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Successful treatment of acne scars usually involves using several different techniques, layered on top of one another. For instance, deep acne scars may require subcision (to raise the deepest part of the scar), filler (to further plump up the scar and return it to normal skin level), and light resurfacing, to smooth out any skin texture irregularities around the acne scar. By using a combination treatment approach, I have been able to achieve results impossible to attain by using any one method alone.
For the final light resurfacing step, I have been particularly impressed by the results of the Fraxel/Mixto laser systems.  I have been using these lasers in my office since it came on the market, and I find it to be an indispensable tool for management of acne scars and other scars.
After one treatment with a combination Fraxel/Mixto laser systems, the texture of the skin is remarkably improved, and the acne scars are substantially diminished in appearance.  

Labels: Artesense, Evolence, Laser Peel, Laser Resurfacing, Lasers

Whitish bumps after any resurfacing laser treatment can be several things. The most common are milia. These are retention cysts after injury to the skin and will generally resolve on their own without any scarring other other problems.

Rarely and more seriously whitish bumps can also represent either fungal infection or bacterial infection. In these cases, medical treatment is necessary as scarring can occur. It is best to have the physician who performed your treatment examine your face as soon as possible to determine the best course of treatment, if any. If they are milia, there is no way to avoid getting them, but they tend not to be a long term problem.

Labels: Fraxel, Laser Peel, Laser Resurfacing

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.

Labels: Dermatoses Papulosa Nigra, Laser Peel, Laser Resurfacing, Lasers

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.

Labels: Laser Resurfacing, Lasers, Seborrheic Keratoses

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!

Labels: Laser Resurfacing, Lasers, Skin Tags

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.

Labels: Laser Resurfacing, Lasers, Pores

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

Labels: Laser Resurfacing, Lasers, Skin Tightening, Soft lift

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

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

How is Laser Resurfacing Performed?

Laser skin resurfacing uses a carbon dioxide (CO2) laser to remove skin layers by vaporization rather than with chemicals or a sanding device. Dr Shah is able to specify the amount of energy transmitted to the skin's surface by the laser beam and control the depth of penetration.

What kind of conditions can Laser Resurfacing treat?

Any of the following conditions may indicate that you might be a good candidate for Laser Resurfacing.

• wrinkled or sun-damaged facial skin
• vertical wrinkles around your mouth, such as those that cause lipstick "bleed"
• "crow's feet" lines around your eyes and perhaps some skin laxity in your lower eyelid area
• fine wrinkling of your upper eyelids
• brown spots or blotchy skin coloring
• certain precancerous skin growths
• acne or chicken pox scars
• superficial facial scars from a past injury

Like the other resurfacing methods, the laser is effective in treating wrinkles, blotchiness or age spots, and scars from acne or other causes. It can be used on the entire face or specific areas. Certain other characteristics of your skin, such as its thickness and texture, may influence whether you are a good candidate for laser resurfacing. Some patients may benefit from the laser's mild "tightening" effect on the skin, particularly in the lower eyelid area where the skin often becomes somewhat loose as a result of aging.

Doctor Consultation: what to ask about laser skin resurfacing

In addition to History and a Physical Examination, the following will be performed.

Skin Evaluation: You should be carefully examined to determine which resurfacing technique, or combination of treatments, will provide you with the best results. Your skin type, the severity of any sun damage, the extent of uneven pigmentation and the depth of skin imperfections will be evaluated. Fine lines, coarse wrinkling or deep acne scarring each may require a different approach to treatment.

Medical History: You should come to the consultation prepared to discuss your medical history. This will include information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries, and medications that you currently take. Be sure to tell your plastic surgeon if you have ever had x-ray treatments of your facial skin such as those used in the treatment of acne or if you have had a prior chemical peeling procedure. Current or past use of AccutaneT, as well as Retin-AT and other topical skin preparations, must be reported to us. For your safety, it is important that you provide complete information.

Getting ready for Laser Resurfacing

We may may place you on a pretreatment program during which you will apply special creams, lotions or gels to your skin for a few weeks or longer. You may also be given certain oral medications that you should begin taking prior to your treatment. We will provide you with additional instructions.

You should arrange for someone to drive you home after the procedure and probably assist you for a day or two.

During Laser Resurfacing

Medications will be administered for your comfort prior to the treatment. Frequently, local anesthesia alone or combined with oral analgesics is used for patients undergoing skin resurfacing procedures.

After Laser Resurfacing

When the treatment is completed, your resurfaced skin may be covered with petroleum jelly or other protective ointment. In some cases, dressings, tape or a bandage may be applied.

