Non-Surgical Procedures

BOTOX® Cosmetic

Administered Exclusively by Dr. Michael Macdonald, San Francisco Cosmetic & Facial Plastic Surgeon

BOTOX® and tissue fillers are two of the most effective and reliable injectable treatments available today.  Performed in the office, these treatments may be administered with minimal discomfort and little to no recovery.  Dr. Macdonald personally performs all of the injectable treatments in the office, ensuring that his patients will receive treatment only by an experienced expert.  Dr. Macdonald is director of a BOTOX® Cosmetic National Physician Training Center, and a member of the Allergan National Education Faculty (NEF).  As such, he teaches minimally invasive procedure courses to other physicians across the globe on behalf of Allergan (the company that makes BOTOX®) and also serves as a consultant to their product research and development team.

*Try our new BOTOX® Treatment Visualizer >>

Dr. Macdonald has been a pioneer in the field of BOTOX® treatments.  He was the primary author of a study conducted in 1995 at the University of California where he has served as a Clinical Instructor and Assistant Professor for over 13 years.  This was the first anatomical study conducted to identify surface landmarks that physicians could use as reference points to the underlying musculature in the treatment of upper facial rhytids (frown wrinkles between and around the eyes and on the forehead).  In other words, this study set the standard for BOTOX® injection techniques to achieve optimum patient results.  For more information on Dr. Macdonald’s study and its findings, you can read the article “An Anatomical Approach to Glabellar Rhytids” published in December 1998 in the Archives of Otolarygology-Head & Neck Surgery Journal.

Procedure Information & Various BOTOX® Applications

BOTOX® is a registered trade name for botulinum toxin, which is a purified protein.  It has been used therapeutically for more than 20 years to treat a variety of medical conditions - originally in the treatment of eye conditions (such as blepharospasm) and facial ticks, as well as neurological voice problems and various muscular problems in the body.  Its use is approved in more than 75 countries.  The botulinum toxin is used in such small amounts that generalized systemic side effects are avoided.

BOTOX® is a quick and minimally invasive procedure consisting of a few tiny injections.  Dr. Macdonald will determine exactly where to administer these injections to achieve the best results for you.  No anesthesia is required, though to relieve any minor patient discomfort Dr. Macdonald usually chooses to numb the area with a topical anesthetic cream prior to injecting.  The entire procedure takes approximately 10-15 minutes depending on the number of areas being treated and there is no downtime afterward.

Below is a description of the various safe and effective applications for BOTOX® that Dr. Macdonald has been administering to his patients for several years.

1) Wrinkles (“rhytids”)

This is the most well known cosmetic use of BOTOX® in which it is injected into the muscle beneath the skin to reduce or eliminate “dynamic” wrinkles such as those triggered by repeated squinting, frowning or raising of the eyebrows.  Elimination of these wrinkles is accomplished by interfering with the muscle’s ability to contract, thereby eliminating its ability to produce wrinkles in the treated areas.

Most common areas treated are in the upper face, including: glabella (frown lines between the eye brows), “bunny lines” (on sides of nose), forehead and “crow’s feet”.  Other treatment areas include:  neck wrinkles, neck bands, lip wrinkles, down-turned corners of the mouth, and abnormal dimpling in the chin.

2) Facial Contouring

• Square Face/Jaw – to achieve rounder, less aggressive-looking facial shape.
• Brow Lift – to address “drooping” brows that makes a person look tired or severe.
• De-emphasize Almond-shaped Eyes – to give a rounder shape to the lower eyelid

3) Medical Applications (may often be reimbursed by your health insurance)

• TMJ Syndrome
• Chronic Tension Headaches and/or Migraine
• Excessive Sweating (hyperhydrosis) – of the arm pits, palms of hands, feet, hairline/scalp.  To learn more www.sweathelp.org

Recovery Information

There is little to no discomfort following the procedure.  Some patients may feel slightly nauseous for a few hours afterward or experience a slight headache after their first treatment, but this is not common and is easily treated with Tylenol.

You can expect to see results within days of your treatment and will experience the full effect within 7 days.  Although patient results will vary, the initial treatment of BOTOX® often lasts 4-6 months.  With each successive treatment, the injectable BOTOX® appears to last longer.  A secondary effect will be a change in the muscle’s pattern of behavior so that the result may ultimately become permanent.  Cosmetic applications of BOTOX® may often avoid or substantially delay the need to consider surgery in the upper face, hence the fact that 22% of all physician-administered BOTOX® cosmetic procedures are performed on both male and female patients 19-34 years of age.

View BOTOX® Before & After Photos

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Tissue Fillers (Injectables)

Administered Exclusively by Dr. Michael Macdonald, San Francisco Cosmetic & Facial Plastic Surgeon

Injections of small amounts of tissue filler, such as JUVEDERM®, Restylane® or Radiesse™, can produce wonderful results in improving the skin’s texture, and in restoring facial contour in areas of tissue volume loss.  Depressions in the skin surface (e.g. post-acne scarring) can be raised to the level of the surrounding skin.  Lines and scars can be minimized.  Textures can be improved to soften the skin’s appearance and give a more even contour. 

