Botox Cosmetic has a myriad of excellent and popular uses in today's dermatology world.  But certain uses are definitely more prevalent than others.  Below, we would like to highlight several lesser known uses for Botox.

*Brow Lift

A lateral brow lift refers to placing Botox to the outer edge of the eyebrows to create a subtle lifting of this area.  This outcome is natural in its appearance because it allows the brows to return to their normal position when the eye muscle isn’t contracting and pulling this area down.  Typical dose is 5 to 7 units each side.

Los Angeles Botox Injections by Celibre Medical

Often referred to as “smoker’s lines”, vertical lines above the upper lip isn’t necessarily from smoking.  The mouth muscle is quite strong and pulls down and inward like a purse string effect as time goes on.  By using a small amount of Botox above the upper lip border, we are able to achieve softening of the lines as well as a subtle eversion or rolling out of the upper lip.  This provides a natural, more youthful appearance.  Typical dose is 4 to 8 units.

Los Angeles Botox Free Consultations

*Pebble Chin

Small amounts of Botox to the mentalis muscle (chin) results in a softening of the chin to prevent the dimpling effect when this muscle contracts.  Typical dose is 4 to 6 units.

Los Angeles, Botox Before and After Pictures

Lori Haney, RN, MEP-C

Certified Medical Laser Safety Officer

The term “gold standard” is often used to define something that has been recognized and tested not only as effective, but premier in what that something claims to do.  Often, the “gold standard” is a way to measure something new against another that's tried and true.

In our area of practice, Laser Dermatology, this term is used more often than it should be.  It can be overwhelming for consumers to try to figure out which laser is best at treating their particular skin condition.  A laser that is FDA-approved for a particular treatment does not necessarily mean that it’s the gold standard.  Unfortunately, there is a very low hurdle required for FDA approval when it comes to efficacy versus the higher hurdle for safety.

At Celibre, we believe in offering only treatments that have been proven to be safe and effective as evidenced by research, consumer and practitioner feedback and more importantly, by our own experience.  We are firm believers that safety and efficacy can go hand in hand.  Unfortunately, we see many practitioners that trade one for the other by using devices that are very safe (read "FDA Approved" but not very effective). 

It’s not unusual for the media to promote the “newest” latest and greatest laser or to profile a media savvy doctor that offers these treatments.  While it’s tempting to be lured by the excitement associated with new equipment, consumers should beware of unproven technology.  Many practitioners within the aesthetic practice industry will promote their technology as being effective for numerous conditions.  We liken this claim to a printer, fax, copier concept.  A printer, fax copier is a jack of all trades bu master of none.  In contrast, at Celibre, we use over 20 different lasers so that we may be very specific about choosing a laser for a particular skin type and condition.  Because of the breadth of the technology we use, we can reach for the "gold standard" laser for the conditions we treat, rather than relying on the "printer fax copier" type machines.  It is for this reason that our lasers are powerful, precise, safe, and effective.  

The term “gold standard” may be used by those facilities that have no better option – thus, it’s their own gold standard.  We promote the gold standard should only refer to a higher standard set forth by best practices and outcomes and generally recognized as such by experts in that particular field and based on unbiased research.

Excessive sweating can be a problem with the palms of the hands, feet and the underarms.  When serious enough, this condition (called hyperhidrosis) can impact one’s social activities and necessitate treatment. Some traditional treatments for excessive sweating include oral medications, topical preparations containing aluminum chloride, surgery and Iontophoresis which involves the use of electrical currents.  A more recent treatment for hyperhidrosis is the use of Botox.  

Many people with hyperhidrosis are not aware just how effective Botox can be for limiting excessive sweating.  They only think of Botox as a way to smooth out frown lines.  Botox is an FDA approved treatment for hyperhidrosis and works by having an effect on the muscle fibers of the sweat glands thereby eliminating or dramatically decreasing the amount of sweating.  The treatment typically involves 50 units of Botox to each underarm and takes less than twenty minutes.  Discomfort is easily managed by ice packs since the needles utilized are extremely small.  

Although Botox treatments for hyperhidrosis to the underarms may be quite an expense initially, the effects last anywhere from six to nine months.  For those preparing for a special event, this treatment is an excellent option to avoid a potentially embaraasing situation.  For many, the idea of not having to struggle with excessive sweating on a daily basis makes Botox a good long-term investment.

