Cosmetic Dermatology is a discipline of medicine based on years of scientific research spearheaded by Dermatologists. We are proud to offer the safest and most effective cosmetic treatments:

• Neurotoxins: BOTOX© and Xeomin®
• Fillers: Juvederm Ultra®, Juvederm Ultra Plus®, Radiesse®, Restylane® and Perlane®
• Laser Treatments: excessive hair, brown spots, red spots, skin tightening, rosacea, acne, scars, stretch marks, spider veins, & birth marks

Neurotoxins: BOTOX® and Xeomin®

• Dr Knuttel has been using these medications since 1992 both personally and professionally. She performs all the treatment herself and has completed thousands of procedures
• BOTOX© and Xeomin® are injected medications that lead to reduced wrinkling by relaxing the muscles of the frown area, forehead and crow's feet, around the mouth and neck
• These medications are ideally suited to treat wrinkles that occur when you contract your muscles but can also soften the wrinkles you have at rest and can prevent wrinkles from deepening
• Neurotoxins have been used safely since 1980 for disorders of the muscles and have been used cosmetically since 1986 with an excellent safety profile
• After rigorous clinical trials, BOTOX© was FDA approved for cosmetic use to the frown area in 1998. Xeomin® was approved April 2009 for the same indication. Other cosmetic uses of these medications are considered off label but have been used safely for many years
• The FDA has stated that cosmetic use of neurotoxin is quite safe with no reports of side effects other than mild discomfort with the treatment, temporary swelling, bruising, and eyelid swelling
• The cost of your treatment depends on your goals, the size of your muscles and your budget:
  • Frown area ~$312.50 - $437.50
  • Forehead area ~$ 250 - $375
  • Crow’s feet alone ~$ 312.50 - $375
  • Brow lift ~ $125
  • Lipstick lines ~ $ 62.50
  • Neck ~ $312.50 - $625

• If you are pregnant or nursing, you should not receive treatment.  If you are allergic to cow’s milk, you should not receive Xeomin
• The effect takes about two weeks to be fully developed and can last up to 4 - 6 months.  If the desired effect is not achieved after two weeks, you may return to the office for an adjustment or touchup
• If you love your results and wish to maintain them and prevent your wrinkles from deepening you should return every 4- 6 months for re-treatment 

Click the image above to view before and after videos

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Fillers:

• Cosmetic filler procedures are extremely popular ways to instantly improve your look in 2011 
• Fillers are indicated for treatment of wrinkles, contour deformities of the skin, volume loss, lips restoration, ear lobe restoration, nasal defects, some acne scars, thinning of the skin caused by disease or trauma, frown lines and hand restoration
• You will experience immediate, visible results even after one filler session in most conditions
• Examples of fillers include Juvederm Ultra®, Juvederm Ultra Plus®, Restylane®, Perlane®, and Radiesse® each of which has special properties that determine its indications.
• Rigorous clinical trials to determine the safety and effectiveness of these treatments have been conducted and the fillers used in our practice have all been approved by the FDA for treatment of the nasolabial folds
• Just like BOTOX© and Xeomin ® additional treatment areas are considered off label but have been used safely for many years
• JuvedermUltra®, JuvedermUltraPlus®, Restylane® and Perlane© are injectable medications composed of hyaluronic acid. Hyaluronic acid is a natural substance that exists in the human body and gives the skin volume and fullness. The amount in the skin decreases as we age. These are well suited to restore volume to lips, ear lobes, mid face and other uses include lip margin restoration, lines around the nose, mouth and eyes
• Radiesse® is a medication composed of calcium hydroxyl apatite, a synthetic version of the same form of calcium naturally found in the bones and teeth. When this medicine is injected into the skin, it fills in depressions and minimizes the appearance of wrinkles.  It is especially suitable for the nasolabial folds, cheeks, and around the mouth
•  Price per syringe: $600
•  Risks of filler treatments include but are not limited to pain   during injection, bruising and swelling at injection sites, over correction, formation of a sore and scarring as well as an allergic reaction to the implant
•  We will have you apply a numbing cream to the treatment areas; treatments are usually quite comfortable. We cater to wimps!
•  A consultation is necessary prior to treatment with any filler
•  In order to be treated with filler:
  • Avoid aspirin, Motrin and related drugs and Vitamin E for 14 days before your procedure to minimize bruising and swelling
  • Apply topical numbing medication to the treatment area 90 minutes prior to your appointment time
  • After the procedure, to minimize bruising, you must apply ice to the treatment area 10 minutes per hour while awake
  • Keep your head elevated above the level of your heart
  • Avoid significant movement or any massage of the treated area for 24 hours
  • Just in case you get bruised or swollen, schedule your filler at a time when you have no social obligations. Bruising can last a few days or even up to 2 weeks
  • Treatment with our VBeam Perfecta can fade your bruises instantly so call if you develop them

•  Schedule an appointment to return to office for re-evaluation after 2 weeks

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Laser Treatments

Chelsea Davis Smith, RN
Robin Knuttel, MD and Sonoma Skin Dermatology & Laser Center,  welcomes Chelsea Davis Smith, RN, to our staff at Sonoma Skin Dermatology. Chelsea’s expertise focuses on coordination of patient care, office laser procedures including treatment of acne, rosacea, unwanted hair, spider veins and stretch marks under the direction of Dr. Robin Knuttel as well as Cosmetic Procedures for BOTOX© and filler injectables.

