Question:

Hello Dr. Garcia,

It has been quite a while since I visited your site. From your photo, you're looking great.

What are your thoughts on skin tightening? Specifically, "SkinTyte", which claims that it uses a pulsed light technology (infrared energy) to trigger collagen to heal itself and create new collagen. Does it work?

Thank you!

Answer:

I am sure that some patients have seen an improvement, but I would guess that not all patients have the  same result and I am also wondering how long the improvement will last before they need to be repeated

Question:

Hi Dr. Garcia. I'm 71 and had an IPL treatment with pretty bad bruising that helped a little with brown spots. A different dermatologist is recommending a SkinCeuticals Corrective Peel. Do you think I will see any positive results from it? I'm not very wrinkled, if that helps. Thank you.

Answer:

I do think the chemical peel is a worthwhile thing to try, you will be red for a little while but should help the brown spots, not much for wrinkles though.

Question:

Large Patch of skin from temple over top cheek and under eyes that feels and look like a think layer of hard scab which pulls together after using AHA peel. They are other patches of red dry rough skin as well, but around the lower eyes are the worst. What do you recommend over the counter to use? Is a and d ointment good for that? I tried aloe gel, essential oil but that doesn't seem to help. The swelling went down, this was from Tuesday. How long will it take til the dry scabs come off and what should I use since the skin is pulling. Thank you.

Answer:

It is difficutl without seeing what it looks like but I think trying some squalene oil or tea tree oil is where I would start. The scabs, if any, will only fall off once there is adequate healing beneath them.

Question:

Thank you for helping me with your advice dr garcia.

How long would you anticipate something like this would take to clear o  its own?

Also,  if treatments were successful how much could they speed things along?

Answer:

On it's own I would guess maybe 3-6 months, with the laser or IPL, which is not a true laser, you might shorten it by 30-50%.

Question:
Answer:

They may have used a stronger setting and that is why that has occurred. It will usually get better on its own but it might take 2  weeks or more in thin skinned patients. Use total sunblock when you are outside until it resolves

Question:
Answer:

IPL can work on recent brown spots and very small veins. Since the IPL is not a true laser, it is not strong enough to treat older spots and larger veins. At times using a true laser like an Nd:YAG is more effective. That may be why the dermatologist suggested another treatment.

Question:

Does a Q-switched laser eliminate dark pigment (age spots) all in one zap or does it take a few zaps? Do Q-switched lasers and 25% TCA peels remove dark pigment about the same or is one method faster the other? I know with 25% TCA peels, one needs a few or several treatments. And is one method more effective at keeping the dark pigment from  returning inthe same spot? How logn do results last for each considering one avoids the sun.

Answer:

The removal of spots with a Q-Switched laser is done as a single pass over each small area, and then a period of 6 weeks needs to transpire before another session can be done. I would never expect a single session to remove the spot. Also you must understand that if you expose yourself to the sun or fluorescent lights, the spots will come back. This means wearing sunblock, not sunscreen, at all times from here on out after the laser. Although TCA peels can also fade spots, they have a higher risk of post-inflammatory hyperpigmentation and the risk of recurrence is the same.

Question:

I've done Fraxel RePair every 18 months-2years with my plastic surgeon for the past six years. She always uses aggressive settings and does six passes to ensure that I get the best result. At that strength, it takes two-three full weeks to heal rather than the advertised 7-10 days. She did it again last week at the exact the same settings, but I seem to have healed much, much more quickly this time, making me believe that not as much damage was inflicted on my skin as has been in the past and, therefore, that I will see fewer improvements. (I do these treatments to improve my skin's tone, texture, and fine wrinkles.) What do you think happened? Have you ever seen patients who have had multiple laser procedures whose skin responds less vigorously over time? Or could it be that my skin has actually improved from the treatments I've had previously and is getting thicker as a result, just making it heal faster than it has in the past?  I'm 50 years old, white, female,  non-smoker, sun-avoider. I use Retin-A, and I use full sunblock daily. Thank you for your opinion.  This is a great service you provide!

Answer:

The energy settings may have been lower this time in spite of the number of passes is the most likely thing that occurred. I do not think your skin has gotten any thicker to the degree that you would heal faster, actually it would be the opposite, that your skin had gotten worse and needed a stronger setting than before to achieve the same down time. Possibly the machine needs a service call to adjust it to the proper energy. Wish I could offer you more info. Happy Holiday season to you!

