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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

Wrinkles & Loose Skin 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.


Wrinkles, loose skin, and laxity are effectively treated with aggressive skin care. Fine wrinkle lines are the one feature most significantly improved. The finer the lines that are present, the more effective they are treated. Deeper lines, loose skin, and loss of elasticity are improved and softened also. This program is often begun prior to surgery, and continued after to preserve your plastic surgery results.


Your examination will range from mild fine wrinkle lines and textural superficial wrinkles, to very loose skin and lack of elasticity, and many levels in between. All degrees of laxity can be improved.

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. Microdermabrasion facial. This is to mostly to exfoliate and prepare the skin for better penetration of products. It effectively smoothes fine lines and tightens the skin and removes some of the superficial pigmenatation.
    2. Begin the Obagi Nu Derm System. This is the combination of Retin-A and Hydroquinone that is highly customized to your skin and lifestyle and very effective at tightening and smoothing the skin.
  2. 4 weeks:
    1. Repeat Microdermabrasion for increasing the effects noted above.
    2. Intensify the Nu Derm program by increasing Retin-A and other products as tolerated.
  3. 8 weeks:
    1. Begin a chemical peel program. This removes any remaining superficial wrinkles that have by now been significantly reduced by the above steps. It also serves to nicely remove any pigmentation.
    2. Continue on the Nu Derm home program as adjusted to get the maximum benefit.
  4. 12 weeks:
    1. Second chemical peel. This serves to remove the wrinkles to now a deeper level.
    2. Review and adjust the Nu Derm home program as indicated. Usually it is reduced at this point.
  5. 16 weeks:
    1. Third chemical peel. These are very beneficial in a series and serve to continue to remove wrinkles each time to a deeper level. It is important to have these treatments in close sequence to obtain the deepest peeling and best results.
    2. Continue products as adjusted
  6. 20 weeks. Maintenance phase:
    1. By now you should have obtained an excellent result. You may benefit from more peels as determined by your results. At this time we consider to 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