Question:

I have tiny spider veins on my nose and have gotten conflicting information on how to treat them. One says injections and another says IPL, still, another says that's the wrong laser! You I trust. What would you advise? Thank you for your time

Answer:

My preference for spider veins on the nose is either an Nd: YAG laser or a hyfercaton with a handheld device. Please understand that no matter what you use, in time, you will get more spider veins.

Question:

I saw the posting about Venus Viva. Any chance of scarring from the needles injected into the skin? I'm imagining possible scars in the shape of the device head. You also say that the results will be temporary, but isn't that also true of other treatments like CO2 resurfacing? Thanks for this great service, Dr. Garcia.

Answer:

you are correct regarding the longevity of the results. I posted an answer to that but somehow it disappeared. CO2 laser will last longer than RF micronedeling  though. It is a degree of 'skin injury'. High energy CO2 laser will last longer than a lower strength CO2 laser, and both will last longer than the RF microneedling. The chance of scarring in the shape of the head, if the proper settings are used, should be a rare problem, but if higher energies are used to try to get a 'better' result, it certainly can happen.

Question:

I am a middle aged woman who has had thin hair my whole life. It's getting thinner! Do Laser Hair Growth devices work??? Thank you for your advice and time, I value it.

Answer:

In my experience neither the in-office nor the home lasers intended for hair growth have been effective, sorry.

Question:
Answer:

We still offer free tattoo removal for juveniles that have been in trouble with the law and then, we remove only the gang-related tattoos. We do offer tattoo removal for adults, whether they are gang tattoos or not, the fee for that is $100 for 15 minutes, the sessions can be done again to the same area every 6 weeks

Question:

This is a continuation of a previous concern. I was given an IPL treatment, November 30, 2017. I was not given any information regarding IPL or instructions other than to use a numbing cream. I was recommended the IPL for small broken capillaries. I assumed this was what the IPL was correcting, and there were a few. I had beautiful smooth skin prior to the IPL. The volume I was told was going to be turned up. I had no idea what that meant, I was there for a few broken capillaries. It's been six months and has gone from some scarring to irregular texture my entire face, hypopigmentation, criss-crossed like marks in the skin, maybe like a grid..they are noticeable when the light the skin. I'm shocked. I had gone back early on regarding scaring was then seated at a VISIA Beauty analyzer machine but the magnification was turned up that neither myself or the nurse tech knew what we were looking at. As I had won a free Signature facial and there was no suggestion of what to do I mentioned that the nurse tech speaks with the esthetician. I was given a microdermabrasion with the facial. No improvement, no follow up. And I honestly don't think they wanted to. I do not know what to do...how do I get my skin smooth again and the colour tone the same as the rest of my complexion which is now blotchy. My skin is also sensitive now. I was using a product called, C E FERULIC by SkinCeuticals which I am sure you're familiar with. I think however the product was irritating my skin so I stopped. I also lost some facial volume, forehead more so. I do not know what to do? What can heal my skin on a deeper level? Thank you ...you're an amazing human being to take your time to read and respond to all of the questions from many who need guidance from one who is an expert in their field. Thank you very much for reading my question, Dr. Garcia.

Answer:

I think seeing a plastic surgeon or a dermatologist in person should be next. A laser, such as a Q-switched YAG, can help even out the pigmentation. As to the texture, that is more difficult. That might require some Fraxel lasers sessions to smooth out. It is unclear why the fat or volume loss would occur, and when it happens from facial treatments, such as Ulthera or other radio-frequency treatments, they can be hard to correct; at times requiring fat injections or long term fillers to correct. Skin products such as the one you tried can help in some cases but everyone's skin is different and tolerates things differently, so there is a trial and error process. Wish I could tell you more. 

