Question:

Thanks, the energy level (mJ) was 30, treatment level was 5, with 8 passes. Actual kJ was .82 whatever that means. What do you think?

Answer:

8 passes I think was the culprit. JG 1.14.13

Question:

I know you`re not a fraxel expert, but I can`t seem to get a honest answer from the doctors who use this laser. I had one fraxel restore about a year and a half ago around my mouth. Since then I`ve developed some scarring and crepy skin where I used to have a lot of acne but no scars.Is this scar tissue? My skin also became very dry in this area and I wondered if the oil glands were also affected. I`m 58. Any hope for inprovement in time?Thanks for being here....

Answer:

it can be scarring if the Fraxel was set at too high an energy or areas were overlapped.The oil glands are usually not affect with a Fraxel as they reside much deeper than the energy of the laser is delivered. I am sorry to say that if it has been 18 months there is not much chance it will get better and you will need to use good moisturizers in that area. I wish you the best. JG 1.14.14

Question:

Hi Dr. Garcia, What do you think of Ultherapy for the neck? I was wondering if it might help define the jawline a bit until I`m ready for a surgical procedure? Thank you for taking the time to answer my question.

Answer:

I am not a fan or believer in the claims. It might define the jawline by killing off some of the fat cells, but it will not tighten skin to any degree if it does not accomplish that. If it does kill some fat, there is truly no skin tightening but only skin redraping so it appears tighter because the skin actually has to cover a larger area. If there is no fat there for you to lose, I believe the change in skin will be minimal to none. JG 1.13.14

Question:

question from my mother: she had facelift 6 yrs ago.. since then sculptura to they eyes about once a year to fill up the hollows. She went in for the creping look that she was getting under her left eye which also demonstrates a bag. The doctor (same one who did original facelift) said she would do best for an allover face Lumina laser for really the eye she states which is her major complaint, but says he thinks it will help her face all over ...14 day recovering...and gen. anesthesia. hes quoting her like 4k with anesthesia. He told her she does not need facelift.or a mini. How do you feel about Lumina and the price hes charging? She is 69 and looks wonderful. thank you

Answer:

' '

Question:

question from my mother: she had facelift 6 yrs ago.. since then sculptura to they eyes about once a year to fill up the hollows. She went in for the creping look that she was getting under her left eye which also demonstrates a bag. The doctor (same one who did original facelift) said she would do best for an allover face Lumina laser for really the eye she states which is her major complaint, but says he thinks it will help her face all over ...14 day recovering...and gen. anesthesia. hes quoting her like 4k with anesthesia. He told her she does not need facelift.or a mini. How do you feel about Lumina and the price hes charging? She is 69 and looks wonderful. thank you

Answer:

fair price but i think the wrinkles around the eyes will only look better for 12-18 months as they cannot use a high setting on the laser on that thin skin. The rest of the face will yield longer results. JG 1.12.14

Question:

What is your opinion of the melanage peel? Is it effective and safe?

Answer:

I cannot say as I have never seen a patient who had one, sorry. JG 12.26.13

Question:

I am a religious retin-a user. I am going to have a series of light PCA chemical peels. How long before and after the peels do I need to cease use of retin-a?

Answer:

2-3 days off before and after. All the best. JG 12.20.13

Question:

I am the gal with Melasma who asked the question about PCA peel treatments vs Melasma. You recommend laser as being faster, about how many sessions would it take? Do you have any recommendation for the Phoenix metro area?

Answer:

I would use a Nd:AYG laser but I am not sure who has one in Phoenix, might have to look at their websites to see rather than calling, look for dermatologists or plastic surgeons though, they are usually the ones with that type of laser. JG 12.19.13

Question:

If my mild melasma has been present on my face for a few years now, is it likely to respond to a series of PCA peels? Or is it best to just skip the peels and do laser treatments?

Answer:

lasers will be faster. JG 12.19.13

Question:

I t looks like you`re not a big fan of peels. Is that right? In reading your posts, the theme seems to be that the results are extremely short-lived and any visible benefit is due to temporary swelling. That said, do you think they are harmful? My dermatologist is recommending a series of 25% TCA peels to my hands. Would you say that this is safe? And if safe, just a waste of money in your opinion? Thank you!

Answer:

I am a big fan of peels for spots. The only peel I think will help wrinkles though is either a phenol peel or a croton oil peel, neither one done by most docs anymore. I do to think the 25% will do much negative except flatten your wallet to the dermatologist`s benefit, He should know it is a waste of time, especially on the hands at that strength, if it is being done for wrinkles. If it is spots, then I would suggest a YAG laser for them, much more effective. I wish you the best. JG 12.4.13

Question:

Three weeks ago I had a VBeam treatment for diffuse redness on my chest, neck and cheeks. Predictably, I was bit pink and swollen immediately after but then everything settled down. Today, I awoke absolutely covered in flat, dark red marks! I called my dermatologist`s office and all they would say was that this is normal but they didn`t tell me why this occurred. What happened? And how long will it last? Does it mean that the treatment was unsuccessful? Or that it was particularly effective because it caused some damage that needed to be inflicted? I really appreciate this service you offer, Dr. Garcia.

Answer:

It is normal and expected, it is a good thing in the long term, might take 1-2 wweks tor it to resolve though. JG 12.2.13

Question:

Thanks for your answer about the aggressive glycolic peel. I`m taking the antihistamine, using cool baking soda gauze soaks, and topical hydrocortisone. To my great dismay, I am even redder, bumpier, and more blotchy today than yesterday, but I am sure you are correct; this is likely temporary. That said, is there any chance that I might experience some positive benefit -- maybe even more than I would have with a normal strength glycolic peel-- once this all settles down? Probably not but I`m looking for a little consolation! What an idiot I am for falling for this sale! I guess I got what I deserved. Thanks, Dr. Garcia.

Answer:

I do not think the hydrocortisone will do any good and might slow down the healing as you are not having an allergic reaction which is the only thing the hydrocortisone would help with. I think there will be a short lived benefit from the additional downtime, but don`t expect more than 6-8 weeks at best.Sorry. JG 12.1.13

Question:

My dermatologist`s office is running a Thanksgiving weekend series of sales to boost their income...and, I think, to train new aestheticians. I took advantage of one of the sales today and had a glycolic peel by an aesthetician I`ve never met before. I am an itchy, bright red mess tonight. Is this normal? I don`t think so. I`m using OTC hydrocortisone to handle the pruritis, but it`s not working very well. Can you suggest anything else? How long will this likely take to heal? Thank you. I hope you had a great Thanksgiving! Personally, I feel like a turkey for having been so stupid to buy this service on sale!

Answer:

that should not typically happen, they might have used too strong of a concentration, I think in a few days it will look much better as it is difficult for that type of chemical peel to cause permanent damage, but you might want to find a new dermatologist.You can try some benadryl orally, OTC, 50mg every 6 hours or so for the itching. How long it will last will depend entirely on what concentration they used of the chemical, might be 4-7 days in some cases. I wish you the best. JG 11.30.13

Question:

I wrote to you last month about cryotherapy to AK`s on my hands and forearms. The burns seem to have healed now but have left scars and shiny oval marks -- almost like the liquid nitrogen simply made the AK`s more visible. They look 100% worse than they did before tx. My dermatologist (who did the cryotherapy) tells me that the Fraxel Duo Restore is FDA certified for AK tx and is now recommending that we try that next week. What do you think? Thanks for your opinion, Dr. Garcia.

Answer:

I prefer to hyfercate them lightly or use Efudex cream, more controlled and little to no scarring. JG 11.17.13

Question:

What kind of laser is used for mild melasma/hyperpigmentation of the face?

Answer:

My preference is an Nd:YAG Q-switched laser. JG 11.17.13

Question:

PS on the vessels: I`m guessing that some of my wild reaction is a histamine response. Might anti-histamines help? Thanks so much.

Answer:

it does help in some case, no down side to trying them. JG 11.12.13

Question:

I had some visible vessels on my cheeks treated on Saturday with the Nd YAG. My face is BRIGHT red, extremely rippled (why is that?! what happened there?!), and incredibly swollen. have been icing, drinking lots of water and avoiding sodium, which I do anyway, but it doesn`t seem to be getting any better. I`m such a sight that I don`t think I can go to work tomorrow. I`ve had vessels treated before but never had a reaction like this. Had I known I was going to look like this, I would have scheduled the treatment at the beginning of a vacation. Based on your vast experience, how long do you think this reaction will last? By the way, I am of Scandinavian descent -- paler than the snow. Except now. I`m redder than Santa Claus`s suit. And my face looks like Tip O`Neill!! Ha!

Answer:

it all depends on the energy settings chosen, to strong and things like this can happen but it will get better and in many cases the more severe the reaction the more effective the improvement there is. Hard to say how long it will take to get better without energy setting and head size but it should be lots better in 5 days or so. Give it some time and hang in there, it will get better soon. JG 11.12.13

Question:

Hey dr Garcia, a family member is planning on investing on the vectus diode machine. How much do you trust the results from this machine? Would you prefer another one over this?

Answer:

a reasonable choice. JG 11.11.13

Question:

Dr., Is there any laser out there that will help with skin tightening for the body? Thank you.

Answer:

lots that claim to do so but none that I believe truly work. JG 11.4.13

Question:

Hi Dr. G. I was wondering if you have changed your mind about Fraxel? Since it will take about a week to recover from the redness, etc. and requires a serie of 3 treatments, I am wondering if it is work doing. I have Asian skin and some pigmentation that has improved from using the Strivectin Vitamin C. Thank you as always.

Answer:

I am sorry but I have not changed my mind, and especially not for Asian skin.I would not have it done. JG 11.4.13

Question:

Good morning, Dr. Garcia! I had a V Beam treatment under my eyes last Thursday to reduce generalized redness. It`s now Tuesday and the skin beneath my eyes is redder than ever -- almost tomato red! What happened? Is this normal? I was trying to ameliorate the erythema, not exacerbate it! Thanks for your help.

Answer:

it looks worse before it gets better, give it a few more days. Hang in there for a bit more. JG 10.29.13

Question:

What do you think of the derma pen for the horizontal neck bands, could it give some improvement and if not what do you suggest non surgically?

Answer:

I do not think the Dermapen is worth it and there is really not much that can be done for the horizontal lines on the neck, the lasers and chemical peels cannot be done strongly enough to make a difference, sorry. JG 10.21.13

Question:

It looks like you`re not a believer in Fraxel Restore. I had a treatment on Wednesday and my face is pretty swollen, especially under my eyes. I know enough to sleep with my head elevated and to use ice. I`m just wondering if the ice will help much after 48 hours. Thank you.

Answer:

Ice, elevation, avoid salt and time, all will be less swolllen in time. JG 10.18.13

Question:

hey dr garcia, i got the tca peel done on my lower back. it frosted and then immediately turned very dark. its been 8 days now and its stiff dark and rough. is it normal that it hasnt started peeling yet? its very dark and gross looking. please tell me what to expect

Answer:

Give it time, it will peel in a bit. JG 10.17.13

Question:

told me to leave it without applying anything but i just bought the lotion u suggested and about to apply it.

Answer:

OK. JG 10.10.13

Question:

hey dr garcia, tca girl again. so will i still peel if i keep it moisturized? i was told to keep it dry and not apply anytthing so it peels. plz advice

Answer:

The Aquaphor does not stop any peeling, the peeling skin sticks to the cream. What did the person who did the peel tell you to do? JG 10.9.13

Question:

Good morning Dr. Garcia, I have several spots of hyperpigmentation on my cheek and temple area. Would I get better results from a spot TCA peel or IPL facial? Have a great day!

Answer:

TCA spot, best of luck. JG 10.9.13

Question:

You recommend a TCA peel to remove the spots on my lower legs following Fraxel Restore. My dermatologist uses Skin Medica Peels. Does their Rejuvenize Peel (the strongest in their line) contain TCA? If not, should it work anyway. Thank you so much for your help, Dr. Garcia.

Answer:

Sorry, likely not strong enough, no TCA. JG 9.29.13

Question:

the new model that uses laser plus IPL.

Answer:

IPL adds absolutely nothing to the hair removal. JG 9.28.13

Question:

I`m 58 and getting lots of brownish shiny flat spots on my arms. Does anything help with these? Products,lasers?? Thank you.

Answer:

Hydroxy acid cleansers and erbium lasers. JG 9.26.13

Question:

What are your views on demapen? Will it help soften lines and dark circles under eyes?

Answer:

not a believer and do not think it will do anything for the dark circles or the fine lines. JG 9.23.13

Question:

Dr. Garcia, I have had 4 dot lasers in the last five years on the upper lip area. Finally caught on that this doesn`t work. A friend of mine had a deep sciton contour laser treatment and it worked on her lines--they were fine lines. Mine are deeper. The surgeon said he could do it on my perioral area only, but said it would be around four months before the color would be normal. After seeing her recovery, I can`t imagine co2 would be any harder. She was a bloody mess for several days and red for two months. Also, the surgeon said there wasn`t much danger of pigmentation changes, but I can`t believe this totally. Since I have had the dot four times, am I more susceptible to pigment changes? Also, do you still think the co2 will get better results? My dermatologist says there will be a white lip. Thanks so much for your time. Is the sciton an erbium laser?

Answer:

I do not think you are more susceptible to pigment changes, but it is always a risk when treating segments of the face rather than the entire face.I still do think the CO2 laser is the Gold Standard but I prefer to treat the entire face to avoid the lines of demarcation. Sciton is an erbium.JG 9.22.13

Question:

I purchased an OTC glycolic peel. It didn`t come with an acid neutralizer. What chemical is typically used to neutralize glycolic acid? I don`t want to wash it off simply with water -- even if it is a low concentration of acid -- for fear I won`t remove it all and it will give me a deeper peel than is safe to do at home. Thank you for your help.

Answer:

There is no need fir neutralization, just tap water splashed copiously then dried. JG 9.16.13

Question:

I had a VI Peel last Friday, and as of today, I have 7 huge cystic pimples on my cheeks that weren`t there at the time of the peel. I haven`t had acne in 25 years. What happened? I thought that this peel is used to treat acne, not to cause it, in those who suffer from that condition. I was doing it simply to refresh my complexion. Now, at 45, I look like a teenager struggling with blemishes. Did the peel simply bring to the surface some of the clogging in the pores that already existed or did it cause the pores to become clogged? Thank you, Dr. Garcia.

Answer:

peels of that strength that go a little deeper can cause what is termed purging, where deep seated collections of skin oils in plugged pores come to the surface but look more angry than usual due to the irritation form the peel. It does not cause a permanent acne problem though. Hang in there, it will get better. JG 9.9.13

Question:

Thanks for your answer about the non-peeling peel. You said the benefits will be mild but you didn`t say what those mild benefits are. I`m not sure what I should be looking for in terms of benefits -- mild or otherwise. Sounds like you don`t think peels are particularly beneficial. Is that so? Thank you and sorry for the second question.

Answer:

all you will get is some of the brown spots being removed, that is all. I think peels are good for spot reduction, but it is not permanent nor will all of the spots be gone, and it does very very little for wrinkle reduction unless you have a deep phenol peel. Hope that it explains it better, sorry. JG 9.8.13

Question:

I had a strong chemical peel 10 days ago but never peeled because my skin is well exfoliated. The aesthetician said I would benefit from the peel anyway. What specifically are the benefits if one doesn`t actually peel? Thank you, Dr. Garcia.

Answer:

They will be mild at best. JG 9.8.13

Question:

What is the actual mechanism that causes the skin to be extremely itchy when chemical peels are applied?

Answer:

The release of histamine when the burn occurs. JG 9.7.13

Question:

hey dr garcia! whats ur opinion on the cynosure laser hair removal?

Answer:

a good option. JG 9.4.3

Question:

I had an IPL treatment to my chest last Wednesday night. It`s Tuesday now, and my chest is covered in tiny red spots which look like dried blood. What`s going on? How long will these last? Thanks very much for your help.

Answer:

likely small superficial broken blood vessels that will heal and disappear in another 5-7 days. Use sunblock and stay out of the sun until then. JG 8.27.13

Question:

Thanks for your honesty about peels. So...any suggestions for tightening skin on arms and hands? You are really generous with you time and expertise, Dr. Garcia. Thank you so much for that!

Answer:

I am sorry but there is nothing reliable, lasers and peels are either too weak or dangerous. Fillers do not last. If I had something good I would be a millionaire. Sorry. JG 8.25.13

Question:

Thanks for the answer about the Jessner`s peel. What other peel might you recommend instead of such a mild one?

Answer:

Honestly, chemical peels are OK for spots, will not tighten skin on your arms and hands. I use lasers for the spots and I think peels are a waste of money on arms and hands. JG 8.24.13

Question:

My aesthetician is advising a Jessner`s Peel for my arms and hands. As peels go, is this particular one considered strong, average or mild? Do you ever use it for your own patients ? Thank you.

Answer:

Very mild, safe, not very effective. JG 8.23.12

Question:

what is the best laser for wrinkles under the eyes and mild dark circles with a little bit of under eye puffiness. I am 49

Answer:

I think an erbium or CO2 laser will help for a period of time for the winkles, but no laser will remove the puffiness and the dark circles will likely need a filler to improve rather than a laser. JG 8.23.13

Question:

for brown spots and broken capillaries on face what is the difference between and IPL and nd yag. I have very sensitive skin and dont want to end up worse that i started -- thanks

Answer:

The ipl is weaker and less effective than the Nd:YAG but it can be turned down on sensitive skin. JG 8.17.13

Question:

Is there any laser that can remove brown spots and broken capillaries at the same time and if there is or is not should I have a test spot done with any laser? What do you recommend for both brown and red? What is the dis? Thanks

Answer:

An Nd:YAG laser can as long as the settings are changed during the session. JG 8.16.13

Question:

Hi, Dr. Garcia. You kindly answered a question for me over the weekend about the Obagi Blue Peel. I had my hands and face done over a week ago. The face healed just fine but my hands are a raw, red, painful mess. What might you recommend? Aquaphor? I`m also taking Ibuprofen for the pain and edema. Of course, I have absolutely no sun exposure -- even wearing gloves and long-sleeved shirts and wide-brimmed hats (as I always do) over thick coats of sunblock. Thank you so much for your immense generosity! Every blessing to you.

Answer:

I like Aquaphor or Squalene oil for the skin at this point. Hang in there. JG 7.31.13

Question:

Thanks for your answer and encouragement about the Obagi Blue Peel! I`m really excited to see the changes in my skin and so glad I did this! One week of looking like a burn victim in exchange for fresh skin seems likea small price to pay. One thing I forgot to ask: Does this peel usually take care of superficial (flat, clear, slightly scaly) actinic keratoses? I`ve had a few on my hands that have stubbornly resisted other treatments. Thanks ever so much for your help. Your patients are very lucky to have you.

Answer:

I do not think it does much besides the spots, sorry. JG 7.28.13

Question:

I had an Obagi Blue Peel to my face and hands last Monday. Yesterday, my skin peeled off in big, black chunks and now it`s bright red, My hands seem to be a brighter red than my face. How long does it take for the skin to return to a normal color? My skin is Type I, by the way. Also, do you think Obagi Blue Peels are good in general? Thank you, Dr. Garcia.

Answer:

I think they are good peels and I have done many. The hands might take a week or so to look better, but they will get somewhat better every day. Follow the doctor`s instructions carefully in the meantime. Hang in there. JG 7.28.13

Question:

Oh my goodness, you should see me, Dr. Garcia!I had a port wine stain on the dorsum of my hand, which I had treated with a VBeam 2 weeks ago. It was set so high that my skin turned purple and black. Now that the bruises have resolved, I am left with a dark, dark red hand that my dermatologist tells me is inflammation. He predicts it will last 7-8 months! Does this sound right to you? It looks like I have an immersion burn on my hand -- a clear line of demarcation at the wrist. I think that the port wine stain was less unsightly than this. Do you think it will really take that long to resolve? Should the stain be completely gone by then too? In the meantime, anything I can do to lessen the erythema? Laser Genesis?? Thank you for your help.

Answer:

Quite unusual I must say but I do think it will get better in time. I don`t think it will take that long to look better, I believe it will improve sooner than that although there might be small spots that linger for a longer period of time.Keep it out of the sun and I wish you the best.JG 7.28.13

Question:

What is your opinion of the laser lipo

Answer:

a reasonable way to have liposuction done but I do not think there is any advantage over other forms, just the buzzword laser. JG 7.17.13

Question:

I had microdermabrasion and a SkinMedica Rejuvenize peel to my hands, arms and chest on Monday morning. It`s now Saturday and I haven`t peeled at all, and it doesn`t look like I will, but my skin is red, irritated and itchy and the brown spots appear even darker than they did before. I`m kind of bummed out about this because I thought it might help a bit rather than make things much, much worse...and it cost me a chunk of change! I look like I have a dermatological disease. A few questions for you: 1) Even if I don`t peel, will this treatment ultimately turn out to be helpful to me? 2) Is my reaction normal? 3) How long will I look like this? 4) Anything I can do to improve the situation at this point? I`m using OTC hydrocortisone, but it`s not doing much. Thank you so very much for your generous help to all of us out here, Dr. Garcia!

Answer:

The darkening of the spots is temporary, they will flake off and lighten and the peeling does not always happen when performing that on those off-face area.I think the treatments you had will have little effect on wrinkles, although it will help with the brown spots. Your reaction is pretty typical for that treatment. It might take about 5-7 days to look better, all depends on how strong the peel was. I do not think the cortisone cream will help, it just has to heal on its own. Got to hang in there for a bit. JG 7.15.13

Question:

I am considering having the laser procedure on my face and neck. Would this do any lifting in addition to removing wrinkles? Would a chemical peel have practically the same result? Thanks

Answer:

I think the lift will be minimal if any at all and as Phenol peel can come close to the same result but not many physicians use it any longer. JG 7.12.13

Question:

The aesthetician at the medispa I use recommends microdermabrasion prior to peels (specifically, the VI Peel) because she says the peel will be more effective. Is that true? If so, is it safe to do it in the same session? I regularly use Retin A, so my skin is already exfoliated; I assume that fact would make this double treatment safer. Thanks for helping me out, Dr. Garcia.

Answer:

I do think it will make penetration better, but the same can be achieved by cleaning your skin with an alpha hydroxy cleanser or cleaning it with Jessner`s solution, and it would be cheaper. JG 7.11.13

Question:

OK, so I`m at my dermatologist`s office today with the aesthetician for a peel. She goes to open the tiny pre-mixed bottle and the top FLIES off -- like a champagne cork -- hits the ceiling and then hits her in the eye on its descent. (Fortunately, it didn`t hurt her; neither did she get any acid in her eye, which would have been horrible.) So what`s up with that lightening in a bottle routine?! Can those acids expire, spoil and build up pressure in the bottle? I wonder if she was opening an expired product. Or is this something that is always a possibility with those little bottles of acid? Well, it was certainly dramatic. Thanks for shedding some light on this for me.

Answer:

the only way I could see that happening is if the bottle was kept in a hot location and the air inside expanded with the heat. The chemicals do no break down to form a gas that would cause that though. JG 7.11.13

Question:

Hi Dr G. Would you mind telling me why you are not a fan of Ultherapy. Thank you and as always, I value your opinions. Jg

Answer:

It hurts to have done, the results do not appear to last for more than 6-9 months,is not effective in a percentage of people, and there is associated fat loss that can make yo look bumpy or of the fat loss is even it will accelerate the facial aging.JG 7.2.13

Question:

Just curious, do you see many patients that have seen damage done by fractional lasers?

Answer:

Not so much damage as much as visible limitations due to the fractionated technology, including spots left untreated or minimal to no visible improvement. JG 6.29.13

Question:

Hi Dr. Referring to my question below..Ultherapy ..do you think having it in the cheek area will help with mild jowl. Thank you....and Happy 4th of July from Canada.

Answer:

I am sorry but I am not a believer in Ultherapy. JG 6.29.13

Question:

I have some mild micro dot marks in my lower chin area on both sides from 1 fraxel restore treatment. When I smile the texture has changed to many fine lines. Is there any treatment you would recommend for this? I wish there were more warnings about these lasers. Collagen rebuilding did not occur in my case. No one can explain what actually happened. Thank you.

Answer:

Might need to have a totally ablative CO2 laser done lightly to equalize the surface. Sorry the hear about the occurance. JG 6.29.13

Question:

There is a new laser to remove cellulite. Do you think it could also remove or improve stretch marks?

Answer:

In my humble opinion, no. JG 6.29.13

Question:

Good evening from Canada. Dr. G I am considering Ultherapy cheek area to lift very slight jowl..think I have to stay away from NLF as had Dermalive about 7 years ago in that area. Would it be safe to do Ultherapy over Dermalive and do you think cheek area could help with my slight jowl with Ultherapy? Am 3 weeks post Smartlipo Triplex neck area. PS says I am not ready for FL. Thank you.

