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

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• Hello Dr. Garcia - here I am again, seeking your expert advice. I am planning a 25% TCA peel on my whole face which I will be doing myself. My questions are: how long for down time? what results should I expect? How close to the under eye area can I get? Can I apply to the upper lid? Can I apply to the upper lip line? Any other advice I did not address would be appreciated. I have had 2 Obagi peels but was not much impressed. I am 56 y/o, very thin skin. Thank you, it gives me much comfort to know you are just an email away instead of all the physical distance. I am sure you will be rewarded for all your kindness and generosity

  Answer:  well, first of all, I have to say that I do not condone doing it on yourself. Even on the occasions when i have had a chemical peel, I had someone do it for me. That being said, I would suspect the down time to be 4-7 days or so. I would not go too close to the eyelashes because if it gets in your eyes, there will be serious burns. It can be applied to the lip line, yes. I always degrease the skin with acetone, then wipe with alcohol and let it completely dry. I normally have my patients treat for 2-4 weeks with Retin-A 0.1% and 4% hydroquinone twice daily before,and once the skin is healed I start complete sunblock and restart the hydroquinone once tolerated to avoid post-inflammatory hyperpigmentation. Be careful! Thank you for the kind words too. JG 2.1.12

• Hi Dr. Garcia, Is it possible to get hyperpigmentation from v-beam in areas where there was no bruising?

  Answer:  potentially yes, but short lived if it happens and you use sunblock after the treatment. JG 2.1.12

• Hi doc, Iam considering IPL for pores and skin texture. Is there a particular type of ipl i need to ask for to treat this problem? any particular setting on the laser or quality/make of the ipl laser to be sure iam getting the right treatment? thanks

  Answer:  there are no differences between the IPL, as to the setting and filters chosen, they are pretty standard settings issued by the makers of the IPL. Best of luck. JG 1.18.12

• Hi Dr. G, What laser do you recommend for skin - face and body - tightening. Please don`t recommend surgery. I cannot go under the knife and I don`t need that kind of improvement. Thank you for sharing your knowledge and objective input.

  Answer:  as to the face, you could consider lasers such as CO2 lasers or erbium lasers, but for the body, I really do not have anything that is safe and effective, sorry. JG 1.17.12

• Hi Dr Garcia, I religiously use a titanium and zinc oxide sunscreen. I have very faint melasma/hyperpigmentation all over my face. I do not tolerate hydroquinone. Is there a laser (or perhaps IPL) that would be effective for me? I do understand that the results would be temporary and I am ok with repeating the treatment as needed.

  Answer:  IPL might help a small amount but anything stronger you likely will not tolerate if you cannot tolerate the hydroquinone cream. Best of luck. JG 1.15.12

• Hi Dr. Garcia, What do you think about the TNS peel? I know there are two strengths. Also when do you think the restylane fine lines will ever be approved by the FDA? Why the holdup? Thank you!

  Answer:  I think the TNS peels are good and as to the the FDA approval for filler under the eye, I do noy think there will be an application as it is too dependent on the injector and less on the product. JG 1.14.12

• Hi Dr. G, What are your thoughts on Thermage for improving skin tightening. I am not looking for the kind of results one would get from surgery. I have heard in this forum that Thermage used to destroy fat in the face, an unintended side effect. Is Thermage better now?

  Answer:  I think it has been down graded in terms of energy so it hurts less but I am still not convinced you get enough for what you pay for it. JG 1.12.12

• I just had a SkinMedica Rejuvenize Peel last Thursday. Is it OK to use Aquaphor to help with the dryness and peeling or will that impede the sloughing process? Thank you!

  Answer:  yes, certainly OK to do. JG 1.9.12

• What is your opinion of Solta`s new Clear and Brilliant device? My dermatologist is now offering it and claiming it`s stronger than a standard chemical peel, weaker than Fraxel Restore. I`ve never been impressed with Fraxel Restore, so it it`s actually weaker than that, I`m not sure it would do much good. Thanks in advance for your answer.

