Bags Under Eyes - Articles - Zimbio

Eye Bags-Modern Removal Techniques

Thu, 29 Feb 2008 09:29:29 GMT

posted by wianno168

The eyes are the “window to the soul” and our most frequently viewed facial feature and unfortunately the first feature to show the signs of facial aging. Usually by the 30’s we begin to see crow’s feet, wrinkles, eye bags, dark circles under the eyes, and the start of eyelid hoods or hooding of the eyes.

(Contact Dr Seckel)

Traditional plastic surgery called the blepharoplasty can remove eye bags and reverse many of these eyelid aging changes however newer methods using laser blepharoplasty and other laser eyelid rejuvenation techniques are vastly improved methods for eyelid rejuvenation and removal of eye bags. Newer, non-surgical eyelid rejuvenation techniques such as Botox and non-surgical eyelid skin tightening techniques such as the Aluma radiofrequency skin tightening device can improve and help prevent eyelid skin aging changes such as wrinkles and crow’s feet but removal of eye bags requires surgery.

The laser eye lift, which I call the “modern blepharoplasty”, combines new laser and non-surgical skin rejuvenation technology to produce dramatic eyelid rejuvenation and removal of eye bags without many of the drawbacks of traditional blepharoplasty.

Contact Dr Seckel

The laser eye lift combines the advantages of nearly bloodless laser incisional methods with non-surgical skin tightening and skin peeling methods for removal of eye bags as well as wrinkles and tightening and freshening of the eyelid skin. For the first time we can achieve total eyelid rejuvenation, not just removal of eye bags and hooding of the eyes, but smooth young looking eyelid skin with fewer wrinkles and less sun damage and aging changes and removal of dark circles under the eyes.

In addition by using the laser to make a tiny incision on the inside of the lower eyelid (the transconjunctival blepharoplasty) we can avoid a visible scar on the outside of the lower eyelid. The transconjunctival blepharoplasty technique also avoids any change to the beautiful lower eyelid shape, a common and troublesome complication of traditional scalpel blepharoplasty with an external eyelid incision. In addition, with the transconjunctival blepharoplasty it is possible to release the arcus marginalis and thus remove dark circles under the eyes as well as eye bags.

Advantages of the laser eyelid rejuvenation are:

Faster Surgery
Less bleeding
Less Bruising
Quicker Recovery
No visible scar on lower eyelid
No change in lower eyelid shape
Removal of Puffy Eyes, Eye bags, and Dark Circles Under Eyes
Freshening of Lower Eyelid Skin with Skin Tightening and Wrinkle Removal

The laser eyelift consists of 4 steps:

Laser upper blepharoplasty for removal of hooding of the upper eyelid
Transconjunctival lower blepharoplasty with arcus marginalis release and repositioning or grafting of fat to remove the dark circles and bags under the eyes
Laser tightening of the lower eyelid and a procedure called canthoplasty to tighten the lower eyelid and remove eye bags
Lux2940 Fractional Erbium Laser eyelid skin peel to remove wrinkles, sun damage , and tighten lower eyelid skin

The combination of these 4 steps provides removal of eye bags and truly total eyelid rejuvenation for the first time, something which the traditional scalpel blepharoplasty just cannot achieve. Furthermore with the advantages of less bleeding and bruising, recovery time is usually shorter than with traditional scalpel blepharoplasty.

During step 1of the laser blepharoplasty, the laser is used to remove the loose upper eyelid skin which is creating the eye hoods. After the loose skin is removed access is gained to the canthal ligament, which supports the lower eyelid, through the upper eyelid incision, so that the lower eyelid may be tightened in step 3 to restore the shape of the lax lower eyelid.

Step2, the transconjunctival laser blepharoplasty removes bags under eyes, puffy eye, and dark circles under eyes. The conjunctiva is the pink portion of the inner lower eyelid, thus when the laser incision is made on the inner side of the lower eyelid it is called a transconjunctival incision. This approach avoids a visible scar on the outside of the lower eyelid. In addition, the supporting skin and muscle of the lower eyelid is not violated and thus the beautiful shape of the eyelid is not changed. One major drawback of traditional scalpel blepharoplasty is weakening of the lower eyelid and a downward turn of the eyelid referred to as an ectropion, also called the sad eyed look or hound dog eyes. The transconjunctival blepharoplasty avoids this complication.