Raised in Palo Alto, California, Chelsea initially served at-risk youths as a Counselor and Program Director in non-profit settings.  She interned at Marin General’s Acute Psychiatric Unit and medical surgical clinical rotations at Kaiser Memorial and Petaluma Valley Hospitals.  “Her compassionate demeanor and the outstanding level of care for our patients makes Chelsea such a great asset to our Practice” say’s Dr. Knuttel.  For anyone scheduling an appointment with Chelsea for Laser Hair Removal through the end of November, will receive a 15% discount toward treatment.

Chelsea holds a BA  in Anthropology from The University of Washington, 1999 and a Registered Nursing degree from Santa Rosa Junior College, 2010.  Chelsea enjoys, yoga, running and quality time with her husband and 2 children.

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We are proud to offer the highest quality, most effective, most comfortable and safest lasers available. We can treat your acne, acne rosacea, brown spots, precancerous and cancerous skin lesions, sun damaged skin, excessive hair, wrinkles and loose skin, dilated blood vessels and leg veins in our office. In most cases the treatment is done without anesthesia and with minimal down time.

Our current lasers are the GentleLASE, VBeam and GentleYAG, the gold standard by which all other lasers are measured. These lasers emit light that is concentrated in a beam that is attracted to substances in the skin like brown pigment, red blood cells and water.

A consultation with Dr Knuttel or a skin care specialist in our office is necessary to discuss your goals, educate you about the options for therapy and provided you with a quote for your treatment. Most laser procedures range from $175 to $950. In some cases we may be able to treat you the same day. A series of treatments is usually necessary to achieve your desired results. Laser procedures are often described as a feeling of a hot rubber band striking the skin. For most procedures, a cooling spray is used to minimize discomfort and protect the top layer of the skin from burning. The laser treatments involve applying laser pulses to treatment area. NO TAN, LOTION OR SELF TANNER PLEASE!

• Acne, acne rosacea, broken blood vessels, red scars, stretch marks, cherry hemangiomas, sun damaged skin, precancerous and cancerous skin lesions and wrinkles can be treated very effectively with our VBeam Perfecta

• Brown spots on the skin can be lightened or removed by using a laser that targets the brown pigment in the spot

• Hair reduction: The dark pigment in the growing hair follicle and hair shaft absorbs laser light leading to permanent reduction of unwanted dark hair on face, arms, armpits, back, bikini line and legs of both men and women

• Photodynamic therapy (PDT) is a special treatment which combines light from the VBeam laser and a special light-activated topical medication called ALA for treatment of precancerous and cancerous skin lesions, acne, acne scars, acne rosacea, facial redness and broken blood vessels, excessive oil production, enlarged oil glands, large pores, and sun damaged skin. You must stay out of the sun completely for 48 hours after each treatment. Immediately after the treatment the skin may feel sunburned or even have some mild swelling and bruising.  In most cases this will then fade very quickly.  Some individuals may have more swelling and bruising especially around the eyes. Ice compresses and Benadryl 25 to 50 mg every 4 – 6 hours will help. You should take a few days off from activities that cause flushing or blushing in order to get the best results. Expect to have 3 – 4 treatments over 12 – 16 weeks

• Wrinkles and loose skin: We use multiple lasers to customize your treatment. Treatments work by transferring heat to the deepest layers of the skin stimulating the production of new collagen, elastin, and other proteins

• Fractional Laser Resurfacing: We offer FRAXEL repair the only CO2 laser on the market that delivers the efficacy of conventional CO2 lasers—without the prolonged downtime, risks or complications. The Fraxel re:pair laser has revolutionized the industry. It delivers dramatic results in a single treatment—without weeks of downtime. It's a compelling option for patients who want remarkable results without surgery

Fraxel repair

Fraxel repair is a CO2 laser-based procedure which treats conditions that penetrate into the deeper layers of the skin, reducing or eliminating scars, wrinkles, and deep discoloration while also tightening loose, sagging, aging skin. The system provides deeper penetration and results of more invasive procedures, while involving much less downtime than more invasive procedures.

• Fraxel repair offers:
• Faster treatment than comparable systems
• Less risk than with other CO2 lasers
• Can be used for both superficial and deep damage
• Tightens skin, as well as repairs damage
• Precise application
• Varying energy levels allows treatment to be tailored to specific, individual needs

The Fraxel repair technique is considered a minimally invasive procedure, in that no incisions are made in the skin, as with a traditional facelift-type procedure. The laser is passed over the surface of the skin, and the laser energy penetrates the skin to correct damage and result in controlled damage, which actually helps skin appear firmer over time.

The cost of Fraxel repair treatment will vary, based on the extent of the area being treated, generally ranging from $4000 for the full face up to $6500 for the face, neck and chest.

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