Send Dr. Vivian Bucay an email
About My Practice
How does your staff enhance the care you offer?
My exceptional staff, including Karen Adams, PA-C, and licensed medical aesthetician Susan Lujan at our North San Antonio location and Karen Moreland, PA-C, and licensed medical aesthetician Melissa Valdez at our downtown San Antonio location, add a wealth of skill and truly enhance the patient experience.
How do you educate patients?
I take time with each patient and build relationships. One-on-one consultations establish a trusting rapport, where patients can put their confidence in me. I also keep patients up to date on dermatology news and my practice via my Facebook page. (To learn more, find Dr. Bucay on Facebook, Twitter and Google+.)
What anti-aging advice do you think is important for patients to know?
Enjoy life because stress can definitely show on your face. Appreciate the skin that you're in and be comfortable with yourself.
What new procedure are you excited to offer?
I’m excited about Ulthera®, a nonsurgical ultrasound device that is FDA approved for brow lifting. I am the first dermatologist in Central Texas to offer Ultherapy®, and I find that it complements other minimally invasive procedures such as Botox injections and fillers. Another way I complement cosmetic procedures is with Dermaceutic products, a line of professional chemical peels and at-home cosmeceuticals that are designed to either prep the skin before aesthetic treatment or maintain it after treatment.
What extra credentials do you bring to your dermatology practice?
As an art collector, I have an appreciation for the visual form and am more aesthetically inclined. I have also treated patients abroad, gaining an international perspective and additional insight into various skin conditions.
How would you describe your office?
It’s nicknamed La Casita and is over 100 years old. Because our office is inside of a house, within the historic district of Monte Vista, patients find it very charming, quaint and welcoming. We are also very proud to announce that we will be opening our second location in San Antonio this spring
What are you excited about for the future of your practice?
We are excited to announce the opening of our third location in San Antonio, allowing us to extend our patient care even further. We are located at 18707 Hardy Oak Blvd.
What alternative career would you choose?
I'd own an art gallery or be an interior designer.
How long have you been a dermatologist?
I've been practicing since 1991.
How do you reach out to the public?
I go out of my way to pamper and educate my patients and their friends by hosting quarterly informational events. In addition to providing details on the latest technologies, skin care and injectable products, we have fun with lite bites, beauty raffles and trunk shows.
What additional professional positions do you hold?
I’m a clinical assistant professor at The University of Texas Health Science Center at San Antonio and am heavily involved in continuing education initiatives focusing on injectables. I’m also a consultant and trainer for Allergan, Medicis, Sculptra Aesthetic, Radiesse and Ulthera.
In what ways do you relate to your patients?
I survived stage-four melanoma cancer and wrote a lot of articles on that; it reinforced my zest for life, enabling me to relate better to patients. I am also bilingual in English and Spanish, which can be very beneficial for my patients, especially because we are located in a largely Spanish-speaking region.
American Board of Dermatology
Affiliation:Fellow, American Academy of Dermatology
A Minute With
The best skin in hollywood
Cate Blanchett’s skin always looks beautiful
My exam room room playlist
Shakira, Led Zeppelin, Fleetwood Mac, Adele, Mana, R.E.M
Three words that best describe me
Dynamic, committed, genuine
I used to feel guilty that cosmetic dermatology was not “real medicine,”
until a patient once told me, “Never underestimate the way you make us feel, you give us more self- confidence and greater self-esteem.”
The most outrageous medical myth i’ve heard
The biggest myth is that sunscreen causes cancer
My dream innovation
I would love to invent an implantable pellet that offers protection from UV rays, visible light and infrared rays,
all of which age skin
Aesthetics is about restoration, not alteration
What i love most about my profession
Dermatology affords me the opportunity to combine science, medicine and artistic skill into a profession that has the power to enhance a person’s self-esteem
My most unique personality trait
My willingness to share my professional secrets
What i can’t live without
My family, chocolate, art and shoes
- “Liquid Facelift”
- Botox® Cosmetic
- Juvéderm® Fillers
- Sculptra®/ Revanesse® Versa™
- Restylane® Fillers
- Restylane® Silk / Lyft
- Radiesse® / Belotero®
- Noninvasive Skin Tightening
- Facial Rejuvenation
- Cutera Excel V
- Vectus™ Laser Hair Removal
- Chemical Peels
- Hand Rejuvenation
- Customized Skin Care
- Treatment of Acne, Scars, Rosacea, Brown Spots and Stretch Marks
- Body Treatments
- CoolSculpting® / CoolMini™
- Exilis® / Vanquish™
- Silhouette InstaLift™
- UltraShape® Power
- BTL Vanquish ME™
- BTL Exilis® Ultra
- BTL Cellutone™ / ZWave
- BTL Emsculpt®/ BTL Emsella™
- Skin Rejuvenation
- Lumenis® IPL / ResurFX
- Q-Switched Laser
- AcuPulse™ / Laser Genesis™
- Fraxel DUAL Laser
- Eclipse MicroPen®
- FemTouch™ Vaginal Rejuvenation
- Vanquish ME™
- Cellutone™ / ZWave
- UltraShape® Power
- Lutronic GeniusTM
Where does Radiesse belong?What our experts say:
Folds and wrinkles on the face.
