by Peter T. Pacik, MD, FACS
This page on advanced skin care provides general information and guidelines to help you with you skin care needs. Links to both the plastic surgery website and the skin care website are provided to emphasize specific resource articles that are of importance.
Background to our Advanced Skincare Program
I have been involved with skin care since the 1970’s and have provided the services of a certified aesthetician since 1985. We have seen many products come and go, some effective, some not. We have taken it upon ourselves to test all new products before treating our patients. We also insist on receiving clinical studies showing the benefits of a particular program. As an author of numerous medical publications, I understand the importance of well constructed studies and find to my dismay that too many “studies” are poorly done with an inadequate number of patients and poor before and after photos. I find that most physicians are too busy to get involved with skin care, and the patient is left to his/her own devices to get information and products from department stores. I have experienced too often the hype and ineffectiveness of over-the-counter topicals and have been told by my patients of the thousands of dollars of creams and lotions in medicine cabinets that don’t work.
Our Skincare Mission Statement
Our mission has always been to offer exceptional, advanced skin care products and to help you make the right skin care choices through education without the hype. We want you to be an informed consumer when purchasing skin care products. Therefore, we are here to serve you in a specialized manner where we customize skincare and make-up products to your specific needs. In 1997, we created a new division called Skincare-MD to specifically manage the skin care needs of our patients. Over the years, we outgrew the space. In 2010, we moved the skin care division to our expanded facility two buildings away at 37 Salmon Street in Manchester, New Hampshire.
Our Plastic Surgery Mission Statement
It is our goal to make every patient that walks into our office feel as comfortable as possible; as if they were a part of our family. Our highly trained staff of professionals will make sure you are comfortable through every step of the process. Our patients become an important part of our family and we try to get to know each patient individually and customize their treatment to meet their desire.
57 Bay Street, Manchester, NH continues to provide Plastic Surgery services and is the home of our certified surgicenter where we have the services of American board certified anesthesiologists. Here we are able to do most major plastic surgery cases and the ability to provide a comfortable recovery room with state of the art monitors for patient safety. Advanced skin care procedures that need the services of an anesthesiologist are also performed in our certified surgicenter. Dr. Daniel Sterling and I are double board certified in Surgery and in Plastic and Reconstructive Surgery and between the two of us have many years of experience managing a wide range of problems. Both of us are certified in Advanced Cardiac Life Support.
Our Advanced Skincare Programs
We have learned a great deal in the past 25 years and we are thrilled that skin care has advanced to its present level of effectiveness. What could only be achieved with expensive machinery can now be achieved with topical creams that are customized to our patients. A case in point was the use of expensive lasers to resurface the skin.
Now, with the Obagi Nu Derm system, we are able to convert sun damaged skin with its blotchy brown or black areas of hyperpigmentation and generalized sallow dull appearance into radiant skin with more even skin tones. These results can often be achieved in as short as two weeks. Before and after photos using this system can be viewed in our Obagi NuDerm Photo Gallery. A video "Obagi Transformations" can be viewed through our Skincare website. This video highlights three women with skin problems - sun damage, large pores and wrinkles. In 18 weeks with the Obagi Nu-Derm and Obagi-C Rx skin care systems, their skin is dramatically 
improved – less lines, smoother and brighter. Obagi products treat skin at the cellular level, stimulating cell renewal, improved circulation and rebuilding collagen. Some patients with more severe skin problems benefit from resurfacing procedures. We continue to be impressed with the Obagi Blue Peel and the phenol-croton oil peel which can take patients to the next level of having beautiful skin. For patients who have acne scarring as well as sun damage, we combine the Obagi Nu System with dermabrasion and chemical peel.