Question:

The before and after photos for Fraxel Restore don't look very impressive to me. The most marked result seems to be a reduction in pigment (and not always all that much) and not the collagen remodeling that the company claims. Am I missing something? Could one not get just as good, if not better, a result from spot treatment of pigment? I'm looking for fine line reduction but Fraxel doesn't seem to hold much promise. What else would you suggest? I'm white, 46, non smoker, totally sun-averse.

Answer:

no, you are not missing anything, it is a very mild treatment and you get mild results because of that. I would suggest a factional CO2 laser, a few different companies make them, but Restore is intended for minimal down time and risk and therefore minimal effect.

Question:

I am scheduled to have a fractional CO2 this week. 6 months ago, I received a couple of 2nd degree burns on one cheek (each one about 1x1 cm). They have healed, though they've left slight red marks. Is it safe for the dermatologist to treat those areas? She thinks it is, and both she and I don't want to have "skip spots" on my face, but I wonder if it's safe to do if that tissue has been compromised. What is your opinion? Thank you.

Answer:

It is likely OK to do so as long as the energy is turned down a bit and the pixelation is increased so that the density is less. Best of luck.

Question:

Are there any lasers that work for the crinkley texture skin on the neck?

Answer:

I have not seen any lasers that give you more than a few months of improvement. The reason is that the skin needs a significant amount of energy from the laser and that level of energy can scar the skin. Therefore the sessions do not yield very dramatic or long lasting improvements.

Question:

I got a very mild (non blistered) second degree burn on my inner forearm from the oven in March. It's always been flat, but now it is brown. I had a dermatologist treat it with a laser - at first he used a V Beam and then he switched to a Yag. It's still there though. Might it be safe and potentially effective to try a chemical peel like a VI Peel and/or hydroquinone and Retin-A? (I'm white, by the way.) Thank you, Dr. Garcia, for all the help you provide so many people!

Answer:

The YAG laser is the best option, but it always takes multiple sessions done 6 weeks apart. In between the sessions using Retin-A and hydroquinone can be utilized as well. I think the chemical peels on that part of the body and unpredictable and I would not recommend it.Best of luck.

Question:
Answer:

Whether it causes fat loss depends on the amount of energy delivered and temperature reached. One can avoid that with the ThermiSmooth by avoiding high temps. That is facilitated by the constant temperature reading on the machine that others do not share. I think if one expects a mild to moderate improvement, and can tolerate the required temperature for skin tightening with no fat loss, it is worth the money.

Question:

10 days ago, I had my barely-visible pink face lift scars (6 weeks old) treated with a laser (ND:Yag) at my surgeon's office. Since then, I've had to take more time off work because they are now a dark red-brown and not showing any signs of lightening. The entire facelift is now outlined at my hairline, around my ears, and into the nape of my neck. I'm devastated because the marks from the laser are all far more visible than sutures themselves were -- and I'm back in hiding, which I didn't anticipate being. Had I known this would happen, I wouldn't have done the laser to "fade" the scars. What went wrong? Am I permanently scarred by the laser now? The laser marks don't appear to be vascular because they don't blanche on pressure, so I'm thinking that these marks may be permanent. No make-up I've tried (not even theater make-up) covers these marks. What do you think?

Answer:

that can happen depending on ho high the settings were. ^ weeks is pretty soon as the scars are just maturing at that time. I do not think the will be permanent though, but they will take time to fade. I might suggest Dermablend makeup, sold at higher end stores and online, online a little tough to get an exact color but its very close, it does a really good job of covering things. I wish you the best, give it some time

Question:

Dear Dr. Garcia, I wrote to you two months ago about two red chemical burn scars on my face following a deep peel. I've had several V Beam and Nd Yage treatments, and they've faded a little bit but they're still present. They're now 8 weeks old. At this point, do you think I'll have these for life, or do o you think they'll eventually fade? More laser treatments, or is it past the point that they might be helpful? I'm pretty bummed by this. Very disfiguring. Thanks for your help.

Answer:

I still think they will continue to improve. I would continue the laser sessions to help fade them faster. I wish you all the4 best.

Question:

Dear Dr. Garcia, you kindly answered my question about cherry angiomas following a chemical peel. You said, "small localized redness [can occur] in areas of severe sun damage and pre-cancerous spots that become irritated from the peel. The damaged cells absorb the chemical easier and get inflammed."  Does this mean that those areas that became red are now effectively treated -- that if they were "pre-cancerous," the peel has managed to neutralize them? Thank you so very much for your help and answers! 