Question:
Answer:

As you are likely aware, the higher energy used has cause some damage to you skin. In all likelihood, as IPL is not a true laser and since the skin of the face generally is more resilient than other parts of the body, I think it will get better. In the meantime, you need to avoid sun exposure, so not sunscreen but sunblock is needed. Also you need to avoid all skin irritants, so no creams with any types of acid in it. You might want to wait about 2-4 weeks after the session and if no better, seek a consultation with a dermatologist or a plastic surgeon. I also might suggest you not return to that person for any further treatments. As you now know, more energy is not the best option and likely never gives a faster or more effective result 

Question:
Answer:

there ae many options to improve skin tone. They range from topical OTC products to prescription creams, followed by skin peels and that followed by lasers. The source and duration of the poor skin tone will direct what can or should be done but that requires an in-person evaluation. I would be happy to see you in person and discuss your options if you wish

Question:

 

 

Hi Dr. Garcia,

I have had melasma for many years and have had many laser treatments done in this time. My skin is light olive color (Fitz 3-4) and I have hypo and hyperpigmented skin. I just went for my first Pico Enlighten laser treatment using only the 1064 setting and no downtime whatsoever. They treat the whole face with this settings almost as a "laser facial". First off, do you think my hypopignented areas will get even lighter from this treatment and second, do you think this setting will do anything for my hyperpigmented areas since it's so gentle? 

I was thinking the point of the pico enlighten was to also use the 532 setting at the same time but the estethician disagrees. What is your opinion on the treatment plan and would you do something differently? 

I appreciate your help and your advice over the years has been invaluable! 

Dee

Answer:

I think there is progressive improvements with more sessions, it is never a one time deal. The 532 settings is more for red than brown PIH. Having said that, please understand that the skin cells have memory and in time, with sun exposure and florescent lights, the PIH will come back. It will do nothing for the hypopigmentation, but as the darker spots fade, the difference will be less and the skin will look more even. I wish you the best.

Question:

Dr. Garcia,

My doctor prescribed me Tri-Luma to fade my laser induced PIH within my hypertrophic scars.  They were darkened as a result of Pico, 1540 non-ablative fractional, and v-beam.  I want my scars to be the way they were before laser treatment which was supposed to happen.  I realize topicals of HQ/Retinold are the best first approach. 

1. Is it safe to use Tri-Luma on my hypertrophic scars to remove the PIH?  Is scarred tissue at greater risk of negative side effects from Tri-Luma compared to normal skin - even from short use?

2. I heard that Tri-Luma can cause redness and visible capillaries.  Is that just a temporary effect or is that a permanent affect upon use?  Can that occur from short term use?

Thank you.

Richard

Answer:

I would avoid the Triluma for the exact reasons you say, and those problems can be long-term or permanent. I would just use Retin-A and hydroquinone without the steroid

Question:

Dear Dr. Garcia,

I received three lasers: Pico, 1540 non ablative fractional, and V-Beam for three hypertrophic scars on my body.  The scars have PIH in them as a result of treatment.  Do hypertrophic scars (already flattened from steroid injections) exfoliate the PIH over a period of time, or are they permanently discolored due to the PIH?  Does the PIH fading process in scars differ from its fading in regular skin?  This expensive Laser treatment has done the opposite of its effect and reduced my self confidence instead of helping me.  Your feedback is greatly appreciated.  Thank you.

Richard

Answer:

There can be some self-fading of the PIH in time but there is also a possibility it might never go away without intervention. First step is mixed Retin-A with Hydroquinone and the next option is using a Q-Switched laser that can be set to a certain wavelength to fade the PIH without affecting other tissues. The PIH in scars takes much longe to fade than PIH on non-scarred skin, yes. Hope it gets better soon.

Question:

Which is better? Thermage or Titan? Is it true with Thermage you just need 1 treatment? Do you see any results right away with either or do you have to wait awhile. Thanks!

Answer:

I am sorry, but I think the technologies deliver inconsistent results and I cannot in good conscience recommend either one.

Question:

Which is better? Thermage or Titan? Is it true with Thermage you just need 1 treatment? Do you see any results right away with either or do you have to wait awhile. Thanks!

Answer:

I am sorry to say that I cannot endorse either one. I have not been impressed with the results from either technology. Some people have good results but many see no change. Just very unpredictable.

