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Dr. Romano’s “Exquisite Care”
Medical Spa

Injectables and Fillers

Thermage -
Radiofrequency energy
non-invasive skin tightening.

Medical Grade Skin Care
Prescription Strength Skincare Products
Wrinkles & Loose Skin
Skin Textural Irregularities
Stretch Marks
Sensitive Skin

Anti - Aging-
Reversing  external and internal
consequences of age.

Skin Maintenance
Postoperative Skin Care

Acne Treatment and Correction

In my office, the spectrum of providing skin care and educating patients are collectively referred to as Skin Fitness. This is a highly customized program, as it needs to be, to address several related factors. First, a detailed conversation about your impressions of your present skin condition and expectations set the foundation of what we want to achieve together. Next, a careful history is taken that assembles all of your past skin treatments, services, products and results you have obtained from these. Following this, a very thorough skin exam that addresses all aspects of your skin condition and skin health is performed and documented. All this information is then integrated with a discussion of your lifestyle, exercise habits, outdoor activities, work environment and tolerance levels to formulate that special custom program to give you the results you want. In summary, we combine your expectations, history, exam, and lifestyle to formulate your custom Skin Fitness program.

Men have special needs in skin care especially as these may relate to your work and lifestyle. Men generally have larger pores, facial hair that may challenge skin care, and daily shaving that creates its own problems and needs. We understand and address the needs of men.
Your skin care program is designed to give you results in a safe and predictable way. It is designed to delay or prevent the need for plastic surgery and preserve the results of any procedure you may have.


Acne is a chronic inflammatory disease of the sweat glands and hair follicles. It affects patients of all ages. It results from multiple factors, but the abnormal degree of keratinization or epidermal cell stickiness is one of the most important factors. This leads to a high degree of clogging pores which, in turn, leads to the sequence of redness, inflammation, infection, pustule, rupture and scarring. This should be viewed as a sequence and acne may be present at any stage and end there or progress from inflammation all the way to unsightly scars. Open or closed comedones (whiteheads and blackheads), papules, pustules, hyperpigmentation, spots, nodular or cystic lesions can all be present. Hormones and some drugs can stimulate the condition or make it worse.

The goals of treatment are to reduce the degree of stickiness and clumping of the exfoliated, oily epidermal skin cells and to decrease inflammation and the bacteria. This is an ongoing process. All treatments work mostly by preventing new acne. The existing blemishes heal on their own. The improvement process takes time and you must be patient. There are often initial “flare-up” periods when you start a program or new product and your acne will often get worse before it gets better. This process can be frustrating. You may need to change and modify products or usage several times before the “right combination” is obtained. This is why you need a professional to evaluate and initiate and regularly follow-up your program. This way the least amount of time is wasted and you don’t lose time “experimenting” on this or that product.


Your examination will range from full on red, raised, inflamed pustules, to mild blemishes and occasional breakouts, to pigmented areas of former breakouts, to no pustules and just irregularity and scars. So you see, there is a broad spectrum of acne conditions. It is important for us to identify where you are at present, your history of acne, your previous treatments, and formulate a plan.

Program Basics and Overview

This is the basic outline for treating pigmentation. It will be modified according to your expectations, history, anatomy and lifestyle.

  1. To start:
    1. Deep cleansing acne facial. This is to mostly to exfoliate the upper skin layers and especially those cells that stick and clog the pores. It is also to remove the plugs and congestion from the pores and then, prepare the skin for better penetration of products. It also smoothes fine lines and tightens the skin and removes some of the superficial pigmentation.
    2. Topical and/or oral antibiotics according to your condition.
    3. Begin the Obagi Clenziderm System. This is the combination of topical antiobiotic and cleansing and glycolic products to remove the cells that clog pores and lead to acne breakouts. It decreases the inflammation in congested pores and is very effective in clearing your skin.
  2. 2 weeks:
    1. Second deep cleansing acne facial for increasing the effects noted above. It allows us to do even deeper extractions of stubborn clogged pores and clear the skin to the next level.
    2. Intensify and adjust the Clenziderm home program as determined by how you are clearing.
  3. 4 weeks:
    1. Begin a Microdermabrasion facial program. This is to allow for even deeper exfoliation and clear any remaining pustules, which should be very few by this point. It is also now to start the smoothing process to your skin and start working on any pigmented spots left over from the healed pustules.
    2. Begin Retin-A and a program to continue exfoliation and prevent sticky skin cells from blocking pores ever again.
  4. 8 weeks:Second microdermabrasion facial. By now most pustules are gone and this is to provide smoother skin, reduce pigmentation, and improve texture.
    1. Review and adjust the Retin-A and Nu Derm home program as indicated. Usually it is reduced at this point.
  5. Maintenance phase:
    1. Continue the Nu Derm products but on a much less intense level and just enough to maintain your results












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Botox , Cellulite / Fat Reduction, Injectable Fillers,
Skin Peels / Facials, Microdermabrasion, Laser Hair Removal, Laser Skin Resurfacing Laser Vein Treatment

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Dr. James Romano, M.D.
San Francisco Plastic & Reconstructive Surgery
1650 Jackson St., Suite 101, San Francisco CA 94109