Lori Haney, RN, MEP-C

Certified Medical Laser Safety Officer

Overview:  Botulinum products work to limit chronic sweating by inhibiting the release of acetylcholine.  This in turn block contraction of fibers within the sweat glands, which in turn limits chrnoic sweating.  For patients that have excessive sweating (hyperhidrosis) to the underarms, Botox is a great treatment option.

Botox Dosing:  Generally, 50 units are administered in EACH underarm with multiple injection sites.  Discomfort is easily managed with ice packs. 

Duration of Botox/Dysport Treatments:  The expectation is anywhere from 4 to 9 months with the average being 6 months.

Standard of Practice:  The use of Botox for the treatment of axillary hyperhidrosis was FDA-approved in 2004.

Steroid (Kenalog) injections involve a small amount of medication that is injected into cystic (large and bumpy) acne lesions to help resolve them much quicker.  Steroid injections are very useful for large, painful, nodular lesions to help provide relief from the inflammation and tenderness and for cosmetic benefits.  Generally speaking, these lesions will dramatically improve or resolve within 24 to 48 hours or sooner. 

It should be understood that steroid injections are not meant to manage or prevent acne but rather are useful for a more immediate, temporary solution for large painful and nodular lesions.  There are certain potential adverse or negative side effects that must be considered when weighing the benefits of steroid injections.  However, in most instances, the use of steroid injections offers a good option for many suffering from acne.

It is a proven fact that our skin and tissue continues to respond and improve even when laser treatments have finished.  This is based on a known theory called “the lag effect.”

The lag effect refers to how our bodies continue to make collagen to improve the texture of the skin after the laser treatments have finished.  The same improvement over time is true in regard to pigmented acne scars that are red or brown.  Research and experience shows that the lag effect in response to laser treatments may be as long as six months after the last laser treatment.  Although much hard work occurs during the treatment plan, our bodies continue to hear after the  laser treatment program has ended.  

While laser technology is certainly compelling and fascinating, so too is the body’s amazing ability to heal.  Time and lag effect – a good combination.  See below for a visual presentation of the "lag effect" with tattoo removal procedures.

Lori Haney, RN, MEP-C

Certified Medical Laser Safety Officer

Having uneven lips is a very common.  Sometimes lips appear to have an uneven shape or they may have more volume on one side than another.

When assessing one’s mouth, it's important to note the balance.  A balanced mouth will have even sides/corners, an even vermillion (where the white skin meets the pink lip) border,  equal volume (in the pink of the lips), as well as a balanced proportion between the top and bottom lips where the bottom lip is slightly larger than the top.

Los Angeles Restylane Injections  

Los Angeles Restylane Injections Free Consultations

Los Angeles Restylane Before and After Photos   

Using cosmetic dermal fillers such as Restylane or Juvederm can correct and enhance the lips immediately and make them appear more balanced.  Most men and women are concerned that the use of fillers to the mouth will create an unnatural appearance such as puffy lips.  However, a good practitioner will know the importance of creating a more youthful outcome while maintaining a natural, appealing look…balance.

Lori Haney, RN, MEP-C

Certified Medical Laser Safety Officer

Hyaluronidase (also known as Vitrase) is a medication that can be used to dissolve hyaluronic acid (HA) based dermal fillers such as Restylane, Perlane, Juvederm, and more.  This product is derived from sheep or cows to create an enzyme antedote for HA based fillers.  This option is extremely useful in the event that a patient dislikes their results from Restylane, Juvederm, etc. and wants the product removed.  Unfortunately, it’s difficult to reverse only very specific portions of the product and one must be prepared to lose all of the benefits of their filler treatment when injecting hyaluronidase.  Because hyaluronidase is only effective for HA fillers, it is not useful for other cosmetic dermal fillers such as Radiesse or Sculptra.

Los Angeles Restylane Injections  

Los Angeles Restylane Injections Free Consultations

Although not common practice in our industry, Celibre performs an allergy test prior to the use of hyaluronidase to ensure there is no adverse patient reaction.  Although an allergic or hypersensitive reaction is uncommon, it is highly recommended to take the time to rule this out.

