BC Laser & SkinCare Clinic

Melasma: The mask of pregnancy

2009-06-09T15:27:00.000-07:00

Melasma is probably the most common pigmentary abnormality in women. The average age of onset is in the early 30s. Almost half the sufferers from melasma have family members who also have melasma. This condition most commonly starts during pregnancy, but it may also start before or after pregnancy. Much less commonly, it can be seen in males. Melasma is more common in women with darker skin types, and more time spent outdoors during pregnancy is associated with an increased risk of melasma. Inreased maternal age at first pregnancy and multiple pregnancies both increase the risk of melasma. Birth control pill use is another factor that has been associated with the onset of melasma.

The treatment of melasma can be difficult. Sun avoidance is imperative. It's the ultraviolet A that makes melasma worse, and many sunscreens do not block Ultraviolet A well. No sunscreen works as well as shade. Bleaching creams containing hydroquinone have been the mainstay of melasma treatment in the past, and these are still used today. TriLuma is currently used as a prescription bleaching creams, but it has some risks due to the fact that it contains a relatively powerful topical steroid.Lasers have come to play a bigger role in the treatment of melasma, and we have had success with both the Fraxel Restore and the Medlite NdYAG laser. However, it's important to understand that there is no treatment that works all the time, and sometimes nothing will work.

We have found that the combination of Creams, Laser, Peels and Sun avoidance works best. There is no one treatment out there that by itself is supreme.

Botox Vs. Dysport

2009-06-06T15:42:00.000-07:00

People are constantly asking me when is dypsport going to be available? Well it will be available in the USA soon and I do not know when it will be released in Canada. Is it going to be better than Botox? I do not think so. There have been comments from some people that it will take a little time getting used to the exact dosages of Dysport that will produce nice results. I think there will some differences in dosages. Some comments have been made that it will last longer.

I am going to wait and see what happens. Let us get beyond the hype and find out exactly what results Dysport gives. All i do know that as with Botox it will require skilled injectors to deliver exacting results.

Melanoma

2009-05-09T14:59:00.000-07:00

Had a new patient come in for a "pigment" treatment on the chest. 32 year old gal had been tanning all her life. She had some moles all over the body. The pigment area of concern was a "mole". I said we should send it off to the lab for exam. It came back as melanoma. The only reason she ended up in the doctor's office was a cosmetic concern. My advice yearly skin exams, no tanning, suncreen and protective clothing. There is no excuse for it.

Keratosis Pilaris (KP)

2009-05-09T12:40:00.000-07:00

Keratosis Pilaris: A genetic condition of the follicles that sometimes resembles acne, but appears as rough bumps on the upper arms, backs of the thighs, and buttocks. It is also common in teens.

We use an inhouse resurfacing cleanser that works like a treat! Avoid scratching the bumps, as this may lead to scarring or spreading. Lasers DO NOT work for this condition.

Shaving Bumps

2009-05-09T12:39:00.000-07:00

Shaving Bumps: Called Psudo-Folliculitis Barbae, shaving bumps are a widespread problem, especially among women with curly hair and in the bikini area and underarms. As the hair follicle grows out of the skin, it immediately curls and re-enters the skin. The skin becomes inflamed and irritated, creating bumps.

Wash the area twice daily with an exfoliant to raises the hairs from under the skin and prevent them from growing back into the skin. This should be done twice a day. Options include laser treatments to remove the hair follicles.

Dermatoses Papulosa Nigra

2009-05-09T12:37:00.000-07:00

Dermatoses Papulosa Nigra: These little black or dark brown bumps that usually appear on dark skin, and start out as little freckles under the eyes and on the top of the cheekbones. They can grow in clusters, and tend to run in families.

Electrocautery or hot iron tip can be used to melt these right off. Carbon Dioxide or Erbium Lasers are very useful for a clean treatment.