  Answer:  Don`t expect much, it will do less than Fraxel and if that disappoints, the new one will disappoint more. JG 1.7.12

• Merry Christmas, Dr. Garcia! Would you please tell me the difference between the Dot and the Pearl lasers? Thank you.

  Answer:  well the Pearl is a very light laser that usually treats the entire surface of the skin, whereas the DOT lasers, make millions of small spots and leave the other areas untreated. The DOT lasers will give a better results for fine lines over the Pearl, but the Pearl can work well for recent brown spots. JG 12.23.11

• Gosh, you help us to save a lot of money, Dr. Garcia. Thank you for your answer below about the Pearl vs. the Fraxel. One last question: Might multiple passes with the Pearl improve the outcome because it would inflict more thermal damage? I ask because he charges THOUSANDS less for the Pearl but is willing to do many passes. If the answer is yes, what is the maximum number of passes that can be safely done on Type I skin? (I`m Irish and white, white, white.) Thank you again!

  Answer:  Nope, many passes will not yield enough deep injury to get better results, sorry. JG 12.22.11

• Dear Dr. Garcia, Would you please explain the difference between two lasers to me? My derm uses both Fraxel RePair (the fractionally ablative CO2) and the Pearl (not the Pearl fractional but the simple Pearl handpiece that attaches to the Cutera platform) . Neither of these is particularly powerful, I know, but he claims he likes the simple Pearl better than the Fraxel RePair because, although the Pearl is technically less powerful than the Fraxel, it ablates (very mildly) the entire epidermis, whereas the Fraxel ablates (much more aggressively and deeply) only portions of the epidermis, creating islands of tissue damage that then heal more quickly than the older fully ablative CO2. I`m trying to get the most bang for my buck here. Seems to me that the Fraxel RePair might be the better way to go, since it`s more aggressive; but he`s causing me to pause and think this over. What is your opinion? Have I understood correctly what the Pearl does? Thanks, as ever, for your help. You are a God-send!

  Answer:  your thought process is correct, the Pearl is just easier for the patient to deal with, less improvement, and less hand holding by the doctor. Between those two the Fraxel will give you more tightening, fine line improvement. If you are only concerned about recent brown spots, the Pearl might be fine. All the best. JG 12.22.11

• Hi, Dr. Garcia. I hope you can help me out. I had a small red scar on my earlobe tattooed with a very light micropigment. I am extremely fair and the pigment used was ivory, but it ended up looking yellow on my skin -- like crusty old make-up. So I went to my plastic surgeon`s office to have it removed by laser. The technician used the standard parameters, but the tattoo turned from yellow to bright green, which looks just lovely as you can imagine. She is afraid to try again, since she`s never seen this kind of reaction before. I thought she should try the parameters for the removal of green tattoos now, and she thought that made sense but she`s still afraid to try it. The surgeon at this practice is not as knowledgeable about tattoo removal as the laser technician, who has been doing it every day for more than a decade, so he isn`t sure what to do either. Any suggestions? In the meantime, I`m looking like a Christmas elf with bright green earlobes! Thank you!

  Answer:  I would treat it at the same setting for both red and green colors, I think that will do the trick. What you are seeing is the yellow in the ivory color placed reacting with blueish discoloration, making it look green. Best of luck. JG 12.13.11

• What is your estimate of the Dermaceutic line of peels? I`m particularly interested in their 1) deep peel and 2) depigmenting peel. How do these peels compare to the VI line? Thank you, Dr. Garcia. Have a great weekend!

  Answer:  Pretty similar products. Best of the season to you. JG 12.2.11

• Is there any non-ablative laser that will improve wrinkles and scars?

