Question:
Answer:

I think will give you some visible changes, but they will be mild and not long lasting. When doing fractional resurfacing you are only treating a small percentage of the skin, that is why you can heal so fast. As to RF, many companies claim collagen growth, but that will be mild at best and I would not expect that to last more than 6-12 months in the best of cases. Not a waste of time, but temper your hopes.

Question:

I have a visible scar fromnear my mouth from surgery 2 years ago. I've had CO2 resurfacing to it twice, monthly Genesis and IPL treatments, etc.  All of that has helped a little bit, but it's still quite noticeable. My doctor is now recommending dermabrasion. Will that likely improve things or will it be less effective than what I have already tried? I'm afraid of permanent pigment change which, near my mouth, will be impossible to cover with make-up. Thank you for your time.

Answer:

I do not think the dermabrasion will be any better than what you have already tried, and it has more risks than the others. If anything more CO2 laser with a non-pixelated density would be better. In other words, not a fractional laser, the entire surface needs to be treated, not just the patterned pixels.

Question:

What is your opinion of Venus Viva (RF miicroneedling)? I had it done last week, and I was very surprised to discover that I felt and looked just like I did when I had a CO2 resurfacing. I hadn't understood that it was ablative. I had thought the treatment would be comparable to (though it's a different technology entirely, I know) a nonablative fractional resurfacing -- like Fraxel Restore. It turns out that, for me at least, there was a full week of downtime -- extensive and impresive swelling (I couldn't open my eyesy for two days and even my tongue was a bit swollen), lots of pinpoint bleeding and crusting, and aggressive erythema. After all that, do you think the results might turn out to be good? I was hoping simply to tighten my skin a little bit by building some collagen.I didn't have any dyschromia or scarring that I was trying to treat. Thank you for your opinion, Dr. Garcia.

Answer:

some plastic surgeons think the device is great. I do think combining RF with the microneedling is better than microneedling alone, but the improvements, once the swelling goes down, will be mild and not long lasting, maybe a few months. 

Question:

Thank you for answering my question yesterday. A quick follow-up: MIght I have inadvertently given myself a more aggressive (and, therefore, a potentially more effective) treatment by exfoliating in the first two days after the treatment? I think I may be reaching here for an "upside" to this unexpectedly long "downside" of the extended downtime! LOL. Thank you!  (Still bright, bright red, scaly, and streaked!)

Answer:

you certainly may have, but it is unpredictable as to how uniform the added benefit might be

Question:

I had a fractional CO2 treatment last week. When I returned for my post-procedure follow-uptwo days later, I learned that I had been misinstructed on the day of the procedure. The nursing staff told me to gently wipe the exudate off my face with gauze and cool sterile saline every 2-3 hours and then to cover the skin with Elta MD's Laser Balm. When I saw the physician two days later, he told me that I was simply to have kept it covered with fresh coats of the balm every few hours for the first two days, that I should not have wiped off the exudate.  Did I risk scarring my face by wiping it off on days one and two? I must say that one full week later, I am BRIGHT red, extremely scaly, and heavily streaked, and I fear that the "streaks" on my face could be the beginnings of scars. The physician told me not to worry about it, but why, then, would he have not wanted me to sponge off the wounds in the first 48 hours? (I thought that the goal in wound healing is to prevent crusting, which is a contributor to scarring.) Thank you for clarifying.

Answer:

Although it is best to leave the skin without scraping or rubbing for a few days after a laser such as a fractional laser, it likely did no significant harm. The streaking you describe happens even when just the balm is used without wiping. You might have a few additional days for the redness to dissipate, but I doubt there is any damage done. Just follow the instructions here on out and I think all will work out well in the end. 