During step 2 the eyelid fat which is causing the eye bag in either removed or repositioned so that it no longer causes the puffy eye bulge or eye bag. In addition, the arcus marginalis, a condensation of eyelid tissue which tethers the lower eyelid skin and causes the dark circle under the eye, is released allowing the dark circle to ‘open up”. In addition fat is placed beneath the dark circle to plump the dark circle. The combination of fat repositioning and arcus marginalis release remove the dark circles under eyes.

Step 3. During step 3 the laser is used to tighten the lower eyelid skin by shrinking the lower eyelid tissues through the transconjunctival incision. In addition, the canthal ligament, which supports the lower eyelid, is tightened with a suture placed through the upper lid incision, a procedure called a canthopexy. These two procedures tighten the lower eyelid and also provide a small amount of upper cheek lift.

Step 4. Step 4 involves refreshing, smoothing, and tightening of the lower eyelid skin using the Lux2940 Fractional Erbium laser eyelid peel. This new high tech procedure allows for rejuvenation of the skin surface of the lower eyelid and thus total eyelid rejuvenation. In the past with traditional laser blepharoplasty, hoods and bags were removed but the eyelid skin remained wrinkled and old looking. With today’s new laser blepharoplasty and eyelid rejuvenation techniques a truly fresh and rejuvenated eyelid appearance is possible.

The laser eye lift is the modern blepharoplasty approach which provides total eyelid rejuvenation. For further information read Save Your Face or contact me.

Dr Seckel

Boston, Massachusetts

Concord, Massachusetts

978-369-4499

Your Tired Eyes-What causes them and how to correct Tired Eyes

Tue, 30 Jan 2008 13:24:42 GMT

posted by wianno168

The eyes are the window to the soul; our most often noted and viewed facial feature, and unfortunately the first facial feature to show signs of facial aging. Eyelid aging changes begin as early as the late 20’s and early 30’s and are one of the most common concerns that motivate people to seek plastic surgery. The most common sign of eyelid aging is “tired eyes” and the most common complaint I hear is that “people say I look tired and I am not”. Blepharoplasty, the plastic surgery procedure to correct aging eyes is the 3^rd most common plastic surgery procedure performed in the United States today

Happily there are many preventative steps we can take to prevent eyelid aging changes, and if you already have aging eyes there are many exciting new non-surgical methods available to reverse eyelid aging changes.

The earliest eyelid aging changes are eyelid wrinkles called crow’s feet which we see on the corner of our eyelids on the cheek when we smile. Later these wrinkles extend across the lower eyelid and up into the upper eyelid. Later the upper eyelid skin becomes lax and begins to sag or droop and eventually covers the beautiful upper eyelid fold and begins to form an eyelid hood or eye hood which eventually can compress the upper eyelashes and obstruct vision. Eye hoods or eyelid hooding can also be made worse by the descent of the sagging eyebrow.

The lower eyelid also becomes lax and as a result, normal fat beneath the eyelid protrudes or pushes out on the eyelid and creates eye bags or eyelid bags or puffy eyes. This protruding lower eyelid tissue creates a shadow in the normal depression below the eyelid and creates the dark circles under the eye.

Fortunately there are many things we can do to prevent these eyelid aging changes before they occur or reverse these changes early without surgery. If however advanced eyelid aging changes occur, there are excellent modern laser and surgical eyelid rejuvenation procedures available to restore the eyelid to a youthful appearance.

Prevention of Eyelid Aging

Sun block, wrap around sun glasses, and general sun protection are essential eyelid aging prevention techniques, especially in the south, southwest and west where sun exposure is greatest and outdoor activities are so common. A healthy diet and exercise help prevent premature skin aging and tired eyes. Botox prevents crow’s feet. A good anti-aging skin cream like Retin A or vitamin C can help prevent and reverse eyelid skin aging and eyelid wrinkles.

Non-surgical eyelid rejuvenation

Exfoliation of eyelid skin, stimulation of new collagen formation in sun damaged eyelid skin, and tightening of eyelid skin can all be achieved non-surgically and can correct early eyelid aging changes and tired eyes. Topical Retin A, microdrmabrasion and Dermasound are good non-surgical eyelid rejuvenation techniques. For more severe eyelid aging, laser skin rejuvenation with newer less intensive eyelid laser skin peeling techniques such as the activefx laser skin peel or the microlaserpeel, or the lux2940 microfractional laser peel can exfoliate and tighten eyelid skin and remove eyelid wrinkles.