Question:

I know that Sculpsure is effective in reducing subcutaneous fat, but is it possible that it's strong enough to address intra-abdominal fat as well? I ask because I had it done two weeks ago; and 1) it was excruciatingly painful, so much so that I can't imagine that its effects are (or, for that amount of pain, should be) limited only to the subcutaneous fat, and 2) I've already seen such a significant reduction in the fat that I actually have an indentation in my abdomen where the applicator was placed. It seems it would be good if it were powerful enough to address more than subcutaneous fat, but only if that were intentional and controlled.  Thanks for your opinion.

Answer:

The muscles of your abdominal wall will prevent the effects of the Sculpsure from going in deep enough to affect your intra-abdominal fat. The pain you relate is not uncommon with just the superficial fat being treated.

Question:

Do You Treat post filler brusies with a laser?

Answer:

Any bruising form a filler is due to the needle used to place the filler. A laser should not cause any bruising unless nerve blocks of local anesthesia were used as that also requires needles. There can be some discoloration from a laser, depending on the type and purpose of the laser, but that is not a bruise. I personally do not use lasers to help a brusie fade as it can caues the filler to dissove faster. We use warm compresses as well as oral and toipica Arnica Montana and bromelain to speed the resolution of the bruises. Hope that helps

Question:

Hi Dr. Garcia, it's me again. The one with matting on the nose after laser (matting happened both times I had laser). My apologies, I keep intending to stop asking questions on this subject which you've been very gracious answering but my range of emotions changes on a day to day basis. This time due to seeing a new doctor in the area.

It seems my progress was best over the first month but now nearing 6 weeks out it doesn't look much better than 4 weeks. I have seen a couple doctors about this, one that said expect clearance in 3-9 months, but I'm a little distressed now because a new young doctor I saw today said these things usually only clear up 30% of the time without treatment. Is it really that low? If so I might give it another month and then bite the bullet and get another laser. Like I said though it clearly looks better than it did initially, and I have had this matting reaction to laser before and it cleared up completely after several months, but maybe I just got lucky that time.

Answer:

I think I would take the hands off approach due to the hurdles you have encountered. Give it some time. It can be difficult to see progress when you see it every day. If you want, just take a picture once a week and then compare them. The subtle progress that may be occurring is easier to see that way.

Question:

Hey Dr. Garcia, what do you think of a vbeam test spot on low settings on the matting I have on my nose? This is what has been proposed to me by a local laser clinic. Does this have a significant chance to worsen things? 

Thanks for keeping it real over the years. I don't even bother with realself because it's so dishonest. Dr's there won't even acknowledge half the compilations of lasers and other procedures because they only post there to make it look like a walk in the park so they won't scare away possible clients.

It's ridiculous that I can't even find any information in this compication because there are no studies to support it.

 

 

Answer:

I think the VBeam still has a risk of that, I would prefer a Q-switched Nd:YAG myself, there should be one in your city as they are popular for red, brown spots and tattoos also. Thanks for the kind words, I try.

Question:

Here a pic of my nose now over a week out from vascular laser.

http://i68.tinypic.com/2ntzsjc.jpg

I had no purpupra in the procedure. Only a couple minor broken capilaries on the bridge and tip.

It looked clear right after surgery but then within the next few days it started to look bad.

The crusts and skin have healed and all of this in the pic is vascual activity underneath the skin surface with much more broken capilaries everywhere and my entire nose red.

I had laser once before in another place on my face and it cause matting which took a year to clear. This looks like a matting reaction to me.

I'm pretty upset now because I think I'll have to walk around for this with a long time, or have to get another laser which may make things even worse.

What are your thoughts?

Answer:

I agree that it is likely matting. It will take time on its own to go away. If you are going to do any treatments to try to speed the resolution of the problem, I would go very weakly with an ND:YAG or a lesser IPL  type of treatment. Sorry this has happened again to you

Question:

5 days out and the crusting has come off to reveal bright red underneath. The rest of my nose is now pinkish/red too an if I push a finger on it, it goes white before filling back up with red color and if I look close I can see more dialated capilaries. I should mention I had filler at the same time and the filler made my nose swollen. I only had a few dialated capilaries to start but now my whole nose is red. All considered, is this an abnormal reaction to laser and will it require retreatment?

