Ask Dr. Garcia - The Archives

• Hello Dr. Garcia, I consulted with a PS, who has all the proper credentials. I had a L/B many years ago so now all I have are some fine lines around the eyes. he suggested a 35% TCA peel for a quick fix. Would you not use hydroquoine or retin a prior to the peel? I don`t want pigmentation issues? Nothing was said about it--what do you think?

  Answer:  I personally use those products everytime I plan on any laser or chemical peel, yes. JG 2.8.10

• Your opinion of CO2 lite lasers done over 3 sessions Thanks!

  Answer:  not as good as one deep one. JG 2.8.10

• Hi Doctor.. I`ve used the search for question having been preciously asked, but no results, though i`m sure someone must have asked this by now, sorry if repeating a question. Outside of surgery and CO2 with its down time, is there any laser and cream that can firm and even mildy tighten the facial skin. I`ve been using Retin A (I`m a 46 year y/o guy with minimal sun damage)and find that smoothes but not tightens the skin. My friend had 4 Harmony Pixels with noticable success and i`ve read that Estriol Cream brings moisture and collagen building efforts to the face as well. Can you dispell any of these and what further treatments (creams and lasers, excluding peels) do you recommend? Thanks very much!!

  Answer:  I think once the swelling from the Harmony goes away, so does the skin tightening, but you are free to try it. I do not suggest Estriol as moisture will not tighten skin and is only of benefit in women who have low estrogen levels. I think with the limitations you have placed, you are doing what I would suggest, the Retin-A, sorry. JG 2.8.10

• so if you were me which treatment choice would you choose? the yag laser on the entire face? micropigmentation (permanent makeup) to fill in the color in that spot to best match the surrounding skin? IPL on the whole face? or excimer/relume laser? because I have to do something, ive been waiting for a few years now and the redness/color hasnt returned

  Answer:  The YAG laser for he entire face except the pale spots. JG 2.8.10

• what is the exact name of this yag laser peel/ are you referring to a regular 1064 yag laser? do you perform this procedure in your office? and do you feel the spot size of this laser is sufficient to cover the entire face without undertreating certain areas or missing certain areas? I just want to make sure I dont make my skin worse with more procedures. is there any way to just make the rednessblood vessels grow back into that lighter spot, would repeated sun exposure of relume laser induce blood vessel regrowth/ flushing to come back?

  Answer:  for red we use the 532, it is a Q-switched YAG so it has both frequencies. We have one in our office, yes. There is no spot that will cover the entire face, there has to be a overlap pattern at all times when using lasers, that is up to the person performing the treatmetn and their experience, missed spots can always happen to all people. There is not way to just incite the blood vessels and them alone to regenrate, sorry. I think th eeffects of ReLuem are short-lived in my opinion. JG 2.7.10

• what is a yag laser peel, and how will it help to reduce the blood vessels. redness in the surrounding skin? is it like the vbeam laser or is it an actual peel like an acid peel? does it have any complications?

  Answer:  it is a laser that is performed to reduce redness and attempt to stimulate a small amount of collagen lost with aging, it is a focused energy source that clots small blood vessels in the skin seen with aging. It is lighter than a VBeam and safer and more specific than a chemical peel. Very safe. JG 2.7.10

• Dr. Garcia, I messaged you al ong time ago regarding my issue, I had a vbeam laser treatment done one one spot on my forehead, penny-sized. That spot has been noticeable lighter that the surrounding skin and no longer flushes red with the rest of my skin. Is there anything that can be done to even out the skin tone on my forehead, I know you said relume laser doesnt work permanently as I`d need continuous maintenance treatments and this carriers a skin cancer risk do due to UV exposure correct? What else if anything can be done to even the skin tone? maybe a peel or something? I just want even skin tone.

  Answer:  might try a YAG laser peel on the surrounding area to at least lessen the redness in that skin so the difference is not as visible, wish I had more to offer. JG 2.6.10

• Dr. Garcia, My Doctor`s office is offering a new radiofrequency laser called Pelleve. I know about fat loss with Thermage, but this one is suppose to be safer. I have also considered the Pixel Laser and tightening with the accompanying Laser 360. Which on this would you recommend for a 50 year old with slight sagging and light wrinkling? Do you think the Pelleve is a safe (non fat-loss) radiofrequency?

  Answer:  of those, the only one I would say yes to, is the Pixel, but its not an enthusiastic yes.Sorry. JG 2.6.10

• how about the Titan? Thanks again

  Answer:  mild. JG 1.30.10

• I have uneven skin tone,large pores, spider veins around my nose and wrinkles under my eyes most concern with wrinkles and veins. What would be the best laser to get the most bang for my money and since rytec went bankrupt does anyone still offer the protrait laser in GA?

  Answer:  no one single laser will correct all of the problems, the lasers that help reduce the wrinkles and remove spots will aggravate the spider veins, and there is nothing that will help the pores for more than a few weeks. It will be a combination of a resurfacing laser followed by a pigment laser, like a CO2 first and a YAG laser second, after that it would be microdermabrasions or IPL for the ppores. I still have a few heads for my Rhytec and there is a company that is getting ready to start sellling new heads, not sure about new machines though. All the best. JG 1.30.10

• What is the difference between the Pixel(fraxel) laser and the CO2 Lite? Thanks

  Answer:  not much. JG 1.29.10

• Dr Garcia I have freckles and aging skin and was told chemical peels(hydrox.) would help. I don`t want to do lasers and can`t do a lot of down time. Your opinion? Thanks!

  Answer:  well, glycolic or alpha hydroxy peels well help some when done in a series, but nothing dramtic or long lasting. JG 1.27.10

• Hi Dr. Garcia, I had a BBL treatment on a dark spot on my nose. A few days later shingles broke out on the treated spot and went into my eye. It has been pure misery. Since then I have read that pre-treatment with an anti-viral like valtrex or acylovir is recommended prior to ultra violet light treatments because they can activate the shingles virus. I am extremely disappointed that my doctor did not recommend any pre-treatment meds or warn me of possible side effects. What have you heard about this side effect? Will I ever be able to safely have laser treatments again for anything - skin tightening, hair removal, dark spots etc.? (I have never had shingles and can`t even remember ever having a fever blister, but I did have chicken pox as a child.)

  Answer:  actually a common potential complication and pretreatment should be done even in people with no history of cold sores due to the Zoster virus being so broadly in the environment. Safe repeat treatments can be done as long as there is pretreatment and then continued treatment afterwards until the skin has totally healed. JG 1.27.10

• Dr Garcia, I had a patch test for Activefx laser that didn`t turn out that well. I have olive skin tone and looking for a treatment for sun damaged skin and some blotchiness. I want my skin to look refreshed and not so dull. How do you feel about Trichlor chemical peel? Thanks ...Lori

  Answer:  it can leave you with the same problem, the strongest peel I would suggest would be a beta-hydroxy peel, otherwise Retin-A and hydroquinone. All the ebst. JG 1.26.10

• HELLO DR G. ITS BEEN AWHILE SINCE I HAVE USED YOUR WONDERFUL PROFESSIONAL ADIVCE OR KNOWLEGDE BUT HERE I AM AGAIN.OK SO MY QUESTION IS THERE ANY THING I MEAN ANYTHING THAT CAN LIGHTEN BLUISH RED (PURPLE) TINT UNDER MY EYES.(LASERS IF SO WHAT KIND) I HAVE USED ENDLESS CREAMS NO CHANGE INCLUDING RETIN-A. IS THERE A CREAM YOU SUGGEST? IF THIS WILL HELP YOU DETERMINE.... WHEN I PRESS ON THOSE AREAS THEY DO NOT LOSE COLOR AT ALL ( LIGHTEN UP) AND THEY ARE ALWAYS THERE NEVER GO AWAY OR FLUCTUATE. ALSO IS THERE A POSSIBLITY JUVI INJECTIONS THERE MAY HAVE DAMAGED THIS AREA & THATS WHY I HAVE THEM? I NEVER THOUGHT ABOUT IT TIL NOW BUT SEEMS AS THOUGH ABOUT A YEAR AGO IS WHEN THIS HAPPENED AFTER I STARTED FILLIN IN THAT AREA. THANK YOU SO MUCH!

  Answer:  Welcome back! The only laser I would try is a YAG laser, but the effect will likely be small and you might need a series of them, best of luck. JG 1.26.10

• Thank you for your reply Dr Garcia. I am applying roc retinol daily. Is there any other cream in your opinion that may help this depressed area. I very much appreciate your advice given so far, thank you.

  Answer:  not really, more a matter of time I am afraid. JG 1.25.10

• Thank you for your previous reply Dr Garcia. I have since been back to my dermatoligst and he says there is not enough to fill but perhaps use some retinol daily. As you know I had diolite and it left an indented area on my nose. After the treatment it did blister and scab and since have been left with this depressed area. Can you advise me if you think in time it will get better? I have heard of a product called Syprex scar cream and was wanting your opinion if this may help? Any advice is greatly appreciated, Jane

  Answer:  I do think in time it will get better, but slowly. Most scar creams will help the raised scars but not the depressed ones, just have to give it time. JG 1.24.10

• Hi Dr. Garcia. Not feeling any better about my skin and it`s 2 weeks tomorrow since I had the VBeam laser treatment for thread veins on my face. Under my eye, on the cheek bone, I have a swelling which is not improving at all. (Dermatologist hit me twice on the one spot here as he said the first one did nothing and he turned up the frequency - this area did bruise - and now I am left wih a mark/scar where he did that). Can live with that scar, but do you think this swelling will go down in time? I only have it on the one side, and he treated both cheeks. Also, on my chin area, it looks like I have raised areas in my skin - a few are oval in shape, as if it`s where he hit me with the laser beam - I did not have these before - and it seems to me these are getting worse. They look paler than my normal skin colour, as if there is some fluid underneath the skin - but they are not blisters or burns. Apologies for the questions but I cannot get an appointment to see my Dermatologist until April and since he was very dismissive of me when I saw him a week ater the laser, it`s probably pointless going to see him anyway. What do you think? Thank you for your time.

  Answer:  well, although not normal, it can happen, I think staying in close contact with your dermatologist is very important, they may want to try a Medrol pack to see if they can help the resolution of the swelling. If he is unwillig to see you I suggest you request your records and go see a different dermatologist to get answers to your questions as in this case it is important for someone to see you in person. Best of luck. JG 1.22.10

• Hi Dr. Garcia. If you don`t mind, may I ask you another couple of questions please as I really am very anxious about my face, particularly as I already have experienced a deep burn with a previous laser treatment. In your experience with V Beam laser, is it common for acne scarring to look more prominent 10 days after the treatment? If so, does this settle down, or is this permanent? Also, the day after my laser treatment, I developed a red/purple coloured pea size hard spot on an area which was lasered. Can this occur - and will it go away? No improvement in 10 days. My dermatologist basically doesn`t want to know, so I am getting absolutely no reassurance from him, and this is even more worrying to me! The other thing is, the areas which appear swollen to me, also look as though they are whiter in colour than my normal skin tone. (I am very pale skinned). Does this go away with time? I have a horrible feeling these changes since my laser treatment are going to be permanent, and this is causing me high anxiety. Thank you for your time.

  Answer:  it is common for the scarring to look worse and it does get better and is not permanent, but the VBeam will not help the scarring, just the redness. I am unsure why you developed the discoloration in just one area, but yes, it can happen again if it happened once before. The pale areas should also slowly regain their color too. Hang in there. JG 1.19.10

• hi. i have to ask. can vbeam clear all the redness in the face?? has this happened for people? I have had about 8 IPL treatments with a lot of improvement, but not all of it. i need to know if vbeam will clear my redness before spending $700 on a treatment. i know the results arent permanent, but does it really work? this redness is making me so angry

  Answer:  on a rare occasion it can clear it all up, but in most cases it will reduce but not totally eliminate it. It is much more effective than IPL though so it might be a good option for you.It is also known to come back in many people with time and aging. JG 1.18.10

• i am going to get vbeam for my redness. i am wondering if going with the bruising strength my first time is a good idea since i have very sensitive skin. i had IPL before and the only reaction i had were redness for a day or two and slight swelling that was only noticable to me. i am very nervous. im already upset with my skin, but having burns from vbeam would make things so much worse and i dont know what to do. vbeam is very expensive so i cant afford to get one treatment just to see how i react before going with bruising strength. i hope this makes sense. thanks

  Answer:  I am not a believer in swinging for the fences with lasers for such issues as it is rarely a one tiem thing, I suggest a middle of the road setting to see how things go and then decide from there. If you cannot do a series of more than two I would tell you that then the decision to go deep is understandable but no promises on how you will look after one deep session with sensitive skin.JG 1.18.10

• I wrote earlier about wanting perfect skin. 42 female fair skin. you suggested a light laser peel. What exactly is that called? Is it a certain laser?

  Answer:  I would do a light CO2 laser,lots of different companies make them though. JG 1.18.10

• Thank you Dr. Garcia. That has helped to ease my mind. Would you recommend someone who has this kind of reaction stops with laser treatment? To be honest, after this last treatment, where I had the bruising, it appears to me that the thread veins are actually worse. Also, I was considering a mild chemical peel with a reputable Plastic Surgeon in my area. I am nervous though, based on my experiences with laser. Is there a chance that someone like myself with a very sensitive skin can burn with a chemical peel? Thank you.

  Answer:  well, I would say that more lasers can be used but the energy needs to be turned down, and that will affect how effective it is I am afraid. Chemical peels have some risks too, so you need to start lightly. There is always a chance of a burn, yes. Best of luck. JG 1.18.10

• Following on from my previous question re. swelling 9 days after V Beam laser treatment, I also meant to add that, in certain areas of my face, it looks like I can still see the round indent from where the laser beam hit my face. Have you heard of this happening before to someone with a sensitive skin - and do you think that will go away with time? The bruising I experienced down the side of my nose and under my eye has completely disappeared. I am concerned. Thank you.

  Answer:  those indentations usually go away as the selling gets better, have to hang in there for a bit more. JG 1.18.10

• Hi Dr. Garcia, I have been having V Beam laser to treat thread veins on my nose and face. After 4 treatments, there was no improvement, so the Dermatologist turned up the frequency at the last treatment 9 days ago. I was really nervous, as I received a laser burn 3 years go down the side of my nose - this was with a Lumenis One yd: Yag. It took a lot for me to try laser again! My concern is, certain areas on my face are still swollen and I have read that any swelling should be gone in 3 days. I went back to see the Dermatologist who was very dismissive and would make no comment. Do you think after 9 days this is now permanent - or have you seen cases of this happening previously? I have a very sensitive skin, and I did stress this to my Dermatologist - and he could see the burn on my face from a previous laser treatment elsewhere. Thank you.

  Answer:  No, it likely will stil go away, all people respond differently in terms of swelling though, no way to predict. JG 1.18.10

• I saw in another persons question they had asked how long the pinkness from vbeam will take to go away and you said it could take a few months in some. I also read in another question asking how long it will be before you see final results with vbeam with bruising adn you said 4-6 weeks. i am confused about these answers. if vbeam is for redness, then why would it take so long for the pinkness to go away??? thanks

  Answer:  bruising goes away faster than the pinkness, bruising is black and blue and goes away faster. The redness can take time to go away as the blood vessles are irritated and the process involves inflamamtion and a certian degree of heat and that causes the burning, it is not like turning the color setting off on a computer screen, it does not work that way. JG 1.12.10

• Hi. I am going to get a vbeam treatment for the redness in my face. my dermatologist said most people see a 25-75% imporvement with the first treatment when he does the bruising strength. I am wondering if this is true? He seemed like a very good doctor, but i am very nervous about this. it is also $700 per treatment so after the first treatment i dont know when/if i will be able to afford the next treatment. any info you have on this would help me a lot. thanks

  Answer:  I cannot say about the percentage improvement but I will say that the stronger setting has more bruising, but is much more effective, the price one has to pay. I cannot comment on the $700 as that is up to the individual physician. JG 1.12.10

• Dear Dr Garcia. I had diolite laser for a small red vein on the front of my nose but it has left a dent that is not improving after 3 months. Is there anything that can be done to improve this as I am very distressed, thank you.

  Answer:  might need to have a filler put in to allow it to look better until it heals in on its own. JG 1.11.10

• hrmmmm... the damaged artery from the vascular laser is on the side of my nose very thin skinned area. Do you think frequent light massage of the area can help re-establish blood flow faster? Cheers.

  Answer:  do not think it will do much ot be honest.JG 1.11.10

• I have reason to believe that a vascular laser I received a year ago has damaged an important artery in my face. If this is in fact correct, will the artery heal on its own over time, and will any kind of anti coagulation supplements you can recommend assist in its healing?

  Answer:  in most cases, due to blood flow, arteries restablish their flow over time. No supplements will help though, just time. JG 1.10.10

• 6 weeks post-op CO2, and I have developed peau d`orange, especially on my cheeks. Never had it before. Is this typical/to be expected? What causes it? Is it permanent? Anything I can or should do in the short or long term to improve this? Will I need another resurfacing? Thanks!

  Answer:  it is normal and gets better over time as the skin heals and the pores close up. Do not think you will need more resurfacing. JG 1.9.10

• I recently had two sessions of IPL Laser (with levulan for 1st tx) on my arms and shoulders (1st tx on 12/14/2009 and 2nd tx on 1/5/2009) I continue to look like I have a checkered board along my arms, will this fade? Is this what I should have expected? Thank you in advance for your time, I will be moving to Las Vegas next week from Florida.

  Answer:  if it is going to fade on its own it will do so in about 6 weeks or so, might need some bleaching cream to help it along. No sun exposure at all until it has faded. Welcome to Las Vegas. JG 1.8.10

• I have mild malar bags. I had some restylane to even the bump but it helped only slightly. Will Thermage for Eyes, Refirme, Titan or something else improve the condition even more? I had successful lower blepharoplasty about 15 months ago, but still have the malar bags and now some fine undereye wrinkles. What do you suggest? Thanks & Happy New Year!!

  Answer:  sorry, but I do not think any of those will help.I prefer a light CO2 for the fine wrinkles. JG 1.7.10

• I`m getting crepey skin as I age and was told the pixel laser would help with only a day`s downtime. I`m scared of lasers-any suggestions? I do use retina and peptides daily. Thanks Happy New Year!

  Answer:  personally I think you will be disappointed with how long the improvements last after a pixelated laser, keep the other creams going though. JG 1.4.10

• Dear Dr Garcia, thank you for your very quick response to my previous question. Perhaps I should have not used the word perpura - it was very red but has now faded to more of a pink/tan type color. Slight texture change. It does not sound too good based upon your comments. Could I expect any improvement at all in time if it is a burn/scar? Thank you again.

  Answer:  If it was going to get worse it would have bene doing so, if it has been getting better, I would expect it to improve further. If you had scabbing after the laser, the chances of scarrring are higher, if there was no scabbing, then the chances of scarring are much less. At this point you can use some copper peptide creams to assist in the healing, or aloe and give it some more time, luckily the skin is very resilient. Hang in there. JG 12.30.09

• Dear Dr. Garcia, you were kind enough to answer a question of mine a couple of days ago re: ongoing purpura 3 months post Nd Yag treatment to my lower eyelid. Apologies for labouring my query, but could you please explain further why it does not sound like scarring (I hope you are right) and is it possible/common for it to take many months for marks like this to fade - and if so how long before it will not typically improve any further? Thank you.

  Answer:  scarring would not involve a color change alone in most cases, especially to the purple color. If a burn occurred, it could be pink or red but would also have the appearance of a texture change. Pupura, in and of itself, is just a red purplish discoloration of the skin and involves color and some swelling, but I have never seen it persist for much past one month, especially with a YAG laser, I have seen it last a bit longer when using a VBeam laser though. All the best. JG 12.30.09

• What would you use post chemical peel? I used eucerin 24/7 for a week and am now just using a barrier repair moisturizer given to me by the ps. Thanks for the info on hydrocortisone ...I stopped...they had me putting it on twice a day for redness and itching since last thursday. What do you use after a peel for redness and dryness? Thanks and Happy New Year.

  Answer:  we also at times use a copper peptide cream during the epithelialization phase. Not much you can do for the redness, it will fade with time and for the dryness we use squalene oil. JG 12.29.09

• After a phenol peel do you think that applying hydrocortisone lotion (2.5) helps with redness or does that just add to the dryness?

  Answer:  I would never use it, it will likely thin the skin and make the skin look more red. I do not think it will do much good or bad to the dryness. Happy New Year. JG 12.28.09

• Dear Dr. Garcia, I had Nd Yag laser treatment to my lower eyelid 3 months ago and still have slightly bumpy coloring which my dermatologist says is residual bruising and will eventually resolve. In your experience, can bruising last this length of time (given how sensitive and thin the skin is there) or is it likely to be something permanent like scarring? Thank you so much for your advice.

  Answer:  I do not see how it would last that long to be honest, the bruising from a YAG is minimal, although that skin is quite thin. It does not sound like scarring though, I might suggest giving it some more time and see how it does, I would not worry about it at this point. JG 12.28.09

• When should all of the peeling process be complete after a phenol peel?

  Answer:  in most cases 2-3 weeks. JG 12.28.09

• I had a full face chemical peel(phenol)11 days ago. The ps did a level 2 (of 5) on the sides of my face, a three around my mouth and forehead and a 4 on my chin. If my entire face did not get brown, crusty and then peel, does that meant it did not work?

  Answer:  no, it is because they went to different depths depending on what you needed, that is not unusual. JG 12.28.09

• DR. GARCIA, WHAT DO YOU THINK OF INTENSE LIGHT THERAPY FOR SKIN AGEING AND ACNE? THANK YOU FOR YOUR ANSWER AND A VERY HAPPY NEW YEAR!!!

  Answer:  minimal effect I fear. Best to you also. JG 12.28.09

• I had a chemical peel a week ago. One side of the area above my lips remained white. When I went back for my week check-uo the ps said that that area did not take . The solution did absorb int my skin in that area. He said that sometime that happens to an area....does not know why. Have you ever heard of this?

  Answer:  if the skin is prepared at the time before the chemical peel with a degreasing and cleanser, which is the usual case, it is quite rare. Additionally, as one is doing the peel, one thing we look for is a color change while the chemical is being applied so if in fact the acid did not penetrate. You should see it not penetrate while you are doing it. Merry Christmas and a Prosperous New Year. JG 12.23.09

• I had a phenol peel 6 days ago. The area above my lip is a dull white color on one side. Does that mean I have lost pigmentation in that area? Thanks very much and have a blessed holiday.

  Answer:  no, that would not show up for weeks, it is just the skin that will flake off that is still attached, all normal. Merry Christmas, Happy Channukah and a Prosperous New Year. JG 12.21.09

• What do you recommend for aftercare treatment of a phenol peel? I have been using eucerin. Does anything help speed up the redness removal?

  Answer:  Eucerin is fine and the only thing that helps the redness is time I am afriad. Hang in there. Merry Christmas, Happy Channukah,and a Prosperous New Year. JG 12.21.09

• Thank you for your kind response to my question today re: post-laser red/brown marks. Could you please just advise if there is a laser (e.g. pulse dye) or other method which may be used instead of Retin-A and/or hydroquinone? I have read some worrying things regarding hydroquinone use and would it not be difficult to prevent treating the adjacent areas of the skin which are ok? Thank you again.

  Answer:  could try a YAG laser. Merry Christmas, Happy Channukah and a Prosperous New Year. JG 12.21.09

• Sorry Dr Garcia - regarding my previous question re:typical post-laser treatment healing time, I should have added that the area is also a lttle raised, even where the red/brown pigmentation has significantly decreased. Thank you again and best wishes for the Holidays.

  Answer:  that should get better in time. Merry Christmas, Happy Channukah and a Prosperous New Year. JG 12.21.09

• Dear Dr Garcia, I had Cooltouch Varia laser treatment to my lower eyelids around three months ago and immediately after treatment the area was very red, but it has gradually faded somewhat. However, some brownish marks still remain. Could you please advise if you would typically expect continued healing and improvement post-three months or is this likely to now be permanent. Thank you for your help and advice.

  Answer:  I think the tightening is done and the spots will likely require Retin-A and hydroquinone to fade. Merry Christmas, Happy Channukah and a Prosperous New Year. JG 12.21.09

• How long after a phenol peel can I expect to see the final results as far as tightening of the skin and wrinkle removal?

  Answer:  6-8 months. Merry Christmas, Happy Channukah and a Properous New Year. JG 12.20.09

• Dear Dr. Garcia what are your thoughts on a Sciton Profile laser. I was thinking of using it only for a microlaser peel. I think this would be equivalent to a chemical peel only done by a laser. the heal time is 7 to 10 days. It is called a weekend peel however. I am afraid of lasers and am considering a blue peel. I am 60 by the way and am just interested in mild resurfacing without a lot of down time. Thanks

  Answer:  well, desiring less down time is understandable but realize that means lesser results, especially in view of the fact that the older we get, the less the degree of improvement gets as the amount of new collagen the body can make form the laser or chemcial peel is less robust. I think it is fine to do, might get some brown spot reduction and maybe a texture improvement but I would not expect much wrinkle reduction with that or the Obagi Blue Peel. Best of luck. JG 12.16.09

• Dear Dr Garcia. How long should I wait after full face Erbium resurfacing to have SUBCISION to a scar?

  Answer:  it is usually best to do the subcision first, but I think 6 weeks after the laser is OK. JG 12.16.09

• Dear Dr Garcia. How long should I wait after full face Erbium resurfacing to have a Restalyne injection to a scar?

  Answer:  6 weeks should be enough. JG 12.16.09

• Questions: Do you still have a low opinion of silicone for lips? What`s your opinion of the Vitalize peel? Wh!t`s your opinion on the new TNS serum? Thank you Doctor Garcia!!

  Answer:  always have and always will have negative views of any silcone injections. Vitalize and TNS are OK though. JG 12.12.09

• You said that alexandrite laser is best for hair removal. Do you know brand names of the alexandrite. Places will advertise sheer laser or oter names, but I never hear alexandrite. So does it have different brand names I can look for?

  Answer:  The Alexandrite laser systems include: GentleLASE, Apogee, and EpiTouch Plus. JG 12.10.09

• Four weeks ago, I received a second degree IPL burn, about 3x3 cm. (They had just changed the crystal, and it was running far too hot.) I initially used Aquafor and then switched to Clobetasol ointment. It seems to be healing but slowly and unfortunately looks like it will leave a scar. Anything else you would suggest? Do these kinds of burns tend to heal from the center outward or from the perimeter inward? Thanks for your help!

  Answer:  stop the Clobetasol for fear of thinning the skin and see a dermatologist or a plastic surgeon to make sure all is going well. They heal from the deep surface up. I wish you the best. JG 12.9.09

• Do you know if the regular co2 laser helps to improve burn scars on the arms? The fractional co2 laser many treatments.

  Answer:  I do not think either one will help scars on the arms. JG 12.7.09

• What is the difference between Retin A gel(trentinoin) .1% and Tazarotene cream .1%? besides the testure. I swithc back and forth for fine lines and smothing skin texture. They both make me peel almost daily. is it never ending?

  Answer:  essentially the same and that is how the medication works to improve texture, by exfoliating your skin, typically it gets less over 4-6 weeks, if it does not then a lower concentration is needed. JG 12.7.09

• Yes, I am currently doing the Zerona, but, I would like to ask you your feelings on this procedure. It is a temporary fix?

  Answer:  I think it is a waste of money. JG 12.7.09

• Dr. Garcia, I have been using Rogaine for Women 2% for 2 months. I am not sure if my top scalp hair is growing back yet, but I have been gorwing dark facial hair on my whole temple, cheek, and jaw area. I could never consider laser hair removal on my face before because I had blond peach fuzz. But now I have black hair that the laser can pick up. My skin is very fair. My question is if laser hair removal can work if you have fair skin and dark hair? Are there any chance that laser hair removal can work? If so, which laser(s) is best?

  Answer:  the hair removal laser will work the best on dark hair in light skinned people. I prefer Alexandrite lasers for hair removal, there are a few different manufacturers of them. JG 12.6.09

• i am considering vbeam for diffused redness in my face. I have had about 8 IPL`s with great results, but i was hoping vbeam will finish it off. my derm charges $700 per treatment. so i can only afford one treatment at a time until i can save for the next. He says he can do it gentler nonbruising or more aggressive and bruise. i want the best results possible, but im worried about getting burnt or scarred or having bad side effects if done too aggresively. what are your opinions on bruising or non bruising vbeam?? im very scared about it.

  Answer:  well, the finishing off is great, but likely is not permanent. I think going aggressive, if you can, is best. The burnt or scarring potential is extremely low. JG 12.2.09

• Do the traditional totally ablative CO2 and the phenol peel have the same downtime? Thanks

  Answer:  pretty similar. JG 12.2.09

• Are the risks of scarring and hypopigmentation greater with a phenol peel as opposed to CO2 laser? Does one ultimately cause more collagen production than the other? Thanks so much.

  Answer:  at equal depths it is equal. I feel a traditional totally ablative CO2 laser generates more collagen than a phenol peel though. JG 12.2.09

• My ps has repeatedly told me that a phenol peel is the best option to address the wrinkling around my mouth and eyes. He would do a full face peel using different strengths in different areas. He has a laser but still prefers the chem. peel. Should I go to someone who will do a laser? Which will give the same results as a phenol peel and what are the risks for each. Also, what is recovery time for each? Thanks for your help.

  Answer:  I have done hundreds of phenol peels over the years and they are very effective, just does not sound as sexy as a laser. The recovery, if they go to similar depths, is the same, I cannot predict the downtime without knowing how deep they plan on going but figure 7-14 days before makeup is allowed. Best of luck. JG 12.2.09

• Sheesh! Also forgot to mention (regarding the Slim Lipo) that it is for chubby upper arms. I don`t know why my upper arms look so bad. The rest of me is a size 4 and I`ve been an avid exerciser my whole life and yet my arms are, well, fat and flabby.

  Answer:  save your money. JG 12.2.09

• Dr. G, forgot to ask (regarding Fraxel Repair ) ... can this be used under my eyes? Will it help tighten that area? I has originally planned to get a lower eyelift, but the PS I may use for the Fraxel claims it will tighten that area. (I`m 44, fair to medium skin). Thank you.

  Answer:  it can be used but I feel it is not worth it. JG 12.2.09

• Hi Dr. G, thanks for all the help with my questions. I wanted to ask what you thought of Fraxel Repair and Slim Lipo. Would a regiment of the Obagi system, for example, get the same result? Can I use anything (like Fraxel or another laser) on stretch marks or scars? The Fraxel is costing $4500 for ONE treatment, so I want to make sure I know what I`m doing. About the Slim Lipo - what are your thoughts? I was intrigued, esp since I had HORRIBLE lipo when I was younger. I think the traditional lipo could be the reason my thighs are lumpy and bumpy and that I have some hanging skin - AND I have gotten a saddlebag back in the SAME SPOT that I`ve had it removed TWICE. Thanks!

  Answer:  I think the Obagi system will help with the pigment issues, yes. I think Fraxel and SlimLipo are overrated, I do not think the Fraxel will do anything for stretch marks or scars. I would stick with a good surgeon and ultrasonic assisted liposuction, best of luck. JG 12.2.09

• Dr. Garcia, I have just returned from a follow up visit at my derms office (previous basal/squamous skin cancer issues) and addressed some brown spots I have on the side of my face. I was given a brochure on actinic keratosis so I assume that`s what the diagnosis was and some options for treatment. While I initially thought the RX I was given for the fluorouracil cream was the way to go the more I read about the drawn out potential redness, crusting, etc. the less desirable it becomes. He had mentioned a TCA peel as well and I am now leaning towards that as my train of thought is at least I know pretty much what my down time is and feel like it`s more controlled. I know it will ultimately depend on strength used but do you think one week of down time is pretty reasonable for a TCA? Also, the doctor told me they do not use any type of topical/injected numbing--is that typical? I have had several erbiums on my face/chest--are the after effects the same--angry redness for a while and than peeling? Thank you for your answer!

  Answer:  It is commmon for a TCA peel to have about a one week down time, yes. As to numbing creams or shots, it depends greatly on the depth or strength, we sometimes just use a topical anesthetic cream and then clean it off before the peel is done. It is not terribly painful though. The after effects and healing are much milder than an erbium laser, less redness and less crusting, more like a severe sunburn. Best of luck. JG 11.30.09

• Dear Dr. Garcia I recently turned 60. I am beginning to get those tiny verticle lines around the lip area. What is the best way to be rid of those? I feel fortunate to have not had them up until now. I suppose a filler could work temporarily but I am thnking more of a laser or chemical peel? Any suggestions.

  Answer:  a chemical peel will give you very short lived correction, about the same as a filler, and a laser, if done deeply will give you more time, but nothing really long term I am afraid. JG 11.30.09

• I am 72 hours post-op from a light CO2 resurfacing. I have been soaking in sterile saline and wasihing with cetaphil several times daily as instructed and using the copper peptide cream I was given after the procedure. I have also been taking benadryl to manage the itching. Unfortunately, the itching has continued and worsened, and it is now unbearable. I can barely type this question. Any suggestions? Would a topical, aerosolized antihistmine, like Solarcaine, be effective and safe? Thanks for any help you can offer!

  Answer:  worth a try, or get a prescription antihistamine like hydroxyzine. JG 11.29.09

• Hi,im new to website, been reading ?/replies. i was sincerely wondering why you are not a fan of profractional lasers like the sellas or any other..i was advised by dermo to do that vs. CO2 cuz its very trautmatic on face(but u get better results and its a one time deal)..please help, i also read that IPL does not really work. i have dark spots on my face from sun and picking acne x 5 yrs, tried hydroquinone, retin A..thnxs rocky

  Answer:  well, if you look at what the fractional laser does, it treats only a percentage of the skin, so there is no way that a fractional laser will match the long term results of a totally ablative CO2 laser. I will grant you the down time is much less with a fractional laser, but like all else in life, for less you get less. IPL works for red and brown spots but not as strong as a traditional laser. Might want to try a YAG laser for the spots. Best of luck. JG 11.29.09

• hello - I have had 6 IPL treatments, not much results for pigmentation. I had the medlite c6 laser peel 6 weeks ago great results, tomorrow I have a micro laser peel scheduled for remaining pigmentation, texture issues, is it too soon for the micro laser peel, it would be over 20 microns?

  Answer:  all sounds about right. Sorry I did not get back to you sooner as I was with family for dinner. JG 11.27.09

• Happy Thanksgiving, Dr. Garcia. I can’t believe you’re answering some posts today. Thank you. I had Candela V-Beam a week ago yesterday. If it worked for me, do veins keep fading for a while? It seems to me that most are still there plus a few new ones. Could they improve over the next few weeks? Could it be that, if Retin-A contributed to bringing out these veins, the Candela V-Beam was not the right treatment for my face in that it was too strong for my skin? I had very bad purpura that still has a ways to go in fading. Going forward, is there something that can just target the distinct vein threads individually w/o being too harsh for the rest of my face? Also is there a crème I can use that will help minimize the forming of these veins? Can I start using Blender on red or brown areas now? And I know to use sunblock whenever I go outside. You are a good guy, and readers should not be influenced by some malcontent. It was on your site that I learned Retin-A could cause the appearance of facial spider veins. You provide a great service. Thank you again.

  Answer:  yes, they fade for a little while but you likely will need more sessions in the future and the laser does not hold them off forever. Retin-A will make the broken blood vessles worse due to the irritation and the purpura is normal with that type of laser. IPL treatments are not as harsh but not as effective for inbetween times.Blender and snblock are OK now. Sorry I did not get back to you sooner as I was with family for dinner. JG 11.27.09

• Dear Dr. Garcia I had microdermabrasion yesterday. (the crystal type) I had used retin a and did not stop prior to the treatmen. My face is very red today, will this go away? I know I should have stopped, and the treatment was somewhat aggressive. My face feels red as well. Is there anyway to calm it done. Thanks for being here (or there) for all of us.

  Answer:  yes, it is just that the irritation from the Retin-A allowed the microderm to go deeper and get more exfoliation. You can use some copper peptide creams or aloe if you wish, but it will heal on its own in time. Best of luck and Happy Thanksgiving. JG 11.24.09

• Hello Dr. Garcia, I recently had active fx laser peri-orbital. One treatment is all that is necessary. This is my 5th day and the crustiness has just about disappeared but I am concerned about hyperpigmentation (racoon eyes) because there is still darkness circling the eye. Will this disappear within the next week?

  Answer:  probably, but no way to tell 100%. JG 11.24.09

• I have a problem with texture and huge pores since having a co2 laser. There is an area the size of a quarter that looks terrible. I have 8 huge holes with texture randomly weaving thru the holes. Saw my dermatoogist today. He looked from about 8 ft away and said no they are pores not holes and they will be difficult to fix. He suggested a procedure similiar to a hair transplant..then laser to flatten scar. I am very concerned since I didn`t have this problem until the co2 laser. Could this be caused by the facial texture being burnt. That was my 4th co2 since 1994. An area the size of a quarter is a big area to put plugs in and I am concerned that it will look worse than the holes. Any advice will be appreciated. Can that area be grafted???

  Answer:  it sounds like it could have been a deeper penetration with a resultant burn and scarring. I am unabel to tell you without seeing and feeling your skin whether the proposed procedure would be beneficial though. JG 11.24.09

• I know you`re not a fan of infrared technology for skin tightening, but I have found over the years that it does make a significant difference for me. Two weeks ago, I had another treatment on my neck and unfortunately received a 4 x 4 cm second degree burn. I`ve been keeping it clean with cetaphil and constantly covered in neosporin. Is this the only thing I should be doing to promote healing and to decrease the chances of scarring? I suspect it may be. The plastic surgeon who did this--and then charged me for the procedure!-- told me he would manage the burn, handed me some packets of bacitracin and instructed me to make appointments with him every week for the next six weeks so he could check the progress. I can`t afford to take time off from work every week just to satisfy his conscience and his record-keeping needs if it`s not going to have any effect on the outcome of the healing, which I don`t think it will. (Obviously, I have been burned in more ways than one here.) Two questions: 1) What else would you recommend I do to promote the healing? If you would recommend a product I can`t get in most drugstores, where would you recommend I obtain it? and 2) In your experience, do second degree burns generally tend to scar badly or to heal well? Thank you for your time, Dr. Garcia.

  Answer:  I think what you are doing is fine, nothing more is likely needed.Second degree burns come in two depths supericial and deep, the deep one can cause scarring and the scarring potential on the neck is higher than on the face due to lesser healing capabilites of that skin. I think he wants to see you frequently so that if it does start to scar he can inject it with steroids to avoid a hypertrophic scar. If you do not go in, then he may reflect in your chart that you did not follow up and that he could not help you if you did not come in. You will need to make up your own mind on thtat one. Once healed you can use ScarGuard or Mederma to reduce the scarring and aid healing. All the best. JG 11.21.09

• Dr. Garcia, I had Candela V-Beam treatment yesterday for broken capilliaries on my face. I have a lot of purpura and look pretty beat up. I am taking the Arnica religiously. I`ve read all the postings on your site re purpura, and my question is whether it is most likely to go away in a week as the doctor said. Also, when I exercise going forward, how likely is it that I will have white spots where the laser produced the purpura. In other words, what is the norm afterward for most people who have V-Beam for treating these broken capilliaries? Am I just reading the exceptions? One other question: my other choice for this was the Cynosure Elite. I was told by the ARNP who operates the laser that right after the treatment, my face would have a cat scratch look where the laser was used. That`s pretty different from what I`ve got now, so what do you think the end result would be with that laser as opposed to the V-Beam. If I feel a need to treat these capilliaries in the future, I don`t think I want the V-Beam based on how bad I look now. Thank you for your time and expertise. I greatly appreciate it.

  Answer:  in the vast majority of cases, it does take about one week. In most cases the white spots are rare, and do get better with time if they occur, they are more easily seen during exercise only because the surrounding skin is more red from the increased blood flow and the color difference increases. I do think you are reading about the exceptions, yes. There is many times more down time and more altered appearance for a greater degree of improvement down the road. Hang in there. JG 11.19.09

• Dr. Garcia, looking into laser treatment for my son who has pretty servere outbreaks with acne. What is the difference and between the smoothbeam and starlux. Is one better than the other? Pros and Cons?

  Answer:  I will be honest, I have not been impressed with the results of lasers to control acne breakouts, to treat the scarring afterwards, yes. Any improvements in the breakouts will be very short lived and likely worse right after the laser, sorry. JG 11.18.09

• Hi Dr. Garcia, I had a mid face and neck lift and can now see red vein streaks on the sides of my checks where the skin was pulled, I guess. I had asked you about several lasers for treating these veins but did not explain about the face lift. I`m sure the sun has played a part too. Of all the lasers I asked you about, you said that you have seen the best results with the Candela V-Beam. But I did not ask you about IPL. Which would be better in my situation to lessen these red veins with the least risk of negative side effects. Thank you very much.

  Answer:  IPL will also help, just less dramatic and takes more sessions. Less side effects and risks with the IPL though. JG 11.17.09

• What do you recommend for lines under the eyes. I have botox but even when frozen there are still some fine lines. What would work best for lasting results? Thanks!

  Answer:  Retin-A and then move on up to a CO2 laser. JG 11.17.09

• Dear Dr. Garcia, yesterday you responded pertaining to the fraxel repair around they eye wrinkles for $1K it would last only 4-6 months. that is a lot of money for that length of time. what other options are there? What are your thoughts of a chemical peel as 35% TCA? Would it not last the samt length of time? As always thanks for your time.

  Answer:  the TCA peel would last about the same, once the swelling is gone , the results are gone. All the best. JG 11.14.09

• Dear Dr Garcia, 15 years ago I had a lower bleph but as time has marched on I am developing fine lines/crows feet etc. I am pondering a fraxel repair around the eyes for $1K. Do you think in your opinion this will work or is a waste of money. The dr. is a PS who would perform it. The entire face is $4K. I am not up to spending that much as I would rather have a lower face lift. Thanks.

  Answer:  It might give you about 4-6 months of longevity. It can be repeated though. JG 11.13.09

• Hi Dr, thanks for your reply about the candela gentle ease laser, in which you said it was a good idea to step up the energy gradually. To clarify, the laser treatment should result in a reduction of hairs growing back? The laser is marketed as permanent hair reduction, so I`d expect to see less hairs growing back. Has that been your experience? Thanks again for your time.

  Answer:  well, that is what they s,y, what I would say is do not be disappointed when it grows back. I have never seen it work permanently, it has decreased the rate of growth so it is slower though. JG 11.13.09

• Hi Dr, My dermatologist is giving me a run of IPL to help with very noticeable red veins in the tear trough area under my eyes. He told me that I would more than likely need one session. I had my first session and noticed some minor improvement, but is he correct in saying i need more than one treatment? Why are multiple treatments needed? Thank you

  Answer:  I would say that it is much more then just likely that you will need more than one, I would say it is likely for sure you will need many and the degree of effectiveness is poor and they will in time come back as the cause for the blood vessels will continue ot be there. JG 11.13.09

• I`m having laser hair removal using a candela gentle ease. I`ve had 2 treatments, to remove facial hair.The technician used 24 joules for the first treatment and 26 for the second treatment. My question is which is the highest force that can be safely used on my skin? She said the range for my skin type is 24-30 .I have fair pale skin, no freckles, brown hair. Please advise. I don`t want ot waste money having lots of treatments if the power is too low.

  Answer:  well, stepping up the energy slowly is the correct way to perform it to make sure the skin is not burnt, so it is a slow process, also understand the hair removal is not permanent. JG 11.12.09

• Dear Dr. Garcia, I have red thread facial veins and some melasma. I am trying to figure out how to have the red facial veins treated with the least risk in incurring side effects. My choices seem to be Candela V, Sciton Profile, or Cynosure Elite. In order of choice, what would you say? Also, how important to the outcome is the skill and technique of the laser operator? Thank you for your website and your time.

  Answer:  I have seen the best results with the Candela VBeam, but it might and likely will not, be permanent. The skill of the operator is really dependent only on the settings and that should be determined by the physician after seeing and examining your skin. Best of luck. JG 11.11.09

• Dear Dr. Garcia, I am 51 yo female, my PS rec mild TCA peel for under eye bags. Experienced only mild peeling similar to after a sunburn. Has been ~ 4 weeks since peel, no apparent difference to me. If he suggests repeat treatment, should I agree or should I ask for restylane injection to lower eye trough? Thank you, AB

  Answer:  no, because it will never help bags, it will help pigment problems and might make the skin look smoother while swollen but once the swelling goes, so does the skin improvement. Sounds like Restylane is a better option in your case. JG 11.11.09

• do u think in the long run, peels and ablative lasers age the skin even more or at least in some cases. wouldn`t they contribute to eventual thinning of the skin. Just wondering if it`s better to go with a facelift. I know i can get skin tighening with a laser but, just thinking that a few yrs later it might make me look even older.

  Answer:  the basal layer of the skin regenerates itself and there have been no studies showing that those particular treatments thin the skin. Those techniques do not replace facelifts, the work together not in place of. JG 11.10.09

• Hi! I am 31 and I had a microlaser peel back in March (10 microns) and my skin has not been the same since. After the peel, it was continually red and now I have constant redness, large pores and bumps all over my face. The reason I had a peel is to help with my crow`s feet, which I know wish I would`ve done botox. My skin has been supersensitive to all products and the texture looks horrible (like I have a ton of wrinkles and it needs to peel). Could this be scarring? Could I have developed rosacea from this procedure? Also, is there anything else that I can do now? Thank you so much for your time!

  Answer:  your reaction does not sound like scarring and a 10 micron laser peel is very light, it is hard to imagine the laser causing that effect as it is like a deep sunburn, might have been the creams applied afterwards or soemthing else. I have never seen Rosacea develop from a laser. Wish I could give you a reason for your problem. JG 11.10.09

• You mentioned that the YAG or VBeam might help to flatten raised scars. Does the fractional CO2 (Total FX) also help to flatten raised scars?

  Answer:  I would not use it, not the regular CO2 laser. JG 11.8.09

• Are there any lasers good for raised scars? I am talkign about lots of raised scars like burn scars that look like raised stretch marks.

  Answer:  a YAG or VBeam might help settle the redness and slight flattening. JG 11.8.09

• Hi. I have had about 8 IPL treatments for facial redness with a lot of improvement, but it is still pink in some areas, especially around my mouth and nose. My redness and veins were pretty bad. Im thinking of having the v beam done since i have heard it can give better results. I am wondering a few things. 1. i have heard people can have fat loss from this, is this true? Or are there any other permanent complications that can happen with the v beam? 2. I have heard mixed things about v beam helping acne. If i had v beam done for redness would it also help my acne clear? If so how does that work? 3. I am wondering if the v beam is better for veins or diffused redness? I have heard it is very hard to get rid of diffused redness. I am very confused if i should continue with IPL or switch to v beam. Just want my nice skin back!! Thanks

  Answer:  I have never seen nor read about fat loss in VBeam session. I have not heard of any permanent complications from a properly performed VBeam, but it can leave the area more pale than the surrounding. I do not think the VBeam will affect the acne, to the positive or negative. I think it is a good idea for you to try the VBeam ,and I think the diffuse redenss is actually easier to improve versus dilated blood vessels as they have more blood. JG 11.7.09

• Hello Dr.Garcia- how effective is the Sellas ProFractional laser procedure? Are there better alternatives? Thank you, ladybird.,

  Answer:  I do not endorse or believe in any of the fractioanl lasers, sorry. JG 11.7.09

• What do you think of the Candela Gentle Las for hair removal? Is it more effective than other hair removal lasers?