Tretinoin (Retin A) and hydroquinones are the backbone of the Obagi Nu Derm system. Our patients benefit by not having to pay a consult fee to obtain a prescription for these topicals. We sell these topicals in our office and all skin care products including those that require a prescription. In an effort to contain the high prices charged by pharmacies, we discount all skin care products and offer a no question 30-day money back guarantee if you are not fully satisfied with the skin care program. Once you are a patient, you can re-order these products on our convenient Skincare-MD.com website at the same discounted rates. There is never a charge for a skin care consultation with our certified esthetician nor are there any charges for continued follow up care. All of our patients get the benefit of being evaluated with our dermascope so that they can see the actual sun damage. In this way, we feel we can maximize the results for our patients at charges no more than what would be paid for over-the-counter topicals in a department store. Our patients become a part of our family and we get to know our patients and their needs over a period of many years.
Tretinoin comes in a variety of strengths and is very useful in any skin care 
program. We have found that we get the most compliance by starting with the lowest strength to condition the skin. In this way we can advance the concentration of the tretinoin without the troublesome peeling that occurs if the higher strengths are used too soon. Our licensed aesthetician, has created an “extremely gentle protocol” so that even patients with sensitive skin do well progressing with the Obagi Nu Derm system. More on the values of tretinoin can be found by reading our section on Tretinoin on our Skincare-MD.com website.
For patients who are “retinoid intolerant” and cannot use tretinoin, we carry a milder non-prescription formulation called Retrinal Cream by Avene. Depending on the sensitivity of your skin to topical retinoids, you may want to consider Retrinal Cream which is available in two strengths -- 0.05# and 0.1# as a
healthy alternative to tretinoin that contains stable and powerful concentrations of Vitamin A. Retrinal Cream is less irritating to your skin with a smaller chance of redness, flaking and peeling and does not require a prescription. Additional educational information can be found on Retrinal Cream by Avene on our Skincare-MD.com website.
Hydroquinones are an important part of the Obagi Nu Derm system to even out skin tones. In our earlier years, most of us did not use sunscreens and quite the contrary, tanning was in vogue. As the atmospheric ozone layer began to deteriorate, doctors became alarmed by the increasing number of skin cancers including melanoma. Skin cancers were now seen in younger patients and also on areas other than the face. As with smoking, sun damaged skin is noted by blotchy areas of brown or black hyperpigmentation. The skin develops a yellowish hue (sallow skin) that is dull. By blocking the over-activity of the pigment producing cells, hydroquinones are able to smooth out the pigmentary appearance of the skin. Tretinoin or Retrinal Cream brings in new blood circulation to the dermis. Thus, the combination of hydroquinones and tretinoin create a more even pigmentation of the skin. The new blood vessels in the deeper layers of the skin show through as a rosy radiance that we see in all of our patients who use the Obagi Nu Derm system. A valuable educational resource article on hydroquinones titled "Skin Lightening with Physician Strength Hydroquinone" appears on our Skincare-MD.com website.
For patients who are younger or have less damage, our aesthetician can explain the benefits of the Obagi-C Rx System. The Obagi-C Rx Complete System is a less aggressive system than the Obagi Nu-Derm System and is especially suitable for people who may not need the strength of the Obagi Nu-Derm System or tretinoin or Retrinal Cream.
Skincare-MD Seminars
We have found that seminars are a wonderful way to disseminate new information and to get to know out patient’s friends who are interested in learning more about skin care and facial options. You can sign up for upcoming events by calling either the Skincare-MD at 1-603-296-4920 or 1-877-415-0600, or the Plastic Surgery Professional Association 1-603-669-0290 or 1-800-640-0290. We will be happy to inform you of these free upcoming events.