Answer:

What you are describing is normal. It will get better in time. I would also split the treatments up next time and do the fillers a week after the laser

Question:

After a vascular laser to my nose all the crusting has fallen off but in the area I had the capilarie the scab came off and is now a bright red spot. Will this go away or will I have to have this spot lasered again?

Answer:

It is common for the redness to be there due to the healing process. You need to avoid sun exposure and any hydroxy acids to the skin but in time, that color will fade, it just takes time.

Question:

I recently had filler done to the tip of my nose to fill in pinching which worked fairly well but unfortunately it caused some noticeable blood vessels ae diffuse redness at the tip.

 

To me this seems like I will make it worse with further injections and will have to continually spend even more money trying to keep these vessels at bay as I understand they always recur.

 

Does this sound about right and What is the best treatment modality?

Answer:

I would suggest trying an ND:YAG laser for the veins, they might reduce with the treatment, even if the filler is still present. The dilated veins may recur with further injections, yes.

Question:
Answer:

The possibility of dilated more visible veins on the tip of the nose after a filler are possible. If it is due to the swelling and bruising below the skin, they will get better in a couple of weeks. If they are dilated due to the filler pushing on the skin, they can last longer, possibly as long as the filler is there pushing on it. With time the filler dissolves and the veins should get better even if not all of the filler has dissolved.

Question:
Answer:

I would expect very modest changes and that they will not last very long. It will heal quickly and you might get improvement in recent pigmentary changes and very fine line improvement that might last a few months. Not much more than that

Question:
Answer:

I would expect very modest changes and that they will not last very long. It will heal quickly and you might get improvement in recent pigmentary changes and very fine line improvement that might last a few months. Not much more than that

Question:

Which do you like better, CoolSculpting or SculpSure? The results seem about the same to me -- though they are completely different treatment modalities. Do you agree? Is it just a matter of different cost and (negigibly different) treatment time? In my area of hte country, CoolSculpting is becoming clinically passe, and any ps practices that are making the investment are buying SculpSure; so I'm guessing that the latter might be more financially beneficial to the docs. because they charge more/treatment area than they do for CoolSculpting-- and because it eats up 30 fewer minutes of staff and room time/treatment area than CoolSculpting. Is that right?

Answer:

I do think there is a time differential and that, if you are using the machine constantly does add up. As to employee costs, that is a non-starter since the employee is not in the room and they are off doing other things as well as they have to be in the office at that time anyway. As to which is better, there is very little difference. The reason you are seeing more SculpSure now is many doctors were late getting into the non-invasive technology and they always think newer is better. Having said that, patients also feel newer is better, unfortunately not always the case. Cool Sculpting has evolved with new heads to stay ahead of the competition and many of the other companies out there are unable to do so.I think you are fine with either one.

Question:

I just sent you a question about PIH.  I meant to ask you, What about trying IPL to fade these marks?

Answer:

IPL is not a true laser and I think you have better chance of improvement with a true laser, such as the Q-switched YAG.

Question:

Dear Dr. Garcia, Several weeks ago I wrote to you about severe PIH following VBeam tx (on 5/6/16) for tiny (in fact, visible only to my dermatologist when he wore loops) red spider veins on my legs. Now, 13 weeks later, the PIH has faded only by about 5%. My previously perfectly fine (in fact, really lovely) pale white legs are now covered with 67 huge black and dark red blotches It looks like I have a terrible communicable disease. My legs used to be my best feature. Now they are covered in thick black tights every day, no matter the temperature.  Hydroquinone and Retin-A have done nothing. The dermatologist who did this to me saw me yesterday and told me that the PIH is likely permanent. To say I am heartsick doesn't begin to measure it. He told me he has done some research and learned that a Q-switched YAG might help, but he doesn't own one -- and I would never let him touch me again even if he did! Should I seek one out? He recommended Rox Anderson at MGH. Any other people in Massachusetts you might recommend?  What do you think? Could it make my situation worse? Thank you for your opinion.

