fades within hours to a day or two. ### For the next week - Wear sunscreen every day and stay out of strong sun - Use a cool compress for swelling - Skip hot showers, saunas and hard workouts for a day or two - Don't rub or pick at treated skin Laser and light treatments can cause burns, lasting changes in skin color or scars, which is why careful settings matter. [3] Call us if you notice blistering or anything that worries you. ## Concerns treated These are some of the most common concerns VBeam helps with here. Pick one to see how we can help. ## What treatment costs Cost depends on the area and how many sessions you need. Your consultation is free, and you'll know your plan and its cost before anything happens. You'll find our [current offers](/promotions/) on their own page. Type595 nm pulsed dye laser [2]TreatsRedness, rosacea, vessels, red birthmarks, scars [2]SessionsA short series, weeks apartDowntimeLittle; some redness or bruisingWhereOur Fresno and Visalia offices ## VBeam questions, answered **Q: Does VBeam help rosacea?** Yes. VBeam is FDA-cleared to treat rosacea, [2] and lasers are effective at reducing its redness. [1] **Q: How many sessions will I need?** Many people see clear improvement in a few sessions. Your plan depends on what you're treating. **Q: Will I bruise?** Some people do, depending on the settings used. Any bruising fades on its own. **Q: Does it hurt?** Most people describe a quick snap, softened by the cooling spray with each pulse. **Q: Can VBeam treat red birthmarks?** Yes. It's FDA-cleared for port-wine stains and hemangiomas. [2] **Q: Will the redness come back?** Treated vessels are cleared, but rosacea and sun can create new ones over time. Sunscreen and good skin care help results last. ## References [Skin conditions that lasers can treat](https://www.aad.org/public/diseases/a-z/skin-conditions-lasers-treat) [510(k) Premarket Notification K230990: Candela Vbeam Family of Pulsed Dye Lasers (Vbeam Prima, Vbeam Perfecta)](https://www.accessdata.fda.gov/cdrh_docs/pdf23/K230990.pdf) [Rosacea: Diagnosis and treatment](https://www.aad.org/public/diseases/rosacea/treatment/diagnosis-treat) Content on this page is for educational purposes and is not a substitute for professional medical advice. VBeam is FDA-cleared for specific uses, and whether it suits you depends on your consultation. Results vary from person to person, and new redness or vessels can form over time. Side effects can include redness, swelling and temporary bruising. Rare risks include blistering, burns, changes in skin color and scarring. Individual results may vary. ### VI Peel ## A week to brighter, clearer skin A VI Peel lifts away the dull, damaged top layers of skin so fresher, more even skin comes through. Even a single peel can mean less pigment, smoother texture and brighter skin overall. [1] The application is virtually painless, with just some warmth and tingling. [1] Then you go home with a post-peel kit, your skin peels lightly for a few days, and the new skin underneath shows. ### What it can improve - Dark spots, sun spots and melasma [2] - Active breakouts and acne marks [2] - Acne scars and rough texture [2] - Fine lines and early signs of aging [2] - Dull, uneven tone [1] - About a week Peeling usually starts around day three, and most people are done by day seven. [1] [3] ## Your VI Peel, day by day 1. Your appointment Your skin is cleansed and the peel is applied in layers. It feels warm and tingly, not painful. [1] 2. The first few hours Leave your skin alone: no makeup or other products for the first 4 hours. [1] 3. Days 3 to 7 Light peeling starts around day three and lasts a few days. [1] Use only your post-peel kit products for the full week. [1] 4. The reveal By about day seven, most people have finished peeling [3] and see brighter, smoother skin. - All skin tones VI Peel treatments are made to be safe and effective for all skin tones. [1] ## A VI Peel for every goal Each formula is built for a different concern. Your consultant matches the peel to your skin. PeelMade for [2]VI Peel OriginalSensitive skin and first-time peelers, early signs of aging, rough textureVI Peel AdvancedMature skin (40+): wrinkles, fine lines, loss of firmness, roughnessVI Peel Precision Plus, with peptidesStubborn pigment: melasma, sun damage, dark spots and marks left by breakoutsVI Peel PurifyActive and hormonal acne, oily and congested skinVI Peel Purify with Precision Plus, with peptidesActive acne plus the dark marks and texture it leaves behindVI Peel BodyBelow the collarbone: discoloration, body acne, rough bumps, stretch marks, scars Not sure which is yours? Your [free consultation](/cosmetic/consultation/) settles it. For a lighter or more