Seborrheic Keratoses

2009-05-09T12:04:00.000-07:00

Often known as “barnacles of old age,” these benign lesions occur from excessive growth of the top layer of skin cells. They show up on the body, under the breasts, shoulders, and in places where they get rubbed by clothing. They can range from light tan to black in colour, and look like they have been pasted on your skin. Electrocautery or hot iron tip can be used to melt these right off. Carbon dioxide or an Erbium Laser is very useful at giving a clean reduction without any scarring.

Skin Tags

2009-05-09T12:03:00.000-07:00

Skin Tags: A skin tag is a bit of skin that sticks out and may appear attached to the skin. They may be smooth or irregular, flesh colored or pigmented, raised or dangling. They can show up almost anywhere, but most commonly appear on the eyelids, neck, armpits, and chest, and especially in women. They can be instantly snipped away almost painlessly with surgical scissors. We also use a cutting laser that works at the speed of light!

Open Pores

2009-05-09T12:02:00.000-07:00

Open Pores: Pores expand because they become clogged with dead cells and oil - which make them look larger. Sun damage, lack of exfoliating, and clogging blackheads are common culprits.
Treatment To get pores back to their normal size, you need to get rid of the blockage that causes them to expand. The key elements are unplugging the pores and cleaning dirt, bacteria and oil; limiting sun exposure; exfoliating and using the right ingredients like vitamin A, Azelaic acid, and alpha and beta hydroxy acids. Some of the latest LASER treatments really give excellent results.

Moles

2009-05-09T12:01:00.001-07:00

As moles age, the pigment gets deeper so they lose their colour and stick out more, which makes them more visible. A simple shave biopsy can bring the mole down to the level of your surrounding skin. If done right, it doesn’t even leave a scar. Moles can also be excised, but then a scar is a given

Pedicures: Be careful

2009-04-18T12:24:00.000-07:00

Pedicures can cause problems if you go to any unsanitary nail salon.

1. When you have a pedicure you can be put at risk for fungal infections and serious bacterial infections.

2. Ask the salon how the instruments are cleaned

3. One physician even advises patients to buy their own instruments and ask the salon to use those instruments to minimize the risk of contracting infections.

4. Foot baths should be properly disinfected so that the risk of contracting infections is minimized.

5. It is a common myth that pushing the cuticle keeps nails healthy and make them grow. Actually the cuticle is the nail's natural protective barrier. Smoothing the nail surface with nail files and buffers too aggresively damages the cuticle.

Spider Veins

2009-04-18T11:54:00.000-07:00

Some more thoughts about spider veins.

Spider veins are like little roadmaps stuck on the skin. They are very tiny superficial blood vessels that increase in size over time and usually occur on the legs. But they can occur any where on the body.
Some people are more likely to get them if they have blood relations with people who have them. If you stand a lot in your work you may get them as well. Anything that increases pressure in the venous system of the legs will cause them.
Crossing your legs does not cause them. Everyone crosses their legs and it does not occur in everyone.
Treating the veins by tanning actually may make them worse due to tanning breaking the skin collagen down.
Losing weight may increase the veins as losing fat from the skin unmasks the veins
Vitamin supplements and horse chest nut does not help reduce the veins.
Treating the spider veins with sclerotherapy is regarded as the gold standard. Lasers can be used but then you have to treat the veins slowly and it is painful.

Lipodissolve or Injection Lipolysis

2009-04-16T12:55:00.001-07:00

Injection lipolysis (breakdown of fat) may work best when two ingredients are used, according to an expert.

Phosphatidylcholine, when it is combined with deoxycholate for injection lipolysis, "may lead to reduced swelling and fewer nodules," says Adam Rotunda, M.D., a Newport Beach, Calif., dermatologist.

A recent study conducted by Giovanni Salti, M.D., of the Florence Surgical Center, Florence, Italy, has suggested the procedure is effective at breaking up fat cells in the region where it is injected, Dr. Rotunda says.

When phosphatidylcholine is included with the other agent commonly used, sodium deoxycholate, the effect was the same, but the inflammation and immune reaction was less.

