Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12...
Transcript of Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12...
![Page 1: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/1.jpg)
Facial Rejuventation
Facial Rejuventation
Ross J. VanAntwerp, DOLaser Center of MarylandRoss J. VanAntwerp, DOLaser Center of Maryland
![Page 2: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/2.jpg)
Trends in Facial Rejuvenation
• Trends towards minimally invasive procedures
• Moving away from old fashion coronal facelifts
• More options on market
• Lasers
• Dermal fillers
• Neurotoxins
• Patients want less downtime (still want same results!)
![Page 3: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/3.jpg)
Tell us about your goals
• Laxity?
• Vascularity and Redness?
• Sun Damage?
• Fine Lines and wrinkles?
• Scarring and Textural changes?
• No downtime
• 24 hours downtime
• 3-5 days
• 1 week or more
What do you wantto achieve?
Maximal Results Minimal Downtime
![Page 4: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/4.jpg)
The Aging Face
• Facial shape changes over time. The triangle become inverted with increasing age
![Page 5: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/5.jpg)
Layers of the Skinmicroscopic viewLayers of the Skinmicroscopic view
Epidermis: 5 layers
60-100 microns thick
Epidermis: 5 layers
60-100 microns thick
Papillary Dermisthin layer of collagen
100 microns thick
Papillary Dermisthin layer of collagen
100 microns thick
Reticular DermisDense Collagen
1000 microns
Reticular DermisDense Collagen
1000 microns
Stratum Corneum: 10 microns dead skin cells
Stratum Corneum: 10 microns dead skin cells
Model courtesy of Jared Mallalieu, DO.Model courtesy of Jared Mallalieu, DO.
![Page 6: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/6.jpg)
What’s a wrinkle?
Lines and wrinkles are caused by collagen loss and sun damage and are improved with laser, neurotoxins, and
skin care
Folds are caused by volume loss and respond best to filler
![Page 7: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/7.jpg)
Tell us about your goals
• Can treat variety of conditions
• Rhytids
• Dyschromia
• Rosacea
• Laxity
• Scarring - Acne and surgical
Lasers
![Page 8: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/8.jpg)
The ArticPeel(Series of 5)The ArticPeel(Series of 5)
Photos courtesy of Pozner, Jason, M.D.Photos courtesy of Pozner, Jason, M.D.
![Page 9: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/9.jpg)
The ArticPeel(Series of 5)The ArticPeel(Series of 5)
Photos courtesy of Pozner, Jason, M.D.Photos courtesy of Pozner, Jason, M.D.
![Page 10: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/10.jpg)
The ArticPeel(Series of 5)The ArticPeel(Series of 5)
Photos courtesy of Pozner, Jason, M.D.Photos courtesy of Pozner, Jason, M.D.
![Page 11: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/11.jpg)
Microlaser Peel(Single Tx 60microns)Microlaser Peel
(Single Tx 60microns)Photos courtesy of Pozner, Jason, M.D.Photos courtesy of Pozner, Jason, M.D.
![Page 12: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/12.jpg)
Microlaser Peel(Single Tx 60microns)Microlaser Peel
(Single Tx 60microns)Photos courtesy of Pozner, Jason, M.D.Photos courtesy of Pozner, Jason, M.D.
![Page 13: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/13.jpg)
Microlaser Peel(Single Tx 60microns)Microlaser Peel
(Single Tx 60microns)Photos courtesy of Pozner, Jason, M.D.Photos courtesy of Pozner, Jason, M.D.
![Page 14: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/14.jpg)
UV PHOTO(After 20 then 30 micron
MicroLaser Peel)
UV PHOTO(After 20 then 30 micron
MicroLaser Peel)
![Page 15: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/15.jpg)
Profractional(4 weeks after 3rd tx )
Profractional(4 weeks after 3rd tx )
Photos courtesy of G. Todd Bessinger, M.D. PhDPhotos courtesy of G. Todd Bessinger, M.D. PhD
![Page 16: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/16.jpg)
Profractional & MLP(4 weeks after 2nd tx )Profractional & MLP(4 weeks after 2nd tx )
Photos courtesy Adam Baker, MD
![Page 17: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/17.jpg)
Profractional(3 weeks after 2nd tx )
Profractional(3 weeks after 2nd tx )
Photos courtesy of G. Todd Bessinger, M.D. PhDPhotos courtesy of G. Todd Bessinger, M.D. PhD
![Page 18: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/18.jpg)
Healing(20 micron MLP with 250 Pfxc)
Healing(20 micron MLP with 250 Pfxc)
Before &Immediately
After tx
Before &Immediately
After tx
Day 1 to Day 2
Day 1 to Day 2
Day 2 to Day 3
Day 2 to Day 3
![Page 19: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/19.jpg)
Perioral ResurfacingPerioral ResurfacingPhotos courtesy of Pozner, Jason, M.D.Photos courtesy of Pozner, Jason, M.D.
![Page 20: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/20.jpg)
Perioral ResurfacingPerioral ResurfacingPhotos courtesy of Pozner, Jason, M.D.Photos courtesy of Pozner, Jason, M.D.