Answer:

The Ultherapy should be fine with the Dermalive. Best of luck. JG 6.29.13

Question:

PS- for the question below regarding hair removal, I am speaking of laser hair removal. Thanks

Answer:

I figured. JG 6.27.13

Question:

Hi Dr. Garcia, I am considering full pubic area hair removal. Though I understand that not all of the hair will be gone, I have a few questions: 1) how dangerous is it? 2) How painful is it? A place where I had a consultation told me that most clients do not experience any discomfort, but they can prescribe topical anesthesia in the rare cases that it is needed. That sounds a bit unbelievable. Please enlighten me.

Answer:

Not dangerous, the numbing cream helps but it still hurts. JG 6.27.13

Question:

I asked about the vein under the eye and you said sclerotherapy is not a good option. Are they any other good laser that are successful in removing it? I think the one they used before was a YAG.

Answer:

Nothing except the ligation. JG6.27.13

Question:

I had a 3 laser treatments for a blueish vessel under my eye to get rid. It swelled and puffed for a couple weeks but once that went down it look like the vein would be gone. However it didn`t seem to last. Now it almost seems bluer and the vessel itself seems puffy. Is scleotherapy something that could be done for a vessel under the eye? Will it get rid of it and what are the risks?

Answer:

I would not suggest sclerotherapy due to the risk of blindness. About your only option might be to have a surgeon make a nick in the skin at the begining and end of the vein and tie a suture around it to close it off, but there will be a small residual scar left on a permanent basis.JG 6.26.13

Question:

I recently had a VI Precision Plus peel, but my skin never peeled off. I keep my skin exfoliated through regular use of Retin-A. Is that the reason I didn`t peel? And is it possible to get benefits from a peel if one`s skin doesn`t physically shed? Thank you

Answer:

Should still get some improvement but not very dramatic. JG 6.6.13

Question:

I have been having a laser used to dissolve the dark vessel under my eye. Does that irrate the fat pad. It seems to be healing well but I have puffiness which I do not think is swelling. Is there anything that can treat that and help the fat pad go back down in size?

Answer:

I doubt the laser has affected the fat but it certainly can cause swelling that can the fat pickets to look worse. That swelling might take a week or two to go away. Ice and avoiding salt will help. JG 6.4.13

Question:

Which laser is used to dissolve blue or purple veins in tear troughs of eyes?

Answer:

I would not use a laser to treat those veins, nor would I inject a sclerosing agent either.JG 5.29.13

Question:

I am using a laser under the eye to dissolve the vessel. I just had my 3rd session and she was very aggressive and now it is very red underneath-- I guess from a bunch of capillaries also bursting. Is the anything I can do to get this to heal faster, It is also quite puffy underneath too. Thanks :)

Answer:

not much I am afraid, but ice will help with the puffiness. JG 5.29.13

Question:

In terms of effectiveness and risk of scarring, what is the best method (e.g., Alexandrite laser, Yag laser, Erbium laser, radio frequency) to remove flat, benign, brown moles apart from excision? Thanks.

Answer:

Yag. JG 5.26.13

Question:

In terms of effectiveness and risk of scarring, what is the best method (e.g., Alexandrite laser, Yag laser, Erbium laser, radio frequency) to remove flat, benign, brown moles apart from excision?

Thanks.

Answer:

' '

Question:

In terms of effectiveness and risk of scarring, what is the best method (e.g., Alexandrite laser, Yag laser, Erbium laser, radio frequency) to remove flat, benign, brown moles apart from excision? Thanks.

Answer:

Yag. JG 5.26.13

Question:

The reason I asked about carboxy is because I`m reading mixed reviews. I think it`s helping me a little but I certainly don`t want to risk getting infected or scarred. Would you advice to discontinue? I`ve had my third session and have 3 more to go. But if its not goi g to help drastically I would like to save my money.

Answer:

I would stop them. JG 5.23.13

Question:

Never mind just read your answer below. Thanks!

Answer:

no worries

Question:

I am having Smart Lipo Tripex and started Arnica two weeks ago and my surgery is June 11.. Is it safe to continue with these pellets until that time and do I continue with them after. Thank you.

Answer:

Safe to continue and also for 7-10 days after. JG 5.19.13

Question:

hey dr garcia, Can i get laser hair removals after carboxytgerapy for stretch marks? if not how soon do i need to wait brcause i just got a session of carboxy for stretchmarks on hips butt and legs today. also whats your opinion on carboxytherapy for stretch marks?

Answer:

I would wait 7-10 days. JG 5.19.13

Question:

Is it ok to have a laser treatment on the face in the summer months?

Answer:

as long as it is very light it is likely OK, but nothing aggressive or deep. JG 5.13.13

Question:

Will Ibuprofen help to reduce the swelling following IPL? Ice never seems to do much.

Answer:

I do not think the ibuprofen will do much either. JG 5.10.13

Question:

Morning Dr. It is me again ..Dermalive getting Tripex..will the Tripex procedure affect my chin implant (silicone). Thx again from Canada

Answer:

no affect, you can proceed. JG 5.9.13

Question:

Hi. I have Dermalive injected nose to chin (NLF)...been there for at least 7 years and have had no problems. Am having laser (called Smart Lipo Triplex) done along the jaw area..one pass for fat,one for tightening and one for Lipo. As this supposedly stimulates collagen, could it have a negative effect if it touches that Dermalive. PS says I am no where needing surgery yet...am 56 with quite good skin but some fat under chin and mild droop along NLF/jaw. Do you think I am ok to go ahead despite the Dermalive. As always..thank you big much from Canada. :)

Answer:

I do not think the treatment you are planning on having will affect the Dermalive. I wish you the best. JG 5.8.13

Question:

What are the names of the lasers that remove broken red vessels? And does one laser focus more on it than other lasers?

Answer:

VBeam and Nd: YAG. Both are good. JG 5.5.13

Question:

If I have lasering to remove vertical lines on my upper lip, what kind of healing time can I expect? Thank you

Answer:

depends on what type of laser and what the energy settings are, but you can count on a range of 4 days to 4 weeks depending on what is done. The stronger the treatment, the longer it takes to heal but also the greater the degree of change and the longer it will last. JG 5.1.13

Question:

I am considering laser hair removal of the upper lip for my daughter. She has very sensitive skin. I have light olive skin but hers is even lighter--not much olive. She has medium brown hair. I am worried about discoloration due to her sensitivity. I know two offices that offer ClearScan ALX by Sciton or GentleLase by Candela. Any ideas which, if either would be better for this? Thank you so much!!!

Answer:

Pretty similar, they can lower the settings to reduce the risk, might take a few more sessions is all. JG 4.27.13

Question:

How does IPL hair removal laser rate to other hair removal lasers? Which is best?

Answer:

either no result or something very temporary as it is not a true laser. JG 4.23.13

Question:

What do you think of Sciton`s BBL? Is it just a souped up IPL?

Answer:

yes, just souped up IPL. JG 4.18.13

Question:

What laser treatment is better, laser genesis or gemini laser? Looking to improve skin texture, fine lines, redness, pore size and broken viens/capillaries. What is the down time on each?

Answer:

The Gemini is likely better, should have hours to a day of downtime, about the same downtime with the Laser Genesis. JG 4.18.13

Question:

I`m sorry,can you explain what you mean about it eliminating any benefits?

Answer:

fractional lasers are promoted as faster healing and with less risks of pigmentary changes as they are treating only a fraction of the skin, but if you do repeated passes, those elements of less surface being treated thereby healing faster are gone and the risk of pigmentation the same for the same reason.It would be the same as doing the older deeper totally ablative laser, but I guess they want to use their machine so they can pay it off. JG 4.12.13

Question:

I had a fraxel restore treatment for just the perioral area . Energy 30mg, treatment level 5,and 8 passes. Do you consider this aggressive or standard for the first time? Thank you.

Answer:

relatively aggressive with the 8 passes, and it honestly does not make sense to me to use that type of technology and do 8 passes, it eliminates any advantage the Restore claims to have. JG 4.12.13

Question:

Hi, Dr. Garcia. I had an aggressive V-Beam tx to my face last Friday, and I am still incredibly swollen; in fact, my eyes are still swollen almost completely shut. I`m sleeping in a recliner, using ice, etc. Will OTC antihistamines help? How about ibuprofen? When do you think the swelling will subside? Also, I wanted to ask you a question about facial skin laxity. I had cheek implants placed 3 years ago. Since that time, the skin between the bottoms of the implants the sides of the mouth has never fallen correctly due to the stretching from the implants; however, rather than being tighter, as you might imagine it would be due to the lift from the implants, it is sagging and becoming wrinkled. I had a facelift last summer to help with this but no change. Does this frequently happen with cheek implants -- that is, that they stretch the skin so much that they the skins beneath them loose? If so, I wish I had known that before I did it.! Thank you very much.

Answer:

You can try the ibuprofen, not sure how much you will get from it but worth a try. It is hard to say how long it will take as all patients are different and they went aggressively on you too. Might get the doctor to call you a Medrol pack to help it along faster. As to your cheek implant question, I will be honest, I have never seen or read about that happening.Since the implants are placed below the muscle it usually does no stretch the skin. I am not sure why that is occurring in you. Sorry. JG 3.26.13

Question:

If a newly revised scar has raised or bumpy skin on sides of it where stitches were, is there a laser that can make the raised skin flat? Also, is there a laser that can remove the purpleness of new scars or even make the heal faster so they do not stretch as much?

Answer:

yes, that can be done but in most cases it will flatten out on its own in time. As to the pruple color a Nd:YAG laser or a VBeam laser will help the color but not speed the healing. JG 3.23.13

Question:

i meant pelleve in last question. sorry and thanks.

Answer:

Sorry, I think Pelleve is s waste of time and money. JG 3.12.13

Question:

Is preville any good around eyes or jaw line even temporarily . I don`t want to ease money but I would be happy to do often if it were to tighten. Are there any side effects that are bad? Thanks

Answer:

it will not last long and it will fill in lines but no filler tightens skin. JG 3.12.13

Question:

I`m the woman with the fraxel marks. I just posted my question but I don`t think it went through. I was confused about your answer regarding the treated and untreated areas. If the laser worked all over and at the same depth,wouldn`t I have these marks all over? Right now when I smile they sort of join together and give a crepy look. Do you think it`s worth me trying to talk to someone at Solta? My regular derm noticed it right away,but the doctor who preformed the procedure acts clueless. I`m not sure what to do next if anything. I now you`re not a fraxel expert,but I appreciate your opinion.

Answer:

that is correct, but a fraxel laser, by its very design and intent does NOT treat the entire surface. When you look at the skin surface up close, there are only fractions or pixels of skin treated and the majority of the skin is left untreated.I think it is worth speaking to your doctor and possibly to the people at Solta also to find out if your experience is typical for what was done.I wish you the best.JG 3.8.13

Question:

Thank you for your answer. Do you know why they only occurred in certain spots of the treated area? Does it have anything to do with scar tissue? I had acne that I aggressively squeezed and picked at. I`m just trying to understand why this happened to me and not others. Thank you..

Answer:

likely due to the difference in skin thickness, the thinner the skin, the greater the chance of that happening, or skin that is irritated to begin with. Areas of scar tissue will also not heal as well and that can be part of the problem. JG 3.4.13

Question:

Hi Dr. Garcia, I`m the woman with the pin dot marks following a fraxel restore treatment. It`s been 6 months now. Are these likely permanent? I know you don` t use this laser but do you know what caused this? I went in to improve the texture around my mouth but just made it worse. Thanks for being there.

Answer:

well, the longer they are there they likely it will take more laser to correct the problem, something you probably are not looking forward to. The dots are there because the depth of the laser was greater than the surrounding area and they are surrounded by untreated skin so that leaves the treated- non-treated differences.Another laser with less untreated skin and more coverage should make the problem look better. I wish you the best. JG 3.4.13

Question:

It was recommended to me to do the gemini laser because I have redness in my skin and a vessel under my eye which is quite prominent. I have an appointment for my first in a couple of weeks. What is the downtime from this? Will I be able to go to work the next day?

Answer:

Should have minimal downtime, but no way to predict as all patients respond and react differently, you should be able to return to work the next day but I cannot promise you that. JG 3.3.13

Question:

Thank you for the answer about Lupus.. So is that butterfly rash. Not vascular in nature? If it were, I would think it would respond to the laser and IPL treatments. If it`s not vascular, what is it?

Answer:

It is vascular in nature but the safe technologies for controlling a vascular lesion are the one you have tried already.The Lupus is causing the problem and it creates a continuing cause for the vascularity to be seen. Normally there is nothing like lupus that continues to cause it on a continuing basis so it works in other cases better than it does in yours.JG 3.3.13

Question:

Hi Dr. I hope you are enjoying the weekend. For maintenance, in addition to using Retin A and a cream to help with fading discoloration - and sunscreen - what else should I be doing if I want to establish a maintenance program? Do I need monthly dermabrasion? What series of laser should I purchase for skin tightening? Also, what supplements do you recommend for aging well? Is there anything I can take that will help prevent hair from turning gray? Sorry for the many Qs. My concerns are not just for vanity reasons. I am in my 50`s, have been told I can pass for early 40s, I work in a company where age discrimination is a reality and I need to work for at least another 10 years, given what the last few years have done to my 401(k). So I need to do everything I can to age well. Thank you as always for sharing your knowledge.

Answer:

Microderm maybe every 6 weeks, use sunblock not sunscreen. Supplements I would say Vit C and E and omega three fish oils, skip the home lasers. You will not need much as you have good genetics. JG 2.16.13

Question:

Two more questions Doc: Is the PIH from a 532 Yag dermal or epidermal? Also, you said the Rentin-A helps with lighting and the HQ just supresses right? Would that mean that weekly peels would more likely help with the pigment that is already there? Thanks so much!!!

Answer:

More epidermal than dermal. Weekly peels would imply a lighter peel for it to heal and then be able to be repeated again and in cases of melasma I do not find that effective. JG 2.12.13

Question:

Hi Dr. Garcia! I recently had a 532 and 1064 QS Yag laser done for my melasma. I am a Fitz Type III. I got PIH from it and now a month later my doctor wants to try and do the 1064 alone w/ a fluence of 2. Have you seen this making the condition worse ever? It is so much darker now than when I started that I am devasted. My doctor has now put me on 8% HQ+RA+Steriod instead of the 4% I was currently using for the past few months. Your advice would be greatly appreciated!

Answer:

well, not sure why the melasma was treated initially with the 532 as it is mostly brown and the 1064 is a good place to start. Initial darkening is not uncommon as the skin gets irritated and will look darker for a bit. The fluence of 2 is OK normally but if you got PIH from the first session I might suggest going less energy and more time in-between sessions, especially in Fitz III. I think the 8% HQ is being diluted down with the mixture so it is less, I do not see any reason though to use the steroid in it unless you cannot tolerate the Retin-A. The HQ will prevent further darkening from the sunlight or future laser sessions but will really not reverse anything in place, that effect will come more from the RA while HQ can be used to minimize the possible PIH from the RA if your skin is sensitive to it as any skin irritation can cause PIH in susceptible people.Best of luck. JG 2.12.13

Question:

Good evening. What do you think of the Serious Skincare Micro current Toning Device. .. I am somewhat skeptical however the Reviews are encouraging. Thank you.

Answer:

I would imagine they are paid reviewers, I would save your money. JG 2.7.13

Question:

Hi Dr., You recently indicated that there are options for firming the face that work (as opposed to firming options for the body). Would you recommend Ulthera? I have heard from several people that they are pleased with the results. Thank you.

Answer:

I do not recommend it as I think it can cause fat loss that will make you look older down the road, but not right away. It is also not something that lasts long, possibly 9 months at best and it is uncomfortable to have done. JG 2.6.13

Question:

Dr., What options are there for tightening skin (face and body)? Does Ulthera work for the face? What about the body? Does Velashape help, even if it has to be maintained regularly?

Answer:

I think the non-invasive options for body tightening are for the most part not effective at the present but for the face they do work much better. JG 2.2.13

Question:

I have very wrinkled hands and fingers which look so much older than my face. My doctor said she could give me a hand peel that would help.Do you agree with her.

Answer:

' '

Question:

I have very wrinkled hands and fingers which look so much older than my face. My doctor said she could give me a hand peel that would help.Do you agree with her.

Answer:

' '

Question:

I have very wrinkled hands and fingers which look so much older than my face. My doctor said she could give me a hand peel that would help.Do you agree with her.

Answer:

' '

Question:

I have very wrinkled hands and fingers which look so much older than my face. My doctor said she could give me a hand peel that would help.Do you agree with her.

Answer:

' '

Question:

I have very wrinkled hands and fingers which look so much older than my face. My doctor said she could give me a hand peel that would help.Do you agree with her.

Answer:

' '

Question:

I have very wrinkled hands and fingers which look so much older than my face. My doctor said she could give me a hand peel that would help.Do you agree with her.

Answer:

go for the brown spots is about all you will benefit from that. No improvement on wrinkles, sorry. JG 1.28.13

Question:

Dr. Garcia, I`m 5 months out from a fraxel restore procedure and I still have the pin point marks. Do you think at this point there is any hope? Have you seen this before?

Answer:

Have seen it, might be worth having a YAG or VBeam laser for the spots. JG 1.27.13

Question:

Hello Dr - Would having my face lasered reduce the possibility of skin cancer. I have some friends who have had to have mohs surgery for skin cancer on their face. Thanks!

Answer:

In theory yes, but it would be a reduction at best, you would still be susceptible as deeper cells could still harbor pre-malignant cells that will show cancer later. JG 1.21.13

Question:

I like to use my Benzoyl Peroxide, a vit C rich cream/serum and a cream with retinoid (like neutrogena`s rapid wrinkle repair). Which ones should go first and which ones should not be used on the same night/day? I know there are some ingredients that should not be used in conjunction due to ineffectiveness and irritation. Also, I`m interested in a laser for acne scarring, rolling and pitted, but am olive and scared of PIH. What are your thoughts on Dermapen? In theory, it sounds great. Derma-rolling was well documented but this seems less painful and controlled. I was also considering IPL and e-matrix. Thank you in advance for your time.

Answer:

If your skin tolerates it, it is OK to use all three, I would apply them as you wrote them, waiting a few minutes between each product to let them absorb. I would not do any lasers on olive skin so I really do not have much to offer for your acne scars except possibly subcision nd immediate fillers, but that is temporary. As to Dermarollers or DermaPen, I would save your money. IPL could be done but I think you would be disappointed with the E-Matrix. I wish you the best. JG 1.17.13

Question:

Hello Doctor! Looking for your opinion on something...I had a laser (QS YAG)treamtment done and was wondering what you recommend post op other than Aquaphor? I tend to break out easiy and was wondering if you suggest anything else. Also, I have scabbing that has formed and do these always need to be wet? Or will just a light moisturizer do? Thank you!

Answer:

Might want to try squalene oil, less chance of breakouts even though it is an oil, it is quite thin an very similar to our natural oils, easily absorbed into the skin with no residue. Sold at most health food store. Best of luck. JG 1.14.13

Question:

I got hair removal with an alexandrite on my upper lip and chin today and under the chin. Its my 4th tx and for the first time, I got burnt. the chin and under was really red and stinging. I ice packed it and now, its still red and bumpy and from experience, I know the red will turn into dark tread marks (I had this on my legs and went away in 2 mos). I put trianex 0.5% on the area to reduce PIH so far. What can I do to minimize the damage beside sunblock? Keep up the steroid (Trianex), add hydroquinone? Anything? This is my face! I`m so afraid it`ll take 2 mos to go away. Please help....

Answer:

I would use squalene oil and sunblock, with lasers the steroid and hydroquinone will not help the healing. It will fade in time. JG 1.13.13

Question:

Is there anything I can use to facilitate the healing? It`s been 4 months. Is there ant time frame or does it vary? As always I appreciate your help. Hope you have a great holiday! Sincerely,JD

Answer:

If you are talkung about lasers, try some copper peptide. Merry Christmas. JG 12.23.12

Question:

I don`t know if you can answer this, but do you know why a fraxel laser would leave pin point marks on your face? I `d like to know if these are permanent but my dermatologist doesn`t want to really comment one way or the other. Thank you.

Answer:

The pin point spots are where the laser hit the skin, it leaves dots because that skin was burned and the rest was not, it will fade in time as it heals. JG 12.22.12

Question:

Hello Dr. G., I hope you had a good weekend. My PS is sold on Ulthera for tightening, saying she has been following it for 2 years. I think I need more filler in the marionette area but she said more filler there would make my face look fuller and that she believes I would benefit from Ulthera, which she says work for tightening/lifting. What are your thoughts? I`m exhausted with all the laser options, none of them, it seems, does what they claim, especially given the cost.

Answer:

I am not as convinced on the Ulthera, might give you 6-9 mionths only. JG 12.17.12

Question:

Several months after a face lift 3 1/2 years ago, I was prescribed Obagi (retin-A and a bleaching cream)by the surgeon and then started to develop thread-like spider veins on my face. I learned from your site that retin-A can contribute to these forming in some people. I`ve had Candela V-Beam and IPL treatments to lessen their appearance. I am now considering a chemical peel for melasma/sun spots on my face and wonder if it would have an impact on my tendancy for these spider veins to develop. I am now 67, if age has any bearing. Thank you, Dr. Garcia.

Answer:

The peels should be OK, it is the constant long term irritation with Retin-A that causes the problem. All the best. JG 12.15.12

Question:

Hi Dr Garcia About a year ago I had a facelift and fat injections in eye area and cheeks. My questions is: 1. if I have the q-switch laser to remove one quite large age/sun spot on my cheek will this in any way interfere with the fat injections I had eg cause a dent? 2. Is the laser painful? Thanks in advance doctor

Answer:

it is not painful and it will not have any adverse effects, all the best. JG 12.12.12

Question:

Hello Dr. G., My PS suggests Fraxel as a maintenance program. For the holidays, the special he is offering is $400 for face/neck/chest (decolletage). Do you still hold the same opinion about Fraxel? What is it supposed to do exactly? Thank you for sharing your expertise.

Answer:

the only maintenance going on is the fine doctor`s checking account. I suggest avoiding the sun, no smoking, using Retin-A and saving your money for needed stuff down the road. JG 12.10.12

Question:

I have lots of broken blood vessels around lower lip from injections to remove the vertical lines. I was told that if I laser those places it may remove the pigment from my lip. What are your thoughts. Would anything besides a laser tx work. Thanks so much

Answer:

properly applied laser should not affect the redness of your lip.I think laser would be the best and most effective option. Best of luck. JG 12.7.12

Question:

I had one fraxel restore treatment on a low setting, three passes. Well it`s been 4 months and the texture of my skin is worse than ever. More lines, larger pores and acne scars that we`re never there before. Thank god I only had my lower face done. Is there anything to do? Copper peptide cream, emu oil, vitamins? I`m shaking writing this- I also fear it might get worse. Of course I`ve since read many of these same complaints recently,I thought I researched it very well. When will the FDA or someone do something? Hope you can help me or direct me to someone who could. Thank you for being there and understanding.

Answer:

I think it is a bad as it is going to get, I might suggest some Retin-A at this point. I would avoid any lasers now and I think the healing period has passed for copper peptides to help, sorry. JG 12.4.12

Question:

Good evening. I am schedule for a full face fractional CO2 resurfacing in January. As directed, I`m using Retin-A and hydroquinone in preparation for this. Would it also be good to get a light peel or two (like SkinMedica`s Rejuvenize) to prepare my skin for this to achieve the optimal results? Thank you.

Answer:

I see no need or advantage to doing it. JG 11.28.12

Question:

How long after erbium laser on face does rough texture smooth out? Skin looks great at 10 days post, but still feels tight and dry and a little itchy at times, and slightly rough. aquaphor is still my best friend, but I wear regular cetaphil cream during day under make up. Still pinkish, how long will that last?

Answer:

Might be a week or two more. JG 11.27.12

Question:

I have some hemosiderin stains on my legs from a laser treatment last spring. My dermatologist is recommending a series of IPL`s. He also treated them today with a YAG. Does this seem like a good plan to you? How much longer will it take for these to go away? Any chance they might be permanent? They`re really ugly. Thank you.

Answer:

I think the YAG will help, but the IPL will likely not as it is not strong enough. JG 11.12.12

Question:

Which IPL machines work on broken blood vessels? My derm`s machine only targets the brown spots. Thank you.

Answer:

' '

Question:

Which IPL machines work on broken blood vessels? My derm`s machine only targets the brown spots. Thank you.

Answer:

IPL`s all have filters, the machine is the same, it is the filter that needs to be changed for the red, he just needs to buy the correct filter. JG 11.7.12

Question:

Is Cutera`s Limelight and IPL or is it a true laser? Thank you.

Answer:

no, it is an intense light with filters, not a true laser. JG 11.5.12

Question:

I had a TCA undereye peel a few days ago and one of my lower lids looks droopy since on one side. I just read TCA peels can cause this and I`m freaking out. It still hasn`t peeled yet what are your thoughts?