Answer:

So sorry to hear that there has not been better fading. I do think the Q-switched YAG is a good choice. I have one in my office and find it works well. It will require a series of sessions though, about 6 weeks apart. I hold Rox Anderson in very high regard and think that would be a great choice. I do not think it will make it worse with the Q-switched laser. Best of luck.

Question:

I usually have pigment treated withIPL. This past week when I went to my ps, she decided to treat these diffuse spots more aggressively with a 520 nm (???  I'm not sure) laser. Does that sound right? My chest, arms, and hands are now covered in red blisters that show no sign of resolvingfive days later . She told me to expect "a little blistering," but I had no idea this would happen. Is this a typical treatment? Is it an effective one? How long will I look like i have a raging case of acne? If I had known this would involve weeks of recovery, I would have insisted on IPL again, especially in summer. I'm wearing turtleneck jerseys in 90 degree heat! I am very, very, very fair by the way -- almost translucent skin, red hair, blue eyes. Thank you for your help. 

Answer:

IPL is not a true laser, it is just intense light, so it is not as effective as a true laser. The IPL can be safer though due to the lower energy. It is not uncommon to treat hyperpigmentation with a true laser and depending on the energy setting, what you describe can be seen. Usually the first time a laser is used for something like that a lower setting should be used to evaluate the patient's skin response. I do think that it will heal in time but it can take 2-3 weeks if a high enough energy setting was employed. Using products such as NeoCutis will speed it along. The resolution of the hyperpigmentation should be more dramatic but with it comes the downside of longer recovery.In the meantime avoid the sun as you are doing. I wish you the best, sorry this has happened to you

Question:

I had arthroscopic surgery on one of my knees in early February, which left three small but noticeable scars. In early May, my dermatologist treated them with a VBeam, and since then they have been significantly darker. He also treated small, nearly invisible broken capillaries in my legs at the same time with the VBeam, and since then, I have been left with dozens of dark brown and dark red spots where he treated me.  I saw him today and he told me that they have all hyperpigmented due to the inflammation from the laser and that they should take another 4-6 months to lighten up! Nothing else he can do. Does this sound right to you? I'm extremely fair skinned, Type I, so PIH shouldn't be much of a problem. I live in the Northeeast where it's extremely hot and muggy, but I've had to wear black tights since early May, Do you have any suggestions of things I can do to try to improve this situation? Thank you.

Answer:

I have seen that happen. It depends greatly on the settings chosen. Typically lower settings are used for Fitzpatrick Type I skin as they are so fair. I have to say that they usually get better, but once there has been some discoloration, it can take a long time. Avoid sun as you have is important. Using a product like Dermablend cover up makeup can help hide the spots at the same time as protecting them from the sun. Wish I had more to offer you. I would stay away from chemical peels, microneedling and other lasers for now

Question:
Answer:

I do not think lasers or thermal heating will produce reliable and predictable removal of lumps left from fat grafting, especially around the eyes. Sorry.

Question:
Answer:

My first choice is an Nd:YAG laser, but understand, no matter what laser or method you choose, in time, with mild sun exposure and exposure to florescent lighting, the freckles will all come back. There is no permanent removal solution.

Question:

What do you think of SculpSure? Is it as effective as CoolSculpting? More effective? Less effective? Is it more flexible than CoolScuplting -- that is, can it be applied to more and different areas than the CoolSculpting handpieces allow? It's really expensive in my area, and I don't want to waste my money. And how does it compare to the new ultra-sound device (the name of which I forget but about which I've heard) that melts fat? Thank you for your opinion, Dr. Garcia.

Answer:

I think the CoolSculpting is superior, it now has many new heads for a greater varierty of areas. I think the CoolScupting wil be a better and more reproducible choice. Compared to the Ultra-Sound devices like UltraShape or Liposonix. They are effectve, the Liposonix hurts a bit to have done, but it cannot treat as many areas as CoolSculpting can. Thos two are best suited just for the abdomen

Question:

Had V Beam to small surgical (arthroscopic) scars 2 weeks agao today. They wer barely visible before but are still srurrounded by dark red marks from the laser and look far, far worse than they did before. What do you think happened? Will they continue to look like this or will they get better?