Question:

Hello Dr. Garcia ,,,,Are the results of non ablative laser Palomar 1540 for acne scars permanent or with time the acne scars will return to their previous shape before the laser ? I know that aging is a normal process but i am asking about the shape of the improved scars , will the scars preserve this great improvement or they will return to their previous shape before the laser ? Also is it safe to take like 20 sessions of non ablative laser Palomar 1540 over three years with good healing time between the sessions?Is there any risk of too many sessions of non ablative palomae 1540?THANKS SO MUCH DOCTOR
 

Answer:

They are not permanent. As the skin relaxes the same issues will return. That includes the shape.I think the risk of non-ablative being overdon3e is minimal to none. That limit comes with ablative lasers. You can proceed with what you have planned, but understand it is not a cumulative effect, by that I mean doing more does not make it any better in the long term, the results will still fade away.

Question:

I have small black asian characters on my neck. In total about 3x1 inch. The tattoo is a few years old and i want it lasered. I am half meditteranian, and half irish. Olive/White complexion.
Do you think this can be done with between a 90-100% blemish free appearance bc that is the only way it would be cosmetically acceptable to me. Otherwise I may just cover it again with a new tattoo afterwards.

Answer:

Black is the easiest color to remove and I think laser removal is a good option. The skin underneath should look pretty close to normal when you are done, but you need to be patient as it will take a series of sessions, no way to tell how many. We use a Q-switched Nd: YAG laser for that

Question:

Hi Dr. Garcia. I have a pea sized bump (but a bit larger and a bit flatter) on my nose which I believe is the early stages of Rhinophyma. I also have some uneven bumpiness (raised fibrous tissue) on the front as well as enlarged pores.
have read that Fraxel or Co2 laser may be best for early Rhinophyma to smooth the skin and get rid of bumps and enlarged pores, is this true?
Also, can you spot treat the nose with Fraxel or Co2 laser or must you do the entire nose for uinform results?
Will doing Fraxel or Co2 laser laser on the nose make the nose different colour or texture than the rest of the untreated face when using co2?
Can you recommend a reputable doctor in Toronto, ON for my procedure? How do I find the best one? Thanks so much!!!
 
I understand nose skin is thinner and I did Accutane 7-8 years ago which also left my skin drier and thinner permanently but I heal fine when I get cuts and scrapes etc.
 

Answer:

You can spot treat it if there are no other areas involved. Having said that the pores will not get smaller as there is oil deep in the pore that may not be removed with the CO2 laser or Fraxel. I have found photofacials to actually work pretty well for that as well as microdermabrasions to empty the oil and let the pore close. The area of Rhinophyma will always have  a rougher texture, the surface will be flatter not smooth like it was years ago. You might have to Google for doctors in Toronto for it, the only guy I know up there is Mulholland at SpaMedica. Best of luck.

Question:

Does your practice still offer this treatment? Why or why not? I've heard it's a bit passé now, as better technologies now exist. Do you agree? Thank you!

Answer:

I no longer use the technology as the company went bankrupt and closed. It has since been bought out and re-started but I do not use it any longer. I think there is really no new technology that shows a marked and reproducible improvement for skin texture or fine lines in terms of resurfacing compared to what was out there 3-4 years ago. Lots of claims made and not much proof in the pudding from what I can see.

Question:

I recently had a fractional CO2 resurfacing. It's healed pretty well. I know I'll be pink for a while, but I wonder how long the striations from the laser will be visible. It looks like I've been mauled by a clawed creature. I have long, red streaks down my face. What is your estimate of how long these will take to fade? Thank you and happy New Year!

Answer:

might take 3-6 weeks depending on how much energy they used and I wish you a Happy New Year also!

Question:

I had a fractional CO2 resurfacing 2 weeks ago. It's healed pretty well, and I know I'll be pink for a while, but I wonder how long the striations from the laser will be visible. I look like I've been mauled by a clawed creature -- long red streaks down my face.  What is your estimate on that fading of those marks? Thanks for your help and Happy New Year!

Answer:

They may be there for 3-6 weeks, depends on how strong of a setting they used. A Happy New Year to you also!

