NOTICE: Ask Dr. Garcia is intended for educational and discussion purposes only. It does not constitute a formal medical evaluation nor consultation. No doctor-patient relationship has been formalized by this communication. If you desire such, please feel free to call and schedule an appointment. Otherwise, please be advised that all information that has been given here should be cleared with your primary care physician before changing or instituting any therapy. Explanation of off-label use of substances may be discussed here in but does not reflect an endorsement nor promotion of such off-label use.

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• Hi Dr. Garcia, I got a v-beam treatment a week ago for a relatively light pink/brownish spot under my eye. Though it was slightly swollen for a day there was no purple bruising, but for the last week it has been a much darker reddish/brown color to the point where it looks like I have a black eye. Is this likely to fade to its original color, or does this sound like a hemosiderin stain? Thanks

  Answer: 

• Hi Dr. Garcia, I`m 37 years old and am starting to see fine lines appearing on my forehead and around my eyes. More noticable wrinkles around my neck and decollete. I have very fair skin. What treatment would you recommend? I`ve been trying to do my own research and it`s been very confusing with all the different methods of treatment. Thank you for your time.

  Answer:  At this point sunblock not sunscreen, no cologne on your neck or upper chest, Retin-A to the areas, start at night only and progress to twice daily as tolerated. Possibly a little Botox to weaken the muscle of the forehead and around the eyes to slow but not stop the aging process and lessen the degree of muscle and therefore skin flexion. Avoid smoke if possible and maybe in the future some light fractional lasers might be worth it. All the best. JG 2.3.12

• Hi Dr. Garcia, I got a vbeam treatment earlier this week on the tip of my nose, and for the first few days after treatment, the pigment was the same color as beforehand. Then 4 days after the treatment, my nose became pink in the area where I got v-beam. Is this a common reaction to get delayed pinkness? And will the pinkness fade?

  Answer:  It is common, and yes, it will fade in time. All the best. JG 1.28.12

• Hey Doc, I had Fractional Erbium Laser at the end of August last year. I still have this tingling in my face that comes at random times. Around the temples (mostly left side) and sometimes forehead. Usually more towards the end of the day. Or sometimes when I drink beer or work out or get hot...but definitely not always. My dermatologist explained that this was collagen production, but I have my doubts. Since it`s been this long, should I have any reason to worry. Is this possible nerve damage. I`d appreciate any help you can provide. Thank you.

  Answer:  more likely is nerve covering irritation from the deeper pixels, should get better with time, not a very common problem, but I would not worry, might take a year to totally go away. JG 1.26.12

• Do you do versapulse laser treatments around the eyes?

  Answer:  Sorry, but I do not own a versapulse laser. JG 1.12.12

• Dr. Garcia, I have developed a very small mole or sun spot, just under my lower eye area that over the last year or so has now become quite visible. I know that this area can be quite fragile, what would you suggest to get rid of it or minimise as much as possible. I am from a Danish heritage if that helps. Thanks

  Answer:  Start with Retin-A, progress to a light chemical peel or a YAG laser series. JG 1.12.12

• I`ve had a blepharoplasty and canthoplasty but still have some bags under my eyes. My surgeon is suggesting CO2 resurfacing to tighten the skin. Do you think that will help? Thank you!

  Answer:  it depends on where the bags are, if they are herniated fat pockets or a festoon, I do not think the CO2 laser will help. If it is persistent fat pockets, it needs more surgery, and if it is a festoon, it will also likely need more surgery, but not through a blepharoplasty. Sorry. I wish you the best. JG 1.19.12

• I had dot laser for entire face six months ago. His setting were 1300--previouslyl I had a treatment of dot at 800 and had no problems. This time I had a lot of trouble healing. My upper lip area is very slightly different in color and texture--a tiny bit chalky looking. Is it risky to have the upper lip treated again even at a lower setting? Thanks a lot, as always.

  Answer:  I would wait 6-12 months to see what happens before considering another session, even at the lower settings. You need to make sure what has happened has healed before trying anything again. JG 1.10.12

• Dear Dr. Garcia, Again, thank you for taking this time to answer my questions. I am Asian with acne scars, and since you don`t believe laser resurfacing is a good option for Asians with acne scars, what do you think would be a good option? I personally don`t like the idea of fillers, and I can`t really think of any other methods that do not cause permanent hyperpigmentation.