Answer:

If they were superficial, possibly yes, no way to know 100% though. Keep on eye on them and see if they change over time.

Question:

Hi, Dr. Garcia. I think you didn't see the question I sent this weekend because you answered others but not this one. Here it is again. I had a VI Peel on my chest, hands, and forearms. Within two hours, I was covered with cherry angiomas. What happened? Will they go away on their own, or will I need a laser treatment?  Thanks for your help.

Answer:

Sorry, I was out of town and I was having internet issues. I have never seen actual hemangiomas form after a peel, VI or other wise. I have seen areas of small localized redness in areas of severe sun damage and pre-cancerous spots that become irritated from the peel. The damaged cells absorb the chemical easier and get inflammed. In those cases it usually all goes away in a couple of weeks. I would not consider a laser treatment for at least 6 weeks after the VI peel, so give it a bit more time. Should all go away on its one though.

Question:

I wrote to you a while ago about two large red chemical burn scars on my face from a peel. My dermatologist let it heal and then tried a V Beam, which didn't do much. She doesn't think that approach looks promising, even with repeated treatments, and is now proposing a CO2 resurfacing of my whole face to even out the tone from the burns. Understandably, I'm nervous about this and about making things worse. What do you think, Dr. Garcia? I'm worried especially that 1) the previously burned skin may not be able to take the laser and that what was a second degree burn will turn into a third degree burn and/or 2) the end result will just be same -- two different tones of skin, darker red where the burns are and lighter red for the rest of the skin. I am very fair, of Irish descent, so she thinks my skin will heal well, but I'm still worried. The current state of affairs is pretty unacceptable though, which is prompting me to give this a try. But of course, I don't want to regret this forever. Thank you for your opinion.

Answer:

A CO2 will never remove red spots, so I am not sure what the dermatologist is thinking will improve. You will possibly be left with fewer brown spots, but it will not positively affect the red. Fro that  a color-specific laser is needed. VBeam or an Nd:YAG laser is what is most commonly used for that. Maybe a second opinion is warranted.

Question:

I had a couple of chemical peels on my hands in the past 6 months, and now the skin there is shiny. Was it over-peeled? Is this permanent or will it heal and go back to normal? I must say that it's not looking promising. I'm 57, white, stay out of the sun but didn't as a kid so I have a fair amount of solar damage.

Answer:

It should get better in time. Chemical peels on the hands can be risky due to the thin skin there and the inability to heal well if a peel is done too deeply. Getting back to normal can take a long time as the elements needed in the skin to heal are in short supply in that skin. Keep out of the sun and use lots of moisturizing creams in the meantime.

Question:

I had a chemical peel on Thursday from an aesthetician at a dermatologis't office. Unfortunately, she left it on too long in two areas, and I now have two bright red circles on my face -- cheek and forehead -- where I was burned. Even worse, at the center of each burn, the skin is broken through and has a cover of whitish skin. I saw the dermatologist herself on Friday and she confirmed second degree burns. She advised that I keep them moist with bacitracin ad then aquafor and, of course, that I keep it from any sun exposure. I wonder if you have any additional suggestions and, most importantly, if you have any sense of how long it will take for these to heal. Each burn is about the size of a dollar coin. I am very fair -- of English descent. The dermatoglogist said that is in my favor in terms of scarring, that it would be worse if I were darker-skinned. Thank you for your time and help. 

Answer:

It can take a week or two in some cases for it to heal. I do agree with what the dermatologist is recommending to you, as well as refraining from make up, using it to as minimal amount of time as possible. I do agree the more fair your skin is the less visible and sequelae will be. I wish you the best.

Question:

The callouses on my feet don't respond to anything I've tried.  Do you think that if I asked a dermatologist to do a strong TCA peel or another kind of peel on them that might help? Any other thoughts? So appreciate all the advice you offer all of us, Dr. Garcia! Be well.

Answer:

The callous is thick enough that I do not think the chemical will penetrate it. Might need to use a sanding stone or have a podiatrist shave them down.

Question:

I have a new dermatologist. She spot treats actinic keratoses with 35% TCA. Do you think this is effective? My former dermatologist used cryotherapy. Thank you.

Answer:

I think for actinic keratosis the cryotherapy is much better.

Question:
Answer:

I have not had any patients use that peel. We use the V Peel in our office.