Visit our new location for our Skincare-MD Store
We encourage patients who live in New England to visit us in our skin care store 
located at 37 Salmon Street, Manchester, NH 03104. Here we have on display a range of highly effective products and Jane Iredale Mineral make-up that can help you with your skin care needs. We can show you the various sunscreens such as the sunscreens by Obagi Medical, MD Forte, Applied Therapeutics and La Roche-Posay. La Roche-Posay, a division of L'Oreal, received approval from the Food and Drug Administrative (FDA) to market a broad-spectrum sunscreen formula that contains Mexoryl SX (ecamsule) plus L'Oreal's patented association with avobenzone (Parsol 1789) and octocrylene. Our trained staff and licensed aesthetician can customize a program to fit your skin care needs. You will be able to learn more about the Clarisonic Pro Skin Care Brush. To enhance the thickness and length of your eyelashes eyebrows, we sell Revitalash and RevitaBrow . We also offer free prescriptions for Latisse by Allergan for those who consult with our licensed aesthetician for a free skin care consultation. Our aesthetician is available Monday through Friday from 8:30 am to 4:00 pm and can be reached at our toll-free number 1-877-415-0600 or 603-296-4920.
Medical Grade Microdermabrasion
Microdermabrasion can be very useful in removing the dead layer of skin that prevents or retards the penetration of skin care products. .
Facial Rejuvenation with Botox and Facial Fillers
As the forces of gravity continue to pull our structures south, there are many procedures that can be done to 
maintain youthfulness. An advanced skin care system can be combined with injectables such as Botox to help remove wrinkles and facial fillers such as Juvederm, Radiesse and Restylane to plump out areas of the face that have lost volume. For more severe aspects of facial aging, face lifts and neck lifts can be performed. It is not only the face that loses volume, but other areas as well such as the breasts, abdomen and thighs. For these patients we are able to offer breast lifting surgery, breast enlargement surgery , tummy tucks (abdominoplasty) and body lifts.
Advanced Skincare Programs are Physician-Directed and Supervised
Dr. Sterling and I take 24 hour call 7 days a week to manage unexpected problems. This is just one more way we can support our patients to give them the very best in both Plastic Surgery and Skin Care.
Visit our Skincare-MD Website
Additional educational information on all of our product lines can be found on our Skincare-MD website. All of our advanced skincare products can also be ordered on-line.
Contact us at Skincare-MD
We encourage you to call our office and schedule a free skincare consult with our licensed aesthetician. We will be happy to talk to you about your skin type and condition and make product recommendations. Our MD Forte, Vivite, Clinique Medical, Prevage MD, Glytone, Kinerase, RevaleSkin, Clenziderm, Eau Thermal Avene, Elastiderm, Rosaclear, Obagi Nu-Derm, Obagi-C Rx Advanced Skin Care Programs are all excellent for skin rejuvenation. We can help you decide which skin care program would be best for you. Our aesthetician is available Monday through Friday 8:30 a.m. to 4:00 p.m. EST at 1-877-415-0600 or (603) 296-4920. You may also contact us by completing our information request form. Most emails are answered within 24 hours.
The Plastic Surgery Center of Manchester, New Hampshire specializes in cosmetic plastic surgery, including body lifts, breast enlargements, breast lifts, breast reductions, eyelid surgery, ear surgery, facelifts, fat grafting, liposuction, male breast reductions (gynecomastia), neck and chin surgery, nose surgery (rhinoplasty), surgery after massive weight loss, tummy tucks and BOTOX® Cosmetic for vaginismus. We also offer facial rejuvenation (chemical peels, dermabrasion, Obagi Blue Peels, Glycolic Peels, Microdermabrasion), injectables and facial fillers (BOTOX® Cosmetic, Radiesse®, Juvederm®, Perlane® and Restylane®) and advanced skin care to patients from all over New England (Maine, Vermont, New Hampshire, Massachusetts). While no responsible practitioner gives guarantees for the work they do on the human body, we can at least reassure you that you will receive the expertise and dedication of over 30 years in practice. Our patients become an important part of our family and we try to get to know each patient individually and customize their treatment to meet their desires. Visit our skincare website to purchase MD Forte, Obagi-C Rx, Obagi NuDerm, Prevage and Vivite advanced skincare products.