Most common areas of treatment include :

1. Lips – results in a more full and voluptuous mouth.
2. Nasolabial folds (between the nose and corners of the mouth) – are softened or eliminated.
3. “Marionette” lines (corners of the mouth) – are softened or eliminated.
4. Glabella (between the eye brows) – often used in conjunction with BOTOX® for the most effective and long-lasting results.
5. Lower Eyelids (tear trough area) – adding volume to “sunken”, tired eyes.
6. Midface/Cheek Area – to address “drooping” effect caused by age-induced natural tissue volume loss.
7. Prejowel Area (along jawline) – to address natural tissue volume loss.
8. Hands (a lesser known but recently very popular application) – used to correct the hollowed, aged look on the back of the hands between the fingers.
9. Other Applications:
   • Acne scarring
   • Scarring of any type
   • Brow lift
   • Ear lobes

Proven to be safe, with almost no side effects or downtime, these products provide a soft, natural looking appearance with results lasting 6-12 months or more.  The results tend to last much longer in less mobile treatment areas.  These various tissue filler injectable treatments do not require a skin test and you can have your treatment the same day as your consultation, if desired.  Patients receive immediate gratification in that the treatment results are immediately visible.  You may experience slight swelling or tenderness at the point of injection, but most patients indicate this quickly subsides within 24-48 hours.

Please call or contact us online> at any time to further discuss your questions about BOTOX® or Tissue Fillers and the various uses that may be right for you.  Or, visit our cosmetic surgery offices in the Union Square district of San Francisco, California.  Our offices are conveniently located for easy accessibility from the entire San Francisco Bay area.

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Lip Enhancement

Performed by Dr. Michael Macdonald, San Francisco Bay Area Facial Plastic & Cosmetic Surgeon

Lip Enhancement Before & After Photos

Please call or contact us online at any time to further discuss your questions about lip enhancement options.  Or, visit our cosmetic surgery offices in the Union Square district of San Francisco, California.  Our offices are conveniently located for easy accessibility from the entire San Francisco Bay area.

Veins and Age Spots

Treated by Dr. Macdonald, San Francisco Bay Area Facial Plastic & Cosmetic Surgeon

VariLite™ Laser Treatment for Pigmented & Vascular Lesions

Dr. Macdonald uses the VariLite™ laser in his office for the treatment of small facial and leg veins, as well as for lesions (“age” spots or “sun” spots) on the face, chest and/or hands.

Vascular lesions are comprised of blood vessels of various diameters, lengths and shapes, many of which lie near the skin’s surface.  The coloring of these lesions can be red, blue, purple, light brown, or dark brown.  The unwanted appearance of veins very near the skin’s surface on the face most commonly occurs on the side of the nose, the cheeks, chin, or in the front of the ears.  Sometimes they are more diffuse, as with rosacea.  Non-malignant, pigmented lesions are comprised of melanin in various intensities and sizes.  Currently, the preferred method of treatment for these lesions, when they occur on the face, chest or hands, is laser therapy.

The VariLite™ laser emits an intense beam of laser energy that is selectively absorbed by the color in the vessels or abnormally pigmented lesions so that there is virtually no adjacent tissue damage.  Treatment success and patient satisfaction is very high with this procedure.  The results are observed immediately!

ScanLite™ Laser Facial – PhotoFacial™ or Fotofacial™

A laser facial is a gentle procedure that uses the handheld ScanLite™ scanner with an IRIDEX laser system to improve the overall appearance of the skin.  This laser procedure can reduce sun-induced damage, even out pigmentation irregularities, remove vascular and pigmented lesions, decrease redness from rosacea, and give skin a more youthful appearance.  Laser “facial” treatments can be performed on the face, neck, chest, back and hands.

Sclerotherapy for Larger Leg Veins

In the legs, superficial veins known as “spider veins” may be eliminated with the VariLite™ laser alone or in conjunction with sclerotherapy (direct injection of a sclerosing solution into the vessels).  Selection of the appropriate treatment modality depends on the vessel diameter.  The KTP laser is most effective in treating smaller-diameter vessels, while sclerotherapy is better suited to the elimination of larger ones.

Veins that are raised above the surface of the skin, otherwise known as “varicose veins”, are not amenable to VariLite™ laser treatment or sclerotherapy.  They require more complex management, most often by a vascular surgeon.

View Laser Therapy Treatment Before & After Photos

Please call or contact us online at any time to further discuss your laser therapy options and questions.  Or, visit our cosmetic surgery offices in the Union Square district of San Francisco, California.  Our offices are conveniently located for easy accessibility from the entire San Francisco Bay area.

Laser Resurfacing – CO2, Erbinum Fraxel®, Fractionated Resurfacing

Performed by Dr. Michael Macdonald, Cosmetic Facial Plastic Surgeon

Procedure & Recovery Information

Dr. Macdonald performs laser resurfacing as an out-patient procedure.  To ensure patient comfort, Dr. Macdonald uses topical and local anesthetics during the procedure and prescribes mild pain relievers to control the patient’s post-procedure discomfort at home.  Occasionally, when a more aggressive approach to skin tightening and wrinkle reduction is planned, a general anesthetic may be considered.  Patients enjoy a relatively short recovery period after resurfacing, with 7-10 days initial healing time.  The post-treatment period is meticulously monitored to ensure optimum improvement.  Initial redness fades to pink in 2-3 weeks as vibrant new skin is formed.  The pink hue is easily camouflaged and usually disappears completely within 6-8 weeks.

Combination Therapy for Non-Surgical Full Facial Rejuvenation

When used in conjunction with the laser, certain specific deep creases and folds in the face can be relaxed using BOTOX® injections.  This method helps the newly regenerated tissue to heal more smoothly because the underlying uscles aren’t holding the wrinkles in place.  BOTOX® injections offer a safe, simple solution to frown lines between the eyes, forehead wrinkles, and crow’s feet.

Please call or contact us online at any time to further discuss your questions about laser resurfacing.  Or, visit our cosmetic surgery offices in the Union Square district of San Francisco, California.  Our offices are conveniently located for easy accessibility from the entire San Francisco Bay area.

Collagen Induction Therapy

Performed by Dr. Michael Macdonald, Cosmetic Facial Plastic Surgeon

Laser Hair Removal

Performed at California Center for Aesthetic Medicine (CCAM)