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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

Skin Textural Irregularities

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.


Patients present for treatment of textural irregularities which may present in any number of various stages and caused by a number of different conditions. Irregularities in the skin surface may be very mild to very severe. What we are focusing on here are patients that have any degree of skin texture irregularity that is other than perfectly smooth skin, which is our ultimate goal.


In your examination there is any degree of textural irregularity. This may range from very mild to very severe. In its mildest form there may be patchy swollen areas due to fluid retention or blocked lymph channels. The next stage up is large pores and swelling around the pores. Both of these conditions are due to congested and clogged pores and poor circulation. They are also due to some inflammation in the pores and bacteria and build up of dead skin cells. The next stage up is the irregularity that is often seen with mild acne and breakouts that leaves some scar below the skin surface, just enough to see a mild bump or dent. The most severe form of textural irregularity is the more advanced acne scars with actual scar tissue and deep “ice pick” indentations. All these forms can be treated and you can expect improvement. Your improvement will depend on the degree of irregularity, the program we use, and your time frame. Program Basics and Overview
This is the basic outline for textural irregularities. It relies on the principles of cleaning out clogged pores, eliminating infection and inflammation, and removing the buildup of dead, thick skin surface cells. It will be modified according to your expectations, history, anatomy and lifestyle.

  1. To start:
    1. Begin deep cleansing facial. This is to mostly to exfoliate the upper skin layers and especially those cells that stick and clog the pores, if this is a factor in your texture. It reduces the pore size, allows for better lymph flow, less swelling, and prepares the skin for better penetration of products. It also smoothes fine lines and tightens the skin and removes some of the superficial pigmentation.
    2. OR
    3. Begin chemical peel series. If congested clogged pores are not as much the cause of your textural problems, then we move right into aggressive removal of excess surface skin. This creates the smoothness. It also allow for better product penetration. We custom select the peel solution and type with you.
    4. Begin the Obagi Nu Derm System. This is the combination of Retin-A and Hydroquinone and glycolic acid that is highly customized to your skin and lifestyle and very effective at removing the upper skin cells, increasing collagen and elastic fibers and smoothing the skin.
  2. 4 weeks:
    1. Repeat chemical peel. Here the peel is intensified to the next level to remove more of the skin and provide further smoothing.
    2. Continue and adjust products
  3. 8 weeks:
    1. Repeat chemical peel. Here the peel is intensified to the third level.
    2. Continue and adjust products.
  4. 12 weeks:
    1. Repeat chemical peel. Here the peel is intensified to its fourth, and probably maximum level.
    2. Continue and adjust products.
  5. Maintenance phase:
    1. Continue the Nu Derm products but on a much less intense level and just enough to maintain your results
    2. Peels as indicated at the frequency that will allow you to always have smooth, firm, non-pigmented skin










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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