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Facial Concerns

Acne Scars
What Causes Acne Scars?
Acne scars generally result from inflamed blemishes caused by engorged skin pores.

Acne Scars

What Causes Acne Scars?

Acne scars generally result from inflamed blemishes caused by engorged skin pores. Skin pores can swell up from excessive oil, bacteria and dead skin cells, causing a break in the follicle wall. Minor breaks in the follicle wall do not take as long to heal, but a major one can cause infected material to spill into the surrounding tissue and create deeper lesions.

While your skin has its own healing technique for lesions, forming new collagen fibers to help repair them, our bodies produce less and less collagen as we age. This makes it harder for acne scars to fade the older we get. In addition, despite the amount of collagen our skin produces, the repaired skin never looks as pristine as the original dermal layer.

What Are the Main Types of Acne Scars?

Scars resulting from acne are identified as either hypertrophic/keloid or atrophic/depressed. Hypertrophic scarring develops when the body produces too much collagen as acne wounds heal. They look like a mass of raised tissue on the skin’s surface. Atrophic scars are caused by a loss of tissue. Often referred to as “icepick” scars, they appear as small, visible holes in the skin. “Boxcar” scars are depressions that are commonly round in shape. They can look similar to the scars you can get from the chickenpox.

How Can I Avoid Worsening My Existing Acne Scars?

Make sure to stay out of the sun, as excessive sun exposure can darken acne scars and make them more visible. Remember to avoid over-scrubbing when you wash your face, as friction will irritate inflamed skin. Never pick at your scars, especially if you haven’t washed your hands. Bacteria from your hands and nails can result in the formation of additional cysts.

How to Treat Acne Scars

At Nouveau MedSpas in Gig Harbor, Dr. Rubin provides Icon and CO2 laser treatments, microneedling, chemical peels, HydraFacials and IPL treatments to improve acne scars. If you’ve had acne scars for years and are tired of seeing them in photos or when you look in the mirror, these treatments allow you to reduce them without surgery or significant downtime.

Bunny Lines

What Are Bunny Lines?

Bunny lines may sound cute, but this name is for the wrinkles at the top of your nose when you smile or laugh. These lines are horizontal and slightly unswept, similar to the laugh lines around the eyes.

What Causes Bunny Lines?

If you find yourself with bunny lines, they may be a natural consequence of aging. For those who have received BOTOX before in other areas, bunny lines can unintentionally become more noticeable. BOTOX works to smooth wrinkles in the upper face by relaxing your facial muscles, but with a smooth forehead and eye area, deep bunny lines can appear, or existing bunny lines may look obvious and unnatural compared to the surrounding line-free skin.

How to Treat Bunny Lines

Regardless of whether your lines formed naturally or after an injectable treatment, neuromodulators like BOTOX Cosmetic can be used to treat them. Dr. Rubin will inject tiny amounts of BOTOX, Xeomin or Jeuveau into the upper nose area to prevent bunny lines from hopping up. As a trained physician, Dr. Rubin administers injectables while keeping all of your facial dynamics in mind. She has the skill and expertise to create the right balance for your face.

Crow’s Feet

What Are Crow’s Feet?

Crow’s feet, also known as laugh lines, are the fine wrinkles around the outer corners of your eyes. These lines are more prominent when you flex the muscles around your eyes, such as when you squint, laugh or smile. As flattering as laugh lines sound, these unsightly wrinkles can appear in your 30s or earlier if you don’t use an effective skin care regimen or adequate sun protection. Either way, these inevitable lines appear as we grow older.

What Causes Crow’s Feet?

Our skin loses elasticity as we age due to reduced collagen and elastin production — the two most important proteins that help our skin maintain a youthful look. The skin around the eyes is much thinner and often the first place on our body to show signs of wrinkles. Other contributing factors to crow’s feet include sun damage and a slower renewal of cells (skin turnover) in the body.

How to Treat Crow’s Feet

Dr. Rubin uses BOTOX Cosmetic, Xeomin and AQUAGOLD fine touch to treat crow’s feet. BOTOX and Xeomin are FDA-approved formulas made from botulinum toxin type A that reduce the appearance of these lines by relaxing your facial muscles so they cannot contract. AQUAGOLD fine touch is a microneedling treatment used to administer BOTOX or Xeomin that also improves the overall texture and quality of the skin by addressing wrinkles, fine lines, acne and large pores. Unlike typical injectable treatments that use long needles, AQUAGOLD uses 20 tiny needles to deliver the formulas to the area just below the skin’s surface.