  Answer:  I think it is a pretty average effect. JG 11.2.09

• Hi Dr. Garcia. I will be having some surgery that will require about a week of downtime. Am thinking about doing a medium peel at the same time. I am 50 and was wondering what peel you would recommend as the best one to give an overall refreshed even toned look.

  Answer:  maybe a 20-25% TCA peel, I think that should heal in about that amount of time. Best of luck. JG 10.30.09

• Hi Dr. Garcia: I have had close to 10 treatments with various lasers on my facial spider veins. This last time a cutera cool glide laser was used and created three deep crater like scars on the sides of my face and chin. I was told by two different professionals that the technician overtreated the areas. It is now three months out..What is my best chance for improvement or complete restoration of my skin in those areas?

  Answer:  well, I think you have likely exhausted all treatment options that are safe, the depressions will likely fill in with time, I think you might be stuck with the veins I am afraid. JG 10.28.09

• hello dr. garcia, I had the medlite c6 laser done on my back for some sun spots a few months ago. I used to look like I had a few freckles on my back - now I look like I used to have acne on my back? Its like it scared it in about 10-12 spots all in kinda same area... I`ve tried topical vit. A to try & heal/get rid of spots - do you have any suggestions??? Thank you!

  Answer:  I would let it heal on its own and not do anything that would irritate it, usually it takes multiple sessions to remove freckles, if they went too strongly in one session it might take a while for the redness to settle down. JG 10.26.09

• doc I have alot of fine lines (forehead, around the eyes, skin generally) my face also has some tiny brown spots not everywhere but they`re there. Also my skin doesnt look very elastic. The problem is im still young. What do you think about fraction laser for me? I know co2 is good but you reccommend it to older patients. I don`t mind repeating a treatment ongingly to succeed the results. Please suggest something. I have been using retin-a has helped but not all the way. Im looking into this and im finding light chemical & strong chemicals with lasers (with different names) Im getting confused with the names...! can you please suggest a treatment like laser or chemical peel? so i can maintain my skin for the ongoing years? thank you heaps. + also we dont have rhytec portrait laser here.

  Answer:  I am not a believer in fractional lasers, but if you do not need much, it might be OK to use. A CO2 lasers can be done lightly in younger patients if desired. Repetition of the treatments will be required no matter which one you use as none stop the aging process. I have not found chemcial peels to help much for wrinkles past the swelling point. JG 10.25.09

• what will VI peel do for the skin? for late 20`s person. & how long will it (normally or approx.) last? can this peel repeated while seeing effects wearing off? thank you, thank you , thank you

  Answer:  hard to say what it will do without seeing you, the peel can be repeated for recurrent pigmentation problems in the future. JG 10.25.09

• Dear Dr. Garcia, during the upcoming holiday season I have some time off from work, and have been considering a mild laser prodedure for basic skin resurfacing. I am 60 and am afraid of lasers for all the negativie things I hear. I am considering an Active FX from this site. Have you ever heard of him? I am also considering a weekend face lift which might be my best bet as I have mild sagging. Thanks for your thoughts as always. http://ilamed.com/

  Answer:  well the Active FX is likely OK but don`t expect too much return on the investment, the less downtime the less the degree of improvement. Same goes for the weekend facelift, less is less, all the way around, but if you are prepared for that and the fact that not all of what you want will be corrected, then it might make sense. Best of luck. JG 10.22.09

• In my area it seems so difficult to find someone who will do co2 laser on my moderate lip lines. YOu had told me before that a light co2 might help. I have a consult with a Dr. G.D. Castillo who is pretty close to me in Ill. Besides asking to see pictures, are there any other important questions I should ask? Thank you as always.

  Answer:  maybe ask to speak to a patient, best of luck. JG 10.20.09

• What laser or treatment is best to remove brown spots or hyperpigmentation from the skin? Is the fractional CO2 the best laser for that?

  Answer:  since no matter what treatment you choose, they will all come back in time, I prefer to use a YAG laser that can be specifically dialed to treat the brown with no skin ablation which increases the chances of post-inflammatory hyperpigmentation or new brown spots. JG 10.16.09

• Hi Dr. Garcia, I have some malar bags (more prominent on left). Will Fractional 2940 Erbium laser resurfacing help tighten the skin better than a peel? Or is there anything else to treat malar bags? Thanks so much!!

  Answer:  I do not think anything on the surface will help the malar bags since their cause is much deeper, they ultimatley might need to be cut out. JG 10.15.09

• Hi Dr. Garcia, I am going to have a TCA peel with a dermaotolist in the near future. I read that a series of microdermabrasions before a TCA peel helps the peel to go deeper/more evenly. Is this true? If so, how many microdermabrasions would you suggest? And how long after the last one could I have the TCA peel? Thanks.

  Answer:  the difference would be minimal as to the penetration for the TCA peel. I see no reason to do that. JG 10.11.09

• Hi Dr. Garcia, I would like to get a full-face CO2 laser done, but I`m worried about scarring. How common are complications? In your own practice, how many patients have you had with permanent problems from the CO2 laser? Will the CO2 laser tighten (mild) skin laxity on the forehead and around the jaw? Thanks for the generous donation of your time. You`re the only PS I`ve ever seen who says that certain things are useless or downright dangerous.

  Answer:  in experienced hands the risks are low. I have had mayeb about 0.5% of patients treated with some visible scarring that responded well to kenalog injections and a YAG laser. Nothing ended up permanent.I think the skin tightening will be slight, it is done for fine lines and texture, it will not appreciably lift sagging or falling skin, especailly around the jawline. Best of luck and thanks for the kind words. JG 10.6.09

• Sorry Dr. Garcia, but further to my previous question re:Cooltouch Varia, when I mentioned `bruising`, I just wanted to add that this was how it was described to me. It actually appeared more as reddish dots/areas than a blue/purple form that I would personally expect bruising to take. As I said, this has now faded to a more grazed/lightly scabbed appearance. Thank you again.

  Answer:  should all get better in time. JG 10.5.09

• Dear Dr. Garcia, I had laser treatment to remove blue veins in my lower eyelids performed using Cooltouch Varia a few days ago. I had previously had this treatment a couple of years ago, but unlike on that occasion when there was not even residual redness afterwards, this time there is quite a lot of bruising which has now turned to a slight dry scabbing/grazing. I have read that this may sometimes happen, but as it did not occur after my previous treatment I am now rather concerned. Do you think there is any possiblity of any long term skin damage as a result or would you expect this to just resolve normally in time? Thank you so much for your help.

  Answer:  low likelyhood of anything negative long term. JG 10.5.09

• dr. garcia, what do you think of lazors to tighten neck and jawline. i am 59 and my doctor suggested he could tighten my skin when i asked about a facelift. i am a 59 year old woman, with some mild to moderate sagging in neckline. enjoy your site, its nice having another doctors opinion, altho you cant see me, its great to have a general idea . thankyou

  Answer:  I would not use a laser of any kind to tighten skin of the neck and jaw as the depth of laser treatment required to get that effect will likely burn your skin. I think the facelift is likley a much safer and longer lasting option for you. All the best and thanks for the kind words. JG 10.4.09

• Dear Dr Garcia, Do you have a good opinion of Melanage Peel, a rather new treatment for the skin discoloration? I am Asian with lighter skin tone, my brown spots are quite light, but spread on my entire face. I am thinking of this treatment or IPL. Which one would you recommend? I always count on your opinion. Thank you!

  Answer:  I have never used it so I am sorry, I cannot say whether it would be a good and effective option for you. IPL is good but has more risks of reactive hyperpigmentation in Asian skin vesus Caucasian skin. Best of luck. JG 9.29.09

• Hi Dr G, Have you heard of the use of LED for skin rejuvenation? A few people who have used it are very pleased with how it has improved their complexion and I must say they look really good. The cost is much less than IPL and other lasers. What do you think? Another johnny-come-lately waste of money or is it worth a try? As always, so grateful for giving your time and expertise!

  Answer:  well, just because things are approved for sale and for use does not mean they are effective in terms of the difference the person is going to see. Personally, I am not a believer in LED lights helping skin tone or texture, but the testimonials for the machiens are out there. I think I would wait it out, some things are not what they seem. For example, take the LifeStyle Lift. Lifestyle Lift`s dirty little secret Sep 10, 2009 ALBANY, N.Y. — New York State Attorney General Andrew Cuomo has settled a complaint against a cosmetic surgery company that admits it used its employees to pose as satisfied customers in online ads, reports news source InjuryBoard.com. According to InjuryBoard.com, the company ordered employees to write positive reviews of its facelift procedure Lifestyle Lift on Web sites. Lifestyle Lift also created its own sites of facelift reviews to appear as unsolicited testimonials. In an email, the company instructed employees to “devote the day to doing more postings on the Web as a satisfied client.” Cuomo’s office says in so doing, Lifestyle Lift violated consumer protection laws. Cuomo announced the $300,000 settlement with the plastic surgery firm that created the Lifestyle Lift procedure, which is performed in doctors’ offices in New York and 21 other states. It is believed his office is the first to address these “Astroturf marketing” techniques, so named because they are aimed at creating bogus grassroots buzz about a product. In addition to the cash settlement, Lifestyle Lift has agreed to stop publishing anonymous online reviews and to identify fake reviews posted by employees. Caveat Emptor! JG 9.24.09

• Do you think the fractional C)2 laser is best for hyperpigmentation? Which laser is best and usually how many treatments are needed (for age spots for example)?

  Answer:  I think the Nd:Yag is better and safer, no way to tell how many treatments it will take, but likely the spots will all recur. JG 9.24.09

• Dr. Garcia: I am experiencing tiny red dots on my face that may be broken capillaries(?) I have read that IPL can help erase these. Questions: (1) When lasering these spots, can the laser pinpoint only these specific areas or does the entire cheek have to be lasered? (2)Will it leave a white/dark mark? (Please note that approximately 10 years ago I had a CO2 laser resurfacing that left my face very sensitive. In fact, I wonder if my now thin skin as a result of the previous laser treatment has left me vulnerable to these unsightly broken capaillaries.) (3) Is there a topical cream or any type of medication I can adhere to that may strenghen these capillaries? I have even stopped drinking my 1 glass of red wine at night as I am afraid this is worsening the problem. Please let me hear from you. Thanks, 9/22/09

  Answer:  yes, IPL will help, but it will need continued sessions as with any other treatment. You cannot pinpoint the veins, they need to be treated by areas. Done properly the chances of a pale spot are very small. I do not think the prior CO2 has caused or accelarated what normally happens with aging anyway.There are no topical creams that will slow th eprogression of the veins. Keep drinking your wine, that has no effect, all the best. JG 9.23.09

• Have you heard many patients complaining about laser hair removal not working? Can the laser permanently remove hair in patients with light skin and dark hair?

  Answer:  yes, very frequently, it is not nor ever has been approved for permanent hair removal. JG 9.17.09

• what`s the best filler for acne scars? Can you use a laser like nd:yag after having a scar corrected with something like silicone or radiesse? I`d like to use both a Yag laser and a filler to correct scarring but don`t want one to undo the other. Also, does topamax cause acne?

  Answer:  I personally feel fillers for acne scars are difficult to get right and do not routinely use them for that. I think a YAG laser is OK after Radiesse but no one knows after silicone injections. I have not heard of Topamax causing acne but you might need to look at the product insert. JG 9.15.09

• is there any good IPL laser or any other type of laser (that really works) that is not too harsh on the skin, for getting rid of some light/medium brown pigmentation that resulted after the aggressive fat injections 5 years ago into my tear trough/upper cheek area. There are several small blotches of that pigmentation on my upper cheek area. The rest of my skin is absolutely translucent and clear, so those blotches stand out. Actually it looks like in some places the tissue under my skin looks slightly blotchy (maybe due to the damage) and that is what is showing thru my skin. Can all this be corrected? and permanently? wud IPL be the correct treatment, or anything better exists? i already tried some creams which did not work at all cos looks like in some places the damage is not on top of the skin, but rather right under the skin (which is showing thru).

  Answer:  the effective leasrs will be much more harsh than an IPL to be effective after this much time. Sorry. JG 9.13.09

• If skin responds well to IPL (for redness and scarring/red scarring), but tapers off, is nd:yag a good option? Are the risks much higher? I`m olive complected but my derm is very experienced and says she`ll go light as she has experience with my skin for years using the IPL. Will the Nd:yag help with the redness in the acne scars? the IPl hasn`t been able to but did help with the overall redness.

  Answer:  well, it will give you more but there is a point where nothing else will help because the redness is part of the aging process nad that cannot be stopped. JG 9.09.09

• Is it possible that IPL can burn skin that`s been exposed to glycolic acid (like toners) in the recent past? How long before IPL should you d/c those if so?

  Answer:  I suggest stopping the acids for 3-5 days before the IPL to minimize the chances of burning. JG 9.09.09

• Hello again Dr, Just going back to my Accent post just now. I am now very concerned about the fat loss issue .. Could this be a high risk - the treatment itself felt warm but not hot and would this affect areas which were not treated such as the cheeks? Thanks

  Answer:  I think in general it is a low risk thing overall, but I do not think that particular machine is very effective in getting visible improvements that last more than a couple of months.It would affect only the areas treated. JG 9.8.09

• Hi Dr, I had an Accent RF facial recently but before doing so, I expressed my big concerns about facial fat loss following the Thermage stories. The nurse explained that the temp is only heated to 41deg and not hot enough to melt fat so it would be fine. I only had my lower cheeks and jowls treated. Do you think there is a risk? Thanks

  Answer:  I see no evidence that what she said to you is a valid hope to believe there is no possibility of fat loss with that particular machine. In other words, lots of mumbo jumbo to allay your fears and not cancel the procedure. If it were that good, every single plastic surgeon and dermatologist would have one in ther office.JG 9.8.09

• I had a glycolic peel (50%) last week with a new aesthetician. She left it on for under 3 minutes, and I have seen no difference at all in my skin. I have always seen an improvement when I`ve had these peels in the past, but I believe that it has taken 5 minutes or more. What is the average appropriate amount of time that acid at that strength should be left on the skin?

  Answer:  the time depends totally on the acid used and the strength, there is no one correct answer for all peels. JG 9.5.09

• Hi Dr, Is radio frequency safe these days? I have been looking at doing a course of Accent and wondering if this may have the same fat loss risks as Thermage... thanks

  Answer:  I personally will not use it as I think it is not effective, even bypassing the very small numbers of reported cases of fat loss. JG 9.4.09

• Hellllllp. Hi Dr G. I had a 15% acid peel on my ace, 3weeks ago. Now I have so many small pimples my skin looks really bad. What shall I do? what do you think has caused this? thanks

  Answer:  warm moist towels applied to the face 3-4 times per day and let them open on their own. JG 9.1.09

• I was burned a little by a Quantum IPL around my mouth on both sides two months ago. I responded well to the treatment for years and even on this occasion, I think the area around the mouth was sensitive because of excessive use of a glycolic based toner. Anyhow, the area became red, scabbed and after the scabs fell off, there is darkness and some uneven texture there. I`ve been using HQ. If I add Retin-A to the mix, does that help both with hyperpigmentation and unevenness? Or am I doing more harm than good because in all fairness, it has lightened a lot but not as well as I`d like it to have. The other option I was more interested in was having the derm treat me with IPL again or the Nd:Yag laser for dark spots. This time I`ll lay off the toner. Any thoughts/suggestions? I was thinking of the Nd:yag for mild scarring and redness in scarring anyway. I am olive complected and have responded well to IPL for years. Is that a good option for me anyway?

  Answer:  in most cases the addition of the Retin-A to the hydroquinone does help. I would hold off on any light therapy for at least 3-6 months. JG 8.25.09

• I had IPL on my face. I bought a package- I think it was 6 treatments to make my skin look more clear. I read lately about IPL causing fat loss. Is this true? If so, how many treatments cause fat loss? And does it only happen in some people- if so, why? It has been 10 years since my treatment and I am not sure if I had fat loss or not.

  Answer:  I have never seen that happen with IPL unless it was combined with RF, which most do not. If it were going to cause fat loss, that happens a few weeks after the sessions, not later. JG 8.8.09

• Hi Dr, I have a few red blotches on my face with some noticeable red veins on the sruface , particularly noticeable near the crescents under my eyes and a bit around my nose, from being prescribed cortisone for too long that was probably too strong (even though i only used it for a month). Could IPL help me with those spots, to help the redness and veins fade? is it safe? Thank you

  Answer:  yes, should help and is safe in experienced hands. JG 7.28.09

• Dear Dr. Garcia, Do you thing the eyelash treatment, latisse is safe to use? Also, do you think hand peels are effective for hand wrinkles? Thank you, Annettew

  Answer:  I personally do not sell it in my office due to potential side effects. I think peels will no work for hands, all improvements will be gone when the swelling goes away. Sorry. JG 7.27.09

• Hi Dr. Garcia, Hope you are having a good weekend? I`m wondering what your opinion is concerning the Fraxel laser for smoothing the skin on the neck? I know it won`t have results like surgery but would it improve the appearance temporarily? Thanks in advance for taking the time to respond.

  Answer:  thnaks, I am having a good weekend, but as to the Fraxel on the neck, I would never use it there. I have seen permanent scarring there and has been published in the medical literature, sorry. JG 7.26.09

• I just posted the question below and wanted to add something. I am the 40 year old with light olive skin. I do use Retin-A currently. I was just wanting something a little more that that to help my skin look fresher and help with mild sun damage and fine lines. Its pretty good for my age but needs a little help! Thanks!

  Answer:  might suggest my peptide cream. JG 7.26.09

• I have some dark spots from acne and some PIH from IPL scabbing left over. I don`t want to go back for more IPL right now. I am using hydroquinone to lighten the dark spots. How can I speed it up? I use sunscreen religiously. I wanted to know if I should try alternating retin-A and Hydroquinone every other night or try mixing retin-A, HQ and a steroid cream to make my own Tri-luma instead. Which mode would be more effective? I also have a home microderm tool which I am using lightly to manually exfoliate. Is there anything I am doing wrong or should change? I am olive skinned and the PIH is around the chin, jaw line and temples.

  Answer:  could add some Retin-A to the hydroquinone too. Mix them together, the steoird cream will help the irritation but will not help the PIH. If you can avoid the steroid, do so. I do not think home microderm is a good idea as it might make it worse. It would only help PIH that is very very recent, a few weeks at most, older PIH will not be helped and can be made darker. JG 7.23.09

• Good Morning Dr. Garcia!!! How long should I wait after fraxel (spot treatments) before having microdermabrasion? Also, after the microdermabrasion, when can I resume using Tazorac Gel (.1%)? Thank you :)

  Answer:  I suggest waiting 4 weeks for both. JG 7.23.09

• Thanks for you answer about pink skin from lasers. How long do you think I would have it and which laser and what settings (if that`s the correct word) are best? Thanks so much

  Answer:  impossible to say what the setings should be without knowing the make and model of the laser along with your skin examination. The pinkness can likely take 2-6 weeks, hard fo rme to say more. JG 7.23.09

• What laser will tighten loose skin under eyes. Also, I`m afraid of turning pink, how is that avoided? Thanks!

  Answer:  for it to work, you will have down time and pink skin for awhile so if you cannot toelrate the pink skin, then lasers will not be for you. JG 7.22.09

• What do you think of a laser hair removal device you can use from home called Silk’n? It states it slows down hair growth for one year like IPL lasers. Would you get the same effect as professional lasers using silk`n meaning it might permanently remove hair in some, but not others?

  Answer:  I would not use any home laser hair removal device. It cannot have the same energy as the professional ones so its effectiveness will be quite less. It will never be permanent either. JG 7.18.09

• I had an IPL on my face seven days ago and I still have considerable puffiness under my eyes from it. Should I be concerned about this or will it take more time to go down.- Also, did the IPL do damage under my eyes to cause permanent swelling?

  Answer:  that is unusual, not much you can do though besides ice and tme. I doubt there is any permanent damge, just prolonged healing is all. JG 7.18.09

• Thank for answering my recent question about the redness and light scabbing post IPL. What are the chances that the pink skin under the scab will go back to normal and not develop PIH? is there anything I can do to prevent PIH besides applying Neosporin to the scabs? Should I have my doctor prescribe Triluma?

  Answer:  if you avoid sun exposure the risk should be relatively small. I would not use TriLuma until healed. JG 7.13.09

• I had IPL a few days ago and the side of my mouth toward the chin became realy red and I felt them stinging and burning. I think its because I use a 10% glycolic acid toner around that area more than others. Anyhow, when the redness subsided, light scabbing formed over it. I am not picking at it all but some of it is peeling prematurely revealing pink skin, which is bothering me because I`m afraid that it`ll turn dark soon after. I am an olive complected woman with red undertones. What can I do if anything, to reduce the chances of hyperpigmentation? Steroid cream over the scabs a few times a day? Also, is there anything to speed up the bumps on the chin from plucking ingrowns, that seem mildly infected now? Thank you.

  Answer:  no steroid crema, just neosporin and avoid sun until healed and then sunblock is a must. Might want to call the doctor that supervises the clinic and get some antibiotics to help with the hairs. JG 7.13.09

• Dear Dr. Garcia, I had L/B done 12 years ago which was sucessful. I am now experiencing fine lines and wrinkles. I am not sure how to be rid of them. I have consulted with a PS for a 35% TCA peel. I am also thinking of a fraxel laser for the area but I am fearful of either!! Which do you feel would be safest? The TCA was only $250. Do you think the TCA could make it worse? Which would you choose? Thanks.

  Answer:  I think the TCA peel will do nothing long term for the wrinkles, it will help only while swollen. I think the Fraxel will be marginally better. Just becasue the TCA is cheap does not mean you should throw your money away. JG 7.13.09

• Dear Dr Garcia,What is the difference between fractional CO2 laser, and the repair type? Or the one that states Afirm? how do they all differ? Do you think it is a safe laser for resurfacing purposes? Thanks for your time.

  Answer:  fractioanl and repair types are essentially the same,it is all marketing terminology hype, they only treat a small percentage of the surface of the skin in order to get faster healing, but then you get less improvement too. I think all lasers have risks and treating a smaller surface might injure less skin but can still have risks of changes in pigmentation. JG 7.10.09

• Dr Garcia My hands look so old-thin skin -age spots and crepey skin . what laser may help and what injections would you suggest? Thanks

  Answer:  Might want to try Sculptra injections, there is no laser I would recommend for that, sorry. JG 7.9.09

• DR G::: What is the best laser to thicken shin, esp under eyes and temple area. thanks

  Answer:  CO2. JG 7.8.09

• I am confused. I read that laser hair removal is not permanent since the hair eventually grows back. Today I met someone who told me she had laser hair removal and the hair did not grow back. It has been 5 years since her last appointment. Does laser hair removal work for some, but not others?

  Answer:  in rare cases, especially in fair skinned people with dark hair it can be, alot of it depends on how much hair was there to begin with too. JG 6.24.09

• How will Vbeam or YAG laser help with crepiness? does it smoothe the skin. SLT

  Answer:  no, just redness. JG 6.24.09

• Hello Dr Garcia, I have been advised to have regular radio frequency and use Retin A to maintain a good skin condition (I am 42). I know that you are not a fan of Thermage but are there other radio frequency devices you would recommend and do they all cause fat loss? Thank you

  Answer:  I agree with the Retin-A and I feel radiofrequency is a waste of time and money, sorry. JG 6.23.09

• Hi. I had a photo facial a month ago. After the treatment my brown spots turned black and then went away leaving me with freckle free skin. The problem is that they missed alot of skin and I have these squares on my forehead of nice skin and in between freckles and darker skin. Is this normal and what should I do to get my skin all one color again? Thanks

  Answer:  I suggest in cases of photofacial to treat the entire face for that reason. The color should come back slowly over time though. JG 6.23.09

• dr garcia my friend want to perform tca at home. I cant stop her. Can you please give some suggestions what to do? or not to do? pleaseee....

  Answer:  find a new friend! JG 7.1.09

• Hello Dr. Garcia, hope all is well with you...I wrote in the past about my daughter`s ongoing problem with acne. She is 21 and had fraxel about a year ago. After each of her two sessions she was extremely swollen, red, and there was a demarcation that lasted approx. 6 months (where jaw, etc. meets the neck) I though her face was going to be permantly burnt but it eventually go better. But, although the fraxel results finally looked good (smoothed out the acne scars) after only a few weeks she started to break out a lot and so the new pimples caused new scars again. Does fraxel cause breakouts? Now she is trying isoloz and it seems to help but it is not getting rid of the acne scarring. I just read about levulan used with blue light therapy and wonder what you think of it and if you think it is safe. The doctors that she has seen in New York tell her that she should go on accutane and that it is the best option for a permanent solution. Which do you think is safer and produces better results. My daughter appears to scar very easily every time she gets a pimple it leaves a mark. Her skin tone is tawny and she tans easily. P.S. her sister, has opposite skin tone (lighter with blue/pinky undertones and she just did her second fraxel to get rid of old acne scars and it looks amazing. What should we do for her sister!?!?!

  Answer:  Fraxel does not really cause break outs but it does injure the skin and then the skin needs to heal itself by generating new skin and the skin has to produce oil to do that, and that can cause new pimples or blocked pores to form. I think Levulan for acne is a reasonable option, and in experienced hands is safe, yes. I do think that in some cases, Accutane is the way to go to control the acne long term and prevent further scarring from recurrent cysts. Best of luck to her. JG 7.1.09

• I have read some studies that idicate that facial fat loss is indeed possible with IPL. Lipid peroxidation occurs 6 fold in skin that has been exposed to 9J/cm2 of IPL (a much lower dose than many people receive by they way). This information was taken from a published report entitled Effect of Intense Pulsed-Light Exposure on Lipid Peroxides and Thymine Dimers in Human Skin In Vivo by Sorg et al. Just wondering what your thoughts are on this.

  Answer:  the study you mention does document lipid peroxide elevation, but that is how all ablation works, you cannot remove something without oxidatie damage so it should not be a suprise, it should be expected. Also, no thymine dimer elevation is good. Any method, including surgery, causes oxidative damage for a period of time, but that damage related here shows no correlation to potential fat loss in IPL done in isolation. I would feel comfortable with IPL treatments. JG 6.12.09

• Is there a peel which can be used on the neck, chest and hands that will create a good result? I`m 36 and have had a 25% TCA peel done to my hands because of thin skin but it has done nothing for me. Is the CO2 laser too strong for these areas? Are there other lasers that can be used? Thank you very much.

  Answer:  sorry, but no, there is no peel that will do all of that. JG 6.8.09

• which treatment is better vi peel or tca peel?

  Answer:  depends on the strength of the TCA peel. JG 6.8.09

• hey doc, Its so complicated to find a ipl treatment done in my area... and when getting ipl done for pigmentation, capilaries, and reaching the good result would you need to repeat the treatment every month? or is it till the effects are worn off? I found one place saying ipl treatment is done 3-6 sessions with about 2 -3 weeks apart... and then you wont need any more.. is this right? would you need to repeat this treatment again each month or after several months? or every month? i hope i explained it properly..

  Answer:  typically it is done every 3-4 weeks and then needs to be kept up once you are at the point where it is better, maintainence is about 4 times per year. JG 6.8.09

• sorry, is erbium yag laser the same as yag laser.. we have erbium lasers here alot..

  Answer:  no, erbium is for resurfacing and YAG is for discolorations. JG 6.8.09

• whats are different options for red blood vessels, pigmentation, pores and toning skin? and whats needed for finer lines for a younger patient? im assuming for red blood vessels on face with pigmentation and pores... is a treated different from fine lines and collagen production... if with consistency what are the two seperate options that will be ideal for a younger patient with some visible finer lines from your experience? therefore Im thinking there is 2 treatment involved for pigmentation and the other for fine lines... please suggest something as im so confused with all the options here.. i will like to start a skin maintenance.. but i dont know what to start with... I want to first get rid of the little fine lines and boost collagen and then get rid of the red blood vessels and yellowish look(sun spots)pigments.. and i will be consistent with the effort... please please helppp

  Answer:  try an IPL and use sunblock is where I think you should start. JG 6.8.09

• Hi there! Does a TCA peel cause the skin to age faster? I was just wondering if TCA actually damages the skin because when applying the TCA it causes a burn/trauma to the skin. How is that good for your skin? Thank you for your time.

  Answer:  no, it does not damage the skin nor accelerate the aging process. It is good only for sun spots though, nothing else. JG 6.8.09

• Hi. I had my 2nd IPL treatment 2 weeks and 2 days ago. I saw slight results with the 1st treatment and handled it well so she turned it up a bit for the 2nd treatment. I was expecting to see better results, but so far i am not seeing anything. I thought i saw my blood vessels changing like they did after the first treatment, but they havent disapeared yet. Will it take longer to see results after the 2nd treatment since she turned up the machine? I am going crazy trying to figure out if this is going to work for me. Also, does it usually take longer to get rid of the visible blood vessels than the all over redness? I am so frustrated by this and want to know if i am seeing results or if im waisting my money. Does it fade the redness all over or will i get a splotchy look with white patches? I am so confused. After how many treatments does it usually take to see a difference? Any info on this would be great. Thanks

  Answer:  the results from the series of Plasma Sessions you are receiving are never meant to see a difference after this period of time, the three sesssions done 2-3 weeks apart, which is the usual procedure will nto yield its maximum improvement for 4 months or so. If they went deeper the second time the healing will be a little slower, yes. The redness will in some cases take a full month to go away. JG 6.4.09

• Which laser(s) can reduce redness in new scars?

  Answer:  YAG and VBeam. JG 5.31.09

• Dear Dr. Garcia Can laser treatments be done on just the forehead or is it advisable to have the whole face lasered at the same time? Thanks Annette

  Answer:  depends on the depth used, the lighter you go the safer it is to just do smaller segments. JG 5.27.09

• Thanks for your quick reply Dr. Garcia regarding my 4 pink fraxel spots. When can I resume using my Differin Gel? Thanks!

  Answer:  10 days or so should be enough but it might make them stay red longer. JG 5.26.09

• ok, do yu know anyone in Newyork that does tradional co2 laser?

  Answer:  I am sorry but I do not know the answer to that one. JG 5.24.09

• I wear 30 spf in the sun but I am one with darker pigment who tans VERY easily. Does the tan mean I am doing damage to my skin?

  Answer:  tan is sun damage, yes, you need sunblock, not sunscreen. JG 5.24.09

• How long should I wait for a repeat VBeam laser to the same area of the face? Thank you.

  Answer:  4-6 weeks. JG 5.22.09

• Hi Dr Garcia, I have had two treatments of Diolite laser to help resolve fine capillaries and am left with atrophic scarring, little pimple or milia like formations, hyperpigmentation and a deep redness. After the first treatment my skin blistered and I was left with scabbing. I followed all of the dermatologists instructions on aftercare eg. antibiotic cream, sunscreen etc and have been extremely careful of keeping out of the sun. It is now 5 weeks post treatment and the veins have come back. Is there any hope for me and do you suggest an alternative treatment?

  Answer:  I am sorry to hear about your problems, might suggest to have them hyfercated but understand that eventually, no matter what you do, they will come back, there is nothing permanent, sorry. JG 5.18.09

• Dear Dr. Garcia Thanks for your quick answer. Would going out in the sun (you said it could help) for the erbium laser pigment issue be a permanent fix or always just temporary?

  Answer:  well, it wil tell us if the melanocytes are stil workigng and if it helps, you might have to intermittently use a little sun. JG 5.17.09

• High Energy PSR - I am having this done in 2 days. Can you share with me the best aftercare tips on healing/recovery? I know to use vinegar and water as well as aquaphor but is there anything else I need to know and or do at home? Will I need a painkiller to help selp at night?

  Answer:  we prescribe low dose pain pills, although most people do not need it, we also give antibiotics and antivirls to avoid infections, and we use copper peptide creams after the first 24-48 hours. JG 5.17.09

• What do you think of the radio surgitron for the removal of flat moles?

  Answer:  works to flatten moles but if used to remove the entire mole will leave a scar like all others. JG 5.16.09

• To my horror, I found out recently that my daughter started injecting a new tanning method called melanotan 2, which apparantly actives melanin in the skin and makes a dark tan easily acheivable. Any last night she came over with a horrified look on her face and immediately I noticed her face was covered in many freckles and moles that she did not previously have. This had all occured within only two weeks of her injecting the substance! Do you think these will require lasers to remove or do you think they will go away with discontinued use of the substance? Thank you.

  Answer:  yes, lasers might be needed but they also might come back with sun exposure in the future. JG 5.13.09

• I had my first IPL treatment for redness and blood vessels and 4 days later i had to put my dog down and i cried pretty hard for a few days straight. I was wondering if all the crying could have effected the healing of my IPL and caused it to not be as effective? Thanks

  Answer:  no problem with the IPL but my condolences are your loss. JG 5.12.09

• I just had my first IPL treatment for redness and blood vessels a week and a half ago. I am wondering when i will start seeing results? I think i see an improvement in the vessels and some redness. Am i just fooling myself? Does it not work that quickly? I am driving myself nuts trying to figure out if this is going to work for me or not. If i do not see an improvement after the 1st treatment does that mean it is not working?

  Answer:  it usually will take a series of treatments so I would not expect much at this point. Need to have more of them done. JG 5.8.09

• Is there any treatment that can tighten sagging skin around mouth and jawline? What do you think of BBL?

  Answer:  would need the skin lifted surgically for that to improve. JG 5.8.09

• I am having a profractional treatment in 10 days. they have not provided pre-procedure instructions, but from reading on this site, do I need to discontinue vitamins for this procedure? I take quite a bit of vitamins in therapeutic doses, including omegas, SamE, B, D, CoEnzeme, etc., so I though I should ask if necessary to get off them. Also if I have to stop, for how long and when can I resume taking them.

  Answer:  should be OK to take the ones you mention. JG 5.6.09

• Thank you for a great service. I am getting a profractional laser treatment done in two weeks. I know you are not a fan, but I have had this laser several times with impressive results and it really improved the appearance and firming of my skin. In two weeks following the laser, everyone comments on how great I look. So I feel it has been worth it. My question is I just had botox and juvederm put in by my dermatologist (a separate doctor), and it will be 3 weeks in by the time I have the profractional. Will that affect the longevity of the juverderm in particular? Or the botox? Thanks in advance for loggin in on this concern.

  Answer:  it should not affect the fillers or the Botox, all the best. JG 5.3.09

• Hi Dr. Garcia, Thank you in advance for taking the time to respond to my question. What is your opinion of the Titan laser for reducing wrinkles under the eyes? I previously had 2 treatments with the Portrait Plasma with minimal improvement. Thanks again!

  Answer:  you will likely get less with the Titan. JG 4.30.09

• Dr. Garcia, Is there ANYTHING that will get rid of fine crepey lines (more crepey than actual lines) directly under (no lines laterally) the eye for more than a year or two? I realize normal aging commences after any procedure, but I would expect a little more longevity than a year or two. Wrinkle reduction for 4-5 yrs would seem more like normal aging - the 1-2 yr longevity of results of these types of procedures seems hardly worth the effort and certainly makes me wonder if there`s really any wrinkle removal or if the effects are mainly due to dermal edema for a yr or two (afterall, one would expect longer lasting swelling with deeper skin rejuvenation procedures). Well, what`s your opinion? Thanks in advance!

  Answer:  no there is not, sorry. Once your skin has aged to the degree that the wrinkles are seen, it shows that the reparative properties of the skin are reduced, there is no technology at present that will yield a 4-5 year length of improvement.

• Hello Dr. Garcia, I have the early stages on Rhinophyma, transient swelling, flushing of the nose along with a raised patch of skin or bump on the right side with some enlarged pores on it. I understand that Co2 is likely the treatment for pronounced Rhinophyma but seeing in that I am in the early stages, what can I do to stop it from progressing and to stop the transient swelling and redness? Also, is there anything I can do to help smooth out the dime size raised bump on the one side? Co2 makes me nervous and seems a little drastic in the early stages...any other lasers to help treat a relatively minor or early bump from Rhinophyma? Would a low strength topical retnoid like Differin cream help at all in the early stages? Curious for some info...thanks for your time.

  Answer:  can try a series of IPL treatments in the meantime. JG 4.25.09

• You said it would be ok if i got IPL treatments while on bactrim DS and i am also on retin A. I just started the meds a week ago and i am just wondering if it will make me more likely to burn or scar? I am so worried about this. I dont want to scar or disfigure my face and i know these meds can make my skin more sensitive to burning.

  Answer:  you need to stop the Retin-A for a couple of days before and after the IPL, the Bactrim should be OK, but if you are concerned, you can stop that too. You will need to do so everytime you have the IPL though. JG 4.24.09

• Can i have IPL treatments while on Bactrim DS? I just started it a week ago and am getting my first IPL in a coupl days. Thanks.

  Answer:  should be OK to do. JG 4.24.09

• The sciton laser this doctor is promoting is a profractional? Would you recommend this one? If not what laser would you recommend?

  Answer:  would not recommend it. I normally would use a totally ablative CO2 laser for significant improvement or a Rhtyec Portrait for something lighter. JG 4.24.09

• Dear Dr. Garcia, are there any lasers in the industry that create face tighening opposed to a face lift? A dr. I went to who does a lot of laser work told that face lifts are becoming a thing of the past due to facial distortion. I still feel that a face lift is the only thing that can help with sagging. Your thoughts please--thanks for all your help.

  Answer:  no, there is not bacause a facelift removes excess quantity of skin and also repositions sagging tissue below the skin. Lasers improve the quality and not the quatity of skin and do nothing for the tissues below the skin. That is the fact, and more experience with lasers does not make the machine do something it cannot. I do agree with the doctr`s interpretation that poorly done facelifts should become a thing of the past, but claiming that lasers will replace facelifts I think is a completely selfserving commnent, one I would expect from someone who does not perform facelifts and is a smudge on his reputation as the more expereicne you have with lasers, the more you should know the facts. is expereicne coems form years o fusing lasers, always new and improved ones ad if htey were so great there woudl be no need for new lasers. I suggest you see, in person, a plastic surgoen who performs both facelifts and lasers for an unbiased answer. JG 4.23.09

• I had microdermabrasion and before getting it i over used my peeling milk face wash pretty badly. Now i have a lot of redness in my face and broken capillaries on my cheeks. I am also breaking out on my chin/jawline area. My dermatologist didnt think it was rosacea. He gave me retin a for the breakouts. I have used it once and can see it is already clearing up the breakouts. I am concerned that it will worsen my reness and broken capillaries. I am getting IPL treatments in a week for the redness and blood vessels. I am concerned about using the retin a while getting ipl for redness. I plan on using the retin a every third night since it seems to work fast to lessen irritation and redness. I am just wondering your opinion on this. Should i keep using the retin a after my ipl treatments? Give it a week or more off? stop using it all together? The retin a is the only thing that really seems to be working for the breakouts and i would like to use it, but i am very bothered by my redness and dont want to worsen it or cause the ipl to be ineffective. I have been an emotional mess by the breakouts and redness for a long time and this dermatologist finally had some answers, i left there feeling good, and then i started reading about how retin a is irritating and causes redness. Thanks for any advise or info.

  Answer:  I would stop everything, let your skin heal and then re-evaluate things. JG 4.22.09

• how safe is IPL treatments on the face? also do they help broken capillaries on the face along with redness? I am going in in a week and i am just freaking out. So scared. I have read about fat loss and scarring and i am wondering how often this happens? and what causes this?

  Answer:  in experienced hands it is quite safe. It does help the broken blood vessels on the face, yes. There have been no documented facial fat loss cases with IPL alone. JG 4.22.09

• Hi. I just went to the dermatologist for some acne and facial redness and veins. He put me on retin A. I am starting out by putting it on every other night. I was wondering if this is ok to use since i already have a problem with redness and veins. Will this make it worse? I am also on bactrim DS. I am going in to get IPL treatments in a week and i am wondering if i can use the retin A after the IPL treatments while my skin is heeling? Will the Bactrim DS or the retin A be harmful or effect the IPL treatments in any way or will it effect my healing after? Thanks so much.

  Answer:  It will help the acne and make the veins and redness worse. The IPL will help with the redness and the veins but as long as you are on Retin-A I think the IPL will be a waste. The Retin-A needs to be stopped two day before and after the IPL, sounds more like Rosacea than acne though. JG 4.21.09

• Thank you Dr. Garcia on answering my question and for your patience as I ask another question that my girlfriend was looking for my opinion on. Have you heard about the procedure called Refirme? see attached commentary I found on web ReFirme is a FDA cleared non-invasive Skin Tightening procedure* featuring the revolutionary elôs™ technology that enables you to comfortably achieve a more youthful, toned and lifted appearance without enduring downtime. ReFirme is a complete anti-aging solution for targeting those telltale signs of aging, including, jowl and neck laxity, sagginess under the eyes, saggy brow lines, and nasolabial folds. Unlike conventional laser skin tightening treatments that are time and treatment intensive, and often too painful for many patients; ReFirme offers virtually painless and fast treatment for sagging and wrinkled skin. Thank you again Dr. Garcia, ladybird

  Answer:  I would skip it, I have not been impressed with their results, especially longer term. JG 4.20.09

• Dear Dr. I was wondering the difference between the fraxel repair laser and plain fraxel. My dr. whom did a lower/bleph many years ago is well known. He has always used the regular CO2 laser which he still has, but is now doing a fraxel repair with great results with much less down time. You seem to dislike this laser if I understand your replies correctly? I was shown pictures in the office, and the results looked good. Your thoughts please. As always thanks for your time.

  Answer:  as to the Fraxel laser, make sure when they show you pictures, they are at least one year after the Fraxel, that is when you will see the real result, all lasered patients look good three months after, it is what they look like 6-12 months later that tells you whether it was worth it. JG 4.17.09

• I have been using clindamiacin lotion at night for about a month and a half now and i see no improvement. I think my breakouts are clogged poors, since i see the clogged poors coming and then they break out. Proactive seems to imediatly start clearing them up, but i had a bad microdermabrsion job a year ago and have a lot of redness and broken blood vessels from it, and the proactive isnt good for the redness. Before the microdermabrasion proactive worked wonderfully if i had a breakout and now i cant use it because of the redness. I am not sure what to do. I have been using the proacyive in the morning only every couple days and then cetaphil gentle skin cleanser at night and on the days i dont use the proactive and it seems to be clearing up the breakouts, but i am concerned about the redness. I am going in to see about laser treatments for the redness. After the laser treatments will i be able to use the proactive to get rid of the breakouts? I dont think i have rosacea.

  Answer:  shoudle be able to do so after the laser, best of luck. JG 4.16.09

• Hi. I am going to see about laser treatments for the redness in my face and broken blood vessels. They offer iridex laser, im not sure what they will use on me, but i know this is one they have. I have been reading a lot of reviews from people who had laser treatments who had really bad experiences with them. Bad scarring and burns and fat loss in their faces. I am so scared! I dont know what to do. I cant live with this redness, but i dont want to disfigure my face! Do you have any advise for me or anything? i dont know what to do. I am always in tears about this. thanks.

  Answer:  I think the Iridex is commonlly used for broken blood vessels. As to hte negative comments on the web, remember, happy people rarely post things on the net, so you likley have a slanted opinion regarding potential resutls. JG 4.16.09

• I would like to have Co2 Faxel laser done on my face and neck. Who would you recommend to perform this treatment in the San Diego area. I also have a 27 year old daughter with acne scars. What procedure would be most effective. She is on a budget. Thank you

  Answer:  sorry, but in my opinion,as I think it is a waste of time, I would not suggest you have it done. JG 4.16.09

• I am young and looking to adress some superficial fine lines and flat moles I have aquired from sun exposure. I understand that the advantages of C02 over Erbium are in terms of skin tightening, but I am not looking for skin tightening at my age, so in theory, would Erbium work as well for superficial texture? also, how deep would have to be gone to remove flat moles?

  Answer:  in your case Erbium might be a reasonable option, as to the flat moles, the Erbium and CO2 will not do much, could darken, them too. They will either need to be cut out or lightened with a YAG laser and it will nto be a permanent lightneing and will nedd a series of treatments.JG 4.15.09

• I had my derm blast a blemish/spot on my chin with IPL in the hopes that it would lighten it. She went over it 3 times and it became really red and felt burnt at the time. However, she was right, it just scabbed over and the scab fell off after a few days. Now, the mark is twice as big, in fact, there are two marks, both white in the middle with a very dark border around them so it looks worse. Should I have my derm treat it again with IPL, this time more gently? Or leave it alone and let it heal and fade? Is the whiteness going to blend in as the dark border lightens too? I`m a medium olive complected woman.

  Answer:  well, first of all, I think you should not be telling a professional like a dermatologist how to treat something, that is their job. Secondly, I find it unbelievable that the dermatologist would do something at your request when they should know that a triple pass with an IPL is likely not help to fade anything faster or more effectively and is likely to cause harm and further problems. For now, I would let it heal and not continue to irritate it, and I strongly suggest you get a second opinion on your problem. It might get better, all depends on how strong the IPL was set for, but when there is scabbing, there is a chance, especially in olive skinned people and darker that there might be some permanent color loss. JG 4.14.09

• Which is the best and fastest way to clean up the pores, babnd bhopefully shrink their appearance as well as eliminate blackheads? Microdermabrasion, A facial with extraction, or a chemical peel? Thanks

  Answer:  all of those will help, they can be combined. JG 4.14.09

• Dr.Garcia, what procedure is more effective for skin rejuvenation: MDB or peel(which one and what %)? Thanks.

  Answer:  a phenol peel is the msot effective for wrinkles but has serious down time, as to the peels, they are good for pigment problems and the microdermabrasion is good for recent sun damage and for pores. JG 4.13.09

• vinegar girl here-- i was just concerned that when i used toomuch of the vinegar if i did permanent damage, like a burn,, is that possible? just worried

  Answer:  not permanent, just temporary. JG 4.13.09

• what is the best way to reduce dark hair on upper lip?

  Answer:  waxing or electrolysis. JG 4.12.09

• I have been doing electrolysis for 2 years on the upper lip when I suddenly started to have hair. All hormone tests have shown to be normal (although I still think there is something going on). I tried IPL originally and the first experience was very scary as I went through a shedding phase (dark hair? dots? on skin that came to the surface) that lasted for a week. I never went back to do IPL again. In the last 2 years the hair has gotten finer, but there is still dark hair that grows. Has there been imporovements in IPL? I am a 30 year old white female. What would you recommend?