Answer:

Just temporary from the swelling, give it a bit and it should all go away. JG 11.4.12

Question:

I`m sorry, but I don`t understand your answer below about the difference between the Alexandrite and the Q-switched YAG and if the combined laser is better than either one of them. I need pigment treated. I`m white with brown pigmented lesions. Thank you.

Answer:

I would treat the brown with the Nd:YAG only and not the Alexnadrite. The combined would be worse than the Nd:YAG alone. JG 10.29.12

Question:

What is the difference between a Q-switched YAG and a an Alexandrite laser? My dermatologist has a laser that is a combination of these two which he uses to treat pigment. Is the combined laser better for this treatment or is one or the other of these two lasers better? Also, has Voluma now been approved for use in the U.S.? Thank you.

Answer:

Voluma us not appeoved in the US, just n trials. As the the laser, alexandrite is good for black and not much else, so if it has the other it will for other things. JG. 10.28.12

Question:

What laser do you recommend to treat small broken blood vessels? I know I have some from repeated juviderm injections. Also,what is the downtime? Ipl did not work. Thanks so much.

Answer:

VBeam or Q switched Nd: YAG, maybe 5-7 days downtime. JG 19.27.12

Question:

I had hair removal done on my legs and thighs almost two weeks ago. This time (my 4th) I reacted a little poorly, the redness and probe marks did not subside like they have in the past. The redness and swelling lasted 24-36 hours. Then the marks settled into blue-black `tread` marks and now they have lightened considerably but still visible, in a pattern still from the probe, more on the back of my thighs. a) How long before the complete resolve? b) can I do something to speed it up? Another laser, steroid, etc? My derm said I should have put Hydrocortisone on my legs the day after but I missed my window.

Answer:

it might be 4-8 weeks for them to fade I am afraid. steroids will not help in any way, so you did not miss any window. Another laser would just potentially irritate the skin more and prolong the healing. It is likely best to let it heal on its own, keep them out of the sun completely. I would never use Cortisone on the skin the day after or even now, it would do no good and could potentially thin the skin and cause broken blood vessels. The only thing I would try is possibly some hydroquinone mixed with Retin-A to help them fade and also to prevent them from getting darker, but the effectiveness of the mixture is not as good on the legs as it is on the face. I wish you all the best. JG 10.23.12

Question:

Regarding the fraxel question,any idea at how long it can take? I only had one restore treatment on allow setting,three passes,but I don`t trust my doctor`s answer now.thank you for your help.

Answer:

in the unlikely instance of scarring, it will get better over 6-12 months. JG 10.15.12

Question:

Dr. Garcia, have you ever seen any pinpoint type scarring from your patients that have had fraxel laser treatments? If so, do you know if it resolves with time? Thank you.

Answer:

In most but not all caes. JG 10.14.12

Question:

First, I have to say that I learn SO MUCH from your site. I have been an esthetician for 12 years and learn more from you than most people, books or doctors out there. I also wanted to thank the woman who posted about Dr. Eisen in the Boston area. I saw him last month & he said his laser is a combo YAG/ALEX and I did not have good luck w/the Alex laser for my melasma so I stayed away. MY QUESTION IS THIS: I am just learning that the newer lasers on the market can be done by estheticians/laser techs. CYNOSURE makes the MED LITE C6 and RevLite that are both Q-switched lasers that are being done in laser clinics .. Is this the same lasers that could only be done by doctors years ago? Is it because there is no/less trauma to the skin? Also, how often do you suggest doing these treatments and approximatley how many? P.S. I cancelled my visit with the doctor who didn`t know the proper setting to use on my skin. Thank you for the reassurance on that! It did not feel right. YOU ROCK!!

Answer:

These newer laser are weaker and not the same as traditional older ones. Who can use a true laser varies fron state to state, and the salesman will not know that, they just wany to sell machines. There are many problems coming out of medispas where improper tecnique and inadequate supervision. I believe in time that laser techs will disappear and will need to be done only by nirses or docs, all due to malpractice issues. JG 10.10.12

Question:

Hi Doc! Can you tell me the settings you would start at for melasma on a Fitz 3 with a Q-switched Yag? I am getting it done by a doctor that doesn`t usually use the YAG for melasma. I had it years ago but unfortunatley can`t get my records because the doctor has since passed away. I just want to make sure the doctor isn`t way off in his decision on settings since he doesn`t do it often. There are not many people in the Boston area that have the Qswitched YAG. I tried IPL 3 times with no improvement. THANK YOU!!!! :)

Answer:

I will be honest with you, that is not information I will give to you as a patient. He should know what the settings are, if he doesn`t, they should be in his training manual. If he does not have that and does not know, you need to find a different doctor. JG 10.9.12

Question:

So how often do you think one should do peels for a maintenance schedule in any given year?

Answer:

depending on the person`s skin, maybe 2-4 per year. Also depends on what chemical strength is used, lighter peels can be done more often but do not yield as much. JG 10.6.12

Question:

My aesthetician, who has flawless skin, tells me she does a chemical peel every 4-5 weeks and recommends that all her clients do the same, Of course, she stands to make more money if we all do that, but I`m wondering if you think that`s reasonable schedule for maintenance peels. If not, what do you recommend? Thanks very much, I hope you`re enjoying the long holiday weekend!

Answer:

I do not see a need for it, I am sure she gets some benefits from an occasional peel, but her genetics are more likely the largest influence on her skin quality. Save your money.I wish you the best. JG 10.6.12

Question:

hi , i would like to ask whether 2 coats of TCA 25% is equal to the strength of a single coat of TCA 50% ?.. is the former still milder compared to the latter or both are just the same in terms of strength , thank you

Answer:

No, they are not the same and I would never use anything over a 35%, and that would be a single pass. JG 10.6.12

Question:

on the Q-switched yag questions: The PULSE WIDTH IS 0.5-300 msec. Just in case you needed to know!

Answer:

for melasma that is OK. JG 10.5.12

Question:

Hi Doc! WHAT IS THE DIFFERENCE BETWEEN A Q-SWTICHED YAG & a NON Q-SWITCHED YAG? A nurse uses this laser CYNOSURE ELITE MPX Nd: YAG 1064nm AND IT does NOT say it is Q-switched. I am looking for someone to do the yag laser for my melasma on olive skin & wanted to know if there was a difference in lasers and if I should have it q-switched in your opinion. THANK YOU! You are an angel! :)

Answer:

Q-switching, sometimes known as giant pulse formation, is a technique by which a laser can be made to produce a pulsed output beam. The technique allows the production of light pulses with extremely high peak power, much higher than would be produced by the same laser if it were operating in a continuous wave (constant output) mode.Q-switched lasers are often used in applications which demand high laser intensities in nanosecond pulses. I do not believe the Elite is Q-switched, it will work well for hair reduction, but not good for treating reds and oranges, so only darker hair or darker spots. I would use a Q-switched in your case as you are treating melasma and you have olive skin. I wish you the best. JG 01.5.12

Question:

Hi Dr. What is VBeam, and what does it do? My doctor used it to zap discoloration under my right eye. When does the swelling go away, and when can I tell if the discoloration will improve? Thank you.

Answer:

it is a laser that is used to treat pigment issues, such as red, blue and brown spots. The swelling will go down slowly, but in areas where the skin is thin, the swelling is visible for a longer period of time, might be a 3-6 week period before you see the improvement. JG 10.5.12

Question:

Hi Doc! Have you heard of the ILLUMINASE laser for melasma? And if so, your opinion of it. Do you still prefer the Q-Switched YAG? Thank you!

Answer:

all it is is a combination of a YAG laser, a microdermabrasion and fading creams, merely an attempt to make it sound new and improved, when it is not. I would stick wit the YAG laser but adding hydroquinone before and after the laser sessions is a good idea. JG 10.4.12

Question:

Good morning. Wondering about pigment. 52 yr old white female (Type I), hx of extensive UV exposure for first 20 yrs of life. Complete coverage with clothing, hat and sunblock (apllied 4x/day, 365 days/year)/extremely minimal sun and flourescent light exposure for the past 30 years. 15+ years use of Retin-A + hydroquinone, IPL every 10-12 wks for the past 15 years; multiple laser txs over the past 15 yrs (CO2, fractional CO2, VBeam, Q-Switched YAG, 1064, etc.) I also have professinal chemical peels 5-6x/year. The question: my UV photos do not show improvement from year to year, and I still need to have pigment removed. Why is this so? isn`t there a finite limit to the amount of pigment I can make after all these treatments and since I`m using full-spectrum sunblock, covering completely in clothing and living like a vampire, avoiding all light? Anything else I should be doing? Thank you for your time and insights.

Answer:

Well, the melanin cells in the skin have memory, and they are the ones that create pigment. Although you certainly have had good protection and have had numerous treatments over the years, in order to tell an monitor your progress, you would need to have a UV photo done after the IPL and lasers to see what effect if any they are having. You might require more intense treatments that will be accompanied with more downtime and risk.Ultimately you should treat for the improvement of what you see with the naked eye though, not the UV photo, that will always show much more. JG 10.1.12

Question:

Dr. Garcia , are there cases of hypopigmentation following deeper TCA peels that goes back to its original color prior the peel ...or is hypopigmentation following deeper TCA peels always permanent

Answer:

well, if it is true hypopigmentation, no, it can be permanent. But if it is a relative hypopigmentation, and by that I mean where the treated area has the sun damage removed and the adjacent area does not, it will look lighter until you get some new sun and sun damage. JG 9.30.12

Question:

good day Dr. Garcia , i would like to ask whether hypopigmentation on the forehead after a 20% TCA Peel is permanent ... is that always the case ?

Answer:

Probably not. JG 9.29.12

Question:

sorry meant to say hate to HAVE brown spots lol. will the brown spots fade over time? (the fractional laser on calves)

Answer:

probably, depends on how high of an energy setting was used. JG 9.29.12

Question:

hey dr garcia, last week i did a fractional laser on my calves for stretch marks immediately after it was red and now i see lightt brown spots where she zapped with the laser on the skin..is this part of the healing process? will it go away i would hate to hate brown spots..i have light olive mediterranean skin tone.. what should i apply to fade them or should i leave them alone. kinda worried about it..

Answer:

It is normal for the red spots to turn brown, but I am afraid it will not work, I would never treat stretch marks on the calf with Fraxel, especially in olive skin. I wish you the best. JG 9.28.12

Question:

I am interested in your co2 total ablative peel. What is the process in performing this treatment? What is the downtime and how invasive is it. I have seen your before and after pictures and this procedure looks very effective. Why do you do a chemical peel on the neck and not the co2?? Thank you for your time. I love you site.

Answer:

I perform it under general anesthesia, it takes about 3 weeks before you can wear make up to hide the redness, and the pink skin can last 2-4 months, depending on how deep of a treatment its needed. The neck skin does not heal as well as the face and if you did a CO2 laser on the neck, you could induce scarring. I perform the chemical peel to attempt to achieve a better color balance, while the chemical peel can be performed safely on he neck and will remove a lot of sun damage. Thanks for visiting and thank you for the kind words. JG 9.18.12

Question:

Hi Dr G: I had an erbium laser done under my eyes and while healing I did not peel at all. I was very swollen but never peeled. I was told its most likely because I`ve used Retin A and Glycolic Acid creams on my face. Is this so? I`ve always thought you had to peel to get the benefits of the laser?? Was I even given an erbium or not?

Answer:

There does not need to be peeling during an erbium all the time because the skin that was to be removed can be vaporized by the laser, leaving only the skin that has to heal, and no skin that has to peel off. The skin should look like it is scraped off or like road rash, if it looks like that, it is the way it should look and the peeling occurred during the application of the laser. The Erbium healing is not like a chemical peel healing. A laser does to always have skin peeling but a chemical peel has to have peeling all the time. JG 9.8.12

Question:

Re the mesg I sent about peeling post op on an Erbium laser - I have NOT peeled. (I typed it too fast ---sorry)

Answer:

Got it, you should have like road rash at least on your skin. JG 9.3.12

Question:

HI Dr. G. I had an erbium ;aser under me eyes on Thursday late afternoon. It is now Monday and no peeling and started. Isn`t peeling part of the process? The anesthetician said not necessarily, especially if I had previous lasers in the past. She says I will get same results even if I don`t peel. (My first laser I peeled bad). Is this correct?

Answer:

I disagree with her, the only way you should not peel is if the laser was done so lightly that you will probabaly not get any benefit. Also, unless she is also a nurse, in most states it is illegal for am aethetician to perform laser treatments. All the best. JG 9.3.12

Question:

I was on a short-term course of tetracycline for a skin infection. I stopped it today. How long must I wait before I can have IPL or any laser treatments? Thanks so much for your help.

Answer:

I suggest 7-10 days. JG 8.24.12

Question:

Dr.G, I know you think fraxel lasers are a waste of money but do you ever see patients that have been damaged by them? I`ve had one fraxel restore but after reading some stories online, I`m a little worried and hesitant to continue. Thanks for your help.

Answer:

rare, but if the treatment is done too strongly or there is a post laser infection, problems care ocurr. Nothing is 100% safe. So experienced hands are needed. JG 8.18.12

Question:

Thanks ever so much for all your help with my questions about folliculitis this week. I`m booking a series of IPL`s beginning next week, thanks to your good advice. One final question: might light chemical peels also be beneficial or would they aggravate the condition? I`m thinking they would help. Enjoy your weekend, Dr. Garcia.

Answer:

no effect, good or bad wits the chemical peels. Sorry. JG 8.17.12

Question:

What is the risk of fat atrophy or permanent scarring from IPL? How many weeks before and after the treatments should Retin-A and hydroquinone be used? Thanks so much.

Answer:

Properly performed, the risks of fat loss and scarring should be very low. We stop the Retin-A amd hydroquimone three days before amd restart once skin lools good, usualy 3-5 days. JG 8.14.12

Question:

Is the erbium laser good for fine wrinkles and to tighten the skin? And is a Nd:Yag 532 nm the same as an Erbium laser??

Answer:

i think the erbium yields mild improvemenrs for wrinkles, and the Nd:YAG is for color issues, not effective for wrinkled so much. JG 8.11.12

Question:

What is your opinion on the Nd:Yag 532 nm ??

Answer:

For red spots, it is effective, but not for much more than that. JG 8.10.12

Question:

My teenaged daughter has a persistent breakout of tiny acne along her jaw. Her dermatologist has used Isolaze to good effect, but is now following up with a series of mild glycolic peels (30%). She had her first today and now where each tiny acne lesion is, her skin is red (like pin point bleeding). She looks like she has measles. Does this mean that the peel is working or does it mean that it was too strong? Thank you.

Answer:

' '

Question:

My teenaged daughter has a persistent breakout of tiny acne along her jaw. Her dermatologist has used Isolaze to good effect, but is now following up with a series of mild glycolic peels (30%). She had her first today and now where each tiny acne lesion is, her skin is red (like pin point bleeding). She looks like she has measles. Does this mean that the peel is working or does it mean that it was too strong? Thank you.

Answer:

that is how it works, it needs to open the plugged pore or cyst to let the material inside out, it will all fade in time. All the best to her. JG 8.10.12

Question:

What do you think of Erbium laser??

Answer:

Milder improvements compared to CO2 laser. JG 8.8.12

Question:

What is the cost for your CO2 ablative peel? How long is the recovery? Thank you

Answer:

our fee is $4,200, all inclusive, and it takes 3 weeks before you can wear make up, will be red and then pink for 2-4 months. JG 8.7.12

Question:

Hi, Dr. Garcia. It`s me, the leopard-spotted lady from the Q-switched YAG for pigment. I wrote to you three weeks ago after I was treated and you kindly offered reassurance. Well, it`s now been 3 weeks and 2 days, and I would say that the spots have faded about 10-15%! I still look like I have a contagious disease. It`s terrible. How much longer do you think this may last? I`m assuming that this isn`t the case, but have you ever heard of these marks becoming permanent? Thanks again for your help. Spotted in Spokane!

Answer:

`the improvements should speed up now, but no way to tell how long it will take. I seriously doubt it will be permanent. JG 8.5.12

Question:

I have skin colored seborrheic keratosis, but they look warty. I read a dark pigment can be applied to the growth to help concentrate the laser light. Which laser or lasers could be used for this?

Answer:

my preference would be a CO2 laser, no color needed. JG 8.4.12

Question:

Dr. G. What do you think of foto facials and matrix resurfacing? Which is the best face peel that you would recommend? Do you have products that peel the face? You are my favorite doc! thankx

Answer:

I think foto facials are nice options for brown and red spots but it has to be done in a series of sessions and then continued to maintain the improvements. As to chemical peels, I like the TCA peels for the most part, they are done in physicians office though. As to the matrix resurfacing, or fractionated lasers, I am not a fan, I think the degree of improvement is small and there are still risks. We personally only use Retin-A as a prescription if there is an need for exfoliation, but we do not offer the peels like a MediSpa does. I wish you the best and thank you for the kind words. JG 87.23.12

Question:

Dr. G I had a blapharplasty about 3 years ago and under my right eye I have a small fat pad that is noticeable, Looks like I have a black eye sometimes. When I pull back the skin tight under my eye the fat pad is gone. What can be done to get rid of this without having another blapharplasty?? What about a peel to tighten under the eyes and if so what kind. Also someone told me Radiesse would help. Seems like when the skin is pulled tight under the eye the pad lessens, Please help.

Answer:

I think a filler like Restylane would be fine but the company thay sells Radiesse has specifically warned not to use it there.JG 7.19.12

Question:

Hi Dr G: What do you think of a TCA peel to tighten the skin under the eyes?

Answer:

Very short term result, it works for spots but not for wrnkles, once swelling is gone, wrinkles are back. JV 7.19.12

Question:

Hi, Dr. Garcia. I`m the person who wrote to you a few days ago about the dark red and purple marks left by a Q-switched YAG when I was treated for pigmentation. (It actually looks like Kaposi`s sarcoma.) Are those marks supposed fade or should they peel off? I ask because one of them seems to be peeling. I was under the impression that they would simply fade. Thank you so much for your encouraging words on Friday and for taking another question from me. Oh my, I am quite a frightful sight!

Answer:

Due to the energy applied, you will heal via both methods. Ideally it is just fading but it can blister in high energy sessions, sorry. JG 7.16.12

Question:

Dr. Garcia, I wrote to you some time ago regarding a small brown spot between my cheekbone and lower eye lid. The small brown spot has now turned into a small mole, which is slowly growing. What would be the best way to treat this as it is now becoming noticeable. I have had the Portrait in the past (would that be effective?)Thanks so much and regards from Aussie Land

Answer:

The best likely option would be to cut it out, a definitive removal and should heal well. All the best. JG 7.14.12

Question:

I`m freaking out a bit. I had pigment on my arms, hands face and legs treated today with a Q-switched YAG and I am covered -- actually covered! -- in angry, DARK red/purple spots. I`ve had this treatment before and had almost no response at all, so I was shocked to see this when I removed my goggles. My dermatologist said it will all fade in 7-10 days, but I`ve had lots of laser treatments, and to my eye, these things look they`ll be here for many months to come. I`m horrified. Ugh! And in the middle of the summer too. Terrible! How long do you think they`ll take to fade? (Type I skin)Thank you so much for being there for all of us. I hope you`ll have a great weekend, Dr. Garcia.

Answer:

might take anywhere from 1-3 weeks,the lower on the body, the longer it takes, probably not a good thing to treat spots with lasers or peels in the summer anyway. The reason you had it this time might be because of a stronger setting.Hang in there. JG 7.13.12

Question:

I am considering having my teen daughter do laser hair removal on her upper lip. I have contacted a reputable plastic surgeons office who does this and they said they use a Sciton laser. In your opinion,is this safe or viable? She has brown hair and lighter skin.

Answer:

should work well, I wish her the best. JG 7.13.12

Question:

Hi Dr. G, The only sunscreen my family and I have ever loved and didn`t mind using got discontinued! Ever since then, I have tried every brand out there and each is horrible. It feels like a vat of oil is on my face. Most leaves a white coating, and worse, pills! It makes me want to wash the whole thing off and go without, which of course, I can no longer afford to do. So ... you recommend a block instead of a sunscreen. Can you please share the names of some of the sun protection you would recommend that doesn`t make me look I fry food for a living? Also, if I appy sun protection, then foundation (where needed), doesn`t that remove some of the protection? Why is something even so straightforward as sun protection so complicated? Help! Thank you.

Answer:

I like Bullfrog sunblock and also the sunblock by Neutrogena Ultra Sheer Dry-Touch. We also sell some on my website, but it is always a trial and error issue as all patients are different from one another. As long as you apply the sunblock first, let it soak in and then apply your foundation, the protection should be there. I wish you the best. JG 7.9.12

Question:

Hi Doctor! What kind of YAG laser do you like for melasma on a Fitzpatrick IV skin type? Short pulsed, long etc...? THANK YOU!!

Answer:

Q-switched Nd:YAG. J 7.2.12

Question:

is there a downside to the laser genesis -if it doesn`t work that`s not a downside to me but can it hurt your skin ?thanks!

Answer:

the only downside would be the money you spent and did not get what you expected in return. Performed properly, there should not be any negative long term effects. JG 6.26.12

Question:

Just saw the question below about hair removal. I`m curious about this too. I`ve been considering buying the No No hair removal device. The hair grows back, so there`s no promise of permanent removal, but as I understand it, that`s true of laser hair removal too. In the long run, if they both only temporarily remove hair by damaging the follicle, then it would make sense to spend far less money on the No No and do it myself than to spend thousands at the dermatologist. Would you agree?

Answer:

I would go to the spa for a safer and more effective option. JG 6.9.12

Question:

For about the last 4 months I have been using a razor gently for the upper lip (near upper corners) for hair growth (mild mustache to the corners.. and red splotches have formed and havent gone away in these 4 months. I stopped the razor, and did yag laser last week and the hair growth has come back. Is yag something I need to keep up permantley? Should i just start doing waxing? What is the best thing for permanent hair removal? And will the splotches go away? thank you so much!

Answer:

I might need to be done a number of times at first and then the frequency will likely be able to be reduced or eliminated with time. Waxing can cause redness too as can electrolyisis. Laser hair reduction might be an option or you can use Vaniqa, which is a cream that is applied daily to control the hair growth, but when you stop, it comes back. There is no true permanent hair removal, just reduction. companies claim it but it is not true. JG 6.2.12

Question:

Hello, I`m 38 and only in the past 10 years have I ever had freckles and uneven skin tone with sunspots on my chest and shoulders, i believe due to a few very bad sunburns. I`ve had laser treatments and peels to remove some of the spots, but left me with a few spots of loss off pigmentation. I was wondering what you might suggest to improve and even skintone. Laser resurfacing? Is there any way to get back to the way my skin tone was originally? Thanks for your help, i`m very uncomfortable with the way my skin looks.

Answer:

I am sorry but I do not know of any safe, reliable ways to repigment the skin that has lost pigmentation. JG 5.28.12

Question:

My teen daughter is going to have laser hair removal on her upper lip. I don`t think she would tolerate electrolysis . She has medium brown hair and light to medium skin. Should it wait until fall when there is less sun exposure or does it matter? Also I am nervous about discoloration. Should I test in in an inconspicuous area first before doing it on the upper lip? Is there a certain laser that would minimize this risk? Thank you so much!!! You are so wonderful to provide this help!!!

Answer:

I do think avoiding sun after the treatments is a very good idea, so the fall or winter might be better. Testing a spot on a different part of the face will not predict what would happen on the upper lip, but the chances of pigment change on the upper lip, if done by an experienced person, should be small. All lasers, if done properly, should be pretty safe. An Alexandrite laser is a good choice for hair removal. JG 5.28.12

Question:

Hi Doc! I am a Fitzpatrick Type IV and want to get the Qswitched YAG laser for melasma. I have tried areas before with it and have lightly scabbed and then the scabs fell off after 5 days-is that what should happen? Or is the setting too high?? Also, since my face is very uneven with melasma and a bit of hypopigmented skin and normal skin.... 2nd QUESTION is this: If I laser my whole face with the YAG should the whole thing scab? And also, will I hypopigment in the areas that are done that don`t have melasma? How could it possibly get even toned? THANKS SO MUCH! :)

Answer:

Very difficult problem, the peeling skin is common with normal settings. I think the areas of lighter pigment would likely get even lighter with the YAG if done to the whole face. Also, in time, most of the color will slowly come back, it is not a permanent effect. JG 5.26.12

Question:

Hi Dr Garcia I am wondering about smartxide dot co2 fractional resurfacing. Firstly is it recommended for ethnic skin acne scarring and general laxity in the nasolabial area and some fine lines showing up on my forehead... I cannot tolerate Botox. i am middle eastern skin type 4 on the fitz table. Do u offer this procedure or similair? what are your thoughts

Answer:

I do not offer that procedure, I do not think it will help with the laxity in the nasolabial fold, I think it has a risk of hyperpigmentation and the development of brow spots on your face and I think the improvement of the fine lines on your forehead will be mild and relatively short lived. JG 5.25.12

Question:

Hi Doc! I have melasma and have had two laser treatments in the past.(5yrs ago) The first with a Q-switched Alex laser and then two more with a YAG laser. I do hyperpigment from the laser but not if I start using HQ right after healing. My question is this... I now have more melasma elsewhere and the area that was lasered years ago is lighter than the melasma areas with small spots of hypOpigmentation. It is very uneven. One derm suggested the Alex & YAG combined laser. What is your opinion of this laser? And your opinion of the Alex and Yag separate? I am Jewish and Moroccan but get pretty light skin in the winter and can tan easily in the summer(but don`t). Dark hair & eyes...But still yellow undertones. And lastly, would you just laser the dark areas of the face and not the skin that is melasma free. I feel as it would be hard to blend. One doctor mentioned Fraxel but I said NO due to your advice to others on the topic. I would love to fly to see you in your office but is it something that could be done in one treatment? THANK YOU, THANK YOU!! You are amazing for taking the time to do this.