Answer:

The V Beam laser is essentially for red discolorations. It works best on scars that are red, but even if the scar is not red, there is always some underlying red in the skin due to the blood vessels. What you are seeing is normal, and in time should go away. I cannot say if the scar will look better if it was not red to begin with though.

Question:

thanks for the response to my question but I wasn't quite clear of what you meant.  Sculpsure is saying 24% reduction in fat in one treatment.  Hot Sculpting is saying you need multiple treatments...are these to techniques the same or different.  Also are they the same as Vasershape or Venus Legacy.    In your opinion  between Hot Sculpting, Sculpsure, Vasershape and Venus Legacy which is the best

Answer:

many of the companeis make claims but when you read it carefully, most times it says thinsg like 'up to' so if the patient does not get a smuch as they expected, they have covered themselve. In genral the technologies for the machines are different. They are trying to harm and dmaage the fat cellls using radio-frequency, focused ultrasound, laser energy, etc. I think the Vanquish does a nice job but cannot be used all over, it is limited in the areas it is approved for. I do not think the laser methods to destroy the fat are very effective so I would stick with either cryolipolysis, where the fat is damaged by cold (CoolSculpting), or focused ultrasound where it is damaged by intense focused heat (Vanquish or VaserShape).

Question:

I am wondering what you think of these new fat removal lasers:   Fotona Hot Sculpting  (​www.clarionmedical.com )   and  Cynosure Sculpsure   thanks so much

Answer:

I beleive the focused ultrasound as well as the cryotherapy techniques work well. As to lasers, in my opinion, I have not seen them be visibly effective. The ability for laser energy to be absorbed of high enough strength to kill a fat cell is difficutl when you are trying to avoid injuring the skin. If the laser energy is delivered through a metal probe beneath the skin, there can be a very mild reduction, but that is not an external laser, it is internal.

Question:
Answer:

as long as all you expect is a small amount of fat removal and tightening of the skin to a mild degree, a much lesser degree in older patients, it is OK. I do not think it has anything groundbreaking or of significant advantage over a pure liposuction though. I do think tagging it with the word face lift is a deceiving claim though

Question:
Answer:

In my opinion the CO2 laser will work better and is more relaible and predictable

Question:

I was charged $3250 in Dallas for a fractional co2 laser peel. This was a huge ripoff!! After 4 months my skin looks exactly the same. The small wrinkles were not affected at all, and the brown spots have all come back. He supposedly did 2 passes around the peri oral area, and there is no improvement in the wrinkles. I am not sure if Dr. B is just ignorant or if he is dishonest. Either way, think carefully about getting this type of \"peel\" When I pointed out the lack of results, he just said, \"you have to keep doing it\". How asinine is this answer? Does anyone keep doing these at $3250 a pop? How many passes should be made for it to be effective.

Answer:

The fractional laser only treats a percentage of the skin, that percentage is controlled by the doctor. The greater the percentage of surface treated, the more effective it is but then the quick healing time is gone. The greater the surface area treated, the more dramatic results. I use a totally ablative laser, not a fractional one and I do three passes on most patients.

Question:

Hello Dr. Garcia, What do you think about the Syneron Candela Sublative skin rejuvenation for lip lines & smile lines that are just now starting to be there even when I'm not smiling :( Or do you have another recommendation for those areas? Thanks so much|

Answer:

I think you will some some improvement, but it will be mild and likely will not last too long. I will be honest, due to muscle function in that area, long lasting results are sought but never found. A deep CO2 laser with significant downtime might give you 3 years, but anything less than that will be months to maybe  a year at best.

Question:
Answer:

I think it best to just apply warm moist heat and let them go away on their own, I think the IPL could have some temporary worsening and is not worth the risk

Question:
Answer:

I would not perform it on anyone under the age of 18 and I would also want to see if they can lose weight first.