  Answer:  IPL will never help reduce hair, sorry.JG 4.12.09

• Dear Dr. Garcia, What are your thoughts on the ActiveFXDeep fractional CO2 laser. A Dr. is advertising safe, 12 minute in office procedure. I am interested in my under eye area only. They are saying the down time would be one week. Your thoughts please. Thank-you so much.

  Answer:  safe, likely yes, 12 minutes,yes, effective, I do not think so, sorry. JG 4.9.09

• hi. sorry about all the questions, but you are very helpfull. I am 25 years old and going to the dermatologist about laser treatments adn i am very nervous. My mom is going to come along with me and she is planning on coming into the appointment with me to help me remember any questions i have and remember what the dermatologist has to say and just for suport. we are wondering if this will be weird or if many people have friends and relatives come in the appiontment with them. i have just been thru a lot with my skin in the last year and i get a little intimidated sometimes. i went to a dermatologist a few months ago and was very disapointed with how he handled my situation so i am going to a different one. thanks

  Answer:  no, it is common to have friends or family come. That should not be a problem. JG 4.9.09

• hi. I was just wondering if dermatologists keep before and after pictures of laser treatments for redness and is it ok to ask to see them? Also is it ok to ask about their experience with the lasers? I am not sure what to expect. Also when i go to see about laser treatments will he just look at my skin and decide if it is a good option and make the appointments for the laser? I am not familiar with how this works and i am hoping to get the laser treatments started as soon as possible. Thanks!

  Answer:  I think many do have photos and it is certainly OK to ask to see them. I think it is also OK to ask about their experience level with the treatment proposed. A consultation first to determine if you are a good candidate for the laser is typical. JG 4.9.09

• hi. I have a pail complection and am hoping for laser treatments for my redness. I was just wondering how many treatments it usually takes to see results with the iridex laser? Also can it make me breakout? Thank you so much.

  Answer:  no way to tell because it depends on your ski and the energy used, there is no set number. JG 4.9.09

• hi. I am on minocycline 50 mg twice a day and clinamiacyn lotion at night and have been using it for about a month and a half and i still am not noticing a difference in my breakouts. They dont seem to be getting much worse or better. How long will it take for me to see my skin clearing up? also will my dermatologist do laser treatments for my redness while i have some breakouts? The breakouts arent too bad, but enough to bother me. thanks so much

  Answer:  if by 6 weeks it is not helping you will need different things. No reason not to do the laser for redness if you are breaking out. JG 4.9.09

• The redness in my face was caused by over using a peeling milk face wash and then i had a microdermabrasion and it did blood vessel damage in my face quite a bit. If i get the laser treatments and then i am much more gentle with my skin will the redness come back? Before the microdermabrasion i had pretty nice skin. Thanks for your advise.

  Answer:  maybe not in that case. Best of luck. JG 4.8.09

• Hi. I want to get laser treatments for the redness in my face. There is quit a bit of it. Are there any risks with the iridex laser and what are they? I just worry about making my skin worse than it is already. do these lasers really work at removing the redness? I need to know what i am getting into before doing it. Thanks

  Answer:  at times some people will get a little scabbing, and there are a smaller number that have pale splotchy skin for awhile. Nothing that can be done will improve it on a permanent basis though. I think Iridex is good, as is a YAG laser and a VBeam laser too. JG 4.7.09

• Hi. I just have one more question. I was wondering if any medications i am on can affect the outcome or make the dermatologist not want to do laser treatments on my face for redness? I am on minocycline orally and i use clindamiacyn lotion.

  Answer:  they might put you on sunblock and a bleaching cream is all. JG 4.6.09

• Dr. Garcia, I am Spanish, 63, and have an olive tone of skin. I would like your best recommendation for if/how I can have my face wrinkles reduced. I had a couple of Glycolic chem-peels done for my melasima. Because of some accidental burning by my doc (now recuperated completely). I now offered some free chem-peels, but I was wondering if I should have some other treatment for wrinkles after the peels or instead, and which ones to request that would be safe for my skin. I have very soft to touch delicate skin (never had hair in arms,legs,etc). Should I wait for a while, how many treatments for best results, recuperation time, would lasers be effective? We plan to move in a year and want to finish treatment. About how much is cost? Thank you for your help.

  Answer:  microdermabrasions and very very light glycolic peels and maybe Retin-A with sunblock is about all I would suggest with your skin. All the best. JG 4.6.09

• Hi. I have written a few questions to you and love that you answer so quickly. Thank you. I have another question. I am going to the dermatologist in about 2 weeks to see about getting laser treatments for the redness in my face. I just want to know if there is any reasons he would not dot the laser treatments on me and do laser treatments? The redness is has been very hard for me to deal with since i do not wear makeup and this visit is my last hope and i am very worried he wont do the laser treatments for some reason. I just want it fixed. Its been very hard. It was caused by a bad microdermabrasion. Im only 25. Thanks

  Answer:  usually the redness is not a problem. If it is Rosacea they might suggest lighter treatments like IPL. Best of luck. JG 4.6.09

• ok, i am a doctor , and i have a co2 scheduled for thursday and am taking off thurs, fri, sat, and sunday i will be seeing patients on monday.. what opinion do yu have for me.. will i be able to see patients? what do yu suggest.. it is going to be deep non fractional co2 for lower face only?

  Answer:  I think if it is a deep non-fractional CO2,if it is done at much past 50-75 microns, you will not be able to wear makeup in that time. Sorry. JG 4.5.09

• Hi. I am going in to see about laser treatments for my facial redness and veins in my face. My dermatologist offers the iridex laser. WHat kind of laser is this? I heard the pulsed dye lasers are best for redness. Is there any possibility that it could make the redness worse? Im scared. Thanks

  Answer:  should work for that, it is used for veins mostly. Do not think it will make it worse. JG 4.2.09

• Thank you so much for your prompt response one important for Acne scars what is the best procedure my scars are now pretty acceptable with makeup I look fine Thanks again Doctor Liialna

  Answer:  I feel regular, non-faractioanl CO2 is the best. JG 4.2.09

• I asked you below if I should switched the fraxel for Juviderm or the smartest think will be continue doing my microdemabrassion with salycil adid ?? pls kindly advise liliana

  Answer:  use the micorderms and peels and the Juvederm. JG 4.2.09

• Thanks for answering so soon, I have schedule another Fraxel for May 9th because it was prepaid so I get a special price. Do you think that Instead to do this fraxel I should do Juviderm I will see better results ??? I will wait for your advise. my skin is pretty good. Thank you liliana

  Answer:  they do different things, but if you have a need for Juvederm, that is likely more worthwhile to have done. JG 4.2.09

• Dear Dr. Garcia my problem was the acne scar I am a 43 yrs old women with Olive skin I did 4 series of Fraxel two years ago up to 40mj People said that I got improved a lot.that I look great . but after those series I had a 5 series of microdemabrassion along with salicylic acid it was a blessing because the acne on the chin got much better and muy whole skin looked young I got confussed I do not know if it was the Fraxell or Microdemabrassion who got my skin so good. but Doctor said it was the Fraxek What do you think ? finally last december I search in the internet and start using Zinc vitamic 50 mg Betacarotene 10000 iu Primerose oil 1000 mg and magic my acne on the chin gone I was doing as a maintance once every month and a half one microdemabrassion to keep my skin clean . Now March 14 I went to a same dermatology and he told me my skin look pretty good it was up to me if want to do another last two series of Fraxel or do Juviderm or nothing .. so I choose Fraxel I did Fraxel( 5th one after two years ) level 6th 60mj pretty strong I read on the internet that improvement will be up to six months since collagen continue to built Last Fraxel is schedule for May 9th and that`s it I will go back to Microdemabrassion.. Question my doctor said to Stop microdemabrassion until finsih the treatment but I see that I am breaking out with acne ??? I think from March 14 until the next fraxel is too long without Microdemabrassion Your opinion will be much apprecciatte it.. I am using clenziderm for acne treatment the cleanser the toner and vitamins and today I use Retin A next fraxel is schedule May 9th Pls advise what is what really worked on me Fraxel or Micro as I mentioned I had 4 fraxel two years ago and when I was done only a 5 series of Micro and a maintanance after for once every two months Pls kindly advise Thank you Liliaan

  Answer:  more likley it was the salicylic acid that helped control the acne. I think Fraxel might have helped some with the texture, to a small degree. I am not sure if your skin was better with all that you have done why you would do another Fraxel. I think the microdermabrasions and the salicylic acid will help control your acne so I think that is a good thing to continue. I would skip the Fraxel as you can see, although it might have helped your skin feel better, it did nothing to control your breakouts. JG 4.1.09

• After 3 rhinoplastys, its been 18 months since the last one, my nose is red with broken capillaries. I also have artefill in a small dent. I would like to have my nose lasered. I read that the pulsed dye laser does the best job, my doctor only offers Genesis and IPL, are those dye lasers? Will it affect the artefill? What would be the name of a pulse dye laser?

  Answer:  the IPL wil help some. It will not affect the Artefil, the pulsed dye laser is a diode laser, but a YAG laser or VBeam laser will do as well if not better. JG 3.31.09

• Dr. Garcia, In regards to the upper lip wrinkle questions I have been asking...if the lines were eradicated by a laser, would there still be the dynamic wrinkling when you talk? Also, would the lines of demarcation be permanent or can they be feathered like they say at the time of the lasering so they will blend in? Thank you so very much. I am about to take the plunge.

  Answer:  yes, there will still be dynamic wrinkles, no way to ever remove them. The lines of color demarcation should not be permanent unless it is done so deeply that the pigment is loss, but that is rare. JG 3.31.09

• Hello Dr Garcia, Which laser or light therapy works best to reduce ance? thanks

  Answer:  I feel CO2 works the best to correct the scarring, some people believe that acne can be contolled with a blue light laser but I have not seen it work. JG 4.1.09

• Dr.Garcia what procedure with a 2 week recover time would you suggest for very fine lines for under the eye area? Would a CO 2 laser be to aggressive? Or a fractional laser be more effective with less down time? I will only have a 2 weeks period for recovery for an event. Thank-you.

  Answer:  the Fractional will heal in that time, just the degree of imnprovement and the length of time it will look better is less, but with only two weeks of downtime, you might not have any other choice but to accept the compromise. JG 3.30.09

• Good Evening Dr. Garcia. I hope you are doing well! I had my 1st of 3 fraxel treatments 3 weeks ago on a few scars on my face (just spot treatments, not the whole face). I`m going on a trip in May, so I won`t have my 2nd treatment until I return (mid-May), then I`ll have my 3rd treatment the end of June. Would it be safe to have a microdermabrasion treatment (with a diamond tip wand) on my entire face in April? Thank you :)

  Answer:  likley safe, yes. JG 316.09

• Dr. Garcia, does the CO2 laser peel cause more elastin to be deposited as well as more collagen? Also, do you know if the collagen/elastin deposition causes a greater amoint of collagen/elastin than the amout with which one starts? (In other words, is there a net gain?) Also, do you think it`s possible the improvement seen with a CO2 laser peel is mainly due to miniature scarring as with phenol peels? If so, is there a chance of aging faster since scar tissue is less elastic and doesn`t have the tensile strength that normal dermal tissue has? Thanks in advance.

  Answer:  to some degree but the effects on collagen are more intense. It will never get you back to the normal amount of collagen/elastin you had in youth though. There is always a net gain though from where you start. The pathology slides that are done after one year in properly done CO2 lasers do not show the scarification that phenol peels do. Scar tissue is less elastic but also does not sag as fast. JG 3.15.09

• Dear Dr. Garcia, I have fine lines under my eyes. I am having a 35% peel done by a PS---he said that or a laser would be fine, they are not that bad at all. I had a lower Bleph in 1996 but of course I continued to age. (A good thing Better than the alternative.) At any rate would Emu oil be good to use after healing as a moisturizer for the under eye area? I am hoping this will the last time I need to address this area! Thanks.

  Answer:  might be a good option as to the after treatment, all the best. I will say though, you will need more in time, especially in that area and with a 35% TCA peel, expect to need something in 18 months or so. JG 3.15.09

• Hello again, Would CO2 laser cause an existing granuloma from a permanent product in the lower eyelid area to increase in size due to the stimulation of collagen? Thank you

  Answer:  should not. JG 3.12.09

• Hi Dr. Would Medlite laser over a series of sessions create sufficient collagen comparable to one session of CO2? Thanks

  Answer:  never. JG 3.12.09

• what would be your best recommendation for treatment of the neck for wrinkles and creping of the skin. This area really bothers me.

  Answer:  I feel creams and lasers offer little and surgery will pul the skin tighter but will not imprve skin quality, so improvements will not be dramatic, sorry. JG 3.12.09

• Hi. I was just wondering if there are any reasons that would make me not a good candidate for iridex laser treatments for all the redness in my face and are there any bad side effects that could happen? thanks

  Answer:  I think it is worth a try, it is usually well tolerated. Best of luck. JG 3.12.09

• I forgot to write- do you need to leave or shave your hair for a diode hair removal laser?

  Answer:  leave a very small amount. JG 3.12.09

• I know there are some hair removal lasers which you need to show hair and there are some you need to shave your hair. For a laser hair removal session, do you know if you need to shave or leave your hair?

  Answer:  a small short stubble is best. JG 3.12.09

• Dear Dr. Garcia. I`m scheduled for a 20 % TCA peel in two weeks. Now I have read all your comments on TCA peels and that they don`t do much for wrinkles, pores and scars. My questions are: Will a 20% peel do much or is that considered a light peel? Or can more layers be applied for a more efficient result? If so, how many layers? What percentage can be used on the neck and chest if the skin is a little crepe? And will the peel renew the skin and make the crepe look go away? Thank you so much for your time, it is greatly appreciated.

  Answer:  it is considered a light peel and will likely help some brown spots. I think the only chemical peel that helps wrinkles long term is a phenol peel which is rarely done anymore as most of the improvement is from miniature scarring of the skin. I think the improvement in the crepey skin will disappear with the swelling. JG 3.10.09

• Dr. Garcia, Several Q`s please. First, do you think the improvement after a decent CO2 laser peel could possibly be nothing more than subclinical dermal sweeling that lasts a year or two? I guess what I want to know is do you think it`s possible the good efects of a CO2 laser peel should last 5 yrs if due to real improvement on a histological level? (It seems to me if the effects are true thickening of the dermis - rather than just replacement of what was lost during the procedure- PLUS, true reorganization of collagen and also presumably, better, tighter elastin, then I can`t imagine being back to square one in just a couple of yrs - would think at least 4 or 5 yrs). Beyond that, my main concern would be possible long term bad effects from any kind of peel, including CO2 laser - such as perhaps a NET thinning of the skin and no real improvement in elastic quality (and, if so, both combined, I would imagine would serve to, over time, hasten aging of the skin). In any event, overall, if there are no real histological bad effects from repeated peelings (of any sort), then even if merely sublclinical edema, I`d be happy to undergo repeated procedures over the years as long as I looked good in the interim. However, of the net overall effect is to somehow accelerate apparent aging, I`d prefer to age as is (as in the lesser of two evils, so to speak). Also, do you know of any long term scientific research I could peruse. Am most interested and hope to make some decisions based on both empirical observations with experienced persons such as yourself combined with data from long-term research. Many thanks in advance. :)

  Answer:  medical studies show significant dermal collagen remodeling at one year with a CO2 so I do not think there is any residual swelling after one year than can casue the improved appearance. How long it lasts depends greatly on how fast you yourself are aging, that is the great unknown. Your aging speed will determine how fast collagen and elastin is lost and then control the longevity of the procedure. The net bad effect would only enter into play if there is scarring, there is no thinning of the parts of the skin as the skin regenerates from the basal layer. You can see medical articles under Google Scholar and type in CO2 laser effects. Best of luck. JG 3.10.09

• I had IPL treatment to remove the broken red blood vessels on my nose and after 6 months they came back. What treatment do you recommend to permanently remove facial small red blood vessels?

  Answer:  sorry, nothing permanent. JG 3.10.09

• SORRY, I meant focal TCA indeed, but it`s not CROSS TCA, I missed the word CROSS in the start of the previous question!!!

  Answer:  I think repeating it too soon can lead to scarring and unecessary repeat treatments. JG 3.7.09

• Dear Doctor :), normally, after a TCA focal peel of around 35% (not TCA, but because of particular issues, the derm uses it only focally), how long does the skin take to heal enough / the collagen to improve or buildup enough as to have a second pass of TCA? I was told that peels that are made quite close one to the other are better to accelerate the process of regeneration of the skin (sort of get the skin into the regeneration mode continously). I must schedule peels but need to know how little I can wait between treatments to plan the appointments. I know your answer can only be estimate, but how long does normally take the collagen to regenerate enough as for other application of an acid to not kill the new collagen but kickstart even more collagen production? I am talking of TCA, but is it the same for other acids or concentrations? Hugs!

  Answer:  I would not repeat a 35% TCA peel for 6 months. Lighter peels can be done more often. JG 3.7.09

• Hi Dr. Garcia... Want your opinion please. I did a 35% TCA peel until it frosted to level III (and a good solid plaque at that, all but but going greyish; which I know is getting too deep. At any rate, I did it about 3 weeks ago under my eyes only (up to about a mm or 2 from my lower lases and to down beneath where people get malar bags, so it was a decent sized area), AND it looks great. It took 6 or 7 days to crust/become brown and a total of about 12 days to be completely scab free. I`m thinking the good results might just be swelling/edema (still have loose skin that bunches upon smiling, but not a line in sight). I`m thinking I got into the upper recticular dermis and maybe even a little into the mid portion, so I`m hoping it`s actual wrinkle amelioration (as I said, not a wrinkle in sight), but do you think the improvemwnt is still an artifact of swelling at this point? BTW, I am still a deep pink in the area and expect to be for the next month or two...although no where near as maroon as I was after the initial re-epitheliaztion. Would love your opinion. Thanks much.

  Answer:  sorry to say that in 34 months you will be back were you were before. JG 3.8.09

• Is there any other laser besides CO2 you would recommend for removal of fine lines and wrinkles for the under eye area? One that has less down time?

  Answer:  a Rhytec Portrait but it is not technically a laser, but works in a similar fashion. JG 3.5.09

• Hi. I am 25 years old and almost a year ago i had a microdermabrasion at a new place that had just opened. It was not a dermatologist who did it. It cost me $50. Before the microdermabrasion i was using a face wash called a peeling milk. I am pretty sure i had over done it with the peeling milk before having the microdermabrasion. After having the microdermabrasion my face was very red and raw and broken out and they broke a lot of blood vessels in my face. I am pretty sure my skin was severly over exfoliated. They gave me no directions on how to care for my skin afterward. I went home and started using proactive to get rid of the breakouts, which was working, but after months of using it i realized the redness, although it got a little better, wasnt going away. So i stopped using that and started being gentle with my skin. The breakouts started getting worse again. I am pretty positive i do not have rosacea. I researched that and it isnt like that at all. I am on minocycline and cyindamycin lotion for the breakouts right now and in about 2 months i am going in to see about laser treatment for the veins and the rest of the redness. The laser they provide is Iridex. I was wondering if you though that i would be a candidate for the laser and is that a good laser for my veins and the redness?? This has been very frustrating and hard to deal with since i do not wear makeup and before the microdermabrasion i had nice skin, with the occasional minor breakout. Any advise would be helpful, i am very confused. Thanks

  Answer:  well the Iridex is a good laser for that problem but I probably would go to a different place than the one you first went to. JG 3.5.09

• You wrote that the Alexandrite laser is the best for hair removal. However, does the diode laser work for hair removal? Does it take longer, but still work?

  Answer:  it does work but can cause some hyperpigmentation or dark spots to form, but all lasers have that potential risk, just some less than others. No laser will permanently remove the hair, just so you are aware of that also. JG 3.5.09

• I had an IPL session (2 passes to be exact) with Lumenis One today and drove back home on a very sunny day. I didn`t wear sunblock stupidly and hit traffic which prolonged my sun exposure (an hour or so in my car). Does that undo my IPL session or do further damage instead of helping my skin repair? My main concern for having the IPL done is Rosacea and redness in scars.

  Answer:  I think the damage if any wil be small. Be more prepared next time I guess. JG 3.5.09

• Hey Dr. G, tonight on the news it showed Fraxel (and another laser I don`t think they named) as a way of improving stretch marks. I noticed you don`t have a big opinion of Fraxel - but will it work on stretch marks? If not, is there anything that will? Thank you!

  Answer:  no, I do not think Fraxel will help stretch marks and at the present time, since a stretch mark is essentially a scar, there is nothing reliable. JG 3.5.09

• 1. What do you recommend for lines and wrinkles on the neck.I know you feel Fraxel is not worth it and I would be disappointed. Is there another treatment? 2. What is your opinion on Fraxel for the arms and hands. If you do recommend this, how many treatments? Thank you

  Answer:  I think that anything on the neck will be very temporary and I do not suggest much besides light peels, and as to the Fraxel anywhere on the body, I feel the same, if it is not going to improve facial skin the other areas will get even less. JG 3.4.09

• Dear Dr. Garcia, I have slight wrinkles under my eyes. I previoulsy had a lower bleph with a CO2 laser years ago and I am thinking of repeating this--in your opinon which would heal faster with removal? A underye peel, or a laser procedure? Would the fraxel work? I need something with a fast recovery period for social events early May? Thanks in advance.

  Answer:  well, if you have fine wrinkles a surgery might not remove that so I feel the laser will likely be a better choice and can be repeated this far away from the original. I am not a believer in the Fraxel. Might suggest a light CO2 laser is all. JG 3.4.09

• I am 55 years old with lines and wrinkles on my neck. I have read and seen video of Matrix RF and Fraxel for the neck. They say even after one treatment you seen results. It is expensive but if it works I would spend the money for this treatment. I am embarassed of how wrinkled and old my neck looks and really would like a treatment that would help. What would your recommendation be for my problem

  Answer:  I can understand your concern but I think you will be disappointed once the swelling goes away, sorry. JG 3.3.09

• I see you reccomend Retin A for fine lines and wrinkles but not TCA peels. I don`t understand arent they both means of exfoliation only TCA is much stronger?

  Answer:  they do both exfolaite but the effect on wrink reduction is not only exfolaition, that only removes the top layers of skin, and there also needs to be a stimualtion of the deeper layers with no scarring. Retin-A stimualtes the deeper dermal layers and TCA does not, sorry. JG 3.2.09

• Hello! What treatments and results can I expect for halo scars on my forehead? Thanks.

  Answer:  usually the holes need to be cut out and then ScarGuard or Mederma for the scars after that. JG 3.2.09

• Dr. Garcia, 16 years ago I had a lower Bleph with a CO2. It was done very well, but as time has progressed I am seeing fine lines/wrinkles in the under eye area. Is it possible to have that area lasered again through the same techiique? It would be twice to the same area? Or do you recommend something else? Is botox put in that area? Thank-you.

  Answer:  yes, that would be a good option as you know what it entails. Should be safe to repeat. Best of luck. JG 3.1.09

• Dr. Garcia, I had a 35% TCA peel under the eyes. It took about 6 days before crusting/brownish color finally appeared, so I think it went fairly deep. Do you think this is anywhere close to the depth of a CO2 laser peel? Also, I know you generally say TCA isn`t effective for wrinkles. I`m wondering as to the reason why. Does it just not go as deep as CO2 or what? Lastly, I`ve had deep TCA peels in the past and have noticed a lacy texture for a few months afterwards. It usually eventually resolves. Do you know what causes this, however. Very curious.

  Answer:  no, it is not as deep since there was no heat generated it will never create as much new collagen as the CO2 laser would. The chemical peel will help with the brownspots but all a chemical peel do is create skin tighening by swelling and in some cases by small amounts of scar tissue that will stiffen the skin but can look unnatural. CO2 lasers, as they generate heat, cause the collagen that is present to tighten, which is good, and it forms new collagen which is documented in skin biopsy slides at one year and when properly done will cause nto scar tissue like the chemical peel. The lace like appearance is due to the uneven absorption of the chemical. JG 3.1.09

• Hello Dr. Garcia & what a great find you are. I had a 3 part combination of Profractional, Microlaserpeel & Skintyte (sp?) perfromed 8 weeks ago & am terribly concerned I may have permanent damage in a few places: under my eyes it remains terribly pink, but also with what feels like a raised scar under both & verticle red lines else where that are not making any progress either. I`ve taken extremely good care, finest skin products, diet rich in antioxidents, etc. Makeup can`t cover up at all so bottom line - when do I see a different doctor to determine if I have a real problem on my hands? I paid the doctor who preformed the procedures over $4000 for a series that would include to more times in the chair - I`m scared. Your thoughts & thank you so, so much!

  Answer:  well, I think having that at 8 weeks is certainly something I would ask to see the doctor as soon as they can see you, that is normal and getting appropriate treatment will be the best thing to avoid any permanent scarring. Best of luck. JG 2.28.09

• Dear Dr Garcia. I had a pearl laser treatment on my decollete 5 days ago and my skin is still extremely red and rough and still painfull. I am worried that this will not go away. It was my understanding that the pearl laser was a harmless treatment and that the downtime was appprox 4 days, I am now into my 5th day, and the only thing noticeable is that the extreme heat (I felt that my chest area was on fire) which was there the first few days has now dissipated. I am worried that I will not heal. For the first few days I used almond oil in the area which was recommended by the girl who gave me the treatment however, I wonder if this only added fuel to the fire . I would appreciate if you could give me advice, as I am worried that the redness and the marks from the pearl laser etc will not go away. Thank you in advance for your response.

  Answer:  not sure who told you it was harmless, but it should get better with time. I suggest you ask to see the doctor who should be there as a supervising physician. JG 2.28.09

• Hi Dr.Garcia, I am just wondering how long after a fraxel tx. (done high) will my skin color turn back to normal? It`s been 8 days and I have found the red has turned into a bronze color (I look tanned) I read on here that someone`s skin had turned that color and it didn`t go back to normal. I`ve only left the house once since my tx. and wore an SPF total block of 58 along with a scarf covering my face. (I was the passenger) Other then that I`ve remained in my house and did not wear sunscreen in the house. Was that a mistake? We have alot of windows with alot of sunshine pouring in....which I did avoid. The office that performed the laser had told me that there was no need, but I`m thinking if a person needs to wear it while being in a vehicle wouldn`t that be the same? Thanks,

  Answer:  do nto think it was a mistake and it might look like that for another 3-5 days. JG 2.28.09

• When a doctor burns your face with a chemical peel, how long does it take to have the burn marks fade? If no other treatment like plastic surgery is done, do they remain forever, even though they are flat to your skin? Last night I began putting Cemiosil Laser Gel, but the stickiness does not go away even when I wash it to put it back on this morning and I barely put it on last night. Isn`t this more suitable for fire burns?

  Answer:  no way to tell, the deeper the burn, the longer it can take. If the burn is very deep it can last forever but in most cases it is usually gone with creams and avoiding sun in 6 weeks or so. As to treating it, a burn is a burn, no matter how it was burned. JG 2.27.09

• Hi Doctor Garcia, I wanted to ask you what is the best way to treat a post-surgery scar? I had a minor surgery a few years ago which has healed but the scar remains. Its an inch long scar on my face. I am considering laser but wanted your advice about the best possible treatment to fade the scar as much as possible.

  Answer:  the laser will fade the redness if it is stil red, otherwise, if it is raised, it might flatten it out some, but nothing will ever remove it entirely, it wil always be visisble, no matter what you treat it with, sorry. JG 2.27.09

• Hi Dr. Garcia, I am looking for facial resurfacing for help with large pores, tighten skin under my eyes and improve skin tone/texture. It`s confusing with so many lasers out there, and was wondering, with my goals, what you thought of the Candela Gentle Yag laser versus either CO2 or the Erbium/Yag laser. I had CO2 laser under my eyes only, about 10 years ago, but it seems a lot of doctors are moving away from it. What do you think? Thanks SOOO much for your great help to all!

  Answer:  well, if you choose soem lasers you will get some of that but no the pore redcution, at least no for any significant length of time. I think the YAG laser for what you seek will fail on all points though. I think the Erbium will give you a little more and the CO2 will yield the most difference. Doctors are moving away from the CO2 because of the longer healing time and they have been romanced by the promises made by the newer eess invasive lasers giving similar results and with less downtime, but as all in life, what sounds too good to be true usually is and the newer lasers have not held up their end of the promises. Best of luck. JG 2.26.09

• After doing laser treatment for permanent lipstick, after how long will the tattoo start getting lighter after it has gotten dark? Also, how dark will it get after a laser procedure? My lips are a dark pink, almost red.

  Answer:  there is no way to predict when it will start getting lighter as it depends on the energy used on the laser, the type of pigment that was tatooed and your body`s response to the laser. Almost always the color gets darker, like deep red to black before it starts to fade. JG 2.24.09

• what is a good over the counter moisturizer to minimize the redness and dryness on my face after having a cosmetic laser procedure?

  Answer:  Oil of Olay or squalene oil are good but clear it with your doctor first as the type of laser used might make other things better. JG 2.21.09

• I was wondering if you do laser tattoo removal for permanent lipstick? If yes, around how much would each session cost? Also, when will I start seeing results?

  Answer:  yes, we do it in our office, each session is $100, no way to tell how many sessions wil be needed and the color gerts darker before it gets lighter. JG 2.20.09

• hi dr garcia, I am writing to ask what do you think of tca peels. Do you think they reduce fine lines and skin texture? Do you think they are damaging for the skin? I am just wanting to take away crepiness on the skin to make my skin more youthful,I do not have deep wrinkles. I was worried that my skin will be damaged in some way. Do you think a peel is better than fraxel or pixel laser. I am 37 years old.thankyou

  Answer:  I feel the TCA is only good for skin discolorations only. Texture will be likely better for a few weeks to months and likewise for the fine lines, once the swelling is gone both of those go back to the way they were. Might suggest just old-fashioned Retin-A and I am not a fan or believer in the claims of the Fraxel or Pixel lasers, sorry. JG 2.19.09

• Hi Dr. Garcia, my dermatologist suggested a PhotoFacial treatment with the intense pulsed light (IPL) for better skin tone, pores and veins. I`ve heard that some of these treatments can cause facial fat loss. Is this true? Also, is it true that Juvederm and Restyline can possibly move to areas other than where it`d been injected? Lastly, my PS wants to inject restyline under my eyes -- is this safe? any risk? Thanks so much for all you do to give us sound advice!

  Answer:  the ones that have beee reported to cause fat loss are the ones combined with radiofrequency heating only. I have not seen the fillers you menton move to any significant or visible amount. I do perform Restyalen injections under the eyes and it works well there. Best of luck! JG 2.18.09

• Hello Dr. Garcia I need your help. 6 weeks ago I had permanent lipstick done. I had requested for a natural look; however, it had came out looking darker then I wanted. They said it should lighten up a month after it was done. It`s been 6 weeks and it`s still dark. Is there any cream I can use on my lips to help the color fade faster? Maybe like a facial peel such as Rentin-A or Differin Gel? PLEASE HELP ME

  Answer:  I am afraid there is nothing topically you can do that will make it fade as the ink is below the skin. I think using sunblock on your lips will keep it from getting irritated. The only other option there is is to use a laser like a YAG laser, but at times it can look darker before it fades. Best of luck. JG 2.14.09

• I have sun damage in my face, mainly on my cheeks. I have tried chemical peels and IPL treatments, but I would like to do something more, what do you suggest?

  Answer:  CO2 laser would be my next step. JG 2.13.09

• Hi Dr. Garcia! My Q is what do you suggest for acne scarring, texture and some tightening? Would you choose the original Co2 laser or the fractional Co2?

  Answer:  original CO2. JG 2.12.09

• Hi Dr, I had lots of milia cauterised under my tear troughs about two and half weeks ago, it scabbed over very nicely, the scabs dropped off for very nicely and the majority of milia were gone and skin looks good. but in the last three days the skin has suddenly gone very red and dark. Is that normal? should i be concerned yet or is this something that happens, and how long will it take to disappear? Thank you!

  Answer:  should be temporary, just stay out of the sun for now. JG 2.11.09

• Hi Dr. Garcia, thank you so much for your advice. I had an active/deep FX procedure done almost 4 weeks ago, and my skin used to be very fair, and now it looked like I have a tan, kind of `amber` tone. Mineral makeup covers it, but I wanted to know when will my skin be `back to normal` and have my old fair complexion again. There is no scarring, or hyperpigmentation. It slightly helped the appearance of acne scarring, but not much, however it gave me new acne to as a result of using the aquaphor post-procedure, and I have red marks from that acne. I use copper peptides right now with a product called `Emu-oil.` Before the procedure, I used the Obagi Nu-Derm line, and my skin looked really good. (hydroquinone, retin A, and glycolic/lactic acid in those products) Am I able to return to using those products again? and will get my face looking fair again after a little more time? Would using a sauna at my gym help or be harmful. My doctor says that that the longer my face has an `amber` tone, that means my skin is building more collagen, and I will have a much better result in a few months. But, I think your opinion would have much more knowledge than his and be unbiased. I sure do appreciate it.

  Answer:  hard to say but if you are having that issue it certainly sounds like post-inflammatory hyperpigmentation, that is not patchy, that will need intervention. At minimum it will require Retin-A and hydroquinone along with sunblock, the need for a light chemical peel series is also a possibility. Sauna will have no effect. Amber color has nothing to do with collagen production, nice try on the doctor`s side though. I would certanly get back on the Obagi and see what happens with that. Best of luck. JG 2.11.09

• Hello, I want to thank you for helping all of us. I had 6 multiplex non ablative laser. The physician told me that I should not have anymore than six treatments because I do not need anymore. He did not want me to waste my money. I asked what the nornmal maintenance and he said I may have one a year from now. What is the standard now for maintenance on non ablative lasers? By the way I loved the results from the multiplex laser. My deep acne scars are gone. This is the first time anything every had any effect on acne scars. THank you. Sue

  Answer:  no real set number, it depends on your skin, you age, the amount of skin damgae, lots of variables, but once a year for non-ablative lasers is likely not enough, might need it more often. JG 2.7.09

• Hell Dr. Garcia. I am half chinese and half mexican (I know, interesting combination!) I have medlium olive skin complexion and I have been going to dermatology clinic here in California and have been getting the Aramis and Med-lite treatments for brown marks and mild acne scarring. It was recommended to me that I should have a Jessner`s Chemical peel. I am really scared to get a chemical peel b/c I am afraid of hyperpigmentation. I was told that the peel is very superficial and only takes off the top layer of the skin. There isn`t any downtime and was told that I may have occassional flaking in some areas. Because of my ethnicity, do you think it would be safe to have this kind of peel?

  Answer:  well the Jessner`s peel is likely no more risky for post-inflammatory hyperpigmentation than what you have already done with the lasers. I think it might help a little with the brown spots, but not to any greater effect than what you have already done. I think what you are thinking about and what you have already done might help the spots, but do not expect much in terms of the acne scarring. JG 2.5.09

• hi dr garcia! what do you about photofacials for olive skin tones? can it cause hyperpigmentation problems?

  Answer:  if done at higher setting you can develop post-inflammatory hyperpigmentation, yes. Done on a weaker setting you might not get any visible benefit. JG 2.4.09

• I am scheduled to get a 35% TCA peel under eyes by my PS. I am 31 years old. I told him that you said that TCA only works for pigmentation and not for fine lines, and he said that he agrees with you except around the eyes. He said in cases like mine where the lines around are very fine he likes to try TCA and botox first because that is usually enough in this area due to my age and the fact that the skin around the eyes is very thin so he doesnt have to go as deep to see results. He said he prefers using C02 for lines around the mouth, and only for deeper lines and wrinkles around the eyes. Do you agree with what he is proposing?

  Answer:  well, it is always worth trying something less invasive, and you likely do not need as much as someone who is older, but I think once the swelling goes down, it will likely look like nothing was done. Best of luck. JG 2.3.09

• I just asked about the 35% TCA peel. For the under eye i had during surgery, like i said, he wanted me to wipe the area with wet gauuze at 1 week, but i will ask him when i see him tomorrow if it should have been sooner. Do you have your patients do this or just use the lotion? ( i used Aquaphor) and you didnt say how often TCA can.should be done, and if milder, same instructions/procedure?

  Answer:  we do not wipe, we splash water, let the skin fall off on its own and apply the creams over it. Aquaphor can be used and is a good product to use 2-4 times per day. JG 2.3.09

• Hello, Dr. I have heard conflicting reports about whether sedation/anesthesia is needed for a 35% TCA peel? I know it needs to be done by a PS at that strenght, but what about a milder strength? PS or spa tech? also, how often do they need to be repeated? I had 35% under my eyes but was asleep due to other facial surgery. I remember it being just dark under there and didnt wipe the skin off till i got my nose splint off at 7 days post op. What are you supposed to do, as far as the skin agter TCA? leave it alone or help it along with wet gauze at a certain point? I was told for under eyes,almost as an after thought at my one week, that i can start wiping at the skin. PS seemed surprised that i hadnt done anything at that point? Also, should area around mouth that i had Co2 be left alone? I know alot of questions in one but if you could try to answer all pls. Thanks you.

  Answer:  in many states no one except a docto can se TCA, need o check with yourstate regulaions. As to edation and anesthesia being needed for a 35% peel, I would say yes, it hurts. I use creams after the peel, but every docotr does it diferent, I think you need to be clear with his protocol ande that should be discussed before the procedure. We also use Valtrex to avoid herpes out breaks after the peel tha can occur even if you have never had it before. If the skin has healed well after the CO2 is is OK to do the TCA over that area now. Best of luck. JG 2.3.09

• Would an erbium peel done as deeply as a phenol peel yield the same results? Why?

  Answer:  likely yes. JG 2.3.09

• At what depth of microns in a C02 peel does side effects like scarring and hypopigmentation become more likely in type 3 skin?

  Answer:  there is no set depth at which that will occur. JG 2.3.09

• what would the down time for 35% TCA peel be for the forehead? i just want to even out texture. Retin A seems to be making it look like cracked earth. I really have no wrinkles there, just oange peel like texture from sun damage.

  Answer:  might be 10-14 days before make up. JG 2.2.09

• dear dr. i have a scar from an infection caused by sculptra or restylne or aquamid not sure which one caused it. i had all 3 injected in the same area not at the same time..what can i use to fill out the scar?its quite deep and looks like a huge wrinkle.dr who gave me infection does not want to know me. would laser help?..thanks

  Answer:  doubt a laser would improve it to any great degree, they work better for very superfical indentations. I think a filler is likely the easiest, although cutting the indentation out and sewing it back up could be done, but would leave a permanent scar. JG 2.2.09

• In your view, how many microns deep of a C02 peel would be needed for the slight aging related changes of a 30 year old (very slightly looser skin, some fine lines around the eyes and some deeper ones on the forehead), and what kind of healing time can I expect?

  Answer:  75 to 150 microns, the time to heal would be about 5-12 days, the deeper, the longer. JG 1.31.09

• Hello..you advised me to go with C02 (I was asking about profrac and microderm). I have looked and can`t seem find a doctor in my area who does it (Winnipeg, MB). Is there a listing somewhere of where these procedures can be done? Also wondering if i should chance it as I have had pixel (no issues) but did a PDT treatment 2x with a chemical peel (blisters and clumps of skin too) reaction and never understood why. This was a year and a half ago and in that time have gone on accutane and now been off six months. What do you think? Thank you so much for your time. (I have large pores, scarring oily skin sometimes burns sometimes tans and am caucasian)

  Answer:  since there are so many differtnt companies out there that make the totally ablative CO2 laser, I am not aware of a centralized listing. I will say that its use is much less than before because the doctors have gone to the lesser invasive fractional treatment as it is an easier downtime and easier to sell, but I think they have lost on the effectiveness. I will say that anything you do will help the pores only on a temporary basis, will not control the acne, but might help the scars some. JG 1.31.09

• Hello Dr Garcia, Its pretty sad that laser resurfacing is not an option for olive skinned people.. If I want to get a chemical peel to even out my complection and renew it, what do you think I should go for? I have heard that some peels cause hyperpigmentation promblems for olive tones. What is your recommendation?

  Answer:  I think a chemical peel has the same exact risk profile as a laser I am afraid. JG 1.30.09

• dear Dr. whats the best and most effective latest method of lazer hair removal if the hair is very thick ?

  Answer:  I prefer an Alexandrite laser. JG 1.30.09

• Hi. I`m 19 with very thin, sensitive skin that`s prone to flushing. My derm assured me I don`t have rosacea. My skin is dull and unevenly textured, I was wondering what kind of chemical peel would be appropriate for my skin.

  Answer:  I wodul only start with soem ligth alpha or beta hydroxy acid peels at the skin spa. JG 1.29.09

• I never had a pimple on my face until my late 30`s. I am now 46 and have been plagued with deep small pimples that erupt occasionally. They are so deep that they take nearly weeks to resolve and then leave red marks (not pits,thankfully). I have tried micro-dermarasion and peels. These seem to help while the treatment is continuing, but 4-6 months afterwards the spots come back, although a little less rosy. Without makeup, and even with my face looks spotty. What would you recommend to solve this problem and give me an all-over even skin-tone? I really hate make-up and like a more natural look. My skin is not really fair, but not what I would consider olive either.

  Answer:  might needd to see a dermtologist to make sure you do not have Rosacea that can be treated but the miicrodermabrasions will only aggravate it. JG 1.29.09

• what s your opinion on the home TCA peels? risky to do yourself? whats the highest percentage out there to buy to do yourself? Also, I am thinking about getting a TCA peel on my forehead only for orange peelish texture. I had 35% under my eyes during facial surgery. forehead skin is thicker. would the same percentage be used, and what kind of numbing is use before hand, if any? How long before skin starts peeling and about how much social down time? and is it good to use Retin A before hand for some time? I am currently using the .01 gel.

  Answer:  I think it is crazy to do them at home. I think a professional doing the peel on your forehead is reasonable. I think the 35% should be good enough for orange peel like skin though. It will likely need to be redone though in a year or two. It can be done under a nerve block and topical anesthetic. Social downtime would be about 10-12 days. We always pre-treat with Retin-A and hydroquinone for 2-4 weeks before and then start again after 3-4 weeks. Best of luck. JG 1.29.09

• Dr. Garcia, I wanted to add some info on laser hair removal since I have had it done 8 years ago on my chin and upper lip. It does work on DARK HAIR and mine has never grown back. It does not work on white hair. I was blatantly lied to about that. It does work best on women with white skin and black hair. I am very fair with blonde hair but my face grew black hair...go figure. It is not cheap, hurts a little but I feel it was worth it. I had it done in two different plastic surgeon offices. Tell everyone that it is best to use lasers and not the radio frequency ones....;you get what you pay for and pay ore and get it done right. Mine has not grown back and I am 59. Hope this helps.

  Answer:  thanks for the personal report, I am sure it is appreciated by the readers. JG 1.28.09

• my face always gets red so easily. I`ve suggested to my derm that i might have rosacea but he disagreed. sometimes, i see tiny red capillaries but they go away sometimes,especially when i wake up in the morning when my face is calm. my skin reacts very easily to the temperature. im wondering if IPL will help?

  Answer:  I think the IPL is worth a try. JG 1.28.09

• Hi Doctor Garcia, you were right, the active/deep fx I had 11 days ago made no difference in the look of the acne scarring I have. It actually caused me to get many more pimples. Some of them are very very stubborn. How do I get my face clear again? My face still has a pinkish tint without makeup. When will it be my normal skintone again? Would you happen to know when I would be able to use my Obagi Nu Derm products with retin A? My doctor says I have to wait a month, but I need to get rid of these pimples. He claims that I need to keep wearing the Aquaphor, but this makes my pimples much worse, and that will cause even more scarring. These aren`t little pimples, they are big lumps that won`t shrink or pop. I am very frustrated because I had my acne under control before I had the Deep/Active Fx done, and even the doctor said that my skin looked very good for being 39 years old. What do you think about using organic apple cider vinegar to treat the acne? I really respect your advice more than anyone else`s. Thank you.

  Answer:  Might want to use some vinegar diluted in water to open the pimples up and let them drain, or some warm moist towels with plain water but in time they usually resolve once the skin is more healed. The pinkness will usually get back to normal in 2-4 weeks, all depends on how many passes they performed. I would not use the Obagi products for one month after the treatment. I would likely stop the Aquaphor and switch to squalene oil which is less comedogenic. Best of luck. JG 1.27.09

• I`ve been told I have post inflamatory hyperpigmentation on my leg. I had a small minor wound & later went in the sun aware this would occur. One doctor gave me a steriod shot and it looked to be healing by turning redish but is now brown again and it looks to have spread alittle (dime size). I am afraid of this getting worse (by darkening or hypopigmentation) with any laser treatments but was told to get fraxel may by one doctor and Yag by another. I am currently using bleaching creams hoping this will help it fade. What do you suggest?

  Answer:  I think a Fraxel will not help and could make it worse, I think the YAG is a much safer and more effective option, along with continued sunblock and hydroquinone too. JG 1.26.09

• In your opinion, what would be better for uneven texture, fine lines, and large pores: a chemical peel or a microlaser peel? Which would be safer and what are the possible complications? Thanks!

  Answer:  a microlaser will be more effective, and likely safer too. Complications are brown spots but they are usually temporary. Unfortuantely so are the results. JG 1.26.09

• Would you say that males have better outcomes than females with laser resurfacing, worse, or is it the same?

  Answer:  I think they heal faster because their skin is thicker but because of that, they get less of an improvement as it contracts less. JG 1.26.09

• Hi Dr G...about 4 years ago I had a TIA due to a disected carotid artery in my neck....it is resolved and I have have had no further incidents..they felt it was due to a chiropractic adjustment to my neck...my question is is there any risk with getting Candela Laser treatment for spider veins in the back of my legs? Thanks...

  Answer:  should not be affected, best of luck. JG 1.22.09

• Good Evening Dr. Garcia. I hope you are doing well! Yesterday, I had two small areas around the crease on either side of my nose smoothed out with an erbium laser. They are about the size of a pencil eraser. I am scheduled to receive an enzyme peel on my entire face for some very stubborn milia in 3 weeks. Should I reschedule this appointment? I don`t want to harm the lasered spots. Thanks!

  Answer:  most likely it will be healed enough after the erbium that you can proceed, should not harm anything, best of luck. JG 1.21.09

• Hi Dr. Garcia- I am an African American female and I have severe acne scar mars (dark discoloration on both cheeks) Is there anything that I can do to lessen the appearance of the marks such as laser surgery etc....

  Answer:  I am afraid I have nothing safe to offer except for the minimal improvement with Retin-A, sorry. JG 1.20.09

• Hi again Dr. Garcia, I wanted your advice on laser resurfacing and/or peels. I`m very nervous about doing work on my face (I once had a strong peel under my eyes to help with bags. The PS said it would be red for about 3 weeks. It took EIGHT MONTHS for the redness to go away - and worse, the bags came back at the same time!) But the skin on my face is just looking dull, some large pores and a few age/acne spots. What would you recommend? Thank you!

