Consult Overview


Long term outcomes require work! 

We highly recommend purchasing a package not because we want to make money off of you, but because we want you to obtain long lasting, excellent result. At 1228 our procedures have minimal to no down time. 

What is melasma?



Melasma (muh-LAZ-muh) is a common skin problem. It causes brown to gray-brown patches on the face. Most people get it on their cheeks, bridge of their nose, forehead, chin, and above their upper lip. It also can appear on other parts of the body that get lots of sun, such as the forearms and neck. It is imperative to have your provider evaluate your thyroid, your hormonal status, as well as evaluate copper levels. 

One of the most common treatments for melasma is sun protection. This means wearing sunscreen every day and reapplying the sunscreen every 2 hours. Dermatologists also recommend wearing a wide-brimmed hat when you are outside. Sunscreen alone may not give you the protection you need. 

Women are far more likely than men to get melasma. It is so common during pregnancy that some people call it the mask of pregnancy. Hormones seem to trigger melasma. Heat makes melasma worse,

Tretinoin and corticosteroids: 

To enhance skin lightening, your dermatologist may prescribe medicine. This medicine may be tretinoin or a corticosteroid. Sometimes a medicine contains 3 medicines (hydroquinone, tretinoin, and a corticosteroid) in 1 cream. This is often called a triple cream. 

At 1228 we do NOT use hydroquinone secondary to liver toxicity association.

Other topical (applied to the skin) medicines: Your dermatologist may prescribe azelaic acid or kojic acid to help lighten melasma.

Procedures: If a topical medicine does not get rid of your melasma, a procedure may succeed. Microneedling ( SkinPen) and chemical see neutralizing peels such as glycolic or TCA peels will help your condition as well. Ask your provider for your customized treatment plan. (See our melasma annual membership /microneedling and peel rotation)

If you notice any of the following after treating melasma, be sure to call your provider: 

Skin irritation. 

Darkening of the skin.

Other problems.


Under a  medical care, many people with melasma have a good outcome. Melasma can be stubborn, though. It may take a few months of treatment to see improvement. It is important to follow your dermatologist’s advice. This ensures that you get the most benefit from treatment. It also can help avoid skin irritation and other side effects. 

After your melasma clears, you may need to keep treating your skin. Your provider may call this maintenance therapy. Maintenance therapy can prevent melasma from returning. 

You can help prevent your melasma from returning by wearing sunscreen and a wide-brimmed hat every day.

Dry Eye and Rosacea


Do you flush easily? Do you notice that your eyes are often " scratchy" and that you can never seem to find the correct might have dry eye! Ask us about our gel masks and referrals for MGD evaluation. 



If you are being offered services  for " an incredible price"  please ask yourself why you are being offered a deep discount?  Please ask yourself how long the provider has been performing the procedure. Ask the practice for their actual client before and afters. How up to date is their machinery and do they attend courses often to update his/her skills? " Knowledge is power, but only if you know how to use it"

If you have a service that you are saving for ask us how we can help. We are always looking for independent contractors for marketing and models for trainings. We will always give you our honest opinion and work with you to obtain a natural but noticeable result. Please allow us to work with you and never discount your results.  



Follow us on social media as we travel around the country teaching others how to provide some of the  "best practices". One Saturday a month, Joni C Ricketts MSPAS, PA-C trains local medical providers how to perform advanced procedures including but not limited to advanced combination therapy by using mcrocannulas, PDO threads, Ultherapy, prp, prf, and micronized fat transfer. Trainings are held cat the Garcia Institute.


Questions and Answers

What is medical grade skin care?

Our Skincare

Medical-grade means that the products you are purchasing are available from establishments that operate under a physician’s license. This means that there must be a medical director for the retailer to sell these products. Usually the facility offering these products will require a consult to ensure your safety and to address your long term goals. The practice also usually keeps your last medical history in mind as well, to make sure there are no contraindications. Medical- grade skincare may seem more expensive however with medical grade skin care the product is is more concentrated, so you will use less. Using less product will result in a longer lasting product. Therefore the cost/benefit calculation actually makes medical-grade products a better bargain in the long run.

Our Private Label Medical Grade Skincare

What is PRF?

The Vampire Facelift

What is PRF?  