  Answer:  well, the honest answer is that there is not much that will help, doing a skin only facelift was an option in the old days, the acne scars do look better with the tension on the skin, but over time, the skin relaxes and the textural differences come back. Along with that, you will have the scars from the cheek or facelift. JG 1.9.12

• Hello again Dr. Garcia, If you do not think laser resurfacing is a good option for acne scarring, what do you think is a suitable option, other than fillers? Especially for texture, because that is what I am concerned with most. I am less annoyed by the random pits as I am by the texture of my skin due to some of the more superficial scars.

  Answer:  well, I do think lasers are OK for acne scarring in pale skinned patients, but not in fair skinned Latinos, Asians or African Americans. JG 1.9.12

• Hey Dr. Garcia, Thank for answering my questions so quickly. Why are lasers only temporary? If the point is to make new collagen, why doesn`t this collagen last?

  Answer:  be cause the body`s aging process, environmental causes, personal habits such as smoking or sun exposure are constantly breaking down collagen. Usually the amount of collagen formed form laser, especially fractional lasers is minimal and it is quickly gone. JG 1.9.12

• Hello Dr. Garcia, First of all, thank you for taking the time to do answer these questions, they`re very enlightening. I am a 23-year-old Asian male with acne scarring on the cheeks as well as various PIH acne redness in various spots on my face. I do not know what particular skin type I am, however, I do get pink pretty easily (I have been pretty much a standard pink my entire life). I had a Lux 1540 to treat the acne scars back on November 30, 2011. So far, I`ve had some results, some of the scars have gotten softer, though I am suffering from some mild post-inflammatory hyperpigmentation (asking around, I appear to be the only one that notices the PIH at all). The PIH seems to be mostly making my skin redder than anything else, not really darker, but there is noticeable demarcation. The PIH occurred even though I had been using a zinc dioxide-based sunblock (SPF 30). I generally don`t wear the sunblock indoors, but I always have the curtains drawn shut when indoors + I always take care to put on sunblock even if I`m going to get the mail. I asked the doctor and the skincare specialist at the office about the PIH, and they both did not like the idea of using hydroquinones because it could irritate my skin and make it even redder. I had been taking Lux Vs (IPL) before my Lux 1540 to handle some active acne, and I took a PDT on December 28, using Metvixia as the topical treatment and a Lux V treatment as the activating light source. Both the Lux Vs and the PDT have has great results on my existing acne, and I have been happy with that process. I believe the PDT also helped with my PIH redness, though that may be a subjective observation. I am scheduled to take another Lux 1540 around January 21. My acne scars are mostly boxcar. Some of the scars looks almost like wrinkles or cuts. They are very soft, and aren`t visible at all under certain lights. In fact, they disappear completely if I stretch the skin taut. A few questions: 1. Do you think Lux 1540 is good for treating acne scarring (other than icepick scars)? 2. What can I do to help prevent more PIH from future Lux 1540s? What can I do to treat existing PIH? Is IPL an option for my PIH, considering that I actually responded pretty well to it? 3. I came upon this study a while ago: http://www.thefreelibrary.com/Evaluation+of+clinical+improvement+in+acne+scars+and+active+acne+in...-a0264928598 It seems to suggest that Lux 1540 is actually pretty good for treating and preventing acne outbreaks. Would you agree with that assessment? 4. I read earlier that you didn`t think laser treatments of any kind were permanent, that, in fact, many of them were temporary. Is that really true for acne scars? I`ve heard from various sources that laser treatments for acne scars are either permanent or only temporary. I`m really confused as to what this means. The most in-depth explanation I`ve heard about it is that collagen loss does occur eventually as you get older, but because laser treatments stimulate new collagen growth, the way the loss occurs will not make your scars come back, rather it would be an even loss of collagen across the entire face (and body). This assessment was from a random doctor online, not from my own doctor, though my own doctor later told me a similar assessment. But I am not sure if I can trust that. What is your opinion for the longevity of laser treatments for acne scars? Again, thank you for taking the time to answer my questions. P.S. I am surprised to hear from you that Lux 1540 is actually partially ablative, despite the fact that other lasers of similar wavelengths are not. In fact, this is the first time I have heard that Lux 1540 was ablative anywhere, and I`ve done a lot of extensive research on the topic.