  Answer:  well, the first problem is that bags would never get better with something done on the surface as a laser or chemical peel, that was not even wishful thinking, it was plain wrong to suggest it. I think for your skin now I would start with some Retin-A and then progress to some light chemical peels to freshen up the surface, could try some microdermabrasions too. Best of luck. JG 1.19.09

• what laser cosmetic procedure would be best for smoker lines above lips?

  Answer:  totally ablative, non-fractional CO2 laser. JG 1.19.09

• Dear Dr. Garcia, You had told a woman to use a laser for marionnete lines if they were that bad, not just a filler. What kind of laser would help those lines? Thanks.

  Answer:  no laser will help marionette lines, sorry. JG 1.18.09

• Sorry if this is a duplicate. I posted a Q earlier but it seems to have disappeared in the galaxy somewhere. Last year, I had several shots in the undereye area to remove bumps, which have finally disappeared. However, I now have dark smudged in the undereye area, almost toward the top of the cheekbones. IPL has helped somewhat; Retin A and hydroquinone combination, not so much. Can you suggest a product that might fade the smudgings or another laser since I was told the dark areas are not hyperpigmentation but a result of oxynation? Thank you as always.

  Answer:  might suggest a YAG laer, it is stronger than the IPL. Best of luck. JG 1.18.09

• Hi! I am confused. I just turned 30 and I would like to have a peel done. I have been told to have a chemical peel by some and a microlaser peel by others. This would be my first experience with any peels. Do you have an opionion on which would be a good one to start with? Thank you!

  Answer:  well the chemical peels and the microlaser peels will help with skin disoclorations, but the amount of new collagen formation and skin firming is minimal. JG 1.14.09

• Hello Dr. My PS just prescribe the RetinA gel.01%,the other day, he said he thought it was better . I used it for the first time last night and believe he is right! I have been using the cream just on my forehead, hoping to even out the orange peel texture, before doing anything more drastic(peel). This morning i just wiped my fingers across my forehead and lots of skin just came rolling off! Whats your opinion on gel vs cream, same strength? Ps said if i tolerate it well i can use it twice a day. What do you think?

  Answer:  well the gel can allow a little more irritation but I do not think clinical results in terms of better skin quality will likely show up for weeks. If tolerated, it cna be used twice daily. JG 1.12.09

• What are the different levels of Co2? How are they rated? is it like a scale of 1-10 or is it a percentage thing? I was never told what level i had around my mouth during surgery(never asked). What number/level would be considered light, medium, and deep? I go tomorrow for a 3 week check up, will ask then. Am anxious for that skin to get back to normal texture. And one place actually looks pulled above my lip, making diagonal pulling lines, where there used to be vertical lines Will this improve?

  Answer:  there is no rating, different energy levels will go to different depths, the depth used depends on the needs and the risk/benefit ration. I think all of what you are describing should get better in time though. Best of luck. JG 1.12.09

• I am half Swedish and half Italian. I have blue eyes, brown hair and a pale olive complexion that tans easily and burns sometimes. I have never had a problem with hyper or hypopigmentation before. What do you think is the most I can do for resurfacing? TCA? Fractional C02? Erbium? Rhytec? C02?

  Answer:  light CO2 with adequate pre and post treatment wth hydroquinone should be OK. JG 1.11.09

• How long before the skin from Co2 returns to normal texture? I am almost 3 weeks post op from a bunch of things, that around the mouth being one. I can cover it easily with make up, tho the pinkness seems to be staying the same. Should i still be using aquaphor on it or switch to something else? I bought some SkinCeuticals Epidermal Repair cream from PS office that seems ok. anything OTC u would recommend? will this area always be pinker than the restof my skin?

  Answer:  depends entirely on how deep they went and with which technology. If they went deep it can take 3 months at times. At three weeks I think Skinceuticals is fine, the pinkness will fade in time too. JG 1.11.09

• I don`t think I worded an earlier question correctly. I would like to know if LightSheer Diode laser has an added benefit of lightening hyperpigmentation while removing hair. Or should I supplement my hair removal with IPL to lighten the areas darkened by the plucking of the hair? Thank you

  Answer:  it migth but one of the side effects of using the LightSheer diode laser for hair removal is reactive hyperpigmentation, so it will likely get worse while treating the hair removal and then it can be turned down to treat the hyperpigmentation. JG 1.10.09

• Hi Dr. Garcia....Can I have your thoughts on the Vi Peel? Is it stronger than a medium strength TCA Peel? I`m looking for some tightening of facial skin, getting rid of fine lines & wrinkles, eliminating small areas of uneven skin tone. I`ve had glycolic & salicylic peels in the past and have used Obagi products (with Retin-A & hydroquinone), but would like to go up a level without going to the CO2 laser resurfacing or Rhytec Portrait if possible. Does the Vi Peel fit my needs or do you believe it is just another medium strength peel with no different results from the Obagi blue peel? Thank you in advance for your response!

  Answer:  do not think you will get what you are looking for with a chemical peel of any sort,except for a phenol peel, sorry. JG 1.9.09

• My question was left answered a few hours ago: I am getting lightsheer diode treatments for my chin hair. The area is darkened due to the hair and my incessant plucking of it. Will the lightsheer also help lighten the dark spots while removing the hair?

  Answer:  IT MIGHT BUT WITH SUN EXPOSURE IT WILL LIKELY RETURN. JG 1.9.09

• I am getting lightsheer diode treatments for my chin hair. The area is darkened due to the hair and my incessant plucking of it. Will the lightsheer also help lighten the dark spots while removing the hair?

  Answer:  it might but no always, and with sun exposure they will likely come back. JG 1.9.09

• Hi Dr. Garcia, I had 3 bbl`s for redness and melasma. On the third treatment she used a 560 cut off filter and turned it up to rosasea settings. I was thrilled with the first two, but a month after my third treatment I still flush bright orange if I put anything on my skin, and my skin is still a red to pink color. I was thinking of going somewhere else for a light bbl in a month (give my skin a break) would you advise a light bbl to get rid of the orange flushing and pink skin, or will it go away on its own? I am really afraid of the pinkness/ redness being permanent as it makes my face a darker color. When I wash my face with cool water it just makes it red, if I take a hot shower (no water touching my face of course) my skin color looks normal. I know the orange flush is pih, but I think HQ would burn like crazy and turn me as red as a brick. Thank you so much -

  Answer:  it will likley go away on its own and doing another treatment, even a light one, could aggravate the redness you have now. I do not think it is a permanent thing though. PIH or post inflammatory hyperpigmetnation is brown and not red, so that is not what you have and yes the hydroquinone used for PIH would make you more irritated and would not help fade the redness. JG 1.8.09

• Does the Spectra laser, IPL laser, or CO2 laser cause fat loss. If so which ones and why? What type of lasers do cause fat loss?

  Answer:  it is only the ones with radiofrequency that have been associated with fat loss. The IPL and CO2 lasers are safe. JG 1.7.09

• Dr. Garcia, Also, i forgot to ask, I`ve read some posts on other sites that CP serum helps with regaining skin pigmentation for those with laser induced hypopigmentation, is this possible? what do you think?

  Answer:  I have never seen that happen personally. JG 1.5.09

• does novitil (dermabest) work for laser induced hypopigmentation, I have a penny sized hypopigmented spot on my forehead from a vbeam treatment almost 3 years ago. That spot is lighter than the surrounding skin and never flushes or gets red anymore also.

  Answer:  I am sorry but I have never had a patient use it so I cannot say. JG 1.5.09

• What do you think of Photorejuvenation with the Lumenis One? Said I would need it on my face, neck and chest, because the other parts would look bad if I only did the face. How would it help my neck, can it fade neck lines and tighten? I`m 43. Does $1300.00 for the 3 areas sound excessive? Thank you!

  Answer:  I think it is mild enough that you could do the face alone, I think it is a mild treatment though, so do not expect much, especially with only one treatment. JG 1.4.09

• I know you are a fan of the plasma lasers. I think it is equally important as to who does the procedures. I live in the PHL area, close to New Jersey as well. Are there any qualified dr.s in the area who performs this type of laser? Thank-you.

  Answer:  I am sorry but I do not have a list of those physicians that perform the plasma in your area. JG 1.4.09

• I had Co2 around my mouth and TCA peel under my eyes during multiple facial precedures 10 days age. I had asked PS before surgery if he could add CO2 to my forehead. He said no, doesnt need, no wrinkles, just orange peelish, and to make appt with his Spa girls to figure that one out. I really dont have wrinkles there(thanks to Botox) but not crazy about the look of the texture. Love the TCA under eye result and Co2 but those were both for fine lines. What would you rtecvommend for my forehead. I have done Micro Laser Peel, too painful, would rather go chemical route. What would you recommend to smoothe? I havent started back on retin a but intend to. I guess i could now on the forehead. since i already look like crap(10 days post eyes, nose, lower f/l) But in the future, would like your opinion on what kind of chemical peel to do up there?

  Answer:  maybe a 25-30% TCA for the forehead. JG 1.2.09

• How long does that nice new shiny skin look last after a TCA peel?

  Answer:  the deeper they went the longer it looks that way, but in general, not long, a few weeks to a couple of months. JG 1.2.09

• Had co2 around mouth during multiple facial procedures on Monday. was told for first week to wipe area with cold water on gause pad to get rid of yellowed skin 6x a day. then apply aquaphor. a couple patches dont want to budge. doesnt exactly feel good to try to scrub these peices off. yesterday i went to get it checked. PS said to keep at them but dont make myself bleed. nurse said he might want to have me use a mild white vinegar/water combo after my 1 week check. that area around my mouth is brightred now. what are the stages it will go thru, and time line towards normalcy?

  Answer:  all normal, the area wherere the material was more adherent is normal and will loosen when the skin underneath is more healed, just give it some time. Merry Christmas and Happy New Year. JG 12.27.08

• How long after a 25% TCA peel should tanning booths be avoided. I know it`s never good to tan but what is the minimum time?

  Answer:  personally I do not understand you wanting to use a taning bed after attempting to help your skin, hovever mild, with a TCA peel. Please stop and think about your actions and your question. The answer is you should never go in to a tanning bed again. JG 12.24.08

• How long does the swelling last with TCA peels that temporarily reduces the appearance of fine lines? and do continued TCA peels over time thin the skin?

  Answer:  it might take 4-6 weeks for the swelling to totally dissipate, it all depends on the strength of the peel, and I do not think the TCA done repeatedly will thin the skin, skin is very good at regenerating itself. JG 12.22.08

• Is it rare for celebrities to undergo lasers such as C02 resurfacing or do they usually just stick to more traditional procedures? Occassionally you`ll see a celebrity with a botched facelift, but I havent noticed any with laser work that went bad, that could be disasterous.

  Answer:  the issues with CO2 lasers are uneven pigmentation and in experienced hands is a low risk, and they always wear make up too so it can be hard to see. JG 12.20.08

• Hi Dr Garcia, I was extremely happy with the results from my course of Medlite laser for skin rejuvenation, until a friend in the medical world totally disagreed with my decision, stating that although the immediate results may be good, there could be underlying irreversible damage to cells in the dermis which may not be evident for many years. This is obviously really worrying and I wondered what your views are on this as I know you offer Medlite in your clinic. Many thanks

  Answer:  I see no reason for them to claim that, it stimulates the dermis to create collagen and in all the reading I have done on lasers I have never seen any legitimate claims to suport what you have been told. JG 12.21.08

• Dear Dr. Garcia, I just had a diolite laser treatment for milia. My face is swollen and the doc did not recomend me anything to use after that. 1- Should I use any antibiotic to prevent infection? 2- How long am I going to have the red dots in my face? 3- Do you think this is a right treatment for that? Thanks a lot, Adi

  Answer:  I do not think you need toical antinbiotis, the red dots might last up to one week, and that is a reasonable laser to use for the milia, yes. JG 12.20.08

• Hi Dr. Garcia, First of all, truly, I appreciate both your answers to my previous two questions: one on 12/3/08, and the other one on 12/8/08. For you to take the time to answer my questions is really great, because I know your time is limited. So, gain, thank you very much. I asked you, specifically, about your thoughts on the Fraxel vs CO2. I mentioned I had a a Fraxel treatment, and an Active/Deep FX (Lumenis) treatment, but to no avail...in terms of the results I was looking for. I will forward some photos of what I want repaired, and if you feel the C02 could work for me, I will schedule an appointment. Thank you.

  Answer:  please send them to drgarcia@lvcosmeticsurgery.com All the best for the Holiday Season. JG 12.17.08

• Dear Dr. Garcia, there are so many out here saying they`ve lost all their facial fat from lasers, yet I have never seen any photos demonstrating fact. Have you seen this result and do you believe these stories of total fat loss from procedures? Thanks very much.

  Answer:  I personally, after having used lasers for over 20 years on hundreds of patients, have never seen it happen, it is natural though to try to find something to blame. JG 12.16.08

• hello - i had a jessner`s peel on friday (it`s now monday night) and my derm didn`t tell me anything about the aftercare. i`ve been helping the peeling along and now i`ve read online you`re not supposed to pick or pull at it and that could lead to scarring or discoloration. none of the skin i pulled off hurt when i pulled it, and i haven`t bled at all. the skin is very pink and slightly sensitive though. i have dark olive skin tone. am i going to have any permanent damage from doing this? i`m obviously not peeling away at myself anymore but i didn`t know and now i`m worried about scars/discoloration.

  Answer:  doubt there will be any permanent damage, but stop picking and call the dermatologist`s office tommorow and get the instructions they should have given you before the procedure was performed. JG 12.15.08

• Would it ever be possible to have another retired PS sit in during a phenol peel? It is ssomeone who has alot of experience with it, says the results are amazing, and lasts 20 years. He did one to his wife, she is fair and freckled. I saw the pics of the chunky peeling process, not pretty but her results are amazing. The PS i am thinking about Is Dr Haroon Qazi, from Indianapolis. Retired after 45 years in practice. The docs in the group I am thinking about going to worked under him at one time or another, or studied , whatever the term would be. They all know him here in Indy. Is that sort of thing allowed, or do PS s frown on having another person in there, even if they have more experience with phenol peels than they do?

  Answer:  it is up to the plastic surgeon performing it, I cannot say what they will fell like. JG 12.14.08

• i know that skin which has undergone a phenol peel loses its ability to tan, but does self tanner work on the face after such peel?

  Answer:  it can help, yes. JG 12.14.08

• Is there a Phenol peel that is mild enough not to require being put to sleep? I gather there are differnt levels? I thought phenol peels were on their way out due to cardiac issues, and other negative things? What about Jessner?

  Answer:  phenol peels can be done with sedation but it is always done slowly to avoid the cardiac problems, they only occur of you try to perform the procedure too quickly. The real reason that phenol peels went out of favor was due to potential pigment loss if one went deep, that can happen with lasers too though, and also it did not sound as up to date as a laser does. A Jessner`s peel is a very weak peel, mostly just to take dead skin off is about all. JG 12.13.08

• Hi..I have large veins under my eyes. I am 58 & with thin skin, I look like an owl. I have heard that there is a laser that can get rid of veins (or at least diminish the size). Is there such a laser that can reduce veins in the face & what is the name of the laser. What would be the cost for a laser procedure to treat the veins under my eyes. Thanks for all your advice. Happy Holidays to you!

  Answer:  there are lasrs that help with veins but only the very small fine ones, not large blue ones. JG 12.12.08

• Do you think resurfacing lasers will ever evolve to the point where one can get ablative C02 results without C02 risks or downtime? I find it very doubtful considering it`s the injury that C02 causes which leads to its dramatic results. It seems like they`re going backwards in a sense with the new fractional C02 lasers in that they`re just decreasing the coverage at the expense of results. Ironic that the first lasers used for resurfacing still get the best results. So they`ve now fractionated the erbium and C02, seems like they`ll be running out of ideas in what to try next.

  Answer:  I think it will be difficult and if it were, it is likely at least a decade or more away. The fractional lasers are a move backwards in terms of the improvement but it is putting lots of money in the laser company`s pocket as they prey on patients` hopes and desires for less downtime and less risk. As to what they will think of next, don`t fear, these snake oil salesmen will always find some new sliced bread to take your money. JG 12.12.08

• Thank you for answering my question about pitting along the sides of my nose. Again, the pitting was caused by a hyfercator, and various lasers, all in the attempt to eradicate telangiectasia. You suggest a CO2 laser is my best option - why? I have had two fraxel treatments that did not help. I thought the frazxel was part CO2. Thank you.

  Answer:  when I say say CO2 I mean a totally ablative laser, not the fractionated lasers as they ae not treating a large enough surface to cause tightening nor smoothing, do not be fooled into thinking that a fractionated laser that uses CO2 is a true CO2 ablative laser, that is deceptive marketing by them to try to capitalize on the name CO2 yet not deliver the results. JG 12.11.08

• Good evening Doc, are we any closer to any treatments for exogenous ochronosis in Blacks?

  Answer:  not that I have read about in any medical journal, sorry. JG 12.7.08

• What do you think of the erbium and iridex lasers for the face and eye area? Is the erbium another name for the yag laser? What is your choice of laser for skin rejuvination?

  Answer:  I think they will provide little to nothing for skin wrinkle reduction. My choice would be Rhytec Portrait Plasma or a light CO2 laser. JG 12.2.08

• What type of laser do you recommend for eye wrinkles?

  Answer:  CO2 laser, regular, not fractional, or a Rhytec Portrait Plasma. JG 12.2.08

• I had a light laser treatment underneath my eyes a few years ago (can`t remember what kind, but it was supposed to be on the mild side). While the skin did tighten, it was red for MONTHS. It faded slowly (when my PS told me it would only take a few weeks .) Anyway, very shortly after the redness went away, the puffiness came back (nice, huh?) Then it was made worse last year when a different PS said a filler (Radiesse, I think) would fill in the area and thereby keep the skin from pulling down. What it ACTUALLY did was give me lumps that STILL have yet to go completely away (will be 2 years in March 2009). In fact, that filler made the puffiness worse - and located it mostly where he injected the filler. I`ve been contemplating a lower eye lift, but is there anything you might suggest so that I can wait on going under the knife? Thank you!

  Answer:  well, it sounds like it was a CO2 laser if the redness lasted that long, and no laser, no matter what type, will ever improve puffiness, it will only improve small fine lines and pigment problems of the skin, it will not affect anything below the skin. I do not inject Radiesse on the orbital rim due to the lump problems that are well known, if anything I use fillers such as Restylane or Juvederm. In your case, if the filler lumps are still there, it likely has become a granuloma and might need to be cut out. I cannot say whether surgery will make your scenario better without seeing you in person, but it sounds doubtful, except for the lump removal. JG 12.1.08

• Dr.Garcia I started a series of beta peels, Im on my first one, But i was told it would be little to no down time but im on my 5th day and im peeling like a snake, some flaking too, Oh and my forehead Just started peeling, How much longer will it take and why did I experience more downtime, is it going to be like this on my other peels? Thank you

  Answer:  the downtime is related to the strength of the peel and the conditon of your skin. The thicker and more damaged your skin is the less the downtime initially, as your skin gets better and less covered by wax the intensity of the peel needs to be decreased. I think in a couple of days it should all get better. JG 11.26.08

• Dr. Garcia What good are lasers using radio frequency? What is the purpose if they do nothing? They are not cheaper than regular lasers in my investigations. Do you think companies come out with new hype or marketing just to confuse us consumers> If you agree, than why would PS buy them if they can buy the good ones instead? I am so confused and leary right now that I am avoiding making any decisions. Is there a book or good website you would recommend that can filter out all of the info on lasers and give info on the best? Thanks for all you do. Have a wonderful Thanksgiving.

  Answer:  well, to be honest, they are no good. The purpose of them is to feed on hopes and wishes of unsuspecting patients in order to make a profit, basing it on very flimsy science and years of poor results sprinkled wth a handful of good ones. I think the companies do come out and overhype based upon patient wishes and desires, no matter how effective or ineffective the technology is. Some plastic surgeons will buy them for atempts to get people in the door and then sell them on something else, some surgeons are foooled by the marketing of the felow surgeons, I know I have been before, and some are just interested in appearing to offer the newest and easiest as a way to make money. I am unaware of a good book to filter all of this out as the field is constantly being updated so a book is quickly out of date, and many if not most of the doctors that are experts have received something from te laser companies and some therefore do not have a completely objective veiwpoint. Sorry. All the best. JG 11.26.08

• I got lucky and you are on answering, i need to hurry and get my questions in. I asked about IPL and you said the results are good on face. What are the results adressing? I am looking for smothing of some small wrinkles and even out skin tone. How long before seeing these results?

  Answer:  it will help fade red and brown spots, minimal effect on very fine lines over time and nothing on wrinkles. JG 11.23.08

• What happens after MicroLaserPeel? Flaking/peeling/redness? for how long and are there different debths? How long after before using Retin A? should i stick with the .5% or go higher?

  Answer:  a little of both, but not much at all. There is typically only one depth and all of that, if it occurs, usally is gone in less than 12 hours if it is truly a mcrolaser peel. I would stop the Retin-A for 2-3 days before and after. If your skin is toleratig the 0.5 then it is OK to increae it if desired. JG 11.23.08

• What is your opinion of IPL phot facials? I had Titan on my abs once, it realky hurt, did nothing, and i received 3 blisters. Should i expect the same with IPL? when they say hurts like soft rubber band snap my experience with Titan was more like cigaretee burns! Are there different levels with IPL like with Titan?

  Answer:  I think the good effects on the body are minimal, can occasionally burn if the settings are too high, it works well on the face only. JG 11.23.08

• Dr. G: What is a yag laser and what it it good for - and how long does it last? Its this like the Co2?

  Answer:  YAG lasers are mostly used for skin discolorations and it is not a collagen forming laser like a CO2, they compliment each other not replace each other. JG 11.22.08

• Dr. Garcia, What treatment would you recommend for orange peel skin, mainly on the cheeks(its Not very bad/deep). Thank You.

  Answer:  start with Retin-A and then maybe some IPl sessions. JG 11.21.08

• Hi Dr. Garcia, I am 40 years old and I am very interested in getting the Portrait Rhytec. I had adult acne which left post inflammatory hyperpigmentation along with some hypopigmentation. I also have sun damage and some fine lines around the eyes. My question is, I would like to have the procedure done at a high setting so i see the maximum results. Do you think that I am a safe candidate? I am dark haired, blue eyed with medium colored skin. I want to do my face, neck and decollete. Will the portrait help with the fine line around my eyes? what settings would you recommend on the face, neck and decollete for maximum results? Any risks? Thank you for your time.

  Answer:  I think the risk profile is safer than a CO2 laser, yes, but there are still risks of temporary hyerpigmentation, usually easilly treatable with creams, I think for isolated fine lines and pigment problems it is an option, I think for acne scars, not a much but certainly more than alot of other fractional lasers out there. The neck and decollete can only be done lightly though. Best of luck. JG 11.20.08

• Dr G; I had a undereye TCA peel to tighten the skin and remove wrinkles and it did not work( or I should say it did`nt last) so my PS gave me a Erbium laser with profraction and went pretty deep and says that in the next 6 months my skin will get tighter - although I see a difference I am beginning to see little wrinkles coming back and I had this done last month - I have a follw up in December should I suggest another Erbium w/ profraction or should I sugets a Co2 laser w/o profraction. Or ashould I wait another 5 months for more improvement.

  Answer:  personally, although I do agree that a CO2 lsaer is the logical next step, I might suggest seeking care from a different surgeon, unless he is doing all the subsequent treatments at a significant discount. I would have never expected the TCA to do anything to tighten the skin and I would have had to cross every dual part of my body in order to hope the profactional erbium would do anything as it is the best of no world, it just combines two ineffective options to yield one ineffective option. JG 11.18.08

• DR Garcia I had a erbium laser with profraction and after reading what your opinion is on the fractional lasers - could I suggest a C02 laser be done and how soon after?

  Answer:  I would wait at least 6 weeks to see what has occurred. Best of luck. JG 11.18.08

• I have a very bad case of melasma on both cheeks, and across my chin. I have had several IPL`s and several microlaser peels. The spots have lightened a lot, but not gone. The plastic surgeon now wants to do a combination profractional and microlaser peel. I think this is the combo. I know the profractional part is. However, he said it would bleed and require longer to recover. Do you know if this will work? What else can I try?

  Answer:  I would rather go with a deeper YAG laser to treat it. JG 11.18.08

• Dr G how long does a co2 laser last?

  Answer:  depends on how deeply it is performed, and how old the skin is, might be 1-5 years, maybe more in a small number of cases. JG 11.18.08

• Dr. Garcia, So what would you recommend for smoothing the skin?

  Answer:  Rhytec Portrait or a ligth CO2 laser, non-fractionated. JG 11.17.08

• Dr. If i want to even out my skin texture and some hyperpigmentation would you recommend a chemical peel, if so which do you recommend and at what grade, Thank you so much, Your website is Awesome!

  Answer:  my choice for spots is either a chemical peel or a light Rhytec Portrait, but if the skin needs smoothing I do not think the chemical will do it. Best of luck. JG 11.17.08

• Dr Garcia,i want to get my facial peach fuzz removed .I heard that the elaser by Syneron is the only laser that can remove light blond hairs is it true???

  Answer:  no laser works on blonde hair, it is all hype. JG 11.17.08

• Dr G: I had a Erbium laser with profraction (under my eyes)a month ago - do these usually require multiple treatments and if so - how often could I get the next one - also are Erbium laser w/ profraction good for the skin and wrinkles?

  Answer:  well, if you are going to get any improvement, from what I have seen, it does take a series as it is otherwise not very effective. I personally think it is a waste of time though and would suggest you seek out a different treatment modality that is not fractionated. JG 11.15.08

• Dr. What peel or laser would you recomend for mild scaring (post acne) and for brown spots? Is there anything that will take care of both issues with one thing? Thank you

  Answer:  for both to be treated at the same time I suggest a deep Rhytec Portrait or a medium to lighter CO2 laser. JG 11.13.08

• Dr G: Would you recommend any chemicals peels that you could do at home - or lasers?

  Answer:  I would not recommend either be done at home, sorry. JG 11.13.08

• Dear Dr Garcia, I know you are a fan of Portrait and CO2 laser, but I am thinking of having a Hetter Peel, Looks very impressive on the website, say`s it will increase collagen, and have some down time. Just wondering if it the same as a TCA Peel, only stronger! I really admire your work and commitment in helping people like myself and others, so that we don`t end up making the wrong decisions. thank you for your candid reply.

  Answer:  well, I believe I can speak well on the subject as Dr Hetter was my partner for years before he retired and I performed a number of Hetter peels and have followed his and my patients for many years, I think the Hetter peel is much more than a TCA, has potential for skin discolorations greater than a TCA peel, but is effective if done deeply to remove spots and tighten skin, the method it tightens skin is by inducing a small amount of scarring in the skin to cause a tightening, the degree of improvement of the wrinkle is not due to the collage formed as that collagen is not organized like normal collagen. I think lasers or Rhytec is more precise of an option. Best of luck. JG 11.13.08

• I am 55 years old, long time sufferer of rosacea. Just bad telangiectasia, very few papules. I would like to try Smartxide fractional CO2 for skin firming. Is it adviseable or should I skip it with my skin condition? Thanks a heap.

  Answer:  I think it migtht, at least for awhile, aggravate your condition. JG 11.12.08

• Hi Dr. Garcia, What is your opinion of the effectiveness of Fraxel SR1500 Laser for treating acne scars, some are pretty deep scars? Any major side effects I need to be concerned about? If this is not an effective treatment what would you suggest? Thank you for your time.

  Answer:  I have not seen reliably impressive results on acne scars with that technology. I think the major effect is the risk of hyperpigmentation with little improvement of the scars. I usualy do either a deep Rhytec Portrait or a CO2 laser for deep acne scars. JG 11.11.08

• Dear Dr Garcia sorry to keep asking questions but im trying to find the best treatment without wasting my money up to now I have taken your advise as I trust it, Could you tell me if this treatment works they say they do fillers as well would this work for fine lines and wrinkles? Our skin peels are non glycolic so they do not require pre prepping of the skin. Our skin peels are pain free, non-irritating and doesn`t cause your skin to shred or redness. Our skin peels are unique because they work deep within the skin to stimulate the production of collagen and elastin and encourage cell renewal. Your skin is thoroughly washed with a mild cleanser, a prepping solution is then applied to the skin. The peel is applied evenly to the skin by your Cosmetic Surgery Nurse. Whilst the peel dries, the skin is kept comfortable with a fan, a 2nd layer may be applied at this stage. Then, a layer of wet gauze is placed over the skin and the peel is activated by the application of cold water. The gauze is removed and the appropriate serum/recovery cream is applied to you skin. The treatment takes 30 minutes and 45 minutes if you are having the Medial Microdermabrasion as you can combine this treatment in the same day. We offer a range of skin peels to treat fine lines, shallow acne scars, dry or rough skin, dull skin tone, reduce sun damage, hyper pigmentation, acne and enlarged pores. Our fully qualified Cosmetic Nurse Counsellor will recommend the best treatment for your skin.

  Answer:  I think it would be a waste of your money, not strong enough to see a visible diference once the swelling goes down. JG 11.11.08

• hi doctor. i just got a photo rejuvenation on friday, and my face was slightly pink for about half an hr. nothing else has happened. it took my doctor 5 minutes to do my face. does this sound right. thanks for your answer in advance.

  Answer:  well, it sounds right as they are quite mild and may take a long series of sessions to see anything. JG 11.10.08

• i had a photo rejuvenation lazer treatment that only took five minutes. it produced no results. i had it on friday and for about an hr my skin felt like a sunburn and it was very slightly pink. nothing has happened so far. my brown spots still look the same.i have about 8 noticeable brown spots. am 58 fair skinned blond female. thanks so much for your opinion

  Answer:  migth need something stronger, like a medium depth Rhytec Portrait Plasma. JG 11.10.08

• Dear Dr. Garcia I live in Wheaton, Il and would like to get some injections or lazer treatment to help those marionette lines in the nasal folds and the lines on the sides of the chin area what and who might you recommend. Thank you.

  Answer:  call Sthepanie and Michael Marschall, they are a husband and wife team of dermatology and plastic surgery, tell them I sent you. JG 11.9.08

• Hi Dr Garcia,I shall be getting Rhytec Portrait done in december or jan, and I have the following 2 questions I`m hoping you`ll be able to answer: (1) I read from your posts that I should pre-treat with Hydroquinone. Can I use Epiquin Micro (its got retin-A in it), and do I only treat spots or should I use it on my face and neck, ie: all parts to be affected by Rhytec? (2)could you please tell me what supplements I should be taking prior to this procedure, and for how long prior I shold start? Pls also let me know if I should buy anything to help the healing. I just wish I had the time, etc, to travel to you form Singapore for this. I don`t suppose this is done too often by yor patients? and logisticaly difficult after that for post-proc work if needed... Thank you in dvance for your input and for this great site :)

  Answer:  I think the Retin-A will cause some irritation and get the skin to heal faster. If you are going to use it I suggest treating the whole face as the entire face will be treated. As to supplement before the Rhytec, just a good B-Complex and Vitamin C is about all you need, Best of luck. JG 11.9.08

• Hi Dr. Garcia, I have tried every cream and gel imaginable for dark undereye circles. They are good for puffiness only. Nothing has changed the dark black circles under my eyes. Is there any cosmetic procedure ie lasers that can reduce the dark pigment in the orbital area under my eyes? I have great skin, no wrinkles, 41 yrs old. I m very frustrated with these black circles that never change. I love to walk around with with no makeup but the black circles look horrible. I know of the juvaderm and restalyn option but is there anything that can be done that`s more permanent? Money is not a concern.

  Answer:  there is not surgery or lasers that work, I do have a new cream for sale in my office that helps about 60% of patients. It is not on my shopping cart yet but if you call the office they can sell and ship it to you. JG 11.8.08

• Hi Dr, What would be your choice to brighten up fair skinned, slightly sun damaged skin in a 40 year old. I have been advised a course of Medlite or a light TCA peel? Thanks

  Answer:  I think Retin-A is the easiest and safest althought the others can do it too, the TCA has a small risk of reactive hyperpigmentation though. JG 11.9.08

• hi dr. garcia, what are microlazers? what do you think of them

  Answer:  they are just lasers set to very low energies in order to attempt ot break up brown spots and induce collagen with minimal to no downtime, the faster the healing, the less the imporvement though. JG 11.9.08

• Hi Dr. Garcia, Can you tell me what specifically you don`t like about thermage? Also what are risks in your opinion? thanks for your help.

  Answer:  no significant improvement in the vast majority of patients. The most common risk is spending moeny and getting nothing for it, the reported facial fat loss is very rare. JG 11.7.08

• I`ve been seeing a derm.for a while now for fillers and laser vein treatments and respect her very much. She`s been doing thermage for years and has the latest machine and tips-do you still feel the same about the procedure? I`ve spoken to a couple of her patients who have been very pleased.thank you.

  Answer:  I still feel the same, I would doubt she would have you talk to any of her patients that were not happy. JG 11.7.08

• I suffer from a very mild form of Rosacea, and have red veins on my cheeks and nose, can you please advise what is the best treatment for this,laser I have been looking at the Cutera Genesis laser/Cutera Coolglide, there are so many lasers out there I dont know which to choose?

  Answer:  I think I would start with IPL treatments and then progress to VBeam if they do not respond, but it takes a series of sessions and the improvements for all lasers are temporary. JG 11.6.08

• Dr Garcia just asked about the peels but thought it best to let you read what the clinic say about them on their site, it explains more thank you for helping. Glycolic Acid/TCA Peels TCA and Glycolic Acid peels help reduce cell build up at the lower levels of the skin. This facial will resurface the skin giving dramatically softer, smoother, skin also reducing fine lines, wrinkles and scaring. It improves acne scaring, skin discolouration and coarse texture. After just a few weeks your skin looks brighter, clearer and dry skin becomes hydrated and smooth. The recommended number of treatments is 5, one every 2 weeks, followed by a maintenance peel 3 times per year. Features and benefits Assists to resolve photo-damaged skin (sun damage), Acne and scar reduction, premature ageing or hyperpigmentation. Significantly decreases the appearance of fine lines and wrinkles, stimulates collagen and elastin. Accelerates the results that can be achieved with home care products. Make-up can be applied and normal activities can resume immediately. Following a consultation with our Medical Practitioner, a suitable `peel` programme will be determined to suit your specific needs. Obagi Protocols Restoration System OBJ is a light TCA Peel, which removes thin surface layers of damaged skin to reveal new unblemished skin! Using a low concentration of the chemical trichlorocetic acid (TCA) mixed with a special blue base to slow penetration, the blue peel allows your medical practitioner to monitor the appropriate depth to effectively remove the thin surface layers of aged and damaged skin from the face or other parts of the body (i.e. neck, chest, hands, back, arms and legs). These dead skin cells are replaced by healthier ones, allowing the skins own clarity and tightness to resurface. Obagi Protocols are an integrated system of specialised creams and lotions, which greatly enhance the result of the blue peel, or can be used alone for skin rejuvenation, to help remove sun spots, damage coused by light acne scarring and uneven pigmentation. The number of peels required for the desired result is between 1-3 peels with 6-8 week intervals between each peel. Recovery Period: After the procedure, a slight bluish tint remains on your skin, which will usually wash off in 12-24 hours. Your skin will begin to peel within 2-3 days. For lighter exfoliation, blue peel healing is completed in 3-6 days hence known as a `weekend peel`. A deeper blue peel will take an average of 7-10 days to peel. Make-up should only be applied after the skin is healed.

  Answer:  TCA and especially glycolic acids work on the superficial part of the skin, not the deep part. They do help with skin discolorations though. The acids applied do not hydrate the skin, that comes from whatever you do after the surface has been peeled off, so that is incorrect also. If you are able to apply make up right after then the injury to the skin is less than a bad sunburn and will not incite much change in the quality and character of the skin. I have used Obaji products for over 18 years and I am speaking from that experience. Also, understand that when they use the word medical practitioner, you have no idea what training they have, the one thing you can tell for certain is that they are not a dermatologist or a plastic surgeon because they would have told you that, so more likely it is a medical assisant, a nurse or some other type of physician who took a weekend course on skin care. JG 11.5.08

• Dr Garcia do you think Glycolic Acid/TCA Peels are better then laser? there is a clinic near me saying they recommend six every two weeks and it removes scarring and fine lines and wrinkles, I am trying to decide laser or peel thanks Dr Garcia your so good to answer all thease questions. I always take your advice

  Answer:  I completely disagree, maybe they are saying that because they do not perform lasers. I think lasers are a better choice for wrinkles, scars and fine lines. JG 11.5.08

• WOW, that was a quick reply. Your site is so appreciated Dr Garcia, thank you. Just going back to my last question though ... out of interest, would having a filler such as Perlane Sub Q protect the fat layer during a Thermage treatment? Thanks once again

  Answer:  no protection effect, but does hide the dent for awhile. JG 11.4.08

• Hi Dr, I just read an article about a lady who noticed obvious indents from loss of fat 18 months after Thermage. Could this happen at such a late stage? I have already posted before about my concerns and hoped that I was out of the danger zone having done the treatment 8 months ago .... Would I have noticed something by now? Thank you

  Answer:  typically the fat loss happens soon after the treatment and can progress for long periods of time, in some cases, if there was swelling present, and some areas are more prone to swelling than others, the fat loss is not appreciated until a long time down the road. In most cases the fat loss is appreciated within 4-6 weeks. I think you are likely out of the zone of risk. JG 11.4.08

• Dr. Garcia, I have some more questions concerning the 35% TCA peel. When can I do a microdermabrasion at my beautician (I need it to close my pores after this peel)? I thinking about Accutane (I don`t want to take BCPs or spironolactone to the end of my life in order to control my acne)and would like to know if and how long after this peel I should wait to start accutane teraphy. And the last one, what do you think about taking accutane by the person who suspects that her hairs are falling out because of dht sensitivenes. Sorry for taking you so much time and thank you for your incredible patience! :)

  Answer:  I do not think a microdermabrasion should be done for at least 6 weeks, as to the Accutane, its effects are not permanent either. I would not use the Accutane for at least 6-8 weeks after the peel. Hair loss has been reposrted with Accutane but it is due to the drug`s effect directly on the hair follicles and not due to DHT, all the best. JG 11.3.08

• I have read some lasers/ RF and IPLs can cause fat loss. Do you know if this has happened with MedLite?

  Answer:  it is the rdaiofrequency that has been associated with the fat loss and MedLite has no RF. I have used a MedLite laser for over 13 years and have never seen fat loss. JG 11.3.08

• dr garcia as for the pin prick part of the fraxel laser, what are they supposed to do?

  Answer:  that is where the laser made a hole in an attmept to create new collagne and tighten the skin. JG 11.2.08

• how many microns is considered deep with the micro laser peel? i am not expecting dramatic results or any colagen rebuilding, just want to reveal newer skin. Is it like having used Retin A for a year? Or more like a bunch of microdermabrasions? Does one deeper one last longer? what are the stages the skin goes thru after? if any?

  Answer:  I would say 20-30, it is relative. It will be similar in the effects of consistent Retin-A use, yes. Similar to a series of microdermabrasions although some microdermabrasions can be done deeper. If done deeply you might be red or sunburned for a day or so is all. 11.1.08

• Thank you very muche for your valuable advices. I`ll colect many on treatment in your clinic.

  Answer:  all the best. JG 10.31.08

• Thanks a lot for your fast answer. I`m really worried because my doctor sugested me next tca 35% peeling after one month :(. I will wait at least half a year, as you adviced me. But what product whould you recommended me to use to clean skin (still have acne), clear up red marks and reduce acne scars. Maybe you know a good dermatologist/ plastics surgeon in Poland or in Europe who could help me. I`m in deep depresion due to my skin appearance.

  Answer:  well, in my experience with 35% TCA peels for over 22 years, it takes almost 6 weeks for your skin to even hold make up well, much less do another peel. I think copper peptide creams are good to heal the skin but it will take time,I will also interject, if he is doing 35% TCA peels to improve your acne, stop, it will not work, it is meant for skin discolorations and the improvement in scars will fade once the swelling goes down. I am sorry but I do not have any referrals for you in Poland. All the best. JG 10.31.08

• Hi Dr. Garcia. I have TCA 35% peel a week ago. 1. I would like to ask you when can I start using anty acne products and which kind of them would you recommend me to keep results of this peeling (sth with glicol acid, benzol pyroxide or azelic acid?) 2. When can I do the next peel? 3. Is it better to wash face or not to wasch within the first days after peel? 4. How long after peel should I use cram like cicalfate or cicaplast?

  Answer:  I normally advise patients to wait at least one month, your doctrr should have told you that. As to another peel, I would not even begin to make that decision for 6 months. We have our patients splash water for the days until all of the peeling skin has come off before washing it with any cleanser. JG 10.31.08

• Hi Dr. Garcia, I have had the portrait plasma level 3 about 12 days ago. My skin broke out really bad with blisters and bumps. My antibiotics were changed three times because the culture came back that it was a bacterial infection. All of these bumps and pimples are pretty much gone but the red blotchy marks are still there. Being that this happened on my new skin after treatment, will those red blotchy marks and bumps all over be permanent? If so, how can I reduce the appearance of red blotchy bumpy skin? Thanks for your time.

  Answer:  they should all be temporary. Just got to give it some time. JG 10.30.08

• during a lower face lift, how far around the mouth can laser be done? Just to the point where the jowl skin has been undermined? with Co2 or Rhytec, on a fair/med skin type, would there be a definate difference in lasered pigment?

  Answer:  up to the nasolabial folds or laugh lines, or to the extent of undermining, yes. The difference in skin pigment would be greater with the CO2 but the improvement would also be greater. JG 10.30.08

• what is your opinion of Micro Laser Peel by Sciton? It is reasonably priced so i am thinking of doing that, followed by Retin A to maintain. Your thoughts?

  Answer:  well, effects are very mild with any company`s micro-laser peel so the Retin-A will help, but do not expect dramtic changes or improvement in collagen content with the laser peel. JG 10.30.08

• About how long for Rhytec laser recovery for a medium pass? What exactly are the stages the face goes thru while healing? Don PS s ever laser do whole face during lower face lift or ? Is Rhytec done under anesthesia?

  Answer:  7-10 days or so. The stages are a slow peeling of the denatured skin and revealing the younger sensitive skin below, like a bad sunburn. I do my deep Rhytec under general anesthesia and I suggest not to resurface skin that has been undermined or lifted at the same time. JG 10.29.08

• what is the point of Fractional Lasers? If only a fraction of skin is actuallt lasered, how can there be much improvement? Whay not laser whole area? I would think that making pin pricks would be a waste of time and recovery for nnot much result? What makes Sciton Profractional any different/better than regular Fraxel?

  Answer:  personally, it is all marketing, trying to get people who want something to heal faster, who wouldn`t want that, to pay money on the hope that less is more. I think the degree if disappointment in all fractional lasers is equal, they are all equally less than impressive. JG 10.28.08

• Hi Dr. Garcia, I have been applying the white vinegar to my face to get rid of the red and white cyst like acne all over my face after having a level 3 Portrait Plasma treatment. I am now at day seven and my face looks like I have the chicken pox. It is red and blotchy with crust like blisters. Very dry and flaky. I can`t use the aquaphor to moisturize. What would you suggest as a moisturizer as well as a calming agent for the redness and acne? My dr. has me on strong antibiotics and acroyclor (herpes medicine) 5 times a day and a yeast infection medicine. I don`t think I am being treated properly. I think I have allergic contact dermatitis from the latex gloves or just a bad reaction to the aquaphor. Any suggestions to what medication I should be taking? Nothing seems to be working. Please help.

  Answer:  get some squalene oil from the health food store and use that, or EMU oil, but I prefer the squalene, that should help, but the redness and splotchiness is normal. JG 10.27.08

• why dont you believe in vibraderm? thankyou for you time and web site dr.garcia. i am a 58 year old female. my doc has offered to me free if i spend so much money. i feel he is a good doctor and have been satisfied with the fillers he has administered in the past.

  Answer:  well, at best it is a microdermabrasion feel-a-like, and even the company has no medical studies to back up any of the claims they are making. If he is so convinced, ask him to provide you and I with the medical studies that show it works.I always find that doctors are always willing to give things away that are effective, juts kidding. JG 10.26.08

• Is the q-switched yag ablative? I thought it wasnt but I recently saw someone who had it done for brown spots and it seemed to look ablative in that the skin on the surface of the face was scabbing over where the brown spots were.

  Answer:  no, it is not in the way others are, there can be small skin slough due to the injury below the skin in some few cases, but that is not how it is meant to work. The skin that was treated can peel as the skin heals but that is not becasue the skin was attempted to be removed but from the destruction of the pigmented cells below the skin. JG 10.26.08

• he dr. can you tell me what you think of vibraderm and does it work well. thanks

  Answer:  not a believer, sorry. JG 10.25.08

• Hi Dr Garcia im still looking into laser treatment have you heard of pixel laser and does it remove fine lines a clinic here is saying its effective, also does Copper Peptide Serum really help with scars thank you Dr garcia.

  Answer:  I think copper does help with recent wounds and I am not a fan of pixelated lasers. JG 10.25.08

• hi, sorry last question. I am the one with the portrait plasma treatment. It is later on in the day and the condition is getting much worse. The white blisters (pimples) are completely covering my face and becoming larger. The peeling is almost complete so now my face is raw and has this white pimples all over. I haven`t been able to stop myself from helping the peeling along and picking at the white blisters. How much damage am I doing to my new skin? I am so worried? My Dr. is out of town and I am really concerned I am having a reaction to something and doing damage to my skin. Promise, last question. Thank you so much.

  Answer:  I might suggest putting a tablespoon of white vinegar in a liter of distilled water and soaking a gauze in it and then placing it on your face to open the white pimples, stop the Aquaphor, and tomorrow call the doctor`s office and see if he has another doctor covering his patients for complications, that is the standard of care when one goes out of town. JG 10.23.08

• I am considering having Fraxel yet I also get fillers and was wondering if the laser will degrade the filler? Have there been any studies done regarding this? Thank you!

  Answer:  there is some possibilty so I would do the fillers after the Fraxel if you are convinced you want the Fraxel done. The latest studies show some theoretical effect on dissolving the filler due to the stimulation of inflammation down deeper. JG 10.23.08

• Thank you so much for your quick response. I feel a little better knowing there is nothing unusual going on. When I wash my face with the cetaphil in the shower and I pat it dry, I have noticed that the white bumps are popping and the peeling is coming off. Will this leave scarring? I appreciate your time.