Recovery from Laser Resurfacing

It is important to realize that the amount of time it takes for recovery varies greatly among individuals. We will probably see you on multiple occasions in the first two weeks.

First few days: Laser skin resurfacing will produce redness and swelling to varying degrees. Depending on the post treatment regimen selected by your plastic surgeon, a scab may or may not form over the treated area. You will be advised about cleansing your skin, as well as if and when you should apply any ointments. In the case of men who have undergone resurfacing procedures, shaving must be delayed for a while. It is essential that you follow our instructions and avoid doing anything that might interrupt the healing process.

Within 7 to 10 days: New skin will have begun to form. After the initial redness subsides, your skin may be pink for several weeks to months. Camouflage makeup usually can be used within a couple of weeks, but we will advise you.

Depending on the type and depth of your skin resurfacing, straining, bending and lifting should be avoided during the early period following your procedure. For deeper resurfacing, you should be able to return to work within a week or two.

Results: what to expect from Laser Resurfacing

Because of the persistence of skin pinkness following many types of resurfacing procedures, it may take months before you can fully appreciate your new look. Most patients feel that the results are definitely worth waiting for and, in the case of deeper treatments, the benefits are relatively long-lasting. More superficial resurfacing treatments may need to be repeated periodically in order to maintain their benefits.

Your skin will, of course, continue to age. Also the type of wrinkles caused by movement of your facial muscles will eventually reappear. Some wrinkles may recur sooner than others, depending on their location as well as the type and extent of your resurfacing treatment. Despite this, you can expect that improvements in skin quality and texture achieved by resurfacing will make your complexion appear younger and fresher for many years to come..

Laser Resurfacing side effects

The subject of risks and potential complications of laser resurfacing is best discussed on a personal basis.

Potential risks include:

• infection
• abnormal healing
• allergic reactions
• if prone to herpes, possible eruption
• raised or thickened scarring
• unanticipated skin color changes or skin blotchiness

Following all resurfacing treatments, it is important that you avoid direct or indirect exposure to the sun until all the redness or pinkness of your skin has subsided. Even after that, it is advisable for you to protect your skin by regular use of a sunblock and, whenever possible, a wide-brimmed hat. If the area around your eyes has been treated, you should wear good quality sunglasses when outdoors. After some types of skin resurfacing treatments, you may need to be careful about exposing your skin to chlorinated water.

You can minimize certain risks and help to maintain the results of your skin resurfacing treatment by following the instructions given to you.

Laser Resurfacing cost

Laser Resurfacing cost can vary widely due to the nature of the laser used and the area being treated.

Labels: C02, Laser Resurfacing

Is there a difference between the UltraPulse CO2 laser /Fraxel repair /Pixel /Mixto/DOT lasers? I'm confused by all the different names and think the doctor will try to sell me on whatever machine he has- without it necessarily being the best for me. How can I know I'm doing the best treatment?

There are a lot of laser devices out these days and you do have to do your homework to keep things straight. There are basically 3 categories of lasers: 1) Fully ablative that includes CO2 and Erbium lasers, 2) Fractional Ablative lasers that include Mixto, Fraxel Repair, Lumenis Total Fx (these are both fractionated CO2), Pixel, DoT and others, 3) Fractionated non-ablative lasers such as Affirm, or Fraxel Restore

The main difference between these categories is the amount of downtime that goes along with them. The Fully ablative lasers require 1 treatment and will require 2-3 weeks to heal and possibly some redness beyond this time frame. The fractionated ablative CO2 lasers usually only take 1 treatment and reduce the healing time to about 1 week. The nonablative fractional lasers require 4-5 treatments but only have 1-2 days of redness for healing.

The other main consideration is results and what the treatment is for. A basic rule is that the more aggressive the laser, the better the results and the more the downtime. All lasers are indicated for wrinkles, acne scars, pigmentation, and sun damage. For wrinkles, more aggressive treatments are better.

This is some basic information to help you along. The other questions you should ask are what are my options. If the practice only offers one laser and one laser for everything then you should be wary. If options are presented to you with variable results and healing times then it is reasonable. Any serious laser practice will offer options or combination treatments. For example, our practice has multiple lasers for various applications so that we can offer options to patients depending upon their needs and lifestyle (healing time tolerance).

In terms of the CO2 laser, it is not the machine that is important, it is the kind of experience that your doctor has in dealing with the machine. CO2 machines are powerful and they do give wonderful results. But your physician has to have experience in the use of the particular machine.

Labels: C02, Fraxel, Laser Resurfacing