If you have crow’s feet or other facial wrinkles or loose skin, TempSure Envi, IPL (intense pulsed light) Photofacial and our CO2 laser treatments offer more comprehensive rejuvenation for the whole face. TempSure Envi uses radiofrequency (RF) energy to smooth the texture of your skin. Our IPL Photofacial uses light to stimulate collagen and elastin production for smoother, tighter skin. Our CO2 laser emits laser energy and radiofrequency energy to smooth wrinkles and revive your skin.

All of these treatments are nonsurgical and provide exceptional results that last. There is no downtime involved, no bruising or damage to the skin, nor will there be any indication that you’ve had anything done.

Eyelid Laxity

What Is Eyelid Laxity?

Eyelid laxity refers to the loose, drooping skin of the eyelids. It can give you an aged, fatigued appearance even when you don’t feel that way.

What Causes Eyelid Laxity?

Eyelid laxity is primarily caused by the natural aging process, where the production of collagen and elastin proteins decreases, leading to looser, sagging skin around the eyelids. Other factors contributing to eyelid laxity include sun damage, which breaks down collagen and elastin fibers, and genetics, which may predispose some individuals to experience skin laxity. Additionally, behaviors like smoking and constant eye rubbing can exacerbate the condition, making the skin around the eyes more prone to laxity.

How to Treat Eyelid Laxity

TempSure Envi offers an effective approach to addressing eyelid laxity. It utilizes radiofrequency (RF) energy to stimulate collagen production, which is a crucial factor in skin tightening and rejuvenation. This RF system is appreciated for its capability to treat smaller, more delicate areas, making it a suitable treatment for eyelid laxity​.

BOTOX Cosmetic, when injected into the muscles around the eyes, can temporarily lift the eyelids by relaxing the muscles. This treatment can reduce eyelid laxity to achieve a more refreshed and youthful appearance.

Flattened Brows

What Are Flattened Brows?

Flattened brows, often referred to as brow ptosis or drooping brows, are saggy or low eyebrows that create a grumpy, tired or sad look. In some cases, the brow will hang over the upper eyelid. You may also notice horizontal creases along the forehead and frown lines between your eyebrows or across the top of your nose.

What Causes Flattened Brows?

The natural aging process is a primary cause, where the gradual loss of skin elasticity and weakening of the muscles around the eyebrows lead to a downward shift or flattening of the brows. Repetitive facial expressions can also contribute to this condition, as continuous contraction and relaxation of the forehead muscles can cause the skin to lose its firmness over time. Additionally, underlying medical conditions, previous surgical procedures near the eye area or trauma can result in a change in brow position, leading to flattened or drooping brows.

How to Treat Flattened Brows

To reverse flattened brows, Dr. Rubin uses a small amount of BOTOX Cosmetic to pull up the muscles of the brow. A BOTOX brow lift is the perfect way to get your desired results without extensive plastic surgery.

Forehead Wrinkles

What Are Forehead Wrinkles?

Forehead wrinkles naturally develop over time as we age. The lines form due to repeated facial expressions and muscle contractions.

There are two types of forehead lines: the horizontal lines above the eyebrows and the vertical lines near the top of the nose (glabellar lines). The horizontal lines, also known as forehead rows, form when we raise one or both eyebrows. Glabellar lines form when we frown and furrow our brows.

You can take steps, such as skin care, sun protection and facial exercises, to delay these lines, but an aesthetic treatment can provide long-lasting, effective results.

How to Treat Forehead Wrinkles

Dr. Rubin provides BOTOX Cosmetic and Xeomin injections to treat forehead lines. BOTOX Cosmetic and Xeomin are both muscle relaxers that cause the facial muscles in your forehead to undergo temporary paralysis. This immobilization will allow the muscles in your face to rest, resulting in smoother skin.

Results can last several months, and Dr. Rubin recommends scheduling regular maintenance appointments to keep your forehead wrinkles at bay. With each treatment, smaller amounts of BOTOX or Xeomin will be needed, and the results may last longer. If you have a fear of needles, Icon laser treatments can also be used to address wrinkles and fine lines on your face.

Frown Lines

What Are Frown Lines?

Frown lines, also known as the “11s,” are the stubborn vertical lines that form between the eyebrows on the forehead. They may make us look perpetually annoyed, and they can eventually become etched into the skin and show even when we aren’t frowning.