How do you keep your lips puffy and plump?What our experts say:
To date collagen has disappeared so there is no FDA-approved filler for the lips right now. Which is not to say that a doctor can't make the decision to use something like Juvederm or Restylane for lip enhancement because they are FDA-approved products but they were not studied in the lip. Restylane is close it should have already been approved for the lips. That's the one that's about to be approved at any moment for the lips. I think that the thing to make sure with the lips is to maintain facial proportions. The ideal lip, typically the upper lip should be about one-third of the volume of the total lip.
Is a chemical peel good for acne?What our experts say:
Chemical peels are growing again. I like chemical peels in several situations, definitely for acne. There's no age restriction on that. There's the right chemical peel for each skin type and it definitely helps with acne, with the discoloration and also with active lesions. The reason I like peels is because they're very affordable and it gets people interested in their skin care. It's a good starting point for other procedures. I personally think that while lasers are very good, I'll always try a chemical peel first.
Which laser treatment can get rid of broken blood vessels on my face? There are some tiny vessels near my eyes and some bigger ones on my cheeks. Are these removable with the same laser or do I need multiple appointments?What our experts say:
Treating the capillaries can be done with a laser or with intense pulse light, IPL, but the advantage of a laser is that it specifically targets the red pigmented blood, so it seeks out the blood vessels specifically. There are several lasers that are out there. I use the one by Iridex, called the Gemini laser, it's actually a long pulsed ND:Yag. I think it works beautifully, and depending on the amount of capillaries, or blood vessels that somebody has, it can be treated in one treatment. It's important to realize that although the vessels will appear to disappear, the body has to break them down and absorb the pigments and that's why you need at least four to six weeks to see whether or not a laser has been effective in removing those.
Do lips seem natural if they're filled?What our experts say:
Yes, they feel natural and you can't tell when you have had improper material put in, For example, Radiesse is one that should never be put in the lips. But people request it because it lasts longer. The lips will feel rock hard. People who have had silicone might in the beginning feel soft but then they start to feel hard.
Do the injectables used for enhancing lips last forever?What our experts say:
No. You're still going to have to come back and do it every six to 9 months or once a year based on personal preferences.
How are Ulthera and Thermage different and which is better for skin tightening?What our experts say:
Ulthera uses focused ultrasound and Thermage is based on radiowaves or radiofrequency so they use completely different technologies. With the Ulthera, because it's ultrasound, there's no need to ground the patient with a grounding plate, there's no chance of shocking the patient. Even with Pelleve you have to have a grounding plate attached to complete the circuit or the patient is going to get shocked. People who have pacemakers can still have Ulthera done because it's not interfering with those devices. That said, Ulthera is FDA-approved for non-surgical browlift and it's approved for use on the face and the upper neck.
How many treatments of Ulthera would I need?What our experts say:
Ulthera was designed to be a single treatment but now we know that people can have a second treatment, certainly no sooner than three months and maybe at around six months. At six months you're going to see what you're going to see results-wise. It has absolutely no downtime because there's no peeling of the skin and minimum swelling. Because it's not working on outer layers of the skin, in contrast to something, say Fraxel or a chemical peel, it is possible to go right back to normal activity the very next day.