Surgical Eyelid rejuvenation

Modern eyelid rejuvenation surgery utilizes the laser and revolutionary new blepharoplasty techniques to rejuvenate the aging eyelid with minimal or no scarring and can correct tired eyes while preserving the beautiful eyelid shape. Surgical lower eyelid rejuvenation utilizes a laser incision on the inside of the lower eyelid through the pink portion of the eyelid called a transconjunctival blepharoplasty. During this procedure the eyelid fat is repositioned to remove the eye bag without creating a hollow eyelid appearance. Dark circles under the eyes are removed by a procedure called the arcus marginalis release, all with no scar. Upper eyelid hooding or eye hoods are also removed with the laser with virtually no bleeding, thus less bruising, quicker recovery and a small scar that is invisible when the eye is open. If wrinkles and sun damage of the eyelid are severe a new more gentle Lux 2940 microfractional laser skin peel can be done to smooth and freshen the eyelid skin for total eyelid rejuvenation.

With prevention, eyelid aging can be forestalled and early eyelid nagging can be treated with simple painless non-surgical high tech methods. Once eyelid aging has occurred remarkable truly revolutionary laser eyelid rejuvenation techniques are available to correct tired eyes, restore a youthful, open, alert, bright look to the eyes, the window to our soul.

To learn more about eyelid aging prevention, modern eyelid rejuvenation, and facial rejuvenation, read Save Your Face or contact me.

Thank you,

Dr Seckel,

Boston, Massachusetts

Your Tired Eyes-What causes them and how to correct Tired Eyes

Thu, 29 Feb 2008 09:17:08 GMT

posted by wianno168

Prevention of Eyelid Aging

Non-surgical eyelid rejuvenation

Surgical Eyelid rejuvenation

To learn more about eyelid aging prevention, modern eyelid rejuvenation, and facial rejuvenation, read Save Your Face or contact me.

Thank you,

Dr Seckel,

Boston, Massachusetts

Dark Eye Circles-What Causes Dark Eye Circles and How To Correct Dark Eye Circles

Tue, 20 Feb 2008 06:43:33 GMT

posted by wianno168

To better understand the treatment of dark eye circles under the eyes I will discuss the various types of dark eye circles under the eyes that I encounter in my plastic surgery practice and my understanding of the cause of the dark eye circles, and what I feel is the most effective treatment to remove the dark eye circles under the eyes.

Understand that the eyelid skin appears darker than the surrounding facial skin in all people-dark eyelid color is the normal condition and is caused by shadows created by the overhanging brow and the fact that the eyelid skin is much thinner than the surrounding facial skin. Below I am talking about exaggerated dark eye circles under the eyes that cause people to be unhappy with their appearance.

Causes of Dark Circles under the Eyes

Thin Eyelid Skin

The eyelid skin is the thinnest in the body and many people with dark eye circles under the eyes have extremely thin skin on their eyelids and around the eyes. This thin skin is an inherited trait. The dark eye circles under the eyes are caused by the fact that the purple color of the underlying eyelid muscle shows through the thin skin and creates a bluish or purple color. The color is darkest near the nose and on the lower eyelid near the nose.

Treatment of dark eye circles under the eyes caused by thin skin is very difficult because it is very difficult to make your inherited skin thicker. Cover up make up like Jayne Iredale Eye Cover, Dermablend, and Covermark are very helpful and my first recommendation. Frequent microdermabrasion and Retin A cream over a long period of time will build new collagen in the dermis will thicken the skin and provide some improvement.

There are new lasers on the horizon which are very effective at stimulating new growth of collagen in the dermis and these new technologies may prove very beneficial. Be sure to sign up for my free newsletter to be informed when these new technologies are available.

The Arcus Deformity discussed below creates a very severe dark eye circle in people with thin eyelid skin and correction of the Arcus deformity with Arcus release and fat grafting can be very helpful treatment for dark eye circles under the eye in these individuals.

Prominent Eyelid Blood vessels and Veins

Everyone has veins and blood vessels called capillaries in their eyelid skin. In many people however the veins are very prominent and the blood vessels add to the dark color of the eyelid.