  Answer:  In my humble personal opinion, there is not. Sorry. JG 12.1.11

• I have some minor wrinkles and an area of red,crepey, wrinkled skin from a scar in my left nasolabial fold from a scar. Because I have no downtime, the dermatologist recommended a series of non-ablative laser treatments with MedLite. Would this help at all? Are there any risks since it doesn`t break the skin? Is this a yag lasaer? Thank you

  Answer:  I think the Medlite will give a very mild to no improvement, sorry. Most Medlite lasers are YAG, yes, but not all. JG 12.1.11

• Hi Dr, I am 43 and have noticed the condition of the skin on my neck is deterioratig rapidly - not much lose skin but very crepey. I have been using Retin A for over a year but there doesnt seem to be much improvement. Do you know if Pixel or CO2 would be effective for this area? Thank you

  Answer:  I think they have to be done very weekly for fear of scarring, so although it can be done, don`t expect much improvement past when the swelling goes down. JG 11.15.11

• Hi Dr. G. I am 60 years old and have sun damage & sometime between my eye brows my skin is red & peel but does not bleed. Skin Looks raw then heel over then peels again. Could this be a Actinic keratosis.I have had 1 IPL treatment on my face 2 weeks ago and it did not improve the red skin area between my eye brows & did not remove any sun damage.My doctor is recommending Alexandrite laser because he has used alexandrite on my face before on age sun spots. What do you recommend for red skin area, could possibly be Actinic keratosis. What treatment and/or laser do you recommend

  Answer:  certainly sounds like an AK or something similar. I think a VBeam laser or an ND:YAG would be my preference, Alexandrite is good for brown but not as good for red. JG 11.11.11

• Hi Dr. Garcia, I had IPL done & it took off facial hair.Will the facial hair grow back? If so, will it grow back thicker? What is the best way to get rid of facial hair? Thanks for your time

  Answer:  yes, IPL is not effective in hair removal, it might take time but ti will grow back. It will grow back the same without any changes. JG 11.10.11

• Hi Dr.G. I had one IPL treatment on my face 2 weeks ago this Friday. I noticed some red blotches on my face that were not there before the IPL treatment. Are these red blotches burns from the laser?? What causes these blotches & how can they be fixed ? Will they fade away? If so, how long will it take? I am suppose to have more IPL treatments? What would you recommend?

  Answer:  the red more likely is from some superficial skin damage removal from the IPL. They will fade over time, but I would not repeat the IPL until they have gone away. It might take 3-4 weeks in some people. JG 11.9.11

• Hi Dr. G. I am 61 years old & my skin is very thin on my face. For sometime now, I noticed near my eye brows & between my eyebrows, I have reddish flat spots that look like I am missing skin/like a scrap.I have to be real carefully when I am wiping my face dry because some of these reddish flat spots do peel. When the skin peels off, it looks more red. Do you have any idea what these reddish areas/spots could be. They look like age spots/discoloration but reddish. Is there any treatment to get rid of them. Any laser could fix them?

  Answer:  I think a laser in soemone like yourself with thin skin could make things worse. I might suggest a trial of low dose Retin-A to see if it can thicken you skin a bit, it is something that happens to people with thin skin as they age though. JG 11.9.11

• Hi Dr. Garcia, I recently had a IPL treatment to get rid of brown spot/sun damage on my face. After the treatment, my face was a little red & my cheeks were swollen.However, nothing flaked off my face & I still have my brown spots. I am not going to do another IPL treatment. My doctor is recommending using a laser called Alexandrite to get rid of brown spots on my face. Do you think that this a good laser for brown spots on face? What laser would you recommend to use to remove brown spots on face?? What are the side effects of the Alexandrite laser. Thank you for responding to my question.

  Answer:  We use an Nd:YAG laser, it usually takes a series of sessions, and in time, it will come back, sorry. JG 11.8.11

• I was in the middle of getting a tattoo removed and then I got pregnant, so I stopped the process. I am currently breastfeeding and I was told that I cannot continue the process until 6 weeks after I stop nursing. Why can`t you get a tattoo removed while nursing? and why do you have to wait until 6 weeks after you stop nursing to remove the tattoo?

  Answer:  Well, the safety of it has never been studied, so the docyyor is just being safe. It is not a bad idea to wait. JG 11.8.11

• What is your opinion of the smartxide dot laser? Is this basically fractional CO2? Does it require more than one treatment for resurfacing/wrinkles? Is it more like a chemical peel? Thank-you.