  Answer:  hydroquinone will not help with the redness, that is a matter of time, I would not use too much topically as it could irritate things, if anything, you could use some copper peptide creams to assist in speeding the healing. I do not think any laser is good for ice pick acne scars and in Asian skin, I would be very apprehensive about using lasers for acne scarring to to the depth required to see an improvement and the attendant risk potential. As to avoiding PIH brown spots using hydroquinone before is an option, but besides using a lesser setting, there is not much to avoid the redness, it is normal healing from a laser. No laser will help prevent acne break outs as no laser can affect the causes, at most it might decrease the bacteria in the skin is about the most you can expect. I think any benefit with lasers for acne scarring will be even less long lasting than for wrinkles as the problem is much deeper. All the best. JG 1.8.12

• Dear Dr. Garcia, I see from your archives that you`re not a big supporter of fractionally ablative resurfacing, but since it`s the only ablative kind of laser that can be used off the face, what do you think of it for the hands? My PS offers it (both Fraxel RePair and Total FX) and claims to get good results. His before and after photos look good, though I know you think that the after photos should be taken a year or two out for the best indication of improvement. Even if the results are mostly temporary, might the treatment provide some kind of long-term benefit to the skin? That is, might my hands look better long term if I do it rather than forego it? I`m looking to tighten the skin a bit, and I don`t think that there`s much else that can be done for this problem besides fractional resurfacing. Is that right? If there`s something else available -- or something that soon will be -- what is it and what do you think of it? in the meantime, do you think that the Fraxel RePair is more powerful than or equal to the Total FX? I`m trying to choose between the two. If I want to optimize the tightening benefit of this treatment, is there a specific set of parameters I should ask the surgeon to use? Thank you for your help. Happy New Year!

  Answer:  I do not think either technique will create enough new collagen for a long standing degree of improvement to be established I am afraid. You can certainly try it as there is really nothing else out that that works, but if you get anything, it will be some brown spot reduction but no thickening of the skin. I think both of those technologies have little differences between them, so either one is OK to try. I would not dare give parameters though for something I would not perform myself. all the best. JG 1.8.12

• Hello Dr Garcia although 47 !!! i still have active acnee..they want to lazer co2 resurface my face and injec fat(from lipo to my thighs) in my cheeks and noselabial under general anestesia..oh and lipolift in my jowls.i m worried i will look weird for more than two weeks i m also concerned about getting my face looking like a pancake...i temporarily canceled it..i sugested to put radiesse first to see if i like it!!!

  Answer:  Good thinking, that they ate proposing could leave you puffy for 4-6 weeks. JG 1.7.12

• My plastic surgeon is recommending CO2 resurfacing under my eyes and at the lid-cheek junction. I know that there will be a long recovery and months of redness, and I`m not too thrilled about that but am willing to do it for the long-term improvement. I`m concerned though that the surrounding skin will never match the color of the resurfaced skin once the wounds heal. Is that common? I`m afraid of looking like a raccoon. Has this ever happened to your own patients when you do a partial face resurfacing? (My surgeon doesn`t want to resurface my whole face because he thinks I don`t need it, and I agree with him.) I am British and extremely fair--almost translucent I`m so white. Thank you very much for your kind help, Dr. Garcia. I hope the people in your life are as unfailingly generous to you as you obviously are to others.

  Answer:  Thank you for the kind words. As to the segmental laser, as long as you have fair skin, it should be safe and there should be equal skin tone once healed. Happy New Year. JG 12.29.11

• Hi Dr. Garcia, I received vbeam treatment a couple months ago, and in the past week, some darker red/brown spots which had been eradicated by previous vbeam treatments came back. Is this delayed hyperpigmentation part of the healing process? And should the darker spots eventually fade? Thanks!

  Answer:  this far out it is just a recurrence of the prior spots, nothing will remove them permanently, in time, with sun exposure and florescent light exposure they will come back. You will not see any further fading of the spots from the prior VBeam this far out. JG 12.27.11

• I had CO2 resurfacing around ten years ago with (after prolonged healing) very good results except the Dr. went all the way down my neck. He said that he would feather it and there would be no line of demarcation. Well there is a line that is mask-like. Is there any way to diminish that line?

  Answer:  Maybe a series if chemical peels to remove more layers. JG 12.26.11

• Dr Garcia, I have red veins in the white parts of my eyes that have developed after belpharitis...I think they are conjunctival and not scleral. However I have seen a laser opthamologist who has said that YAG laser will be able to remove the veins. Is this safe? And is more than 1 session usually required? It`s really depressing me and I`m desperate for treatment. Thank you so much for your time.

  Answer:  I think it is safe to have done in experienced hands.More than one session is not uncommon.Best of luck! JG 12.24.11

• Hi Dr. Garcia, I got a v-beam treatment about 6 weeks ago, with a week of subsequent bruising. I still have some light brown PIH where I bruised. It`s nothing too terrible, but I was wondering if this will continue fading and eventually return to the color of the surrounding skin. Thanks.