Patients treated with injection lipolysis often have localized adverse effects including swelling, redness, and sometimes the development of nodules that may last for months.

At BC LASER we use combined phosphatidylcholine and sodium deoxycholate for reducing small pockets of persistent fat. The other alternative that we offer is the use of Ultrashape using ultrasonic waves to break up fat.

Laser Peel’s the most popular part of our clinic

2009-04-16T12:34:00.001-07:00

We perform laser peels for "benign epidermal pigmented lesions and rough texture". These are those irritating brown marks that people find annoying with some rough skin. We use an amazingly powerful technology from Hoya Conbio called the Medlite C6 laser which allows for an ideal light based peel. We use a particular wavelength called the 532 nm light (Green Light) that is suited for lighter skin types.

The advantage of this peel compared to IPL (which a lot of spas and clinics use) is that it does not leave any residual pigment behind that is left after 5 or 6 IPL treatments. 532nm can remove any light pigmentation effectively. We usually find that couples of sessions are enough for the treatment. Once the treatment is done a mild redness is left on the skin for 4 days. This can be nicely covered up with mineral make up. The brown spots start to lift and flake off over a period of 7 to 10 days with small crusts. It is no touch treatment.

In our practice these laser peels are even more popular than Botox or fillers. This laser peel requires maintenance once or twice a year. We prefer a real laser to an IPL. It is a much more effective treatment.

Botox for headaches

2009-04-16T11:05:00.000-07:00

We have been using Botox for the treatment of migraines for about 4 years. Recently our use has been increasing. Patients have been finding this a rather convenient way of managing their migraines. They come in and get Botox injections performed and usually they are headache free for 3-6 months. We have just completed our review of patients treated at BC LASER AND SKINCARE and have found that over a period of time the need for injections begins to reduce from twice a year to once a year. We have also noticed that whilst they are receiving their Botox injections their need for migraine medication reduces significantly from none used to minimal.

We have been using Botox for tension headaches and Temporo-mandibular joint (TMJ) pains for the last two years and have been getting good results. Some patients find that their extended health plans will cover the injection costs.

Latisse: The new eyelash treatment!

2009-04-16T10:12:00.000-07:00

It is rare that a product or procedure is introduced that opens up a new area of cosmetic enhancement, or redefines an old one. The introduction of collagen filler injections was one, as was the introduction of Botox. The use of lasers to resurface the skin and destroy blood vessels was also a paradigm changer. Now we have the introduction of Latisse, which reliably produces longer, thicker and darker eyelashes in the vast majority of people.
83% of American women use mascara, more than the 64% who use lipstick. The release of new mascaras with vibrating wands has boosted sales. Now, with the release of Latisse, there is a product that may make mascara obsolete for many, at a somewhat increased cost.Latisse is an offshoot of the drug Lumigan, made by Allergan. Lumigan is used as an eyedrop for the treatment of glaucoma. An unexplained side effect noted with Lumigan was the growth of longer eyelashes. Because the product had already passed safety tests for use in the eye, Allergan was able to obtain relatively rapid approval of the product for use on eyelashes. Side effects seen with Latisse have been irritation of the eyelid skin and eyes, and some apparently temporary brown discoloration of the skin near the eyelashes. When the product has been used as drops in the eyes, there has been, in a small percentage of people, a permanent darkening of the eye (iris) color.The eyelash growth takes two months to be noticeable and takes four months to reach maximum.
Latisse is not available in Canada yet. It may be released in the end of the year

Tips on getting a new Tattoo

2009-04-15T12:36:00.000-07:00

Most people do not think about removal of a tattoo when they are having a tattoo applied. Nevertheless, the statistics show that 80% of people with tattoos eventually regret having them put on. That means it would be smart to at least give a little thought to the possibility that you might not be totally happy with the tattoo sometime in the future.