  Answer:  no, that will not scar, it is just the plugged pores opening up and letting the oil out. JG 10.23.08

• Hi Dr. Garcia, I just had a Portrait Plasma Regeneration procedure done about 3 days ago, and I began peeling after the first day. Is that ok, or is it too soon. Also, my Dr. told me to stop the vinegar treatments but I only had just started them. I have developed white milia (small white blister like pimples all over my face) and the Dr. attributes it to the aquaphor that I need to apply constantly. He suggests I lay off of it but every brochure and instruction emphasizes not to discontinue the aquaphor. My face dries up without it and I am afraid of scarring. The swelling in my eyes and face are still really bad, is this all normal and do you have any suggestions what I can do about the small blisters? They are driving me crazy. Thank you for your time.

  Answer:  the time of peeling depends on the patient`s skin and how deep they went, that is not unusual. I think continuing the Aquaphor is OK, the milia wil all open on their own in time. Swelling around the eyes is common, keep your head up and appply some ice if you can too. Let the blisters heal on their own, it will not take too much time. JG 10.23.08

• I had a light chemical peel 5 days ago and it made a blood vessel on the bridge of my nose flare up and look about twice as prominent. Is this permanent?

  Answer:  most likely no. JG 10.21.08

• I recently posted about having a vitalize peel that I prematurely peeled. The areas I prematurely peeled were red and sore but now seem to be scabbing over again... but every time I eat or move my face, the scabbing over my NL lines keeps cracking and revealing raw skin underneath that burns. I dont want the area to scar. What can I do to stop this other than not move my face over the next week? because that is pretty challenging!

  Answer:  try staying on a liquid diet for a few days, that will minimze the motion of the folds. JG 10.21.08

• Is it bad for the skin to get frequent ipls, peels, and lasers? Alot of doctors say that the chronic infamation repeated treatments causes prematurely ages the skin.

  Answer:  well, it greatly depends on depth the treatments are done to, I do find that in the patient`s attempts to never age that they overdo it at times, and they are at times encouraged by the technicians that sell the procedures too. JG 10.20.08

• Hey Dr Garcia, I am from India and I am not very dark not too light either.. well compared to most indians i guess I would be considered light skinned. From the past few mosts I started noticing some pigmentation and uneveness in my skin tone with a few acne marks. I have been using tretinoin cream 0.012% concentration from the past 5 days and my skin is dry and still peeling. I want to try the lactic acid peel 40% soon. Can I go ahead and start that even though my skin is slightly dry and peeling very little? also what cream can I apply to lighten the marks and make my face brighter even and lighter? please lemme know. thanks!

  Answer:  I think the lactic acid is OK but stop the retinoid for 2-3 days before and after to avoid a problem, I think adding some 4% hydroquinone to the retinoid will help lighten the brown spots too. Best of luck. JG 10.19.08

• I had the vitalize peel done on thursday evening, and parts of it started to peel on Sat, I stupidly took a shower today, on Sun and rubbed my face to assist the peeling and now some areas where the skin peeled look red and burn a little. 1 part in particular looks the most worrisome and is slightly raised, shiny and red. Is there any creams I should use to help make sure I these areas dont scar?

  Answer:  use some aloe or neosporin until you can see the doctor to have them look at it. JG 10.19.08

• I have got infection after laser affirm treatment. i have had 5 previos treatment and this didnt happen with another doctor can u tell me how and i have been given augementin tablets dalcin t and auriderm cream and vitamin e cream please advise will my skin heal it had been 5 days now

  Answer:  to be honest I am not sure how that happened but it is a small possibility as the skin is heated and if there was a small blister it could get infected, it is also very prone to a viral infection and you need to find out if that is the problem as antibiotics will not help the infection if it is viral. JG 10.19.08

• Dear Dr. Garica, Is affirm laser a co2 laser? what is the difference from draxel laser? Are u convinced it helps reduce fine lines wrinles and pigmentation? Can it worsen pigmentation ? Can it burn the skin?

  Answer:  no, the Affirm uses no CO2 laser and as to the draxel, I presume you mean the Fraxel, and I think they are both not effective as to the claims they make. JG 10.18.08

• Hi Dr., I was wondering how close to the eye you can go with IPL? I have some freckling underneath my eyes and on the sides of them and was wondering if it is safe for the laser to be used in this area. I was also wondering hat strength is ussually the most effective for light skin with acne mark and sun damage. Thanks

  Answer:  I do not recommned any higher than that very small piece of lid skin that could be pulled up on the upper lid or down on the lower lid so that the skin is lying over bone, I would not treat the eyelid skin if it were lying over the eyeball. The effective strength needed goes up higher with the worse the damage and I think the effects on the acne are minimal. JG 10.18.08

• Oh check this out. I`m the guy who just posted about Dettol. I just looked it up on wikipedia and dettols chemical formula is C8H9ClO. And phenol is C6H5OH. Does this mean that dettol is even more toxic?

  Answer:  potentially, but do not know if it has the same cardiac dangers as phenol. JG 10.18.08

• One day I forgot to mix dettol I was applying on cut with water so it was basically 100% dettol. The area burned and swelled up and a few days later their was a big scabby patch of skin that came off where I applied the dettol. To my amazament, the skin was incredibly smooth and fine lines on my face and age spots were also removed with the dettol solution. Since then I have been spot treating dettol to all my wrinkles and age spots and it`s actually worked! A five dollar house cleaner is giving me the results of laser resurfacing! I understand how dangerous this is, but I`ve had no negative side effects so far. This is taking cosmetic skin care to the absolute ghetto! Does dettol compare to phenol in its level of toxicity and the depth that it treats?

  Answer:  I do not think dettol has the cardiac dangers that phenol does but I STRONGLY advise you not continue that method, if you use that reasoning, using diluted battery acid would be cheaper and more effective. I think you have ben lucky but suggest you stop. JG 10.18.08

• Dr garcia, 3 days ago i had affirm laser treatment on my face and neck i have redness peeling and crusting also some pimples my skin was good befroe i am concerned will i have scarring and discoloration?

  Answer:  I do not think there should be any scarring. JG 10.17.08

• I really like your blog and agree with pretty much everything you say, but I disagree with when you say TCA peels dont help for fine lines. I had a 35% TCA peel with Jessners and it got rid of the fine lines around my eyes and diminished my rolling acne scars by about 15%. It`s been nearly a year and the fine lines still arent back yet. Could have something to do with the fact that Im 29 though and had very fine lines.

  Answer:  yes, I feel your age has all to do with it, the degree of fine lines due to skin thinning and loss of collagen in your age groups is usually due to skin dehydration and escessive keartinization and not loss of skin components, I am afraid the TCA will not give you the same degree of improvement as you get older but am glad you got what you did this go round. All the best. JG 10.17.08

• I had thermage aprox 8 months ago and sustained a mild ammount of fatloss from the procedure along with pock marks and dents. Most of which occured within a couple of weeks following Thermage and my skin seemed to stabelized thereafter although I may still be losing a little fat. Some areas of my face look a little more hollow since but it`s progressing at such a slow rate, if at all, that its difficult to notice. I am contemplating proceeding with some very light methods of resurfacing (sciton microlaser and acid peel), not so much for the scarring, but just to give my skin a little bit of its glow back and I am scheduled for a microlaserpeel tommorow, 8 months after the Thermage, however, I just read something very troubling that may make me cancel my appointment, one doctor theorizes that the fat loss caused by Thermage is not due to it melting the subcutaneous fat, but rather the fats reaction to an inflammatory response from the procedure. Do you think the microlaser and peels could potentially agravate this inflamatory response at this point and cause more scarring and fatloss, or should I be safe to proceed?

  Answer:  in the thousands of laser treatments I have done with a variety of lasers I have not seen that claim be true. Best of luck with the treatments. JG 10.16.08

• 50 micron erbium ablative peel Vs. 300 micron erbium fractionated peel. Coverage vs. Depth. If you had to pick one, which one would you lean towards for effectiveness.

  Answer:  the ablative peel. JG 10.15.08

• What do you think is a better option for thread veins between hyfercation and veinwave? Which is less likley to cause the small pitted scars you mentioned in my last post regarding veinwave? Tried lasers with no success. My skin seems resiliant to them. thanks much

  Answer:  I think either one can cause pitted scars if the energy is turned up too high. I think if you did not repsond to the lasers you might still respond to the hyfercator and maybe to the VeinWave. JG 10.8.08

• Do you think veinwave has the potential to cause fat loss since it incorporates thermo-coagulation?

  Answer:  probabaly not fat loss but the depressions seen after its use on some cases is more likely due to pitting due to scarring pulling the skin surface down rather than fat loss. JG 10.8.08

• Which treatment generally goes deeper into the skin, ND Yag 1064 vascular treatment, or Q-switched yag pigment treatment?

  Answer:  it depends more on the energy setting selected than the laser. JG 10.8.08

• Does self tanner work on skin lightened by Co2 laser?

  Answer:  yes, on a temporary basis, it will wash off like all other self tanners. JG 10.7.08

• would doing a co2 laser on entire face be preferred to just partial, due to possible loss of pigment? i know u are not a fan of profractional but my skin is really not bad enough for co2. i am getting a full face PFL possibly with MlcroLP before to better prep skin but may skip that part(your advice) what if after the month that goes by Dr during lower face/neck lift surgery goes over upper lip area with Co2 instead of the planned deeper PFL? would there be any benifit to this? disadvantage? i want to ask him about this when i go for botox in couple days. thanks so much

  Answer:  I think getting even skin tone is much easier when the whole face is done, yes. The CO2 laser can be used at a lower setting to lessen the potential color difference from the treated to the untreated skin but that will also lessen the degree of improvement. JG 10.6.08

• Thanks for the reply.... I said in my last post: Dr Garcia I am half italian/half scottish and olive skinned but I do NOT tend to hyperpigment when I cut or get a pimple. What would be the % limit that I could go with a TCA peel? What would be the micron limit that I could go with a microlaserpeel? You said >>>> Answer: well, the deepest TCA I would do is 35% (about 50-60 microns)and the microlaser peel will never be that deep, more on the order of 20-23 microns. JG 10.6.08 >>>>>>> I reply: I think we are talking about different versions of the microlaserpeel. The place I am looking at offers Erbium yag ablative 20-50 microns ablative microlaserpeel. Just as safe on my skin type as the 35% TCA?

  Answer:  about the same safety margin. JG 10.6.08

• Hi Dr. Garcia, I`m a 23 year old male. i went to see my dermatologist about clusters of little white dots that have suddenly sprung up on my lower eyelids. He diagnosed them as syringomas and said i could either have them cauterised but that comes with a risk of scarring, or he recommended i go see a plastic surgeon about using carbon dioxide laser. Do you think carbon dioxide laser is an appropriate treatment (also given my age and that i don`t have wrinkles or any other skin issues) or if not can you recommend anything else? Thank you!

  Answer:  the CO2 laser would be used as a spot treatment in your case so it will not do anything to the surrounding skin and it has a small chance of scarring if done as a spot treatment and they will come back in time no matter what you have done. I usually just hyfercate them and accept that I will go lightly t avoid scarring, especially since I will need to do it again in time. JG 10.6.08

• Dr. Garcia, you said that cosmelan could cause pih and I would need pre treatment before the peel. What would you suggest? How common is pih from the cosmelan peel? Would a bbl be better that a fotofacial? Thank you so much

  Answer:  I suggest Retin-A 0.1% and 4% hydroquinone for 2-4 weeks prior, the darker one is the longer I pretreat, the liklihood of PIH is dependent on the person`s skin to the greatest extent. I think fotofacial is likley safer but also not as dramatic and also cab have PIH if done strongly. JG 10.6.08

• Dr Garcia I am half italian/half scottish and olive skinned but I do NOT tend to hyperpigment when I cut or get a pimple. What would be the % limit that I could go with a TCA peel? What would be the micron limit that I could go with a microlaserpeel?

  Answer:  well, the deepest TCA I would do is 35% (about 50-60 microns)and the microlaser peel will never be that deep, more on the order of 20-23 microns. JG 10.6.08

• Hi. You have said that Matrix/refirme is a waste of money can you tell me why?

  Answer:  the only research to back up their claims has been done by people that work for the company and I think the science behind its effectiveness is not well documented anywhere else. JG 10.4.08

• Dr Garcia, in your opinion, what is the best laser for sun damage, fines lines, wrinkles? You say you are not a fan of any Fraxel because of the down time producing minimal results, even the profractional. (you helped me decide to not combine it with microlaserpeel). I could email you pics of myself if i had your email. I asked Dr steve Perkins, Indianapolis, who is doing my f/l and nose, if he promised this profractional was worth it, and that i would see results, and he did. he is also a friend and lives 2 doors down from me so i trust him. And he has every laser ever invented so its not just needing to pay for a particular machine by recommending it. Thank you. JR

  Answer:  my choice for those problems will be CO2 laser first and then the Rhytec, if you believe him then you might feel comfortable with proceeding. I also have had many lasers over the years. I have never bought a fractioanl laser because I never felt they worked and have not been impressed with the photos shown at medical meetings, the marketing photos are certainly dramatic but are not the typical results I feel. Best of luck. JG 10.4.08

• Dear Dr. Garcia, I have PIH from fraxel and melasma that has not responded to HQ, retin a, or photofacial. Will a cosmelan peel help with these issues? It is very confusing with the old/new cosmelan formulas theories floating around. How much improvement could I expect, if any?

  Answer:  it might help, yes, but you need pre peel treatment and the peel can cause PIH too.I think the degree of improvement goes down the longer you have had the problem. JG 10.4.08

• Thank you for the MicroLaser/profractional advice. The cost of 1 profractional is 1500, package of 2, 2000. and doing the Microlaser peel is an additional 300. I will take your advice and skip the Microlaser. Would you recommend getting back on Retin A before PF? i have been off it since beginning of summer. Do you think the PF is good for what i describe i need? Thanks!

  Answer:  I think Retin-A and hydroquinone before any ablative laser is wise, even it is a fractional one, in order to decrease the chances of hyperpigmentation. I cannot say whether the PF is what you need without seeing you, but in general I am not a big fan of any fractional treatment, I think they tend to be overhyped, overpromised and expensive and do not give much in return. All the best. JG 10.3.08

• Dr Garcia, i posted about the combo of microlaser and profractional same day. They said it would give better results, the Micro laser would be first, with the profractional immediately after. does this make sense? Thanks!

  Answer:  zero sense, if the microlaser is done first, the level of exfoliation and collagen production, since it is a very superficial tretment, will all be removed by the Profractional, I stil think it is a waste of money if you do it in the reverse method to. It would be like using a piece of sandpaper and then going over it with a power sander. Skip the microlaser if you are convinced you want the fractional treatment. JG 10.3.08

• Hello Dr Garcia, I have scheduled atreatment of the Sciton Profractional Laser combined with the MicroLaserPeel couple days before Thanksgiving, and am scheduled for a lower face/neck lift litle less than 4 weeks later(gift from hubby as i am aproaching the big 50 next summer) When i had the consult with the PS(Stephen Perkins, Indianapolis) he said he was going to do the same laser(PF) around my mouth during surgery. I have been told it is fine to do the peel that close to surgery but wondering if he will still need to go around the mouth again? those vertical lipstick lines are IMO the worst. Also, they said that i would only probably need 1 treatment since my skin is decent, just some fine lines on jaw/cheek area and orange peelish on forehead. What is the healing like, exactly? is there peeling involved, or just redness? and how long?

  Answer:  that laser is prettty quick to hela so it can be repeated at the time of surgery, I am a little confused as to doing a microlaser peel on the same day as the profractional laser, the microlaser will be a waste of money.Peeling is for a few days and there is some skkn bronzing and as long as you have minimal fine lines on the cheek skin, it might be enough, but not for the area around your mouth, those are much harder to improve and usually need soemthing more agressive or many more treatments. Best of luck. JG 10.3.08

• How many microns deep would a 25% TCA peel go on average if layered to the point of frosting?

  Answer:  possibly as deep as 30-35 microns. JG 10.3.08

• Hi Dr. Garcia you have a wonderful service here. I am looking into get a sciton micro laser peel to freshen up my skin. I am half italian and half irish with olive complexion, yet I never really seem to get hyperpigmentation problems after I get a cut or a pimple. The peel is erbium ablative and goes between 20-50 microns deep. How many microns do you feel will be safe for my skin type without pretreatment? How many microns do you feel will be safe for my skin with pretreatment? Thanks in advance!

  Answer:  I cannot say how many microns you need to see an improvement without seeing you in person but since typically a series is needed, start low and progress as tolerated. Best of luck. JG 10.2.08

• Dr. Garcia, thanks for your previous response. I posted a question regarding scarring caused by 1064 ND Yag vascular treatment I received and you responded that I should be okay with the Q-switched ND yag for brown flat moles. However, I would like to know the science behind that statement for me to consider it. As a laser tech, I am primarily working with ipl, profractional and mlp`s so the q-switched yag application is a way outside of my expertise. How do the settings of a 1064 q-switched treatment differ from a 1064 vascular treatment? Do you think there are safer lasers out for me given my past experiences? How about the 755 nm Alexandrite? I`m scared of anything with too much depth. Thanks for all your patience with my questions.

  Answer:  I think the Alex laser is likely too hot, I have seen some people get burned with it, and long pulsed YAG will not work as well I feel for skin discolorations as the Q-switched Nd:YAG but the long pulse might have a slightly better safety profile, there is always a trade off I am afraid. JG 10.2.08.

• Doctor Garcia, I`m confused about your posts that say that laser cant cause fatloss. Aren`t there many lasers specifically used for that purpose? (laser lyposis) Also, I`m looking into getting a 25% TCA peel, but I read the contraindicitations for that procedure are a history of keloid scarring. I have a few scars on my body and on my face, but no keloids except the one I got from having my cartlidge in my ear pierced which appeared about a year after having the piercing. Should I be okay with the peel?

  Answer:  there are lasers that when applied directly onto the fat, in direct contact, and not through the skin, that can, if enough energy at the correct frquency, cause fat to be broken up so it can be aspirated out, yes, but the lasers used for skin resurfacing typically do not even reach the deepest part of the skin so it would be impossible for fat loss to occur from a skin resurfacing laser. If fat loss from a skin resurfacing laser were to occur, there would have to be enough heat to burn the skin at the same time, so if fat loss were t occur from the laser there would be a horrendous scar also. Lasers do cause swelling and once the swelling is gone the face can look thinner and one of the reasons that lasers are done is to make older people look younger and a frequent problem with the aging process is facial fat loss, and in some cases I think that degree of facial fat loss was not appreciated or not shown to the patient before so then they attribute it to the procedure performed. In general the 25% TCA peel, if applied by an experienced physician should not cause a full or deep thickness burn which is what would cause a keloid. Best of luck. JG 10.1.08

• Dr Garcia. I feel that you are too readily recommending procedures like the PSR3 and C02 to users on this board, many of which do not even seem to need it judging by their ages and problems described. Sure these modalities can net the greatest results, but at what cost? Portrait Plasma is essentially a bunsen burner , as the tip puts out plasma flame activated by the nitrogen gas and radiofrequency energy. Since there is NO spacer on the tip to ensure consistent distance from the tip to the skin, there is a great chance of unevenness. This procedure requires much skills from the practitioner. I have seen some bad outcomes, thus adverse effects from unskilled hands . I find that when used in areas of bony prominenece, nothing over 2 joules should be used as too avoid the sizzling effect that many patients are experiencing. The treatment may go over well in your practise, but your recommendations on this board often lead people to seek other practicioners without your skill and disasterous results may ensue. I also feel you are too readily writing off the new partially ablative fractionated C02`s. These are not the fractionated Erbiums of yesteryear. They have been well recieved thus far in terms of patient satisfation, downtime and overall efficacy. Alot more precise than Plasma and a lot less dangerous than full bore ablative C02. From reading your board it seems like you won`t get any results from anything that isn`t Portrait Plasma or C02 and that simply isn`t true. I`ve even see many patients get great long lasting results from TCA peels. Not meaning to crash the party, just my take... Thanks V

  Answer:  any laser will cause similar actions in order to injure the skin and create new collagen. As to there not being any spacer, you are absolutey incorrect, there is spacer available if the doctor wants to use it. That will lessen the skill that is needed to properly apply it. It clearly appears that you are someone who offers skin resurfacing with modalities other than what I recommend. In your practice you might be totally happy, I am glad. In my experience, the majority of people who have had fractional therapies are either burnt beyond wat was described to them with significantly more healing time and hyperpigmentation or they spent their money and got nothing for it and then come to me to get something more effective. Medicine and especially cosmetic medicine is a matter of opinion, there is no 100% correct answer, what is offered here is my opinion, it obviously differs greatly from yours and you obviously have your biases too, the source of which I could venture to guess at. As to TCA peels, I still use them, hace used them for over 20 years on hundreds of patients, but only for pigmentation, I would ask you to mention a link on a peer-reviewed medical journal where any TCA peels have shown clinica wrinkle reduction that lasts longer than the period of swelling does. As to the Fractional CO2 versus Erbium, it is matter of marketing, when the erbium fractioanl lasers came out, the sellers and sers said it was the best thing, better than CO2 with gorgeous effects, but lo and behold, there were so many disappointed patients that they had to come out wiht a differnt energy source, the CO2, and althogh maybe more effective than the fractional Erbium, certainly not dramatic. It might be that the patients you treat have lower expectations than mine, that is great, but all I render here is my opinion, it certainly is different than yours and I wish you continued sucesss with the modalities you have chosen to offer. JG 9.30.08

• A year ago, I had a bad experience with laser. I went to recieve a ND Yag 1064 treatment at a med spa facility (wanted to save a buck big mistake) to treat 2 spider angiomas on my face. One under my lip, and the other beside my nose by my upper cheek. Nothing really happend to the angioma under my lip (didnt get better or worse) but the other area next to my nose swelled up after it was lasered... presumably because the skin was much thinner there. A couple of days later I noticed 2 small indented lines appear around the area she lasered by my nose, and then my upper cheek also in the area began to hollow! The area that hollowed was aprox 1 inch away from the angioma that she spot treated. The indentations that appeared were aprox .25 inches away from the area she lasered and are now shallow atrophic scars. All things considered the damage is not really that noticable, but for such a small treatment to affect the surrounding tissue on my face in such a negative way has me extemely worried to proceed with any more laser treatments as this was the only time I was ever lasered. I went to my derm to see what was up and he told me that the spot treatment caused me a small ammount of fat loss!! A very rare reaction but very scary. Now I am looking into getting various flat moles on my face depigmented with a Q-switched yag laser, but my concern is that it will affect me in the same way as the ND yag laser. Do the q-switched and NDyag lasers work differently in the depth they treat? If I experienced problems with the depth of the ND Yag do you think I will also experience the same problems with the Q-switched yag? I am actually training as a laser technician but the difference in the fuction of these Yags is confusing even to me. Thanks

  Answer:  I have never seen lasers cause fat loss without skin loss, that is only reported in radiofrequency heating machines so I am not sure what to tell, you, I think most likely the Q-Switched laser will be fine but understand the color will come back in time and the treatmeent therefore is not permanent. JG 9.27.08

• I know that you are not a fan of either for wrinkles, but I am only 29 years old and dont need any long downtime heavy resurfacing. What do you think will give me more for fine lines and texture, an introductory level average strength TCA peel or and average strength Erbium microlaselpeel. Also which between the two has a higher rate of complications? I`m half medditerranean, should I pretreat with hydroquinone?

  Answer:  it probabaly will yield little difference between the two, so take your pick. Complication rates are about equal too. I think all patients should pre-treat, darker skinned individuals for 4 weeks, lighter skinned people for two weeks. JG 9.27.08

• Hi Dr. Garcia i had a mark on my face cauterized by my dermatologist a few days ago and he didn`t mention anything at the time and this didnt happen right away but a few hours after the procedure the area directly around where it was cauterized went very red. Now a few days later a scab had formed where it was cauterized but the skin around remains very red. is that normal and if so how long should it last? thank you

  Answer:  that is all part of the normal healing process and the surrounding redness is just temporary. JG 9.26.08

• Hi Dr. Garcia. Thanks for your past help. I have been on a rollercoaster ride of diagnoses, medications, and laser treatment for rosacea. At my last derm appt, my derm thought I may have scarring around my nostrils from the laser treatment, as 3 months had passed and the skin was still red with texture change; however not being a laser specialist, he referred me back to the laser center. They said that it was probably not scarring and using a gemini would possibly help and definately not hurt. Well, needless to say, I went ahead with it. However, now, where the original persistent redness was, I am developing more of the same, with tingling and itching in the area 8 days later. And the skin feels tight. My question is: what can I do to help this area to heal without scarring? I tried Mederma, but it really itched me badly. Are silicone sheets good? I really don`t want more scars. Thanks, Alyssa

  Answer:  not sure silicone sheets will do much, I suggest a VBeam or YAG laser for the redness,can also try some copper peptide cream, best of luck. JG 9.26.08

• Dr. Garcia, I had a mini-facelift the end of August of this year. I want to have pixel laser on the scars. Is there an amount of time to wait for scar healing before having laser? Thanks,

  Answer:  you can likely proceed at any time but do not expect much, the scars would get better likely as soon or sooner without it. JG 9.24.08

• Hi Dr Garcia, I had erbium laser under my eyes about 7 years ago and was really happy with the results. I feel as if I need a second treatment but am thinking that doing another round might damage my skin under the eyes. I spoke to a doc and she felt that the whisper laser (two treatments) might do the trick. What do you think and do you know what the real downtime is- I feel as if I am told a shorter downtime than what is actually the case. She said that for two days I would be red and be able to go back to work?? I should look totally normal within a week`s period. ALso, can the whisper laser work for the lines above the mouth (I also have a brown spot developing there)?? Thanks so much

  Answer:  I will whisper into your ear about the Whisper laser.... it won`t help. I think the erbium again is your better bet but it will not give the same degre of improvement as you are older now, best of luck. 9.20.08

• Dr. Garcia - Which proceedure would you recommend for age spots on the face and chest? Photo finish laser-by photo-energy system, Soli-Tone or a ViPeel? Does one have less down time than the other, better results, and where can I find out more information? I am a light skinned. Thank you

  Answer:  I am sorry but I have had no patients that have used those technologies so I cannot endorse any of them. JG 9.18.08

• Hi Dr.Garcia, My doctor prescribed me Differin to use for pitted scars on my face and I was told that it should take about 6-12 months to see the results. Will it really help if I use it for that long period of time ?

  Answer:  well, after 12 months the degree of improvement will be maxed out, as to how long it will take to see improvements, it might take 3-6 months to see something in most cases when looking at scars. JG 9.18.08

• Hi Dr. Garcia, What is safer treatment for post acne marks on a face with mild Roscesa. Glycolic peel or Microdermabrasion?

  Answer:  microdermabrasion I feel. JG 9.18.08

• Do you think having a beta peel once a month by a dermatologist will help with the appearance of fine lines around the mouth? I`m unable to use retin-a products because of skin sensitivity.thank you.

  Answer:  no, I do not. JG 9.18.08

• Sorry to ask another question, just a follow-up to the facial aser hair removal for light olive skin. Do you not think it will work at all or might I do it do reduce the amount of facial hair If I don`t expect it to be permanent and am willing to do regular maintenance?

  Answer:  I think the risk of hyperpigmentation is greater than the potential for less hair growth. JG 9.9.08

• I have very light olive skins and have done electrolysis for years on my upper lip. It always comes back, as my hair is resistent (Italian descent), although it has thinned out. Now at 43 my whole face is growing hair. It is bad!! I am desperate to get rid of it and eletrolysis would take too long. I know you are not a big fan of lasers due to pigment problems. But is there any new laser that I might try as I need help? Which laser would be least risky?

  Answer:  no lasers that will work, sorry, might try some topical OTC progesterone cream though, or prescription Vaniqua. JG 9.09.08

• I apologize but I`d like to complete the question about the Tanda light therapy. I`m 33 years old but people thinks I`m about 27, I don`t really have much sun damage since I never liked it, I don`t have wrinkles but I have laugh lines due to midface sagging and sagging skin under my eyes that make me look tired, I have 4 almost vertical lines around my nose...it seems like every treatment in my research may be too strong..I tried restylane but it lasted just a couple of months and I`m afraid to do it under my eyes...what would you recommend? would Tanda help?

  Answer:  I think light laser like Rhytec Portrait or fillers for now are the best. JG 9.8.08

• Hello and thanks again in advance for sharing your acknowledge and experience. Do you think is worthy to use the Tanda light therapy for home use? it offers the head with red light for acne and the blue for regeneration..

  Answer:  I personally do not feel it is worth it. JG 9.8.08

• I am writing again about the peel...will the light moisturizer, prolong the peeling process, shorten it, or neither? And will the moisturizer affect the depth of the peel, and shut down the peeling process?

  Answer:  it will do neither and it will not make the peel go deeper. JG 9.4.08

• I am writing again about the peel...will the light moisturizer, prolong the peeling process, shorten it, or neither? And will the moisturizer affect the depth of the peel, and shut down the peeling process?

  Answer:  neither, it will also not affect the depth, that has already stopped. JG 9.4.08

• Hi, as always, thanks for your help! I had a fairly deep tca peel. It is my third one over time. I keep getting mixed information on the healing process. Do I keep any oils and/or moisturizer on it during the peeling process or do I keep those things OFF it?? I read both, and get different info from the dr. office. I need it to peel as fast as possible, as I have something I need to attend on Sunday last minute. What can I do until then to ensure speedy recovery and not compromise the level peel. I read about using ointment on the skin at all times, and also using a warm compress - but I also read to leave anything off and tough it out to speed up recovery and peeling. PLEASE help. I need to look okay by Sunday. I can do anything until then to help this happen. Also, I wanted and aggressive treatment, and wondered if heavy swelling was any indication that the peel went deeper.

  Answer:  we use a light moisturizer on it for comfort and to allow the dead skin to come off with less discomfort. Peeling faster at times can lead to red raw skin as the skin below has not fully healed and then the make up will not adhere normally and might leave prolonged redness. Warm compress will likely not do much for a TCA peel. The deeper they go the more the swelling, yes. JG 9.4.08

• Thanks for your fast reply to my question about hypopigmentaion. You mentioned that I should start tanning to see if the color comes back. Its been almost 4 months since the treatment. Should I wait a few months or go ahead and start tanning? I read you recommended others to try IPL, fotofacial or chemical peels to lighten the tanned skin. Would this apply for me as well? If so which do you recommend trying first? Should I do one of these procedures before I try to tan again? Thanks!

  Answer:  I think you can start now and see what happens. I think hair removal on the legs will need a very large area of normal skin and I would not suggest trying to fade the other areas as it is too large and unpredictable. JG 9.1.08

• Hello! I have been receiving laser hair treatments on my legs for about 1 yr now. I was in FL for every treatment and was out in the sun and tanning frequently and never had bad results. I moved to Phoenix and had my last treatment from the same person in FL and became very hyperpigmented and now its hypo pigemented VERY badly on the front of boys legs and on the calf of one of my legs. The girl who did the treatment told me to stay out of the sun and eventually it would even out to give it a few months. The skin that was burned off was my tan skin and the hypopigmentation is my natural skin color. I have not been tanning and use 80 sun screen. I have a friend who works for erchonia.com She says that gettins treatments with that laser and applying cypress or helichrysum w/ palo santo in jojoba oil will help. I wouldnt have to pay for these treatments since she is my friend. Will this help or make it worse? Is there anything else you recommend I do for the hypopigmentation? I may not see her for a few months if those treatments will help and need to do something ASAP. I have been tanning for at least 15 yrs and I am very dark complected. Thanks for your help!!

  Answer:  well you can try it as they are free but I seriously doubt they will work. I do not think it will make it worse though. As to the hypopigmentation, about all I can suggest is eventually getting some sun to see if the superficial sundamge that was removed can come back and tan the skin. In darkly complected people, this issue is much more risky, and I usually do not suggest laser hair removal on darkly sun-tanned patients at all. JG 9.1.08

• Dr. Garcia, I recently had a session of BBL Laser Light done to my face to get rid of sun spots, I am 30. When doing the treatment she burnt some of the top of my eyebrow off, will this grow back? It has been a month and nothing has come back yet. I had it waxed recently, on other areas, and that hair is already starting to come back in. Really worried about this!! So my only question is... Will it grow back, and if so how long should it take? Thank you!

  Answer:  it should grow back in most cases. It might take three months or longer though. JG 8.26.08

• Hi Doc Many doctors claim v-beam treatments will improve wrinkles after the 2-3 sessions, especially in the thin-skinned eye area. is this even marginally true, that v-beam helps with wrinkles? that is not my understanding of the laser. thanks so much.

  Answer:  I have never seen that work, sorry. JG 8.25.08

• DCoes laser hair removal permanently remove hair? If not, the hair at least grows in finer/lighter than it was before? How many treatments does underarm hair usually require?

  Answer:  no, it is not permanent, but is usually grows in finer, yes. No way to predict the number of treatments needed though. JG 8.23.08

• Hi Dr. Garcia. This is a follow-up question about telagiatasias under the nostrils with unsuccessful vbeam treatment. You said I could try YAG and then get them hyfercated. Is hyfercation the same thing as VascuTouch? Also, what do you think about the Cynergy laser to treat stubborn nasal telagiatasia? Thanks so much for your help. You`re the best! Alyssa

  Answer:  no, the hyfercation is essentially cauterizing them with electricity to burn them closed. If the VBeam did not work I do not think the Cynergy will. JG 8.22.08

• Hi Dr. Garcia. I have telagiatasia radiating out from under my nostrils, causing red patches under my nose. I have had 3 vbeam treatments, but they don`t seem to be getting any better. What would you recommend for veins in this area?

  Answer:  can try a YAG but if the VBeam did not work, all else would fall onto getting them hyfercated. JG 8.21.08

• Hello Dr. Garcia, I am very impressed with your compassion paired with your knowledge. I am 43 years old and had a laproscopy gall bladder surgery last year April. My two side insisions have healed nicely with very minor keloid scars (small). I have one 1 inch scar above my bb that is keloid and diamond shaped with some pleat or puckering. (I am not sure if that is due to the fact I put on weight after the surgery or not. I would like to know your advice regarding what type of treatment to use to lesson the scar: laser, injections, topical, or revision. I have been told that revision is not a good idea as it would result in another keloid, however, perhaps the scar could be revised to be hidden in the middle of the bb? I thought of getting a bb ring to hide the scar but I have been turned away due the thickness of the scar and it would just be pushed out. Please advise. Thanks.

  Answer:  I think the best and most reliable is to surgically revise them, the keloids can form after laparoscopy due to pressure at the port site and repeat incision and closure typically helps the scars look much better in those cases. All the best. JG 8.19.08

• Hi Dr. Garcia. Can IPL under the eyes cause crepey skin to become crepier? If yes, is that permanent or temporary and how long would it last? Thanks!

  Answer:  maybe for a short period of time if it irritated and dried it out but not on a permanent basis I feel. As to when it gets beter, it depends on the patient age and moisturizers used. JG 8.18.08

• i had laser treatments for sunspots but the laser left white spots on some areas.. will my skin tone come back eventually?

  Answer:  it should in the vast majority of cases. JG 8.16.08

• Hi Dr. Garcia- hope you are enjoying your weekend! Thanks for all you do to help! I had my 1st IPL treatment for brown spots & redness on my chest 2 weeks ago...wow what difference!!! How long should I wait for 2nd treatment or length of time between treatments? Thank you again!

  Answer:  3-4 weeks, so glad all is going well. JG 8.17.08

• Hello and thanks in advance for the advice. I have had a peel on my under-eye areas to treat damaged skin. I really want it to heal great so here`s the question: I am currently maintaining a mask-like layer of Biafine on this small area. I`m concerned about letting skin form a hard dry crust considering that the skin around the eyes is very elastic, flexible and in constant movement. Can I keep applying a thick layer of moisturizing Biafine or is that a major problem for the healing process? Is moisturizing a crust in excess problematic for post-peel healing? What are the consequences of preventing the crust from forming by excessive moisturization? Just to be clear, I am not talking about removing crusts once they already exist. Thank you.

  Answer:  I am not familiar with Biafine, I suggest a copper peptide cream usually but you should really follow the doctor`s instructions as I am not sure what type of peel or to what depth you had and their instructions would be more specific. If they did not give you any instructions, then the peel is so light that the topical application will not influence it much. JG 8.14.08

• Hello Dr. Garcia, sorry to bother you again but I previously queried if hair removed during IPL skin treatment (Lumenis Quantum SR) would regrow and you confirmed it should given time. However, it is now almost 3 months with no change, would it typically take this long? Thank you again.

  Answer:  hard to say, might take 6 months or more in some cases, especially in darker hair. JG 8.14.08

• what is your opinion od the CO2 laser-active FX?

  Answer:  I am not impressed. JG 8.13.08

• Hello Again. I had a vein thrapy with a cutera laser on my face by my nose and nasial lines. I had quite a few so Im not sure if the Dr used to high a setting or did not ice me enough??? or is it normal to have welts also scabs & pus bubbles? I called otday and they were not sure but said to keep it moist to prevent scarring. PLease tell me what you recommend as I can see little chunks of my skin missing in the areas where it has) was this normal? & B) how can i prevent scars? Thanks you very signed panicky

  Answer:  welts and scabs, happen, pus pockets should not. I suggest you have them see you in person to make sure nothing more than moist applications are needed. That is important in order to avoid the scarring. JG 8.13.08

• Hi Doc. I`ve had approximately 6 -7 Photofacials over the past 2 years with not ill effects. However, the last time, about 5 weeks ago with the Palomar laser (the others were probably the same machine though I can`t say for sure) my hair fell out of my beard (yes, I`m a guy) 2 weeks after the procedure. It hasn`t grown back. I`ve seen mixed information on the net, the practitioners website, and your archives on whether this is permanent or not. I would appreciated your input and if you don`t believe it is permanent what do you think the time frame is that I can expect to see hair growth in the areas of my cheeks, chin, and neck. Many thanks

  Answer:  I have never seen it be permanent and the light source is not strong enough to get to the follicle, but the hair that was there has been injured and has fallen out, it should come back in time, slowly. JG 8.13.08

• Hello Doctor :) I read and heard that IPL can be used too for the treatment of spider veins/telangiectasia. Is it really effective for it (in the thigh/leg area, I mean) or is old sclerotherapy better for them? (assuming there are not underlying problems linked to varicose veins).

  Answer:  I think sclerotherapy is more effective and longer lasting compared to IPL on the leg. JG 8.13.08

• is there any medication that you can think of which I can apply to that paler/lighter spot where the vbeam was zapped which can theoretically help the redness come back, I read somewhere that some estrogens and prednisone speeds up blood vesselregrowth. what d you think of micropigmentastion for this problem.

  Answer:  sorry, but none,and I do not thik the micropigmention will ever match. JG 8.11.08

• Hi. I am 40 yrs old, 5`2 and about 108lbs. I have had 2 children ( 3 yrs and 8 months old) and am having a breast lift w/aug. I also have some sagging in my arms and dr said Thermage would be great for that after reading your website I am not so sure. Do you still feel it does not do anything?

  Answer:  still feel the same, yes. JG 8.10.08

• but doesnt niacin induce flushing and redness? wouldnt this cause blood vessel revascularization? please explain what niacin exacly does and if there are any serious side effects. Do you think relume can have any lasting effects? like will it cause blood vessels to regrow faster and leave the skin pink without maintenance treatments.

  Answer:  it will make the area red for a few minutes if at all. Niacin is a vitamin and does cause flushing of the body in sensitive people when taken orally but not in all.I do not think Relume has lasting effects. JG 8.10.08

• Hi Dr. Garcia, I`m the guy with the circular footprint left by the vbeam laser on my forehead which is lighter than the surrounding skin and does not flush with the rest of the skin. It never becomes red anymore on its own, only if I squeeze the skin on that spot but then it returns to being pale. You said that the vbeam probably coagulated all of the blood vessels in that spot. Will applying topical Niacin induce the redness/bloodvessels/flushing to return to that spot. All I want is for the lighter spot to match the surounding skin color on my forehead, its been almost 3 years and the redness has not returned on its own like you said it eventually will. I dont know what to do anymore, the options previous docs have said are relume laser which can return pigment to the spot and increase ther rate of blood vessel growth, is this accurate? micrpigmentation, what do you think of these and Niacin because Ive heard Niacin can cause flushing and redness for people in places they havent had it before.

  Answer:  I do not think the Niacin will help and I think the Relume might help but needs continued application. JG 8.10.08

• what are the risks of using the relume or excimer xtrac laser to repigment hypopigmented skin or scars? does this cause skin cancer eventually after prolonged number of treatments?

  Answer:  never heard of it causing cancer but they have not been out long enough to evaluate that issue since sin cancer can take many years to manifest itself. JG 8.8.08

• will repeated exposure to sunlight help speed up revascularization, I heard that the sun causes blood vessel formation

  Answer:  it can, yes, but wear sunscreen on the normal skin so that it does not get darker at the same time. JG 8.5.08

• I had a spot vbeamed on my forehead. That spot is a littlelighter than my surrounding skin. this spot no longer flushes, it never becomes red unless a squeeze the skin on that spot, but then it gets red for 15 seconds and becomes pale again. Even when I exercise it never flushes anymore with my surrounding skin. I assumed this was hypopigmentation, but when I get a sunburn, my whole face gets red but this spot still stays pale. It doesnt even sunburn. However if I go in the sun long enough and frequently enough it tans a little bit but no sign of a pink tinge. What does this mean and how can it be corrected, please help. Its been 3 years since the v-beam treatment Answer: all of that is temporary and in time will get better, the issue is there because the blood vessels have been reduced on a temporary basis and that caused the effects you are seeing, as the blood vessels are re-established, it will return to normal in almost all cases. JG 6.30.08 is there anything I can do to speed up this process of the blood vessels returning and flushing returning. Its been almost 3 years now and it still doesnt flush and that spot is lighter than the rest of skin, please help me there must be something I can do.

  Answer:  I am sorry but there is nothing that will speed up the re-vascularization of the trested spot. JG 8.5.08

• hi dr.garcia,i have very little cellulite on my thighs.it just started to appear, what is the best solution and how long does it last? thank you

  Answer:  VelaSmooth or Endermologie, it lasts a few weeks at most. JG 8.5.08

• Dear Dr Garcia - is there a laser treatment that actually tightens skin and is there one that stimulates collagen. i am almost 50 with great skin- no lines at all- but my age is starting to show in a breakdown of the collagen under the skin as well as slight looseness at neck area - I would like to address it but think surgery is a bit drastic at this point. Thank you as always for your generosity with your time and knowledge

  Answer:  ablative lasers do that, but it takes a fairly deep treatment, and that means downtime, the older one is the deeper you have to go because the ability of the skin to make new collagen and tighten are less strong in older individuals. Best of luck. JG 8.2.08

• Hi! I know you have probably addressed this Q many times already but I can`t seem to find it in the archive. Can you explain why IPL/Foto-facial help lighten dark spots and yet could also create new ones? How does this laser work in lightening? Is it good for Asian skin? Thank you. You are wonderful and so generous!!

  Answer:  it is a fine line of irritation causing the body to digest the pigement versus too much energy and heat causing a spot to form, that is the frustration, that you need to go slow and low. I is more risky in Asian skin than in caucasians. Thanks also for the kind words too. JG 8.1.08

• Hi, Can you tell me what RF laser does,as opposed to infrared? Is it true that RF laser causes fat loss or does it depend on the level used? Is there a book you can recommend that will provide information on all the various options out there? For instance, I am confused about IPL vs. Fotofacial and all the various manufacturers, etc.

  Answer:  they, RF and infrared. both do the same thing, waste your money. RF has bene reported to cause fat loss, yes. IPL and Fotofacial are essentially the same thing, just a marketing term coined by a doctor is all. JG 7.30.08

• Good morning, I am SO confused. I am Asian, have slight skin laxity and struggling with hyperpigmentation. Portrait is out for Asian skin at the higher level. Hydroquinone and Retin A (combined via doctor`s prescription) is not doing much. Photo-facial, you said, may help if the hyperpigmentation is new (but how to tell when the spots come and go in different places). It seems like every potential treatment for hyperpigmentation creates new problem. So what is out there? And what will work for slight laxity other than a face lift, which is out of the question for me?

  Answer:  I really do not have anything else for the pigment and I feel the surgery will be youe safest option for the lax skin, sorry. JG 7.30.08

• Hi Dr, My Dr. told me that Radiesse is better than Restylane and the other newer fillers because it lasts longer - a year. Is that true and what are the risks for filling the lower face (naso labial folds and by the mouth? Thank you!

  Answer:  well, it does last longer in most cases, but whether it is better depends on your definition. Lasting longer does not always make things better. JG 7.30.08

• Hi Dr. G., I had a skin tightening (radio frequency) session over the weekend, followed by fotofacial for hyperpigmentation. The doctor who performed this said that over the years, she has learned that this combination works better (and cheaper) than Thermage. She recommended 6; I`ve had 1 and was pleased but now I`m seeing in this forum that radio frequency in laser isn`t good. Can you provide guidance? Thank you!

  Answer:  I would save our money and skip all the treatments she has suggested, your improvement right now is only from swelling and will all go away in a short period of time, but the IPL will help with some pigment problems, especially if they are relativley recent. JG 7.30.08

• Hi Dr. Garcia. I have been struggling with issues with my skin since receiving IPL treatments in Feb and March. My skin has been red, inflamed, blotchy and itchy since the IPLs (I did not have this problem before). In particular, my nose is extremely oily and oozes sebum at all times. Needless to say, I am now getting enlarged pores, which I`m afraid won`t go away. I have seen many derms, the last of whom put me on antibiotics, which I couldn`t continue to take due to side effects. I`d like to try accutane, but I`m wondering if there is a period that you should wait after laser before going on accutane. I had a vbeam treatment 5 weeks ago, trying to calm some of the redness I was experiencing (previous diagnoses were rosacea). Do I need to wait before accutane treatment, or is 5 weeks after vbeam safe to start on it? Thanks Alyssa

  Answer:  I think the lasers you have had done are mild enough that you can start the Accutane now, best of luck. JG 7.27.08

• I have had a peel 30% TCA. My dr advises not to use any oinment or moisterizers until the peel is done. Why is this. Everything online says to keep it moist. The nurse suggested that using anything oily would be couterproductive to all the work the peel has done. I am miserable and want to put some Aquaphor (sp) on - but don`t want to reverse or reduce the results of the peel. Why would she say to not put anything oily on my skin once it starts peeling? Will it hinder the results

  Answer:  I typically will allow some Aquaphor in a TCA peel that is done that deep, it will in no way reduce or harm anything. JG 7.27.08

• Hello doc, thanks for you answer about my morphea. You told that the YAG laser could help me, have you already experienced it on morphea patient ? Thank you very much :)

  Answer:  we have not but I have read about it being used. JG 7.25.08

• in regards to the medlite C questions, is genesis better?

  Answer:  nope, will need something much more aggressive with some downtime to get an appreciable effect. JG 7.25.08

• HI Dr. Garcia, my derm suggested Medlite C laser treatments for collagen building and a more youthful skin glow, as well as skin tightening and discoloration under the eyes. what are your thoughts?