  Answer:  yes, using a little Retin-A and some hydroquinone, along with avoiding the sun by using sunblock will help it along. All the best. JG 12.21.11

• Hi Dr, I was wondering what you think the best lazer is best to remove wrinkles and some light discoloration on the hands and neck and chest area, I dont mind the downtime, just want to do it once and get it over with. Thanks

  Answer:  well, lasers cannot be done very strongly on the off face area, a fractional laser might be safer, but in time, with sun exposure, all of the spots/wrinkles will come back, there is nothing that will remove them forever, sorry. JG 12.21.11

• My plastic surgeon is trying to stall on doing a CO2 resurfacing around my eyes, which we both agree I need. I`ve done 3 fractionally ablative treatments in the past two years (with dermatologists, not at his office) with very, very minimal results. He doesn`t own any fractionally ablative lasers because he doesn`t think they`re effective. Instead, he had me use Cutera`s Pearl handpiece (which isn`t even as powerful as fractionally ablative treatments), using three passes. Nothing. I didn`t even turn pink, and I lost another $1,000. How can I convince him that it`s time for the CO2? I don`t think he should charge me for it either, since I`ve wasted yet more money at his practice at his insistence. Does that seem fair to you? I`m 53 years old, by the way, so I don`t know why he thinks we need to wait to do this. Thank you for your opinion, Dr. Garcia.

  Answer:  It will be tough to get him to do something he does not want to do. You might have to see someone else. JG 12.20.11

• I am a olive complected Indian female. I have done well with V-beam and IPL on face. I want to have hair removal done on my legs. The aesthetician wants to use the Alexandrite; will that pose any major risks? Should I take any precautions? Also, what do you think of the e-matrix for the face?

  Answer:  I would mot use either one due to the natural color of your skin, for fear of hyperpigmentation. Sorry. JG 12.21.11

• An ophthalmologist foolishly inject a huge dose of kenalog under my eyes six years ago to reduce the scar tissue from a bad bleph. As you could predict, it eroded my midface, thinned the skin (leaving me with sagging empty circles of skin beneath my eyes) and left me with permanent erythema, which has caused me to need regular VBeam treatments just to keep the skin light red rather than dark red. I`ve had cheek implants inserted which, though I hate them, have at least held up my mid-face a bit. My new plastic surgeon is now suggesting CO2 resurfacing to produce new skin which will at least be tighter/less saggy under the eyes. He also thinks that it may make the skin there a bit thicker when it heals. Of course, the CO2 will produce its own erythema for quite a long time, but he believes that the chronic capillary damage caused by the kenalog may be eliminated. What do you think of this strategy? Will it help bit? If not, will it at least not make my current situation worse? (I realize I will look a LOT worse for quite a while before I look better. I mean, will it cause further damage to this already compromised area of my face?) It`s amazing how much damage was caused by that one injection all those years ago. It totally disfigured--and utterly devastated--me. I`m willing to try anything to make it better, but I don`t want my desperation to drive me to an unwise choice. Thank you so much for your honest and uncommonly generous help, Dr. Garcia.

  Answer:  I think it will help, for maybe a few years, and then can be repeated and I think in experienced hands, should be safe. JG 12.18.11

• Hello Dr. Garcia, I just got a single spot v-beamed yesterday. It was a blemish that had healed about a week ago, but there was still a red spot that hadn`t yet faded. Anyway, today the red spot is even redder/pinker than it was before the vbeam procedure. I`m not very familiar with v-beam. Is it common for red spots to get redder/pinker the first day or so after v-beam before eventually lightening? Thank you in advance for your response.

  Answer:  it is common for them to get worse first, yes. It will get better over time, slowly. Best of luck.

• Thank you for your answer about the CO2 resurfacing. Very informative and helpful. I just want to be sure that I understand one of the points you made. You say that pigment cells don`t migrate upward, but my dermatologist has led me to believe that the sun damage below the skin will eventually rise to the top and become visible. I`m asking this because I have very little visible pigment now due to my vigilance and regular IPLs and fractional resurfacings. I`m scheduling the fully ablative CO2 prophylactically, to head off the appearance of the damage my dermatologist is predicting I will soon see; but your answer below leads me to think that it might be an expensive, painful and unnecessary waste of time and money if I don`t see the pigment now. Can you clarify that for me? Thanks so much, Dr. Garcia!