Answer:

I think the Alex YAG combo is fine, but I would start the hydroquinone 3-5 days before and continue post laser along with sunblock. I would treat the entire surface too, not just spots. All the best. JG 5.18.12

Question:

Just saw your reply to the other person about VBeam to the legs. I had it done today and--oh my!--what a mess I am. Will compression stockings help speed along the healing and the fading, as they do for sclerotherapy? I look like I was attacked by a lion -- and just in time for summer too! Very pretty. LOL!

Answer:

Compression won`t do much, just a matter of tome, maybe arnica. JG 5.16.12

Question:

I had some spider veins in my legs treated with a VBeam 4 weeks ago, and I`ve still got dark red/purple marks on my legs. Is this to be expected? How much longer are they likely to hang around? I`m white, by the way -- very, very white! Thank you for your generous help.

Answer:

on the legs, yes, pretty common with VBeam on the legs. Might be there another 3-4 weeks, hang in there. JG 5.16.12

Question:

Hi, I have hypopigmentation on certain areas of my face as a result of Profractional laser. Is there anything that can be done to restore color?

Answer:

if it is true loss of pigment, then sun exposure might help, if it looks lighter because the surrounding skin is still darker form prior sun damage, then the darker under treated skin needs to be treated to remove its sun damage. JG 5.15.12

Question:

Hi Dr, I wrote to you in March regarding dents and small indentations which appeared on one side of my face a few weeks after IPL (administered by a dermatologist) in January. With time, there has been no improvement in these marks, which are easily seen. Is it likely that these are permanent scars now? Also, do you have any tips/suggestions on what I should do next or if there is any miracle cream etc etc? Thanks.

Answer:

the longer you go without it improving, the greater the chance there is either fat loss or scarring, yes. Might need a filler if it is fat loss , hard to suggest options for scarring without seeing you in person though. No miracle creams though, sorry. JG 5.14.12

Question:

In the past two years I had a series of dot laser. The first was a light one and no problems. The last two which were six months apart were aggressive. He went particularly hard on the upper lip area wrinkles. It is a little bit lighter than the surrounding area. Problem is I can`t tell whether it is hypopigmentation because the surrounding area got hyperpigmentation which I am using over the counter bleach cream on. Should I be using stronger bleach cream on this area? Also, I am beginning to think I wasn`t a candidate for this afterall. Although I am green eyes and dark blonde hair, my mother was half African-American. My father was blonde and light skinned. Is it your ancestry that determines whether you have laser or what you look like? Thanks so much.

Answer:

I would start with getting some prescription strength hydroquinone and Retin-A and mixing them together, then apply them to the darker skin to see if you can lighten it. It is most likely that you have removed the sun damage to a greater extent in the aggressively treated area and you have a relative loss of color but not true hyper or hypopigmentation. The best way to determine if it is OK to use ablative lasers is to tell your doctor how you react in the sun, if you get a deep dark tan, even if red initially, then the risk factors go up, no matter what you parents looked like. I wish you the best. JG 5.9.12

Question:

Dr. Garcia, I know you`re not a fan of fraxel lasers. Do you like the newer ones any better? ie; Fraxel Dual 1550/1927. Thank you.

Answer:

nope, just as ineffective in my view, unless you want really mild improvements for a relatively short period of time. JG 5.9.12

Question:

I am 45 years old, very fair, minimal sun damage due to use of sunscreen but have noticed some skin textural changes and fine lines on my face, neck and chest. Currently use Renova. Derm suggested fraxel (I asked about a TCA Peel) and said I am too young for TCA. I am put off by the high estimate for fraxel treatment. Any suggestions for the best type of peel or laser treatment for these areas? Thank you.

Answer:

I do agree that the TCA is not for you, but I think it is because the TCA peel is good for discolorations, and does little for fine lines past the period of swelling. I do think lasers are better, but with the fractional or pixelated lasers, you can expect 6-18 months at most, depending on high the settings were. Stronger laser settings can give longer periods of correction but also longer healing times. Nothing will stop the aging process, all we can hope for is reversal of some of the damage and understand that the skin will age again. I do agree that the prices being charged for Fraxel can be high, especially when one takes into consideration the length of time the improvements will last. Wish I had something simple and reliable for you. JG 5.2.12

Question:

I had a phenol peel around my mouth five weeks ago and am still very, very red. What would you recommend to help with redness?

Answer:

there is really not much that I would do right now except let it heal, more treatments will irritate things, and avoid cortisone cream on it too. It will get better over the next few weeks. Avoid warm temperatures and spicy food too. JG 4.27.12

Question:

hi Dr.Garcia,3 months ago I had facial vein removal with the Cutera coolglide.The nurse lasered me in areas where I had no spider veins.I have indents that are deep around the nose and imprints that are not as deep in the shape of the laser head.I have seen 80% improvement in the last month.Would Revlite laser treatments,copper peptides ,and retin a fill in the deep areas faster?Will the laser head imprint areas disappear completely ?thanks

Answer:

I think it best to let it get better on its own, I think trying more things can delay the healing at this point. In time the head imprints should fill in on their own. I wish you the best. JG 4.24.12

Question:

Hi Dr. G. What is the best option on the market today for skin tightening (face, neck and body) and for treating cellulite? Thank you for sharing your knowledge.

Answer:

CO2 lasers for the face, nothing except surgery for the body, and for cellulite you can try endermologie or Cellulaze, but neither is permanent. JG 4.21.12

Question:

Hi Dr. G. For cosmetic varicose veins in the legs, especially calf areas, do you recommend laser instead of injections? I have had many sessions of injections and don`t find them terribly effective. That is, not only do the veins return (I assume this would be the same with laser) but there is a long period of brusing and worse, discolorations. Is laser more, the same or less effective? Thank you.

Answer:

Lasers are less effective than injections, sorry. JG 4.21.12

Question:

Hi Dr. Garcia, I used retin-a and hydroquinone and had a series of 6 PCA peels at the medi spa. Though I am happy with the lightening of my melasma, the process was a real pain in the buttocks. Next time I need a melasma tune up, could I get the same results by pre-treating with HQ and tretinoin and having just 1 or 2 TCA peels from a plastic surgeon like yourself?

Answer:

yes, that is certainly a possibility. Best of luck. JG 4.19.12

Question:

Dr. Garcia, can you explain how chemical peels help the skin? I recently had a three layer peel with high concentration of lactic acid as well as retinol and my skin literally feels frozen and extremely tight. There is some peeling around the nose and mouth. I am suppose to have 2 more, but am afraid I might be doing more damage than good.

Answer:

the act as a deep exfoliation of the skin to remove superficial pigments, remove the excess keratin waxy layer of the skin, and cause a minimal amount of new collagen formation. The skin has to be injured wit the chemical and then it will peel off revealing the newer skin cells. What you are describing is expected in many chemical peels.Properly done, they are safe. JG 4.18.12

Question:

I have used hydroquinone and retin-a daily throughout a series of 6 PCA chemical peels to treat melasma. I am pleased with the results. However, my skin has become irritated from the hydroquinone. How often do I need to use the hydroquinone to maintain the results?

Answer:

once you are healed and faded, the hydroquinone can be stopped, as long as you are using sunblock. The irritation might be from the Retin-A too, though, and that can be stopped also. JG 4.17.12

Question:

Hi Dr. Garcia, Some very mild rosacea has left me with a few visible red vessels/broken capillaries on my upper cheeks. What is the best treatment for this? How many sessions would it take?

Answer:

I would use an IPL or a Nd:YAG laser, but I cannot say how many sessions it will take as everyone is different. The treatment will also not yield permanent results, they will come back in time. JG 4.16.12

Question:

Hi Dr Garcia, I had Mixto SX microfractional laser done 10 days ago. Now after reading your comments/opinions about fractional lasers, I wonder if I wasted my $3200.Can I expect any improvement? I haven`t seen the Mixto mentioned here. Thanks, Mary

Answer:

It takes about 4 weeks to even start seeing new collagen formation, and that continues for about 3-4 months, whether you have wasted your money I guess depends on how dramatic of a result you were expecting and how long you wanted to last. It will have some mild improvement for about 6 months, maybe a little more, and after that you will get back to what you looked like before. JG 4.16.12

Question:

Hi, Dr. Garcia. My dermatologist has been chasing with lasers dilated capillaries in my cheeks for years. They popped up after steroid was injected there for scars -- a really bad idea, by the way! I`m Irish and extremely fair, so the redness was really visible. Anyway, a few weeks ago, we decided enough was enough, so he set the parameters on the VBeam as high as he could to produce purpura in the hopes of resolving this problem. Well, my face didn`t bruise in a purple tone but in a DARK black and the swelling was just unbelievable. I couldn`t open my eyes for an entire week and then just had slits for eyes for another week. But I was willing to endure the extended downtime if it would get rid of the red blotches under my eyes. So now the bruising has resolved and the swelling is (mostly) gone...BUT I`ve been left with BRIGHT red skin on my cheeks and under my eyes where I had the treatment and a bunch of wrinkles I never had before. (I look like I have been scalded by boiling water.) Make-up can`t cover the redness (even make-up with a green tint), and even if it could cover the redness, it just gets stuck in all the new lines/creases/wrinkles that I now have. I saw my derm on Friday and he said that while he`s never seen such a dramatic response to the VBeam before, what I have a very serious case of inflammation. He predicts it will resolve in 2-3 months. 2-3 MONTHS??!! Yikes! So I`m writing to you hoping you will offer me some consolation and tell me that my derm is right, this is just inflammation and not permanent. If he is right, do you agree it will take 2-3 months, or is it likely to get better before then? Or God forbid, is it likely to take longer than 3 months? Also, if you think he`s wrong and it IS likely to be permanent, I need to know that now so that I can start adjusting emotionally to this. Finally, any suggestions for making it a little better, whether it`s temporary or permanent? My derm said there`s nothing to do but ride it out. My job puts me in the public eye constantly, I had to return to work this week and spent most of my days offering explanations to alarmed people. I am frightening to behold. Thank you so much, Dr. Garcia, for your time, generosity and expertise. May God bless you.

Answer:

I do not think it is permanent and will get better in time, I think it will take time to get better, but no way to tell how long. Although I think stronger treatments are needed at times, the dilated veins are never able to be removed permanently, the treatments need to be strong enough to decrease them balanced with low healing time. Hang in there and I wish you the best. JG 4.15.12

Question:

Is a diode laser the same as an IPL laser? I heard that IPL laser can cause fat loss. What about diode lasers for hair removal?

Answer:

IPL is not a laser, it is a filtered pulsed light, much weaker than laser and does not cause fat loss. There are diode lasers that work for hair removal, but not all diode laser are the same. JG 4.14.12

Question:

Happy Friday, Dr. Garcia!A few years ago, I had a surgical scar on my face treated with Fraxel Restore and it made a HUGE difference. What a great technology! I`m about to have two pre-cancerous lesions excised right in front of my eat and on my lower back. How long after the sutures are removed can I have this laser treatment? Will it work as well on my back as it did on my face? Thank you. Have a great weekend!

Answer:

I would wait 4-6 weeks to allow them to heal a bit. I do not think it will work as well on your back as on your face, sorry. All the best. JG 4.13.12

Question:

What great news about the Medlite ND YAG tx for the dermatofibroma! Can you please tell me the parameters you would use so that I may give them to the technician at the PS`s office? (The surgeon doesn`t use the lasers very often and wouldn`t be of much use if the technician consulted him on this.) I have Fitzpatrick Type 1 skin. Thanks ever so much.

Answer:

well, you would treat it like melasma. I will be honest with you, although the technician is the one performing it, they do it under the supervision of the doctor, otherwise they would not be able to do it. if the supervising doctor is not well versed in using the Medlite laser, I would seek out a different location to have the sessions done. JG 4.11.12

Question:

Hello Dr. G., Regarding Cellulaze, even though you don`t offer the treatment, do you think it works? Thank you for your professional opinion.

Answer:

well, it is FDA approved, but until I see long term results, I will not believe the claims. There are things that help with cellulite, but they are very short term. JG 4.12.12

Question:

Hi Dr., How does Cellulaze work and is it effective? Would you happen to know the price range? I know it depends on geographic areas but I was just looking for a range. Thank you!

Answer:

it attempts to break the connections of the skin to the deeper lasers, small incisions are made to place the instrument in, I do not offer the procedure, nor plan to so I cannot tell you the price. Sorry. JG 4.11.12

Question:

I am 9 days post phenol peel around my mouth. I used eucerin for 7 days. I have since bought squalene oil and Neocutis bio-restorative cream. The PS is telling me to use hydrocortisone cream 2x a day for 3 weeks to help with extreme redness. Should I use the squalene and Neocutis...wht will help reduce redness faster?

Answer:

The redness you have will not be helped with topical steroids, I suggest the NeoCutis and squalene. JG 4.5.12

Question:

I had a phenol peel around my mouth. The PS said I could not use sunscreen for 6 weeks. However, he said I could use Dermablend cover makeup to try and cover the redness, which is terrible. I am 9 days post peel. The Dermablend has SPF 30 in it, which I told him. Does that make sense...no sunscreen but can use makeup with SPF30? Thanks for your help.

Answer:

I feel if you are healed enough to use Dermablend, that I would say put the sunblock on first, wait ten minutes and then apply the Dermablend over it to get better sun protection. JG 4.5.12

Question:

When you answered the light sheer laser might result in reduction in hair, doesn`t that mean some hair is permanently gone since you will not have as much hair? I often hear women say they never have to shave again because they had laser hair removal. Doesn`t this mean it is permanent hair removal?

Answer:

not always, at times, the growth rate is slowed or the thickness of the hair is reduced so it is thinner, but it does not mean that the hair will be permanently gone. Some areas of the body respond better than others, the faster the hair grows back in an area usually means the harder it is to reduce or eliminate it. I think some women will have some permanent, loss, but not all will have that. Here is the simple way to think about it. Ask the person who will do the treatment if they will treat you forever for free if the treatment does not permanently remove all of the hair and see what they say, they are the believers, so lets find out the degree of their belief. JG 4.4.12

Question:

How long is the recovery for a co2 peel. I have read on your site that you feel this peel gives the best results for aging skin. I am a fitness instructor and would need to take enough time off to sufficiently heal. Thank you

Answer:

2-3 weeks before make up and as you overheat and sweat, the make up will fall off for 6 weeks or so. Your skin will be pink for 2-3 months when working out. JG 4.1.12

Question:

My tattoo has had a scar since I first got it because the tattoo artist dug so deep in my skin. Does having this scar tissue affect the laser tattoo removal process?

Answer:

Should stlll be effective. JG 4.1.12

Question:

When I google copper peptide cream so many different ones come up. Which would you recommend after a phenol peel and where is a safe place to buy it? Thanks very much.

Answer:

Neocutis Bio-restorative, on line is OK. JG 3.31.12

Question:

Will eucerin cream do the same as copper peptide after a phenol peel? I am 4 days out and was told to use eucerin for 7 days. I have squalene oil but no copper peptide. Should I switch to the squalene now?

Answer:

Eucerin is OK, once the superficial skin has healed. JG 3.31.12

Question:

What do you recommend for treatment after a phenol peel...what to use and how long?

Answer:

NeoCutis for about 2 weeks, then squalene. JG 4.1.12

Question:

What do you recommend for treatment after a phenol peel...what to use and how long?

Answer:

Copper peptide cream for 2-3 weeks, then squalene oil until healed. JG 3.30.12

Question:

I had a full face phenol peel about 2 years ago. We did not get the result around my mouth that we hoped for so the PS re-peeled around my mouth and chin at no cost. I am 3 days out and I do not remember the skin being this purple! Will the color blend with the rest of my face and how long before the redness fades? Any suggesstions for getting rid of the red faster...what to use? Thanks so much.

Answer:

how well the skin will blend depends on how deep the peel goes, and it is not uncommon to have some purple or blue discoloration at this point during the healing process, that will get better. Redness will fade on its own, and it is best to let it fade on its own rather than doing things to treat the redness as that can prolong the healing. I think it is just a mater of time, just avoid any skin irritants, like retinols or glycolic acid washes and creams. I wish you the best. JG 3.30.12

Question:

Will vasculight IPL make melasma worse?

Answer:

It can for the first few days or long term if head is not used properly. JG 3.29.12

Question:

So which IPL machine is best for redness?

Answer:

The difference between brands is minimal, none are great for red, effects are short lived. JG 3.29.12

Question:

Is the vasculight IPL better for redness/small veins or is it better for brown spots/melasma?

Answer:

brown spots.JG 3.29.12

Question:

Hello Dr. Garcia. My friend had an erbium fractional ablative and non-ablative re-surfacing done 6 days ago. The swelling has gone down and her face is pretty much back to normal, but the wrinkles in the areas where the doctor went a little deeper actually look more pronounced, especially above her lips. Is this temporary?

Answer:

All pretty normal, will take time to see the improvement. JG 32.12

Question:

Dr. Garcia, I had ipl done last week for brown and reddish brown spots. Seems to work well on the brown only. Is there another ipl that would work better? I read something about the sciton broadband. Are you familiar with that one? Also I`m just curious,how did you decide to create this blog-it`s extremely generous. Again,thank you.

Answer:

At times they have to use a different filter head to target the red better than the brown,and it will take a series, not a single session. Atso other ipl machines, they are all about the same. As to the blog, I learn as much as the patients do from it. All the best. JG 3.27.12

Question:

Hello Dr., I am always confused about all the various potency of Arnica tablets. I never know what strength I should buy. I bruise easily and other than avoiding aspirin, alcohol, etc., what can I do to prevent or minimize how bad and how long the bruise will last? How many tablets of Arnica should I take, and for how long before a procedure. Just looking at a needle makes me bruise. Thank you as always.

Answer:

I use Hylands Arnica Montana 30X homepathic dose, 4 tablets 4 times per day. JG 3.26.12

Question:

Dr.Garcia, Do you think numbing creams affect the outcome of Ipl treatments for redness and brown spots?

Answer:

Should have no effect. JG 3.19.12

Question:

Dr. G, Have you heard of Nectifirm cream, and does it really work to help the appearance of the neck skin? Also, what do you think is the best option available for (1) tightening body skin and (2) cellulite. Thank you as always.

Answer:

Nectifirm might help small wrinkles and fine lines but will not tighten skin. There is no reliable way to tighten loose skin of the body except surgery and as to cellulite, I suggest VelaSmooth, endermolgie or CelluLaze. JG 3.19.12

Question:

Hi Dr., Have you heard of CelluPulse, and does it work to improve on cellulite? Thank you for sharing your knowledge.

Answer:

I have not been impressed with the results once the swelling goes down. JG 3.18.12

Question:

Hello Dr., What is Ulthera and does it work to tighten skin? Thank you.

Answer:

it is a method of heating the skin with ultrasound waves in an attempt to tighten loose skin. It is uncomfortable to have done and the results in many patients last 6 months or less. It can cause fat loss too.JG 3.18.12

Question:

I had VBeam on my legs for spider veins and some matting 2 weeks ago. The treatment areas are still red and dark purple. It looks like I drew blotches on them with a Sharpie marker! How long does it take for bruises on the legs to fade? I`ve had VBeam on my chest, next and face before and never had this kind of reaction. Thank you very much.

Answer:

It can take 3-6 weeks on some patients, especially on the legs. JG 3.16.12

Question:

I know you don`t think much of Fraxel, but I wonder if you agree with my dermatologist who says that the nonablative (Restore) version of it promotes the skin`s health. Is it prophylactically helpful for texture and tone? I`m scheduled to do a series on my hands. (I`ve checked your archives and see that you don`t advise ablative lasers for the dorsum of hands, but are nonablative OK in your opinion?) Thank you, Dr. Garcia.

Answer:

I see mo way that any laser is prophylactic in any fashion, they all work by creating damage and then healing, that is therapeutic, not prophylactic. As to nonablative lasers off the face, I fear you will be disappointed, sorry. JG 3.11.12

Question:

Good morning, Dr. Garcia! My aesthetician--who obviously stands to gain financially from this! -- tells me that light peels (like the VI Peel and SkinMedica`s Rejuvenize) done every 8 weeks or so improve skin`s health and are worth doing regularly. Your thoughts? Also, I see you answer some general health questions, so I thought I`d ask one for my sister. She`s trying to lower her triglycerides, and in addition to following a low fat diet, her doctor recommended Alli, which evidently prevents about 25% of any fat consumed from being absorbed. She is wondering if taking two pills instead of one with each meal will prevent about 50% of any fats consumed from being absorbed. Thank you for your help. Have a beautiful, restful weekend!

Answer:

I think some level of exfoliation helps, the older one is the more it is needed. As to how often it is required, it depends on how fast your skin is aging. I think every 8-12 weeks OK, if needed. As to the Alli, I think you will get more diarrhea and abdominal cramps with a higher dose. All the best. JG 3.9.12

Question:

Hi, Dr. Garcia. I had a VI Peel last week. My face and neck peeled and healed nicely, but my chest is a raw, red, itchy mess. Topical cortisone and squalene oil aren`t helping. Other suggestions? Is this likely to leave scars? How long does it usually take for the chest to heal? Thank you so much!

Answer:

might want to use some copper peptide creams, unlikely it will scar though, that area just takes longer to heal as it does not have as many sebaceous glands and hair follicles as the face does, and that is where the healing comes from. Might be another week or so I am afraid. JG 3.7.12

Question:

Dr.Garcia,are Cutaneous depressions from laser vein removal permanet or temporary?Do they fill in?thanks

Answer:

They usually fill in over time. JG 3.6.12

Question:

thanks Dr.Garcia. It`s so nice of you to answer all these questions. God bless you!Denise

Answer:

You are very kind. JG 3.3.12

Question:

thanks Dr Garcia for your quick response. You said the indents would heal.Did you also mean the imprints from laser too?thanks,Denise

Answer:

Yes, those also. JG 3.3.12

Question:

hi Dr.Garcia. I had coolglide laser treatment for facial veins 5 weeks ago. I developed clear blisters shortly afterwards.No burning or pain.Turned into impetigo.That cleared up.But now I seem to have a imprint of the head of the laser in the areas where I was lasered.Especially around the nose.Some areas are indented that don`t look like the laser head,but are where the veins were.Will these go away?I`m scared.thanks in advance.

Answer:

the indentations should get better with time, it is just surrounding swelling. JG 3.2.12

Question:

What care do you recommend after a phenol peel?

Answer:

Squalene oil or Neocutis, sometimes a copper peptide cream. JG 2.28.12

Question:

How soon after a phenol peel can you wear sunscreen?

Answer:

As soon as the epidermis is intact, your doctor can tell you in your case. JG 2.28.12

Question:

What is the difference in keeping the Neocutis High Protein cream on your face after a chemical peel or just using eucerin?

Answer:

I feel the NeoCutis has healing factors that will help you heal faster. JG 2.28.12

Question:

What is your opinion of the ultherapy treatment?

Answer:

I am not a believer. JG 2.26.12

Question:

What is your opinion of the ultherapy treatment?

Answer:

Painful, not as dramatic as advertised and not as long lasting as advertised. JG 2.26.12

Question:

You recommended Neocutis High Protein after a phenol peel...which one, where do you get it and when do you start it?

Answer:

Google it amd you can purchase them online. JG 2.26.12

Question:

I thought broken blood vessels and cherry spots were the same thing or the same treatment could work for both, but the laser tech said the Gentle YAG was one for the broken blood vessels?

Answer:

A YAG laser works well for red, as to the Gentle YAG, they just have to use enough energy. JG 2.25.12

Question:

I know the Gentle YAG laser is good for broken red capillaries. But is it alos good for red cherry spots? Do the same red capillaries come back after some time?

