Injectable fillers are not just for the face at this time in aesthetic medicine. The Grafenburg or G-spot in the area of the vagina offers increased sexual enhancement and gratification to patients who need a boost to this erogenous zone. In 1950, Dr. Grafenburg noted that increased stimulation and swelling of the G-spot produced identifiable increase in orgasms. The G-shot was developed by Dr. David Matlock where a painless procedure injected filler in this area on the G-spot to produce a similar sexual experience.

The G-shot is intended for women with healthy sexual function for enhancement of sexual function. It is not a cure for dysfunction.

For the women who want rejuvenation and have the concern of saggy and relaxed genital lips injection of fillers to increase firmness, correct shape and unevenness of the labia majora and labia minora. With the new style of removing pubic hair the area becomes more visible and many more women seek out non-surgical alternatives which are kinder to the area. With our procedure there is no mutilation of this sensitive area.



Many aesthetic doctors are familiar with the problems of fake neurotoxins such as Botox, dermal fillers and other counterfeit products in the practice market. It’s an epidemic which leads to consumers feeling the product works poorly. Law enforcement is poor in containing the problem. It’s so important to avoid hurting people as physicians and to maintain good standards in a profession. The problem is accommodating the “Groupons” of the world to encourage more sales. I think consumers have to be smart. In a very public warning to 350 US medical practices in December 2012, the FDA named the physicians and medical groups that may have purchased fake Botox from pharmacy outside the US and online mega pharmacy linked to the marketing of fake cancer medicines and other defective pharmaceuticals.

Increasing use of fake injectable and medicines have been known to do great harm. “Good deals” can be just the opposite. A bad economy has increased the use of these Internet drug web sites.

Even worse is when patient seek treatments in countries outside the US to save money. I have seen disaster after disaster in injectable, fillers and neuromodulators, plastic surgery and if something goes wrong, where do you go for follow up? Often enough it’s the US doctors that have to deal with that patient but the results are never optimal. I have patients that come in from abroad with fillers that rupture through the skin, with breast jobs that look massacred, and the list goes on. The fillers that are used outside the US are often not a proved in this country because of the problems they cause. Bovine collagen is injected abroad without skin testing and patients are not told of the consequences of permanent fillers. Life threatening infections, allergic reactions, deforming and scaring patients as well as death are not uncommon side effects to these procedures off shore.

My advise, don’t go to the $10 store when it comes to applying substances to your body or doing surgery. If I’m having surgery I want someone who will be around me for years to come, a car ride away at most.



Pigment problems are one of the most common issues in my practice. Sometimes people think of the lighter skin types having issues with hyperpigmentation but the truth is that ethnic skin such as Asian, Hispanic and African are at risk to develop this problem. Photodamage from the sun is the main culprit but vascular changes, hormonal issues, acne, and tattoo ink colors produce unwanted areas in our body.

Freckles, liver spots and melasma can be treated with CO2 fractional lasers, IPL and RF treatments. Chemical peels when the pigment is more superficial is an alternative but care with ethnic skin must be taken because peels can produce even more hyperpigmentation in this group of people. There are cream alternatives, natural ingredients such as kjoic acid, licorice, arbutane and vitamin C are mild treatments for pigment. Hydroquinone is a melanosome inhibitor but good for 3 months or less in treatment. Combination with glycolic acid, retinol and some of the above can work. For deep pigment and permanent results I find that a 50+ UVB/UVA block is a must, combined with laser.

Laser treatment for melasma is different from freckles or liver spots. Seborrheic keratosis is a tan pigment that can be flat or raised, requires CO2 laser or surgical removal when very raised. Post inflammatory hyperpigmentation from Acne does well with creams but at times a laser treatment is indicated. There are lasers for localized areas and large areas. Treatment of scar hyperpigmentation is achieved with laser and creams in combination. Lower energies, density and patterns are used for ethnic skin treatment.



Wrinkles in the area of the forehead can be divided into the glabella (area between the eyebrows), the mentalis (forehead) and the ocular or eye area (crows feet). These areas are known as dynamic wrinkles because the problem is muscular movement. As patients grow older, dynamic wrinkles become more permanent and neurotoxins such as Botox or Xeomen have to be combined with hyaluronic acid fillers such as Belotero and Juvederm. Lines at first stage are absent unless muscular contraction happens but as time goes by they can be seen even when at rest of the muscle.

Many younger patients come in to treat the problem, seeking prevention of the deeper, more fixed problem. Agent that worsens wrinkling is lack of vitamin d, low omega 3 level, poor hydration and poor skin elasticity brought about by heredity or the sun. Free radicals destroy elastin and produce cell death, increasing the chances of premature wrinkling. Poor hydration induces cell damage so oral intake of water during the day and good humectants nurture our skin. Treatment of the skin against these agents will help retard the aging cascade of the forehead.

When I was in high school I read somewhere about applying scotch tape over my forehead while at home and sleeping. Well, that didn’t go far so when I started working I tried Botox and have been a user ever since. The nice thing about it is that the longer a neurotoxin is used, the less strength of contraction over time so today I use minimal amounts. Continued use weakens the muscle groups enough where you can save money down the line. Some people have larger and stronger muscles needing more product.



It doesn’t matter where you go, or how long is your get-away, must always think ahead and be prepared to protect your body during the fun times. I think about my body as an extension of every organ put together in a well oiled machine. Water is the key to all our body functions. From our brain, to our heart, hydration of the system is essential because without it we risk dangerous increases in body temperature as well as toxic buildup of metabolic waste that accumulates in our muscles and can hurt us severely. Rhabdomyalisis is a life threatening condition where people deplete the water reservoir and damage the kidney to the point of killing them. Severe exercise, prolonged walking or bicycling can produce this condition that can lead to hospitalization and death.

Sun block every 2 hours if you are outdoors is advisable. Sweating and touching your skin will wipe off the protection. If you burn, vitamin AC serum helps to resolve even blistering of the skin and reduces pain much quicker. Hats are a great aid to protect the skin of the face and avoidance of direct sunlight between 11 AM-4 PM is ideal. Protective clothing helps to prevent water loss as well as sunburn so long sleeves can be of benefit. Healthy snacks such as fruits and nuts are better than sugary treats. Coffee is a diuretic so drinking water is much healthier.

Being outdoors is a wonderful experience. Combine hiking, biking, paddling, swimming besides walking when possible. Take supplement vitamin D and omega 3 oils and then have fun.


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