  Answer:  I think prophylactically doing the laser is not wise, can cause post-inflammatory hyperpigmentation(read new worse spots)and is not needed, will not get you much better from what you are describing, and will only put money in the doc`s pocket. If you have little visible pigment, now is NOT the time. JG 11.30.11

• Hi, Dr. Garcia. I`m scheduling a fully ablative (not fractional) CO2 resurfacing next month. If I understand this procedure correctly, it removes the entire epidermis. Is that so? If yes, I`m assuming that the pigment from previous solar damage will be eliminated, since pigment only forms in the epidermis. Is that correct? I`ve been using full spectrum sunblock 365 days/year for over 2 decades now, but it wasn`t available in the first 25 years of my life. I had a UV photo taken ealrier this year, and what it revealed was horrifying. If I don`t do the CO2, I`m assuming that all the pigment I see in the UV photo will eventually rise to the surface of the epidermis. Is that correct? And having the procedure will eliminate all that damage? Since I have almost no sun or flourescent exposure now, I`m hoping that once that pigment is gone, it won`t come back. Thank you very much for your guidance!

  Answer:  yes, it does remove the epidermis, and the upper part of the dermis, depending on how strong the settings are. The pigment from prior sun is in the epidermis and the dermis, so not all for it will be gone I am afraid. Pigment cells will not migrate upwards, and the other thing is that fluorescent lights also can have effects on pigment. There will be significant improvements but likely not total removal of pigement issues. Sorry and all the best. JG 11.30.11

• Hi Dr. Garcia, Thankyou for helping all of us with our questions I had 1 IPL treatment on my face, 2 weeks ago to remove sun damaged age spots. Just with one treatment, it appears that my age spots got darker and none faded. Is it possible for the IPL laser could make age spots darker?? I am hesitant to have any more IPL treatments. What do you recommend I do?

  Answer:  Getting darker is common before it fades, you will need a series of sessions and in time it will come back. JG 11.8.11

• Hello Dr Thanks for your prompt response to my quest. I am the 70 yr old female that wrote-in on 11/3. I would appreciate an opinion on what you would suggest for the various problems I indicated. Thank you so much for your time. It is very appreciated

  Answer:  if you could send me some pictures to drgarcia@lvcosmeticsurgery.com and your concerns in terms of priority, I would be happy to respond to you directly. JG 11.4.11

• Hello Dr. Garcia. Thank you for this forum. I am a very young-looking 70 yr old - really. I had an excellent natural looking face lift when I was 60. No one knew as always had good features so just looked better for some reason. I`ve taken excellent care of my skin since the age of 12 and it shows. I have had radiesse around the nasel labial folds a few years ago and it lasted about 2 years. I am now noticeing puffiness under the eyes, the upper eyelid needing more elasticity. I also have sagging thighs now. My decollete has sun damage. (this is the one spot I was not educated about in my youth but I am now constantly reminding my granddaughters about it) My Dr. has suggested Fraxil Repair for the eyes and chest and radiesse for the nasil labial area. He has suggested Thermage for the thighs. He Fraxil he said would have social down time of about a week. He intends to do the work on the face only once. I`m concerned about what does this do exactly to my face. I wish I could see pictures during recuperation. He said this is somewhat painful but he will make me comfortable; the same for the Thermage. What do you think? I really appreciate your feedback

  Answer:  I think the Fraxel will help the eyelids for a while, but it will be short lived, a few months. I think Thermage for your thighs will be a disappointment, but Radiesse for the nasolabial fold is a reasonable option. JG 11.3.11

• dear doctor garcia, whats your opinion about the co2 smartdot laser?any good for pore tightening and dark marks on skin pigmentation etc.. iam hesitant about waisting my money any advice? secondly ive heard about intradermal botox injections to reduce pores and oil reducton on the face is that any good?

  Answer:  might help the dark spots but they will return in time, and will do nothing for the pores, actually might make them look worse if there is any significant skin tightening. Botox can slow oil production, but it is impossible to get it to stay in the skin, so the underlying muscles could get affected, not always a good thing. JG 10.13.11

• I know you`re not a supporter of fractional resurfacing. I just want to know if Cutera`s Pearl Fractional is as powerful as Fraxel`s RePair or Lumenis`s Total FX. I ask because my plastic surgeon allows his nurse to do the Pearl Fractional, but in other area practices, the plastic surgeons are the ones who do the Fraxel or Lumenis fractional resurfacing. I`m guessing it`s because Cutera`s is much less powerful. Is is, like the others, fractionally ablative or is it entirely non-ablative (like Fraxel`s ReStore)? Thank you!

  Answer:  The Pearl is less strong but still fractional, not totally ablative. JG 10.13.11

• I`ve had both Reliant`s Fraxel RePair and Lumenis`s Total FX, both times aggressively. Instead of the predicted 7-12 days of recovery, I had 5-6 weeks of redness followed by about 4-5 weeks of pinkness. (I`m so fair I`m almost transluscent.) Since neither of those fractional resurfacings made much of a difference, my PS is now recommending the old school fully ablative CO2. He thinks I`m likely to have the same length of recovery with this treatment as I had with the others based on my skin type and recovery history and based on the fact that 12-16 weeks is about the length of time it usually takes people to recover from the full CO2. But I`m wondering if it may actually take longer for me to recover from this than that standard length of time because it took me longer than the usual amount of time to heal from the fractional CO2. He says that my previous recoveries are a good predictor of what to expect this time around, but I`m not so sure. What do you think? Thanks so much!