![Page 21: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/21.jpg)
Custom Repair(Fraxel Repair and Erbium)
Custom Repair(Fraxel Repair and Erbium)
Photos courtesy of Ross VanAntwerp, DOPhotos courtesy of Ross VanAntwerp, DO
![Page 22: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/22.jpg)
Custom Repair(Fraxel Repair and Erbium)
Custom Repair(Fraxel Repair and Erbium)
Photos courtesy of Ross VanAntwerp, DOPhotos courtesy of Ross VanAntwerp, DO
![Page 23: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/23.jpg)
Mole RemovalMole RemovalPhotos courtesy of Ross VanAntwerp, DOPhotos courtesy of Ross VanAntwerp, DO
![Page 24: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/24.jpg)
Mole RemovalMole RemovalPhotos courtesy of Ross VanAntwerp, DOPhotos courtesy of Ross VanAntwerp, DO
![Page 25: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/25.jpg)
Custom Repair(Fraxel Repair and Erbium)
Custom Repair(Fraxel Repair and Erbium)
Photos courtesy of Ross VanAntwerp, DOPhotos courtesy of Ross VanAntwerp, DO
![Page 26: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/26.jpg)
Custom Repair(Fraxel Repair and Erbium)
Custom Repair(Fraxel Repair and Erbium)
Photos courtesy of Ross VanAntwerp, DOPhotos courtesy of Ross VanAntwerp, DO
![Page 27: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/27.jpg)
Perioral ResurfacingPerioral ResurfacingPhotos courtesy of Pozner, Jason, M.D.Photos courtesy of Pozner, Jason, M.D.
![Page 28: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/28.jpg)
Fraxel RepairFraxel RepairPhotos courtesy of Ross VanAntwerp, D.O.Photos courtesy of Ross VanAntwerp, D.O.
![Page 29: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/29.jpg)
Longevity(5yr. Post deep Resurface)
Longevity(5yr. Post deep Resurface)
Photos courtesy of Pozner, Jason, M.D.Photos courtesy of Pozner, Jason, M.D.
![Page 30: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/30.jpg)
Photos courtesy of Jared Mallalieu, DOPhotos courtesy of Jared Mallalieu, DO
SkinTyte - 4 weeks s/p 4 treatmentsSkinTyte - 4 weeks s/p 4 treatments
![Page 31: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/31.jpg)
SkinTyte - 4 weeks s/p 4 treatmentsSkinTyte - 4 weeks s/p 4 treatmentsPhotos courtesy of Jared Mallalieu, DOPhotos courtesy of Jared Mallalieu, DO
![Page 32: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/32.jpg)
Adjuvant Surgical Procedures
• Can treat the submental region with single 3mm incision
• Two stage process
• Fat melting - 1064 nm
• Skin tightening - 1319 nm
Laser Assisted Liposuction
Blepharoplasty• Upper and lower procedures may be done at the same time
as other services
![Page 33: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/33.jpg)
Adjuvant ProceduresLaser ASsisted Liposuctionwith SkinTyte 4 sessions
Adjuvant ProceduresLaser ASsisted Liposuctionwith SkinTyte 4 sessions
Photos courtesy of Jared Mallalieu, DO.Photos courtesy of Jared Mallalieu, DO.
![Page 34: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/34.jpg)
Laser ASsisted LiposuctionLaser ASsisted Liposuction
Photos courtesy of Jared Mallalieu, DO.Photos courtesy of Jared Mallalieu, DO.
![Page 35: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/35.jpg)
Laser Assisted Liposuction NeckLaser Assisted Liposuction NeckPhotos courtesy of Jared Mallalieu, DOPhotos courtesy of Jared Mallalieu, DO
![Page 36: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/36.jpg)
Laser Resurfacing with Upper and Lower Blepharoplasty
Laser Resurfacing with Upper and Lower Blepharoplasty
Photos courtesy of Jared Mallalieu, DOPhotos courtesy of Jared Mallalieu, DO
![Page 37: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/37.jpg)
Dermal Fillers
• Minimal downtime - “liquid lift” and “lunchtime lift”
• Multiple Products on Market
• Hylauronic Acids - Juvaderm, Restylene, Belotaro etc
• laser 9-12 months
• Semi-permanent - Artefill (polymethylmethacrylate microspheres and bovine collagen
• lasts 2 plus years
• Sculptra (Poly L-lactic acid) - restores volume to face
![Page 38: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/38.jpg)
Facial Fat and Bone
![Page 39: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/39.jpg)
Lip Filler - Juvaderm 1ccLip Filler - Juvaderm 1cc
Photos courtesy of Jared Mallalieu, DO.Photos courtesy of Jared Mallalieu, DO.
![Page 40: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/40.jpg)
NLF - 2cc fillerNLF - 2cc filler
Photos courtesy of Jared Mallalieu, DO.Photos courtesy of Jared Mallalieu, DO.
![Page 41: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/41.jpg)
Filler - Sculptra 3 sessionswith Profractional Laser
Filler - Sculptra 3 sessionswith Profractional Laser
Photos courtesy of Jared Mallalieu, DO.Photos courtesy of Jared Mallalieu, DO.
![Page 42: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/42.jpg)
Argyria
• Case of a 25 year old Russian male who had previously taken elemental silver as dietary supplement
• Skin and mucous membranes develop blue discoloration
• Treated with Q switch 1064 nm laser
![Page 43: Aesthetic Medicine by Ross VanAntwerp.pptmarylanddo.org › wp-content › uploads › 2013 › 12 › ... · • Scarring - Acne and surgical Lasers. The ArticPeel (Series of 5)](https://reader031.fdocuments.us/reader031/viewer/2022040615/5f0e90e67e708231d43fdba2/html5/thumbnails/43.jpg)
Treatment of ArgyriaTreatment of Argyria
Photos courtesy of Ross J. VanAntwerp, DO.Photos courtesy of Ross J. VanAntwerp, DO.