What Causes Frown Lines?

These lines form due to a combination of repeated muscle movement over time, a loss of elastin production in the skin, heredity and sun exposure.

If you are tired of people asking why you look angry when you aren’t, multiple aesthetic treatments can help you address your frown lines. We cannot stop the aging process from happening, but we can correct lines and forehead furrows.

How to Treat Frown Lines

Dr. Rubin uses neuromodulators (such as BOTOX Cosmetic and Xeomin) to treat the 11s. The neuromodulator formula is injected into the targeted muscles to block nerve signals. This will allow your facial muscles to relax and smooth out, giving you a relaxed, carefree look. We also offer Jeuveau, the newest FDA-approved neuromodulator designed specifically to treat frown lines. These treatments can provide results that last for several months.

We also provide the following dermal fillers: Radiesse, Juvéderm Ultra XC and Juvéderm Vollure to smooth facial wrinkles. These fillers are incredibly safe and add volume to the areas of your face that need it. With more voluminous skin, wrinkles and lines are phased out.

With neuromodulators and fillers, we can use the AQUAGOLD fine touch system, a microneedling technique that uses multiple small needles to deliver the formulas just under the surface of your skin. Think of it as the ultimate facial.

TempSure Envi, IPL (intense pulsed light) and our CO2 laser treatments can also address frown lines while rejuvenating other areas of the face as well.

Hollow Cheeks

What Are Hollow Cheeks?

Hollow cheeks, or sunken cheeks, can give us a grim appearance. They appear to recede inward into the facial bones instead of projecting outward. The thin, hollow cheek look popular in the ‘90s is now a thing of the past. Now, more and more people desire a plump look to their face, as fuller facial structures tend to create a more youthful appearance.

What Causes Hollow Cheeks?

The aging process often results in a loss of facial volume. Not only do our bodies produce less collagen (which gives skin its elasticity and plumpness) as we grow older, but they also produce less subcutaneous fat. A sudden loss of weight, smoking and other lifestyle choices can also accelerate this look.

How to Treat Hollow Cheeks

Cheek augmentation is performed at our office in Gig Harbor, WA, using Juvéderm Voluma and Juvéderm Ultra XC. Using these facial fillers, Dr. Rubin can add volume to your face and give you the plump look you used to have or have always desired.

Hollow Temples

What Are Hollow Temples?

Hollow temples refer to volume loss at the temples, the region on each side of the face next to the eye between the top of the cheekbone and the brow bone. Volume loss in this area can create an unflattering shadow effect, leading to a dreary appearance around the eyes.

What Causes Hollow Temples?

Hollow temples are often caused by the natural aging process, which leads to decreased collagen and elastin in the skin. This results in a loss of facial volume and support, particularly in the temple area. Lifestyle factors like dramatic weight loss or smoking can also contribute to this appearance.

How to Treat Hollow Temples

Adding volume to the temples with injectable facial fillers can provide stunning results and a more youthful look. Fillers like Juvéderm Voluma use a naturally occurring substance in the body called hyaluronic acid (HA) to replace lost facial volume and reshape the temples. Radiesse is another dermal filler used to add volume to the temples. This filler is composed of calcium hydroxylapatite microspheres and stimulates the body’s natural collagen production to restore volume and firmness in the treated area.


What Is Hyperpigmentation?

Hyperpigmentation is a common condition in which patches of skin become darker than the surrounding skin. The most common forms of hyperpigmentation include age spots and melasma.

Age spots, also called sun spots or liver spots, are the smaller brown dots that often develop on the face and hands. Melasma usually appears in larger brown or blue-gray patches and is often referred to as the “mask of pregnancy” because it commonly develops on the faces of pregnant women.

What Causes Hyperpigmentation?

Most hyperpigmentation is caused by excessive sun exposure. The sun’s UV rays end up causing your skin to produce more melanin in order to protect itself from damage. While those with lighter skin tend to fare worse when exposed to UV rays, everyone can end up with brown spots. Brown spots are your body’s natural defense, but only some people will develop these over time, as it depends on genetics as well as how diligent you are with your sun protection. Some age-related factors can also cause an overproduction of melanin in the skin and contribute to hyperpigmentation.

The cause of melasma is not entirely clear, but it often appears when hormonal changes occur, such as during pregnancy or as a result of certain medications and birth control. Radiation, whether ultraviolet, visible light or infrared (heat) light, is believed to contribute to this condition.