Question:

Thank you for answering my question about the CO2 resurfacing. It is indeed a fractional resurfacing. My surgeon uses Fraxel RePair, and here are the settings he will use on me. (He does 5 passes.)
Lower Face: 20mjl/ tx level 12/ 50% coverageForehead:    20 mjl/ tx level 11/ 50% coverageEyelids:       15 mjl/ tx level 10/ 40% coverage
Do you think that will be a mild, moderate, or aggressive treatment? And should that result in the tightening I am hoping to achieve?  Thanks very much for your time, Dr. Garcia. 

Answer:

about mild to moderate. I think it will give slight tightening, nothing dramatic though, just so you are aware.

Question:

What degree of skin tightening can one typically expect from CO2 resurfacing? I'm 50, white, limited solar damage, and have only a little bit of laxity. I'd like to achieve and maintain the modest degree of "tigthening" I get from the mild swelling after a chemical peel like Skin Medica's Revitalize Peel. Is that a reasonable expectation for the outcome of a CO2 resurfacing? Thank you.

Answer:

it is more for fine lines, you will get some level of skin tightening but it depends entirely on how much energy is delivered to the  skin, so a totally ablative laser will get more tightening than a fractional treatment, but the fractional has less downtime. I  think your expectations can be met for that degree of tightening, yes, with either type of CO2 laser treatment

Question:

Hello Dr. Garcia,
I've read a lot of the archives but can't seem to hone in on a consensus and I'm interested in your opinion. I need laser resurfacing of some type on my face for sun damage and wrinkles (especially cheeks), but I have kids and can't take 3 weeks off from life (or more) to undergo the healing from a traditional CO2. If I can only handle about 3-4 days down time at most is there a laser you would recommend ? Or is there one with minimal to no downtime that I could do in a series that might help? I'm convinced now that I need to find the laser that will work the best, and THEN find the surgeon to do it, because you know how it goes with the hammer and nail analogy, and I think a lot of the surgeons only recommend what they have in their office (naturally). Thanks for any recommendations. 

Answer:

well, as you are willing to compromise due to the life circumstances, I think a CO2 laser still would be the best, the milder version of it would be the Fraxel repair, it might have to be redone to get a significant improvement but healing time is short. I only have the stronger deeper CO2, so you can search for a physician with the Restore at this website. http://fraxel.com/find-a-doctor/find-a-doctor. Best of luck

Question:

Dr. Garcia,
I thank you so much for your response. I believe you hit the nail on the head regarding what I see is an inherent conflict of interest that so many physician specialists face....that being that they may be prone to only offer the interventions that they provide in their practice, even if its not necessarily the best treatment for the patient's problems, lest they lose the patient. I know that the oath is "do no harm" so I'm certainly not saying that physicians purposely do things that won't work, but it was already apparent to me that this conflict of interest is an inevitable part of the profession and many other professions as well. Your honesty and ethics are so commendable. Thank you so much for this and for helping all of us confused souls in the plastic surgery world :)
 

Answer:

Hope I helped,  I think you might benefit form seeing a couple more docs and you might see the slow emergence of a leaning towards one,but it is hard to stop the conflict of interest. Lucky for me I have been in practice 27 years so things are a little different for me, I  guess I can say I have more interest and less conflict at this point in my career.

Question:

Hi Dr. Garcia,
You are a saint to answer all these questions. I'm so confused. I'm 56 and have led a very active life. I'm very fit hence I have a thin face. My chief complaint is wrinkles under the eyes, cheek and upper lip wrinkles and some slight sagging. I've been to 3 different plastic surgeons who all recommended different interventions: fat transfer, sculptra to the cheeks, voluma to the cheeks, lower bleh, restylene to the tear troughs, matrix laser, limited incision face lift, to name a few. I probably need the limited incision face lift but will that cure cheek wrinkles? What are your favorite non-surgical interventions for facial wrinkling and sun damage, specifically to the cheeks and lower eyes? Can a lower bleh cure wrinkles under the eyes if theres not a lot of excess tissue? Thank you for your opinions. 