targeted option, see our [SkinCeuticals peels](/treatments/skinceuticals-peels/). ## Where a VI Peel makes the biggest difference AreaWhat changesFaceBrighter, more even tone and smoother texture [1]Neck and chestSun spots and uneven color fadeBack and shouldersBody acne and marks clear with VI Peel Body [2]Arms and legsRough bumps and discoloration improve with VI Peel Body [2] ## Real results from patients - 3 to 6 peels The series recommended for the best results, spaced 4 to 6 weeks apart. [1] The Paz difference ## The right peel, chosen for your skin With six VI Peel formulas and SkinCeuticals peels offered here, your peel is matched to your skin and goals rather than picked from a single option. And if acne, melasma or scarring need more than a peel, your plan can include lasers or medical care in the same practice. ## Is a VI Peel right for you? ### You're likely a good fit if you: - Have dark spots, melasma or uneven tone - Have acne, acne marks or rough texture - Want brighter, smoother skin with about a week of peeling - Can avoid strong sun for the week after your peel [1] ### Please don't book a VI Peel if you: - Are pregnant or breastfeeding [1] - Are allergic to aspirin, hydroquinone or phenol [1] - Have taken isotretinoin (Accutane) in the past 6 months [1] ## Your week after the peel ### For the first 7 days - No makeup or other products for the first 4 hours [1] - Use only the products in your post-peel kit for the full week [1] - Avoid direct and extreme sun, and wear SPF 50 sunscreen [1] - Don't pull peeling skin; trim loose flakes with clean, small scissors instead [1] Some people peel a little more or less depending on their skin. [3] Call us if your skin becomes very red, painful or blistered. ## Concerns treated These are some of the most common concerns the VI Peel helps with here. Pick one to see how we can help. ## What treatment costs Cost depends on the formula and how many peels are in your plan. Your consultation is free, and you'll know your plan and its cost before anything happens. You'll find our [current offers](/promotions/) on their own page. FormulasOriginal, Advanced, Precision Plus, Purify, Purify with Precision Plus, Body [2]ApplicationVirtually painless [1]PeelingStarts around day 3; most done by day 7 [1] [3]Series3 to 6 peels, 4 to 6 weeks apart [1]WhereOur Fresno and Visalia offices ## VI Peel questions, answered **Q: Does it hurt?** No. Most people feel only warmth and tingling during the application. [1] **Q: How much will I peel?** Light peeling usually starts around day three and lasts a few days. [1] It's more flaking than sheets, and it's easy to hide at home. **Q: Will I see results after one peel?** Yes. A single peel can mean less pigment, smoother texture and brighter skin. [1] A series of 3 to 6 gives the best results. [1] **Q: Is it safe for darker skin?** VI Peel treatments are made to be safe and effective for all skin tones. [1] Your consultant picks the formula that suits yours. **Q: Can it help melasma?** Yes. VI Peel Precision Plus is made for stubborn pigment, including melasma. [2] Daily sunscreen helps keep it from coming back. **Q: When can I wear makeup?** After the first 4 hours, [1] although many people prefer to go bare while they peel. ## References [VI Peel FAQ](https://vipeel.com/pages/vi-peel-faq) [Our peel formulas](https://vipeel.com/pages/patient-results) [VI Peel treatments](https://vipeel.com/pages/vi-peel-treatments) Content on this page is for educational purposes and is not a substitute for professional medical advice. The VI Peel isn't right for everyone, including during pregnancy or breastfeeding; whether it suits you depends on your consultation. Results vary from person to person, and a series may be needed. Expect about a week of peeling, with some redness and tightness. Individual results may vary. ## Providers ### Amal Muthana, MSN, FNP-C ## About Amal Amal is a board-certified Nurse Practitioner specializing in dermatology, with a passion for delivering high-quality, patient-centered care. With a strong foundation in both medical and cosmetic dermatology, Amal is skilled in diagnosing and managing a wide range of skin conditions, including acne, eczema, psoriasis, rosacea, and skin cancer. She also performs skin exams and minor procedures such as biopsies and cryotherapy. Known for her compassionate and thorough approach, Amal takes the time to educate patients and develop personalized treatment plans that align with their unique needs and lifestyles. She stays current with the latest advancements in dermatological treatments and evidence-based practices to ensure the best outcomes. Amal is committed to fostering trust, promoting skin health, and empowering