Lori Haney, RN, MEP-C

Certified Medical Laser Safety Officer

*Glabella (Between Eyes)

This refers to the group of small facial muscles that are used to create a frown.  This is the FDA-approved area to be treated with Botox or Dysport for the cosmetic purpose of softening fine lines and wrinkles.  This area is also referred to as “the elevens.”  The standard Botox dose is 20 units.

*Forehead (Above Eyebrows)

The frontalis muscle (forehead) is a broad muscles that creates horizontal lines.  Contrary to what most think, this area requires much attention to dosing and technique on the part of the one doing the treatment.

The standard dose is 10 to 20 units depending on muscle size, gender, animation.

*Eyes (Outer Eyes or Crow’s Feet)

Treating the strong muscles that encircles the eyes is quite common for women but benefits both men and women.  Treating this area will soften lines that develop when smiling and animating.  When done correctly, the outcome is very natural and appealing.

Lori Haney, RN MEPC

Medical Laser Safety Officer

Below find our recommendations for several top laser resurfacing treatment options.

*C02 Laser

Still considered the gold standard, the C02 laser offers the most dramatic outcomes for skin resurfacing.  Unfortunately, it isn’t ideal for those with medium to darker skin color.  One must give much consideration as to whether or not the downtime, prolonged redness and swelling are outweighed by the dramatic results.

*Erbium MicroLaserPeel

This modality is a step down from the C02 laser but provides consistent, predictable outcomes.  A series of 3 treatments is usually equivalent to one C02 laser treatment.  Downtime and recovery is far less than the C02. 

*Fractionated Technology

These types of lasers may also be combined with the C02 and Erbium lasers.  The term “fractionated” refers to partial ablation or partial treatment.  Many believe that this concept aids in less downtime but still provides good collagen stimulation by leaving columns of tissue untreated.  Others may view this partial ablation as less superior than full ablation as achieved with the C02 and Erbium MicroLaserPeel.

Lori Haney, RN MEPC

Medical Laser Safety Officer

We have lots of patients that use tanning beds.  Especially in sunny Southern California, many like the idea of being bronzed year round.  What many young consumers do not realize though is just how damaging tanning beds can be for your skin.  A division of the WHO (World Health Org.) called IARC (Intl. Agency for Research on Cancer) officially lists UV radiation-emitting tanning devices (tanning beds/lamps) as one of the most dangerous forms of cancer-causing radiation. In fact, for many states and countries, tanning salons are restricted to those only over 18 yrs of age. For those under 18, they requiring in-person, written parental consent and/or a physician prescription.

Tanning beds offer more risk than traditional sun bathing. Research has shown that the risk of melanoma increases by 75% when tanning beds are used before the age of thirty. In addition, Dermatology groups now list photodamage (sun and tanning beds) as the number one contributing factor to the aging process.

Los Angeles, Laser Sun Spot Removal

Laser Age Spot Removal Free Consultation

Laser Age Spot Removal Before and After Pictures   

Lori Haney, RN MEPC

Medical Laser Safety Officer

Laser tattoo removal has become a very popular cosmetic treatment in large part because there are so many consumers with tattoos.  As the procedures have grown in popularity so too have physicians and consumers interest in finding out which lasers are best for their particular tattoo and skin type.

When speaking on the issue of which lasers are best for tattoo removal, it's important to understand that there is a distinction between the TYPE of laser being used and the BRAND name of laser being used.  The TYPE of laser refers to the type of light being used for the treatment and the BRAND name of the laser refers to the manufacturer that produces the laser.  This is an important distinction to understand when search for a tattoo removal facility.  Also important to understand is the fact that some q-switched types of lasers are better at some colors than others. 

First let's discuss the TYPES of lasers used for tattoo removal and which colors they are ideal for:

• Q-switched Nd:Yg laser (and double frequency Nd:Yg).  This laser type is most commonly used for laser tattoo removal because it has two wavelengths, 1064 (Nd:Yg) for dark colors and 532 (Double Frequency Nd:Yg) for lighter colors.  The 1064 wavelength of light is best on black, brown, blue, deep purple and other dark colors, while the 532 wavelength is best on red.  There are a lot of colors in between including yellow, orange, pale blue, green, etc.  While the 1064 and 532 can usually remove these colors, it can take many treatments (5-15 is the expectation we set at our practice).
• Q-Switched Ruby laser.  This laser is uses 694 nanometer wavelength of light and is effective at removing green and darker colors.
• Q-Switched Alexandrite laser.     This laser is uses 694 nanometer wavelength of light and is effective at removing green and darker colors.