Answer:

Surgery is for excess skin, fillers are good for folds and lost volume and lasers are for the fine line issues. I think seeing a surgeon who does all three options is best  so they can be objective, but it sounds like the laser is the way to go for you.

Question:

Hi Dr. Garcia,
You are a saint to answer all these questions. I'm so confused. I'm 56 and have led a very active life. I'm very fit hence I have a thin face. My chief complaint is wrinkles under the eyes, cheek and upper lip wrinkles and some slight sagging. I've been to 3 different plastic surgeons who all recommended different interventions: fat transfer, sculptra to the cheeks, voluma to the cheeks, lower bleh, restylene to the tear troughs, matrix laser, limited incision face lift, to name a few. I probably need the limited incision face lift but will that cure cheek wrinkles? What are your favorite non-surgical interventions for facial wrinkling and sun damage, specifically to the cheeks and lower eyes? Can a lower bleh cure wrinkles under the eyes if theres not a lot of excess tissue? Thank you for your opinions. 

Answer:

surgery is for skin excess and lasers are for fine wrinkles. For folds or lost volume then fillers is an option. From what you are describing I think that a laser will be the way to go at this time. I always think it best to see a surgeon who offers all the options, otherwise you become the nail if he only has one hammer.

Question:

Hi Dr. Garcia,
You are a saint to answer all these questions. I'm so confused. I'm 56 and have led a very active life. I'm very fit hence I have a thin face. My chief complaint is wrinkles under the eyes, cheek and upper lip wrinkles and some slight sagging. I've been to 3 different plastic surgeons who all recommended different interventions: fat transfer, sculptra to the cheeks, voluma to the cheeks, lower bleh, restylene to the tear troughs, matrix laser, limited incision face lift, to name a few. I probably need the limited incision face lift but will that cure cheek wrinkles? What are your favorite non-surgical interventions for facial wrinkling and sun damage, specifically to the cheeks and lower eyes? Can a lower bleh cure wrinkles under the eyes if theres not a lot of excess tissue? Thank you for your opinions. 

Answer:

well the short answer is that surgery, like a cheek lift or a lower lid blepharoplasty removes excess skin, fillers replace lost volume and lasers can improve the quality of skin. Lasers do not remove excess skin, surgery does not improve poor quality skin and fillers do not replace either one totally. Fillers such as Restylane into superficial lines will help but will last a few months at best. Deeper fillers like Sculptra or Voluma last longer but are only to be injected deeper so they do nothing for the fine lines and they lift skin if the cause of the folds is due to lost volume, if it is not due to that your face will look overfilled.It is hard for me to say without seeing at least pictures of your face but it sounds like you have always had a thin face and merely have small fine superficial lines at this time. For that I think a laser resurfacing would be your best bet. Remember though that not mater what is done fillers, surgery or lasers, you face will improve in the relaxed pose but as soon and you animate or move the facial muscles the folds and creases will re-appear. The reason you got three different answers is because they want to do what is either easiest for them or what they like/can do and have disregarded evaluating all the options. If you see a doctor that does not perform what you need they will at times suggest what they can do not what the patient would be best served by. When they see a patient that would benefit from something they do not do they should refer the patient to someone else, that is what I do, but then you will lose the patient.

Question:

Dear Dr. Garcia, I have some scar tissue by my nose from having had some vessels there cauterized some years ago. It's dark in color and thickened a bit. IPL, YAG, and V Beam haven't worked. I'm thinking of doing an ablative resurfacing to my whole face to improve wrinkles. Might that help with that darkened scar tissue too?

Answer:

It might as the surface will be taken off and might reveal less dark color.