  Answer:  I think it will take longer as a larger surface area will be treated and there will be more thermal injury caused, which is good in the long term but adds to the healing time. JG 10.9.11

• Just a follow up on the Q-switched Yag vs. CO2 resurfacing. You said the Yag is safer. which I know it is. But I`m 54 and in addition to wanting to get rid of pigment, I also have a fair amount of wrinkles and textural damage I`d like to improve. Would you still recommend the Yag over the CO2?? I thought that the totally ablative CO2 was the gold standard. Thanks for your help.

  Answer:  no, I was suggesting the YAG if the only was only pigmemt, the YAG will not give much wrinkle reduction, for the both issues combined, then it is a CO2 laser. All the best. JG 9.26.11

• I am having a hard time finding doctors who perform CO2 laser resurfacing around the eye area. I am not looking for the Total FX laser. I am looking for the original CO2 laser. Do you know if there is a website or company that would have a list of participating CO2 laser doctors?

  Answer:  I would suggest Laments.com. You would want a doctor that has an ultra pulse and then they have to set it with a high density pattern. JG 9.25.11

• Dear Dr. Garcia, I am on my tenth day post dot laser. I had this done a year and 7 months ago with no problems. My skin felt very smooth and clar after the sixth day. This time he was more aggressive because the burning was intense when he did it and an hour following. I peeled on the fourth day like he said I would but this time the lingering pinkness is not going away. It itches and is prickly and there is a slight roughness to the cheeks. I have an appointment to see him tomorrow as he thinks this sounds like an infection. If it is an infection, can my skin heal from this? The upper lip area where he got even more aggressive is fine as is the forehead. It is just reddish and splotchy on the cheek area and sides of face. I am so worried that this might be permanent, and I don`t think he will tell me the truth. Thanks as always.

  Answer:  rare for an infection to encompass the whole face, more likely is that they used a stronger setting and the treatment went deeper, in that case longer redness is expected and will fade as time passes. If it is an infection, the skin should heal well in time though. JG 9.20.11

• In late July I had fractional CO2 to get rid of a few wrinkles and dyschromia. The only thing I got rid of was a LOT of money. What a waste of cash! So now I`m looking into the full-ride, which scares me but seems to be the only way to go if I want real improvement. How many months do I need to wait until I can safely do it? Thank you for your help and time.

  Answer:  Sorry to hear about that, I would give it 3-6 months. All the best. JG 9.14.11

• I`m scheduling a CO2 resurfacing (not fractional), and I need the hard truth about how long I`ll need to be out of work. My surgeon is saying 2 weeks because I can use mineral make-up at that point, but I`ve seen some of his patients at two weeks and let me just say, YIKES! Even with make-up, I can`t imagine I`d be anywhere near presentable at 2 weeks. In your experience, what can I REALLY expect? And when do your patients usually see the red turn to pin? And then how long, typically, before the pink turns to white? (By the way, I`m almost translucent I`m so white! 54, non-smoker, sun-phobic/full-spectrum sun-block-wearing-365-days-per-year female who has a LOT of solar damage from the first 25 years of her life when sunblock didn`t even exist and when we all thought the sun was good for us). Thank you, Dr. Garcia.

  Answer:  closer to three weeks, and then , the make up will need to be reapplied or touched up every 4 hours or so. Red to pink depends on how deep you go, but it happens at 4-6 weeks. As to the pink fading to normal, it is 3-5 months. JG 9.11.11

• Hi, Dr. Garcia. Sorry to send the same question twice, but I don`t think you saw it in the list you`ve recently answered Does fully ablative CO2 resurfacing improve pore size as well as wrinkles? Thank you!

  Answer:  no effect on the pores. JG 9.10.11

• Does fully ablative CO2 resurfacing improve pore size as well as wrinkles? Thank you for your time and expertise.