PRF stands for platelet rich fibrin. PRF is a by product of blood that is exceptionally rich in platelets. These platelets release growth factors that stimulate stem cells. These stem cells are a power house and present a variety of treatment options for you. By using your own blood we can:

- accelerate healing

- reduce infection risk

- awake mesenchymal cells( why great in combination with filler)

- restore skin

- assist in autoimmune skin disorders ( psoriasis) 

- Hair restoration

- Improve and restore hair loss from androgenic alopecia ( polycystic ovarian syndrome and male pattern baldness)

- Improve acne scarring    ( excellent with microneedling)

- Joint and bone restoration 

- Improve allergic shiners darkening of eyes

PRF filler demonstration

What is PRP? PRP stands for platelet rich plasma. PRP is also a by product of blood that is exceptionally rich in platelets.PRP is similar to PRF, but when we use PRP we us an anticoagulant. When we use PRP, we do not utilize the does not have white blood cells from the whole blood products. PRP  does not contain a fibrin sheath like PRF. PRF also has mesenchymal stem cells. 

( see PRF vs PRP)

We do rotate PRF and PRP in our autologous stem cell membership. 

The trademark called the Vampire Facial and the Vampire Facelift use PRP.. 

Find out more

What is Kybella?


KYBELLA® is the only FDA-approved injectable treatment that destroys fat cells in the treatment area under the chin to improve your profile.  At Twelve Twenty Eight Mobile Medical Wellness we inject  KYBELLA® safely into stubborn fat pads on the body as well.

Find out more

What is Ultherapy?


Ultherapy is the only non-invasive procedure FDA-cleared to lift skin on the neck, under the chin and on the eyebrow and most recently on the décolleté. Ultherapy utilizes ultrasound. Ultrasound, of course, has been used safely throughout the medical field for more than 50 years and our board certified medical providers read this ultrasound to differentiate where to deliver energy. By delivering this energy , a micro injury results and creates a more lifted and organized structure. Over three months you will see collagen promotion and a lift. At Twelve Twenty Eight we provide “ off label” Ultherapy. 

Off label simply means that the procedure is not yet cleared or approved by the FDA. We have been providing Ultherapy to the body for years with safe and consistent beautiful outcomes With Ultherapy can help you achieve a fresher, more youthful look from your brow to your toes!

Safe Ultrasound. No Surgery. Ultherapy has been established as safe and effective in clinical studies and in more than 350,000 treatments worldwide.

We highly recommend pairing Ultherapy with PDO Threads. 

Ulthera result usually last  three years, but we have seen maintained results at five years. 

Schedule Ultherapy with Joni at the Garcia Institute

What are PDO Threads?


PDO stands for Polydioxanone and this refers to the material used to make the threads used in the lifting procedure. Novathreads is the brand of our favorite PDO Threads. The PDO threads offer a number of specific benefits:

* threads have no cones, thus no damage to the tissue

* excellent safety record – the same thread used in cardiac, plastic, obstetric,  and other surgical sutures

* ultra-fine threads ( smooth or twist threads) are naturally broken down within the body over 6-8 months, although the results naturally ‘wear off’ over around 18 months.

* Barbed threads last longer and produce a stronger more instant result. 

* PDO thread  material is invisible within the skin

The principle behind PDO thread lifting is not simply about pulling the skin into a different position, but rather to stimulate the body’s natural reaction to a ‘foreign body’ – which is to produce collagen and improve blood circulation, contracting the tissue. As the PDO dissolves naturally over time a strong collagen bond results. 

The PDO lift has a series of benefits

* naturally improves skin elasticity and texture

* reduces wrinkles

* brightens skin tone

* produces more defined facial contours

* rejuvenating and lifting effect

* covers prominent forehead veins

* improves texture and tone 

* We often call Ultherapy the  “Spanks” and PDO threads the the “ panty hose”.

How many sessions do I need for threads?

We highly recommend a consult to customize a treatment plan to obtain your goals. As with any aesthetic procedure we assess and discuss partial verse complete correction ( see what is partial verse complete correction)

Twist and smooth threads typically need 3-6 sessions to obtain a complete correction.

Barbed threads usually require one session to obtain a complete correction. We also recommend PRF/ PRP and hyaluronic fillers kn combination with threads for volume. 

Call us to schedule!

What is partial verse complete correction?

Patient has half of face done with threads. Picture taken mid procedure.