Los Angeles, CA Laser Tattoo Removal 

Los Angeles Laser Tattoo Removal Free Consultation

Los Angeles Laser Tattoo Removal Before and After Pictures 

The following are manufacturer's BRANDs of Tattoo Removal Devices:

• Hoya Conbio Medlite (C3, C4, C6 and Revlite), Q-Switched Nd:Yg (and Double Frequency Nd:Yg). The Hoya Conbio 1064/532 combination lasers is one of the leaders in tattoo removal equipment and has been producing top quality, high energy Q-switched lasers for many years.
• Palomar Q-Yag V Q-Switched Nd:Yg (and Double Frequency Nd:Yg).  This machine is similar to the Hoya Conbio lasers but has an added feature that allows the practitioner to mix 1064 and 532 wavelengths of light, adding more flexibility to the treatment program.  It is especially useful for tattoo removal in darker skin types because of this mixing functionality.
• Cynosure Affinity QS, Q-Switched Nd:Yg (and Double Frequency Nd:Yg).

The answer to this question is not as easy as it may seem because there are many different types of chemical peels and laser peels.  There are very superficial chemical and laser peels that will result in modest resurfacing of the skin (10 microns or 1/100th of an inch) and have no healing time associated with them.  There are also very deep chemical peels and laser resurfacing that can resurface up to 300 microns (or 3/10ths) of an inch and require several weeks of healing.  Generally speaking, the more healing time needed for the procedure, the more dramatic the results will be for conditions like wrinkles, sun damage and acne scars.  Some common light chemical peels include glycolic acid peels (less than 30% acid) and Jessner's peels.  A common light laser resurfacing is the Erbium laser.  Deeper and more dramatic chemical peels include the phenol peel and a common deep laser resurfacing peel is the CO2 laser.

Los Angeles, CA Laser Peel

Los Angeles Laser Peel Free Consultation

 Los Angeles Laser Peel Before and After Pictures 

Both chemical peels and laser peels can be effective, but it depends on your condition and lifestyle.  For example, a 50 year old person that has been smoking for 35 year, has never been out of the sun and has wrinkles that are measured in 1/8ths of an inch deep is not a candidate for a light laser peel or chemical peel.  This type of candidate would need a heavy (phenol) or laser resurfacing peel (CO2) because of the depth of wrinkles.  On the other end of the spectrum, if a patient is looking for very mild improvement in the tone and texture of their skin then a light chemical peel or laser resurfacing can do just that, remove the very outermost layers of skin, making it appear fresher and softer.

The one significant and measurable difference between chemical peels and laser peels is that lasers (ex: Erbium YAG, Fractionated, CO2) have the ability to very precisely remove the sin tissue to an exact depth.  This kind of depth control cannot be achieved with a chemical peel because the peel is manually applied by the practitioner and the depth of penetration of the peel depends on a number of factors including the type of skin and the time left on the face.  These variables make chemical peels much harder to control compared to laser technology.  Although both chemical peels and laser peels can be effective treatments, the more aggressive types (phenol and CO2) also carry a higher risk for adverse side effects.  Certain skin types - those with darker pigmentation or those with sensitive skin - may not tolerate chemical peels well and may be higher risk for a poor outcome.

Deciding between a chemical peel vs. a laser peel will be dependent on one’s skin type, condition, goals, lifestyle, budget, and whether or not they are able and willing to have recovery time.   Find a practitioner that knows the answers to the above questions and tailors the treatment plan your situation.

Lori Haney, RN, MEP-C

Certified Medical Laser Safety Officer

At Celibre, we take much pride in being advocates for patients and consumers.  First and foremost, we value the teaching process and believe most consumers do as well.  It is not unusual for patients to come to us with very little or incorrect information on how to manage their skin condition - even when they are being managed by a dermatologist.  Many describe wasting time and money on treatment methods that don't work or, as is often the case, make their skin condition worse.