  Answer:  no, it will not, and anything you do to try to minimize pore size is very temporary. JG 9.10.11

• Thank you for your informative answer about the CO2 resurfacing. You`ve convinced me! I`m electing that option. Thank you so much for your help. One thing about your answer confused me. When I asked if I should request a more aggressive treatment, I meant a more aggressive setting of the ablative CO2 rather than a lighter setting of it, even though the surgeon thinks I need just a light treatment. You say both that there is no need to treat deeply if it doesn`t appear that I need it AND that you would bite the bullet and go for the more aggressive treatment. Which should I request? I don`t mind a few extra weeks of redness if it`s going to pay off in a better, longer-lasting result; but if it doesn`t make scientific sense (that is, if I won`t get a better, longer-lasting result from a more aggressive setting because that`s just not how laser resurfacing works), then I obviously shouldn`t request it. Sorry for the extra question! I was just confused by your answer. Good night, Dr. Garcia. (Do you EVER sleep, by the way?! It seems you don`t!)

  Answer:  I think it best to get what you need now, it can always be repeated a few years down the road, no sense in going deeper than you need as degree of tightening is not needed at present. Get what you need now, the future will come and we might have better things when you need the next one. As to sleep, yes, I love it, great time to dream! JG 9.5.11

• Hello, Dr. Garcia. I`ve been on two consultations with two different plastic surgeons about laser resurfacing. I see from reading this blog that you favor fully ablative CO2, and I`m leaning in that direction myself. One of the surgeons I saw says he only does fractional resurfacings now not only because of the reduced risks and shorter recovery time but also because he finds he can achieve better skin tightening for his patients because the fractional technology, while only partially ablative, goes deeper than the traditional CO2 and therefore is able to stimulate more collagen growth. It sounds like if I chose that option, I`d be trading less surface improvement to my skin for greater tightening, and if I chose the tradition CO2, I`d be getting greater surface improvement but less tightening. Is that right? Also the surgeon who does the traditional CO2 said that the length of recovery time depends on the strength of the treatment. He says I`d fall into the category of patients he would treats more lightly than others. (I`m 50, extremely fair with blue eyes, have moderate fine lines, some textural changes on my cheeks and only very light scatterings of pigment.) Does his assessment of me sound right to you? If so, when you treat patients more lightly than others, how much shorter is their recovery time? Should I just bite the bullet, opt for the longer recovery, and ask him to be more aggressive now to achieve a greater and longer-lasting improvement, or does it not work that way; that is, is the strength of the treatment determined only by the current, visible damage on each individual patient or can it be made stronger to be preventive and longer lasting despite the level of current, visible damage ? So sorry for all these questions, but you can see I need some guidance! Thank you very much for your assistance. Good heavens, I hope YOU have some people who are as helpful to you as you are to all of your readers, Dr. Garcia. You are lovely.

  Answer:  I disagree with the fractional going deeper and therefore causing more tightening, a fully ablative laser can go as deep as desired, leaves no skip areas and it is the total surface of dermis injured which affects the amount of tightening, so when you injure less, you get less tightening. I think the shorter healing is a few weeks, but no need to go deeper unless it is needed. I personally would bite the bullet. All the best and thanks for the kind words. JG 9.5.11

• Dear Dr. Garcia, I have several pinpoint burn scars (about 1,5 mm deep x 1.5 mm wide) on my cheeks from IPL years ago. I`ve tried fractional resurfacing to address them and for overall textural improvement but haven`t been impressed. I`m looking into fully ablative CO2 resurfacing now. In your experience, should that take care of those small scars once and for all? Thank you.

  Answer:  difficult to say, the depth is the issue, they are like acne scars and unless you go to the same depth as the scar, the laser will not help. It might be better in the long run to have them cut out and closed with a stitch. All the best. JG 9.4.11

• Thank you for the suggestion about the ultrasound for the periorbital edema. My surgeon recently purchased Ulthera, which of course is an ultrasound technology. Do you think that might help?

  Answer:  Certainly worth a try. JG 8.28.11

• I had Fraxel Repair in July and healed well, but I have been left with an immense amount of swelling under both eyes. The fluid extends from my lower lashes to the lid-cheek junction and is raised about a half centimeter above the rest of my cheeks. It looks like two plastic bags of water -- well, bags of water is exactly what this is -- were installed under my eyes. My PS says he`s never seen this reaction before. Of course, I`m sleeping sitting up, avoiding sodium, icing, etc., but it`s not going down. I`ve also tried gentle massage to see if I could stimulate lymphatic drainage, but it`s not helping. My surgeon suggested when I last saw him that the treatment may have tightened the skin enough to create an inflammatory reaction that could trap fluid beneath it permanently, which is a scary possibility. What do you think? Any suggestions? Thank you for your help, Dr. Garcia.

  Answer:  I do not think it will be permanent, might consider topical ultrasound to the area, the machine they use physical therapy, can be don`t 3 times per week. Best of luck. JG 8.27.11

• 4 weeks post fractional CO2 (Lumenis Total FX), still have some erythema. Is it safe yet to do laser Genesis to take down some of the redness? Thank you!