I am 39 and my chin is still breaking out. Shouldn't I be past the pimple stage? What is best way for me to treat and prevent them?What our experts say:
One out of every three women over the age 30 is going to have acne. I've seen patients even into their 70s with breakouts. One of the most important things that is overlooked in personal hygiene is what kind of toothpaste we use. And whitening toothpaste in particular has ingredients that can cause breakouts on the chin. It's called perioral dermatits and so the chin is an area that's prone to that. Try using a toothpaste that's not a whitening toothpaste. The other thing is in the chin there's also a lot of sebaceous glands relative to other areas of the face and because of the way the chin naturally creases, cell renewal is a little bit more challenging there too, it's not like in the cheeks. Most people will get little whiteheads and breakouts on their chin.
I have a lot of sun spots and sun damage, any quick fix?What our experts say:
I would recommend a good home regimen and a chemical peel.
I want to relax the wrinkles on my face and make my skin look tighter, should I use a filler like Juvéderm or a relaxer like Botox? Are there other brands or things I should consider?What our experts say:
It all starts with the evaluation. You have to go see someone who is qualified in facial aesthetics and they have to evaluate if your lines or wrinkles are due to overactive muscles, in which case something like Botox or Dysport is appropriate or are the wrinkles forming because of loss of volume in which case a filler is appropriate. Is there loss of muscle tone, muscle laxity in which case Ulthera or Thermage or even Pelleve also would be appropriate. Oftentimes it's not a matter of a single treatment but rather a combination of treatments to address all the factors that contribute to aging.
Is Ulthera for full body or just for the face?What our experts say:
Right now it's FDA-approved for the face but there are clinical trials being done for body areas as well.
Why would you use Ulthera rather than an injection or filler like Botox or Restylane?What our experts say:
The perfect example is for a nonsurgical browlift. If somebody has heavy eyelids, due to muscles of the forehead dropping down, you would not want to put Botox or Dysport or a neuromodulator in that person's forehead because they'll lose their ability to lift the brow and their eyelids are going to seem heavier. That's the main difference there. You would want to do this in a situation where you're trying to make the eyes look bigger and more wide open. The true surgical alternative for this is a browlift. You can get some brow elevation with Botox by treating just the depressor muscles of the brow but that means no treatment whatsoever of the forehead. In Ulthera one pass is delivered to the muscle but the second pass is delivered to the dermis, where the collagen producing cells are. So it's a dual treatment, you are tightening the muscle but you're also building collagen. It takes about three months to see the results.
Is it really Rosacea or something elseWhat our experts say:
Establishing a specific diagnosis depends on a good history and physical examination. That said, the description you give sounds like a condition called seborrheic dermatitis, which is characterized by sometimes pink, dry, flaky skin that can involve the areas you mention and can also affect the eyebrows, scalp and ears as well. Effective treatments can include a topical antifungal cream such a ketoconazole and possibly a mild hydrocortisone cream if there is a lot of inflammation. Another diagnostic consideration is a condition called perioral dermatitits, which is a sort of hybrid between acne and seborrheic dermatitis. Seborrheic dermatitis and perioral dermatitis can coexist with rosacea. Finally, if you are not experiencing relief of your symptoms, you need to visit your dermatologist for follow up and adjustment to your current treatment.
What treatment can be done for "orange peel" skin on my chin?What our experts say:
Without a photograph that allows me to evaluate your skin and overall facial volume, I can only give you general advice. If the dimpling on the chin is due to an overactive muscle, then treatment with Botox or Dysport to weaken that muscle can work beautifully. If you have volume loss, for example, you see shadowing or marionette lines that run from the corners of the mouth to the chin and jawline, then a filler may be the way to go to replace a volume deficit and smooth out the skin. Laser resurfacing would not be my choice to treat this problem because causes of a dimpled chin include overactive muscles, volume loss, or, very commonly, both.
Let's talk about the pores around your nose and on your cheeks. The first thing you must understand is that pore size is determined by genetics and pore diameter is a fixed size and cannot be changed. All we can do is improve the appearance of pores.You state that you have enlarged pores, not acne scars. The fact that you took Accutane 30 years ago works in your favor because Accutane reduces the size and activity of sebaceous glands, which makes pores look smaller. As we age, we lose collagen - the main source of support in our skin - causing the skin to lose its firmness. We also lose overall facial volume, around 1 teaspoon a year starting at age 30, so overtime, our skin just isn't stretched as tightly over our faces. The loss of firmness and "loose" skin makes pores look larger. Any treatment aimed at increasing collagen production and increasing skin thickness can work to improve the appearance of pores. Options include fractional laser resurfacing, intense pulsed light (IPL), and medium depth or deep chemical peels. Any treatment must be maintained with a good home care regimen. A good sunscreen and a topical retinoid (over-the-counter retinol or prescription strength, such as Retin-A, Renova, Tazorac, or generic tretinoin or adapalene) are the two nonnegotiable elements of an effective skin care regimen.