  Answer:  will work for brown discoloration, will give your skin a healthy glow, will not tighten skin, will not reduce fine lines to any appreciable extent. JG 7.25.08

• What do you think the risks might be for an Asian with some hyperpigmentation to undergo Portrait at the highest level (vs. the much lower 1 joule over 3 visits) that is normally recommended for the most effect?

  Answer:  significant risk I feel. JG 7.24.08

• Hi Dr. Garcia, What do you think of all the infrared wraps that are suddenly popping up everywhere? Are they as effective as they claim, ie they help with weight loss, inch loss and even cellulite reduction. Frankly, I wouldn`t mind having an alternative to Velasmooth as, even though it works for me, I don`t like seeing more spider veins after my treatments! Thank you as always.

  Answer:  lots of hype for very little to no result. JG 7.24.08

• Hi Dr.Garcia. I was wondering if you have heard anything about the Pearl Laser? I was looking into Fraxel, and came across the Pearl and was hoping you could enlighten me as to how effective either of them may or may not be for hyperpigmentaion. I have some slight melasma on my forhead and cheeks and across my upper lip. I noticed that it really became prevelant after I did some IPL treatments about 2 years ago. I did a series of 6 treatments and then started to have the brown patches.not sure if that was coincidence or not, but either way I am hoping to be able to get rid of the discolorations. That being said, do you offer any such treatments in your practice? Thank you so much for your time.

  Answer:  I think if it is relatively superfical and or recent hyperpigmentation, it will likely help some with a series of treatments. I do not think it is strong enough to do anything for the melasma and in some cases can make it darker since it is an ablative laser. Any light therpay can worsen the pigmentation, especially if precautions are not taken like using hydroquinone. I do not offer the Pearl laser, but we do use a YAG lser for isolated brown spots and find it to be effective, it will not totally correct melasma but typically will lighten it to make it easier to cover with make up. JG 7.24.08

• Does hair eventually grow back with electrolysis, or is it just laser hair removal it grows back?

  Answer:  it can grow back if the follicle is not damaged. JG 7.23.08

• Why don`t think laser hair removal is effective? Does hair eventually grow back?

  Answer:  well I think that because I have never seen it be permanent and the FDA has never seen it be permanent, if they had, they would have allowed the marketing materials to say that and they do not, doctor break the rules on what should be said all the time though. The hair will eventually grow back, at times slower and lighter but it will grow back. JG 7.23.08

• hi is diathermy a good option for capillaries? and how does it work? is it true you only need about 3 treatments and last for about 2-3 years?

  Answer:  it does help in many cases. It basically burns the blood vessels closed. As to needing more than one treatment,that is true, as to lasting 2-3 years, no way to say whether that is true, likely not though. JG 7.22.08

• hi doctor this is really embarrassing but im a female with hair growing on my chest and breast. I want to remove the hairs but too embarrassed to see a doctor for it. What will be a good laser to remove this problem? would Electrolysis be a good option? Please help, give me good advice........... thakyou

  Answer:  electrolysis is good as well as Alexandrite lasers. Best of luck. JG 7.23.08

• hiiii you said hair removal is not permanent but ps tell me it is with some lasers.. obviously you have your reasons, I was excited now im upset. then after hair removal laser treatment does one need to get a treatment for the rest of there life to leave hair off? and how often do you then need to get the treatment done . thanks

  Answer:  I am afraid so, the hair growth will slow down and the hair might become more light, but it is not permanent. If you look at the FDA website, theree is not a single laser that is approved for permanent hair removal. It does remove the hair at the time of treatment because the shaft of the hair is burnt, but if the follcile is not damaged, the hair will eventually grow back. What your doctor is saying is completely false and is likely based on laser company hype and his lack of understnading of how the technology works or does not work. As to how often you need it for maintaining the lesser hair, that varies from person to person and also on area of the body treated, cold be weeks to months. JG 7.23.08

• I have facial hair and cappilaries. Can IPL laser be used at the same time to treat these two problems? say if the laser is being used for the hair will it also help the capillaries? and is IPL the correct laser for it?

  Answer:  IPL will help the capillaries but will not help the facial hair, sorry. That will require a different laser, like an alexandrite laser, and the hair reduction is not permanent. JG 7.22.08

• hey doc its me with the IPL question again. you said after the treatment you need to get it done every 4-6 weeks to keep up with the effects. is that one session every 4-6 weeks or another few sessions starting all over again? and is it expensive? i thought you just get it done every once a week. wow.

  Answer:  one every 4-6 weeks to maintain the results once you are to the degree of improvment that has stabilized. JG 7.22.08

• dr Garcia when having IPL done you said few sessions will be needed to have the desired effect but after that how often will it be needed to have IPL repeated again? every one month? 6months? a year later? THANKS, YOUR THE BEST)

  Answer:  it usually is repeated every 4-6 weeks for maintainence. JG 7.22.08

• I was thinking of getting a Pixel treatment for fine lines, pores and tightening. What`s your opinion of this laser. Am 52 but not facelift ready yet - had juvederm (naso.-marionette) and botox...Going broke fast...thanks dr.

  Answer:  very temporary fix if at all, if money is tight, save it for something better in the future when you are ready. JG 7.22.08

• Hello again Dr. Garcia, further to my earlier question regarding treatment for seborrheic dermatitis, I am also considering UVB light treatment. However, I understand that this can be aging and potentially cancerous to the skin if used long term and would appreciate your opinion. Thank you so much again.

  Answer:  I would skip the UVB if possible for the reasosns you site and its minimal effect in most cases. JG 7.22.08

• Hello Dr. Garcia, I have mild seborrheic dermatitis in the oily skin area of my nose and cheeks and have tried various topical and steriod creams with no success. Could you please advise any treatment that may help? - It has been suggested to me that pulse dye or IPL may improve the pink/redness, at least temporarily. Thank you.

  Answer:  I think the IPL is a good idea, might take a series of sessions and then once a month for control. JG 7.22.08

• hello doctor, what kind of laser will treat capillaries, fine lines, pores and make skin more tight? if seperate laser needed can you please name them for me?

  Answer:  IPL for the pores and capillaries and a Rhytec Portrait Plasma for the fine lines, do the Rhytec first and the IPL will require a series and will not be permanent in its effects. JG 7.22.08

• Hi Dr. Garcia.....You suggested the possibility of Accutante therapy for helping to reduce pore size & eliminate milia since I have tried many other expensive options that have basically wasted my money. I am 50 years old & do not have acne, but do have very oily skin - when I rise in the morning, especially the t-zone & throughout the day as well. Is the goal of Accutane to reduce the amount & thickness of oil production to prevent it from clogging the pores? Would a low dose therapy (even 10 mg.) be effective to achieve my goal? Also, do you have an opinion on use of daily flaxseed oil to thin the sebum produced b my body? Finally, would the Lam probe be an effective instrument for my milia? Thanks so much for the time & patient education you provide on this forum. If the above fails, I am considering having the Rhytec Portrait with you, but am avoiding this avenue unless absolutetly necessary.

  Answer:  yes, that is how Accutane works. As to what would be the effective dose, it varies from patient to patient. I do not think flax oil will affect the sebum production to any degree that would make a difference. The LAM probe would help with the milia, yes. JG 7.20.08

• What do you think about the genesis laser for the face?

  Answer:  waste of time. JG 7.17.08

• Hi Dr.Garcia, I am currently using differin every night and I also would like to have glycolic peel 30% once a week. But I know that differin should not be used few days before and after the peel. So, let`s say if I stop differin 2-3 days before and after peel, it will take almost a week already. Therefore, does it mean that I cannot do both things at the same time ?

  Answer:  pretty much, 30% glycolic acids peesl weekly is not a practica thing. JG 7.17.08

• Hi Dr. Garcia....I`ve been researching the best possible option for reducing my enlarged pores and eliminating stubborn milia on my face. I have used the Obagi Nuderm line for 2 cycles & continue to used Retin-A, glycolic acid and Nia 24 products, but the enlarged pores & milia are still present. I`ve been considering either the ablative Active Fx laser resurfacing, the Palomar Lux 1540 non-ablative laser resurfacing or the Obagi blue peel to hopefully achieve my goal. My skin looks pretty good right now with the exception of these problems. Since I`ve wasted my money in the past on IPLs, microdermabrasion series & superficial peels with only minor results, which (if any) of these procedures will help me solve these problems? Do you have any additional suggestions for me? Is it possible for the Obagi Blue Peel alone to give me results (since the cost for this is much more reasonable than lasers)? Thanks so much for your reply.

  Answer:  firstly, anything you do will be temporary in terms of its pore improvements by that I mean a few weeks to a month or more, I do not think any of the new things you have suggested will do the job, and although Accutane is an option, it has significant downside risks. JG 7.17.08

• Hi Dr. Garcia. I was wondering if lasers had any effect on aging the skin. i have had about 20 laser hair removal treatments on my face, 5 acne laser treatments, 1 microdermabrasion, and 2 Fractional Laser treatments. i feel like doing all that stuff to my skin and my face must have some type of effect, even in the long run and it`s got me worried. i`m 21 years old. can you please tell me what you think? thanks!

  Answer:  I think the negative effects on your skin from the treatments you have had performed will not harm you in any way. JG 7.14.08

• I know that you think that a face lift is far more effective that any of the lasers. I do not want to go under the knife. I would like to get rid of the sagging I am seeing in the jowl area and lower face (I don`t have a lot). Do you think that any of the procedures such as Thermage, Refirme or Titan are better than the others? If not is there anything else you recommend other than a face life. Thanks for your continued help.

  Answer:  sorry, all equally poor at helping you with your area of concern. I do not think any skin wrinkle reducing device will lift the skin enough in a reliable way to make you see a difference. I am afraid with the limitations you are imposing, there is nothing that will do the job. JG 7.14.08

• Is it safe to have glycolic peel about 2-3 months after accutane ? Thank you very much.

  Answer:  if the skin has regained its normal moisture it should be OK to use. JG 7.13.08

• Hi Dr.Garcia, Is it safe to have a microdermabrasion treatment while having acne ? I heard that MD is good for acne treatment but would not it create a risk for more scarring, in case that it may squeeze the acne during the procedures ? Thank you very much.

  Answer:  yes, OK to do, it might bring some deeper cysts to the surface and make them come out to make the skin look worse in the short term. Mederma is a good option for healing scars, yes. JG 7.13.08

• If the TCA peel and pearl laser only helps while there is swelling, then what is the best procedure to have beautiful skin?

  Answer:  well, that is a difficult question to answer as it depends entirely on what you feel makes skin look beautiful, if removing brown spots is the main thing, then the TCA peels might get you there, if it is a number of things that are required to have beautiful skin, it will likley take multiple modalitities, and none will be permanent due to nothinng stopping the aging process. JG 7.10.08

• Hi Dr.Garcia. Would the pearl laser improve my skin more than thr 35% TCA peels that I have been getting? In other words, is the pearl laser better than the peels?

  Answer:  both will work for superficial recent pigmentation problems but I find neither one effective for wrinkle reduction, once the swelling goes down it all the improvement goes away. JG 7.9.08

• what can help a hypertrophic surgical scar?

  Answer:  kenalog or 5FU injections, YAG lasers and external beam radiation. JG 7.7.08

• Can dermabrasion help a hypertrophic surgical scar?

  Answer:  I do not feel it can, no. JG 7.7.08

• Wow ... you are so amazing. You not only generously share your knowledge and give your time to your legions of audience ... but you respond faster than my own doctor!!! This is a follow up Q. In order to minimize veiny legs, would it make a difference having my legs done at a lower setting so the Velasmooth suction is not as hard? Seems only my front thighs develop more veins, not the back of the thighs. Also, now that the same company offers Velashape, do you think that is better than Velasmooth? Will they remove Velasmooth from the market at some point? Thank you and god bless!!

  Answer:  well, the problem is that the lesser setting with the VelaSmooth might help make less spider veins but the trade off might be less cellulite reduction or skin smoothing at the same time. I do not think the risks of VelaShape are any less and the fat reduction I feel is unpredictable. All the best. JG 7.7.08

• I am Asian, 52, most people think I am in my 30s. My skin is pretty good, some blotching and my jaw line is not as tight as it used to be. What can I expect from Portrait? I understand the risks for Asian skin is potential hyperpigmentation so 1 deep pass is not an option. What do you suggest? Thank you!!

  Answer:  mild improvements I feel. If you go for a series of three lighter ones the degree of improvement I feel will be less.JG 7.7.08

• I have been getting Velasmooth maintenance treatments every 2 months or so. It helps with the dimpling but I am noticing a lot more veins, spider and otherwise, even on areas that have been treated by my vein specialist. So now what? Am I now left with the horrible choice of less dimply legs but veiny or more dimply legs but less veiny? Ugghhhh. Any suggestions? Thank youQ!

  Answer:  there is a trade off in many pateints I am afraid, you might need to get the veins treated but continuing the VelaSmooth will make the spider veins come back due to the suction. JG 7.7.08

• Do you perform laser surgery for excessive sweating (armpits)? If not, any suggestions?

  Answer:  I am not familiar with any laser that helps reduce armpit swelling, Botox can be used for that, and the results of liposuction are unpredictable with any technique employed. JG 7.3.08

• Dr. Garcia, I have brown patches on my forearms that are bothersome. This year they seem to have spread all the way up my arm (now that I am in the sun). My Dermatologist said they look like birthmarks. Could there be a medical condition going on I should be aware of (allergy related) or is this just sun damage? PS.. any new laser treatments out there that would signifigantly help for this problem? I am a 40 yo woman fair to medium skin. The only medication I take is vitamins and omega fish oil. Also, when I apply sunscreen it makes the area look even more dark and dirty so I feel at a loss. Thanks, kgo

  Answer:  just likely sun worsening the brown spots that were there but were lighter, you need to wear sunblock not sunscreen when outside to help slow the progression. JG 7.3.08

• Hi Dr Garcia. Back in February and March, I had 2 IPL treatments for mild flushing rosacea and some redness under my nose. About 3 weeks after the 2nd IPL (30 J double pass), my rosacea got soooo much worse, leaving me with permanent redness on my nose and upper cheeks, as well as worsening redness under my nose and uncomfortable itchy skin. In addition, the sun, heat and exercise turn my face bright red and shiny and it is quite uncomfortable, something that I never experienced before. Also, each morning when I wake up, my nose is swelled up. I am now going through vbeam treatments (subpupuric) at a different laser center in NYC in an attempt to get back to a halfway normal looking complection and a tolerable lifestyle. I think it is getting a bit better, as it no longer itches and the swelling seems to be going down somewhat, but it is hard to tell as it is still very uneven red and blotchy. Also, since this ordeal started, my nose has gotten very oily, which also was never a problem before, and my pores on my nose are becoming quite enlarged. I feel like I`m in some awful face nightmare! I have a few questions. Why would I react to IPL like that, as it sounds like such a safe procedure. Do you think the vbeams are the right course of action? My new laser derm seems quite confident that they will help, but also doesn`t seem to believe that the IPL had anything to do with this, which makes me nervous, as it is so obvious to me that it did. And third, what can I do to stop these enlarged pores, keeping in mind that I have pretty active rosacea on my nose right now? I currently use azelic acid, but it doesn`t seem to be helping. Do you know anything about DERMAdoctor Picture Porefect Pore Minimizing Solution? Sorry I have so many questions. Thanks for your time! Alyssa

  Answer:  not all people respond well to IPL, although most do well, hard to say why that happened. I am actually surprised the IPL did that and the VBeam did not as it is a stronger laser, might have been a coincidence. I think the VBeam is a good idea, as to the DermaDoctor, sorry but no personal experience. JG 7.2.08

• Hi Dr. Garcia, thank you so much for creating this forum and also for your quick response. Would you please tell me which peel is most effective for fine lines, dull skin and a little hyperpigmentation? I am fair skin, light eyes. Thx.

  Answer:  I, in general, do not feel chemical peels do much for wrinkles, but if you were going to do one, it would be a 35% TCA. JG 6.30.08

• its been 3 years since the v-beam treatmnt, the lighter circular spot on my forehead is till there, how long does it take for blood vessels to grow back and for flushing/redness to come back? 10 years?

  Answer:  no way to tell I am afraid. JG 6.3.008

• (the guy with the lighter spot due to vbeam on forehead) is there anything that can accelerate the blood vessel growth into that area? any creams? relume maybe? anything?

  Answer:  I would suggest you let nature take its course, ReLume might help but the improvemnt will stop as soon as you stop the treatments. JG 6.30.08

• Hi Dr. Garcia, I am a male who just had his first IPL treament for mild facial rosacesa 3 1/2 weks ago..Some areas of my beard hair fell off a week after treatment. How long will it take to grow back? Thanks

  Answer:  it will likely take about 6 weeks to start growing again. JG 6.30.08

• I had a spot vbeamed on my forehead. That spot is a littlelighter than my surrounding skin. this spot no longer flushes, it never becomes red unless a squeeze the skin on that spot, but then it gets red for 15 seconds and becomes pale again. Even when I exercise it never flushes anymore with my surrounding skin. I assumed this was hypopigmentation, but when I get a sunburn, my whole face gets red but this spot still stays pale. It doesnt even sunburn. However if I go in the sun long enough and frequently enough it tans a little bit but no sign of a pink tinge. What does this mean and how can it be corrected, please help. Its been 3 years since the v-beam treatment

  Answer:  all of that is temporary and in time will get better, the issue is there because the blood vessels have been reduced on a temporary basis and that caused the effects you are seeing, as the blood vessels are re-established, it will return to normal in almost all cases. JG 6.30.08

• hello dr. garcia, I want to know what you think of Active FX? Thank you

  Answer:  sorry but I am not a fan. JG 6.29.08

• Dr. Garcia, I am a 38 year old female of Indian origin. I have moderate acne (that seems to be under control right now). My skin is very patchy and has acne scars (shallow, no pits). I also usually have two episodes (1 month each)of cystic acne breakouts a year, but I`m trying to regulate that through a better diet. My problems are uneven tone and very dark patches around my entire eye (not just underneath but on my lid too). I was recommended Fraxel by two dermatologists. I did three treatments which caused hyperpigmentation. I`m pretty much back to normal through using hydroquinone/kojic compound. So laser is not an option for me since I hyperpigment very easily. Tazorac didn`t help with my skin tone. And hydroquinone just lightened the hyperpigment from the laser but didn`t even my face out. I have consulted with several sources who suggested different options for my skin tone issues: 1) Obagi Nuderm 2) Jessner peel 3) silk peel 4) microdermabrasion 5) chemical peel (more concentrated than jessner but I don`t recall what kind). Do you have any thoughts on these options given my skin issues? I did a 1 layer Jessner to start and didn`t have any bad reactions to it. So I am considering slowly ramping up on Jessner and then doing Obagi in the fall/winter time. But I have heard that chemical peels are not recommended by some doctors for Asians. Also my eye darkness is *very* severe. Over the counter treatments have done anything. It is very noticeable as I`ve gotten older. Since this is genetic is it untreatable?

  Answer:  I think some beta hydroxy acid peels or a Jessner`s peel is a reasonable thing to try with your skin type. JG 6.25.08

• Hi Dr. Garcia, What are your thoughts on genesis lasers? I started last summer with good results but my derm recommends a series of 6, they are very expensive and I am hesitant to invest, however I am not ready for a more invasive treatment. Is there any other laser you recommend with little down time or any topical remedy, to brighten and tighten skin?

  Answer:  sorry but I am not a fan. I think superficial skin peels or microdermabrasions can make your skin shine more but there is ntohing with minimal downtime that will give significant tightening. JG 6.23.08

• Hi Doctor, I`ve been searching the Internet for before and after pics of laser treatment of poikiloderma of Civatte and didn`t find that many. But one pic, it looked like the red area just became brown. I would be unhappy with that result, but if that happened to me, could I then use the hydroquinone to fix it? What do you think of lasering POC? Do people usually have good results? Thanks!!

  Answer:  it can become hyperpigmentated and it can be treated with hydorquinone to help fade it some if it does occur. I do not suggest lasers there as it has a higher risk profile though. JG 6.23.08

• How long can I expect the effects of IPL to last? I am going for a series of treatments for mild rosacea. Is this something I should expect to repeat every year, every few years? Thanks!

  Answer:  3-6 weeks for Rosacea. You will need it redone every few months. JG 6.4.08

• Hi, i had a dermabrasion nearly 2 years ago, and i am very unhappy with the outcome, i have patches of hypopigmentation and i also have patches on my cheeks that have absoloutly no pores, it`s like the pores have been completely obliterated, why is that? Thanks

  Answer:  the loss of pigment is from the dermabrasion going too deep and losing melanin in the skin, the area with no pores is because it is essentially a scar, and scar does not show pores, sorry. JG 6.4.08

• hello dr garcia, How does IPL work? and will you need few sessions normally? and how often do you need to repeat the procedure???? once every 6 monthsss?? or year???? i really want it for the capillaries on my face.... please give me some info about this as i have nooooo information.... thankyou

  Answer:  it works by damaging the pigment cells in the skin and it always takes a series of treatments, usually at least 6 and then followed by a maintanence program afterwards. The sessions are typically done every three weeks. It is not permanent. JG 6.4.08

• Vbeam on surgical scar again...thanks so much for your lightning-fast reply! 2 more questions: would Dermatix C have an effect, positive or negative, on indented scars? And what would you recommend as an eventual treatment, if any exists, to help fill in the indentation? Thanks again. It`s wonderful that you do this for complete strangers!

  Answer:  no effect, I feel, with the Dermatix C. As to the eventual filling, normally we hope the surgical revision would have relieved that, but if you are seeing a depression after less than one month, then the tissue below the skin that should have been moved underneath the scar has not stayed there, therefore it will require a filler such as Radiesse or Sculptra to fill it in. I would wait about 3 months before doing that. Best of luck stranger! JG 6.3.08

• Hi Dr. Garcia, I had Vbeam performed on a red, indented surgical scar on my cheek, 3 weeks ago and 3 weeks after scar revision surgery, as recommended by the laser surgeon (not my plastic surgeon). I`ve seen the laser dr. before and gotten good results; she used the same low setting on the new surgical scar and said it would help with the depth as well as redness. Now it seems the scar is deeper, still red, with a deeper depression in the middle. Have I made a mistake in getting lasered so soon after surgery? Irreparable? Or is it possibly a sign of progress? I`m due for the 2nd of 3 treatments in 2 weeks, but should I cancel and wait for the scar to heal more on its own? Thank you so much.

  Answer:  Well, not a mistake, I think it will all get back to looking better in time, I think normally I would wait at least 6 weeks for the scar to heal before starting a laser treatment series. A VBeam will establish no significant amount of new collagen, so there will be no filling in from the laser. I do not think you have done anything irreparable. Wy don`t you wait a full month before the next treatment though. JG 6.3.08

• Does smoking make the skin sag and cause wrinkles around the eyes? and why? and what can fix it?

  Answer:  yes, becasue it allows the collagen and the cross links to break and then the skin gets loose, one can laser the skin to try to regain some of the cross links and the lost collagen. JG 6.3.08

• Hello. I have a red birthmark on the back of my neck that extends into my hairline Which laser is best to remove this, and how many treatments are necessary?

  Answer:  YAG or VBeam are good options. No way for me to tell how many treatments though. JG 6.2.08

• What laser is best for fine lines under the eye area? Fraxel or Candela Smoothbeam? Thanks.

  Answer:  neither one is very good. JG 6.2.08

• Hello Dr. Garcia, I had a very aggressive vbeam for rosacea that left many bruises all over my face. The purpura took about 3-4 weeks to change to brown marks which took another few weeks to resolve. Unfortunately the bridge of my nose still has a large reddish/brown splotch on it from where the bruise was. It has been over 4 months now. Is this just a slow to heal bruise or has the aggressive treatment induced rosacea on my nose? I didn`t have any problems with my nose before and really only wanted the vbeam for my cheeks. thanks, Ken

  Answer:  more likely post inflammatory hyrperpigmentation, might need some Retin-A and hydroquinone or some light IPL treatments to help it fade. JG 6.1.08

• dr garcia, will rhytec or co2 laser help with the pores?

  Answer:  for a short period of time. JG 6.1.08

• sorry to bother you again. I am the lady who had 1 pulsed dye laser with bruising, then 1 KTP for sudden facial redness. You have said to go with IPL, is it safe to have that after the others? Also as it costs the same in UK as KTP and Pulse dye will it be as effective at evening out the skin tone or should I just try 1 more pulsed dye with bruising or KTP as can probably only afford 1 more treatment. Many, many thanks.

  Answer:  you can try the KTP if the price is the same I suppose. JG 6.1.08

• Suddenly this yearafter temperature virus got continual flushing of the skin. Have been told its either rosacea or sundamage. It is really irritating as burns for lots of the day. However, I do not flush after excercise or alcohol so not sure if rosacea is right diagnosis. Had one treatment with pulsed dye laser which left bright purple bruises for 5 -7 days. Made some nice white patches. Then couldn`t afford the downtime so was recommended by the pulsed dye laser man to his colleaguge for KTP. Now still look patchy I think worse that when I started as always had even skin tone albeit suddenly pink. Should I complete pulsed dye treatment or have more KTP. Do you think I can get even skin tone again. Also after pulse dye laser thought I had some indents and depressions on cheek almost like chicken pox scars although laser surgeon did not think the laser was responsible. I would value your opinion. I am very miserable. Many thanks.

  Answer:  I would go with a milder option such as an IPL. JG 5.31.08

• Dr. Garcia, My question is regarding pigmented demarcation line (PDL) in both my legs/thigs. Is there treatment? Do you offer it? Or I`m a stuck with this forever ): I have read a lot of literature about it, but cannot find information that directs me towards treatment/ Can you help me? Respectfully, MCDJ

  Answer:  maybe a YAG laser done as a series, we do offer it in our office but without seeing you it is hard to say whether it will be worth your time. JG 5.31.08

• dr garcia will rhytec laser help Capillaries on the face?

  Answer:  no, it will not. JG 5.29.08

• hi dr garcia, I just spoke to a ps to get co2 procedure. The ps is telling me that rhytec is much better then co2. Ps told me i wont be getting co2 because rhytec is heaps better. im confused... i thought co2 was better?

  Answer:  what is better about the Rhytec is that is has less downtime and the risks are less, but it is not as strong or dramatic of an improvement. Depends on how you define better I guess. JG 5.28.08

• hello, how long will co2 last? will i need to repeat the laser one or two years after the first to see the same results???

  Answer:  all deepnds on your age and skin quality, could be 3-5 years in some, less in older people, more in younger people. Repeating it is possible but the degree of improvement will likely not be the same as you will be older and the body`s ability t create new collagen will be less the second time around. JG 5.28.08

• Hi Dr. Garcia! I am having IPL for mild rosacea. I also have dark pigment under my eyes which Dr. says is superficial pigmentation and will be helped by IPL. Is that possible?

  Answer:  I doubt it. JG 5.27.08

• hello, can co2 be used for upper eyelids? and how many treatments needed for co2 normally? can it just be one session??? for the whole face.thanks

  Answer:  yes it can, how many treatments depends on how strong they go. It can be one session yes, just like the face. JG 5.27.08

• Hi Dr Garcia. I had 2 IPL sessions for rosacea, the last being a little over 2 months ago. Three weeks and 2 days after the last IPL, I spent a couple of hours in my garden. I did not have sunscreen with me, but put on makeup with 10 sunscreen in it and wore a baseball hat. I thought that 3 weeks was sufficient time with no sun exposure. A couple of days later, my face got very pink, with a perfect line on my nose where the goggles were during my ipl. Five weeks later, and my face is still red with that same line. I had a vbeam treatment a week ago, which seems to have helped somewhat. Is it possible that I permaenently disrupted the pigmentation of my skin. Could it be a deep burn that will fade with time? Have you ever heard of this? Thanks for your help.

  Answer:  no, nothing permanent has been done, just give it some time. JG 5.26.08

• hi doc, for loose skin over the entire face will co2 or rhytec be more suitable and how many sessions will co2 require?

  Answer:  CO2 will be more effective. JG 5.25.08

• dr Garcia, if rhytec laser is used with high energy under the eyes for one only treatment will it cause any complications to the area???

  Answer:  it should not. JG 2.25.08

• Hello, Do you think the newer Fraxel Repair is any better/more beneficial than the restore treatment that has been out for years? It sounds like the Repair is supposed to be a more aggressive treatment. Thank you!

  Answer:  I do not think so, I feel the company has exagerrated their results frm the beginging, so believing them now is going to be hard. JG 5.24.08

• hello dr Garcia, you metioned that IPL laser treatment doesnt tighten the skin much and doesnt effect the collegen production, will rhytec portrait plasma resurfacing do the trick though? and how does this treatment work?

  Answer:  Rhytec will tighten skin better, and remove brown spots but will not fade redness. JG 5.24.08

• Hello, sorry to be painful- its me - the retinaldehyde girl! Thanks for answering my questions... I asked if retinaldehyde worked as well as retin a but without the irritation and you said this isnt true. Sorry to be dense, but do you mean it doesnt work as well or it does but will still give irritation? Thank you very much

  Answer:  I think the irritation might be less, but the effectiveness will be less too, if any efectivenessvat all. JG 5.22.08

• what are the risks of ipl treatment?

  Answer:  post-inflammatory hyperpigmentation and it not working to remove red or brown spots. JG 5.22.08

• Hi there, I just posted a question about using retinaldehyde on mild scarring & looseness on the upper cheekbone/under eye area. Would you recommend portrait for this area? Do you think one strong session or a series of mild ones would be best? I`m 33, very healthy, with pretty normal skin (although it is now a little sensitive in that area). Thanks again

  Answer:  I think Portrait would help the scarring but not the redness, for that I suggest an IPL or YAG laser. If the scarring is minimal then I would suggest a series of lighter treatments to decrease downtime. JG 5.22.08

• Hi Dr Garcia, I have been using Retin A on my upper cheekbones to try to get rid of some mild scarring from a retinol peel. I am experiencing broken capillaries from this. It seems to be working as the scarring appears to be `coming` out - looking worse at the moment. I have been told that retinaldehyde works just as well but without such irritation. What do you think? Thanks very much

  Answer:  sorry, but not true. JG 5.22.08

• Hi Dr Garcia, I am a 27 years old woman. A year and a half ago I had rosacea fulminans. I took isotretinoin for about 6 months, and it disappeared. the problem now is that I still have red scars. They had faded quite but not enough. I used some creams for that, but I left them because now my skin is too sensitive to anything. Also i see my skin aged and dry (I use nothing for that either because I get pimples)...contradictorily, I have seborrhea too, but that is under control...I have large pores and some areas are red and sometimes with a ligth flushing...What can I do to improve my skin look? I don`t want to use more irritant creams...I have heard something about IPL, microdermoabrasion, etc, but I am scared...what treatment would you recommend me?...or do you think that if I don´t do anything more, time will stabilize my skin and clear my scars and redness? thanks a lot for your patience!

  Answer:  I think IPL would be the best option, mild yet effective. JG 5.22.08

• Hi Dr. This is one of your old buddies, remember KTVY I was the guest coordinator (Terry) I remember your show with you and Della, You said than I didnt need a face lift.LOL..I surely need one now. But thats not the question. I have a big brown spot and 2 blood moles, my insurance wont cover their removal, they say theyre cosmetics, I say they hurt. But anyway, what woiuld you charge me for the removal, I guess its laser. I would love to see you again and I trust you. Well maybe, anyway nice chatting and awaiting your answer. I have not won the lottery so take that into consideration. Thanks Terry

  Answer:  feel free to call and make an appointment, we usually charge $50 per lesion, hope all is well with you and thanks for remembering me. JG 5.22.08

• Hi Dr. Garcia. I had IPL done about 3 months ago. Now I have an area on my cheek that`s a strange texture. It sometimes looks discolored but when I look close it`s not a different color but is different texture than my other skin. I`ve seen that sometimes you say Copper Peptides to fix the texture. Will this help after all this time? Also, I was taking a break from Retin A. Should I start using it again? Will it help the texture? I`m older (50). Thanks.

  Answer:  it stil might help it some, not as much as if you had done it sooner, hard to say what caused it too. I think if you have the Retin-A, I would start that back up also. JG 5.21.08

• heyy dr Garcia, im 27, female, i wanted to know some laser treatments to treat my undereyes and my whole face.. the result im aming for is to make my skin tight and firm.. is there any laser treatments that does the whole face? and how does it work? and how long will it last? how often will i need to do the treatment?thankss

  Answer:  at you age, and without seeing you in person, I would suggest using a Rhytec Portrait for the entire face. It can be repeated in 18 months if you need it. JG 5.21.08

• Hi doctor, I am African American, I have brown skin to light side. I have little chicken pox scars and large pores, they are not bad but they are extreme bothersome to me, I was told to have punch graft, but I don`t thing this going to benefit me a lot, because I want all over all rejuvenation everywhere, U heard about co2, and I know not all lasers work on dark skin, what do you think I should do, I rally want flawless skin, what laser should I have, what I am looking for regarding in skin color change, I have fading light spots and areas on my skin, I read something before if there trauma to the skin like laser, that might trigger full vitiligo, but I just want to go for it. how long recovery I am looking at, will my skin get so dark and then will go back to my natural color, how can I chose the doctor? if the doctor never had experience on dark skin would that not the doctor for me? what laser should I ask for specifically, sorry for so many q. but I find that treating skin and chosing skin doctors is the hardest of all cosmetic procedures. thanks a lot

  Answer:  well, the first thing is you need to understand that you will never have flawless skin, no matter what you do, you have scars that are permanent, can be improved, but will never be removed, and the dilated pores will recurr over time due to skin oil plugging the. I would not do a CO2 laser on an African American and any resurfacing will be potentially risky. You might want to reconsider the punch grafts and possily fillers for some of the depressed scars and microdermabrasion for the plugged pores. Best of luck. JG 5.21.08

• where and what brand of copper peptide do you recommend?

  Answer:  ProCyte`s. JG 5.19.08

• Dr Garcia i had a tca peel and was pleased with it but still have some red spots under my eye (3# weeks) what can I do to eliminate them? creams? Thank youi so much

  Answer:  copper peptide cream or IPL treatments cna help. JG 5.18.08

• Hi Dr Garcia, is 12 months long enough to wait to have a 2nd wire brush dermabrasion after having my last one. Thank you.

  Answer:  should be OK, yes. JG 5.18.08

• Hi Dr. G., What do you think of Velashape? Does it work? Is it the same or better than Velasmooth? Thank you as always. You are completely unique and wonderful in your generosity.

  Answer:  it supposedly works better than VelaSMooth as the VelaShape is suppposed to melt fat, I have not seen any patients in person that have had a result. I think the technology they are using has melted fat when employed in other machines but it was by accident and not on purpose. I think I would wait a while before trying it. Thanks for the kind words and for visiting. JG 5.17.08

• I`m 37(fair/olive skin) on 5/12 I had botox(between eyebrow)restaylne injections(lower,upper eyes) and tca 35% peel under eyes and upper cheeks. My question is, it is day 3 and I have not yet peeled, just have dark brown skin in peel area,very dry,wrinkled and swollen. Is that normal? I`ve been putting ice packs on my eyes and seems to be helping a little. My doctor said to put moistuizer on only when starting to peel.He recommended vasaline or Aquaphor. I`ve never heardto wait before. Is that right? Also I`m concerned that I will have a line on my cheek where he stopped peel. Have you seen that before? Thank you for your time. Andrea(San Diego)

  Answer:  normal, yes, but it will peel in a couple more days most likely. We use the ointments right away, but no real harm in waiting. JG 5.14.08

• Hello again Doctor. I followed your advice of the other day and didn`t even ask to have IPL in the undereye area, as you thought it was not recommendable. My questions are: a) does IPL anyway improve the area, even if moderately only, if applied in the cheeks? Does the beam of IPL (if that is the word for that) only targets right where it was applied or does its effect go beyond the specific point where the wand was held against the skin? b) I was suggested to have another session in 30 days. Does IPL cause enough (I don`t expect miracles, but something useful) collagen production stimulation to be worth having it again? Does it really help with lines and skin texture? Because I rather hear (more often) about it being used for pigmentation problems, rosacea, etc., which are not my specific problem (mine is skin texture and a few lines). Thanks.

  Answer:  It will help with pigmenation only, not much tightening with it. The effect only is where it is placed, not much diffusion. Skin texture might improve but not much tightening of lines. I think in terms of visible collagen prodcution effects it will disappoint you. JG 5.13.08

• hi Dr. Garcia, I am 42 years old and have sun damage to my skin. I have had several spots on my chest, arms, and face removed by freezing it off. They keep coming back! I also have started seeing redness around my nose area. Is there a certain type of chemical peel I should do? With limited time off of work? I`m tired of looking old! Thanks for any advice you can give me!

  Answer:  IPL might help with minimal downtime but they will all come back with time and sun exposure I am afraid. JG 5.10.08

• Hi, I am 2-3 weeks pregnant and I would like to do the Rhytec on my face. Is it safe while pregnant? Is there a higher risk of hyperpigmentation?

  Answer:  I think it best to wait until after the baby. I do not think the risk of hyperpigmentation is increased though JG 5.10.08

• Can facial resistance exerizes performed fifteen minutes a day with tugging and pulling on skin cause surface skin damage? thanks! also what is the latest on the syneron fotofacial and fotofirm (rf)? thanks!

  Answer:  the only thing tthe facial exercises will do is create more wrinkles in the skin. As to the latest on the Syneron fotofacil with RF, I am still not a fan. JG 5.8.08

• My Dr. told me that the over the counter micro dermabrasion weekly treatments are bad because they break down the collagen, is this true? She also suggested a laser treatment every 6 weeks to help prevent my adult acne, reduce pore size and rosacea, will this work? What is the name of the laser that would be used for this treatment?

  Answer:  well, I just think they are not well constructed and it is something that you can over do and scar the skin instead of improve it, that is something best left to someone else who can see more clearly what they are doing than yorusef in the mirror. I think light lasers done every so often can in many cases control pore size and skin texture, yes. Usually the one used for what you need is an IPL laser. JG 5.9.08

• Does IPL help a bit with undereye lines? (collagen buildup to help with wrinkles) If so, can IPL be applied in the undereye area? Doesn`t it harm the eyeballs or something? (assuming anyway that one has the eyes closed, of course!). Can IPL be applied close to the eyes, in the lids, undereye, tearthrough area, etc.? Any precaution other than covering well the eyes if that was the case??? Thanks in advance for the answer.

  Answer:  I do not believe it does much there. I think you would need protective eyegear to try it but I do not recommend you do it. JG 5.8.08

• Hi, I am scheduled to get an aramis laser treatment tomorrow. Is there any chance of being burned by this laser ? Is their any chance of facial fat loss with this laser like their is with thermage? I am geting the aramis for acne and acne scars. Thanks

  Answer:  low risk, but still possible since the water is being targeted. JG 5.7.08

• Dr. Garcia, i have sun damage on my neck and i have received two estimates from two different doctors. one is recommending the pulsed dye laser and the other is recommending the Fraxel. which is best for red damaged skin on the neck and broken blood vessels on the face. also, is there risk of permanent damage with either? last question, what about the Titan laser? will it help either of my problems?

  Answer:  if it is red the pulsed dye laser, the Fraxel will do nothing for redness. I think the Titan is too weak and the risks, in experienced hands of anything negative on a permanent basis is small with the Pulse Dye laser but the Fraxel has some mild risks. JG 5.6.08

• Hi DR Garcia. I am 36 yr old female. Can you please tell me what is the best way to firm the skin in lower face and jowl area. My skin seems to have just recently become slacker in this area. What do you think of botox or IPL for this problem? Thankyou

  Answer:  might consider a Rhytec Portrait, IPL and Botox will not do it. JG 5.6.08

• Hi Dr Garcia. Hong long should one wait after scar excision before using V Beam / YAG to reduce redness? Thanks

  Answer:  6 weeks. JG 5.6.08

• I have been getting a cafe-au-lait birthmark removed with the YAG/MediLight laser. I was told the sun will make it reappear. It is on my arm, so when I am in the sun, will sunscreen over it be enough? He mentioned a band-aid but won`t the rays go through that? I heard the silicone scar sheets block it better, could I put on of those over it? Thanks!

  Answer:  sunblock would be better than sunscreen. The silicone sheet will not block it and the bandaid will not be as good as the sunblock either. JG 5.3.08

• do tca peels work on lines above lips?

  Answer:  no. JG 5.3.08

• i was told that you can order tca peels on line. do they work on vertical lines on lips?

  Answer:  it will not work and they can be dangerous. JG 5.3.08

• What do you think of th portrait express procedure? Also what do you recommend as a creme for fine lines and texture issues especially aroud the mouth? I do not tolerate retin A or any acids. thanks so much.

  Answer:  mild, but good, for the fine lines I sugges DMAE creams, on my shopping cart. JG 5.1.08

• Mahalo for answering my previous question. I have one more. In your opinion do you feel the Fraxel FDDA treatment makes significant improvements in , including rhytids and pigmentation, as well as skin laxity? Do you use this treatment on your patients?

  Answer:  I am not a believer or fan of Fraxel. JG 4.30.08

• Aloha from Kauai Dr. Garcia can you tell me what you know about the fractional C02 peel? Have you used this method in a peel? How does it compare to a TCA peel?

  Answer:  I think it is likely similar to the TCA peel, neither one is very strong. JG 4.29.08

• I`m 55 yrs old and want to know the best method for tightening the upper arms. I had liposuction several months ago which left them a bit crinkly in places and slightly jiggly. I`ve had consultations for the Accent XL laser, but wondered about the rhytec portrait laser for skin tightening? Also, between Accent and Velashape, which do you think is more effective? Thanks.

  Answer:  I think all of those will be a waste of time, I think you likely need surgery to cut the loose skin out. JG 4.29.08

• I have quite a bit of sun damage and crepeness under my eyes. I had an erbium laser treatment two years ago and a profractional laser treatment done this year. Neither have done much to improve the texture under my eyes - do you feel Rhytec might work for me? If not, what would you suggest? Thank you.

  Answer:  I think it will be more effective than what you have already done, but a CO2 laser will be even more effective, but more down time. JG 4.29.08

• My doctor recommended Candela`s Q-Switched Alexandrite laser for several long-stading age spots on my face. She said this laser would completely and permanently remove the spots, and it sounded like this would happen in just one visit. Do you agree with this assessment? Is there a better treatment/option for this problem? Thanks in advance!

  Answer:  I disagree, it will likely not remove them in one session and it will not be permanent. I think any treatment will allow the spots to come back in time and with sun exposure, I think a YAG laser is better personally. JG 4.28.08

• I thought I should post my last question under the proper category. I know that you do not really believe in Thermage. I have had it and the only thing I really notice is a more open look to my eyes. I am beginning to see a decrease in the open look. I do not need an forhead lift but would like to see that wide eyed look again. Should I consider another Thermage treatment to my forhead only or is there something elso to consider?

  Answer:  maybe Botox to elevate the eyebrows is another option. JG 4.26.08

• Hi Dr Garcia. I wrote you previously about a reaction that I have had to IPL treatment. I have had two IPLs for rosacea and sun damage, and since the second one, which was now 5 weeks ago, my face it red and swollen. I can see where I wore the goggles, as the skin around my eyes is lighter--there is a line where the redness starts. The doctor at the center where I got the treatment done had assured me that we would use a conservative, gentle approach, as I have very sensitive skin. However, he did not perform the treatment, and indeed, a different tech perfromed the 2nd one from the 1st. My second treatment used on a Lumenis IPC Quantum was 30 Joules, Progarm 1, 560 Head, double pass. I am a light skinned caucasion woman with mild rosacea. Does this seem like a reasonable treatment? Also, have you ever heard of prolonged swelling after IPL? What is the cause of this? Will it eventually go away? How long should it take to settle down? Thanks for your help with this. The doctors at the center where I had the procedure done want nothing to do with the situation.

  Answer:  it sounds like a reasonable option, it is just that your skin is very sensitive, it should not be a permanent thing and should get better in time.It might take a couple of months in severe cases though, hang in there. JG 4.26.08

• i am 57 with some wrinkles, but not bad, does micrdermabration help wrinkles in marionette lines if zig zaggy, and will it help mouth wrinkles. what does it do and how long does it last. also can you tell me the cost.

  Answer:  I think the microdermabrasion for what you have is a waste of time, fees vary from office to office too. JG 4.23.08

• Hi doctor, I am scheuled to have Rhytec portrait treatment done on my hands in a few weeks. I have the start of sun spots and crepyness forming. Do you use it on the hands and if so how are the results - generally? Many thanks for your time.

  Answer:  yes, it works well, but not as dramtic as on the face. JG 4.21.08

• Doctor Garcia , do sunscreens have expiration dates .. i`m asking because i noticed that all my sunscreens - there are 5 of them ( Banana Boat Nivea Brands etc. ) don`t have expiration dates indicated on the package / container .. , thanks

  Answer:  I would not keep them past 1 1/2- 2 years. JG 4.21.08

• Doctor Garcia does sunscreens which protect against UVA / UVB prevent a person to tan or its only help would be to prevent free radical damage , thanks

  Answer:  they should slow the accumulation of the suntan too. JG 4.21.08

• Dear Dr. what is your opinion on the Mixto fractional laser? Have you used this laser? It is comparable to a co2I was told about 14 days down time. Thanks.

  Answer:  I have not personally used it and do not plan on using any fractional laser at the present time because I think the claims made are inflated and the results are not signifianct enough for most patients. I would tell you that it will not be even close to a correctly done CO2 laser. JG 4.20.08

• hi, Doctor Garcia .. how soon should one apply copper peptide serum after having a TCA Peel .. should the copper peptide be applied the day or two days after the peel or wait until the crusts form ? any suggestion?