  Answer:  I would wait another 2 weeks. JG 8.27.11

• Behold! A miracle! I have found a plastic surgeon who actually still performs the fully ablative C02! NO ONE is doing this anymore. I`ve done the fractional thing and have had only, predictably, fractional results. He has warned me, of course, of the risks of scarring, hypopigmentation and hyperpigmentation. I`m writing to ask you just how common these complications turn out to be in your experience, since you seem to perform many of these procedures. Is it possible to modulate those risks by modulating the settings? I have Type I skin (Irish descent), am 54 and have mild-moderate wrinkles and textural irregularities on my cheeks and forehead. Thank you for your kind help, Dr. Garcia.

  Answer:  In experienced hands and in patients with type I skin, those problems are rare. Best of luck. JG 8.24.11

• I have the same problem as the other person who just wrote about acne after laser resurfacing, though my case seems milder. I`m 12 days post procedure and am remembering an old home-remedy from the `70`s that I used as a teenager: crushing aspirin and making a paste with a drop of water to smear over the lesions. The principle, of course, is that aspirin is an anti-inflammatory. Is this helpful, harmful or just useless in your opinion? Thanks so much for helping out us middle-aged lasered acne sufferers! I guess we wanted to look younger, and boy, we are, aren`t we? Hope you`re having a great weekend, Dr. Garcia.

  Answer:  It will work, it creates salicylic acid, same as what they use in MediSpas. Best of luck. JG 8.20.11

• Thank you, Dr. Garcia, for your reply about acne post laser resurfacing. You say that my pores will need to be opened and drained. I`m sorry to ask such a basic question but what would that involve and where would I have that done? I can`t imagine that my plastic surgeon would spend what I assume would be an immense amount of time hovering over my thousands and thousands of clogged pores! And would opening the pores mean cutting the epidermis?! Wouldn`t that leave scars? And how are they drained ? Are they aspirated with a needle? Vacuumed? Sorry to seem so stupid, but I was under the impression that acne should not be physically tampered with due to inevitable scarring. Thank you for your incredibly generous service to folks like me, Dr. Garcia. You are obviously a great human being.

  Answer:  an aesthetician at a MediSpa can do it with microdermabrasion or a small lancet to open and express the material. It is actually part of many facials and is not to much money.The epidermis is not cut, just the keratin waxy layer plug that is covering the pores themselves. They are vacuumed or pushed clear. All the best and thanks for the kind words. JG 8.20.11

• I can`t imagine how you can stand all of us with our endless questions! You must have many days when you regret opening this site. So I had a fractional resurfacing two weeks ago and now have a raging case of cystic acne all over my face. Where I don`t have a huge, imbedded lesion, it seems almost every other pore is clogged with a blackhead. My face is a complete mess. I`m sure it`s mostly due to the copper peptide compound I was given; I haven`t had acne in 25 years. Now what? It isn`t showing signs of abating. I went on Keflex for five days last week and that didn`t help. EpiDuo isn`t doing a thing either. Any suggestions? Thank you for any help you can offer. It`s really frustrating to have spent all that money for what I knew would be a modest improvement at best to my wrinkles and skin texture only to find myself with a face that resembles a relief map of the Appalachians...or like a scrim of an adolescent`s tortured skin on the face of a 50 year old woman. Unbelievable.

  Answer:  You need to get the pores opened and drained. Once healed enough, microdermabrasion other IPL should help. Can also use Retina A if healed enough. Sorry to hear about all of it. All the best. JG 8.18.11

• I see from your answers to many questions that you don`t think fractional ablative resurfacing is particularly effective, but I`m wondering if you think it`s potentially harmful to the skin. I`ve had it done twice in the past four years and the skin on my forehead and cheeks has developed a mildly corrugated effect, which wasn`t there before. Of course, I`ve gone from 47 to 51 in the intervening years; the textural changes may be mostly due to aging -- and perhaps I would have looked worse if I hadn`t had the fractional resurfacing done -- but I`m wondering if you think that the resurfacing may be the primary culprit here. Would a fully ablative CO2 resurfacing take care of this problem in your opinion. Thanks.

  Answer:  it would be only harmful if the patient reacts with post-inflammatory hyperpigmentation, otherwise what can happen when trying to use too much energy or too many passes to try to get a more dramatic result, that can lead to dilated pores and in some cases, the cobblestone skin you seem to have. A fully ablative resurfacing should correct that, but not any dilated pores. All the best. JG 7.31.11

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