Question:

Are there any lasers that can smooth the rough edges of scars?

Answer:

CO2 lasers do well for that issue

Question:

Is there a certain laser that is good for softening scar tissue in the the nose? See, I have hard rib grafts as well as scar tissue in my tip. I would like to soften it so it will be easier to stretch my tip skin to add more graft or just for the doctor to more easily work in the area Is this possible with a certain laser? If so, how many treatments might it take?

Answer:

I do not know of any laser that can soften scar tissue. Sorry.

Question:

Just found your site. What a great and generous service provide! My dermatologist retired last year, and I just started with a new one. For years, I've had one or two TCA peels each year (35%). My previous dermatologist always neutralized them after a while (5 minutes or so? I don't remember) with a solution (saline?). The new dermatologist didn't and said that it's actually dangerous to do so. He just did this on Monday, so I haven't seen any ill effects yet, but I wonder what your opinion is. Thank you.

Answer:

TCA does not have to be neutralized and actually washing it off will potentially re-aactivate the chemical and allow it to penetrate deeper, eliminating the safety. I do not wipe it off with any liquid. Best of luck.

Question:

 I was considering having Thermismooth, but then was concerned about the silicone injections I had about 15 year ago. So far, no problems with inflammation in those sites, but was worried that Thermismooth might cause inflammation or the nodules to migrate. Do you think this is a concern? Also, is there new treatment for removal of silicone nodule without causing disfigurement?

Answer:

I do not think the nodules would form but I cannot say how hot the silicone could get is my concern. Should be safe, probably. I have nothing new to remove the nodules except surgery, sorry.

Question:

Thank you for the suggestion of the Q-switched Yag. I haven't tried that but I'll ask the dermatologist I just consulted about that too, since he owns one. I truly appreciate your generous help, Dr. Garcia.  Maybe at your professional meetings, you can encourage your colleagues not to attempt positional repairs of facial paralysis with direct cutaneous excisions.  Paralysis + Scars! Yikes! I would never have elected to do this had I known how much worse off I'd be. Your kindness eases some of that pain. Thank you so much.

Answer:

I will try to put it in front of  them, although it is rarely done to be honest, as far as a direct approach. Hang in there and let me know if any other questions arise.

Question:

Hi, Dr. Garcia. Well, it's me again, the Gullwing Liplift Lady, 3 months out. My scar is just terrible (reddish brown, jagged, bordering my mouth, looks like I have failed to wipe jam off my mouth), and my PS doesn't think it's going to get any better. We've tried IPL and Retin-A.  This week, I went to see the go-to dermatologist in our area, who has every imaginable laser. He thinks that 5 or 6 Fraxel Dual (1550 nm) treatments will improve the scar greatly. He showed me several photos of surgical facial scars that he has treated and that faded to complete or near invisibility after such a course of treatment. What do you think? (I have Type I skin.)  I hate to waste yet more money in the foolish hope of improvement. Meanwhile, my facial paralysis has been permanently emphasized by the surgery, something no laser will ever help. I wish I'd never done this. Thanks for your sound guidance, as ever.

Answer:

it might help the jaggedness, but I think its effects on the red/brown will be very small. It sounds like you have exhausted many options so it might be an option for you only because of that. I am so sorry to hear about the lack of progress. Have you tried an Nd:YAG Q-switched laser at the 532 setting? I would try that, and it would also be a series of sessions. I wish you the best.

Question:

If you have CO2 laser resurfacing for brown spots, can those same brown spots come back if you go out in the sun? Or would have the laser removed all of the pigment so it is gone?

Answer:

yes, they will come back with sun or extended flourescent light exposure, still not permanent
 

Question:

When someone asked a doctor how long results last from Excel V laser to treat spider veins, the doctor said up to 1 year. Does that mean the same spider veins will come back within a year? If so, that seems like a waste a money if the spider veins will reappear so fast. Is there any treatment that can last longer?

Answer:

the same ones or new ones right next to the previous ones can show up as the cause for the spider veins, which is a broken valve connecting the deep to the superficial system of veins is broken and cannot be fixed.There are injections that can be done also but how long they last depends on how badly broken the valve system is.