Answer:

It should help when done in a series. JG 2.25.12

Question:

Dr. Garcia, 3 days ago I had a mild TCA peel around the liplines upper and lower. She went really mild due to the fact she wanted to see how my skin would react. She said it would take a series of TCA peels (stonger percentages)) to reduce the lines and soften them but could not promise they would be erased. After they are softened up do you think a fraxel laser would help or should I just get a filler? What filler would be best of that area? Thanks.

Answer:

I think you are wasting your time with TCA peels for wrinkles, better to just go with the Fraxel. JG 2.25.12

Question:

Hi Dr., Would you happen to know when the Cool Sculpting folks are expecting to come out with the head for the arms? If not, how can I stay current on developing news so I can find out? Thank you. You are so wonderful to share your knowledge with all of us. God bless!

Answer:

Unfortunately, I spoke to them 2 weeks ago and they told me the small heads are back on the shelf and not in the approval process yet. Sorry. JG 2.23.12

Question:

Well, here`s a new dilemma for you, Dr. Garcia! Last week, I was finishing a SkinMedica Rejuvenize peel, stretched out on the table and cooling off, when a vial of pigment for permanent make-up, which was on a shelf above the table, fell down (when someone in an adjoining office closed a door too firmly) and scattered its contents all over my face. The aesthetician couldn`t wipe it off with saline, so she scrubbed my face with alcohol to prevent the pigment from staining my skin. She claimed that because the chemicals in the peel had already absorbed into my skin, the alcohol couldn`t wipe them off or dilute them; in fact, she told me I would get a better peel because the alcohol would act as an additional drying agent. Does this sound right to you? One week later, and I haven`t peeled at all. I know that some people don`t peel that much, particularly if their skin is already exfoliated (as mine always is from Retin-A), but I`m wondering if these folks owe me another peel. What do you think? Thanks so much, Dr. Garcia!

Answer:

I know of no medical reason why a drying agent like alcohol would make any peel better if applied after the peel is done, before to degrease the skin, maybe, after, no. Not sure they will give you another peel though because, as you said, although its called a peel, peeling does not always go with it. Sorry. What was a vial of permanent makeup doing open on a shelf anyway?!JG 2.21.12

Question:

Hi Dr. G., I have had leg vein treatments but of course, they come back. While they are not major, I was wondering if I would have better results with laser vs. injections? What are the advantages/disadvantages of both treatments? Is laser more expensive? Thank you!

Answer:

I believe the lasers are no better, and in some cases worse than the injections, due to the heat and potential scarring. Laser costs about the same, but neither one lasts any longer than the other. JG 2.20.12

Question:

The skin on my hands are so thin and wrinkly - what fillers-lasers would help????

Answer:

I personally think lasers on the hands are risky. As to fillers, the ones like Juvederm will last a very short period of time and I have seen granulomas with Sculptra and Radiesse injections. Sorry. JG 2.17.12

Question:

Regarding treatment after chemical peel, what are the non-petroleum based creams you use and for how long? Where do I get squaline oil? Does anything take the red away faster and do you recommend stopping vitamins, fish oil, etc. before? Thanks so much.

Answer:

we like NeoCutis High Protein, the squalene can be purchased at any large health food store. The redness is a matter of time, for sure do not use any steroid creams.I do not have the patients stop their supplements prior to a chemical peel.All the best. JG 2.16.12

Question:

What do you recommend doing before and after a phenol chemical peel to get the shortest recovery....what to use after.?

Answer:

Retin-A and hydroquinone for 2-4 weeks before, after use the ointment the doctor gave you until the surface is healed, we use non-petroleum based creams, and can switch to squalene oil once skin is intact, as a moisturizer, also sunblock after skin is healed. JG 2.16.12

Question:

Good evening, Dr. Garcia. I am undertaking a series of Skin Medica peels. For optimal results, the aesthetician in my plastic surgeon`s office is recommending doing them every 2 weeks. Does that sound like the right amount of spacing to you? Thank you for helping to keep us all safe.

Answer:

2-3 weeks is common. JG 2.14.12

Question:

Is it OK to use the Pearl laser on the hands for improvement of diffuse pigment? I hear it`s not that powerful so I`m wondering if it will be effective. I assume it`s safe, right? (I am white, extremely fair, British descent.) Thank you.

Answer:

I think any laser that causes skin sloughing cam lead to problems on the hands. JG 2.14.12

Question:

Hello Dr Garcia I am a 44 years old and I am trying to keep from going under the knife, I am beginning to see some little signs of turkey type loose skin in my neck and I was wondering what you thought of excillis for tightening and fat removal. I have read that if given enough treatments that it might help with this problem and if not what you recommend, cause I am willing to do maintenance type procedures. Should I stick with the palomar fraxel try excillis, I dont want to waiste money. Thanks so much in advance.

Answer:

I am unimpressed by the results I have seen from that technology. I think the Palomar Fraxel will also yield little once the swelling is down. I personally do not feel there is much non-invasive on the neck that yields enough of a change to warrant the expense. JG 2.14.12

Question:

Morning Dr. Is it safe to do an IPL after completing surgery and a round of penicillin. Am 3 weeks post op hysterectomy... Had a UTI. Thank you.

Answer:

should be OK to proceed, yes. JG 2.13.12

Question:

I had a chemical peel and the PS did not get the result we were hoping for around my mouth. He want to re-do. I do not want to go through that recovery again....is there anything that will give the same result/

Answer:

If the issue was wrinkles, I am afraid the answer is no. JG 2.12.12

Question:

Good Morning Good Doctor! Well, after all the worrying and freakin` out about doing the 25 %TCA on my face, so far, kinda dissapointed. I did it last Thursday and only have a little flaking. The TCA was at least 4 years old, does it lose its strenght? I still would like to improve the wrinkles and remove the 2 `OPS`s (olp people spots ha, humor). What is effective and safe when it comes to peels? My husband is worried that I will end up with thinner and thinner skin. When can I give it another try? Thanks so mucha as always and stay warm! Also, Happy Valentines Day

Answer:

typically chemicals are good for 1-2 years, less time if they are made by a compounding pharmacy.I think seeing a physician for a deeper TCA peel or a laser would be better. It is not uncommon to require a series of sessions though. JG 2.12.12

Question:

is there any laser treatment that will tighten up a slight loosness in the neck area under the chin?

Answer:

In my opinion, no. JG 2.5.12

Question:

I had a Peal (Cutera) laser treatment at noon today. It is now 10:30 PM and I can still smell the burnt flesh; it`s a distinctly acrid scent. Is this normal? My skin originally blanched but it`s now red and has raised dots all over it. Is this OK? Thank you!

Answer:

It is normal and as the charred skin. exfoliates, the smell will go away. JG 2.5.12

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

Which is stronger? a combo Lactic(35%)/Glycolic (25%)acid or a 8% TCA acid? Thank you

Answer:

pretty similar, maybe the combo is a bit more. JG 8.2.11

Question:

I think I have the same problem as the person who wrote to you this weekend. Last year, I had Fraxel Repair and it left the skin on my cheeks and forehead sort of wavy and rough. I saw another plastic surgeon about this recently and he said pretty much what you did in reply to the person who wrote. However, he thinks he can repair it with Total Fx, which is another fractional ablative laser. He doesn`t do full CO2 because of the risks of scarring. Do you think it can be improved with another fractional laser or am I risking only making worse if I go to him? Thank you very much for your generous guidance.

Answer:

As you can now see, partially ablative or fractional lasers have risks too.In my personal opinion, I think the Total Fx will disappoint. There will be some improvement in some areas and not in others.Wish I could agree with the other guy. JG 8.1.11

Question:

Medlite has a new laser specifically for brown pigmentation that my dermatologist is testing and considering buying. It`s presumably much more powerful and effective than previous laster available to address pigment. Do you know it? If so, what`s your estimate of it? My doc seems pretty impressed by the literature and by the clinical results he`s seen in the trials. He`s asked me to be a model for his staff`s training, which I`m thinking of doing. Thank you, Dr. Garcia.

Answer:

No experience with the new one, but I own a Medlite and think they are a good company. JG 7.28.11

Question:

Hi Dr Garcia: I am the one that asked you about the time between erbium and ipl, the doctor told me the erbium was superficial, and just one spot, i mean, not one over another, so, do you think that i can have ipl 20 days after, just to have an idea...

Answer:

should be OK, yes. JG 7.27.11

Question:

Hi Dr Garcìa: How long do I have to wait between an erbium làser for large pores in my nose and an IPL for small broken capillars, I already had an erbium yesterday and I have an appointment for IPL in August 15 can i get it without problems or do I have to wait?, is not too much the treatment that they give me, are small zones and deepness and not frequently. An the other question is if it is not dangerous or bad for the lasers because i have nose surgery?

Answer:

There is no effect on your nose with the lasers. As to the IPL after an erbium, its OK once healed but I cannot say how many days as it depends on how deep the erbium was used to. JG7.26.11

Question:

Is the Q switched Nd Yag laser the same as the Alexandrite? My dermatologist has an Alexandrite laser. How many sessions does it usually take to get rid of the hemosiderin stains? Thanks again for your help!

Answer:

no, they are different, the Alexandrite will not be as effective for the hemosiderin I feel. No way to predict how many sessions as there is no way to tell how fast you will break down the stained particles, sorry. JG 7.15.11

Question:

Saw your note below about laser treatment for hemosiderin staining. I have that on my legs from fat injections last year. What laser should i ask my dermatologist to use and at what settings? (I am white, very fair-skinned.) Thank you, Dr. Garcia. Have a great weekend.

Answer:

I prefer an Q-switched Nd:YAG for that problem. Settings will change from session to session depending on how you respond, always good to start slow. Best of luck. JG 7.15.11

Question:

Would you perform a a totally ablative CO2 laser on caucasian skin? Does totally ablative mean 1 pass? I am not sure if korean brand of laser requires 2 passes if it is weaker machine.

Answer:

yes, on Caucasian skin, yes, but Asian skin is too prone to reactive post-inflammatory hyperpigmentation. Totally ablative means that the entire skin surface is removed, that can be done in a single pass, or in multiple passes if one is using a fractional or pixelated laser. JG 7.11.11

Question:

How do I know if a laser is as effective as the full CO2 laser for facial resurfacing? I am having a laser procedure done in Korea, but they do not have any American brand lasers.

Answer:

hard for me to say, although I personally would not perform a totally ablative CO2 laser on Asian skin. JG 7.11.11

Question:

For CO2 laser skin resurfacing undereyes, how many passes are required for original CO2 laser? Or how many times do you hit a spot with the laser?

Answer:

I would do only one pass assuming ti was set for about a 100 micron penetration. JG 7.6.11

Question:

When I searched for Lumenis ultrapulse encore laser, the fractional laser showed in results. I am not looking for the fractional laser. I am looking for the original CO2 laser that is stronger. Do you have a direct website link for the regular CO2 laser? The one which requires more down time. Thanks.

Answer:

http://www.aesthetic.lumenis.com The settings on the Ultrapulse can be made regular totally ablative when the doctor uses the desired settings on the density of the pattern. JG 7.5.11

Question:

Who is the manufacturer of the full CO2 laser? Not the FX fractional laser, but the regular CO2 laser. Do you know their website? Thanks.

Answer:

Lumenis.com. Ultrapulse encore. JG 7.5.11

Question:

Dr. Garcia, A year ago, I had a full face dot laser treatment, mainly for mild to moderate upper lip lines. You were right--the effects don`t last much. He said he could do the upper lip area only this summer. But because of my work, I have to spend a lot of time outdoors. Would it be better to wait until winter to have this done? I fear that my lip area will be much lighter than rest of my face--even with highest sunblock, I get some tan. I wish I could find someone to do regular co2, but seems no one uses this in my area. Thanks so much.

Answer:

yes, best to wait until the sun is not as string to have it done in order to minimize potential hyperpigmentation problems. I don`t think losing pigment in the upper lip is a high risk thing.Best of luck. JG 7.3.11

Question:

I had a light chemical peel on my legs two weeks ago. The skin is peeling off as expected, but my legs are covered in hundreds of tiny water blisters (not at all painful), which break open and drain as the skin peels off. This has never happened to me before with a peel. Is it normal/OK? Thank you!

Answer:

can be normal, just let them break on their own and go back to see the person who treated you for a follow up. JG 7.1.11

Question:

I`m getting a series of Vbeams to get rid of redness out of both acne scars and some rosacea tendencies right now. I am very intrigued by the ematrix and its results on darker skin patients. 1) what do you think of ematrix results and side effects? 2) Will doing ematrix after vbeam undo the vbeam work on the redness? I see a wonderful derm in NYC.

Answer:

I think the results are minimal to none with ematrix, doing an ematrix after the VBeam will likely not cause any problem to the VBeam. JG 6.30.11

Question:

Thanks very much for your answer below about the non-peeling peels. In what particular way would the peels actually be effective if the epidermis isn`t peeling off?

Answer:

the visible peeling is the dead epidermis, and healthy skin has a relatively thin epidermis, so that sluffs off it is more like a fine but than flakes. The benefits are still the same, stimulation of the basal layer to create new skin cells and the moderation of brown spots. JG 6.24.11

Question:

Happy Summer Solstice, Dr. Garcia! I just had a TCA peel and was given a copper peptide cream by the derm to use during heaing. I`ve had these peels before and was never given this product. Is it helpful in your judgment? If so, should I apply it now (before I begin to peel), during the peeling process, after the peeling has finished, or throughout the whole duration? And how many times/day should I apply it? Thanks very much for your time and help.

Answer:

I think after injuries such as a chemical peel that copper peptide creams do help in the healing process. I would start 24-48 hours after the peel. I would continue for at least one week after it appears healed. I would apply it twice per day. Best of luck. JG 6.21.11

Question:

Hi Dr. Garcia I had an ipl treatment about 10 weeks ago. A lot of brown spots come to the surface even where there were no brown spots showing on my skin. One spot even blistered and left a bit of a scar. The brown eventually sloughed off but it left some marks. I went in for another treatment to get rid of these marks....same machine...same intensity....and nothing happened. Will these marks left by the ipl go away in time on their own?

Answer:

Yes, that can happen and usually heals in time with no visible problems. Best of luck. JG 6.10.11

Question:

Hi Dr. G. I see a reference to Zeftig. Please, can you tell me what that is and what it does? Thank you for your generosity with the most valuable commodities anyone of us have ... time and knowledge. I am SO grateful!

Answer:

The machine attempts to injure fat cells with freezing, causing a potential rupture of the fat cells and then the body breaks the cells down. It is intended for small areas and the results take a few weeks to see as it takes time for the fat to be broken down, it is performed without anesthesia and there is minimal downtime. There are no long term studies to see if the fat cells stay gone, but if you are looking for a non-invasive minimal downtime fat removal, it is an option. Just can`t say how effective it will be, likely variable from patient to patient. JG 6.8.11

Question:

Hi Dr, I am 43 with pale skin and have started to get lots of age spots in recent months on my face and arms, probably due to sun exposure over the years. Is there any kind of laser that can treat them? Thanks

Answer:

Yes, a good option for you, and don`t forget the sunblock. JG 6.2.11

Question:

I have numerous flat moles on my face I`d like to remove but I have a concern. I had an ND YAG laser once on a spider angioma on my face and the treatment caused a small amount of fatloss in the area and a strange pattern like scar indentation. It`s not that noticable but you`d see if you were standing a couple feet from face. My concern is that a Yag laser is also used flat moles and I`m thinking I have so many moles on my face maybe I shouldn`t chance it because maybe my skin doesn`t take well to non ablative lasers and I will scar again. You mentioned that you have never seen this problem with this laser but maybe I am that rare case. I`m thinking the lady who cauterized the vein I had with yag caused these problems because she closed off an artery and cut off blood supply to the sub cutaneous fat in the area. My question is two fold: Are the settings used on the Q switched Yag for moles targeting shallower areas in the skin than the ND Yag for vascular treatment? More superficial? Also, are there any other reasonable options for flat moles that involve vaporizing them like electrocautery, erbium, Co2? I`m thinking maybe I`m better off going that route if there is. Thanks.

Answer:

I do not think a YAG laser is very effective to remove moles, at least not a Q-switched YAG laser, for that an ablative laser such as an erbium or CO2 laser is more commonly used, should not cause any fat atrophy but can be red for a long time (weeks), and since the entire mole is not being removed, it will grow back in time. JG 6.1.11

Question:

hi doc, what do you think about the ematrix sublative laser treatment? iam thinking to try it for rejuvenation and pore reduction am i waisting my money?pls advice also can laser treatment break down filler under the skin? thanks.

Answer:

short lived improvement and not a dramatic improvement for that short period of time. Doubt it will affect any filler already there. JG 5.22.11

Question:

Hi, Dr. Garcia. I see an answer below that you don`t think sclerotherapy for facial vascular irregularities is effective. I`ve had very stubborn veins on my face that haven`t responded to the VBeam or YAG or IPL for the past three years. When I asked my dermatologist if we should try sclerotherapy for them, he snapped back fiercely, So you want to go blind? Because that`s what will happen. You will be blind. I was startled not only by his (uncharacteristic) cutting sarcasm but also by his claim that sclerotherapy to superficial facial veins would result in permanent damage to the optic nerve, which seems like quite a stretch. Is he right? Thanks again for all your help to all of us!

Answer:

I think sclerotherapy for facial veins is a poor choice as it does not work well, but it will not cause blindness, the veins are not directly connected in order to get retrograde blockage of the optic blood vessels. Injecting a glabellar or eyelid vein, a very rare maybe, but it would take about .25 injected under pressure, not a likely scenario. all the best. JG 5.17.11

Question:

If I have the full Co2 laser procedure done on eye area, will I still ned to apply retin-a to make sure wrinkles stay away for 2 years? I was told that you should keep applying retin-a if you have FX laser procedure. But I was hoping the procedure would allow me not to rely on retin-a while I was pregnant for 9 months. Will the results also fade with full C02 laser if you do not use retin-a?

Answer:

I think it will help prolong the longevity of the Co2, yes. You cannot apply the Retin-a after any laser until the skin is healed, but there is no problem using it after that point. I think if you are pregnant, just wait until you are done breast feeding before using the Retin-A to be safe. All results will fade after any laser, the Retin-A just stretches it out. JG 5.3.11

Question:

So if you only get about 6 months of benefit from the deep FX, can it be done every 6 or 8 months? Can`t find anyone who does fully ablative CO2 anymore. If I could find someone who does, I would opt to do that every two years or so. I`ve done two different fractional ablative laser treatments (erbium and CO2 based) and found them minimally helpful - -but with LOTS of downtime anyway. 7-10 days? No way! I was BRIGHT red for 8 weeks and then streaked for another 6 weeks. By the time all that cleared up, so too had most of the benefit of the treatment (which I think was due mostly to micro-swelling). I`m trying to figure out if doing multiple fractional ablative treatments is both safe and cumulatively effective.

Answer:

you could repeat it, I guess. I think if you have had that kind of response form the erbium CO2 combo, I don`t think you will get much more form the Fx, to be honest. I think the multiple option is OK to try, juts need to temper your degree of improvements/expectations. JG 5.3.11

Question:

DR. GARCIA is there a laser on the horizon that can help eliminate white, grey or red hair? My facial hair is getting worse everyday with stiff,coarse white hairs. I am 60 and well past menopause and I am afraid there is no end in sight. Does this mean I have too much testosterone in my body? Other than electrolysis (horrible) or Vaniqua (too expensive) do you have any other suggestions. BTW, the lasers worked on my black hairs about 15 years ago. The white hairs have only been in the last couple of years,but I seem to get more every day, seriously It takes about an hour to pluck them when I can see them but the ones that I can feel but not see still bother me a lot. I am causing myself pimples by doing the tweezing. I would mortgage my house, if I had to, to find something that will work. Thanks for your help as usual.

Answer:

not that I have seen, it needs a color target for it to work. You might need to consider electrolysis. It can happen in women when they stop making progesterone and then the testosterone does convert to DHT which is what causes the problem. I wish I had something better, sorry. JG 5.3.11

Question:

Is there a laser or peel that can effectively tighten lower skin on the face and neck? Is yes, which laser and/or peels does this best?

Answer:

they only fix small lines, for loose skin you will need surgery. JG 5.2.11

Question:

Who is the manufacturer of the full CO2 laser? Thanks.

Answer:

Lumenis. JG 4.28.11

Question:

Who is the manufacturer of the FX laser?

Answer:

Lumenis makes the Active FX. JG 4.27.11

Question:

Hi Dr., What`s the current best treatment for skin laxity (no fat removal needed) in upper abdomen and bra roll areas? Also, what`s the best option for small fat removal, mostly skin tightening for upper arms? What liposuction do you recommend, ie smartlipo, slim lipo, Xerona, etc. I have heard EndyMed might be something to consider but can see you don`t recommend it. It`s so hard to separate the facts from the fiction ... and all of them so expensive. On one hand, the doctors who offer a certain treatment must believe in it (or they wouldn`t buy/rent the machine). On the other hand, it`s hard not to be mindful that they might be pushing the treatment because they have to pay for the machine. Thank you for your honesty and guidance.

Answer:

the only thing reliable there is skin being cut out, there is no non-invasive effective option. If the skin of the arm is in good shape, my preference is to use ultrasonic assisted liposuction. I am not a believer in the other machines out there. I think offering techniques that are more easily accepted by patients is why many doctors buy those machines. Some my not have enough experience in the field to know that the device likely will not work, others might buy the machine just to get the patient to call the office and then they switch things over to something else. JG 4.20.11

Question:

Dr. Garcia, what is the Pelleve RF laser? It says it is new. How reliable is this, and what is so new about it? Is it another Fractional laser or less? Thanks.

Answer:

it is not a laser, it is a radiofrequency device and I am unimpressed by the results. JG 4.20.11

Question:

Hi Dr. G., Have you heard of Endymed, and what are your thoughts on this laser treatment for skin tightening, etc.? Thank you!

Answer:

an attempt to use technology that failed once and try to claim it will work because they are doing it a multiple depths, I would not perform or offer the procedure. JG 4.19.11

Question:

The Dr. who use to do CO 2 now does fractional laser. Does this laser remove those pesky litte lipsick lines horizonaly above the lip line? If not what will? There are very few dr.`s who are doing the CO 2 laser anymore. Everyone has switched to fractional although I know you are not a big fan. If I had that area done there would be line of demarkation there so I would need an entire face done. Thanks.

Answer:

it might, but for a relatively short period of time. The line of demarcation risk is less because it does not go as deep, but you get less for the reportedly safer procedure. JG 4.15.11

Question:

What are the names of lasers that remove hair most effectively?

Answer:

alexandrite. JG 4.5.11

Question:

Is the Erbium: YAG laser the same as the Nd: YAG laser?

Answer:

no, the ND is color specific and the Erbium is not, the ND is used for color issues and the erbium is a non-discriminatory skin ablation with no heat. JG 4.4.11

Question:

What is your total price for C02 laser resurfacing around eye area. Can this be done with local shots at your office?

Answer:

I prefer to perform ti in the operating room for comfort and therefore safety reason and the fee is about $3000. JG 4.4.11

Question:

What are the names of the lasers that get rid of broken blood vessels/capillaries?

Answer:

We sue a YAG laser, but VBeam also works. JG 4.4.11

Question:

What are the names of the lasers that get rid of red cherries?

Answer:

Nd:YAg and VBeam are the most frequently used, pulsed dye laser will also work. JG 4.4.11

Question:

I`m getting conflicting medical advice about this and know you can set me straight! I`m having a 25% TCA facial peel in 2 weeks. Do I discontinue using Retin A and hydroquinone in preparation for the peel or keep up this daily regimen? My plastic surgeon says stop; my dermatologist says continue! What would we do without you, Dr. Garcia? Thanks so much!

Answer:

I have my patients continue until the day of the peel to allow some mild irritation to be in place an allow the peeled skin to heal faster, and also the hydroquinone has to be there to deactivate the tyrosinase enzyme to decrease the risk of post inflammatory hyperpigmentation. I also usually start them up after the peel once the epidermis is intact. All the best. JG 4.1.11

Question:

hi i have very open pores on my skin on my cheeks and forehead with blackheads and oil ect.. what is the best treatment to reduce it? please advice

Answer:

IPL lasers, Retin-A and microdermabrasion, but they are all temporary. JG 3.26.11

Question:

Is there any treatment that has some value in relation to white surgery scars or white spots on the arms? If so, what is the number of treatments required for a satisfactory result in relation to hypopigmentation? Many thanks.

Answer:

nothing I have found worth the money or risk. Sorry. JG 3.24.11

Question:

Hi, Dr. Garcia. Welcome back! I hope you had a good time away. I had a Fraxel RePair in November. Is is OK to do a light chemical peel in early April?

Answer:

Should be good to go, and yes, had a good time fly fishing. JG 3.20.11

Question:

I had a 15% TCA peel yesterday and the skin has not gone hard yet but I have ointment on. I do notice that on one spot of my face in particular is still very red. I didn`t have right under my eyes done but its the part where the crows feet come out, it`s really red and I notice brown spots appearing in the area that weren`t there before. Could this be pih or is it just pigment I couldn`t see coming out? I did not have pretreatment thank you.