To diagnose this cause of dark eye circles look in a mirror with bright light on your face and gently pull the skin of the lower eyelid tight. You will see many tiny branching red and blue lines which represent blood vessels.

You need blood vessels and veins to keep your eyelid healthy and alive. However when there is an abundance of smaller vessels which create a bluish or purplish hue to the lower eyelid some new IPL (Intense Pulsed Light) or laser therapies can be used to treat dark circles under the eyes in people with an excess of small capillaries and blood vessels. The very large veins cannot be treated.

Laser blood vessel treatment is a serious and potentially dangerous treatment for dark eye circles under the eyes and must be performed by a physician who is experienced in the use of lasers and IPL. Most importantly the eye must be protected by placing a shield over the eye during treatment so that the laser or IPL light cannot hit the eye. The laser and IPL light can damage the retina and destroy vision if the beams hit the unprotected eye.

Pigmentation of the Eyelids

Hyper pigmentation, too much pigment in the skin of the eyelid is a very common cause of dark eye circles under the eyes and dark eyelid skin. Treatment of dark eye circles under the eyes caused by hyper pigmentation is very effective, but the pigment frequently returns after sun exposure.

Hyper pigmentation of the lower eyelids occurs because of sun exposure and prevention with sun block, sun glasses, and a hat are the most important first treatment for this type of dark circles under the eyes.

The treatment of hyper pigmentation begins with bleaching creams such as a combination of Retin A and 4% Hydroquinone, Obagi Blender 5, Epiquin or other prescription bleaching cream combined with microdermabrasion.

After the above treatments have lessened the pigmentation causing the dark circles under the eyes, if necessary I proceed to IPL (Intense Pulsed Light) treatments. These treatments do effectively remove pigment causing the dark eye circle but again experience and eye protection are very necessary to prevent eye injury.

Hollow Eyes

Many people have a deep hollow beneath the lower eyelid which creates a dark shadow beneath the eyelid which people call dark eye circles under the eyes.

This deep hollow beneath the lower eyelid is caused by an inherited deficiency of fat and or bone and treatment of this type of dark circle under the eye requires surgery.

The hollow eye occurs more commonly in people from Central Asia and the Middle East but it certainly occurs in all races and from people in all regions of the world.

To treat dark circles under the eyes in people who have hollow eyes I do a laser procedure called an Arcus Marginalis release and fat grafting. The Arcus Marginalis is a structure which tethers the lower eyelid to the bone and creates a dark circle when the eyelid skin above the dark circle falls over the dark circle creating a shadow. Releasing the Arcus Marginalis releases the eyelid skin and eliminates the crease or dark circle.

I then transplant fat to fill the hollow in the bone and plump the dark circle and correct the hollow eye appearance.

Usually, to treat the dark circle under the eyes caused by the hollow eye I have to take fat from around the belly button on the abdomen to have enough fat to adequately fill the hollow eye deformity. The incision to remove the fat is well hidden down inside the belly button and is usually not visible.

Treatment of dark circles under the eyes caused by the hollow eye usually takes me 45 minutes to an hour, can be done with you asleep or awake, and recovery is usually 10 days. Patients do not complain of pain afterwards. The main recovery is waiting for bruising to go away and blurred vision from eye ointment that I have you use for the first week or two. Most importantly after this treatment you need to be calm, rest and not exert yourself. Working out or heavy lifting can raise your blood pressure and cause bleeding. Although you will be up and around the first few days with sunglasses to cover your bruising, I do not want you to exercise or lift heavy objects for at least 2 weeks.

The Arcus Deformity-the True \Dark Eye Circle under the Eye

The most common cause of dark eye circles under the eyes in patients who seek treatment of dark eye circles under the eyes in my plastic surgery practice is the Arcus Deformity.

The Arcus Deformity is a dark crescent shaped circle or depression which occurs beneath the lower eyelid starting beside the nose in the corner of the eye and running out toward the side of the face and curving upward towards the outside corner of the eye.

The Arcus Deformity is caused by the fact that a small structure beneath the lower eyelid called the Arcus Marginalis is attached to the bone of the eye socket and also attached to the lower eyelid from underneath. This attachment tethers or holds the eyelid close to the bone of the eye socket while the rest of the lower eyelid is loose and free to move. The normal fat which is beneath the eyeball pushes out against the lower eyelid which creates a visible bulge on the lower eyelid. You can see this by closing one eye and gently pressing on the closed eye. With your other eye you will see the bulging of the fat against the closed lower eyelid on the other side.