patients to feel confident in their skin. ### Clarissa Alvarado, MSN, FNP-C ## About Clarissa Clarissa Alvarado is a board-certified nurse practitioner. She is a graduate of California State University, Bakersfield with a Bachelors of Science and graduated with a Masters in nursing from Fresno Pacific University. She is a member of the American Academy of Dermatology. In her spare time, Clarissa enjoys traveling, spending time with her friends, family and her dog Koby. ### Dr. Carlos Paz, MD, PhD ## About Dr. Paz Dr. Carlos Paz is a board-certified dermatologist and fellowship-trained dermatologic surgeon. He received his bachelors of science degree from Yale and both his MD and PhD degrees from Harvard. Following an internship in General Surgery at the University of California San Francisco (UCSF), Dr. Paz completed residency in dermatology at the University of Chicago, and then pursued specialized training in Mohs Micrographic Surgery, lasers, and cosmetic surgery in Miami, Florida. He completed an ACGME-approved Procedural Dermatology fellowship under the tutelage of Dr. Eli Saleeby, a Mohs Surgeon who trained directly with Dr. Fredrick Mohs, the physician for whom Mohs Micrographic Surgery is named. During his fellowship, Dr. Paz also gained extensive experience in various cosmetic procedures including liposuction, hair transplantation, mini face-lifts, blepharoplasty (eye lid surgery), sclerotherapy (vein treatment), and the use of lasers, Botox, and fillers. Dr. Paz has also received specialized training by Dr. Jeffrey Klein, the physician who invented the Tumescent Liposuction method. Dr. Paz has published numerous journal articles, written book chapters, and given presentations at national meetings. He is a fellow of the American Academy of Dermatology, American Society of Dermatologic Surgery, American College of Mohs Surgery, and is a member of the California Medical Association and the Fresno-Madera Medical Society. Dr. Paz enjoys traveling, fishing, reading, and art collecting. He and his wife, Vivian, are natives of Fresno County. ## Training and credentials Board certificationDermatologyAmerican Board of DermatologyFellowshipProcedural Dermatology (ACGME-approved)Miami, Florida · Mohs Micrographic Surgery, lasers and cosmetic surgeryResidencyDermatologyUniversity of ChicagoInternshipGeneral SurgeryUniversity of California San Francisco (UCSF)EducationMD and PhDHarvardBachelor of ScienceYaleProfessional societiesFellowAmerican Academy of Dermatology, American Society for Dermatologic Surgery, American College of Mohs SurgeryMemberCalifornia Medical Association, Fresno-Madera Medical Society ### Gabriel Zapata, PA-C, MMSC ## About Gabriel Gabriel Zapata is a board-certified Physician Assistant at Paz Dermatology. He is a graduate of California State University, Fresno with a Bachelor of Science in Health Sciences and Masters of Medical Sciences from Saint Francis University of Pennsylvania. He is also a member of the American Academy of Dermatology and a Diplomat Fellow of The Society of Dermatology Physician Assistants. Gabriel enjoys music, boating and spending time with his wife and two daughters. ### Joanne Gloria, PA-C ## About Joanne Joanne is a board-certified Physician Assistant based in our Visalia office. She is an alumna of the Stanford University School of Medicine. Driven by a strong passion for medicine and a commitment to providing exceptional patient care, Joanne began her career in nursing before pursuing a career as a Physician Assistant, graduating in 2014. Before specializing in dermatology, Joanne spent eight years working in emergency medicine. She also worked as a registered nurse in family and pediatric medicine for six years prior to becoming a PA. Joanne joined Paz Dermatology as a lateral provider in May 2025, bringing over three years of experience in general and procedural dermatology to the practice. She is fluent in Tagalog. Outside of work, Joanne enjoys traveling, cooking, painting, and spending time with her family, including her newborn baby boy. ### Melissa Manriques, FNP-C ## About Melissa Melissa Manriques is a board-certified nurse practitioner. She is a graduate of California State University, Fresno with a Bachelors of Science and Masters of Science in Nursing. Melissa is a vital part of our team and loves working with our patients on an individual basis and educating them about skincare regimens that promote optimal skin health. She is a member of The American Academy of Dermatology. Melissa enjoys fitness and spending time and sports activities with her three sons and husband. ## Articles ### Celebrating the 10-Year Anniversary of Paz Dermatology We are proud to celebrate our 10-year anniversary! We