Answer:

it is just the superficial skin starting to harden and flake off, all normal. It takes weeks for the PIH to form. It also can make some spots that were barely visible to become more visible. I think it would have happened the same way even with pretreatment. JG 3.10.11

Question:

How long after an 18% TCA peel is the skin more sensetive to Sun exposure before it goes back to normal?

Answer:

4-6 weeks, but the more damaged the skin is the faster it goes back to its prior state. JG 3.10.11

Question:

Hi Dr. Garcia I had artecoll filler 4 yrs ago on my inner cheeks and I am schedulled for a gentlemax skintightening laser next friday, will there be any hyperpigmentation or any other side effects from this?

Answer:

should not cause a problem this far out, Best of luck. JG 3.8.11

Question:

My lips have gotten more dark over the years. Kind of more dull and red and less pink looking on the outside. My doctor a 3 layer 15% TCA peel, do you think this will help or is it as waste?

Answer:

I think it will help, yes. JG 3.7.11

Question:

Hello Dr Garcia, I am considering pulsed dye laser to treat a few very fine pink/red veins in my lower eyelid. I also have some residual pink marks from an injury there. I would be very grateful if you could please answer a couple of my questions: 1. As PDL can treat marks left by healed spots/acne, I assume it can do the same for any healed skin which retains some pink pigmentation? 2. I believe the laser light reacts to the veins/areas with some red pigment, my question is does it leave the surrounding (in my case white) skin COMPLETELY unaffected?Does it not also heat that skin or is it simply not applied to those areas? Fortunately, they are of a minor nature and I am trying to weigh up the potential risks involved in non-bruising/bruising treatments. Thank you.

Answer:

yes, the PDL should help fade your red spots, not sure how many sessions it will take though. The surrounding skin has some red so there is some effect, yet minimal. There can be bruising and in order to minimize the effects to surrounding tissue the doctor will likely use a spot size that is small and close to the size of the vessels alone. All the best. JG 3.7.11

Question:

I`m going to have a TCA peel to lighten the color of my lips, but I have a question. My lips have a lot of dry dead skin on them every morning even if I put cream on, and I exfoliate that skin off every morning so my lips are fresher. Should I leave the dead dry skin on my lips when I have the peel or exfoliate it off the day of the peel as I usually do? Seems if I leave a layer of dead skin on my lips it will make the peel less effective, but also dont want my lips to be too sensetive. Thank you.

Answer:

best to exfoliate it off. Best of luck. JG 2.28.11

Question:

Why in your opinion does Retin A help for fine lines but not TCA peels? Aren;t they doing the exact same thing by exfoliating but TCA is just much stronger?

Answer:

The TCA will exfoliate only once and it is the slow and continued exfoliation from Retin-A that is effective. The deeper penetration of the TCA also has higher risks of reactive hyperpigmentation than Retin-A. JG 2.26.11

Question:

How long after a 15% TCA peel should I wait to have an 18% TCA peel?

Answer:

at least 3 weeks. JG 2.25.11

Question:

Hi Dr, Just curious, how come procedures such as Titan, IPL do not cause fat loss and yet RF is renowned for fat loss My experience with IPL and Titan felt hotter and more uncomfortable than RF so wouldnt this also cause fat loss? Thank you

Answer:

the fat loss has been attributed not to the heat but the polar radio frequency penetrating deeper than the IPL would, it is not a predictable fat loss though. JG 2.23.11

Question:

Your thoughts on Ulthera? Snake oil in the form of a laser? Worth trying for minimal-moderate skin tightening? Thanks, as ever, for your candor!

Answer:

would expect 4-6 months of improvements and then all returns, the FDA only evaluated it for 90 days after the treatment, so for the money, yes, snake oil. JG 2.15.11

Question:

I have a 60 year old male friend who swears by chemical peels has given himself several 30% TCA peels over the years (which I know is dangerous but he has a lot of experience) and he looks truly magnificent for his age. I`m talking 20 years or younger or more than he should be. Do you think this is a result of the peels or his genetics? He swears its the peels.

Answer:

sorry, its genetics, but he can`t take any credit for that. JG 2.15.11

Question:

I,m considering a procedure called laser complete performed by a local dermatologist. it is a combination of pulsed light and pixel 2940nm. Are you familiar with this? I`m especially interested in your opinion of the laser and it`s potential risks as well as it`s effectiveness. Thanks for your help...

Answer:

mild improvements, quick healing, improvements might last a few months or so. All the best. JG 2.10.11

Question:

I have some discoloration on the lips darker from smoking. As well as a lot of of small white forsythe bumps. Do you think a Q-switched Yag laser would help both problems? Also does the q-switched yag only target pigment or vascualrity as well? The reason I`m asking is because I had a problem with a vascular treatment years back and I don`t want a laser that goes there ever again. I just want something that targets pigment superficially. Thanks.

Answer:

the Q-switched should be fine for the color but not sure how effective it will be for the bumps. If the energy is set at a low setting it should be safe, but might take a series of treatments. Best of luck. JG 2.6.11

Question:

Have you heard of Re-Firme skin tightening? Are the results any good or is it a waste of money? Thank you!

Answer:

save your money. Sorry. JG 2.2.11

Question:

Dr. Garcia, I`m scheduled for an ablative erbium laser treatment in 2 days. Since I have Asian skin, they recommended doing it in 3 treatments. I have used bleach cream for the past week. Do you think that this would help prevent hyper or hypopigmentation? Thank you.

Answer:

it will help, but not totally avoid potential hyperpigmentation, and the bleaching creams have no effective on potential hypopigmentation from a laser. Best of luck. JG 1.26.11

Question:

Thanks for your answer below about the E-Prime. Sounds like you share my skepticism as to its effectiveness! But I`m wondering if you think it`s safe to participate in this trial. Would you do it? It might not work, but if it does no harm, then it might be worth trying. (My dermatologist is a very careful and cautious clinician.) Thanks so much, Dr. Garcia! Hope you`re warm in Las Vegas...probably the only place in the country where that might be so right now.

Answer:

should be safe, but as they are still testing it out, there is no way to know 100% if it is safe, but it should be. I am sure your doctor would not do something he thought might hurt you. As to Vegas, yes, very pleasant today. Say warm1 All the best. JG 1.25.11

Question:

Have you heard of a new laser being developed by Candela called E-Prime and read any of the published studies on it? It`s an attempt to improve on the skin-tightening technologies that are currently available. My dermatologist is working with the company to test it and has invited me to participate in the trial. What do you think? Thanks for your help and candor, Dr. Garcia. We all appreciate you greatly.

Answer:

it is still being tested as you say, there are no commonly available results to evaluate therefore. Sounds like you are going to be a guinea pig for him though. Funny though how all these laser companies claim to have the best thing since sliced bread when they get a machine approved and literally in less than 2 years they have a new loaf of bread with the newer better slice waiting to be bought. I wish you the best. JG 1.24.11

Question:

Thanks for your answer below about the Q-switched YAG for hemosiderin deposits. Have you also had any luck with Auriderm for this problem? I`m thinking of purchasing it to complement the laser treatment, but it`s pretty costly ($50), and I don`t want to waste my money if it isn`t worth it. Thanks as ever, Dr. Garcia.

Answer:

I think in you case, as the hemosiderin is already there, it likely will not be aided but the Auriderm, if it was an acute bruise, it might. Save your money. JG 1.17.11

Question:

Have you had any luck with the Q-switched YAG in resolving hemosiderin deposits? I have some on my legs 1 year post sclerotherapy and am exploring this with my dermatologist. (Type I skin) Any suggestions of settings he might use? As ever, thank you, thank you for your incredibly generous sharing of your vast medical expertise with the public. Truly, you are a rare and kind soul.

Answer:

Yes, we have done it and there is a considerable improvement most times. I use the 1064 setting and start at a low power setting and move up from there.Best of luck. JG 1.16.11

Question:

Is there anything on the market that is effective for tightening the midriff area (not the entire stomach, which is trim and flat)? Thank you!

Answer:

I am afraid nothing reliable except surgery, sorry. JG 1.10.11

Question:

Hi Dr. G., Happy New Year! Can you please tell me what the differences are between Velashape and Zenora (sorry if this is a mispelling). Thank you.

Answer:

Zerona is a method where low level laser is applied externally to the skin to attempt to break and dissolve fat cells, not very effective in my opinion. Velashape, although touted at breaking up fat cells too, does a pretty fair job on improving cellulite while you are having the treatments, but once you stop, it all is seen again. I have not seen any reliable fat loss with Velashape on the patients I have seen use it. And a Happy New Year to you also. JG 1.10.11

Question:

Dr. Garcia, As a blonde hair blue eyed surfer with fair skin, I developed sun spots/Rosacea on my cheeks after baking in the sun for about 4 straight straight harsh summers. I received 2 IPL treaments about a year ago, first one sloughed off and second did nothing...spots came back. After that I was advised to use Triluma, still surfing at the time which made my condition darker and worse. 4 months ago-Yag 1064 laser treatment done with decent results. 4 weeks later-Yag 564 due to work the next day. After this the brown started going away and more red and broken capillaries started showing up. Noticeably red! So I had the V-star laser done 2 months ago at a non-brusing dose due to work....started seeing slight results 4th week. 2 weeks ago I got the V-star bruising dose and went back two days later for a healing treatment (v-star 564, suppose to heat up the bruises and heel faster). Starting to some white patches which is good but still see some brown spots left. My question is did the Yag laser cause redness/broken capillaries in my skin or did the triluma or both? My condition is getting better...is there another laser/treatment that can solve both brown & red/rosacea. Thanks so much, I know this is long.

Answer:

the Triluma is more likely the culprit, and doing the lighter lasers to control the Rosacea is a worthwhile thing, but until you are willing to stop surfing and going out in the sun, treating the brown spots is a waste of time, and no mater what you do to rid yourself of them as the skin has memory, they will come back in time, even with minimal sun exposure. Sorry. I think IPL is fairly good to treat them both, the YAG laser is stronger though. Best of luck. JG 1.1.11

Question:

i had a 30% TCA peel for some brown spots. they seem to be lighter by not gone. should they be? will i need another peel?

Answer:

in most cases a single peel is not enough, many times it is a series, and it will never be a permanent response. They will come back in time. JG 12.21.10

Question:

Hi Dr. What is fractional laser and what does it do? Is this just another name for Fraxel? Thank you!

Answer:

fractional means that it only treats a fraction of the skin, and that is what the brand Fraxel does. JG 12.15.10

Question:

Hi Dr. G. What is Zenora and does it work for slimming hard-to-exercise/diet away areas? If it does, even temporarily, how long does the effect last? Thank you!

Answer:

sorry, but I am not a believer in the claims Zerona makes regarding dissolving fat. I would suggest you save your money. JG 12.12.10

Question:

Hello to my favorite man!!! I had Sculptra injections on 8/19, 9/23 and 10/28. Can I now have a TCA peel done of 25 % ???? Thank you thank you, wish you lived near me : )

Answer:

yes, OK to proceed, best of luck with everything and thanks for the kind words. JG 12.810

Question:

I have been having a serie of YAG for treatment of hyperpigmentation. Can you tell me how I can tell I`ve reached the limits of what this laser can do for me? I don`t know if there is a point where there`s nothing more I can expect, and it`s just a matter of maintenance instead of treatment. Thank you.

Answer:

I would suggest you take digital pictures of the spots and then again before the next treatment and see if there is any difference. If there is not, then it is only for maintaining it. It can at times, not remove all of the spots, the longer they have been present, the harder it is to get them off. JG 12.1.10

Question:

I was wondering if you have heard of EndyMed, a laser that is supposed to help with skin laxity, and what you think of it. Thanks for sharing your professional opinion.

Answer:

it is an attempt to shrink skin using radiofrequency waves, it has been tried by many, and in most cases it either does not work or causes fat loss and indentations underneath the skin. I would not use it. JG 12.1.10

Question:

I really need your help. My general practioner (MD) one day said he could use IPL to get rid of a sunspot. After 5 tries it didnt seem to be working. Several months after the last one he said we should get more agressive. I went in and he did CO2. It seemed to work. Well, 1 month later it is the same color or darker then when I 1st went in except now it is in man-made shape so it looks strange. I am Asian (Korean) with fair skin and he never mentioned the chance of PIH and never gave me any creams except the anti-biotic. My question is 1. Will hydroquinone help now or make it worse? 2. How likely is that (with sun protection) will this go away? 3. Could IPL work? What would you do? HELP!

Answer:

the cream might help some,yes. I do not think it will make it any worse. Due to the mechanism of injury, I doubt that it will go away with just time and sun avoidance. I do not think IPL will work. The first thing I would do is to go see either a plastic surgeon or a dermatologist to get treated form now on for cosmetic skin care issues as they are the only ones truly trained to do it, instead of a physician who just is buying a machine and gets a 4 hour course. I personally would use a YAG laser to treat the problem. Best of luck. JG 11.29.10

Question:

I am considering having scar revision surgery on front of my neck (had cervical fusion in 2006). Since the skin of my neck is loose (my doctor says it is not loose enough for a neck lift)and crepy looking, I am considering some type of laser. Questions: (1) Should I wait until after the scar revision surgery and (2) what type of laser would you recommend using on the neck? (3) Also, will the laser provide at least a small amount of tightening? Thanks you so much, Dr. Garcia. 11.29.10

Answer:

I think if you are considering any laser treatment anywhere, it should always follow the scar revision. I personally do not do lasers on the neck as I do not feel they are safe to do enough for the patient to see a visible difference as the skin of the neck is not as resilient as the face is for healing purposes. I doubt the laser will tighten anything once the swelling has gone down. Best of luck. JG 11.29.10

Question:

Hello Dr. Garcia, Do you recommend the Sciton broadband light treatment for mild hyperpigmentation? If not, what do you recommend? What is the best treatment for this? Thanks so much!!

Answer:

no I do not, we use a YAG laser or chemical peels for that. There is no one best treatment as all patients respond differently to different modalities. JG 11.18.10

Question:

Thank You for your advice it is appreciated. I had pld laser two weeks ago to help get rid of a broken blood vessel from dr hitting a blood vessel when injecting filler. He did laser for the fourth time two weeks ago and left me with 10 dark purple black spots on my cheek. I did not realize that he was going to do this and was thinking light laser like the other times. The last two weeks have been awful and I had to take time off work as I don`t feel like explaining why I have terrible spots on my face. The color has changed from black purple to bright red(been two weeks), but they are still hard to cover and no matter how much makeup I apply I just can`t cover them. I am miserable and these spots are starting to get me really depressed.Its been two weeks will these spots fade on there own eventually or will I have to do laser to get rid of the spots caused by the laser? I feel the spots are actually worse the the original problem the broken blood vessel. December is a busy month and I am praying that these will be healed by then.Can you give me an estimate on how long it could take for these to disappear or if I will need more laser?

Answer:

the spots should fade with time, that is a known side effect in using a pulsed dye laser, that is one of the reasons I use a YAG laser, as that reaction is not as strong but the laser is still effective. I would say it will take another couple of weeks or so, all the best. JG 11.15.10

Question:

Is Ebrium laser safe on Asian skin? I was afraid of hyperpigmentation.

Answer:

I would not use it. JG 11.12.10

Question:

I already asked a question and thank you for your advice about this but would like to know what you think. I had filler over a month ago and doctor hit a blood vessel, been doing laser and not a lot of change to the discoloration. I had laser done yesterday and ended up with 10 black purplish spots which you said he must have used too much energy, it was PDL laser not IPL. I went in today to talk to him and he said I had a reaction to the laser and that it will be healed in about a week.He gave me some Nerisone cream. I`m really concerned that he is just trying to cover up a mistake and also concerned that I will have discoloration from these awful spots.He said the spots were bleeding from the blood vessels is that true?

Answer:

I think it will get better on its own, the cream is fine, but I would strongly suggest avoiding any sun exposure as the purple spots can turn brown with sun exposure. Also nothing rough like a scrub brush on your skin until it is all resolved. It can happen when using lasers, and in many cases the energy level does have to be turned up to make it effective. The spots are essentially the residual from where the laser exploded on the pigment and caused a new superficial blood vessel irritation. Hang in there. JG 11.3.10

Question:

Hi, Dr. Garcia. My doc v-beamed-me-up last Friday morning. It`s Tuesday night and my face still looks like a quilted mattress pad! Epidermal edema? Any suggestions for how I can improve this? Wow, what a parade of cosmetic woes passing by you in cyberspace every day. You`re great.

Answer:

ice, cold compresses,avoid salt, keep head elevated is about all for now. All the best and thansk for the kind words. JG 11.2.10

Question:

I am considering a 30% TCA peel for brown spots on my face. The Dr said a week recovery is all I will need. Does this sound right? He said I will be red followed by some peeling. I have two young children and want to make sure I dont look scarey to them. Can you tell me what I can expect. Thanks

Answer:

that is about right, yes. JG 10.27.10

Question:

Dr. Garcia, I am considering a radiofrequency laser called Pelleve for facial skin tightening. Have you heard of this laser and know of it`s effectiveness? Dr. Charles Boyd offers this. Have you ever heard of him?

Answer:

never heard of him, have heard of the radio frequncy machines and I think they are a waste of money and can be dangerous with side effects of fat loss. JG 10.25.10

Question:

Dr. Garcia, I recently had a series of IPL treatments and I`m very pleased with the results. Would you be kind enough to explain what actually happens to the brown spots during an IPL? Will the exact same spots come back after sun exposure or will they be different spots and take a long time to develop. What happens to the skin to cause it to produce the coffee grinds? Your website is a reassuring and soft place to land after a cosmetic procedure. I know I speak for many of your readers when I say thank you.

Answer:

the laser disrupts the pigment cells and your body breaks them down and carries the debris away. The same spots and more will come back with sun exposure over time. If by coffee grounds you mean the small spots, it is sun exposure and the skin protecting itself, like a suntan. Thank you for the kind words and all the best. JG 10.25.10

Question:

Hi Dr. Garcia, I read online that you remove gang tattoos for free. Is this true? My son wants to join the military but is not allowed with his gang tattoos, if you could remove them it would be great for him to start his life in the Air Force. Thanks

Answer:

we perfrom that service at no charge only to minors who are going through the court ssytem as part of their parole. For other members we do remove tattoos, but on a cash basis, we charge by time and would be happy to see your son and evaluate him for a laser removal, it is never a single treatment, many sessions are required,depending on how much ink there is. JG 10.18.10

Question:

I am a forty year old female with light olive skin. I have never tried anything on my skin but Retin-a. Am looking for help with sun spots and want to freshen my skin. I am scared of the possibility of skin discoloration. Any lasers, peels, etc you could suggest?

Answer:

have to start very light, maybe a YAG lassr peel or a 20% TCA peel. JG 10.14.10

Question:

Dr. Garcia, I`ve spent a lot of money trying to remove small broken capillaries on my face-only to have them return soom after. What is the best treatment for these? Thank You.

Answer:

well, I like VBeam laser or a hyfercator, but they will come back in time, there is nothing permanent, I am afraid, sorry. JG 10.11.10

Question:

Hi Dr. Garcia; About 5 years ago I had V-beam done on my face to eliminate a Rosacea like redness probably caused from stimulation of growth of blood vessels on my cheeks from over using acne medication when I was a teenager. It worked very well. No more irritating skin or pinkness. My age now is 45. However the side effect was a puffiness on certain parts of my cheeks and forehead. Originally, the V-beam laser left a purple bruising to these areas which vanished in about 10 days. I think the V-beam setting was 11. My questions are: What is the cause of the puffiness? Could it be inflamed blood vessels? Is there any medication or medical treatment, such as lasers that could subside the puffiness? ( non-invasive solutions would better, but both would be good to know ) Will the puffiness eventually disappear after a number of years by itself, because it subsided somewhat originally but over the last few years it may have subsided by only a small amount? Thank You

Answer:

heat absorbed by the tissues being hit by the laser causes temporary swelling, not sure wha occurred in your case. I have never heard of a VBeam causing prolonged swelling that takes years to resolve. There is nothing that can be doen to avoid that and anything less aggressive with less side effects will be less effective I fear. JG 10.9.10

Question:

Hi Dr. G, My doctor told me that YAG at first helps to lighten discolorations but over time, they get darker. Do you agree with this assessment or do you believe it`s a worthwhile treatment? Thank you.

Answer:

well, all improvemnts with all treatments for hyperpigmentation is temporary, so if continued sun exposure continues all of the darker spots will come back, but if properly done, the YAG should not cause the dark spots to be any worse. JG 10.7.10

Question:

Hi Dr.G, I am Asian, and IPL didn`t really work for me on discoloration. I am now getting YAG treatment (per your professional opinion). I know everyone is different, but generally, how many in a serie are needed before results can be seen? Thank you!

Answer:

no way to really tell I am afraid, but the longer you have had them, the more sessions will be required. JG 10.6.10

Question:

Hi, Dr. Garcia. In late August, I received a couple of small burns on my cheek from a YAG treatment. Now that they`ve healed, I`ve been left with 2 small but really visible depressions -- about 3 mm deep by 3 mm wide -- and a brownish discoloration. (I have Type I skin.) Will retin A help those depressions to fill up? And might hydroquinone help with the discoloration? Or do I need another laser treatment to repair the damage? If so, which laser? Also, on an unrelated note, do you think red yeast rice with co-Q 10 supplements really do help maintain healthy serum cholesterol levels? (I know you`re a plastic surgeon and not a cardiologist, but you seem to know a great deal about supplements.) Thank you very much for your generous and informative help Your patients are very lucky to have you. If I lived in Nevada, I`d be in your waiting room!

Answer:

Retin-A wil help a minimal amount to nil I am afraid. Hydroquinone will help only if it is darker.I would not treat it again with any laser for at least 6 months as most likely all of that will fill in on its own with time. I personally take red rice yeast and CoQ so, I do beleive in them. All of the statin drugs are purified red rice yeast componenets essentiually. All the best. JG 10.4.10

Question:

Hi I have olive skin do you think that Pearl Fractional laser is suitable for me and is it good for wrinkls and sunspots. Thanks again Ruth

Answer:

I think the Pearl Fractional laser is not entirely safe in olive skin and you can still react with post-inflammatory hyperpigmentation and the results will be mild and short lived. Sorry. JG 10.1.10

Question:

Hello, I had a diode laser treatment on some pigmentation under my eyes on Monday. I have some raised red bumps where this was done. Is this normal? How long before this redness resolves and is there anything that will speed it up? The swelling is a little better today but still there. I have restylane in the area - could the diode laser affect this? Thank you for your help in answering these questions.

Answer:

it is normal with a diode laser, yes. It should resolve in 3-10 days, depending on how strong the settings were. Diode laser should not affect the Restylane. All the best. JG 9.30.10

Question:

Is a YAG the same as the VBeam? A vascular surgeon used the new (and wildly ineffective) Vein Wave on my legs 6 months ago and they are now a red mess. A relatively minor problem is now a major one. It looks like I have poison ivy all over my legs. A dermatologist has recommended the VBeam laser to correct the problem, but I see you have advised a recent poster with the same problem that a YAG may help. Thank you for any suggestions you can offer.

Answer:

they are very similar in terms of what they do, what they treat and their effectivess. I think if you have access to the VBeam I believe it is OK to proceed with that choice. JG 9.29.10

Question:

Dr. Garcia, I`m considering a peel, but was wondering if 30 percent TCA peel safe for Asian skin? Thank you.

Answer:

I would start with a lighter percentage, maybe 20% and see how you respond, and then increase the percentage over time. That would be safer. JG 9.26.10

Question:

Hi Dr. Garcia, I had Fraxel Dual on my hands (1 treatment) earlier this year for skin laxity and crepiness (not many brown spots). It`s been 4 mths and the crepiness is worse. It`s all over the back of my hands and the skin is looser. This wasn`t a side effect listed in the consent form. Can Fraxel damage your skin this way? My hands look like they belong to a 90 yr old, not a 44 yr old. Thank you.

Answer:

I feel it can as the ablility to heal from a laser on the handsis much less than the normally suggested treatment area of the face.I would never even think about doing a laser on the hands.JG 9.26.10

Question:

Hi Dr. I would like to ask what peel would be best for hyperpigmentation on gluteal area, inguinal, and in between things ... I`ve tried Milk Peel for several sessions but I don`t see much results ... The Derma Clinic offers Dermamelan peel, ICP, Melanin Control mask, TCAs, etc ... what are the post Tx care? How about AHAs ... thanks Dr ...

Answer:

TCA peels would be the best but they do not work are well in those areas as its normal treatment area of the face, it is essentially cared for afterwards like a bad burn with ointments and creams. JG 9.26.10

Question:

I don`t like the scar that is created below the bikini line. Can this be prevented? Do you perform the laser tummy tuck that doesn`t require large incisions and surgical procedure on the abdomen.