Question:

 You were so nice to answer a question I had last week about a chemical peel to my hands and forearms. Sorry to bother you with another question. I've had lots of peels before but never to that part of my body. My forearms have peeled already but my hands don't look like they're going to peel at all. They're still incredibly crinkled and dry, not matter how much moisturizer I put on them. Is this to be expected with hands? If so, how long does it take for them to peel? My face, neck and check always peel completely within a week, so this seems strange and a bit worrisome. By the way, I checked with my dermatologist's office and learned that they used a 35% TCA peel. Thank you again for your generosity and kindness in answering my questions.

Answer:

They will eventually peel but can take longer as the skin is different and tougher than the forearms. The thicker the skin the longer it takes to peel off. It also depends on the strength of the peel and how many layers they applied.Just give it a little more time and back off on the moisturizer so it falls off sooner

Question:

I had a very strong TCA peel to my hands and forearms yesterday. Today, that skin looks like badly crinkled tissue paper, like the skin of a 90-year-old woman. Is that normal? I know that the skin will peel off in a week or two but will the peel have changed the texture of the skin permanently due to its strength once the top layer of skin sheds? It looks really bad right now. I'm only in my 40's, so I don't want to be left with an elderly woman's arms and hands! A happy and healthy new year to you and your family, Dr. Garcia. Thanks so much for helping all of us out here.

Answer:

yes that is normal as all of that skin will slowly peel off to reveal healthier skin beneath.There will be no permanent effects on the skin though. A Happy New Year to you too and thank you for the kind words

Question:

Are TCA peels better for pigment or for fine lines?

Answer:

pigment, not much help for the fine lines once the swelling goes down

Question:

Is a 35% TCA peel considered mild, moderate, or strong? What is the strongest TCA peel that you use in your own practice? And in general, which acids do you yourself prefer to offer in your practice's peels? Doy you like TCA?  Thank you!

Answer:

it is moderate to strong, not as strong as a phenol peel, but those are rarely done anymore. The 35% TCA peel is the strongest chemical peel we do in our office at the present time. Our aesthetician does some lighter hydroxy-acids peel but they are mild.

Question:

I recently moved and found a new ps. I went today for a chemical peel and the aesthetician used regular drug store nail polish remover/acetone to prep my skin. She said that this is the same kind of acetone sold as "medical grade." Is that correct? I was a bit shocked. The peel seemed to go OK though. 

Answer:

yes, it is the same, there are no additives

Question:

Dear Dr. Garcia, I had a mild (30%) glycolic peel yesterday and awoke this morning with very  blotchy skin -- distinct patches of red that are also somewhat itchy. I am assuming that this is a mild chemical burn. I've had this peel many times before and this has never happened. What do you suppose happened? And what do you recommend that I do to treat it? (Of course, I use sunblock.) How long can I expect to look like this? Thank you for your help. 

Answer:

you are correct, what you had with the 30% glvcolic acid is a chemical peel, although on the spectrum of chemical peels it is still labeled as a light peel. What might have occurred in this case was that your skin was prepared with another solution that de-greased it more than before, allowing more penetration, or that the acid was applied over and over, causing a deeper burn. Usually one does not get that with a 30% glycolic peel. Might take a few days to heal up, all depends on how deep they went. I might suggest some Cetaphil or Aquaphor for now and stay indoors until it starts to look better. I would also call the center where it was performed so they can see you in person to monitor your progress. Best of luck.

Question:

Hi Dr. Garcia, what is your opinion of the ResurFX? What is your opinion of combining it with IPL in the same session?

Answer:

I am unimpressed and think many of the claims are over-inflated. I see no reason to combine it with an IPL at the same, it will not be an additive effect and might cause potential damage due to excess injury.

Question:
Answer:

I do not think it works as well as CoolSculpting and I think the results, in most patients, are realtively mild.

Question:

Thanks very kindly for your thorough answer to the question I posed earlier today. I'm sorry to both you again, but I forgot to tell you that I have microdermabrasion every two weeks (with every other medical facial that I get weekly) for the past 20 years and IPL every four weeks for about 15 or 16 years now. Still, I have the pores....and the wrinkles. (As you can see, I have spent a FORTUNE on all this for decades now--peels, lasers, IPL, microderm, facials, prescriptions, a careful at-home regimen, etc.)  My dermatologist says that at this point, I cannot possibly have any oil clogged in the pores and that what's going on to cause the enlarged pores, as well as the general laxity, is a loss of elastin and collagen, from age, and that the CO2 will improve this situation. But it seems you disagree. And do you think that the CO2 won't help the wrinkles and fine lines either? Sorry for the multiple posts. And thank you for your valuable time!