How to Treat Hyperpigmentation

At Nouveau MedSpas, we offer Icon laser treatments, CO2 laser treatments and IPL Photofacials for hyperpigmentation. These treatments target and break up excess melanin from the skin to address various types of hyperpigmentation, including melasma and age spots. We also offer HydraFacials, chemical peels and microneedling to reduce the appearance of dark spots.

Lip Thinning

Lip thinning describes a common concern among women and men, even at an early age. Thin lips have a narrower or less voluminous appearance compared to what’s considered an average lip size. While the perception of lip size can vary based on individual preferences and cultural norms, thin lips are generally characterized by a less prominent upper or lower lip, or sometimes both.

What Causes Lip Thinning?

Around your 30s, you might notice your lips becoming thinner and deflated compared to their more voluminous appearance in your younger days. The fact is, thinning lips develop for the same reason your skin begins to sag over time: lost collagen and hyaluronic acid (HA). Collagen and HA give our lips plumpness, moisture and an overall look of youthfulness. Lip shape and size are also determined by genetics. If your lips are naturally small to begin with, there’s a good chance they will thin out further in your late 20s.

Additional contributing factors to thin lips include dehydration, drinking from straws and aging teeth. Water is vital for our bodies, so it’s essential to stay hydrated by drinking with an open cup. Sucking on straws can make our lips appear more wrinkled and smaller due to the repeated muscle movement. And as we age, our teeth also wear down and our lips start to sink inward, further contributing to a thin appearance.

How to Treat Thin Lips

Dr. Rubin provides Juvéderm Volbella injections to women and men who wish to have fuller, more youthful lips. Volbella is a unique filler because of its VYCROSS™ technology, an innovative combination of low and high molecular weights of hyaluronic acid (HA). This formulation technique allows Volbella to last longer than traditional fillers and provide smoother results, which means natural-looking lip enhancement with fewer repeat treatments. AQUAGOLD fine touch (a microneedling technique) can be used to deliver Volbella with tiny needles to improve the lip area.

Lip Wrinkles

What Are Lip Wrinkles?

Lip wrinkles are the lines and creases on and around the lips, often creating a chapped look. Smoker’s lines are a common type of lip wrinkles. Also known as lipstick lines, they are noticeable when lipstick “bleeds” into the wrinkles.

What Causes Lip Wrinkles?

Aging causes the lips to lose collagen, which results in a loss of elasticity and volume as well as the development of fine lines. Dehydration can also cause your lips to become dry, thin and flakey, making them more susceptible to wrinkles.

Despite their name, you don’t have to be a smoker to get smoker’s lines. These unsightly lines are caused by a variety of factors, such as genetics, age, repetitive lip movements such as drinking with a straw, making a “kissy-face” and yes, cigarette smoking.

How to Treat Lip Wrinkles

If lip wrinkles are ruining your perfect pout, aesthetic treatments can help. The best way to smooth out the wrinkles and lines on your lips is to provide them with volume. With plump, full lips, wrinkles won’t have anywhere to hide. Dr. Rubin uses Juvéderm Volbella lip injections to increase your lip volume. Volbella is the ideal treatment for natural lip enhancement, as the results are smooth, light and long lasting.

For wrinkles around the outside of the lips, such as smoker’s lines, Dr. Rubin uses BOTOX Cosmetic and Xeomin to limit muscle movement and allow the lines to fade. Instead of using one long needle, our AQUAGOLD system with 20 tiny needles can be used to add BOTOX Cosmetic and dermal fillers around the mouth. AQUAGOLD provides all of the benefits of a facial and so much more.

Marionette Lines

What Are Marionette Lines?

Marionette lines are the lines or folds that run vertically from the chin to the corners of the mouth. Even though their name is playful, deriving from marionette dolls, they can make us look unhappy or mad.

What Causes Marionette Lines?

These lines are a common result of the natural aging process that causes a combination of depleting fat (and other facial tissue underneath the skin) and a loss of skin elasticity. As with other undesired facial lines and folds, genetic factors, increased sun exposure and smoking can all accelerate the development of marionette lines.

How to Treat Marionette Lines

Dr. Rubin uses dermal filler injections to add volume to the area above your chin, smoothing out marionette lines. These fillers include Juvéderm Vollure, Juvéderm Ultra XC and Radiesse. Neuromodulators such as BOTOX Cosmetic and Xeomin can also address these facial wrinkles by relaxing your muscles. If you’d prefer not to be treated with a long needle, AQUAGOLD fine touch may be an option for you, as it uses 20 tiny needles to administer injectable formulas like Juvéderm and BOTOX.