  Answer:  24 hours later is likely OK. JG 4.20.08

• Hi Dr. Garcia. I have had 2 ipl treatments for sun damage and rosacea---one a month ago and one 3 weeks before that. The first treatment bruised my nose considerably, and while the bruising cleared up within a couple of weeks, the skin where I bruised is still very red. I assume this is postinflammatory hyperpigmentation? Is this likely to fade? Most of the reading I`ve done says it will, but I see in a previous question that you answered that you said that PIH is a permanent change. In addition to this redness, I have had a really bad reaction to the last ipl treatment in general. It has been a month since my last ipl and my whole face is still pink, like a sunburn. If you look close you can actually see where I was wearing the goggles, because the skin is lighter there. Also, I broke out in cystic acne after each treatment, which I had to have injected, also leaving me with red marks. Is there anything I can do to reverse these PIH changes? Can v-beam or any other laser be used to treat them? I had v-beam years ago for a port wine stain and it worked very nicely. Also, have you ever heard of someone having a reaction to ipl in which the entire treated area stays pink for this extended period? The derm at the place where I have been receiving the ipls is recommending that I continue with the ipl to get the redness under control, but with the reaction that I have had thus far, I am very hesitant to do so. One last question--my regular derm prescribed Elidel for the PIH, which I have not yet started. Will this possibly help? I feel as if I have ruined my skin. HELP! thank, alyssa

  Answer:  redness is just inflammation but the hyperpigmentation part would be brown or bronze in color. The redness you have should fade and applying the treatment for PIH would just irritate you more and keep it red longer, you need to avoid the sun, and some of your topical acne treatments can also keep it red longer. Prolonged redness is very uncommon and a light VBeam would help settle it down. The Elidel is OK but only for a few days. Best of luck. JG 4.19.08

• Hi and great thanks for your fast reply. (I posted a question cons. a facial fat loss after rf + ipl) I have just a few more further questions concerning your suggestions to fix it. Should I wait a half a year before getting fat or sculptra injections to see if lost fat comes back. And which one of those you would recommend Sculptra or fat injections? Also you mentioned a steroid injections. Where could I get those and should I try to get them as fast as possible? I am now very scared of all this. Thanks for your will to share all this information. - N

  Answer:  I would say to wait at least 6-8 weeks and see, if it has leveled and is not getting worse you can try a filler, just be conservative with any filler in case it does grow back. JG 4.17.08

• Hi, Thanks for your wonderful site! I have a question concerning a possible fat loss after 1 Ipl combined with radiofrquency treatment(Syneron estyle). In 2-3 weeks my face has become very skinny and gaunt. Do you think it could be due to a fat loss? And how long after the treatment it may continue? And do you have any experience whether this fat loss could be normalized within a time and the skin get back it´s normal amount of fat or is it permanent? I´m 31. Thank´s a lot! -N

  Answer:  well, assuming there is no other cause for the fat loss like excess dieting, exercise or some illness, I am not sure what else it could be except that. It might continue for a few more weeks in fact. In some cases after steroid injections it can come back and one can hope it will in your case. Whatever is going to come back will come back in 6 months. There is a potential that it can be permanent and you would need something to correct it like fat injections or Sculptra injections. JG 4.17.08

• Hi Doc, Does laser resurfacing help undereye wrinkles, if not, what do you recommend? Thanx

  Answer:  for a while yes, I use either a Rhytec Portrait or a CO2 laser there. JG 4.17.08

• Hi Dr. Garcia, I did ask my doctor about doing the rest of a series of low passes. Apparently, I was not firm enough, and he said he can tell more in 3-4 months what needs to be done. He also said he feels he didn`t really do a low treatment on the one side as he went over it twice. So it appears I am out of luck unless I get the energy to fight this more. So I will just see you on 05/21. Do you think there is a danger that I am losing my window of opportunity to even things out by waiting? I can already see there will be a difference, so doing nothing is not acceptable to me. See you soon, and thanks again. If I could, I would just have you do whatever should be done; maybe we can talk about that, too.

  Answer:  it is not a danger, but it is just that doing the treatment sooner would get you even sooner. Two passes does not preclude doing a series of light treatments. JG 4.15.08

• Hello Dr. Garcia, it is me again - the 1/2 low 1/2 high Rhtyec mistake gal. I have a follow up with my doctor; any suggestions on what I should ask about? I don`t think I will mention my 05/21 appointment with you. You are a godsend, by the way. I cannot thank you enough.

  Answer:  ask him how he treats the low energy patients as a series and ask him to do that for you so you do not have to wait. Best of luck. JG 4.14.08

• Doctor You are the best !Thank you so much for your professional advise , I really appeciatte it ,I never expected that you will answer that quick , Is amazing that I visited so many doctors (Derm) and no one could tell me that my problem is hormonal , my husband just told me few days ago that I should check my hormones since it looks that my problem get worst when I get my period . Thanks again ..

  Answer:  all the best. JG 4.14.08

• Dr.a year ago I had 6 sessions of Crystal microdemabrassion, ,large pores got a lot better and skin got smother on cheeks and forehead, but the acne on the chin got worst specially during my menstrual period, I tried so many things until finally got better with aloe vera plant and vitamin A suplement 10,000 iu . I stopped vitamin A since I read that can be toxic if you are trying to become pregnant what is my case and then the acne came back . should I go back with vitamin A suplements since it really proved me that my skin got a lot of better or is not safe ? Now I went to a plastic surgeon office and I am schedule to have every friday a series of 4 or 5 of Diamond Microdemabrassion with Salycilic acid. I got my first one with 20% salycilic acid and look good , I see the acne went away ,so I am very happy to see my face clean next one is in 8 days . This results last long? after I finish all 5 micro how many should i do in order to keep my face clean? Thank you for your profesional advise,

  Answer:  I think that dose of Vitamin A is not good while trying to get pregnant or being pregnnant. I think it certainly sounds like your acne is hormonal in nature and that needs to be treated in order to best control your acne. The microdermabrasion and salicylic acids peels will help keep things in good balance though. After the initial series it might be once a month or more, depends on how oily your skin is. Might want to ask your gynecologist about a birth control pill and its effect on your acne too, all the best. JG 4.13.08

• Dr. Garcia Thank you for your quick and reassuring response. The difference in my face from my question to you to today is amazing. Because my doctor did two passes (Active FX) under my eyes, those areas are re-epithelializing much more slowly and are still very red and crusty. I read that Retin A may speed up the process. Right now I am just using a lot of Cetaphil. Would it be unsafe to use a mild Retin A cream at this point? Thanks again. Great site. You provide a wonderful service.

  Answer:  Retin-A will help it heal faster if used before the treatment, not after it is done, I would not use it now as it will irritate your skin too much. JG 4.13.08

• Dr. Garcia I had Active FX Wednesday evening (the 9th). My face is very dry and splotchy and extremely red under the eyes (there is also a small amount of crusting under the eyes on my cheekbones--is this OK?). My plastic surgeon (a reputable Chicago doc) said downtime would be 3 days (but no Sat office hours, so cannot call). There is no way I can go anywhere looking the way I do right now. I have an event next Friday. What are the chances that my face will not look normal enough by then?

  Answer:  it is not uncommon for that to happen. The downtime varies with strength at which the laser is doen at, and also the thickness of your skin, so the 3 days is an average. I think by next Friday there will be lots of improvement. Hang in there. JG 4.12.08

• I just had my 2nd IPL treatment today for redness and my skin looks very unsmooth, almost like shallow indentations throughout my cheeks and lumpiness. Is this normal for this soon after treatment? They upped the power today. My 1rst treatment left my skin texture very smooth after a couple of weeks, but did not look like this initially. Thanks

  Answer:  it is common, due to swelling and is temporary. The setting might have bene stronger and it can cause more swelling if it is. JG 4.12.08

• Hello Dr. Garcia, I am 48 years old, female, caucasian, pale, hardly tans, female. I am thinking of getting 3 Siton Profractional laser treatments. Each one would be 3 weeks apart. I have some fine lines, wrinkles around lips, some cheek wrinkling when I smile... nothing too serious yet. 1. Does it work? 2. Are there side effects? 3. How long does the redness last? Mostly I`m concerned about making things worse. Thank you very much. cs

  Answer:  mild improvement possibly around the mouth, the cheeks will only look better while you are swollen. The side effects are that of hyperpigmentation and of it not working. Redness lasts about 3-7 days, all depends on how strong they go. Do not think you will make things, worse on your skin. JG 4.12.08

• Dr. Garcia, sorry to not identify myself as you get so many questions. I sent a question and referred to my 05/21 appt. I am the person whose physician accidentally did high Plasma on 1/2 of face and low on other side, then went over low again.

  Answer:  I figured it out, see you soon. JG 4.11.08

• Hello Dr. Garcia, I did make an appointment with your for 05/21. Is there anything I should bring? As I said, my doctor did say he would do another procedure if I saw a difference in 3-4 months. Quite honestly, I cannot see how I would not, given the extreme difference in the treatment given, at least as it appeared on my skin. I am not so concernec about 3 months out, it is more like 6 - 9 - 12 months. I wanted the results of a high treatment, and no way to sugarcoat it; that is not what I got. I don`t quite understand why I should have to wait so long, nor what your opinion of the correct treatment would be (if any.) I have the feeling he may be just hoping I won`t press the issue. This is very depressing; I do not mean to be self absorbed when people have so many real problems, but I cannot help the way I feel. I also have to say I am skeptical whether he would know whether there would be a difference in time or not, as he apparently is not so comfortable or experienced with the Portrait in general.

  Answer:  if you have the pictures from before the treatments, that might help a little. When I do a series of the ligther treatments in an attempt to get maximum improvements, we do a series of three with 3 weeks in between. See you soon. JG 4.11.08

• Sorry Dr, referring to my question below I didnt make myself clear. I meant, the Vbeam laser is not available in Western Australia. There are other types of lasers, just not this one

  Answer:  Oh, sorry, could try a Nd:YAG laser, there are more of those. JG 4.11.08

• Hi Dr. Garcia, Thanks for answering my question regarding removing the purplish vein underneath my eye. I have done some research, and realise this laser is not available in Western Australia where I live. Are there any other lasers that could be of some help, or any other options for me? Thank You!

  Answer:  I am sorry, but none that I can recommend. JG 4.11.08

• Hello Dr. Garcia, I love being tan.I am am developing quite a lot of brown spots and am considering some sort of treatment to get rid of them. I had Photo Facial on my arms, legs and chest and it helped a little , but not much. If I have Levulan done in October, can I tan again by April of the next year?

  Answer:  I think you are wasting your time and money, once you tan the spots will come back. You need to make a choice, tannned with spots or no spots and spray on tan. JG 4.10.08

• I am going to get laser sunspot treatments done as well as tattoo removal done. i went to two different places that use different lasers. which one is a better laser and would see results better the ipl or the medlittle nd yag laser? thank you very much

  Answer:  I use the Medlite Nd:YAG, an IPL is not a true laser and will not work as well for the tatoo. JG 4.10.08

• Hi Dr, Just wondering what the best treatment for my veins would be. Under my eyes, near where my eye starts to hollow out above my cheeks I have some purple veins. They are a tiny bit lumpy and make the area look purple. Also a few tiny red veins under my eyes. What laser would you recommend? Also, I have some redness on my cheeks. Not veins, just blotchy. What laser can you recommend for this? Thanks!

  Answer:  VBeam would be the most effective but has some downtime. For the cheeks you can do the VBeam or IPL for less downtime. JG 4.10.08

• Dear Doctor. I have few but noticeable little depressed scars on nose and a few on the cheek. My skin is super light and completely even, never had problems with peelings or anything causing hyperpigmentation or pigmentation problems of any kind. What do you suggest for those depressed scars? a) localized dermabrasion (to the point of wounding the skin and then wearing something to protect the area or b) punch excision o however you call that. The scars on the nose are rather big , relatively speaking, those in the cheeks small (not sure if punch can be done with them). A) Which procedure do you prefer as in having better results for the scars to get filled up/not noticeable (I don`t mind having a line, I hate having a depression) B) which one is best for the nose versus the cheek? C) what are the downsides and downtime of each procedure? I have my appointment with the derm tomorrow and even though it is a knowledgeable person from all I know, I value immensely more YOUR advice (more than the one of other docs, since you are so interested only in our education and wellbeing, shhh ;)) and I prefer to go there with an opinion of you to make a better informed decision. Hugs.

  Answer:  possibly fillers for the nose and punch excisions on the cheeks if they are small. Laser might help the nose, dermabrasion could if it is not microdermabrasion,and I do not think lasers or any dermabrasion will help the cheek scars if they are ice pick type scars. Good luck. JG 4.10.08

• hello Dr. Garcia, i have v-beam done about 3.5 months ago with some bruising. well there is one small area that still has some bruising. it isnt huge but i dont like it there. will this ever heal or is there something a doctor can do to make it not discolored anymore? thank you

  Answer:  very unusual. It should be gone by now, might want to go back and see your surgeon and see if they are willing to do anything to help it along. JG 4.8.08

• Hi Dr. Garcia - Do you think the results of a light vs. deep rhytec are similiar?

  Answer:  I think the deep has better results. JG 4.8.08

• Dear Dr, I have rosacea (more than 20 years) and for the past 3 mths have been recently taking isotretinoin capsules on low dosage (10mg every second day). It has been quite effective in reducing red , itchy outbreaks on my face. I have periodic laser treatment to reduce/control telangiectasias, however I`ve read where it can be dangerous to do so while taking accutane. My doctor told me it was OK - if I stopped using the accutane a week prior to laser treatment. Having read your informative web site, I`m not convinced of this assertion as it seems there`s a chance of damage to the skin pigmentation and delayed healing. Could you please tell me if it is in fact safe to do, as my doctor suggested, or should I be waiting until I`ve completed 6 motnhs on the accutane - and if so how long to wait until safe? I don`t want to cause adverse damage to my facial skin. Thank you very much in advance.

  Answer:  well, I think if the setting on the laser is low and since you are not removing too many layers of skin because they are concentrating on the red only, it is likely OK to do it. JG 4.8.08

• Dr. Garcia, Thank you for taking the time to answer all our questions. Here is my problem. I have an approximately 1 inch scar on my nose- right on the flat part so it is painfully obvious. It is 8 months old and has improved somewhat, but not nearly what I would hope. Some areas have linear depressions, others are simply wide and depressed. There seems to be a linear border (slightly raised)which surrounds the entire blemish. I am not prone to scarring, but am to hyperpigmentation. Is it possible to excise a scar on the nose with not a lot of extra skin? What would be the best course of action? Thank you so much. Gigi

  Answer:  hard to revise the scar without loose skin, a laser resurfacing might smooth it out but can be risky, with your skin if you tend to have hyperpigmentation. Fillers are not always possible to smooth out a scar, I think I would give it some more time and see what happens. JG 4.8.08

• Thank you very much for your quick response to my post of the Rhytec procedure 9 weeks ago! In your response you said that it should be evaluated and treated - have you found something that should be used to help prevent or minimize scarring that I could propose to my PS? Thank you again!

  Answer:  might need shots of steroids or 5FU to soften the scars or a laser to fade the redness. JG 4.8.08

• I had the Rhytec Portrait procedure 9 weeks ago at level 3 around my eyes (upper lids, side of eyes, and under down to cheekbones) by a plastic surgeon. I still have significant red areas under my eyes, my eyelids, and on my left temple. My surgeon is baffled as to why this has happened - she says that this has never happened to any of her patients. I am very fair, blue-eyed, with very sensitive skin (which was very nice other than some wrinkles). I am worried that these are permanent scars - they look like burns. Is there something that I can be using to help these areas heal? I plan on going to see a dermatologist but after reading your answers, it sounds like this is very unusual and likely a user error. Thanks for any advice.

  Answer:  very unusual I must say at that setting, assuming only one pass was done. If more then one pass was done, then it is not uncommon. Can prolonged redness be a sign of scarring, potentialy yes, it needs to be treated to make sure it does not go that way. Best of luck. JG 4.7.08

• Dear Dr. Garcia, Having lived in Vegas for about 3 years, I have been getting sunspots on my face and they are getting really dark now (even can`t hide with makeup). I am very interested in Pearl laser or IPL, or any kind of treatments that can make my sunspots go away. Can you please tell me what would the most efficient and the cost of it? Thank you!

  Answer:  I think for low cost and low risk and yet still effective, the IPL is where I would start since they are recent, best of luck. JG 4.7.08

• Dr. Garcia, one more question. I have to go to Las Vegas end of May for business; would there be any chance of having you take a look at my face and give me your thoughts? I did take pictures on day 3. If that would even be possible, do you think it would make sense?

  Answer:  please call the office and tell them you would like an appointment and that we have been communicating on the web. See you soon! JG 4.5.08

• Hi Dr., Is Velasmooth at a lower level just as effective as the highest level, or is it the higher level you go, the better result? Does Velashape work, in your opinion? You are so amazing. There is no other expert in any area who provides such quick response to so many Qs. You are one of a kind. Thank you so much.

  Answer:  typically, the higher the level the more effective. Thanks to you for the kind words. JG 4.5.08

• Hi Dr. G., I am confused about the Velashape. What is the difference between it and Velasmooth? Does Velasmooth have cumulative tightening of the skin with regular (every 6 weeks) treatment, in addition to helping with cellulite? Does having it at the highest level cause spider veins? I seem to be having more visible veins since I started treatment. As always, I am so grateful for your generosity in sharing your valuable time and knowledge. Blessings!

  Answer:  not much difference between the two, just more energy being put out to try to damage the fat to a greater extent. I do not think VelaSmooth has cumulative effects, no. High settings can cause spider veins in some peoeple, yes. All the best to you. JG 4.5.08

• Dear dr.garcia, do you know if Dr Val Lambros can do botox,and treat noticable viens on legs and face freckles? thank you

  Answer:  not sure,you would need to call him. JG 4.4.08

• Thanks, Dr. Garcia. I saw the doctor yesterday. He said he honestly feels I will see no difference in the two sides, and that he cannot do anything for 3-4 months, but if I see a discernable difference, he will do another procedure using less strength on the side he did the high power on and a bit more on the side he did on low power. I guess I will just have to wait and see, but it is stressful. Thanks again.

  Answer:  keep me posted. JG 4.4.08

• Dr. Garcia, are you aware of any creams or lasers that can help with stretch marks...some pink and some white on breast and hips? What about the same areas with old scars (not sure Mederma would help after a long time)? Thank you for all of your past quick and informative answers. Bless you.

  Answer:  none that really work, no. Mederma and lasers will only help if the scars are red and the red is the only thing they help. Take care. JG 4.4.08

• Hola DR. Garcia. About 2 weeks ago I was adviced to spend 400 dollars on a lazer treatment called Q alex to take out the sunspots on my shoulders. I am latino and my skin has a yellow tone and loves color! So after 2 weeks the spots are happy to stay on my shoulders...should have spent the money on a new coat or something. WHAT WILL WORK on sunspots on the shoulder area on a Latino woman? I had a Blift on my face and it took care of scars and spots beautifully...left a trace of color on the face though. Should I do this on my shoulders? I just want even skin in this area. Thanks doc!

  Answer:  a Q switched YAG laser will help, but it will never be done in one sessions, it will take a series, but no way to tell how many. A chemcial peel on the shoulders is riskier than the laser. JG 4.3.08

• Hi Dr., G., I have been using a prescription hydroquinone and Retin-A cream; instead of a solid patch of brown hyperpigmentation, I now have dispersed, blotchy brown and lighter areas. Is this normal? That is, is the hyperpigmentation being broken up and eventually improving/fading? If this is not normal, should I stop using the cream? In addition to the cream, what other options are available that are actually effective for Asian skin? Will the Portrait help? Thank you!

  Answer:  yes, with time it evens out, some areas just respond faster than others. Portrait would help too though. JG 4.3.08

• Hi Dr. Garcia, ThermaTip CL apparently drastically reduces cellulite/and results are long lasting. Does it? As well, if you have additional info, please share. Thank you

  Answer:  I have not seen a single patient in that it worked. I sold my Thermage machine long ago due to my and my pateints` disappointments. JG 4.3.08

• Yes, I totally agree about going elsewhere. Thanks again; I will ask about the extra low pass. Take care.

  Answer:  all the best. JG 4.3.08

• Thank you so much for the answer. Yes, I don`t know what joules were used; I am assuming 1.2 for the two low passes and 3.0 for the high, but I don`t know. What would you think about doing another low pass on the one side in about 3 weeks or so? I see the doc today and may ask him about that. You are so kind, and obviously knowledgeable. I wish I lived closer!

  Answer:  2 times 1.2 will not be exactly equal to a 3 joule pass. I think doing another pass of the 1.2 after three weeks is reasonable. Might want to consider going somewhere else in the future, I know accidents happen, but this is a big one because although the results wil not be bad, the doctor should immediately see a difference after one hit of the low energy spot compared to the high energy, if they do not see a difference, I think that is not good. JG 4.3.08

• What is the difference fractionated UltraPulse Encore CO2 laser (activeFX), which is suppose to be a single treatment) and fraxel?

  Answer:  the only difference is marketing hype. JG 4.3.08

• Hello, I hope you can help me. I just had Plasma skin resurfacing on my face and neck. The doctor did 1/2 my face at high power, went to my neck on low power, then did the other side of my face on low power by accident. Because of that, he then went over that same side again with low power. He said he does not know if two low passes would equal one high pass; we will just have to wait and see. Is there anything we could do now? I am not comfortable just waiting 3- 4 months to see, and I am just so upset (not mad, just very upset.) Any suggestions on what I might talk to him about doing now? I can sure see a difference in the healing between the two sides. Also, the reason I started this is due to abnormal skin cells on my nose; not sure what level was used on my nose. Thank you so much.

  Answer:  well, it should be close, hard to say without knowing the exact joules used, but in most cases it will look pretty close, got to hang in there. JG 4.2.08

• I am a woman in my mid-forties and my concerns are fine lines (getting deeper every day) around my eyes, enlarged pores, crepiness, and sagging starting in the jowel areas. What do you recommend a fraxel CO2 laser or a plasma portrait laser? Thank you for all your help!

  Answer:  I think the PLasma Portrait is a better option for the eye region but likley neither one will lift the jowls to any significant extent. JG 4.2.08

• DR Garcia, You mentioned below the risks of the VBeam Laser. What are they? Can a person have two of them, and if so, how far apart in time should they be? Thank you.

  Answer:  the biggest risk is hyperpigmentation, in rare cases some people have become pale from the redness fading, for awhile. Teye can be done in a series if needed and I suggest 4-6 weeks inbetween. JG 4.1.08

• I read about the micro laser peel and the softlight laser peel, correct me if I`m wrong, but I`ve found that the former has the same downtime as the later, but the former goes deeper than the softlight as it ablates the outer most layer of skin...up to 50 microns. How deep does the softlight laser peel go in microns?

  Answer:  it depends on the energy setting the doctor uses, no way for me to tell. JG 4.1.08

• Where do you suggest going for mole removal on the face?

  Answer:  could try your dermatologist. JG 3.31.08

• In terms of exfoliation after a single treatment, which would you suggest for better results considering all pros and cons of each,the softlight laser peel or one microdermabrasion? How does microdermabrasion affect a face with fine hairs?

  Answer:  the microdermabrasion will not affect hair and if the brown spots are the problem, then the micro laser peel is the way to go, if it is skin texture, then they are about the same. JG 3.31.08

• thanks a lot Doctor Garcia for the answers on the TCA :) more power to you and God Bless

  Answer:  all the best. JG 3.31.08

• What do you suggest for brown spot removal on your face? And what is the cost for this? Also, do you remove moles from side and tip of nose and will there be scarring? Should you do these procedures during the time of year when the sun is less strong?

  Answer:  we use a YAG laser, done in a series, $100 per session, we no longer remove moles and we suggest not using the laser during summer months, JG 3.31.08

• What do you suggest for brown spot removal on your face? And what is the cost for this? Also, do you remove moles from side and tip of nose and will there be a scarring?

  Answer:  we typically use a YAG laser for that, the cost is $100 per session, usually it is a series and we do not remove moles any longer, sorry. JG 3.31.08

• Doctor Garcia, when you apply TCA 30% over a small area like that of a coin and you made 3 passes / coats of the TCA 30 over it , is this sort of equal to TCA 90% delivered in a more subtle way ?

  Answer:  no, it is not, it can be potentially dangerous, and again, I repeat, you should not be doing that at home. That should be done by a a professional only. JG 3.30.08

• Doctor Garcia, can a TCA 30% be used on the jawline area or should it be a lesser percentage ? many thanks. good day

  Answer:  yes, it can at 30%. JG 3.30.08

• Doctor Garcia, is it okay to add water to a TCA 30% before doing a chemical peel to lessen its percentage of acid .. which means there is a mixture of TCA 30% and small amount of water into the chemical peel solution,,,

  Answer:  I do not think you should be doing a TCA peel on yoruself at home. JG 3.30.08

• I am scheduled to have profractional laser procedure for wrinkles around eyes with an erbium peel for smoother skin and remove brown spots. I thought it would be great but am now petrified, it sounds painful with too many risks later. I am trying to research it and am aconfused with all the different names for it. Is fraxel laser the same as profractional?? What other erbium names are there?? I believe they use sciton BBL laser.Knowing this will help me with my research. My goal is to have have smoother skin with less wrinkles around lips and eyes. Mine are not extreme, i am 43 years old and just looking for a little pick me up so i dont look tired around the eyes. The suggested and eye lift but it seems too extreme for my age. Do you think erbium is worth it and profractional??

  Answer:  I think all of the minimally invasive lasers you mentioned will lead to minimal improvements. JG 3.28.08

• dear dr.garcia,i had laser hair removal 2 months ago on the bikini area,i had 4 to 5 sessions all over the area and around it,where i honestly didnt need it,now i noticed the hair growing back, and the area is much wider(hair is growing where it hasnt before) i think useing the laser on very fine(barely there hair) and not just the limited area where hair is visible,.causes it to grow thicker and more noticable.why is this happening?its alot worse than before i had the procedure,hair is appearing where it hasnt appeared before.why?what should i do?

  Answer:  the laser ,in removing hair in some places, has likely made or allowed new hair to grow but the texture difference is not permanent, it will soften as the hair ages. Not much do do except wax or shave in the meantime. JG 3.28.08

• Doctor Garcia, for a TCA Peel at 20 % , when the area applied TCA on turns white completely or frosts, does it mean that it should be taken out at once already or you can still let it stay on the area for a couple of minutes.. if you do , will the TCA continue to penetrate even deeper or the moment it frosts, thats it.. any damage that happens underneath the skin is minimal after complete frosting ...

  Answer:  it is usually left on, TCA is not something that is normally neutralized. It does continue to penetrate though. JG 3.27.08

• Can laser hair removal treatments cause broken capilliaries?

  Answer:  potentially, yes. JG 3.26.08

• I have had 3 laser hair removal treatments so far and the hairs are really thinning out and taking longer to grow, but I have just noticed some broken capilliaries on the sides of the thighs...what would you suggest I do to eradicate or treat this?

  Answer:  could try some IPL treatments to reduce those. JG 3.26.08

• Dr. Garcia, you mentioned that acne blue red light lamps that work are the ones in the doctor`s clinic.. would you know a brand for this acne lamp that is being used ?.. many thanks to you.

  Answer:  BLU-U JG 3.26.08

• Dr. Garcia, you mentioned that acne blue red light lamps that work are the ones in the doctor`s clinic.. would you know a brand for this acne lamp that is being used ?.. many thanks to you.

  Answer:  the one I am most familiar with is BLU-U light therapy. JG 3.26.08

• Dr. Garcia, is water ( applied by spraying over the face and then wiping off ) sufficient as a substance in itself to neutralize the acid from a facial chemical peel?

  Answer:  in most cases, if enough is applied, yes. JG 3.26.08

• I am 39 going on 29 as far as pores,lines and elasticity is concerned with the exception of my hyper pigmentation.When I was 24 I had laser resurfacing with the Urbian Laser. (I think that`s what it was called which just seemed to exasperate the sun spots. I don`t take birth control pills nor have I ever and I do not have liver problems. I have had peels for about 7 years every 30 days like clock work and faithfully used sunscreen for red heads like my life depended on it. I also avoid the sun to the point were my close friends make fun of me. In any case the sun spots some times seem to get a little better but come back and give me a look like I have a dirty completion especially in the summer. I want to fix but because my skin is a light shade of brown with yellow undertones this I am afraid of going to a Dr. or facility that deals with caucasian women. Do you have any recommendations ?

  Answer:  well laser peels can be risky as can chemcial peels and the most important thing to understand is that no matter what you choose to do, it is not permanent, it will all come back in time. JG 3.25.08

• Hi, just wondering ... is the acetone used for nail polish the same as the acetone that is being used as pre peel during chemical peel procedures?

  Answer:  similar bt the one used to prep faces is a more pure product. JG 3.25.08

• Dr.Garcia, What are your thoughts regarding laser skin tightening? Are they overrated? Thank you, Karen

  Answer:  I think in general there are just a few kinds of lasers that are effective, so overall, I think, yes, they are exagerrated. JG 3.24.08

• I have many white hypo-pigmented spots on my arms and legs that get worse with each passing year. I`m 52 and I`m considering IPL treatments for my face. Am I not a good candidate? Also, why do some doctors use gel and not others? I have sun spots,broken blood vessels and some fine lines. Thank you!

  Answer:  you should always use gel to avoid burning, as to being a good candidate for your face, I see no reason that you would not be from what you have said so far. JG 3.24.08

• Dr. Garcia, I am considering having Pixel laser and skin tightening on my neck. What is your opinion on both of these procedures. Thank you kindly, Karen

  Answer:  I do not think the Pixel laser will help your neck to tighten, sorry. JG 3.23.08

• Hi Dr. Garcia, I`m the guy with the pale/lighter circular footprint on my skin as a result of overtreatment with the vbeam laser that doesnt flush anymore and is noticeable lighter than the surrounding skin even when not flushed. Would camouflaging with permanent makeup (micrpigmentation) even out the slight color difference? what do you think of this idea? are there any risks with micropigmentation? The reason i came up with this is I really don`t want to do a series of vbeams or IPLS to lighten my entire skin color on my face, I just want to make this spot darker so its similiar to my current skin color.

  Answer:  I think micropigmentation very rarely will match in my experience. If you do it make it very light if anything at all. JG 3.23.08

• I am 49 and want to build up the collagen in my face and tighten the skin. I have looked at the Sciton erbium laser (2940 wavelength) laser and Thermage. If cost is not the issue, which one would give me the most dramatic results? Is there any other treatment I should consider?

  Answer:  I do not feel either one wil do much, if anything the Sciton will do a little bit more. I think a Rhytec Portrait will give you much more, or a CO2 laser done lightly. JG 3.22.08

• I`m interested in receiving CO2 laser surgery on my lower eyelids. I have several fine lines located directly under my eyelashes. I was just wondering if the laser is able to be done in that area that close to the eye? Thank you.

  Answer:  yes, it is. JG 3.22.08

• Hello Dr. I consulted with a PS who recommended 30% TCA chemical peel for my face.I`m 27 and losing firmness and seeing fine lines (near my smile and below eyes when I smile). Do you think this is a good idea? Will it help with those issues? When I asked about helping with firmness, the PS didn`t really answer me. Thanks so much!

  Answer:  I think TCA works well for skin discolorations but not for much else. I think once the swelling is gone that the fine lines will still be there. JG 3.21.08

• mom of 24y o going for Levulan treatment tomorrow here, that was a quick response. thank you. What are your recommendations for PCOS acne? She needs to come off those birth control pills in a few years.

  Answer:  THE PCOS needs to be controlled by limiting her sugar intake, considering Metformin, and maybe boosting progesterone, best of luck. JG 3.21.08

• My 24 yo daughter is scheduled for a levulan PDT treatment tomorrow. She has PCOS with 2.5 years of acne trouble. She recently started Ortho-tri-cyclin with good results. The acne has caused quite a bit of scarring. From what we understand this treatment will reduce the oil glands` response to the excess testosterone. We are hoping she can get off the birth control pills someday. What is your opinion of this treatment and the results we hope for? After these treatments we want to reduce the scarring. The doctor recommended CO2 laser. That seems extreme to me. American laser wants to do a series of IPL interspaced with microdermabrasion. Which do you think will be more effective for moderate, no icepick scarring?

  Answer:  I am sorry but I am not a fan of that procedure. It migth be as effective as a deep peel for her scarring but it will not control oil production. I do not think IPL will do much and I think the CO2 will be the best for the scarring. JG 3.20.08

• Hi Dr. Garcia, I`m 51 years old and considering Thermage for the lower face and neck area for tightening and smoothing. Would you advise this treatment and are there short-term or long-term side effects I should be aware of? Thanks!

  Answer:  I would not advise it, I think the results are unpredictable and the lower on the face and the older one is the less improvement you get. JG 3.20.08

• *I asked earlier about the light rhytec portriat for the loose skin of the neck> WHat about the regular Rytec pOrtrait for tightening the neck area? Appreciate all your info!

  Answer:  The Portrait should not be used on the neck at the same settinsg as the face because it will burn that skin, the neck skin is not as tolerant. JG 3.20.08

• I performed an at home peel (70% glycolic...stupid I know!!).I used it for under eye wrinkles and it actually indented my skin and made it worse! I rubbed the area too much. I was wondering if you thought a CO2 laser would be able to even out this area? How long do you suggest waiting between a peel and laser? The peel was done the beginning of Feb. I want to be sure my skin has plenty of time to heal. Thanks.

  Answer:  I would give it at least 2-3 months and then either a light CO2 laser or a Rhytec Portrait to see if it can be smoothed out. JG 3.20.08

• Is the light rhytec portrait successful in treating the neck for loose skin and also eye area? If so how may sessions are needed?

  Answer:  on the neck no, on the eyes, yes if done as a series. JG 3.20.08

• Dr. Garcia, what does it mean to cross a tca and how is this different from a regular TCA peel ? thanks

  Answer:  I do not do TCA cross proecedures as I see little to no benefit. JG 3.20.08

• hi Dr. Garcia , during a TCA Cross .. does one have to wait for the area to turn white / frost first before applying a second layer onto the base of the scar if you plan on putting 2 layers of the TCA or you don`t have to wait for anything... no turning into frost, no nothing and just put the second layer right after the other?

  Answer:  your doctor should know the answer to that, I am not sure why you would ask that question. JG 3.20.08

• Hi Dr Garcia, I have been using Retin-A for the past few weeks on my upper cheekbone/lower orbital area at night. Would applying an eye cream over the top take away from Retin-A`s efficiacy? Also, do you think using the 1% would be too strong on that area? Thanks very much

  Answer:  wait 10-15 minutes in between and that should be OK. If you can tolerate the 1% it will be more effective. JG 3.19.08

• I have lines above my upper lip due to age (nonsmoker). What type of peel or laser would help this area. I would prefer not to have my whole face done because I have rosacea and I don`t want to make the rosacea worse. Thank you!

  Answer:  I suggest a deep Rhytec Portrait treatment. JG 3.19.08

• Hi Dr Garcia, I have been using Retin-A on my upper cheekbone/lower eye area to try to erase fine lines and crepey skin - which were both caused by a retinol peel which went too deep 2 months ago. I have been using it for 1 week on this area, and the skin is looking quite dry and even crepier. It is not peeling though. Is this normal? Generally, how long until I see some results using Retin A on fine lines every night? Also, is it okay to get `Omnilux` - red light treatments for healing skin whilst using Retin-A? Thanks very much

  Answer:  yes, all normal and it might tkae 4-6 weeks for your skin to get used to it, best of luck. JG 3.10.08

• Is there a single laser that will remove hair as well as sun spots on the legs and arms? My dermatologist has a Candela laser. What do you think of Candela lasers? Do you think this is better than IPL for hair removal? Also, since I do not know very much about lasers is there a specific laser I should look for to remove sun spots on the legs and arms? Once again, thank you for your time!

  Answer:  no, there is not. I think Candela as a company is good, but not all of their lasers are good. For the sunspots I like a Q-switched Nd:YAG laser as the best option, it is made by many companies. JG 3.8.08

• Dr. Garcia. What is the PIH you were discussing with the woman about her IPL experience? She said it was common on darker skin tones? Thank you.

  Answer:  post inflammatory hyperpigmentation, or where the skin reacts by getting darker to protect itself, like a suntan. JG 3.6.08

• JG 3.6.08Hello Dr. Garcia, In your experience, what is the best treatment for seborrheic keratosis? I have dozens on my legs and hands. I would think that freezing each one would be incredibly time consuming. Are there any proven lazer treatments? Also, do they come back? Anyway to prevent them? Thanks so much for your time

  Answer:  lasers and liquid nitrogen are equally effective and equally time consuming, nothing fast and effective I am afriad. They will all come back in time I am afraid. No way to prevent them once they start to form. JG 3.6.08

• Hello Dr. I am experiencing some loss of skin firmness and elasticity, it seems, all sort of suddenly during the past 6 months or so.I am a non smoker (occasionally on the weekend have a couple). I`m only 27 but have spent a lot of time in the sun. I previsoulsy had perfect, smooth, taught skin. I think I`ve gotten away with a lot cause I have oily skin, though. I`m not sure what is happening, why so fast, it seems my cheeks are drooping, too sort of, losing firmness. I have fine lines that are starting to appear under my eyes and nasal folds. Should I be considering a peel or laser or something to deal with this or am I too young?? I have been using your creams (peptide and DMAE) and they were working great for a few months so I don`t understand whats going on. : ( Please help, I don`t want to look too old before my time. Thanks so much for any advice you offer.

  Answer:  hard for me to say without seeing you, but at your age I think creams are a must, along with sunblock, not fluctutating your weight and possibly a minimally invasive laser to try to tighten your skin might help. JG 3.5.08

• Hi Dr. What is your opinion about Thermage/Therma Cool? My Dr. suggested is as an option in lieu of a forehead lift. Thanx so much! Love your site!

  Answer:  had one of the machines (Thermage) and sold it as I got tired of myself and my patients complaining that they did not get as much of a lift as the few in the pictures used for marketing got. JG 3.4.08

• I have written before and value your opinion. I had IPL years ago for rosacea. The treatments helped the redness but I now have fat loss and an indentation on the cheek. I can`t believe I`m considering this but my rosacea has caused very large pores and redness again so would IPL treatments from a Lumenis One machine cause more fat loss and/or indentations? Or would I just better off using a skin care line (for the pores) such as Obagi or Environ? Thanks so much. Chris

  Answer:  well, the reports from fat loss have been associated with radiofrequency and not IPL, unless there was a burn and then it can cause fat loss. It tends to be a spot loss, not a generalized fat loss. Facial fat loss is very common as one ages, without any treatments, but it is not a spot loss of the fat. I think Lumenis is a good company for the IPL amd I think it might be worth it. If a skin care line will control it, then I would go with that as it will be safer. JG 3.4.08

• Good morning Dr. Garcia, I am the gal who had the cosmelan mask done on Sat. to remove/correct slight hyperpigmentation from IPL done on Feb. 4. I took the mask of Sunday. Monday night, , I develop a small amount of rash on ny forehead. I called the doctor and he said it was normal due the heat. I took bendadryl as instructed and the rash is not getting any worse nor is it itchy. Seems like heat rash, which is not uncomfortable. All is well, my pigments are not darker or lighter. I won`t see some improvement until after 2 weeks or so. I am flaking all over. I have to use sunscreen which has titanium dioxide. The peeling is nothing like IPL, nothing scary, just light flakes all over. I have a few red marks from acne that faded already. No other breakouts so far. I will post of my recovery by the end of the week. I am hoping that my post will help someone out there who suffered from IPL or laser PIH like myself. Luckily, mine was light but I am upset that the dermatologist did not advise me that the risk of PIH is high on olive skin. IPL Lady

  Answer:  thanks IPL lady, keep us up to date, we all appreciate your sharing of the journey. JG 3.4.08

• DR. GARCIA, WITH ALL DUE RESPECT, I AM AN AESTHETICIAN AND ALOT OF YOUR RESPONSES TO YOUR QUESTIONS COULD BE BETTER ANSEWERED. FOR EXAMPLE, A QUESTION YOU WERE ASKED WHICH KINDS OF PEELS REALLY LIGHTEN THE SKIN? YOUR RESPONSE WAS THAT YOUR SKIN COLORATION WAS GENETIC. A BETTER ANSEWER WOULD HAVE BEEN A GLYCOLIC PEEL. GLYCOLIC PEELS NOT ONLY DIMINISH SCARS AND EVEN OUT SKIN COLORING, IT REMOVES DRY FLAKEY PATCHES RESULTING IN A FINE MORE TRANSLUCENT SKIN, BUT IT ALSO RELIEVES PREMATURE AGING!!! I BELIEVE YOU WOULD MAKE MORE MONEY IF YOUR ANSEWERS WERE MORE ACCURATE AND GEARED TOWARD CUSTOMER SATISFACTION.

  Answer:  well, firstly, I appreciate you chiming in with your opinion, but I feel,since you capitalized the whole message and that is tantamount to scremaing on the web, I must answer all of your points. Firstly, skin color and skin discolorations are two wholey different issues. Skin color is genetic but skin discoloration is acquired, like freckles, a sun tan and sun spots. Skin discolorations can be treated by many differnt skin peels, including glycolic acid peels, but genetic skin color cannot be safely altered with gylcoic acid peels. Deep chemical peels can be performed to purposely injure the melanocytes of the skin and attempt to lighten ones skin color, but it can be erratic and fraught with chances of scarring. Secondly, glycolic acid peels will temporarily improve scars while they cause swelling, but since glycolic acid peels remove the epidermis and a small layer of dermis, and since scars are usualy due to injury into the deeper dermis, your statement is wishful thinking. Glycolic acid peels can remove dry flaky patches, at times, depending on their cause, but if it due to a deep seated issue, such as eczema or an allergy or infection, it will not do so. The reason a glycolic acid peel will give the appearance, of a more translucent skin is because it removes the keratiniezed layer of the skin but in truth, due to the average turnover of facial skin, that effect would never last any more than 30 days. As to relieving premature aging, I again, beg to differ. It will take the waxy layer off and remove recent skin discolorations, but the deeper damage done by actinic exposure that occurs deeper into the dermis and basal layers will never be relieved by any glycolic acid peel. As to making more money, I do agree with you there, if I made promises that I could not back up, I could possibly make more money, but not for long. I feel strongly that my answers are acccurate, certainly more than what you have implied. I gear my answers to the truth and not to satisfy what a patient wishes to be true. I wish you all the best. JG 3.3.08

• Hi Dr. Garcia. How much risk is there of scarring with the C02 laser in the undereye area? I am a 43 yo female with very fair skin. Procedure would be performed by experienced occuplastic surgeon. How is scarring managed if it does occur? Thanks for your help.

  Answer:  in experienced hands the risk is quite small. If it occurs it is managed with injectabel and topicla steroids. Best of luck. JG 3.3.08

• What is the difference between Portrait Rhytec and IPL skin treatments. I am a 58 yr old Cuacasian with olive colored skin, I tan easily, and burn sometimes. I guess I am type III skin. which do you think would work better for my skin type.

  Answer:  Portrait is much more effective as it heats the skin but it also removes the top layers too. As to which is better, it depends on what you are trying to achieve, if it is just skin discoloration,in your skin type, the IPL is slower but safer and less expensive. JG 2.29.08

• Sorry to bother you again- I just posted the question about the home tca peel 12%. I am a dark skinned hispanic woman and i am worried that these spots will be forever on my face. Is there anything else I can add to my face currently besides the emu oil? God bless you.

  Answer:  Retin-A with hydroquinone, sunblock, avoiding sun, IPL or YAG laser treatments, they should not be permanent but can recurr. JG 2.29.08

• hello dr garcia- i did a tca peel myself 12.5 % tca for 10 min 2x. I experienced very small discomfort last night but this morning, I woke up to blothcy red spots imbedded into my skin. How long before these go away? I am using a ton of emu oil and copper to moisterize. Do you think anything will get rid of these scars or am i stuck with them forever?

  Answer:  could be a week or more, hard to tell. I think that lieklly it will not scar but it is too early to tell. JG 2.28.08

• Hello Dr.Garcia, I am of east Indian origin with brown skin. One year ago had IPL laser treatment done on my face(cheeks) to remove hyper-pigmentation from sun damage. After about 3 weeks both cheeks turned much darker. I used Hydrouinone/Salicylic followed by Hydrouinone/Retina (tri-luma). when I stop using the creams within couple of weeks the patches turn dark again. I have had YAG laser treatment done a small area of the dark patch about 3 months ago. However the YAG treated area appears to little more darker then the IPL teated area. Do you have any suggestions on what else I can try to remove these dark patches caused by IPL laser? Thanks for your advice

  Answer:  well, it will be a series of treaments with either IPL or YAG, avoiding sun exposure, using the Triluma product, nothing fast, and sadly nothing permanent. JG 2.28.08

• I had a full face Portrait PSR Level 3 about 6 months ago with some success in helping with wrinkles except above the mouth. I had another PSR Level 3 about a week ago only on the mouth area again. I have since healed pretty much so with just a little redness still there but it seems to not of helped with the wrinkles in that area again. What other procedures might help with these tough lines above my lip. I don`t want to use alot of wrinkle fillers that make me look like a duck.

  Answer:  migth need a stronger laser like a CO2 laser for the wrinkles. JG 2.28.08

• Hi I am 42 with mild acne scars on cheeks and almost a slight orange peel to texture...i was told discoloration on my upper lip is from birth control. I have an appt with a registered nurse at a plastic surgeons office tomorrow for first fraxel treatment and I am very nervous since I read so many positive and negatives. She states it is brilliant and they have had excellant results. Should I not go through with it? Will my discolorations get darker I am caucasian with fair skin that tans easily.Also is my face going to be a differnt shade when all is said and done? Help I am so nervous and very vain.

  Answer:  I think the risk of deeper pigmentation is relatively small, but not zero, and I think once the swelling is down the improvement for the acne scars will be very small. JG 2.25.08

• Hi Dr. So happy to have stumbled upon this site... After having 3 Fruit sour peels (closest to German translation I can think of) My Dr. said my skin just didn`t react. I had a 15% TCA peel 4 days ago and have begun flaking at certain areas. My neck, however, has just ended up very thin and wrinkled looking. Do I need to give it another day or was the peel just not strong enough? I feel so dry and sloughy and pray I don`t go on my Trip to N.Y.C. looking this way. Has the cream I`ve used been to thick? Should I be using a finer face cream, just to hydrate? Thank you for telling my what my Dr. should of informed me about!!!! Next time I`ll know to ask!

  Answer:  that is just the dry old skin that is coming off, time and a good moisturizer wil help all of that get better soon. JG 2.25.08

• Dear Dr Garcia. Are you a fan of LLLT? What is it effective for?

  Answer:  not a fan, I feel it is effective in removing money from your wallet and you getting nothing in return. JG 2.25.08

• Dr Garcia, I`m considering a series of 5 IPL treatments for redness & broken capillaries of the cheeks. Would the VBeam or Yag produce a better effect given it`s for redness & capillaries? History: 35yr female, Skin type II, prior TCA medium depth peel apprx 10yrs ago. Regards

  Answer:  I think the VBeam or YAG will be more effective, yes. JG 2.24.08

• Hi Dr. Garcia, i love this site!!! I live in San Diego and would be willing to travel to las Vegas to see you. I almost got the fractional laser but you convinced me it would not give me the results I want. The fractional co2 laser would have cost me 2500.00. I have a feeling the co2 laser is about double that. AM I correct? Can you give me an appox. cost for co2 laser for face, and face and neck. Thank you and happy Sunday to you!