Answer:

I think the CO2 will help the collagen production, the fine lines and wrinkles, but it does nothing for elastin which is totally different than collagen. I understand you have spent tons of money and I am sorry for that. I just think that if what your dermatologist was telling you, that you have lost your elastin and that is what is causing your pores to be open, then it would affect all of you facial skin, making it fall and all be loose and it sounds like you have fine lines and wrinkles and not flaccid floppy skin. I know it is easy for me to say as I am not the one making the money, but I just do not want to see you spend more money than you already have and either get a weak CO2 treatment what will yield a short term improvement of the pores and wrinkles while swollen that disappears or a deep CO2 laser with permanent widening of the pores. Sometimes the doctor and the patient need to realize that we lack the technology we need to achieve the desired effect. Doing something because you have tried everything and it has not helped without scientific proof that elastin loss is the culprit and will be improved with a CO2 laser with a potential negative side effect is not a good idea.

Question:

I meant to tell you that the other RF modality I've tried is E-Prime. At home, I use the Clarisonic brush, CE Ferulic acid daily, Retin-A .10 and Skin Medica's TNS Essential Serum. 

Answer:

The Retin A is the only thing that will help on that list, unfortunately the oil production on your skin is genetically controlled. Having said that, doing things that dry your skin too aggressively like toners, can make your skin produce more oils as a protective reaction.

Question:

Hello Sir,
I am a student at UNLV enrolled in a media relations course. I am doing a project on former successful gang members. I was told that you offer free tattoo removal for such individuals. Is this true? If so, how many such persons have you performed this on, roughly?
I realize that this is a confidential matter, but my only intent is to show the community's bona-fide eeforts in assisting former gang members. I am simply trying to raise awareness of the avenues that kids and their parents have so that they can "erase" the stigmas of their past and become productive, etc. I wish to do this in a positive light.
Thank you,
Silvano Cozzini
 

Answer:

I believe we have over 300 juvenile ex-gang members that either have been treated to removal or are in the process at present. Best of luck with your project.

Question:

Dr. Garcia,
 
What does Genesis and IPL lasers do for the skin? Will there be a risk of hyper pigmentation? If I am planning on getting a series of 5 treatments 21 days apart, can this be interrupted if I go on a beach vacation as long as I allow 6 weeks before getting a lot of sun exposure or should I wait to start my treatment after I return from my vacation? What happens next fall after sun exposure in the summer? Do I have to go through a series of treatments again? 
Thank you.
Dee

Answer:

it is helpful for brown and red spots, it is a low risk issue, it takes a series of sessions 2-3 weeks apart to see improvements as it is not a laser so not as strong. It can be interrupted but just be sure to protect your skin with total sunblock so that you don't take any steps backwards. You likely will need to do a repeat series after next summer yes, the effects are not cumulative. All the best and keep the sun protection going

Question:

Dr. Garcia,
Thank you so much for taking the time to answer all my questions.
What is the difference between Thermiscan and Thermismooth? I am now seriously considering Thermismooth rather than the Erbium as I am afraid of hypo pigmentation.
 
Thank you.
Dee

Answer:

I am assuming you mean the difference between ThermiTight and ThermiSmooth, not sure what Thermiscan is. ThermiTight uses a needle or probe below the skin, while under local  anesthesia, to heat the tissue to a specific temperature. Certain temperatures are needed to be achieved for a certain amount of time create new collagen and skin tightening. This eliminates the skin as a limiting factor for the heat. With ThermiSmooth, there is an external probe placed on the skin that heats it to a desired temperature. The ability to get it to the desired temperature is limited by the patient's pain tolerance as no anesthesia is used. It is done in a series of 6 sessions two weeks apart, whereas the ThermiTight isl in one session. ThermiTight is more effective than ThermiSmooth, but ThermiTight cannot be used in areas like around the lips where ThermiSmooth can. No risks of pigment changes with either ThermiTight or Thermi SMooth.

Question:
Answer:

I would use ThermiTight for that, I think it is more effecive and safer than the fractional laser for you area of concern.

