I Am Modern Magazine for the Connected Suburban Mom

“What cosmetic procedures can be done on the same day” is a question I get asked daily. “I’m coming in for a laser treatment and I was wondering if the doctor has time for botox?” The proper sequencing of procedures is so critical that I’ve constructed a chart for my staff so they know how to schedule appointments in the appropriate order.

Let’s assume a patient calls to schedule an appointment for botox. She’s new to the area and has had botox several times before. This person will be scheduled for an initial consultation/skin analysis and then I would do her botox treatment on the same day. If, however, the person has never had botox, I limit the first appointment to the initial consultation/skin analysis followed by a discussion explaining what botox is, it’s mechanism of action, side effects, potential complications, expectations and whether or not this person is a good candidate for botox. If they’ve never had a particular treatment, I prefer that patients put some thought and consideration into the procedure they want rather than doing it on the same day. Once botox goes in, it’s not coming out so a day or two or even a week of contemplation after the initial consultation is well worth it.

Back to our recently relocated new patient who is already a botox aficionado. The patient has their Visia skin analysis and during the course of the cosmetic consultation, I notice a scab-like, reddish, slightly raised lesion on the side of her nose. During the course of the history and exam I find out this 52 year old white female has a strong family and personal history of skin cancer (a squamous cell cancer was removed from her back 7 years ago). I inquire about the bump on her nose and the patient states: “yeah, this nasty bugger popped up about a year ago…gets irritated sometimes…it’s like the pimple that just won’t go away…I put some Neosporin on it once and thought that did the trick but that sucker keeps coming back…but I’m here for botox. I really need my botox today!”

Do I satisfy this person’s yearning for “immediate” cosmetic gratification?

In this particular case, I did do the botox but I negotiated a compromise with her. Obviously a patient’s health is my priority and with my skin cancer radar going off in multiple directions, I insisted the lesion should be biopsied to rule out skin cancer. This particular woman was lost to follow up by the dermatologist who excised the cancer from her back years ago and hasn’t had a full body mole check since. She’s a trial lawyer (even more reason to take that thing off and send it to pathology, right??), is admittedly “type A,” and I may or may not see her again. The few minutes it takes to do a biopsy buys quite a bit of peace of mind.

Indeed, the biopsy came back positive for squamous cell cancer. This is the type of skin cancer that can be locally invasive as well as metastasize (spread). It required a minimal excision to make sure we got it all and she had no residual scarring. I now “scan” her about every 4-6 months when she comes in for her wrinkle fix.

So, the bottom line is if you come in for a cosmetic procedure and I see a suspicious “bugger” on your face (or anywhere else for that matter), depending on the individual circumstances, expect to buy a biopsy as well as the botox.

Skin Quiz: Which of the following lesions is NOT skin cancer? By Dr. Dima