Answer:

I do not perform it because it will not accomplish what they claim it will.JG 9.24.10

Question:

This is a follow up Q. After my serie of YAG laser, what I meant was, in addition to sunblock, how often should I have the laser in order to maintain? Once a month ... or ...? Thank you!

Answer:

sorry, maybe every 6-12 weeks, it will depend on your skin. 9.15.10

Question:

Hi Dr. G. After I complete my serie of YAG laser, what is your recommended treatment protocol for maintenance? Thank you for being so wonderful.

Answer:

sunblock and moisturizers, all the best. JG 9.14.10

Question:

Hi Dr G, Sorry for all the Qs. What are the possible risks of doing YAG a week after having IPL, instead of waiting 3 weeks like you suggest? And why would this place, that appears to know what it`s doing, suggest this and weekly follow up? Thank you for your time and advice!

Answer:

burns and scars would be the risk when appropriate treatment settings are used. As to doing weekly follow up sessions, if it is done at a very low, essentially ineffective setting, it might be safe and also a away to make more money. JG 9.1.10

Question:

This is a follow up Q. Sorry but thank you! I had 1 IPL last week. I would like to try the YAG tomorrow. Should I do this or should I wait? If so, how long? You are wonderful.

Answer:

I would give it 3 weeks between. JG 8.30.10

Question:

Hi Dr. G, Does the YAG go by the name of Revlite (sp)? One of the few places around my area that offers this YAG laser recommends a series of 8, once every weeks. Qs: Are 8 too many (shouldn`t the number depend on how many is actually needed), done weekly (I thought it`s every month?). After the series, they recommend a maintenance program of once/month. Does all the above sound legit to you? Thank you!

Answer:

Revlite is a YAG laser, as to how many you will need, it depends greeatly on your skin`s condition and the energy used by the person doing the treatemnt. Done lightly, you might need 8, but no way to know. I would not do it weekly, but every 3-4 weeks is OK. What they are selling you seems like a lot of sessions, at least to me. JG 8.30.10

Question:

I received a pretty deep, if small, burn on my cheek on August 13 from a 1064 laser. (Type I skin) I`ve kept it moist and constantly covered with sunblock. It seems to have mostly healed by now, though it is still quite red and there`s still a tiny bit of scabbing that keeps peeling off and reappearing. The burn left a small though extremely noticeable depression in my skin about 2mm deep by 3mm wide. Any chances that this will heal more and fill in or do you think I`m stuck with this scar? If the latter, anything you could recommend to improve it? Thanks very much, Dr. Garcia!

Answer:

In most cases, that will take time, but it will fill in and smooth out due to the relatively superficial penetration. I agree with what you are doing, do nothing more. All the best. JG 8.30.10

Question:

Sorry to belabor the Q. I have seen the slight reactions of a recent IPL (4 days ago) and am wondering when I will start to see improvements. How long should I wait before I get a YAG session? Thank you for your patience and for your site!!

Answer:

might take a few weeks to see the improvements and OK to do another IPL in 3 weeks. All the best. JG 8.31.10

Question:

Hi Dr. Just had the first of (?) IPL. When can I expect to see any improvement, if any, before the next round? How much does YAG cost for each session, and is the same number needed as IPL? Thank you!

Answer:

you might just get the slightest irritation and some skin reaction that looks like a small sunburn. Our YAG peel is $250, but it is more effective than an IPL as it is a true laser. The number of sessions needed differs from patient to patient so no way to tell. JG 8.30.10

Question:

Dr. Garcia, I am a 60-year female who recently completed my second IPL treatment on my face. Unlike the first treatment, the second treatment yielded no dark spots or even a single coffee ground. Would you advise having a third IPL on my face at this time? (I have noticed an amazing improvement in my skin tone and would be willingly to continue if there is an accumulative affect in that regard.) Otherwise I would schedule a maintenance IPL in the future if the sun damage reappears. Your website is a blessing.

Answer:

well, usually the settings need to be adjusted as you have the treatments, they might have decreased the settings too much and it was not as strong, but one should not always expect the same reaction each time as your skin should be getting better after each session so it might not react the same. If you see little change after the second session, trying one more is OK and if there is again no change, then you are on the maintenance phase. All the best and thank you for the kind words. JG 8.30.10

Question:

Hi Dr. Garcia, I`m a drug rep (relevant because my job is in the public every day and not behind a desk). I had IPL on my face 3 weeks ago in a PCP`s office and was left with terrible footprinting squares all over my face (lighter squares where the laser was placed). Initially the squares were dark, sloughed off and are now much lighter than the untreated areas. I`m unsure if it`s true hypopigmentation or just the normal result of the laser leaving the untreated areas darker naturally.It`s faded somewhat. However, they want me to repeat the IPL to go back over the dark areas in a couple of weeks to try to even out my face. My 2 questions are as follows: 1.Do I allow this or do I try to expose my face to some sun instead to see if I can even it out? (I realize I cannot do both). 2. What happens if I do nothing? Will my checkerboard face resolve over time? Thank you for your time. I had a consult with a Derm`s NP who suggested gentlewaves instead. Thoughts?

Answer:

it is transient hypopigmentation as the surrounding areas were not treated and stil have residual sun damage.In time the lighter spots will regain their color, with some sun exposure. I think getting some sun is safer, not sure why they would have left so many skip areas, IPL should be done for entire faces and not for spot tereatments for that specific reason, but I would not expect a PCP, who does not have the knowledge base of a dermaotlogist or plastic surgeon to know that. As to the NP at the derm`s office, skip that also, it has absolutely no effect on uneven pigmentation, and the effects it claims to have on fine lines is so small that is usually not clinically visible in most patients after a few days.Maybe the NP gets a commission from doing the gentlewave. Best of luck. JG 8.29.10

Question:

I`m a 44 year old male who sits in a chair all-day due to work. I`ve developed over the years very ugly stretch marks (and bulging veins) due to lack of exercise - yet I`m thin at 160lbs/5`9. I`ve read that Affirm and Starlux are the best lasers for removal. Are these a.effective in removing or is just improving the appearance? b.Are the results permanent or is it a constance upkeep therapy? c.Which is the safer and most effective of the two - the size and width of the straie range from a width of a pencil to the size of a tooth pick - and the pattern is really disturbing? d.Can you recommend anyone in Florida - I`m in Tampa but willing to travel e.Anything else that I could do? I can`t wear shorts they`re so ugly. Thank you.

Answer:

I do not think there are any lasers that will help the stretch marks and the results for veins in the legs are essentially zero, sorry. Injection treatment might help, is done as as series, prices vary and not permanent. Need to look for a doctor that treats varicsoe veins. JG 8.29.10

Question:

Have you had much luck treating temple veins with the Yag? If so, how many treatments are usually required? And what are the parameters you typically use? Thanks so much!

Answer:

do not think it works very well at all. JG 8.27.10

Question:

Good morning Dr. G, This is a follow up Q: What does IPL do? What does YAG do? Is a series needed for either, and does YAG cost more? Thank you!

Answer:

they are both used to treat brown and red spots, the YAG is more expensive and more effective. Both need a series and the spots come back with time and will need repeat treatments. JG 8.27.10

Question:

Hi Dr., What are the differences between IPL and YAG laser? What can I expect from each? Does each do different thing or is one better than the other. Thank you!

Answer:

IPL is not a true laser, it is just intense pulsed light with filters, the YAG will be more effective and faster in its response, but cannot be done by a medical assistant in a spa, it needs to be done in a docotr`s office. JG 8.26.10

Question:

Hi Dr, I am 42 and am starting to see the signs of crepiness on my neck. I have been using Retin A for many years but this doesnt seem to be helping the skin on my neck. Is Co2 laser an option for this area? Thank you

Answer:

I think CO2 lasers are risky there due to scarring. JG 8.27.10

Question:

Dr. Garcia, im the guy with the lighter spot due to using 3% salycilic acid gel for sebboreic dermatitis, it seems like some of the areas that i used the gel on have hyperpigmented also, can skin hyperpigment from salycilic acid? and how can i get rid of this excess pigmentation

Answer:

yes it can from the irriation, you can try hydroquinone and also remember to use Sunblock all the time. JG 8.24.10

Question:

hello dr. garcia, It seems most co2 lasers are fractional type... which ones are the kind you think are better??? ablative, but what brand? Thanks!

Answer:

Lumenis totally ablative, used to be called UltraPulse or Sharplan, but they were bought out. JG 8.23.10

Question:

hello dr. garcia, I was considering sculptra for fat loss/gravity on my cheeks & I also was considering a co2 laser treatment for skin tightening. Which order would you do them in??? Are they a good combination? 40-ish :)

Answer:

I would do the Sculptra first and then the CO2 laser at least a week later, OK to do them like that, and at the 40`ish should get nice results. JG 8.22.10

Question:

Saw a procedure on The Doctors show. The Dr from LA did a fractional CO2 laser treatment on the eyes upper and lower to get rid of circles, loose skin and crows feet. the before and after photos were quite impressive. Your thoughts and do you perform this procedure.

Answer:

good for the ultra short term, but after 3-6 months, it is all back, at least in my opinion. JG 8.18.10

Question:

What are your thoughts on the vi peel? I am 45 with some sun damage, texture and large pores in the T-zone. Thanks for your opinion.

Answer:

no better than the other peels out there, the pore improvement will be short lived and the brown spots will come back in time. JG 8.17.10

Question:

Hello Dr. Garcia- I had a wart removed on the corner of my lip, which is now a hypertrophic scar. I had one doctor recomened the fraxel laser, others have mentioned that this is not the best for this type of scar. What would you advise. Thanks

Answer:

I do not see how a Fraxel or any other laser will help a hypertrophic scar, sorry. Maybe a YAG or VBeam will reduce redness is about all. JG 8.10.10

Question:

Hi Dr. G, Thank you for your patience. You had mentioned below that you like some of the lasers. Please tell me which one(s) you like, the benefits it offers and any downside. If you can tell me the commercial name of the laser so I can call around my area, that would be great. Thank you!

Answer:

well for skin wrinkles I like a totally ablative CO2 laser, there are a few companies out there for that, and as for brown and red spots along with tattoos I use a Q-switched Nd:YAg laser by Hoya ConMedBio. JG 8.4.10

Question:

Hello Dr. Please forgive if this question is redundant. What can I expect if I do a serie of IPL? What are side effects of treating hyperpigmentation? I have heard the spots get darker before they crust and fall off?!! How many days do I have to put up with that? And are results worth it - since you don`t think much of lasers, fractionals, etc.? Thank you!

Answer:

you can expect improvement in the brown and red spots, a temporary improvement of the pore size, the risks are small, as long as you protect yoruself against the sun, as to the spots getting darker, in some cases it does happen, but that is for a few days only. I do like lasers, I just am not a fan of fractional or pixelated lasers. Lasers are in general much more effective than an IPL which is not a true laser, just an intense pulsed light device masking itself as a laser. JG 8.3.10

Question:

Hi Dr. G. I don`t have deep marionette lines but my cheek areas seem fuller than the area where the marionette lines would be - as if there`s a bit of depression, making my jaw line look not as clean as it used to - jowly instead of tight. Kind of hard to explain. Would you recommend Sculptra? I have had several injections of Radiesse but it hasn`t done much for me - after the swelling goes down.

Answer:

I doubt Sculptra would help, round faces can still have jowls from the tissues falling downward and more fillers will likely just make you look even more round. JG 7.29.10

Question:

What is the best way to get rid of broken capillaries on the face ? thank you...

Answer:

hyfercation or a YAG lser, but nothing keeps them away forever. JG 7.22.10

Question:

What strength chemical peel would you recommend for lips that have darkened due to sun exposure and also for white bumps on the lips (Fordyce Spots)? Is the recovery time shorten than a facial peel? I know the lips heal very fast.

Answer:

recovery is about the same as for the face, I suggest starting with about a 20% TCA and you could go stronger as time goes on if needed. once session will likely not take care of all of it though. JG 7.21.10

Question:

My derm wants to use either a 532 nd:yag or a KTP (I assume a V beam) laser to treat the redness in my skin, mostly in the mild scarring as well as to help fill them in a little. She`s been great at treating my redness/rosacea in the past with IPL but we want to try something a little more strong. I have olive skin so she always goes pretty low (like 10 joules). Which of the 2 lasers do you think is best to try given my skin type and problem?

Answer:

I normally use the Nd: YAG but both are good. JG 7.17.10

Question:

Hi Dr. G., I am 50, with good skin. What do you recommend for maintaining generally gook skin, to keep elasticity, firmness and minimize hyperpigmentation? I am so confused with all the options and different doctors recommend different things, ie laser, infrared, ultrasound, fractional, etc. etc. Eventually, surgery may be inevitable but it is not something I need now. Thank you as always!

Answer:

maybe some Retin-A or my cell matrix cream, you can also have some IPL treatments for brown spots and microdermabrasions to keep pores closed, otherwise, I think the other lasers will give you a small amount and cost a large amount. Skip the ulrasound and infrared. Use your sunblock, avoid smoky environments and don`t go crazy spending money before you need to. Best of luck. JG 7.16.10

Question:

My 15 yr old daughter developed quite rapidly and now has burgundy colored stretchmarks on her breasts. Can anything help to get rid of these? Laser, peels?

Answer:

YAG lasers or Mederma cream is what I would do at this point. They usually fade to a lighter color on their own in time though. All the best. JG 7.13.10

Question:

I wrote the queastion below about red LED light and lasers for improving skin appearance. But what about red light lasers for hair? Is the red light for hair growth the same red light that is used for skin improvement?

Answer:

I would nto use them as the results are unpredictable, not uniform in all patients, I feel it is over-hyped. JG 7.8.10

Question:

Dr. Garcia, I was the one who posted the question on the MatrixRF. You replied about asking for my money back, was wondering why...?? Also what would you recommend instead of doing the matrix. Please leave me an alternative, thank you so much!

Answer:

because I think it will not give you much improvment.If you are looking for skin tone improvement I would suggest something like a light CO2 laser or a deepr chemical peel, I am not a big fan of fractional lasers but if you need very little help, they might do the job. JG 7.7.10

Question:

Dr. Garcia, Please tell me what you know about the RF Matrix laser. I have purchased 3 sessions at $800 each and am wondering what your thoughts on this machine is? I am a 38 yr old white female and wants to tone and get a fresh look. But I heard it is extremely painful and am now scared to go for the treatments. I really appreciate your opinion. Thank you so very much!

Answer:

I would ask for your money back. JG 7.7.10

Question:

Hello Dr. Garcia! I posted a question a few weeks back and would like to follow up: Briefly..I had the fraxel co2 laser done on the face and neck in the surgeons office with great results on the face but the neck is still in a loose chicken skin state only on the right side of the neck with a sort of striated downward pulling only on that side as well.. It`s been approx.11 weeks since surgery.Your response was to hang in a bit longer approx. 4 to 6 more months to see final results. My follow up: (3 questions) 1. Could you please explain how the fraxel works and how you can see continued results that far out. 2. Can you use full strength Retin A (0.01 red tube) on the neck normally and or in this healing state to rid of the graph line which are still present on the neck only not the face..any other suggestions on fade creams..can peels be done on the neck or not recommended. 3. Lastly, if all else fails, can the neck be lifted or tightened if this loose skin state does not cure itself. Always looking on the bright side! Thanks so very much Dr. Garcia for all you do!! Have a great day!!

Answer:

the Fraxel works by irritating the skin and causes new collagen to form, that takes about 4-6 weeks, and then the collagen crossfibers tighten, that takes the 4-6 months. I think you are far out enough that the Retin-A could be used on the neck, start every other night and increase as tolerated. Peels can be done on the neck but the wrinkle reduction is small to none. If all else fails, surgery stil remains an option. All the best. JG 6.30.10

Question:

Dr. Garcia, I am a fair skinned 42 year old, I`ve had 2 rounds of IPL`s and found them very effective. I am wondering, would a few rounds in my 40s (it`s been 2 years since the last) give me an anti-aging benefit? Do you think IPL`s are far superior than the best creams for aging prevention, collagen preservation and or restoration etc?

Answer:

I do not think they are vastly superior but they are good, minimal risk and minimal to no downtime, might be worth having them every so often as a way to slow the progression. JG 6.29.10

Question:

Why can`t Rhytec Portrait be used on the neck? What is so different between the skin on the neck and the skin on the face that would prohibit its use there?

Answer:

it is due the the capability of the skin on that area to heal from that type of injury. JG 6.27.10

Question:

Which lasers are best to reduce hyperpigmentation? Which lasers are only good for darker spots? Which lasers work on both dark and lighter spots or just lighter spots?

Answer:

no lasers work on lighter spots I feel, as for the darker ones we use a YAG laser. JG 6.25.10

Question:

Morning! I had a PDT/levulan/IPL therapy treatment 2 mos. ago. The peeling reduced sun damage. Overall skin the fine lines & texture same or worse, told 4 mos for collagen rebuild...be patient? Need additional treatment? (They advised only one.) Just started using your cell matrix cream as well. Thoughts on this procedure? I am 55 and cheek/chin area are the worst. Very conscious of this, does collagen take that long to be noticeable? Appreciate you being here to answer the ?`s our drs don`t give us!

Answer:

well, here is the info. PDT with Levulan is approved for the removal of premalignant skin cells. It is used by many for fine lines, texture and wrinkles, but it has never been FDA approved for that nor do I think it ever will be. The use of PDT and Levulan together is to try to use a machine they already have, the PDT, in other ways to help pay for the cost of the machine. Once you add the Levulan, the safety profile of the PDT is gone and essentially you have nothing better than a chemical peel, which would have cost you lots less money. As to building collagen, yes it does take time, and you might see some improvement with some more time passing, but in my humble personal opinion, with what you are describing, I think you have wasted your moeny. I feel it is marginally effective for fine lines and texture and when you add in the risks of hyperpigmentation, I think it is not worth the money or risk. Sorry. Also, thank you for the kind words. JG 6.10.10

Question:

I had fraxel (the one that lasts for 5-7 yrs and you only do once and need to stay in for a week) not sure of the actual name - at any rate, it did not seem to work on cheeks and Dr. re-did them but now I have huge jagged brown spots covering both cheeks - he has tried more fraxel and one v-beam, what else could be done?

Answer:

could try TCA chemical peels or a YAG laser, also need to use hydroquinoe at the same time,sorry to hear about the problems. JG 6.9.10

Question:

Hi Dr. G., I hope you are well. I seem to recall that you don`t think much of the Fraxel when it first came out. I was wondering if you feel differently about the fractional offering by Paloma. If not, what do you suggest for general improvement - clarity, firmness, and just generally looking rejuvenated. I am over 50, but have been told I can pass for 40 so would like to do what I can to preserve what I can, if even just in the interest of being professionally competitive in this sad economy. Thank you!

Answer:

the reason I am not a fan of fractional lasers is the expectations, they work in terms of a rlatively mild and short-lived degree of improvement. Most patients that come to see a plastic surgeon expect, to paraphrase Emeril Legasse, BAM! If you are looking for something stealthy that most people will wonder if something was done and accept that it will need to be done every 12 months or so, then the fractional lasers, no matter which company, are fine.I just think they get overhyped and promise things that are not true, the pictures they show are all too close to the last treatment to determine whether it was a wise investment.JG 6.7.10

Question:

Hello Dr.Garcia!! This is really an incredibly helpful website!! Question: I had a fraxel co2 ablative laser about eight weeks ago on the face and neck. I am a late life victim (late 30`s of chicken pox) which left the right side of my face with a good many scars. I tried dermabrasion with decent results but my sugeon suggested the faxel. It did an great job on the face but the neck has a sort of chicken skin texture and a striated type of downward pulling. I had no sagging or neck skin damage etc.. my reasoning behind doing the neck was that dermabrasion left a demarcation line and I thought since you could do the neck with the faxel it would blend it. It has been approx. 8 weeks since the procedure and the fraxel neck lines are still present and ONE side of the neck still has the loose saggy skin..one side continued to heal. My surgeon said a few weeks ago at post op that this happens in some cases that you get hyperpigmentation and gave me some creams. I`m not worried about the fading of the graph lines...just the loose chicken skin (old lady) half neck. Does this continue to heal over months and improve like my surgeon said you`re just not done yet, don`t worry or am I stuck with this. As well, is there any recourse. I always look on the bright side. How long do you continue to see improvement in the faxel? Thank you Dr. Garcia!

Answer:

should get better but slowly over 4-6 months. Got to hang in there for a bit more. JG 6.6.10

Question:

What laser do you recommend to treat tiny broken capillaries around bottom of nose and upper lip area? Any downtime? thanks as always.

Answer:

YAG or VBeam, essentially one to two days with the YAG, maybe a week with the VBeam but the VBeam is more effective, both will likely need more than one session. All the best. JG 6.2.10

Question:

what treatment would tighten the skin under my eyes.

Answer:

for loose skin, it would be surgery, for poor quality skin a laser would help, but not for a long period of time. JG 6.1.10

Question:

Thank you for your response to my earlier question re: which type of laser would be best for acne scars and redness in them. Which one is best for olive type 3/4 skin for raising acne scars and texture? And which one can be used in conjunction for redness? If one causes or exacerbates the other, I guess two can be used to counter the effects of the other. Of course, efficacy but only with lower risk than others is key. I was thinking amongst smoothbeam, v-beam, v-star, or nd:yag.

Answer:

I am sorry but I would not prefrom a resurfacing laser on your type skin due to the high risk of complications. The YAG might be OK for the redness if done in a series of sessions but there is no laser that will give you much for the scarring. JG 5.26.10

Question:

I have responded well to IPL treatments for redness/rosacea. If you had to pick for both efficacy and safety (low risk) for treating shallow acne scars and the redness in them, which one is best for type 3-4 skin; smoothbeam, V-beam, nd:yag, V-star or something else? How much improvement can one expect to see and after how many treatments?

Answer:

I do nok think a single treatment will be effective for both, what helps the red will not help the scars and what helps the scars will make the redness worse, at least short term, sorry. JG 5.25.10

Question:

Dr. Garcia, Im the guy with the hypopigmented circular spot on forehead due to vbeam. Is there are way to implant microcapillaries back into that spot so that the redness/vascularity can be restored? I spoke with a facial plastic surgeon about surgical excision, she said that it might look like a long thin line, and it may also be hypopigmented, do you agree with this, is there a chance the excision will give me an undetectable non-hypopigmented linear scar?

Answer:

no, microcapillaries cannot be implanted. Scars can heal as pale lines and at times heal very well and can hardly be seen, all depends on the tension on the closure. The bigger the spot removed, the greater the chance of it being visible. JG 5.25.10

Question:

I am considering having some laser genesis done for acne scarring, but recently, heard of someone , who told me her scars got worse after 5 treatments. I am now considering cancelling, and would very much appreciate your advice. Please help, I have many sleepless nights due to this. I must have something done!! Thank You & God Bless

Answer:

well, at best it will be a waste of time and money, at worst, you might get hyperpigentation, I would skip it if I were you. JG 5.18.10

Question:

Hi, Dr. Garcia, I know you don`t approve of fractionated laser, but unless I traveled 300 miles, I had to go with dot. The doctor was honest and on day 2, I am very swollen. I am sorry, but I just can`t remember what he said about washing. He told me to use the aquafor right after and the cera va cleansing cream. Is the second day too early for using a gentle cleanser? Also, do I keep iceing for several days? Thank you for any info that will help.

Answer:

just press a cool wash cloth on your face and peel it off, do not rub.Ice for the first 3-5 days is all that I suggest. JG 5.16.10

Question:

Hi. I had my first v beam treatment 3 weeks ago. I forgot to ask my doctor some questions and i was hoping you could answer them for me. 1. how long until i see the full results from the vbeam? 2. i used a at home oxygen peel about 1.5 weeks after the treatment. the oxygen peel is pretty gentle, but i am wondering if i used it too soon and ruined any of the results? 3. how long do i have to wait before getting my 2nd v beam? Thanks for your time. sarah

Answer:

results are usually about 6-8 weeks. No bad effects from oxygen peel and fading the spots most likely. In most cases the VBeam can be repeated after 6 weeks, but it depends on the strength used. Best of luck. JG 5.15.10

Question:

Thank you answering my question re: safest laser for light olive/Indian skin. I have had IPL but with temporary and mild results. I wanted to try the Nd:Yag for the issues I mentioned. What do you think? If done lightly by an experienced derm, would it help the redness and the pigmentation without the adverse effects?

Answer:

I think the Nd:YAG will be more risky and if you try to decrease the risk it will be no more effective than the IPL, also understand that no matter what method you use, they are ALL temporary as the skin has memory and with sunlight or florescent light, the dark spots will come back. JG 5.10.10

Question:

What is the safest and most effective laser for olive (light Indian) skin to treat 1) redness/rosacea like 2) brown pigmentation from acne and 3) light acne scarring, all without high risk of hyperpigmentation or worsening?