Question:

Dr. Garcia,
I'm trying to decide between the erbium laser and the 30 percent TLC peel for my face. I have Asian skin and have some unevenness in skin tone. Which one is longer lasting?  I'm trying to refine my skin tone and remove small wrinkles as well as getting rid of the discoloration. I know that I have to avoid the ablative lasers. 
Thank you.
Dee
 

Answer:

the erbium will last longer but there are risks of hyperpigmentation from it. That can also happen from a TCA peel too if done at 30% or higher and no pre-treatment with Retin-A and hydroquinone.Erbium is ablative, but it can be fractionated to lessen but not eliminate the risk

Question:

IsCutera'sGenesisashort-pulsedYAG?Ifnot,whatisit?Thankyou.  

Answer:

it is  a short pulsed 1064 wavelength laser. YAG is yttrium aluminium garnet, but the Genesis does not say what source they use for that wavelength, it might well be a YAG component

Question:

Hi Dr, what is the difference with radio frequency that causes radiation like microwaves etc. and radio frequency treatments for the skin…Surely it must be similar and can't be good for you? Is there a technological difference ? Just find it all a bit confusing… Many thanks

Answer:

the difference is in the frequency and energy used. It is similar in the manner in which their energy is created and then utilized. Radiofrequency use in medicine has been around for many years but just recently has been harnessed in the sens that we can now monitor the heating effect at the tip to achieve safe and effective treatments. The older RF machines where kind of hit and miss.

Question:

Thanks for the answer about phenol peels. Just checking if you think VI Peels (which contain phenol) are good.  I suspect that they are considerably less effective than straight phenol peels but I wonder if you think that they are effective and a good investment.  You are wonderful, Dr. Garcia. Thank you for all the time you invest in this extremely helpful service.

Answer:

They are good peels, but not as strong of an effect as if the physician did a normal phenol peel, yet still good.

Question:

What is your opinion of phenol peels? And what about pre-mixed peels that contain phenol (like VI Peels)?

Answer:

I think phenol peels are good, but many people feel they are old-fashioned.In many cases they can yield results similar to lasers I think if a phenol peel is done it should be mixed each time by the physician so the concentration can be assured, rather than pre-mixed.

Question:

Besides retin-a cream and CO2 laser resurfacing, is there any laser or anything that thicken under eye skin so dark circles are not as noticeable?

Answer:

all will be less effective than the above, and you might see a reduction of them, but not an elimination.Marketing pictures usually show  people who have purposefully dehydrated their skin to allow it to look worse and then they hydrate it and the dehydration wrinkles go away.

Question:

What laser works best for blue or purple broken veins on skin? Does one laser work best for blue and another one for purple? Does one treatment usually work or do you need multiple treatments?

Answer:

VBeam of a Q-switched YAG work well. The blue and purple are equally treated by either. It will likely be a series, and depending on where they are, they will come back in time. There is nothing that will remove them on a permanent basis.

Question:

My new PS uses Cynosure lasers. He offers (mild) dermal tightening via their long wave-length YAG, finding the modest results to be the essentially same as both Pelleve and ThermiTight, both of which he also offers; in fact, his clinical experience is driving him to choose the laser over those two RF modalities in most cases. Since he charges a bit less for the laser, he's not being motivated by a financial incentive in his choice. What do you make of this? Can one achieve roughly the same amount of thermal injury via all these options -- taking into account a parity of passes and number ouf joules? Thank you for your opinion.

Answer:

I think lasers have less safety as to thermal tightening than the ThermiTight procedure as the temperature is controlled and there is no potential chance for skin injury with the ThermiTight whereas there is with the long-pulsed laser. ThermiTight requires a certain temperature to be achieved for certain amount of time and if that is not able to be obtained during the treatment then a less than satisfactory result will be the result. Your doctor might be using settings on the ThermiTight that cannot get the skin temperature to the setting required.

Question:

I was wondering if there is any new laser out there which is safe for Asian skin. I have a little wrinkle lines above my lip line and I want to refine the skin of my forehead. If there is any that you can recommend, how long does it last before I have to repeat?
 
Thank you.

Answer:

I still believe that surface ablative lasers like fractional  ones for Asian skin are risky with the possibility of resultant hyperpigmentation. I might suggest a ThermiSmooth radiofrequency series of sessions as it does not carry that risk. Done in a series of 4-6 and should last 1-3 years depending on how fast you are aging.

Question:

Hi Dr. Garcia, I have slight crepey skin under eyes from an aggressive lower bleph many years ago. My PS is recommending fraxel. Should I bother? I`d love some improvement just don`t want to throw away money.

Answer:

save you money, the results will be short lived.