During your initial consultation we will create a game plan for success. We will also discuss partial verse complete correction. Partial correction is when we correct the underlying concern to its baseline. We work to improve that area but it is not completely achieved to end desired result in that setting. We often perform partial correction with fillers secondary to expense. We also perform partial correction with several follow up visits to delicately stage the transformation. Complete correction is when we perform a multifaceted approach as well as completely transform to baseline desire. 

example: patient presents with shallow midface and would like volume and lift. Her budget is nine hundred dollars. We recommend two syringes of filler and midface pdo threads. She decides to proceed with one syringe of filler and schedules sequential visits for that second syringe of filler and then the mid face PDO threads. She understands that by only purchasing one syringe of filler she will obtain an improvement but not a complete correction. She proceeds with a partial correction. 

Partial correction may also be preventative therapy to maintain a baseline. 

We support you on your journey and educate you on several options available including but not limited to partial or complete correction. 

Check out our shop

Questions and Answers continued...

Combination Therapy

What is the difference between retinol and tretinoin?

Both tretinoin and retinol are forms of vitamin A 

Tretinoin tends to be stronger than Retinol. Tretinoin is best suited for patients that have oily or tolerant skin. Tretinoin is also a fantastic step up from retinol.  Retinol is a derivative of vitamin A and it is a bit more suitable for those with sensitive skin. Retinol must be converted into retinoic acid to become active. At Twelve Twenty Eight Mobile Medical Wellness we prescribe both retinol and tretinoin. 

Both stimulate collagen, which reduces fine lines and wrinkles. Our retinol is one percent medical grade retinol. We prefer to have our tretinoin compounded by a local pharmacy because we can customize additional components ( ex: tretinoin plus azelaic acid). Biochemically, retinol and retinoids are almost exactly the same thing, however it may just take longer to see results with retinol-based products because they are weaker.

Try our medical grade peels

What peels does Twelve Twenty Eight Mobile Medical Wellness use and what is the downtime?

According to Anna Samuels, PCA's leading clinical educator, " PCA is a healthcare company specializing in blended chemical peels for more than 25 years and are the trusted leader in chemical exfoliation in the industry. At Twelve Twenty Eight we use a variety of formulations designed to be customized to your specific concerns and lifestyle. Do not let the term “chemical peel” scare you. Chemical exfoliation is a safe and effective way to rapidly exfoliate your skin to reveal healthy glowing skin and encourage new collagen and a smoother brighter complexation. You can schedule a Sensi-peel to get that pre -event glow or a series of Ultra Peels or Jessner Peels for a more progressive approach to rejuvenation.  Our Forte peels are physician grade and reach the dermis. Our skin naturally exfoliates every 30 days until our thirties when it slows down. That is why we wake up on our 35th birthday and our skin looks dull, blotchy and our lines are starting to show. This is an indicator that it is time to start regular chemical exfoliation. Monthly chemical peels will literally sluff off the hands of time. Some other lines of peels may burn or blister the skin, but PCA Skin peels use many ingredients that naturally occur in the skin, like lactic and citric acid, coupled with botanicals to help feed, lighten and brighten your complexation with NO down time. Regular treatments will transform you back to the youthful version of YOU! Get ready for less brown spots, refined pores, tighter brighter firmer skin". PCA stands for Physician’s Care Alliance

Do you have acne? Check out our acne facials

What is microneedling and what is Skinpen?

Microneedling has been around for centuries and is referred to as collagen induction therapy. By creating a small injury to the skin, microneedling causes the cells to work harder to heal and promotes collagen. 

SkinPen is a true state of the art anti aging device that repairs and improves sun damage, scars, stretch marks, and hyper-pigmentation through collagen induction therapy. Because the Skinpen has 12 surgical grade micro needles that simultaneously develop tiny micro channels in the skin, SkinPen increases collagen and skin cell turnover. The overall result is an appearance of a more youthful skin. Skinpen is excellent  for fine lines and acne scarring as well melasma. Skinpen reduces pore size and improves overall skin tone and texture. 

Our melasma package

IV Therapy and Supplements

IV therapy or intravenous therapy almost immediately improves fatigue and dehydration. Using a sterile technique, our trained specialists temporary will place an intravenous catheter to deliver a nutrient blend customized treatment solution. This procedure takes 30-60 minutesYour treatment will include a consult for medical clearance prior to the procedure. We customize of IV therapy based on your last medical history, allergies or intolerances, and presenting concern. We do offer supplemental injections ( see B12, Glutathione

on our menu of services) 

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