Removal of names is one of the most common reasons for tattoo removal. Since approximately 50% of marriages end in divorce, it is reasonable to consider that the name of a loved one may not be what you want to have semi-permanently placed on your body. There are gang and prison associated tattoos. These are not necessarily connections that you will want to make public for the rest of your life. We've had people come in saying that they're no longer associated with that lifestyle, and they want the tattoo removed. If you're going to have a tattoo, consider where you have it placed. Visible tattoos may unfavorably affect your ability to get a job or be accepted into the military.Finally give serious consideration to the colour of your tattoos.

Currently there is no standardized tattoo ink, and a variety of products such as car paint and clothing and furniture dyes may be added to tattoo ink. Some of these may change color when struck by the light from a laser, and can change from a treatable to an untreatable color. The effectiveness of the tattoo removal laser depends on the laser light being absorbed by the tattoo ink. Dark blue, black and red are colors that are relatively easy to treat. Green can be treated by a laser, but it requires a separate laser that is expensive and therefore not widely available. Other colors such as sky blue, white and pastels can be difficult or impossible to get rid of.

If you're planning to get a tattoo, it's best to think before you leap.

Sculptra Potential Problems

2009-04-14T20:00:00.001-07:00

Initially fillers were viewed as relatively inert materials, such as collagen, that were injected, immediately plumped up the area to be filled, and gradually were absorbed. These type of fillers still exist, as exemplified by the hyaluronic acid fillers (Restylane and Juvederm). However, a new type of filler has emerged, a filler that works by stimulating the body to make more collagen in the area where the material has been injected.

Currently there are at least three fillers that fill this role. The first of these is Radiesse. Radiesse is a calcium based filler which was first introduced as a traditional filler. However, subsequent studies showed that much of the injected material was absorbed, and the prolonged effect seen was due at least partially to the production of new collagen in the area. In our hands, Radiesse has been essentially problem free.
Sculptra, in contrast, has always been recognized as achieving its effect by inducing the body to produce new collagen. Sculptra consists of tiny particles of poly-L-lactic acid, the same material that is used in absorbable sutures. The Sculptra is suspended in liquid and when injected, the area appears filled, similar to the immediate filling seen in other fillers. However, the liquid is absorbed within 24 hours, and the filling effect vanishes. The filler particles gradually stimulate the formation of new collagen, and it takes at least a month before results can be seen. The final result may not be seen until three to six months or longer.
There are several problems with Sculptra. First, because the result depends on the body's production of collagen, the results are not very precise and Sculptra is best used to fill a wide area, such as the hollows of the cheeks. Second, Sculptra has a propensity to produce nodules, sometimes not visible, but at other times visible. Furthermore these nodules can develop long after the Sculptra has been injected. We have seen Sculptra nodules develop 18 months after the injection and nodules starting as late as three years after injection have been reported. Needless to say, the patients in whom this occurs are not happy. Because of this, we have almost completely stopped using Sculptra.
The last of the fillers that induce new collagen formation is a permanent filler called Artefill. It is currently unclear how much of a problem there will be with nodules with this agent, but some have been reported.

Ear lobe: A Non Surgical Procedure

2009-04-14T19:57:00.000-07:00

A common problem for those who wear earrings is the gradual enlargement of the earring hole due to the repeated downward pull on the hole. In some people the earring will pull completely through creating a cleft in the earlobe. The traditional treatment for this has been a surgical repair, removing the skin at the edges of the hole and suturing the edges together. Now a non-surgical approach has been described for people who have an enlarged hole, but not for people who have a cleft in the earlobe.

In the March 2009 issue of the journal "Dermatologic Surgery" there is an article reporting the use of 90% trichloroacetic acid to treat this problem. Trichloroacetic acid is a caustic that destroys cell proteins causing local inflammation and crust formation, followed by local scar formation. This may be accompanied by mild to moderate local pain and inflammation in the area. Temporary local swelling and redness occur. There may also be a temporary increase in pigmentation in the treated area.
The number of treatments required varied from 2 to 6, and the minimal interval between treatments was 2 days. This technique was used on 32 women of varying ages, and all were reported to be satisfied with the results.This concentration of trichloroacetic acid has been used previously in the treatment of acne scarring, but its use in ear lobe repair appears to represent a significant advance in the treatment of enlarged earring holes.