Marionette lines can also be treated with TempSure or our CO2 laser, both of which use radiofrequency (RF) energy to smooth the skin.

Spider Veins and Other Visible Blood Vessels

What Are Spider Veins and Visible Vessels?

Spider veins are small dilated blood vessels that occur close to the skin. On the face, they are usually found near the nostrils, on the tip of the nose, in front of the ears and sometimes on the cheeks. Visible facial veins like spider veins are often difficult to conceal, leaving red or purple lines on your face that can impact your self-esteem.

Small visible veins on the face are a cosmetic concern rather than a medical condition with risks. Still, many people wish to remove their spider veins to attain a clearer complexion.

What Causes Visible Facial Veins?

Many different factors contribute to the appearance of abnormal veins on the face. Some of the most common causes include:

  • Aging
  • Prolonged sun exposure
  • Facial injuries
  • Certain medical conditions

As we get older, our skin becomes thinner and our veins weaken, becoming larger and more noticeable. UV rays from the sun cause collagen to break down and the walls of the veins to dilate, resulting in more visible veins, especially among people with lighter skin. Genetics can also play a role in how susceptible you are to developing spider veins. In addition, a facial injury or even scrubbing your face too hard can break small veins and cause them to enlarge. If you suffer from rosacea, lupus and/or allergies, you may also develop visible veins on your face.

How to Treat Spider Veins and Other Visible Veins

If you’re tired of seeing spider veins when you look in the mirror, we can help. At our Gig Harbor medspa, we provide Icon laser treatments and sclerotherapy to remove spider veins and other visible facial vessels.

Icon is a noninvasive system that uses IPL (intense pulsed light) technology to reduce redness and visible veins on the face. The procedure comes with no surgery or downtime. Sclerotherapy involves injecting a sclerosant solution into the problematic vein, causing it to shrink and eventually dissolve. Over time, the body reabsorbs the treated vein, making it disappear.

Under-Eye Bags

What Are Under-Eye Bags?

Under-eye bags appear as puffy or swollen areas below the eyes, often creating a sagging or drooping appearance. They can give your eyes a tired or aged look, even when you’re well-rested.

What Causes Under-Eye Bags?

As we grow older, the tissues around the eyes, including a few of the muscles that support the eyelids, lose strength. Aside from age, several factors can amplify this effect. Fluid retention can contribute to swelling of the lower lids that creates puffiness. In addition, a lack of sleep, allergies, hereditary factors and smoking are all linked with bags under the eyes.

How to Treat Under-Eye Bags

To correct the sagginess and weakened support of this area of the face, Dr. Rubin uses facial fillers like Juvéderm Voluma and Radiesse to add volume below the eyes. These injectable dermal fillers add hyaluronic acid (HA), a naturally occurring substance in the body, to the area. The results will leave your under-eye area looking more smooth and youthful.

If you aren’t in love with the idea of longer needle injections, Dr. Rubin can also use AQUAGOLD fine touch to deliver multiple tiny injections of dermal fillers to the area underneath your eyes.

Under-Eye Hollows

What Are Under-Eye Hollows?

Under-eye hollows, unlike puffy under-eye bags, give off more of a sunken look that can create dark circles and a perpetually tired appearance. Many women and men begin to notice hollows in their mid-30s, but if this cosmetic concern is in your genes, you might see under-eye hollows as early as your 20s.

What Causes Under-Eye Hollows?

As we get older, our collagen and elastin levels begin to decrease, which leads to skin laxity and hollowness in the lower eyelids. The fat from the under-eye area can also become displaced and thinner. For women, the bone mass in the area can also decrease with age, providing less support for the eyelid tissues.

Extensive sun exposure and cigarette smoking can speed up the process that causes under-eye hollows. While applying daily sun protection and not smoking can help to slow down the effects of facial volume loss, the best way to reverse the damage of lost elastin and collagen is to replenish it with aesthetic treatments.

How to Treat Under-Eye Hollows

Radiesse and Juvéderm Voluma dermal facial fillers can safely and effectively add volume to the face and reverse the sunken under-eye hollow look. If you have reservations about needle injections, AQUAGOLD fine touch is a very effective alternative. This microneedling technique works like a mega facial, delivering filler formulas into the skin through tiny needles that also stimulate collagen production. 

*Individual results may vary and are not guaranteed

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