I had mixto C02 laser resufacing on my face over 20 months ago, and am very unhappy with the results. What can I do to repair the damage?What our experts say:
First, I am sorry to hear that your CO2 laser resurfacing did not give you the results you had hoped for. Without a photograph, it is difficult for me to give you specific advice because i cannot see your complexion. I suggest that you obtain a second opinion from a dermatologist who specializes in laser procedures, Possible options to improve your skin may include lasers that can reduce redness as well as certain topical compounds that can stimulate pigment production to improve the white lines on your face. The redness and flares at night will eventually disappear, but the white lines may represent a permanent loss of color in those areas.Of course, any further treatment should be performed by the physician only. Lasers are powerful devices that can produce highly satisfactory results, but like so many treatments, the most important part is the knowledge and experience needed to match the right laser to the right patient.
Are facial exercises good for a sagging neck line or actually bad?What our experts say:
I have not found any sound studies documenting the benefit of facial exercises to tighten and lift the neck. In fact, clenching or grimacing to tighten the muscles in the lower face and neck will most certainly cause contraction of the platysmal muscles, which run along the jawline from ear to ear and anchor on the collar bone. This will cause a downward pull giving the appearance of sagging along the jawline along with the appearance of vertical bands in the neck. All in all, not a pretty look. In fact, Botox and Dysport are commonly used off-label to soften the platysmal bands, giving the neck a smoother and more appearance.
Using sculptraWhat our experts say:
As a rule, it is better to avoid using Sculptra under the eyes because of the increased risk of nodule formation in that area. I have used it in the past without complications but now feel that there are better options that give better results. Technically speaking, none of the fillers on the market have the official indication for treating "tear troughs" or under eye hollows - a very popular request - although they can be used safely in an off-label manner for this purpose. The key is to make sure that you receive treatment by an expert and highly experienced injector who is familiar withe pros and cons of each filler and who is prepared to treat any complication in this area. In the right patient, my favorite fillers for treating the under eye area are Restylane and Belotero Balance. Like all hyaluronic acid fillers, they can be dissolved with hyaluronidase in the event of an adverse event.
Can you peel while using either Retin-A or Aczone?What our experts say:
Chemical peels can be performed while on Aczone without having to stop the treatment in advance. Pretreating skin with tretinoin (Retin-A) will actually enhance the results of a chemical peel, but it is important to stop using the tretinoin 4 to 5 days before the peel in order to decrease skin sensitivity. Skin that has been appropriately “primed” with tretinoin will benefit more from peels compared to skin that has not been pretreated with it. It is also recommended to stop use of tretinoin 4 to 5 days before laser treatments or waxing to avoid excessive skin irritation.
It is posible to get the Ulthera in one week and in 3 months get the Thermage... it does not enterfere one with the other? is it dangerous in any way? the thermage still works?What our experts say:
Ultherapy involves using microfocused ultrasound waves for targeted treatment of muscles and deep layers of the skin to increase collagen production. This produces tightening AND lifting of the skin. In fact, Ulthera is the only device that is FDA approved for nonsurgical lifting of the brow, lower face, the area under the chin/jawline as well as the neck. Thermage uses radiofrequency to heat underling tissues to tighten the treated area. There is no danger in having the 2 treatments 3 months apart. However, the results of Ulthera may take 6 months to be fully visible, so doing a second treatment using a different energy too soon may not allow you to see the full benefits of the first treatment.
Do you do cautherization of facial warts?What our experts say:
Facial or flat warts are caused by a virus and can be treated in many ways. It is important to keep in mind that, regardless of their size, warts involve only the superficial layers of the skin, also known as the epidermis, and treatments should focus on this layer of the skin. Treating below this layer can result in scarring. Commonly used treatments include light freezing with liquid nitrogen or trying to produce peeling of the affected areas by using a retinoid (a vitamin A acid medication like Retin-A). Another option can can include using a topical prescription medication like imiquimod to stimulate the skin’s own immune system to fight the virus. Very light cauterization is an option but it is more uncomfortable and can cause discoloration in darker skin types. The success of any of these treatments can be increased by daily use of sunscreen because it protects the skin’s immune system, which is weakened by ultraviolet radiation (UVA and UVB rays).