The eyelid skin that is tethered by the Arcus Marginalis cannot move or bulge, and as the fat bulges the lower eyelid above the Arcus Marginalis it creates a shadow or dark circle beneath the eyelid where the Arcus Marginalis is attached to the lower eyelid skin. This is the true dark eye circle under the eyes.

As we age and our eyelid skin becomes loose or lax, the eyelid skin also falls or sags over the depression caused by the Arcus deformity and the dark circle gets worse. With aging and excess protrusion of fat against the lower eyelid the Arcus deformity can become quite pronounced.

The Arcus Deformity is the true dark eye circle under the eye and I use the term Arcus Deformity to differentiate it from the Tear Trough Deformity which is different. The Tear Trough Deformity starts near the corner of the eye in the same location as the Arcus Deformity but the Tear Trough Deformity runs down into the cheek rather than up toward the outside corner of the eye.

The Tear Trough Deformity is a sign of advanced facial aging and is caused by the sagging or descent of the cheek into the middle of the face which occurs with facial aging in your 50’s and 60’s. Tears run down the cheek and out the side of the face through the Tear Trough instead of straight down the cheek as they do in a child.

By contrast the Arcus Deformity occurs in much younger patients including children. Most people seeking treatment for dark circles under the eyes in my plastic surgery practice are in their 20’s and 30’s. Doctors often misdiagnose the Arcus Deformity as the Tear Trough Deformity which is a major problem if a Tear Trough Implant is used to treat the dark circle. The Tear Trough Implant is designed to plump or correct the depression in the cheek out toward the side of the face, and in my experience the Tear Trough Implant cannot adequately correct the dark circle under the eye where it is deepest, near the corner of the lower eyelid near the nose.

The treatment for dark eye circles under the eyes caused by the Arcus Deformity must include release of the Arcus Marginalis and fat repositioning or fat grafting to plump the area of the dark eye circle.

The traditional plastic surgery treatment for eyelid rejuvenation called the blepharoplasty, during which fat is removed, can actually make dark eye circles under the eyes worse and create a hollowed eye appearance.

Treatment of dark eye circles under the eyes that are caused by the Arcus deformity requires a modern blepharoplasty approach which includes release of the Arcus Marginalis and fat repositioning or fat grafting.

I use a very specific treatment for dark eye circles under the eyes called the transconjunctival blepharoplasty with Arcus release and fat grafting. This treatment is done through a tiny incision on the inside of the eyelid called a transconjunctival incision because it goes through the conjunctiva, the pink tissue on the inside of the lower eyelid. I also use the laser to make this incision.

The benefits of the laser transconjunctival incision are:

No visible scar or incision on the outside of the eyelid
No change in the shape of the lower eyelid-the traditional scalpel blepharoplasty through an external incision usually weakens the lower eyelid and causes a sad eyed look
Less bleeding during surgery
Less bruising after surgery
Quicker recovery

My results following treatment of dark eye circles under the eyes with the laser transconjunctival blepharoplasty with Arcus Marginalis release and fat grafting have been very successful. Most patients have recovered within a week and many who do not bruise are comfortable being seen with make up after 5 days.

Summary- Treatment of Dark Circles under the Eyes

To summarize, effective treatment of dark eye circles under the eyes requires that you correct the problem that is causing the dark circle under the eye. To accomplish this you must understand what type of dark eye circle under the eye you have and what is causing it. The following is a summary table:

Cause of dark Circle	Treatment of dark circle
Thin eyelid skin	Retin A, microdermabrasion, laser?
Prominent Eyelid Blood Vessels	IPL, Laser
Pigmentation of the Eyelid	Bleaching creams, IPL, laser, Microdermabrasion
Hollow Eyes	Arcus Marginalis Release and fat Grafting
Arcus deformity	Transconjunctival laser Blepharoplasty with Arcus release and fat grafting or repositioning

Treatment of dark eye circles under the eyes is possible; the key is understanding the underlying cause of your dark circles. With proper diagnosis and treatment of dark circles under the eyes caused by the Arcus deformity beautiful results can be achieved with the transconjunctival Arcus release and fat grafting.