  Answer:  a regular non-fractional CO2 laser will certainly give a more dramtic change but will have a longer healing period and there are risks such as reactive hyperpigmentation and also lines of pigment demarcation in severly tanned individuals. The CO2 laser with OR and anesthesia fees runs about $4700. Let us know if we can help out. JG 2.24.08

• Hi, Dr. Garcia, How effective are cold lasers in reducing wrinkles? I`ve seen advertisements for several at different wavelengths like 650nm and 830nm. What`s the difference? Are they worth it? Thanks, Greg

  Answer:  not very I am afraid. Not worth it. JG 2.23.08

• Dr.Garcia, I am fair skinned Irish/English heritage with very sensitive skin. I have hyperpigmentation spots on my forehead, nose, upper cheeks and upper lip from the birth control pill. The hyperpigmentation got a lot worse while I was pregnant. I was told that I need 5 Fraxel treatments to remove the hyperpigmentation on my face. However, after reading the many posts on the web, I don`t think that Fraxel is the best choice for me. True? Also, which is a better choice for me, Rytec Portrait Laser or Yag Laser? I am concernced about my sensitive skin and further brown spots. Thank you in advance.

  Answer:  with your skin, stick with the YAG to the spots and only the spots, best of luck. JG 2.21.08

• Hi, I just posted a question regarding a Vitamin A peel I had 5 weeks ago. I forgot to mention that I am 32 years old- I`m not sure if my age is pertinent or not. Thanks

  Answer:  not really an effect in this particular case. JG 2.21.08

• Hi there, I had a vitamin A peel 5 weeks ago, and the skin around my eyes is now loose, very thin wrinkled and crepey, and looks has some scarring that look like graze scars. Previously the skin around my eyes was fine. I`m worried that is is damaged permanently. I am currently using a copper peptide serum on it to help with the healing. My question is - will the skin around my eyes `thicken` again? Is there a chance I will have my nice skin back? Is there anything else you would suggest to help heal / regrow the skin? Thanks very much

  Answer:  it should improve as long as the peel did not cause any deep burns, which can happen with any peel if not done properly or left on too long. I agree with the copper peptide cream and suggest giving it some more time. Best of luck. JG 2.21.08

• Do you know anything about the ViPeel? I just hear about it, sounds like it`s ok for semi-olive skin? thanks

  Answer:  skip it. JG 2.21.08

• Hi Dr G, regarding PP just wondering what the minimal setting should be to achieve a good result to tighten bunching wrinkles on lower lid when i smile. I thought I read on your site previously that you recommend a setting of no less than 5 to get a decent result? Thank you.

  Answer:  I think the Portrait Plasma will help wrinkles of the fine lines seen at rest, the setting depends on what the patient is willing to accept in terms of downtime, I have used settings of up to 3.0 joules, but the skin will still fold when you smile. JG 2.20.08

• Can a GentleLase treament on your chest/breast cause a breast implant to rupture?

  Answer:  I cannot see how that would happen. JG 2.20.08

• What is the downtime for Rhytec Portrait? Will it tighten skin and reduce fine wrinkles and large pores? How many sessions does it take?

  Answer:  depends on treatment depth, light one is about 4 days and the deeper one about 10-12. It helps the fine lines and it helps the pores some. The nummber of sessions varies from patient to patient, no way to tell. JG 2.20.08

• Dr. Garcia, What do you know about the Artic Peel? Does it help fine lines and texture and is it worth the 4 visits @$1500.00 total. Is there much down time?

  Answer:  not much of anything, not much downtime and not much improvement. JG 2.20.08

• Dr Garcia I am going into have ipl treatments started as a package of 5. MY concern is doesnt IPL have RF. Can you please explain to me if this is safe? I thought I read that RF causes fat loss? What is your take in this? BTW I am looking to elminate dull, blotchy, dry suffering skin. Thank you very much for all your answers! Have a great day!

  Answer:  I do not like the combination IPL with RF, so if yours does not have it, that is a good thing. I think the IPL should help you, best of luck. JG 2.19.08

• Dr. Garcia, I have many blackheads on my skin and have been breaking out tremedously with acne that can take weeks to disappear, I am also very fair skinned with sensitive skin. Do you recommend the usage of the skin culture peel 4000, a chemical home peel, and if not what would you recommend for my skin type?

  Answer:  I think seeing a dermatologist or a plastic surgeon for some IPL and microdermabrasions and Retin-A is where I would start. JG 2.19.08

• Do you recommend laser or injections for spider vein removal?

  Answer:  injections. JG 2.18.08

• Dear Doctor, I have a retinoic acid peel (at 3%) scheduled this week. The doc does it in the evening and the substance is washed off many hours after. In theory I can not put anything over it and only wash my face about 8 hours later. I know I react well to it (no skin inflammation, no signs of having had a peel but definitely an improvement in skin texture) but this time I have to go somewhere right after, and not back home. I would like to use some loose powder over the skin to counteract the facial shine that I naturally tend to have that becomes a bit more evident right after the peel, so I don`t look weird during the reunion I must attend. Does loose powder applied sparingly before the 8 hours mark get absorbed by the skin in a way that would counteract or neutralize the tretinoin application? or am I safe as long as I am not putting a cream and actually rubbing my skin until I wash my face? can I use some loose powder and only that? Will I make the peel not work for that reason? Hugs and Happy Valentines` Day for a Dr that shows so much love for his profession and the wellbeing of his patients and non-patients!

  Answer:  I thiunk it best to postpone it if you cannot follow the docotr`s instructions. JG 2.18.08

• I have very light olive skin and currently do electrolysis. It is too time consuming to do my whole face. Do you not advise laser hair removal? I am considering it.Why or why not? THANKS!!!

  Answer:  probably risky due top its not being permanent and also the risk of skin discolorations. JG 2.18.08

• I am reading on forum which more than a few patients are claiming to have experienced fat loss with IPL? Is this normal? Is it still subjective as to who will repond to various light therapy and who will not? I was under the impression that the facial wasting was happening with RF not IPL type? Is this typical?? Have you seen this happen?

  Answer:  I have never seen nor read about patients losing fat with IL alone if all other casues were eliminated, there are some machines that incorporate IPL and radiofrequncy waves and since fat loss has been called into question for that technology, I think it could happen in those combination machines. JG 2.17.08

• A follow-up question. 40 yr old female with light olive skin, currently using Renova and looking for a way to improve fine wrinkles and even out tone without pigment problems. You discouraged lasers as risky, with Rhytec as my best bet. How about photofacial or chemical peels? Do they present pigmentation risk and are they worth the effort and $? Thanks for your help!!!!!

  Answer:  fotofacials are OK, and chemcial peels, as long as they are light are OK, but the effects of both are for skin disoclorations but the effect on fine lines is little to none. JG 2.17.08

• I am a 40 yr. old female with light olive skin and wanted to do something to help fine wrinkles and even out skin tone. I now use Renova. Is that useful? Any other products useful? And if I wanted to do a laser with low risk of pigement problems, what would you recommend? Also, I want to do laser hair removal. Is this risky? What laser would you use? Thanks!!! Chris Lance

  Answer:  I think Renova is fine but your options are limited due to the olive skin, even if light. I think the laser type machine with the least side effect profile for you and yet effective would be the Rhytec Portrait. I think laser hair removal is risky, yes. JG 2.16.08

• Is there anything that will help eliminate brown spots on the legs? I tried IPL but it did not work. Would a TCA peel work any better? Thanks for all of your help.

  Answer:  YAG or VBeam laser. JG 2.15.08

• HI DOC CAN YOU TELL ME IF THERMAGE IS GOOD FOR THIGHTENING THE SKIN AND MAKE IT LOOK LIKE YOU HAD LIPO. HOW LONG DOES THE EFFECT LAST. IS IT WORTH THE MONEY. MY P/S SAID THEIR IS A NEW AND IMPROVED MACHINE NOW AND THE RESULTS ARE MUCH BETTER THAN BEFORE. THANKS FOR YOUR HELP

  Answer:  I think it is a waste of time and money. JG 2.15.08

• Dear Dr. When beard hair follicles become enlarged after a peel / laser is this raised scarring or depressed scarring around each hair? If it is raised, could something like Mederma help soften the appearance? If it is sunken, could Retin A help? Otherwise, any suggestions?

  Answer:  it is usually temporary and not scarring, just material stuck in the pore, Retin-A might help. JG 2.15.08

• Dear Dre Garcia. Following dermabrasion and revisionss in 1991 I have bumpy skin on my chin and an area of enlarged beard follicles. Would CO2 smooth this? Ta.

  Answer:  possibly,hard for me to tell without seeing you in person. JG 2.15.08

• Thank you so much for your response earlier re: my skin tyte treatments with a dr. I have a relationship with - I will speak to her re: my disappointment so far but what i really want to know is do you believe it works - they use the sciton laser and said you need 3 treatments to see results and i still have one left at $950. Is it worth the investment or should i save my $$. Thank you so much for your honesty, i truly appreciate it and love reading about the all the stories, they are all helpful to someone out there!!! Happy Valentines Day everyone

  Answer:  sorry, but I do not think it works. I would try to get your money back. JG 2.14.08

• I had two YAG Erbium laser treatments three years ago to zap broken blood vessels caused by rosacea. The first treatment went fine and I saw some improvement, but after the second treatment, I had burns, with the skin on one cheek blistering and sloughing off. It left me with some orange peel scarring--not terribly severe, but still enough that I wished I could just have the broken blood vessels back instead. (At least I could cover them with makeup!) I went to a different provider and got Foto Facial treatments to resolve the rest of my rosacea flushing and they worked like a dream, but now I want to do something about the mild scarring from the earlier laser problem. Why did I have this kind of reaction to a procedure my doctor said would require no down time, and what is the safest option to treat the uneven skin?

  Answer:  hard to say why you had the reaction besides just too hot of an energy setting, I think Retin-A or DMAE cream might help some. I suggest staying with the IPL, it is safe and effective. JG 2.14.08

• I am 43 years old and pretty good skin but was convinced to do skin tyte as it would rejuvenate collagen and improve my overall skin tightness. I have had 2 treatments at $950. each and have one more scheduled. I am concerned that i have been taken and given bad advice as i have yet to see any changes. At this point do i finish the 3rd procedure they say is neeeded to achieve best results or save my $$? Also is there any recourse in getting my money back? I do have a relationship with tis Doctor and have trusted her staff in the past - I am sick over this - $3,000 is a lot of money for no results. Of course i educated myself online before and everything is positive. I wish i had found you before. Thank you Beth

  Answer:  I think you need to express to him your dissatisfaction and since you have a good relationship with him, they might see their way to giving you a credit towards something else. JG 2.14.08

• Hi Dr. Garcia, I am a fair skinned 25 yr. old male. In September of last yr., I began a series of 5 beta-lift peels and microderms, spaced 2 weeks apart, through a dermatologist for enlarged pores, blackheads, and oily/acne prone skin. After that my skin texture seemed worse. I began after that a series of virbraderm and laser genesis treatments to address this. I have had 5 laser genesis and vibraderm treatments and I still have an orange peel texture on my nose and cheeks. I have also been on tretinion cream .05% for about a month. Am I on the right track? Should I go for more laser genesis? Any suggestions would be greatly appreciated!

  Answer:  I do not think the lasers will help much, I think it is due to the oil production and it clogging the pores. I think some IPL treatments and some microdermabrasions alternated every three weeks is what I would suggest. Best of luck. JG 2.11.08

• Does the Portrait create any issues with loss of pigmentation? x

  Answer:  none that I have seen that have been permanent, if done on a tan face it will remove the tan though. JG 2.10.08

• Hello Dr. Garcia, Please tell me what your opinion is regarding Candela`s Yag laser. I had 2 about one year ago and my skin looked great. I am fair, (norwegian)44, and my skin is in great condition. However, I am looking for a bit of tightening. Probably not a lot tho. (Have been doing IPL`s 3-4 times a year for about 8 years, and use good products). Thanks! I love this forum!!

  Answer:  thnaks for visiting, I do not think a YAG laser will create much tightening, for that I suggest a Rhytec Portrait for mild improvements with low risk and short healing time and a CO2 laser for more dramatic improvements. JG 2.10.08

• I just have my first Fraxel treatment, it is day 4 and I have had a lot of small white pus bumps come up on my chin, upper lip and forehead with red dots everywhere. It with the Fraxel SR 1500 and they did 8 passes on 8. I have used neosporin and cortisone cream and they seem to spread. Any clue what is going on. My skin looks horrible.

  Answer:  plugged pores called milia from the ointments, they should open on their own or with warm moist towels. JG 2.10.08

• The dermatologist said that it was simply a total clearence of blood vessels/ redness (spot on forehead), do you think the IPL can be used to diffuse the surrounding redness, and make the skin more even, and that spot less noticeable?

  Answer:  the IPL should help with the redness. JG 2.9.08

• how would tanning beds help it repigment if its a loss of blood vessels and not melanocytes? whenever I went out in the sun, I would get a red sunburn but that spot remained a paler color.

  Answer:  I think there is loss of both to some degree and whatever melanocytes remain might be helped. JG 2.9.08

• its already been over a year and im getting very nervous about this lighter/paler footprint caused by the v-beam. Is there any modality that I can use to even the tone/color of the skin so its even. I asked the doctor about v-beaming the entire face, and he said that would be risky because I could end up with white spots all over my face, he said he thinks the blood vessels in that spot were completelyt destroyed and will never come back again, what do you think? is he accurate?, can IPL help even the tone?

  Answer:  might want to try some tanning bed treatments to see if it repigments. JG 2.8.08

• I had a spot lasered with a vbeam laser on my forehead, and it left a lighter,paler footprint than the surrounding skin. The circular footprint doesnt flush or get reddish anymore. It only gets red if I touch it a lot. What can be done about this uneven skin color now? Thank you

  Answer:  in time that should get better but it might take months. JG 2.8.08

• Hi Dr. Garcia - 2 weeks ago, I had a first laser genesis treatment. I had a major break-outs and my dermatologist prescribe me some minocin. Now that my acne is almost gone, it however left me with a major pigmentation scar around the chicks area. My question is that should I go on with my next laser genesis treatment ? or rather stop and use antibiotics ? or go for Portrait Plasma for my scar ? I don`t know what to do anymore, I want to get rite of my acne and my scar at the same time. By the way, I have a south asia skin type and I read on the Internet that Smootbeam or YAG laser may be good for my type of skin. Is that correct ? Thanks

  Answer:  it likley will get better, yes. I would also suggest some hydroquinone. I do not particularly find the Genesis that effective and prefer the Rhytec Portrait or the CO2 laser. There is no laser that will correct both the acne and the scarring. A Blu Light laser might control the acne but will not do anything for the scars and those that are good for the scars will not control the acne. I think with your skin it will be especially difficult so no laser that is too strong can be used for fear of reactivce hperpigmentation on your skin. JG 2.7.08

• Hi Doctor, In your opinion how effective is the Rhytec laser on hands and for slightly crepey skin directly under and in the corner of the eyes? This laser in not used widely in the UK, in fact there is only one doctor in London that I can find who does. Have you heard of Mr David Gault by any chance? Many thanks...

  Answer:  I think it is helpful but to a limited extent as the skin on the hands cannot be treated too aggressivley due to the higher scar potential compared to the face which heals better. I think it works well around the eyes, less than the CO2 laser but with less risk and downtime, I am not familiar with that physician, sorry. JG 2.7.08

• What are your thoughts on IPL. Waste of money or worth it. Thank you for your time.

  Answer:  for pores, brown spots and small red spots it is worth it,low risk too. JG 2.5.08

• I had Yag laser treatment of veins on my forehead about about two months ago. I still have very noticable red lines where I was treated and several dents in my forehead, including one about an inch long and 3 mm wide. The dents are getting more and more prominent over time. My doctor says that the dents are the result of the veins shrinking. For a number of reason I`m very skeptical and am thinking now that perhaps I have had fat loss due to the treatment. The ony thing I know about the treatment is that they used what one technician called a very high setting for the laser. Also, I don`t think the veins were close to the surface since there was no blue appearance to them like other places on my body where veins are near the surface. Is it possible that I have lost facial fat due to this procedure, and is there anything permanent that I can do to fix this? I don`t want to have the dents filled every three months for the rest of my life.

  Answer:  I have not heard of fat loss from YAG lasers and as to filling in the dents, you can try fat injections to see if they will sta longer than the temporary fillers. JG 2.5.08

• Apparently there is a new Fraxel, the repair . Do u know anything about it. thanks Doc

  Answer:  well, all I can say is that the Fraxel company continues to amaze me. With every evolution of their technology it promises to make everything out there obsolete because the new one is so much better and the only thing it makes obsolete is the previous Fraxel machine.I cannot endorse it, sorry. JG 2.4.08

• Hi Dr. Garcia, I had a Portrait Plasma Treatment PSR 2/3 to the lower lid one week ago. The skin is healed, peeling appears to be done and redness is fading nicely. I would like to have the full face done in the future. How long should I wait before repeating the procedure? Also, is there any skin prep (like Obagi) that would make the procedure even more effective? Thanks!

  Answer:  I would wait 4-6 months or so. I have not found any skin prep to make a difference, best of luck. JG 2.4.08

• I had IPL (Vasculight) 8-10 sessions for flushing, redness in scars, etc. It made a marked difference; however, its starting to come back. I responded well to Vasculight (med. olive skin). should i stick to it or is there a better, newer laser out that might do a better job in fewer sessions with the same safety stats? Safety (no burns, hyperpigmentation) is my main concern followed by a laser that can help with redness but also with texture, scars, etc.

  Answer:  I think if you have had goood responses to it, I would continue with the tried and true, stronger lasers might work faster but with greater risk, and no laser or other treatment will likely yield a permanent reduction. JG 2.4.08

• Hi Dr. Garcia, I had a Portrait Plasma treatment to the lower lids on Tuesday morning (PSR2/3). When I got home, I noticed the eyelashes on my right eye (upper and lower) were quite singed with areas of no lashes at all. Will the lashes grow back and how long will it take? Thanks for this wonderful site and your expert advice! Kathleen

  Answer:  yes, they grow back, time varies from patient to patient but it will be a couple of months at times. All the best. JG 1.31.08

• what is mixto fractional resurfacing. would the sciton fractional be an example of that? thx

  Answer:  essentially, yes. JG 1.30.08

• can you please comment on Sciton Fractional laser and possible pigment issues on mildly olive skin. thanks

  Answer:  I am not a fan and feel there is a risk of post inflammatory hyperpigmentation in olive skin. JG 1.30.08

• DMAE cream and peptides: what are they? Any brands I would recognize? Do they work the same as Retin A? Would they fade the FL scars?

  Answer:  they accomplish similar things as the Retin-A does but without irritation, they are sold in many locations, including my shopping cart on this website and but not fade scars or brown spots though. JG 1.29.08

• Just read a recent post about veins and antiaging creams. Does Retin-A make spider veins on your face worse?

  Answer:  yes, it can. JG 1.29.08

• Dr. Garcia, What do you think of Lux1540 laser for shrinking pores. Is this okay for Asian skin? I had blepheoplasty about 10 years ago, but now it looks dark under my eyes. Can you suggest anything that would help? Any kind of skin cream or laser? Thank you.

  Answer:  short term improvement if any at all. I think the energy has to be held down in Asian skin so the degree of improvemtn is not as much. I think IPL is about all I would suggest for you. JG 1.28.08

• Dr. Garcia, You have answered my question regarding treatment for hyperpigmentation on Asian skin. You recommended YAG laser. How soon before the spots go away using YAG laser? Is there a risk of post-inflammatory hyperpigmentation with this treatment? thanks for your response.

  Answer:  I am sorry but there is no way to tell on each individual patient how many treatments it will take, the longer the spots have been there the more difficult it will be to remove them. There is always a risk of post-inflammatory hyperpigmentation, the harsher the treatment the greater the risk, that is why it takes a long time since cannot use high energy settings. JG 1.27.08

• will a micropeel tighten the skin? thanks

  Answer:  very small amount. JG 1.27.08

• Hi again! I have two questions: 1). What do you recommend for age spots on the forearms and legs? They are light to medium brown in color. I have tried over the counter skin lightener and have had very minor improvement 2). I had botox injected to obtain a lateral lift of the brows. Unfortunately it collapsed my eye socket and gave me a sunken in look to my eyes. The botox has worn off as it`s been about 4 months, however, while my eyes are less hollow they have never gone completely back to normal. Have you heard of this happening? It`s a little depressing. Any suggestions?

  Answer:  probably a YAG laser for the spots. I have not head of Botx causing loss of fat that would make the eyes look more hollow though. JG 1.27.08

• Hello Doctor :). If you had to pick one treatment over the other, for the purpose of pore size control and collagen production (try to increase the filling in of a few scars and fine lines), which among these would you choose: low strenght (so to speak) IPL (alone), or series of peels with retinoic acid?

  Answer:  the skin peels, but the difference is small. JG 1.27.08

• Hi Dr Garcia, I have very slight sagging in the jowls and neck area and was considering doing Thermage until I read your Q & A section. I know you do not feel Thermage makes much difference and there is the potential for fat loss(something I cannot risk as my face is naturally thin). Do you have any suggestions on what to try other than a face lift? I was also considering doing Thermage on my thighs to get rid of the creepiness, but now I am not sure. Any thoughts on what to do for this area? FYI, I do not have a lot of wrinkles on my face other than crows feet but I am a little afraid to be cut open to get the lift. Lastly, I have terrible age spots on the top of my forearms and legs, do you think a chemical peel would be the best option or perhaps IPL? Will I get any tightening for the creepiness on my legs with either of these procedures? Thank you kindly for your advice.

  Answer:  I think skin procedures like lases are not going to have significant lifting on the tissues below the skin which is what your problem is, so I am afraad that most skin treatments will not give you enough change to make the expense with it without surgery. I do not think the Thermage will be enough for your face and even less effective on the rest of the body. Best of luck.

• Dr. Garcia, i see u recommend the Q-Switched Nd:YAG laser for pigment spots. i have tried the Alex-laser, the new V-Beam and using it for pigment which u can switch the setting or something on it to treat pigment, fraxels too. nothing has worked. how much better is the Q-Switched Nd:YAG laser and how does it actually work. does it completely destroy the pigment and ur body absorbs it or how? thank you for the info

  Answer:  it works like the other lasers by destroying the pigment cells and allowing your body to absorb the residue, I will be hoenst though, if the others have not worked the YAG might not either but there are not many other choices. JG 1.26.08

• Is there a difference between BBL and IPL?

  Answer:  similar in most ways. JG 1.25.08

• Me again. Could you please offer some suggestions on what questions I should ask the spas to determine which may be better for me, regardless of cost? I have advanced rocasea.

  Answer:  ask them what brand machine they use and what seetings they use for your condition and then get the information from the other place and compare, if they do not give it to you, then go elsewhere, there is no need to withold your information. JG 1.25.08

• I live in an expensive urban area where top dollar is paid for cosmetic and skin procedures. The going rate for IPL is $350 to $425. Suddenly, there is a medspa in town offering it a $150!!! The spa charging more also offers other services such as botox, etc., while the other less expensive one is just lasers. The names of the procedures are similar - Fotofacial v. Photofacial. I can`t see any difference from the websites, they even use the same before and after pictures. Whats going on?! Thanks in advance for your insight!

  Answer:  it is likely the same machine and if the same settings are done you will get the same results. JG 1.25.08

• Dr. Garcia, Which procedure would you recommend for the effective treatment of hyperpigmentaion on Asian skin-IPL photofacial or Q-switched ND:YAG laser? Thanks for the info.

  Answer:  YAG. JG 1.23.08

• Do YAG laser leave white marks or streaks on the skin, or any side effect? And does it work for the red & purple tiny capillaries on face? Is it a 1 time session? Do I go to a dermatologist or plastic surgeon for it? How much do these usually cost? Thank You, Dr. Garcia.

  Answer:  if it removes some recent suntan it is temporary, it should not leave any long term steaks. It does work for tiny purple and blue veins. Both plastic surgeons and dermatologists have those types of lasers. All the best. JG 1.22.08

• I have rosacea and seborrhea dermatitis. I use doxicylin, sulpher washes and occassionally retin A. I have had 5 IPL treatments over the past 15 -18 weeks and I think there has been less redness and fewer postules. The first three were done at a reliable plastic surgery center. There was no numbing and it felt like a slight snap to the skin - not at all uncomfortable. But I felt the results after three session were not significant and the med tech did not think I would get further improvement (some people just don`t she said). Well, her back went out on her, so she couldn`t work anyway and so three weeks later I switched to a medspa which used numbing and more aggressive treatment (power), or so it seemed to me. Maybe the machines were different, I don`t know. But, I finally had noticeable results after the fifth session. The medspa tech believes that I would see further improvement with three more sessions. I don`t know whether to invest more money. Is is possible that the first three treatments were simply ineffective or should I consider my self to have completed the series for the year and schedule a follow-up for next year? I have never seen more than 5 treatments advised for rocasea. Thank you!!!

  Answer:  for your issues it is common to need 6-9 or more in some cases. JG 1.22.08

• hi Dr. Garcia, Is there any possibility or known cancer risk for RF foto facial or IPL? (I realize these are four different questions, thanks so much!) Sincerely, just checking in for health`s sake

  Answer:  none reported, best of luck. JG 1.22.08

• Dear Dr. Garcia, I will be doing a series of microderms for pore tightening and light wrinkles. I also have some broken blood vessels on my face and would like to do the IPL for that. Should that be done after the microderms? Will it also help tighten the skin?

  Answer:  I would do the IPL after the microdermabrasion as that will likely make the broken blood vessels worse, I do not think the amount of skin tightening you will see will be very visible though. JG 1.22.08

• Hi Dr Garcia, I am 32 years old, with generally good, smooth medium to olive skin with just a few fine horizontal lines under my eyes. I had a vitamin A peel 1 week ago and now I have quite crepey areas under my eyes around the orbital bone. There is now lines vertically as well as horizontally. Have you heard of this kind of adverse reaction to vitamin A? If so, do you think there is a chance my skin will return to normal- I appear to have aged 10 years! Thanks very much, Laura (Australia)

  Answer:  it comes from the peel drying the skin in the short term but with time and moisturizers it will be better in the long term. JG 1.22.08

• I had niquid nitrogen done on 16 areas of the top of my hands 6 months ago, I have very dark,purple scars. V-beam laser, lightening cream, steroid cream and massage was done with no change in apperance, do you have any advise? Should I try yag or injections.. I look horrible.

  Answer:  I do not think injections would help but the YAG is worth a try, best of luck. JG 1.19.08

• Are you familiar with the fractional lazer? and would you recommend it?

  Answer:  yes I am and I would not recommned it. JG 1.19.08

• Dr. Garcia, Do you recommend Luxir or Faces for skin tightening of the face? I`m looking for a nonablative procedure. Is there any thing out there that I can do to improve the shadows under my eyes. I had the fat removed 10 years ago when I had my blepheroplasty. Thank you. D.

  Answer:  I do not think that technology out there is worth the money and I do not feel it will do much for the shadows below your eyes. Sorry. JG 1.17.08

• Three years ago I had a series of photofacials. Now I read all these horror stories on the internet about fat loss from these procedures. The doctor who performed it on me said it was safe. Are they finding out now that it does have these side effects? Also, can it happen years and years later? Now I am wondering if the slight sagging I am seeing is from the laser or just normal aging. Thank you--I know you are most likely getting tired of this quetion in its different forms. All of my friends and I did this and now we are so concerned.

  Answer:  the problems have been with the fotofacials that have combined radiofrequency units in them, most do not have that. I think you are safe. JG 1.16.08

• What will happen to my pores after a microlaser peel? I have enlarged pores. I did, however, go to my aethetician yesterday and had extractions before the peel, which is next week. Just wondering what would happen.

  Answer:  they will shrink some for a period of time. JG 1.16.08

• I`m the question below about the microlaser peel. When should I discontinue the use of my retin-a. The Dr. said a few days prior. Do you agree?

  Answer:  2-3 days before and after, yes. JG 1.16.08

• I`m having a microlaser peel next week, my first one, and I know the instructions say to use either Vaseline or Aquaphor while heeling. I hear aquaphor is better because it has healing agents as vaseline doesn`t. Is this true and do you recommend another product. Having that heavy vaseline feel doesn`t sound so great, but I`m sure it`s necessary for healing. One other thing, instructions say to clip fingernails because touching or scratching your face can leave scars. How do you avoid the itching? Can I use a q-tip to soothe over the area? Plus, any other info you can give me would be very appreciative. Thanks in advance.

  Answer:  I like Aquaphor for that, better than vaseline. You will only need it for one to two days at most. I suggest benadryl for the itching. Q-Tips are OK too. All this depends on how deep they go, the deeper they go, the longer it takes to heal, it is a microlaser though so it is relatively superficial. Avoid the sun and you can use Cetaphil to wash your face, gently pat, no rubbing. Best of luck. JG 1.16.08

• Is there any way to reduce overly large neck veins? some type of laser tx?

  Answer:  sorry but there is nothing, JG 1.16.08

• Dr. Garcia, I have scheduled a vBeam session with my doctor to remove broken capilaries on my face. I have very light skin and the broken capilaries are not very bad. After reading your web site and hearing about the sides effects some people have experienced, I am wondering if vbeam is worth the risk. Can you please explain the risks and also tell me the difference between vbeam and VersaPulse green light laser and which has less risks? Can they both be used for broken capilaries do they have the same risks and do they both cause the same amount of bruising. Thank you.

  Answer:  The VersaPulse is a little less downtime but might not be as effective. IPL is the least invasive and should work if they are not too bad, with minimal risks but it might take a series of treatments. JG 1.15.08

• Dr Garcia, In your opinion, would a CO2 peel and getting upper eye lids done(i am 48) be one way of putting off the inevitable face lift? I know you havent seen me, but i am told i look way younger than my age now, thats on a good hair/makeup day. I just have some fine lines and little sun damage, and upper lids could use some work. Jowls are just starting to sag, and neck is a tad loose. Face lifts scare the crap out of me, i have had lots of body work but that i can co ver during recovery, not so with the face. Also, do you know a Dr. Steven Perkins from Indianapolis? Very good facial PS. He is a friend and neighbor. Just curious.

  Answer:  well it will help the fine wrinkles and skin texture and disoclorations but will not fix the sag of the tissues below the skin which change the shape of your face which is what the facelift will fix. I am not familiar with Dr Perkins, sorry. I think for what ails you, it will help some of the issues but nothing dramatic for the neck or the early jowls. All the best. JG 1.14.08

• Hi Dr. G, I`m 50, can pass for 40 (so people tell me, including my dermatologist). My Asian skin is pretty good, with minor blotching, minimum sagging - all to be expected, I suppose. What do you suggest would be a maintenance program for someone like me - including daily skin care routine (products, laser, peels, Portrait, etc.) - other than Botox and fillers as needed?. I use a customized Retin A/hydroquinone prescription cream and, of course, antioxidant and sunscreen. I am looking for healthy skin (one that glows, hopefully :)). I intend to fight every step of the way against aging gracefully , if by that people mean accepting the inevitability of aging skin without a fight. And in this fight, you are a great general ... thank you for your generous donation of time and expertise.

  Answer:  Retin-A and hydroquinone and sunblock, Botox only of pou have hyperactivity of the glabella or crow`s feets. I think if you are going to use the Rhytec it has to be done low level to avoid burning. Best of luck. JG 1.13.08

• Dr. Garcia,What are the risks associated with IPL treatments? Why did you stop offering them?

  Answer:  the risks are of hyperpigmetnation if used too strongly, as to why we stopped, it is becasue the machines started being offered to be used by non-physicians so the time involved for my staff compared to locatiosn where there was no medical supervision was not a good business choice. JG 1.13.08

• Hi, and thanks. Which true lasers do you recommend for small wrinkles?

  Answer:  CO2 laser. JG 1.12.08

• I have been getting syneron fotofacial and foto firm for facial rejuvenation, i.e. to slow down aging. I am 54 years old. My skin has recently experienced unprecedented sagging, hallowness in cheeks etc. Could the fotofacials/firm be causing this? Any other reports of this? What else is out there that does not use radio frequency as part of treatment, good for more youthful appearance? Thanks!

  Answer:  There are reports of radiofrequency machines causing fat loss in the face.I think true lasers without radiofrequency are a help for small wrinkles but not for sagging skin. JG 1.11.08

• Hi Dr. Gracia, What do you think of Obagi. I heard it is pretty rough and ugly in the beginning? Also, can Rhytec portrait REALLY take away wrinkles and tighten the skin? Do multiple lower levels work the same as deeper in the long run? I had a microlaserpeel at 50 microns and it did NOTHING! Thanks!

  Answer:  we use it and after the initial rough tiem it works well. A rhytec can take wrinkles away, but it depends on how strongly it is done. One deep session is better than multiple small ones in most people for wrinkles. It needs to go deeepr than 50 microns to do anything, at least 75. JG 1.11.08

• Dr. Garcia, Thank you very much for your prompt response. Does Thermage work well for the area under the eye to tighten and rid the look of tired eyes? I will not have fat injections in that area. What laser treatment works best to shrink pores and refine the skin? My pores seem to be getting larger. Thank you again. D.

  Answer:  I feel Thermage does not work anywhere. As for the pores, things like Rhytec Portriat or microdermabrasion will help but the effects are very temporary I am afraid because it does not stop the cause which is oil stuck deep in the pore that does not let the pore close. JG 1.11.08

• What is the best laser or treatment for wrinkles under the eye and crows feet? I have more profound crows feet; however I am getting very wrinkled from the AZ weather under my eyes. I always wear sunscreen and sunglasses, but once did not. I am 37 and would have had peels for the last 5 years which has improved my skin but not the wrinkles.

  Answer:  sounds like a light to medium CO2 laser, or a deep Rhytec Portrait, but that is not as strong. JG 1.10.08

• About the green peel. They say it`s equal to having about 5-6 medical grade microdermabrasions at once. A heeling time of about 4 days is necessary. Go in on Monday and go back on Friday to remove any left over peeling.

  Answer:  the 50 micron will be deeper. JG 1.10.08

• Can you tell me the difference between a 50 micron microlaser peel and a green peel. I`m trying to decide between the two. I don`t have a lot of sun damage and very minimal acne scarring and extremely fine lines. Thought one of these would give my skin a more radiant look. What are differences?

  Answer:  I cannot say because I am not sure what depth the green peel goes to. Sorry. JG 1.10.08

• Sorry, I meant to say that that what is localized specifically in the nose area are the blackheads, not the blackheads AND pores. In the nose the pores are larger than life *LOL*, no blackheads elsewhere, yet I have large pores/scarred pores in cheeks and forehead. I forgot to ask, as a filler, what do you think of polimetacrilate (spelling?) for acne scars? My friend so far has only used Restylane but wonders if she could or should try the PMCL.... is it a good idea or should she stay with the `ol temporary but safe Restylane?

  Answer:  I think the chances for lumps with that filler for acne scar is high. I would stay with the tried and true. JG 1.10.08

• With so many laser or laser-like technologies out there, it is hard to know how each works and what they are best for. For large pores and blackheads concentrated and localized only in the nose area, a few depressed acne scars and some minor sun damage (that is, sun damage is not the main concern), which of those technologies is more useful? Aside microdermabrasion, tretinoin, IPL... do any of the following help?: Rhytec Portrait, Fraxel, CO2 ablative...? Which is the principle each type of technology is based on? in other words, why do they work? by stimulating collagen? shutting down sebaceous glands? what? Hugs

  Answer:  I think CO2 and Rhytec are good choices. Nothing will fix the pores permanently and the discoloration will come back in time with sun exposure too. JG 1.10.08

• Dear Doctor. I have had a forhead and upper eye lift, and just recently had an active fx treatmnent. Since the active fx (approx 3 weeks ago) I notice that my eyelids have become very noticeably heavy and it looks like the effects of the forhead and upper eye lid lift has diminished significantly. Could the active fx have caused this? If not this, could it be a temporary effect of the activ fx (and will it wear off?): Thank you for your response. Best regards. MVFK 09 jan 08.

  Answer:  most likely just due to the swelling from the Active Fx. Should all wear off in time. JG 1.9.08

• Dear Dr. Garcia, I am recovering from an aggressive case of PIH following laser treatment (V Beam) a little over a month ago. I have been using hydroquinone and Retin A with a very modest degree of success, though I am still badly hyperpigmented. One large spot in the very center of the discoloration on my cheek has not changed in appearance at all since the initial damage. It`s a deep black-brown in color. A friend who is a vascular surgeon happened to be visiting me a few days ago, and he suggested that it may be trapped blood. He told me it`s likely to stain the skin permanently unless it is dislodged with an injection of novacaine, something he often needs to do after he treats his patients with foam sclerotherapy. My dermatologist had never heard of such an approach. What is your opinion? I`m very concerned that I may be left with this very dark stain for the rest of my life. (By the way, I have extremely fair skin.) Also, in your experience, how long does it typically take for PIH to resolve? And does it usually resolve entirely, or is it common for people to be left with some residual damage after such an episode? Thanks very much for this generous service. I`m so glad to have found you on the web, Dr. Garcia! What a great person you must be. I wish you great success in your practice and your life. M.F.

  Answer:  if it is trapped blood indeed that is a good way to treat it, there is little downside to tyring it. If not better in a few more weeks then it might need a light YAG laser to get it to budge and still continue the Retin-A and hydroquinone. Unfortunately I have seen some PIH become permanent. The worse it is, the greater the likelyhood some might remain. Best of luck and thanks for the kind words. JG 1.9.08

• Have you heard of the Palomar Starlux laser? Is it good for brown spots, collagen rejuevenation? What kind of laser it is basically.

  Answer:  will likely help the brown spots but not provide much visible improvement due to coallgen production. JG 1.5.08

• Hi Dr. G! This is an excellent service that you provide, many thanks!! I have two quick questions. 1) I do my own med. strength TCA peels at home (max. 20%) and have for the past 2 years with much success. I recently became aware of the OTC avail. of EMLA cream. I`ve failed to find sufficient info online and am wondering if it`s safe to pre-treat my skin with EMLA prior to TCA application. One study says it increases the peel depth and retards healing....another says it has no impact. I dont want to accidentally give myself a burn but sure would like to not suffer the TCA pain. Do you know if EMLA prior to TCA is safe? 2) Are you familiar with/have an opinion on the the Dermaroller technology? This is also referred to as medical needling tiny needles prick the skins surface, the shorter ones (about 0.2mm) are used by consumers to allow deeper penetration of topicals while longer ones (up to 2.0mm) by docs to stimulate collagen--sorta same idea as Fraxel. Any thoughts? Pls. also send your reply to my email address eniloracm@hotmail.com ...........Many thanks in advance!! Carolina

  Answer:  I do not think the EMLA will increase the peel depth nor slow the healing, it will just make it slightly more comfortable is all. I think it is safe but it has to be totally removed prior to the application of the acid, otherwise the acid will not penetrate. I think the effects from dermarollers is a waste of time, there is not enough of an injury to help stimulate collagen I am afraid. JG 1.5.08

• Hello, I live in the Netherlands and am thinking of having the Elos Photofirm treatment ( combined diode laser and electrical current)Is it really fantastic for skin tightening?

  Answer:  I am afraid you will be disappointed. JG 1.4.08

• Sorry for my ignorance. What is YAG laser? Is that different from IPL and Genesis?

  Answer:  it is a true laser that focuses on certain colors like brown, red and blue/black, IPL is intense pulsed light, is not a true laser and is not as strong. JG 1.3.08

• Hi Dr., I had sculptra in the undereye area (trough) and the result was a couple of lumps in the areas. My dr. tried to remove them by injecting them with some liquids. The lumps are largely gone but I now have some major bruising/hyperpigmentation in the undereye area that I`ve never had before. Are these bruising or hyperpigmentation or, as someone said, oxidation? Can you suggest what I can do to lighten them? Thank you!

  Answer:  might need to use a laser, it can be staining from the iron in the blood oxidizing, yes. A YAG laser should help some. JG 1.3.08

• Thanks for your response to my Rhytec Q. As an Asian, if the plasma is not a good treatment for hyperpigmentation, what does the plasma treat and what results can I realistically expect? If I went through with it, what level should it be used and how often? So grateful for your time and the service you provide.

  Answer:  it is for fine lines, it will treat hyperpigmentation but I would not use it on Asian skin for that purpose. If you were to do it I think a series of lighter treatments at 1-1.5 would be all. All the best. JG 1.3.08

• Hi Dr. G., First of all, happy new year! I am interested in the Portrait since it is now featured on your website. It is great promo until I read your Q&A and got really confused. If the Portrait is supposed to help with so many conditions, including HYPERPIGMENTATION, why (1) does one of your postings say that you personally do not treat Asian or Black skin with a deep Rhytec but will treat them with the lighter treatments and pretreat them with hydroquinone and (2)another posting says several light Rhytec does not equal a deep one ? So does this mean that as an Asian, I can expect the Rhytec to not really be an option for me?

  Answer:  it is an option, yes, but your expectations have to be tempered and be realistic in terms of the degee of improvement. If you are considering it for treatmttn of hyperpigmentation, it is not a good choice I feel. JG 1.3.08

• I was wondering if you had an opinion about which laser is best for hair removal - ND:yag, Lightsheer diode, Cutera or Aurora? Fair skin, medium to dark hair. Thanks.

  Answer:  I think for that Alexandrite lasers are the best. JG 1.3.08

• Thermage has a new tip out , The ThermaTip STC , promisting better results. I`m wondering if it might be worth a try. I did thermge 5yrs ago with decent results. thank you

  Answer:  I would not waste my time but it is your call. JG 1.3.08

• Dr. Garcia, I am at a point now where I want to try the Q-switched ND:YAG laser for my persistent,dermal hyperpigmentation. What are the risks for someone with Asian skin? I`ve heard that it might cause more pigmentation or burning if not done correctly. I have tried different treatment modalities including 4% HQ, microdermabrasion and glycolic acid peels but none had been successful. thank you for your reply.

  Answer:  the risks are that if it is used at too high of a setting you will get reactive post-inflammatory hyperpigmentation, but in general, that does not happen if monitored closely. I think it is likely safer than a chemical peel though. Best of luck. JG 1.3.08

• Is there any laser technology that will improve skin texture/tighten thin neck skin in someone with slight to moderate skin laxity. I believe Thermage is a waste of time and money, but what about some of the other lasers such as Rhytec Portrait, Pearl, Fraxel, or Affirm? Addtionall, is there any chemical peels that provide some slight tighenting of neck skin?

  Answer:  the neck skin cannot be treated too aggressively with lasers or chemcial peels due to its poor healing and high chance of scarring so I am afraid that there is not much reliable out there in terms of laser/chemicla peel skin tightening for neck. JG 1.2.08

• You had said to use a light CO2 or Rhytec portrait instead of laser genesis. I don`t have that much downtime. I`m willing to go at a slower pace to get the results I would like to have. What do you think of a microlaser peel using 20-50 microns? Fine lines, minimal acne scarring, enlarged pores.

  Answer:  multiple really light applications will not add up to one deeper one I am afraid. JG 12.31.07

• about two weeks ago i had the punch graft done on my pitted acne scars the scars now look like raise bumps. its more raised than i thought it would be will they flatten over time? instead of getting lazer resurfacing will a series of light to medium chemical peel do the same as the lazer? why or why not Thank you so very much

  Answer:  very common for that to happen due to swelling and the healing process, they will go down in time. I do not think a series of chemical peels will ever do what a laser will do I am afriad. JG 12.30.07

• dr garcia. post IPL guy. my blister is black and raised. it been 2 days since Tx. i am applying arnica topical and taking pellets 3 times/day. can i do something else to expedite the injury. can you please advice. need to be in work within 2 days. thanks so much.

  Answer:  I would skip the topical arnica as it is nto a true bruise and put neosporin on it to let it flake off. JG 12.30.07

• You said to use a Rhytec Portrait Plasma or a light CO2 for minimal fine lines and scarring. I`m not familiar with either. What are the down times with these and is the procedure performed? Also, does the skin need to be prepped before doing these treatments? Thanks so much in advance.

  Answer:  a deep Rhytec will have about 10 days downtime and the CO2 laser about 2-2 1/2 weeks. The skin needs to be treated with Retin-A and hydroquinoine for 2-4 weeks before the CO2 only. JG 12.30.07

• Would a series of Cutera`s Genesis potentially stimulate as much collagen as a Pearl laser tx? How many Genesis would be necessary? (I am only asking for comparison of these two, not Portrait, if you can comment.) Thank you...

  Answer:  probabaly, because neither one will do much to stimulate collagen, at least to any extent that will be visible to the naked eye. JG 12.30.07

• Hi Doc... I am looking at getting Sciton Profractional done on my face for scarring. A lot of people have mentioned the main change is with tone and color. I will be treating `patches’ and not the whole face. Does this mean that you will be able to see differences in texture from the treated areas to the non treated areas. I am afraid of demarcation and non-uniform color as my cheeks and under my eyes will be treated more aggressively than my under eye area. Will there be a noticeable difference in skin?

  Answer:  I think getting even skin tones with patch area treatments is not as easy to blend the skin since some skin will not be treated at all. I would treat the entire face, or at least the entire aesthetic unit aea. JG 12.29.07

• hi doc,what are the most common complications or problems caused by rhytec portrait.I was very interested in having it done until the dermatologist sort of steered me away from it and suggested thermage I know your feelings on thermage im just wondering why he would rather use the latter? I didn;t feel I got a straight answer are there certain skin types where rhytec is contraindicated once again thank you for the wonderful service you provde and all the best holiday wishes to you!

  Answer:  well, I think actually there are more reported problems with Thermage, like burns and fat atrophy, than with the Rhytec Portrait, as to side effects from the Rhytec, I would list them as either not enough improvement due to too light a treatment or a burn if the doctor does not do it properly.I pesonally do not treat Asian or Black skin with a deep Rhytec but will treat them with the lighter treatments and pretreat them with hydroquinone. Best of luck for the New Year. JG 12.29.07

• Dr Garcia,post IPL to remove redness for my rosacea, I have a blackish raised blister below my eye. I have tanned skin being a dark type 3 but I think my doc was very agressive with his Tx. I am keeping the area moist by applying arnica gel followed by a moisturizer. How much time can I expect before this goes away.Thanks for your help. Any thing else I can do to expedite the resolution of this blister/scab (I am not sure what to call it)? Can you provide me with the currect name.Thanks.

  Answer:  might take a week or more, I suggest seeing the doctor, might need some hydroquinone cream to prevent any post-inflammatory hyperpigmentation. JG 12.29.07

• I`m looking at getting 4-6 laser genesis treatments. I have my first appt. at the first of year. Noticed you don`t highly recommend this product and don`t use it in your office. What laser do you use for minimal lines, wrinkles and slight acne scarring? Also, what others can you recommend? Also, anything good out there for tightening the jowl area?

  Answer:  I use a Rhytec Portrait Plasma for that scenario. Otherwise a light CO2 is what I would do. As to tightening the jowl, since it is due to the tissues below the skin being loose, it requires surgery, nothing that tightens the skin will significantly and reliably improve the tissues below the skin. JG 12.28.07

• What type of laser works best for deep wrinkles and why?

  Answer:  CO2 becasue it goes deeper on a single pass and because it heats the collagen more than other lasers and that causes the loosened collagen fibers to shrink and tighten, along with forming new collagen. JG 12.27.07

• Hi Dr. I am thinking of a chemical peel or a laser ( I would like skin firming) Which o