Question:

 Which is better the Thermismooth or Genesis  to treat  under eye, above the lips, and forehead wrinkles?
 

Answer:

my preference between those two is ThermiSmooth

Question:

 Which is better the Thermismooth or Genesis  to treat  under eye, above the lips, and forehead wrinkles?
 

Answer:

my preference would be the ThermiSmooth as I feel the ability to monitor the temperature increase for effectiveness is better.

Question:

 Which is better the Thermismooth or Genesis  to treat  under eye, above the lips, and forehead wrinkles?
 

Answer:

personally I feel ThermiSmooth is better

Question:

Dr. Garcia,I am debating as to whether I should spend $1,200 for the Erbium laser treatment or whether I should go for a series of microdermabrasions. I want to have a more refined skin texture and reduce small wrinkles. I was told that the Erbiium laser would not help the wrinkles above my lips. What is your suggestion. Also, is it dangerous to have fillers like radiesse or juvederm in the forehead area to fill wrinkles. I don’t like Botox as it give me a “Dr. Spoke” appearance. Does Thermismooth last longer than the Erbium treatment? I'm having problems finding a doctor who has the Termismooth laser in my area.
Thank you.
Dee

Answer:

I would go with the Erbium over the microdermabrasion. I use Juvederm on the forehead area but not Radiesse for fear of granules forming due to the make up of the product. I think the effects of ThermiSmooth are comparable in terms of longevity to the Erbium, yes.

Question:

Dr. Garcia,
How effective and how noticeable would the resurfacing be with the Thermascan laser. Is this non ablative? I don't want to waste my money on a laser which is not going to significaly improve my skin texture. I know that ablative procedures produce more dramatic results. Can Fraxel be safely done on Asian skin if the setting is adjusted lower?
Thank you.
Dee

Answer:

I think the Thermascan will give you very little. As to Asian skin and a light Fraxel, there are many Asian physicians doing it but I am unsure how much they get with the lower settings except spot removal. The effects on acne and wrinkles seems very short lived in that case and is likely just due to swelling.

Question:

I just read about a new CO2 laser that purports that it is good for all skin types. Do you know how safe and effective this is and is this really alright for Asian skin?
 
Thank you.
Dee

Answer:

I know that is what they clam, but I think the risk in Asian, African-American and Hispanic skin still exist

Question:

Does the fractional COs laser work to tighten saggy skin in eyelid crease fold? I mean can it be used as substitute for upper lid bleph surgery? If so, how long do the results last. And what is the price range?

Answer:

It can be performed there and you will get some effect but as the settings cannot be too strong due to the thinness of the skin, I would say expect 1-2 years at most. Price range varies from physician to physician, so there is no way for me to say, but a ballpark would be about $1,500.

Question:

Hi, Thinking about trying the sciton laser, Skin Tyte, to improve skin texture and mild sun damage.What do you think? Can this type of laser cause fat loss in my face? Thanks!

Answer:

mild results and low chance of fat loss if proper settings used.

Question:

I am thinking about trying the skin tyte, sciton laser to improve the texture of my skin and help with mild sun damage. What are your thoughts? Can it cause fat loss?

Answer:

think it might help you skin a small amount and if the proper settings are used then fat loss should be uncommon. Best of luck.

Question:

I am thinking about trying the skin tyte, sciton laser to improve the texture of my skin and help with mild sun damage. What are your thoughts? Can it cause fat loss?

Answer:

think it might help you skin a small amount and if the proper settings are used then fat loss should be uncommon. Best of luck.

Question:

I am 63 yrs old women and I have very bad sun damaged hands including red & brown spots and wrinkled skin...nolaxity left in my skin on my hands. The doctor used vbeam & alexandrite to spot laser the red & brown spots on my hands & then the same day I had fraxel repair done with 2 passes. What kind of results can i expect

Answer:

The spots will improve some but the take a series of treatments, and the Fraxel repair I fear will do little. Sorry.