For more information on dark eye circles under the eyes contact me and feel free to send me photos of your eyes and I will tell you what I see after reviewing them.

Be sure to sign up for my free email newsletter as I often write about dark circles under the eyes and other topics on facial rejuvenation. I suggest you read my book Save Your Face which explains facial and eyelid aging and how to reverse and treat facial aging changes.

Dr Brooke R. Seckel

Concord, Massachusetts

Boston, Massachusetts

978-369-4499

Eye Bags, Eye Hoods, and Puffy Eyes-Modern Removal Techniques

Fri, 20 Oct 2007 14:01:41 GMT

posted by wianno168

(Contact Dr Seckel)

Traditional plastic surgery called the blepharoplasty can reverse many of these eyelid aging changes however newer methods using laser blepharoplasty and other laser eyelid rejuvenation techniques are vastly improved methods for eyelid rejuvenation. Newer, non-surgical eyelid rejuvenation techniques such as Botox and non-surgical eyelid skin tightening techniques such as the Aluma radiofrequency skin tightening device can improve and help prevent eyelid aging changes such as eye hooding, wrinkles, eye bags, and dark circles under the eyes.

The laser eye lift, which I call the “modern blepharoplasty”, combines new laser and non-surgical skin rejuvenation technology to produce dramatic eyelid rejuvenation without many of the drawbacks of traditional blepharoplasty.

Contact Dr Seckel

The laser eye lift combines the advantages of nearly bloodless laser incisional methods with non-surgical skin tightening and skin peeling methods for removal of wrinkles and tightening and freshening of the eyelid skin. For the first time we can achieve total eyelid rejuvenation, not just removal of eye bags and hooding of the eyes, but smooth young looking eyelid skin with fewer wrinkles and less sun damage and aging changes and removal of dark circles under the eyes.

Advantages of the laser eyelid rejuvenation are:

Faster Surgery
Less bleeding
Less Bruising
Quicker Recovery
No visible scar on lower eyelid
No change in lower eyelid shape
Removal of Puffy Eyes, Eye bags, and Dark Circles Under Eyes
Freshening of Lower Eyelid Skin with Skin Tightening and Wrinkle Removal

The laser eyelift consists of 4 steps:

Laser upper blepharoplasty for removal of hooding of the upper eyelid
Transconjunctival lower blepharoplasty with arcus marginalis release and repositioning or grafting of fat to remove the dark circles and bags under the eyes
Laser tightening of the lower eyelid and a procedure called canthoplasty to tighten the lower eyelid and remove eye bags
ActiveFX Laser eyelid skin peel to remove wrinkles, sun damage , and tighten lower eyelid skin

The combination of these 4 steps provides truly total eyelid rejuvenation for the first time, something which the traditional scalpel blepharoplasty just cannot achieve. Furthermore with the advantages of less bleeding and bruising, recovery time is usually shorter than with traditional scalpel blepharoplasty.

Step2, the transconjunctival laser blepharoplasty removes bags under eyes, puffy eyee, and dark circles under eyes. The conjunctiva is the pink portion of the inner lower eyelid, thus when the laser incision is made on the inner side of the lower eyelid it is called a transconjunctival incision. This approach avoids a visible scar on the outside of the lower eyelid. In addition, the supporting skin and muscle of the lower eyelid is not violated and thus the beautiful shape of the eyelid is not changed. One major drawback of traditional scalpel blepharoplasty is weakening of the lower eyelid and a downward turn of the eyelid referred to as an ectropion, also called the sad eyed look or hound dog eyes. The transconjunctival blepharoplasty avoids this complication.

Step 4. Step 4 involves refreshing, smoothing, and tightening of the lower eyelid skin using the ActiveFX laser eyelid peel. This new high tech procedure allows for rejuvenation of the skin surface of the lower eyelid and thus total eyelid rejuvenation. In the past with traditional laser blepharoplasty, hoods and bags were removed but the eyelid skin remained wrinkled and old looking. With today’s new laser blepharoplasty and eyelid rejuvenation techniques a truly fresh and rejuvenated eyelid appearance is possible. Botox is used to prevent the crow’s fet from coming back.

The laser eye lift is the modern blepharoplasty approach which provides total eyelid rejuvenation. For further information read Save Your Face or contact me.

Dr Seckel

Boston, Massachusetts

Concord, Massachusetts

978-844-3116