Question:
Answer:

nothing wrong with it, not sue it will make a big difference or get any better result though.

Question:
Answer:

Burns can happen but at higher temperatures, topical creams will not help , maybe taking a pain pill 45 minutes before, something like Norco will help, but you might need a ride home is all. Sorry

Question:
Answer:

the ability to tighten the skin requires a temperature of 42 Celsius, less than that will not create the tightening required I am afraid

Question:

Hello Dr. Garcia, I thought I read on your blog that you charge $150 per session for thermismooth but I can't locate that again… Is that what you charge? And how many treatments do you recommend for under eyes & around mouth?

Answer:

Th fee is per area, so around eyes and around mouth is two areas. We do it every 2 weeks or so. Most patients have 6 sessions. The first area is $150, the second area is $125, a third area is $100. So two areas per session is $275.

Question:

I have the type of rosacea which forms little bumps under the skin. I've had two opinions,
from well respected dermatologists. I'd heard of v beam, but also wondering about photo dynamic
laser therapy which from what I hear, achieves great results. The doctors who have suggested v beam seemed slightly cavalier.  Which do you think is better treatment? Thank you for answering my question.
You're so lucky to have beautiful weather! We in NY are freezing!!!
Bonnie Rosenblum

Answer:

the photo dynamic has been used for a long time with good results. The VBeam is mostly for red and will help, so you cannot go wrong but I think the photo dynamic is a better choice for Rosacea. Stay warm!

Question:

I wrote to you before asking about a divot in my cheek.  Can IPL treatments cause divots in cheeks 6 months after treatment?  I thought it was only radiofrequency treatments that caused this, (Like Thermage.)  If IPL does cause divots, what can be used to correct them.

Answer:

in most cases if any divots are going to form they start in a few weeks, they do not just start up at 6 months later. The IPL does it by causing a small surface burn. Early microderm or a CO2 laser to smooth the edges out will help if it happens.

Question:

Hi Dr. G., I know it's important to innovate and continually improve but I really miss your old website.  It was user friendly, easy to read, easy to search (for instance, by typing "Fraxel") and I can just go to the "Ask Dr. Garcia" even if I have been traveling and have not been able to keep up with recent Qs and As and get caught up.  I sent in a Q about Venus Freeze and your answer (thank you!) didn't show up anywhere, and there is no Search feature to find it.  However, when I went to submit about my previously submitted Q about Venue Freeze, your answer showed up in the Q box.  The whole thing is weird, and being from Silicon Valley, I don't think your webmaster is doing as good a job for your website as your wonderful service to readers deserves.  Many thanks for your good work!

Answer:

thank you for your input and I will speak with the webmaster, thanks again

Question:

I have enlarged pores on my cheeks and stubborn fine lines all over my face. I've tried everything. In addition to weekly medical facials and peels every 6-8 weeks, I've done all the things typically recommended Fraxel Restore 4x/year, short-pulsed YAG once/month, various RF technologies six-10  times/year (ThermiSmooth, Thermage when it was available,Pelleve), Infrared(e.g., Titan), etc. etc. So I'm ready to try CO2. In your experience, will this help with the pores and superficial laxity or is it as much hype as everything else? I'm female,  56, white, non smoker, broad spectrum SPF every day, almost NEVER go outside after dawn or before sunset, no fluorescent lights, no sitting near windows, etc. Thank you for your kind help.

Answer:

I do not think the CO2 will help, the issue with the visible pores exists because the pores are plugged deep down not at the surface. If you do something to tighten the upper layers of skin the pore will actually look wider or larger. It might give some tightening though. I think IPL and microdermabrasions as well as Retin A help get the oil out of the pores and allow them to close, that is likely better for your pores than CO2 laser.