have had the privilege of serving our community with top-notch medical and cosmetic dermatology services. As a family-run practice with strong ties to the Central Valley, we care deeply about our patients’ skin-health. We extend our heartfelt gratitude to the patients who have placed their trust in us, allowing us the privilege of caring for their skin health. To new patients who have yet to experience our personalized care, we eagerly await the opportunity to welcome you into our family and provide you with the very best in medical and cosmetic dermatology services. As we embark on the next chapter of our journey, we remain steadfast in our mission to uphold the highest quality of care in a patient-focused environment. With gratitude in our hearts, we look forward to many more years of serving the Central Valley community. ### Dermatologic Surgeon, Dr. Carlos Paz Kicks Off Summer by Partnering with Central Valley-Based Kool Breeze Solar Hats Just over 10 years ago, Dr. Carlos Paz and his wife Vivian embarked on a challenging venture by founding Paz Dermatology in Fresno and Visalia. Their entrepreneurial spirit has always driven them to support local businesses, fostering a sense of community and collaboration. In line with this vision, Dr. Paz has partnered with Kool Breeze Solar Hats Inc., developed and founded by Dr. Vernice Nellon. These revolutionary, patented solar cooling hats are designed to deliver maximum airflow to keep the head and body cool, while the wide brim protects the face, ears, and neck from harmful UV rays. Manufactured in Fresno by another woman-owned business, Total Concept Solutions, these hats are distributed throughout the United States. Over the years, Dr. Paz has surgically removed thousands of cancerous lesions from the face and head, many from patients who worked outdoors without adequate sun protection. Understanding the critical need for sun safety, he is committed to encouraging the public to avoid sun exposure whenever possible. When working outdoors, he advises applying broad-spectrum SPF 30 or higher sunscreen every two hours, and wearing hats and long-sleeve shirts to protect the skin. Dr. Paz emphasizes the importance of sun protection, stating, “Kool Breeze Solar Hats are a great sun protection tool for folks in the Central Valley who work outdoors in agriculture and construction. They are excellent for gardening and outdoor recreational activities.” *Pictured above: Dr. Vernice Nellon, President of Kool Breeze Solar Hats, with patient Tamara White.* To commemorate Skin Cancer Awareness Month and support a local business, Paz Dermatology will feature, sell, and raffle Kool Breeze Hats at its offices. Dr. Paz has also created a couple of short videos to share knowledge on how to properly dress for gardening and outdoor work, aiming to provide more skin cancer prevention information to their patients and the community. The partnership was launched in May to commemorate Skin Cancer Awareness Month and to kick off summer. Videos and photos related to the partnership will be shared throughout the summer on social media to remind our community of the importance of sun protection. Additionally, the Kool Breeze Hats were featured at the [CVCF’s April Friend of the Foundation event](https://centralvalleycf.org/community-foundation-advantages/giving-opportunities/friends-of-the-foundation/). You can purchase a hat at Paz Dermatology offices or directly from [Kool Breeze Solar Hats](https://www.mycoolingstore.com/kool-breeze-hats.html). The ultimate goal of this partnership is to enhance public awareness about skin cancer prevention and promote sun safety practices. Through these efforts, Dr. Paz hopes to make a significant impact on the health and well-being of the Central Valley community. ### Welcome To My Blog! Within this regularly updated feature of my website, I will provide visitors with practice news and specials, as well as information regarding the most recent technological advances and new treatments in Cosmetic Services. I believe that patient education and open communication with your doctor are the keys to achieving healthy, aesthetically-pleasing results and patient satisfaction, which is why I strive to provide the highest quality of Cosmetic Services care for patients of all ages. This is done by combining technical skills and broad experience with cutting-edge technology for impeccable medical and cosmetic results. I sincerely appreciate you taking the time to visit my new blog. Please check back often to learn about the latest news, updates, and additions to the practice and within the field of Cosmetic Services, and feel free to post comments and/or suggestions on any posts that you find of interest.