Question:

Following up on the question about the Obagi blue peel: I think I`ll try it for the hands. How long do you estimate the recovery will take? The face heals more quickly, right? Do you like it for the face? My dermatologist used to use it on faces all the time but he now uses a fractional ablative CO2 laser because he says he can control the depth of the peel better. Does that sound right to you, Dr. Garcia? He is still willing to use the blue peel on the hands, since he doesn`t use lasers on hands. Thank you kindly for your generosity to all of us out here in cyberspace!

Answer:

recovery about 4-7 days. The face does heal faster, yes. I use Obagi peels for pigment only, anything else I use CO2 lasering. The latter is better for fine lines. I also do not use CO2lasers on hands as you cannot go too strong on the settings and that is why you do not get much, the same with the peel but it is safer. Just don`t expect too much with the hand peel. Best of luck.

Question:

I had a light chemical peel on Friday to try to refresh my complexion a bit. Today (Monday) my pores are extremely enlarged, which they weren`t before the peel, and look clogged with blackheads, which they didn`t before the peel. Is this normal? I look absolutely terrible. And the peeling hasn`t even begun yet! Yikes! I appreciate your help, Dr. Garcia.

Answer:

It can be normal as the oil in the glands was likely deeper and the peel is causing what we call a purging, it should settle down in a few days, got to hang in there for a bit. Avoid any creams on your face that have petroleum in it or any thicker oils, might want to just use squalene oil for the time being.

Question:

Thanks very much for your reply to my questions about the VI Peel. For the record, I use Retin-A 0.1% and hydroquinone daily (except in the summer); and acetone was used to prep my skin in advance of the peel; so it remains a mystery, I guess.

Answer:

maybe the acid in the peel was old and weakened or exposed to the light or something else that could have made it too weak to be effective, outdated or something. 

Question:

PS I meant to tell you that the VI Peel that I had that didn`t work was a VI Precision Plus Peel, which is allegedly 25% stronger than a plain VI Peel, so I`m baffled by my lack of response to it.

Answer:

Your skin should be prepared before it with some retinol or Retin-A to aid penetration, even if only for a week, and then the day of the procedure it is best to actively degrease the skin in order to get good penetration. Merely wiping it clean with water or a facial wash is inadequate cleaning as all of the oils need to be stripped otherwise they present a barrier to the chemical. In very oily skinned patients we will at times even use acetone to degrease the skin.

Question:

I had a VI Peel 10 days ago and never peeled. What do you think happened? Is it possible to get any benefit from a peel if one`s skin doesn`t actually peel? If so, what exactly would those benefits be? Thank you for your time.

Answer:

Sorry, likely not to get much improvement from it.

Question:

Would facial laser help improve marionette lines?

Answer:

in my humble opinion, no.It works for fine lines not folds like the marionette area.

Question:

How long does redness usually last after laser treatment on the face? Is there any way to speed up the fading of the red? I have heard that ipl treatments can help. Thank you.

Answer:

quite variable due to different skin types, different lasers and what energy settings they used. IPL treatments can help speed the resolution of the redness, yes.

Question:

Three weeks ago, I had a V-Beam treatment (which I`ve have done several times each year) by my dermatologist. He remarked that though he hadn`t changed the settings, my skin was reacting rather strongly immediately. I immediately swelled and became quite red. After I left the office, the skin that had been treated looked quilted and it stayed that way. Now the skin that was treated is still covered with purple-red marks on my face, arms, and chest. What`s going on? Will this clear up on its own or do I need a different treatment? Thank you.

Answer:

It should clear up in time. I suggest using Aquaphor on the spots and avoid hot showers. I wish you the best. 

Question:

PS- (49 year old with olive skin) I already use Retin A

Answer:

add the hydroquinone.

Question:

I am 49 with very light olive skin and am looking for something to help with sun spots on face. Would would be your recommendation for this? Thank you for your help!!!!

Answer:

light TCA peels, about 25% or a light laser with a Q-switched Nd:YAG. Of course also Retin-A, hydroquinone and sunblock.

Question:

I am using a hydroquinone/retin-a regimen from a dermatologist while having a series of 3-6 PCA chemical peels from my local medispa to address some hyperpigmentation issues. The medispa tells me to have the peels done at 3 week intervals. Could I speed up this process by having the peels every 2 weeks, or is it necessary to wait the 3 weeks?

Answer:

it would be safer to wait the three weeks for fear of irritating the skin and causing hyperpigmentation even if using hydroquinone.