  Answer:  it is basically a fractional laser,yes. It can be done deeply or light, so if desired, it can be like a chemical peel. Whether you need more than one session depends on how much energy is used. JG 11.7.11

• I have recently been exploring how to eradicate the upper lipstick lines above and below the lips. They just popped up and I am not a smoker. Most derms perfer to use juvederm for an automatic fix. I am more interested in long term. Do you feel a chemical peel is best? I have also considered the dekalaser which is a smartxide.dot laser. what is your opinon of this laser? Thanks for your time and thoughts.

  Answer:  Unfortunately there is no real long term fix. I think chemical peels only help as long as the skin is swollen, and laser will give you at most 8 months, if done deeply with some couple of months of redness as downtime.If done lightly to decrease downtime, you are looking at 3-6 months.Best of luck. JG 11.7.11

• please can you tell me if iwas to have smarxide lazer done on the manual setting is no more than a tca peel. i was told by dr he would do it on 17 and smaller dot pattern as states in the manual ,would this give any improvment at all or should i look into a tca peel for my wrinkes ,no sun damage .i have light skinand eyes skin 1/2 type) i do not want to waste my money if its ot going tobe done on a setting that will just give a peel. Another dr said he wold do under sedation and be aggressive but this sounded too much . price are from £499 to £1000 and £2500 with sedation seems alot when they are preforming the same treatment. also if i do go for this co2 when can i start using chemical peels and what would you recommend for keeping the skin looking refeshed

  Answer:  I think the light one will be very close to a peel. Sorry. JG 11.7.11

• I`ve had flat warts on my caucasian face and nose for a long time, but they were spreading on the tip of my nose, small, but starting to be noticeable now, creams didn`t work, so I just recently tried V Beam laser targeting potential blood vessels from a Derm. nurse at my health care provider. She was far sighted, and had a hard time seeing them. She hit same spot on tip of nose twice, and it seems to have left a burn mark on the tip of my nose. Are lasers supposed to hit same spot twice? What are results typically for skin on very tip of nose being hit twice with V beam yag laser? It looks horrible, won`t cover up. Mild indent too. Will skin on tip of nose heal well typically from just a severe? burn. I`m worried about atrophy? Has that ever happened that you have heard of? Micheal Jackson? How do you think it should heal, what damage can it do to normal skin prone to warts? She somehow missed the actual warts too.

  Answer:  lasers can be used on the same spot more than on,e yes, but I will clearly say that a VBeam laser will never do anything for a wart. It needs to be an ablative laser, not a color sensitive laser. I think your spot will heal on its own in time and fill in, but the higher the energy setting that was used, the longer it will take to fill in. It will heal like amid level skin burn and leave little to minimal scarring as the nose heals quite well. I think you need to find a new place to go for any further treatments too. All the best. JG 10.24.11

• Hello again Dr. Garcia. I`ve had several successful IPL sessions for rosacea, but the last two times the treatment caused the formation of several milia. So then I had to make another appointment to get those removed. Is this a known side effect? Do I need to stop the IPL?

  Answer:  Yes, the more severe the Rosacea is, the greater the likleihood of bringing deep plugged pores to the surface. I would continue the IPL to control the Rosacea. JG 10.23.11

• What is the best method to diminish a facial scar where the skin is discolored and wrinkled? Area is about one inch long and one centimeter wide

  Answer:  if it i red, I suggest a YAG laser. If it is mostly a wrinkle thing, than a CO2 laser. JG 10.18.11

• I had pearl cutera fractional and was told I did need to have corneal sheillds,when I asked why they were not used I was told the eyes were not done but seven months later I found myself on you tube having this treatment done and my googles were pulled down to use the laser on the eyes..what I would like to know is can this type of laser ever be lowered enough to use on the eyes without corneal shields ..thank you

  Answer:  I would never do it without a shield due to the potential risk of a corneal or eye globe burn in the possibility you flinch while having it done. JG 10.13.11

• Hi Dr. Garcia, I`d like to know what laser treatment (if any) you recommend for age spot removal. What used to look like cute freckles are no longer cute. As always, Thanks for your advice.

  Answer:  we use a Q-switched Nd:YAG laser, it will need to be a series and with time and sun exposure they will come back, so sunblock from now on. JG 10.9.11

• Can a Active FX laser be set to be strong as original C02 laser for laser resurfacing?