Answer:

about the only thing I would suggest as to a laser would be a light series of IPL sessions. Don`t forget the sunblock! JG 5.10.10

Question:

Hi Dr. Garcia, I am considering doing a series of IPLs to treat my brown spots and hyperpigmentation. However, I have a few fine lines and my skin appears relaxed (not as tight as it was when I was 25). I am now 37 and counting. Question is would you recommend for the best results - a series of IPLs or Thermage? How many sessions of each do you think it would take to achieve the best results? Thank you!

Answer:

I do dot think you will get any significant skin tightening with the Thermage, nor the IPL but the IPL will work for the brown spots. The longer you have had the brown spots the more treatments will be required, no way to tell how many though. Not all of the spots will go away, the longer standing ones wil be the hardest to lighten, and in time, they will come back. Nothing will permanetly remove the spots. All the best. JG 4.22.10

Question:

hi dr garcia, What do you think of the pixel 2940nm erbium laser for skin texture improvment? also is there a ipl machine that you prefer?

Answer:

no preference on the IPL machine and I think the pixel erbium will give very limited degree of improvement, and short lived too. Julio Garcia MD 4.19.10

Question:

Last year, my plastic surgeon did sclerotherapy on my legs and ankles with good results. For the past few months, he`s been using the VBeam and the GYag to clear up the remaining small vessels every 6-8 weeks or so, also with good results. Two weeks ago, he used the lasers again (at the same settings), but this time, I was left with more than 30 dark red or dark purple hard, raised circles, about 3-4 mm in diameter; they look like blood blisters -- or an aggressive case of chicken pox! They haven`t lightened at all since the treatment. What do you think happened? Are they likely to be permanent? If not, how long do you think will they take to fade? Anything I can do to speed that fading along? (I have very, very fair skin, by the way.) Thank you for your help and time, Dr. Garcia.

Answer:

do not think they will be permament, I would give it time, might need a little more laser to help them fade, not uncommon around the ankles to be honest. Avoid the sun and you can apply warm packs as that might help a little bit. All the best. JG 4.18.10

Question:

What is the best treatment for broken/red veins on and around my nose, mouth and cheeks? Thanks you!

Answer:

IPL or VBeam laser. JG 4.17.10

Question:

Hi, Dr. Garcia. I had a fractional CO2 treatment 7 months ago which left me with a stubborn case of PIH. It isn`t responding to hydroquinone or IPL. You suggested the YAG might help. I mentioned this to my dermatologist. He said you must have meant the Q-switched YAG, not the Gentle YAG. Is that right? He has both -- the Cutera Alex Laser as well as a G-YAG -- and suggest we try the Q-switched. I thought I should check with you, since I don`t want to make this worse. Thanks very much! I hope you`ll have a restful weekend, Dr. Garcia.

Answer:

correct, Q-swithced YAG laser. All the best and same back to you. JG 4.16.10

Question:

Is the 1540 an effective laser for the improvement of skin`s texture and tone? (Type 1 skin) Thank you for your opinion, Dr. Garcia.

Answer:

minimal. JG 4.14.10

Question:

Good morning Dr Garcia. What do you think of this peel? Obagi Stimulation Peel (Vitamin-Enhanced) Repeat once a month for 3-5 months. Repeat every 4-6 months to maintain healthy skin. Strongest & Most Effective Aesthetic Treatment. Excellent for correction of large pores, uneven pigmentation, scars, sun damage and fine lines. Formulated by Dr. Obagi, the stimulating peel solution and Retinoic Acid (Vitamin A-) stimulate the growth of healthy cells and quickly shed away your damaged skin layers. Noticeable improvement after one treatment. Treatment will result in 4-5 days of mild exfoliation. The maximum amount of stimulation to correct skin with minimal or no downtime

Answer:

good peel, cannot say whether you would need it that often without seeing your skin in person though. JG 4.13.10

Question:

Thank you Dr Garcia, do you think though it could improve it a little, it is widely advertised for atrophic scar treatment, it is just some improvement i am hoping for and would be very anxious to have laser again.

Answer:

impossible for me to tell without seeing you in person, sorry. JG 4.11.10

Question:

Dr. Garcia, can you recommend a facial plastic surgeon in new york that i can consult with about the light circular spot on my forehead that i want excised for a fine linear scar

Answer:

Due to potential legal issues, and some doctors wanting to know why I referred a patient to someone else and not them, I think you are best to go to this website and look for a plastic surgeon in the area you desire. I wish you all the best. JG 4.8.10 http://www.surgery.org/public/findasurgeon.php.

Question:

I had a CO2 laser peel 5 weeks ago. I healed with no problems and the laser took off most of my brown spots, but there are still a few left. My question: could a TCA peel help lift off the remaining few spots, and how long after the CO2 laser could I have it.

Answer:

depending on the depth of the CO2,if done ligth or fractional, it could be followed with a TCA spot peel after 6-8 weeks if the skin has healed. JG 4.2.10

Question:

Dr. Garcia, I am a 42 year old male who has had a couple TCA peels with improved results which I am relatively satisfied with but would like better results. I am interested to know what is the difference in expected final result between doing perhaps 3 TCA peels (20%-25%) over a year or as prescribed vs doing one phenol peel ? I read so much about phenol on the web using terms like dramatic improvement and the like. Any expansion on phenol peels is appreciated. Thank you

Answer:

the phenol peel will do much more, numerous lighter peels do not equal one deep one I am afraid, but the risk of hyper and hypo pigmentation are greater the deeper you go. JG 4.1.10

Question:

what chemical peels do you find more effective, jessners, tca, or glycolic for acne marks and pigmentation? x

Answer:

for acne, nonn of those, for pigmentation, if it is light and recent they all will help some but the most effective is TCA. JG 3.30.10

Question:

My dermatologist is recommending the 1540 laser for me instead of (or perhaps in addition to?) IPL, but I don`t fully understand what the difference would be. Can you enlighten me? Thanks so much!

Answer:

I need to know what they are trying to help you with. JG 3.29.10

Question:

I have some hyperpigmentation and red marks from previous acne and oily skin. Have been recommended the Obagi nu derm system combined with retin a. Do you think this will be effective? I have light skin, sun damaged, oily, some existing acne, and some pigmentation .

Answer:

I think it is worth using for what you have. JG 3.25.10

Question:

I have had my eyebrows tattood (permanent make up) but i dont like them. What do you think is the best method for having them removed? I have heard `E-RASE` is good, or do you reccommend laser? if so which laser?

Answer:

YAG laser in a series of treatments. JG 3.25.10

Question:

I had one Laser Restore treatment 4 weeks ago, and I am not happy at all...the pores are large, my skin is oily and creepy, but the worst is, that i had always a very tight and full face, with prominent cheeks, its seems that my cheeks flatened and my skin sunk, the skin feel soft but never felt so loose before especially on the jowls. Nose folds have become more. Could the new fraxel restore laser cause fat loss? I ahd only one treatment. My doctor said its impossible but I see myself older and worse than before. I am scarred...

Answer:

I have not heard of pixelated lasers causing fat loss, no. I am unsure as to what is going on in your particular instance, sorry. JG 3.24.10

Question:

Dr. Garcia, Im the guy with the hypovascular circular spot from vbeam laser on my forhead 5 years ago. So I spoke to a double board certified facial plastic surgeon on the matter and this was his response, Hypopigmentation (or maybe hypovascularity in your case) are sometimes difficult to correct. If it has not corrected itself over the past 5 years, I would think it is unlikely that it will improve much by itself at this juncture. I guess excision is an option (depending on size, shape and precise location) but it will leave you with a scar (hopefully a good one) so you need to decide for yourself which you would rather have. I am not sure if you have tried topical Rx (steroid or estrogen-based creams) -- they may improve the pigmentation on occasions, you may want to speak with a dermatologist about this option. I am not sure I would recommend doing VBeam for the whole face -- you may end up with a worse problem than what you have presently. I hope this helped a little. , What is he referring to when he says steroid or estrogen based rx topical creams? Ive never tried anything topical on it? do you know what this is and can it really help?

Answer:

I see now way that estrogen cream or a steroid will help it. JG 3.20.10

Question:

Dr. Garcia, I think im going to do the excision of the spot, im sorry to ask so many questions, but just a few more, the thin linear scar left afterwards, will it be level with the surrounding skin or will it be a little elevated? Do you think it will be a lot less noticable than a dime sized hypopigmented circle? meaning will it be much smaller to the naked eye? and I just wanted to comfirm with you that flushing and vascularity will be restored to that area correct? how much downtime will i have after this procedure? how long would i have to wait for the final result? I saw on some websites that plastic surgeons recommend dermabrasion after an excision, is this absolutely necessary?? or can I do without it because that will definitely cause hypopigmentation.

Answer:

no way to predict, it might be raised and red on a permanent basis, the greater the tension on the wound when it is closed, the greater then chances of that occuring. I am unable to say whether it will be less noticeable to the naked eye than the dime size spot you presently have. The flushing and vascularity will be restored because you are brining in normal skin from the surrounding area. Your forehead will be swollen for 2-6 weeks and the scar will take a full year at least to get to its mature appearance. No lifting more than 20 lbs for two weeks and not to full activity for one month. I have never done a dermabrasion after an excision of a scar, there is not reason to do it, if anything it can take a scar that was going to fade well on its own and injure the skin more than needed. JG 3.14.10

Question:

Dr. Garcia ive been doing some research on these punch excisions or excisions and I have another question, is it absolutely likely that the new scar would be hypopigmented and the melanocytes would be injured and it will never tan again, therefore not match the rest of the skin color, or is there a possibility it won`t be hypopigmented and will match the surrounding skin color?and just to verify, you also said that the new scar will flush with the rest of the skin and redness to the area will be restored correct?

Answer:

no, you do not always lose the skin color in the punch excision, but yours is not a small punch excision, it is much much larger than that. Your dime sized pale spot is not amenable to a punch biopsy. JG 3.13.10

Question:

Hi Dr. Garcia, I consulted with a dermatologist today about vbeaming the entire face. He thinks he can evenly get all the redness out and it would have even pigmentation. i get most of my skin color from the blood vessels/redness, do you think he can really get it all evened out, would it be better to use a vbeam or something else like a yag or IPL, im starting to lose hope, maybe micropigmentation is my best bet?? Im starting to think maybe your suggestion of cutting it out is maybe the best bet because people get big moles removed all the time and it looks good, Im just having regular skin removed. I looked and the penny sized spot is above the center of my right eyebrow, in the middle of my forehead from eyebrow to hairline (right hemisphere). maybe you can really cut it out and leave a small thin line

Answer:

well, if it bothers you as much as yu say, I think it is worth a try. I think it will be much more effective than an IPL or a YAG for what you have been describing. Your right eyebrow might end up being permanently higher than the left if it is not directly in the center, just so you are aware. JG 3.12.10

Question:

would a chemical peel such as a 30% tca peel or jessner peel atleast even out the pigmentation so the difference in color is minimal, and give an even skin tone?

Answer:

they only work on brown, not red. JG 3.11.10

Question:

im a young man, wouldnt that be good for this procedure

Answer:

the older one is, the looser the skin, and then the easier to cut it out and leave a better scar, when you are younger, the skin is tighter and then ther is more tension on the closure so the scar does not heal as thin. JG 3.11.10

Question:

what is the likelyhood the result would come out beautufill thin line thats hard to see? if done by you offcourse

Answer:

honestly, at your age, and with the size you describe of a dime, it will be not very thin. JG 3.11.10

Question:

so your saying there is always a possibility the scar would be big and wide instead of small, thin and linear?

Answer:

correct. JG 3.11.10

Question:

Dr. Garcia, Are there any real differences between the Lumenis IPL and the sciton BBL treaments? Which do you perfer and also how many weeks do you recommend waiting between treatments? I have seen some literature that says you can repeat the treatment at 3 week intervals? Thanks

Answer:

very similar, the difference will be in the filters they use and that difference will be quite small. I have used Lumenis machines in the past and prefer that company. If the skin can tolerate it, every threee weeks can be done. JG 3.11.10

Question:

ok, your getting me curios about cutting it out, but if you cut it out how will you be able to reestablish blood flow to that area so that it will flush with rest of skin. and what are the potential risks/side effects of you cutting it out? I just dont want to disturb the look of my forehead with this, meaning i dont really have wrinkles yet, im 28 years old and I dont want it to be a totally obvious scar that ruins the flow of the rest of my skin on forehead. how much would you charge for this and how much time would healing take?

Answer:

the surrounding skin that is not involved is the skin that gets pulled together and that is why if the entire pale spot is removed, the color should be the same as the normal surrounding area. The side effects are a wide scar that you do not like and can do nothing about. The skin being pulled together will also necessitate the nearby skin moving in, so if it is between your eyebrows a horizontal incision might be better as a vertical incision could pull the eyebrows closer together. Healing would take a couple of weeks but it will take months for total scar fading. I could not quote you a fee without seeing you in person, sorry. JG 3.11.10

Question:

well lets put it like this, wat would you do in my shoes, do you think its possible to vbeam or ipl the entire face and get even uniform color. or would you cut it out and trade it for a thin linear scar? would the thin linear scar disrupt the texture of the entire forhead by the way? the lighter penny sized spot is close to the center right side of my forhead, definitely enough adjacent skin to do anything. Also this might sound a bit stupid, but what if I used excimer or relume repeatedly, wouldnt that cause hyperpigmentation (sun damage) in the spot? which would then match the skin tone, and if relume or excimer caused some form of skin cancer then just have it cut out for the linear scar eventually? I appreciate your time and assistance

Answer:

I would likely cut it out, I think the repeat VBem over the entire face is easier and less risky, but the cheeks will likely not fade as much as the forehead. I do nto think using a laser of any sort on the spot that is already pale will help in any way. JG 3.11.10

Question:

if you cut out the spot, would the narrow line be very hypopigmented as not to ever tan again? I just assume thats a lot of skin to cut out, maybe im wrong im not a doctor. Do you think thats since this spot was lasered by the vbeam 5 years ago, is there even a remote chance that the flushing/superficial redness can ever return. Everyone says the effects of vbeam is temporary but it doesnt seem temorary to me, if it was temporary then the blood vessels would regrow by now correct? how big would the new scar be if you cut it out, and do you think it would look better than a circular lighter spot on forehead, and would the new scar line atleast flush with rest of skin?

Answer:

correct, the scar woudl not tan. It is likely a good piece of skin to cut out, yes, but you are were asking for options and that is one of them, might not be one you want to deal with the side efects, but it is an option. I think since it has been 5 years since the treatment, that the skin will not regain any more of the color than it already has. The scar would be about 50% longer than it is wide. How wide the scar will be is hard to say as that depends on the amount of tension upon closing it. The scar should be flush with the skin, but I cannto tell you if it will be better than what you have now as it is a judgement call. JG 3.11.10

Question:

when you say cut the spot out what do you exactly mean. Its the size of a penny on my forehead, won`t cutting out skin and stitching back together leave me with a hypopigmented shiny white scar with no flushing as well? I just wish there was a way to induce angiogenisis back into that circular spot, wouldn`t constant sun exposure or excimer/relume help induce pigmentation and angiogenisis back into that spot or no? Also the only reason why I thought fraxel is because I heard fraxel can induce pigmentation to come back into the area lasered?

Answer:

yes, but it will be more narrow.Sun exposure, which you have already tried and showed no improvement, will not cause the new blood vessels to form I am afraid. Fraxel can induce post-inflammatory pigmentation, and will restablish some redness during the healing phase only I am afraid. JG 3.11.10

Question:

Dr. Garcia, Im the guy with the lighter circular footprint spot from a previous vbeam laser that was done on my forehead 5 years ago now for a pinkish post acne mark which i regret doing everyday. I am desperately seeking to correct this, just to remind you it basically looks like a punched out circular spot on my forehead that no longer flushes red and is lighter than the rest of my skin on forehead. My skin is fairly light and I assume i get a lot of the color of my skin from the redness/blood vessels. and since they were eradicated in that spot by the vbeam it has left a demarcated lighter circular spot. There has to be something that can be done, one doctor offered to vbeam the entire face to make things even and feather everything out with vbeam so its uniform, but what guarantee will I have that it wont make it worse and i wont have white spots all over my face? Then theres the relume laser or excimer laser to bring back pigment into that spot, but the problem is I can tan, its not really a loss of pigment, its just loss of redness/blood vessels. If I go out in the sun for a while and get sunburned that spot doesnt sunburn or get red, it gets brownish (tans). So I dont know what the relume or excimer can do for me in that sense except tan the spot which will make it darker but I assume wont be permanent and id have to keep doing it right? I also heard about fraxel, that it brings back pigment or blood supply, is this accurate? that fraxel can make pigmentation, skin tone even? can this be the one machine to fix this punch out effect I have? would a fraxel spot treatment in that one spot fix things possibly? or do I have to have a whole face fraxel treatment and risk doing more damage? and what about tca peels? PLEASE GIVE ME YOUR PROFESSIONAL OPINION ON WHICH COURSE OF ACTION WOULD BE BEST BECAUSE I AM GOING CRAZY WITH THIS ISSUE AND I CONTANTLY LOOK IN THEM MIRROR, MAYBE SOME PEOPLE CAN LIVE WITH IT BUT I CANT. I JUST DONT WANT TO RISK DOING ANYMORE DAMAGE, BUT I WANT TO HAVE EVEN SKIN TONE LIKE I DID BEFORE THIS STUPID MISTAKE I MADE TO GET A POST ACNE MARK VBEAMED JUST BECAUSE IT WAS A LITTLE PINK. THANK YOU IN ADVANCE

Answer:

I think the Relume will be a waste of time and the Fraxel an even larger waste of time, I do agree that treating the entire face is a good option, and there might be need for small touch ups to get it to be even though. The only other option is to surgically cut the spot out if it troubles you that much. JG 3.11.10

Question:

i had deep fx on face 1/20/2010 i am very pale, green eyes, 58 yrs old my skin has peeled but i am still very red and have some laser marks does this fade away over time w/out any intervention or do i need to do IPL or something else? i have used no steroids thank you.

Answer:

all should fade away in time, I would hold off on the IPL as it might just make it worse. JG 3.10.10

Question:

Hi Dr. Garcia, Which laser would you recommend for hand rejuvenation? I have loose skin, crepey texture, and some wrinkles and hyper-pigmentation. Thanks for your time.

Answer:

hands can be burnt from a laser quite easily if one is trying to tighten the skin. For the brown spots you can use a YAG or VBEam, they are safe, but all other lasers for skin tightening have to be done mildly to avoid a burn, therefore you don`t get much in return. JG 3.5.10

Question:

Hi, I have a birthmark on my thigh that is approximately 1 inch high and 4 inches across with a varying border. I am light olive skinned and the birthmark is about two shades darker than my normal skin color (looks like i would with a tan). this has always bothered me. I have seen 3 different drs, 1 said the only thing he could do is cut it out and leave a scar there, and said the scar might look worse than the mark. the second did a laser test spot, which did nothing and said that was all that could be done. the 3rd doctor gave me Tri Luma cream which did absolutely nothing. this doctor removed a freckle i had (much darker than the scar) with Refraxel machine, which worked but left a redish mark that looks unable to heal after a month. and after asking if that might work for the birthmark, he said he wouldn`t recommend it for the mark. Do you have any advice on what i can do? I hate it and it seems like there are no options. thank you for your time.

Answer:

I would use a YAG or a VBeam laser, a test spot is OK, but it will likely need a long series of treatments as they cannot go too strong for fear of burining your skin. All the best to you. JG 3.1.10

Question:

Hi Dr. Garcia, I have developed hyperpigmentation right after doing 2 ipl. I am an Asian with light skin. The dermatologist then try to remove them with chemical peeling for 5 times and the pigment has been lightened but they are still very obvious. I am now using Meladerm (kojic acid) and Vitamin C 20% serum two times a day and I always feel numbness on the spot that I apply. Will there be any adverse reactions and will this cause skin cancer? Thank you.

Answer:

no, should not be any cancer risk there, all the best. JG 3.1.10

Question:

Hi Dr. Garcia, What might you recommend for post inflammatory hyperpigmentation from the fraxel restore laser (3 treatments almost 3 years ago). I am Indian with type IV skin. The Tri-Luma seems to be making my skin very irriatated. I also have Lustra Ultra and Epiquin Micro. My doctor is recommending chemical peels or IPL. Do you recommend these or are the hydroquinone creams necessary in cojunction with those procedures? Thanks so much.

Answer:

well, to be honest, if the Triluma is irritating you, there is nothing stronger I would suggest, if anything, you might need to weaken the Triluma with a moisturizer cream in equal parts as the irritation will not allow it to get better.The Epiquin might be worth a try amd I certainly would not recommend the IPL or chemical peel as they are more harsh and can cause hyperpigmentation on their own. JG 3.1.10

Question:

I had a GentleLase treatment without the DCD coolant to remove hyperpigmentation (not using the coolant is the protocol to remove pigment). The treatment did ultimately remove the pigmentation but for approx. 7-10 days after, I had marks on my face in the shape of the laser head that could not be covered with makeup. Could this be because the setting was too high or because of a defective head?

Answer:

it is more the setting, and the lack of cooling, it happens frequently. JG 3.1.10

Question:

My 9 year old son was diagnosed with a small telangectasia on his cheek. Do you recommend Vascutouch over Cynergy laser? How many treatments does it usually require on either method for a small vessel?

Answer:

impossible to tell how many treatment sessions but I think they are similar in their effectiveness, all the best. JG 3.1.10

Question:

How long is it before one sees the final results of a deep chemical peel?

Answer:

3-6 months, depending on the chemical used. JG 3.1.10

Question:

PIH--from a bruise--should i try hydriquinone (4 weeks since bruise from injection under eye--brownish color--or should i go straight to IPL or other?? thanks

Answer:

I would start with the hydroquinone and use sunblock too. JG 2.26.10

Question:

what is your opinion of iridex scan lite for pigmented lesions--discoloration from bruising?? thanks

Answer:

reasonable choice. JG 2.26.10

Question:

Dr. Garcia, How long do you recommend that one wait after a fractional co2 treatment on the face to get a Vi peel or an IPL treatment on the face? Also how long should you wait to do a chemicl peel on the face after you have mole removal with the surgitron device? Thanks

Answer:

maybe 6 weeks. As to the chemical peel, maybe 4 weeks. JG 2.24.10

Question:

Hello, It has be 8 weeks since my last session of ipl on my arms (2 sessions total), I have a checkered board appearance that is not fading, even with use of bleaching creams. Any recommendations? I am very concerned.

Answer:

sunblock and give it some time, I would make sure the bleaching cream is at least 4% hydroquinone and you could consider adding Retin-A to the mix. JG 2/22/10

Question:

Hi again Dr. Garcia, Just so I understand you completely, are you saying one cannot have too many pulse dye treatments, and there is not a chance of scarring, or fat loss, correct? Thanks much.

Answer:

well, if you are still red, it is OK ot proceed, it should not be done for preventing red spots though. I have not heard of any issues of fat loss with a pulsed dye laser, correct. JG 2.15.10

Question:

Is IPL effective for PIH? (3 months post procedure). My ps recommended it, but then his nurse manager overruled him, claiming it would only make the PIH worse. He had never heard of this happening, but he conceded to her opinion. (I think he`s interested in making his staff happy and appearing to respect their opinions.) What do you think? Thanks for your help! By the way, you look extraordinarily young in your photos, and your skin is amazing. What do you yourself do to care for your own skin? We would all do well to follow your example.

Answer:

yes, it is, but you need a series of sessions. Any treatment can make it worse in rare cases if not used properly or too harshly. I think the doctor should be concerned about making the patient happy and maybe train his staff on how to properly use the IPL so the PIH from it is rare, as it should be. As for my face program, I use my cell matrix peptide and also Dysport. Thank you for the kind comments. JG 2.12.10

Question:

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

Question:

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

Answer:

not as good as one deep one. JG 2.8.10

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

how about the Titan? Thanks again

Answer:

mild. JG 1.30.10

Question:

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

Question:

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

Answer:

not much. JG 1.29.10

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Answer:

in most cases 2-3 weeks. JG 12.28.09

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Answer:

no, just redness. JG 6.24.09

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

which treatment is better vi peel or tca peel?

Answer:

depends on the strength of the TCA peel. JG 6.8.09

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Answer:

YAG and VBeam. JG 5.31.09

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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.

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Answer:

waxing or electrolysis. JG 4.12.09

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Answer:

likely yes. JG 2.3.09

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Answer:

totally ablative, non-fractional CO2 laser. JG 1.19.09

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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.

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

what is your opinion od the CO2 laser-active FX?

Answer:

I am not impressed. JG 8.13.08

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

What do you think about the genesis laser for the face?

Answer:

waste of time. JG 7.17.08

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

what can help a hypertrophic surgical scar?

Answer:

kenalog or 5FU injections, YAG lasers and external beam radiation. JG 7.7.08

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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