How can I tighten my sagging skin without surgery?

2009-04-13T22:54:00.000-07:00

There are lots of choices but the best answer I can give you is combination treatments, combinations treatments, combination treatments. No one type of aesthetic treatment is enough.
I use a combination of the following to get the individual result the person desires. There is no one treatment that is 100% effective all the time in all the patients. One has to look at the individual and figure out the best combination in consultation with the person seeking the improvement.

Rhytec plasma
CO2
Erbium
Fraxel
Thermage
Refirme
Fillers
Botox
Skin care creams

Some more ideas about a red face

2009-04-12T20:09:00.000-07:00

Despite its association with passion, love, and vibrancy the color red is not what most people want to see on their faces when they look in the mirror. Redness on your face develops from inflammation and from dilated tiny blood vessels right at the surface of your skin. Sometimes the redness can be sudden, whereas other times it can develop slowly over many years. Here are five things your should know about facial redness and what to do about it.

1. The most common cause of facial redness is Rosacea. Rosacea is a chronic inflammatory condition that leads to red, sensitive skin and sometime to pimples on the nose and cheeks similar to acne. People with Rosacea often have sensitive skin that stings when exposed to sun or cold and turns bright red when they eat hot or spicy foods. If you have Rosacea, then try products that contain anti-inflammatory and anti-redness ingredients such as feverfew or licorice.

2. Over-exfoliating or scrubbing your skin can lead to redness. This is common among young women with acne. Remember that acne is from bacteria trapped in clogged pores. Scrubbing with apricot scrubs or using alcohol based toners will not help erase your acne, but it certainly will worsen the inflammation. Often this makes a bad situation worse. Unless you have very oily, sebaceous skin, remember that scrubbing is best done in moderation and in the middle of winter when your skin is already is dry and sensitive, scrubs might not be needed at all.

3. Excess sun exposure over years can lead to redness. The ultraviolet radiation from the sun triggers blood vessels to grow like weeds across your face. If you look closely at some people’s skin, you can see that diffuse redness is actually millions of tiny threadlike vessels right at the surface. This condition can be treated by using a laser that targets blood vessels. The laser can literally explode the tiny vessels, destroying them along with their unwanted redness. The downside is that you will often have obvious bruising for a few days; however, when the bruising heals, the redness is often significantly reduced and sometimes is erased altogether.

4. Allergic contact dermatitis can also cause redness on your face. Common causes of allergy include chemical sunscreens, preservatives in cosmetics, hair dyes, and fragrances. Skin allergies occur when your immune system reacts to a particular allergen. It is the same reaction as poison ivy or poison oak and can lead to redness, scaling, and itching. If you have a rash around your eyes, a rash that is itchy, or a chronic redness and scaling on your face, then see your physician. He or she can do patch testing to determine if you have a skin allergy and can give you a list of products to avoid.

5. Rarely is redness on the face the result of an underlying medical condition. Women with lupus, an autoimmune disease that can affect many organs, sometimes develop a bright red rash on their cheeks and nose, often called a butterfly rash because from a distance it looks like a butterfly on their face. The rash is triggered by sun exposure but can occur any time of the year. If you have the sudden development of this type of facial redness, then you should see a physician. A few blood tests can diagnose the condition and sometimes treatment is needed to keep the immune system from flaring.

Facial Scars, Acne Scars, Surgical Scars

2009-04-08T23:00:00.001-07:00

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.

Varicose Vein treatment using Ultrasound

2009-04-07T22:16:00.001-07:00

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.

Stretch Marks Any Suggestions?

2009-04-07T22:03:00.001-07:00

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.

Rosacea Treatment?

2009-04-06T20:37:00.001-07:00

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.