  Answer:  not in my experience because it will not treat as large amount of the surface area. JG 9.28.11

• Dr. Garcia, I know you recommend C02 as the gold standard for reducing wrinkles. However are there any other type of lasers, peels, plasma, you recommend and use with your patients that achieves similar or the next best results?

  Answer:  Second choice would be a Lumemis UltraPulse with high density or a Portrait Plasma. JG 9.27.11

• Thanks for the answer about the pigment. Which laser do I need instead of IPL? If I have a totally ablative CO2, since that removed the entire epidermis where the pigment lives, will that take care of the problem?

  Answer:  I would use a Q switched Nd:YAG laser. Much safer and color specific. JG 9.25.11

• Hi, Dr. Garcia. With IPL for removal of pigment, I often get a very little bit of scabbing that flakes off in 2 weeks, which I know is the goal; but despite using the most aggressive settings for my skin type (Type I), the rest of the pigment never seems to scab and flake. My question: If it doesn`t scab and flake, is it not working? That is, is IPL effective for pigment ONLY when it scabs and flakes or is it beneficial whether or not it elicits that visual response? If the former is the case, what else do you recommend? (I already use hydroquinone and Retin A.) Thank you!

  Answer:  You need a true laser to get more effect as your pigment is deeper, there should be flaking when treating the pigment . JG 9.25.11

• hi doctor garcia, i need some advice about the non ablative lasers. i have open pores, pigment, oily skin and high sebum production. i have heard about medlite c6 Qswitch laser and the cooltouch, iam not sure which one to go for i want the one with the strongest affects that will really rejuvenate my skin. iam 37, which one do you recomend i should go for? also do you need more than 1 treatment to see results? your opinion will be most apreciated.

  Answer:  I think the Medlite will help with the spots, but the sebum production and the pores, those two being related as to their cause and effect, will have little to no benefit from a laser. Controlling the sebum with Retin-A or Accutane is likely the only thing that will help decrease the sebum and then secondarily the pores. All the best.JG 9.19.11

• Is a Co2 laser for wrinkles a waste of money?? Also I would just need it for under my eyes. The Plastic surgeons office told me (by phone - have not had a consult yet)that they usually don`t do the co2 laser just under the eyes - the doc would perfer to do the entire face so I won;t have an uneven skin tone afterwards. Is this true??

  Answer:  I do prefer the entire face for color issues and I think at best the CO2 laser around the eyes will give 18 months of improvement as one cannot go very deep due to the thinness of the skin. JG 9.18.11

• hello Dr. Garcia, I bought 6 microdermabrasions & 5 IPL treatments... I was wondering which type of treatment should I do first? or should I alternate them every other week or how would you recommend I use these procedures to get the best outcome? Thank you

  Answer:  alternate them every other week. JG 9.14.11

• Oh, I also meant to ask this about the VBeam and wrinkles: 1) The wrinkles can`t be due to the swelling, right? I thought swelling masques wrinkles but doesn`t generate them. 2) Is extensive wrinkling/rippling the typical response to VBeam or am I experiencing an uncommon side effect? Sorry for all the questions, but I`m baffled. My doc should have told me about this! Good night. And thank you again.

  Answer:  no, not due to the swelling.It is an uncommon effect, might be due to a large area being treated rather than a small spot. All the best.JG 9.14.11

• 1 week ago, I had my legs treated with a laser (my dermatologist said it was a pulsed dye laser? does that sound right?) for visible capillaries. My legs are now covered in dark red marks, which I know means that it did something. How long do these marks usually last? And I know that if the capillaries disappear, it will only be temporary and they will come back. How long does it usually take before they come back? Thank you for your help.

  Answer:  could be 6 weeks in seem cases. Legs take longer to fade than the face. As to coming back, figure 6-18 months, every one is different. All the best. JG 9.11.11

• THANK YOU for the reassurance about the wrinkle post-VBeam! You calmed me down instantly. Just curious: what actually causes this? I look like I`m 70 years old!

