Office Procedures

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List of office based procedures:

VIVAA is committed to providing care focused around your needs. We offer a number of in-office procedures that do not require sedation or general anesthesia. Schedule your office-based procedure at a time that is right for you.


Patients can receive joint injections for several reasons. They can help control pain and swelling in joints by administering medications directly into the affected area. This particularly helps patients with conditions like osteoarthritis where joints can flare-up, even as they take systemic therapy. It also helps with pain for those who have rheumatoid arthritis, bursitis, tendonitis, ganglion cysts and neuromas.

Sometimes, we may remove joint fluid for analysis to determine the source of a problem and ultimately fine-tune treatment.

The effects of injections are usually temporary, but they can help patients return to normal activity and help them perform physical therapy exercises to improve the condition. No preparation is required for this procedure.


Trigger point injection (TPI) is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when they do not relax. Such knots can often be felt under the skin. Trigger points may irritate the nerves around them and cause referred pain that is felt in another part of the body.

For TPI, we will insert a small needle into your trigger point that contains a local anesthetic or saline and may include a corticosteroid. The injection makes the trigger point inactive, thus alleviating pain. Often, a brief course of treatment will result in sustained relief.

TPI can treat many muscle groups, especially those in the arms, legs, lower back and neck. It can also be used to treat fibromyalgia, tension headaches and myofascial pain.


Platelet-rich plasma, commonly called PRP, is a non-operative solution for arthritis, ligament and tendon sprains and tears and even hair loss. The treatment does not wear off over time and can help a patient avoid joint replacement surgery. These injections jumpstart your body’s own healing process.

The creation of PRP involves drawing your own blood and placing it in a centrifuge, which spins the blood at high speeds in order to separate it into red blood cells and concentrated platelets. The concentrated platelet-rich plasma is then ready to be injected back into your body, directly into the affected area. Platelets are rich in growth and healing factors, meaning a patient can become pain-free in four to six weeks. When used for hair growth, PRP is injected directly into the scalp to awaken “sleeping” hair follicles.


A biopsy is the removal of a small part of a skin lesion. The size and depth of the removal will depend on the type of skin condition you have. Biopsies give us a diagnosis beyond what we can see in a clinical exam. It can help finalize a treatment plan, especially in the case of pre-cancer or cancer.  Mole removal is often indicated when moles have recently changed shape or size and show cancerous tendencies. Surgical excision is required for larger moles, but smaller moles can often be removed through surgical shaving of the skin.


Most common warts go away with home treatment but occasionally in-office measures must be taken. For more stubborn warts, we may suggest freezing or cryotherapy whereby liquid nitrogen is applied to the wart or application of a stronger medicine called trichloroacetic acid. Some warts also respond to laser treatment.


Skin tags are small flaps of tissue than hang off our skin by a thin stalk. They usually occur in an area where skin rubs together like your armpits, neck, eyelids, under your breasts or in your groin. They are usually harmless, but can becoming irritating if they snag on jewelry or clothing.

They are removed in one of three methods. After number the area, we can snip off the skin tag with special scissors. The second method involves freezing or cryotherapy, which makes the skin tag fall off in about 10 to 14 days. Burning the skin tag sends an electrical current into the growth to dry out the tissue, ultimately making it fall off.


Mirena is a hormonal intrauterine device (IUD) that can provide long-term birth control through the release of the hormone progestin. It prevents pregnancy by thickening mucus in the cervix to stop sperm from reaching an egg while also thinning the lining of the uterus and partially suppressing ovulation. It’s effective for up to five years after insertion and may be used in premenopausal women of all ages.

The device can also decrease severe pain associated with endometriosis, along with a decreased risk of pelvic infection and endometrial cancer. It is common prescribed for women with heavy menstrual bleeding and painful periods.

Mirena IUD  is not permanent. If you decide you want to get pregnant or just don’t want your IUD  anymore, we can easily take it out.


Nexplanon is a birth control implant that is a thin, tiny rod about the size of a matchstick. The implant release hormones into your body that prevent you from getting pregnant. Inserted under the skin of your upper arm, it provides contraception for up to three years by releasing the hormone progestin. The hormones in the implant prevent pregnancy in two ways:

  • Progestin thickens the mucus on your cervix, which stops sperm from swimming through to the egg
  • Progestin can also stop ovulation, so there is no egg to fertilize

Nexplanon is not permanent. If you decide you want to get pregnant or just don’t want your implant anymore, we can easily take it out.

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