Question:

Hi, Dr. Garcia. I'm 2.5 weeks out from ThermiTight to my upper arms. I never had ANY cellulite at all there before, just the very beginning of loose skin over tight, taut muscles My surgeon removed 20 cc's of fat from each arm before he used the RF because, even though they didn't need liposuction, he finds that very, very modest fat removal improves his RF results. Well, it's amazing how that little bit of intervention made such a mess of my arms. They are now both distinctly lumpy and appear completely riddled with cellulite. Honestly, I went from having really toned arms with a tiny bit of loose skin to looking like I'm 75 and have never worked out a day in my life (I'm 48, a triathlete, lift weights, etc.) I'm deeply disheartened and wish I hadn't done this. Is there any chance at all that this is temporary, or did he make things irreversably worse? Has this happened in your own practice? My surgeon is one of the people who invented and refined this technology, by the way, so he knows what he's doing.  Thank you for any advice you can offer.

Answer:

I think you need to give it time as the improvements from the ThermiTight, although originally we thought were done after 4-6 months, I am now seeing improvements continuing for up to one year in some patients. I think what you are seeing is the skin, now thinner, has stuck down to the muscle due to the inflammation from the procedure. Something totally normal and expected. With time and a little massage it will l loosen up and move around better and much of that tethering you see now will go away. I know, it seems like it has been a mistake but hang in there, it gets better. I have seen it happen even without a little liposuction and it gets better.

Question:
Answer:

We only do it for juvenile gang members that have gotten in trouble and complete their detention. I would be happy to see you and help you though, it just would not be offered free of charge

Question:
Answer:

Ultrashape does what it is intended to do, which is to damage the fat cells so that the area shrinks down in size. Initially Thermage was touted as a skin tightening effect, and there were some reports of fat loss that was unintended. The Ultrashape uses focused ultrasound which is totally different than Thermage.At present it is only FDA cleared to be used on the abdomen

Question:

When CO2 laser is done on face, some kind of patch is placed over your eyes to protect from laser. Could you have CO2 laser resurfacing on eyelids since a patch you couldn't place a patch over eyes if resurfacing the eyelids? If the eyelids can't be done for this reason, can a saggy eyelid crease still be done... if the patch was placed directly below the crease?
Will the fractional CO2 laser tighten the eyelid crease or is the full CO2 laser necessary. I'm not trying to fix skin texture problems, just loose skin. One doctor thinks I do not have enough loose skin for upper lid bleph so he recommended laser to tighten the skin, but would it really tighten saggy skin like an upper bleph surgery? And how long wold laser results last compared to upper lid bleph?

Answer:

when I perform a CO2 laser on the eyelid skin, I have the patient protected with corneal shields that are underneath the eyelid skin and protect the eye from the heat and laser. Both the fractional and the totally ablative will help tighten the skin of the eyelid itself but as the skin there is so thin, the amount of energy delivered is relatively small for safety reasons. For that reason, the results are not very long lasting, 12-18 months, the fractional will heal faster but not yield as much of an improvement. A laser will not tighten skin like a surgery will, no matter what laser is used. The surgery results typcially last 5-10 years.

Question:

I have enrolled in a clinical trial for ThermiSmooth 250 (on my thighs) -- essentially ThermiSmooth with a larger handpiece for applications on the body. I will have four treatments spaced three weeks apart. I've had both ThermiSmooth to my face and ThermiTight to my arms and been pleased. Do you know if this new application will be no more powerful than ThermiSmooth, just a little larger handpiece, or is it intended to be closer to ThermiTight in its results? I'm hoping it will be more powerful than the application used on the face and neck. Thanks so much for your wisdom.

Answer:

I think it is somewhat stronger but the biology is the same, you need to get the tissues to a certain temperature. I do not think it is as effective as the ThermiTight though as  it has to go through the skin and therefore is has to be limited in its energy dispersion to avoid a burn.

Question:

Hi Dr. Garcia,
I was wondering what your recommendation is for LHR in dark skinned people? I have not had good experiences with LHR. I feel it has caused induced growth in some places and has not worked.
I know that nd:yag is best, but has there been anything new in the industry that you think is good?

Answer:

I think Alexandrite lasers are better for hair removal than an Nd:YAG laser but it never works well in darker skinned patients and can have problems with skin pigmentation. I might suggest electrolysis as being more effective in that case, but it has its small risk of very minute scarring or bumps due to the heat damage.