  Answer:  It can dry the superficial epidermis and it falls off, leaving fresher skin , the more brown and red spots on the skin, the more it happens. JG 9.11.11

• Dear Dr. Garcia, I had VBeam yesterday for persistent erythema, and today I woke up with my face absolutely covered in wrinkles! I`m only 32 and have never had wrinkles before. Please tell me that this is a passing side effect of the treatment. Of course, I can`t call my dermatologist until Monday for an explanation. Thank you for being there for so many of panicking patients!

  Answer:  it is a passing effect and will go away in a few days. All the best. JG 9.10.11

• Woops! Look like I just wasted a good chunk of hard-earned money. I just saw your answer to the person asking about Fraxel Restore. I had it on Thursday and now am covered in tiny red dots. It looks like pin-point bleeding, but it`s not breaking the skin. Normal? How long should it last? What a bummer that this technology won`t do anything beneficial! Thanks for letting us know.

  Answer:  normal, might last 7-14 days. All the best. JG 9.10.11

• I know you have not been a big fan of Fraxel ReStore, but I wonder if you are more impressed with it in the past year with the development of the duo. If you think it`s not particularly useful for improving the skin, is it at least useful as a maintenance strategy to slow the skin`s deterioration with age? In general, does it at least contribute to keeping the skin clinically healthy and fresher in appearance? Thank you, Dr. Garcia. Have a great weekend!

  Answer:  Maybe for maintain, at best. JG 9.10.11

• 3 years ago I had portrait plasma above my lips to reduce wrinkles. I developed large scabs which took a considerable time to heal. I now have very pale skin in the areas treated. Is there anything that can be done to correct this and restore my pigment?

  Answer:  I am sorry but there is nothing reliable that I can recommend. JG 9.5.11

• Hi Dr. Garcia, Just wondering about your opinion on the FDA cleared Palovia home laser for use around the eyes? Does it produce any proven results or is it more cost effective to have another type of laser at an MD office for crows feet and lines around the eyes? Thanks!

  Answer:  I think you would be better off spending that money at a doctor`s office more a more effective technology. JG 9.2.11

• Dr. Garcia, I am scheduled for my second dot fractional --had first one over a year ago. Since then I read somewhere that a plastic surgeon said he could always tell women who had laser treatment because their skin lost elasticity. As a surgeon, have you ever observed that? Seems to me that women who have laser treatments would have less elastic skin to begin with or they wouldn`t be having laser treatments for wrinkles. Are two fractional treatments in a year too much? Many thanks.

  Answer:  It will not make you lose the elasticity, its OK to proceed, best of luck. JG 8.30.11

• I posted a question a while back. Im the fair skinned surfer who was having problems with hyperpigmentation/rosacea. I have been out of the sun for almost a year now and have been getting IPL treatments. I have seen some great results. Brown is completely gone, still have redness though. I have some events coming up and I am pale as a ghost. Why is it so important to not use sunless tanners after an IPL treatment? Is it due to the fact that it can irritate the sensitive skin? When is it safe to use the sunless tanner? By any chance do you know of any good gentle tanners for Rosacea skin? Thanks!

  Answer:  sun exposure will worsen the red spots and make the brown spots return. I think a self tanner is K 48 hours after the IPL. I think the self tanners are a trial and error product as different people do better with one over another. Best of luck and glad the IPL has helped. JG 8.26.11

• Is the Limelight IPL superior over the regular IPL for removing age spots? (I am asian) Is retin a superior over IPL for removing age spots? Is retin a mirco superior over retin a for removing age spots? Thank-you!

  Answer:  the limelite is still an IPL, no difference if similar filters are used. I think Retin-A is less risky for the spots in Asian skin versus an IPL. I do not think there is a considerable difference between the Retin-A. All the best. JG 8.24.11

• does IPL help with removing reddish brown spots on my cheeks? I think they are left over from acne many, many years ago. What is the approximate downtime? Thanks as always...

  Answer:  downtime should not be more than a day or two, but the longer the spots have been there, the harder they are to remove, it will certainly take a series of sessions to improve them, might not totally eliminate them too. JG 8.19.11

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