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Facial scars are very common from injuries or surgical procedures. If you call your average physician and tell them that you have a recent scar, the chances are they will tell you that there is nothing that can be done for a year after the injury. Unfortunately, this is frequently misinformation.

There is evidence that by treating a scar early, the outcome of the result can be improved. Some studies have shown that when a scar is treated within 8 weeks of the injury or surgery that it can heal much better than waiting an extended time. I have adopted this method of treating traumatic and surgical scars of the head and neck and it has worked well. When a patient presents with a scar of the head or neck that is less than 8 weeks old, I will begin treatment with various modalities including steroid injection, silicone sheeting and pressure. When the scar reaches its point of primary healing then I will most commonly treat it with the CO2 laser. The laser performs several functions to improve the scar. Number one, it allows uneven tissue margins to be blended or smoothed down. Number two, it causes new collagen to be produced to fill in the irregularities and number three it helps blend the coloration with surrounding tissues. Lasering the scar is usually done under local anesthesia and takes only a few minutes. The area will be raw for the first 5-6 days and then be a smooth pink. This pinkness will fade over the ensuing weeks but may last several months in some cases. Sometimes I will use a V-Beam laser to bring the reddness and swelling down before I clean it up with C02 laser.

Sometimes the scar is lasered multiple times as it improves with each treatment. While simple lasering may work great for simple scars, more complex scars may need surgical intervention first. Many surgical procedures exist to make scars less noticeable by changing the direction of the scar, making it it more random (straight line scars stand out more) or making the margins even. Sometimes I will send the patient out to a surgeon before I use laser resurfacing to blend the scar.

Some depressed scars (those that are like craters) respond will to filler injection. By injecting fillers, many depressed scars can be simply “popped out” by filling the base of the depression with filler. This is useful in acne or pock scars. Subcision is another useful technique. Subcision is a process in which a special needle is used to break up scar tissue at the base of a depressed scar. A depressed scar has spider web like bands called adhesions that, in part, are what keep the depressed scar tethered down. By inserting this cutting needle under the scar and swiping it back and forth, these adhesions can be separated and allow the base of the depressed scar to rise up and fill in. Subcision can be performed multiple times to improve a depressed scar.

There are many myths surrounding the treatment of surgical and traumatic scars. Applying Vitamin E, commercial products like Mederma or Scar Guard or covering the scar with silicone sheeting are probably all useful, even if not scientifically proven. Keeping a new scar protected from the sun is also important.

I am always happy to discuss scar management.

Labels: C02, Fillers, IPL, Laser Resurfacing, Reddness, Scars

Ultrasound Guided Sclerotherapy (UGS) is a safe and highly effective procedure that eliminates diseased veins that have traditionally required surgical removal.

Sclerotherapy was thought to be effective with spider veins and small varicose veins that remain after surgery. Neither surgery nor sclerotherapy can prevent new varicose veins from developing as a result of the natural progression of this chronic condition. However, UGS offers a less traumatic, less costly alternative to gain and maintain control. Your specialist has undergone specialized training required in order to treat the saphenous axis by sclerotherapy.

Duplex ultrasound (DUS) is the key to the success of this procedure. First, it locates the diseased "saphenous" vein(s) hidden from view that cause the bulging on the surface. Next, DUS guides both the placement of and the number of injections required according to each individual patient. Follow-up DUS examinations will confirm success, and guide additional treatment if necessary. At BC LASER we possess an advanced Duplex Ultrasound Machine.

The success of both surgery and sclerotherapy depend on accurate control of all reflux (backward flow) points. With recent advances, both methods now share a similarly high success rate when performed by experienced practitioners who were able to accurately target veins using DUS.

Unfortunately, varicose vein disease is not curable. Like many other chronic medical conditions such as diabetes or hypertension, it requires ongoing care and surveillance after the initial course of treatment gains control. Treatment in the earlier stages helps avert unpleasant complications (leg ulcers, dermatitis, phlebitis, blood clots), and relieve bothersome symptoms.

We can work with to find the best course of treatment for you.

Labels: Varicose Veins

Stretch marks are very difficult to treat.  They form when a person grows quickly, gains weight rapidly, or is pregnant.  The skin stretches so quickly that the elastic tissue in the skin actually tears.  That is why stretch marks don't go away when the person loses weight or is no longer pregnant.  There seem to be genetic factors that make some people more prone to stretch marks than others.

Fractional resurfacing is the treatment of microscopic columns of skin within the treatment area.  It doesn't treat all of the skin at once, which could create a large wound, rather it treats a fraction of the skin at a time.  The skin in these fractional zones then heals from the untreated adjacent skin.  Ablative fractional resurfacing, with the carbon dioxide laser, appears to be the best treatment option for stretch marks.  At the very least you should get some fading and blending into the surrounding skin, and in some people (with multiple treatments) they may go away completely.  Fractional lasers that do not use carbon dioxide will give you more subtle results, and will require many more treatments.

Labels: C02, Fraxel, Laser Resurfacing, Scars, Stretch Marks

Rosacea can be divided in to three stages

• Stage I is the general redness and flushness on the cheeks, nose, and central face.

• Stage II is the addition of papules or pustules, and is referred to as acne rosacea.

• Stage III includes the changes associated with long standing rosacea, namely a larger bulbous nose or chin. In addition, rosacea patients can also suffer from blepharitis (inflammation of the eyelid margin) and the formation of styes.

For stage I rosacea, treatments include a topical medication such as metronidazole, sodium sulfacetamide, or azaleic acid twice a day. The effects of these topicals are varied. Laser is an excellent treatment for these cases, and sometimes the only acceptable cosmetic treatment. We use Prescribed Solutions (TM) products which have natural products that help in Calming the skin down.

For both stage I and stage II rosacea, the addition of doxycycline, minocycline, or tetracycline is usually added. Low-dose accutane can also be used in these cases.

For stage III changes, a small surgical procedure or laser can correct some of the changes seen with long standing rosacea.

The goal is to calm down the acne portion of your rosacea, then to perhaps do laser once that part of it is controlled.

Accutane is a reasonable option if you are a good candidate.

Labels: Reddness, Rosacea