One of our female acne patients was diagnosed with acne by one dermatologist and then diagnosed by a second dermatologist with “acne rosacea.”   For the last two years, she has been on a long, frustrating journey of harsh topical products such as retinoids, complicated skin care regimens, and a host of oral medications.  She came to us with skin that was inflamed, dry, irritated, and just plain hurt. She realized that there had to be a better way to manage her skin and became intrigued with the concept of laser treatments.  While laser treatments are not the answer for every patient, in this particular case, they helped immensely.  What also helped was taking the time to sit down, evaluate all the products that the patient was using (from both dermatologists) and then eliminate those that were contributing to some of the problem.  Without spending a good amount of time with the patient, neither physician would have been able to get the whole story that we did.  The time spent on patient education makes a world of difference to our patients.

Los Angeles, CA Acne Rosacea Treatments.

Acne Rosacea Free Consultations.  

 Los Angeles Rosacea Before and After Pictures.    

Within two weeks, we were able to quiet her skin down (see the photos above).  Was it the work of lasers?  Partially.  However, I give most of the credit to providing our patient with good baseline knowledge of how to care for her skin – something that had not been addressed on numerous visits to her previous practitioners.  What the patient does on a daily basis is always far more valuable when combined with what we are able to accomplish on her weekly visits.  By equipping her with knowledge and gentle skin care products, we were able to make early progress to bring her skin into a better balance.

Although we recognize the role of many available treatments whether we utilize them or not – we are firm believers that patient education and involvement must always be at the top of any treatment plan.  You and your appearance are worth investing in – find a practitioner that believes the same. 

Lori Haney, RN, MEP-C

Certified Medical Laser Safety Officer

For lack of a better term, “road rash” is often used to describe traumatic injuries that occur when someone has contact with the ground such as gravel, sand, pavement, and asphalt.  Even when a cut or wound is irrigated after injury, there may be some staining or color left in the skin and tissue well after healing has taken place.  This condition may be referred to as “traumatic tattoos” or "road scars".  With this condition, early laser treatment leads to improved outcomes.  Class IV medical lasers are an excellent option to resolve discoloration related to road rash scars.  Outcomes can be dramatic with laser treatments being safe for all skin types.  Many consumers and medical professionals are unaware of the cosmetic concerns that a patient may have once an injury has healed.  Knowing which laser options are available to treat road rash is a good place to begin.

Los Angeles, CA Road Rash Scar Removal Treatments.

Scar Removal Consultations.  

 Los Angeles Scar Removal Before and After Pictures.  

Lori Haney, RN, MEP-C

Certified Medical Laser Safety Officer

Brown spots or sun spots can be found anywhere on the body.  Although common on the face, it is not too unusual to find them on the lips as well.  For some patients, this represents a cosmetic concern because they are not easily covered.  Sun spots on the lips are effectively treated with Q-switched lasers.  At Celibre, we use Q-switched Yag lasers to resolve these lesions in as little as 1 to 3 treatments performed every 4 weeks.  There is very little discomfort and most treatments are completed in fifteen minutes.  Treatments are safe for all skin types.

Los Angeles, CA Sun Spot Removal Treatments.

Sun Spot Removal Free Consultations.  

 Los Angeles Sun Spot Removal Before and After Pictures.  

When protecting your face with sunscreen, don’t forget the lips.  Lip balms that provide SPF are a good source of protection.

Lori Haney, RN, MEP-C

Certified Medical Laser Safety Officer

Botox Cosmetic and Dysport are both classified as botulinum type A products that are used for not only cosmetic purposes but medicinal as well.  Botox is manufactured by Allergan, and Dysport is produced by Medicis.  Both are well-known companies with an excellent reputation for products.   Both products have FDA approval for the treatment of glabella (frown) lines for cosmetic indications.

 Orange County Botox Before and After Pictures.

Regardless of which product the patient and practitioner decide upon, healthy competition in this arena is a win-win situation for consumers.  This is clearly demonstrated by first-time consumer rebates being offered by Allergan with promotional incentives as well by both companies. 

Be sure to discuss your treatment goals and the available options with your practitioner.

Lori Haney, RN, MEP-C

Certified Medical Laser Safety Officer

Most of us have heard the saying, “You can tell a woman’s age by her hands.”  The older we get, the more we understand what this means.  Changing hands are a result of a combination of factors including age, sun exposure and weight.

As we age, our skin thins.  The fatty layer that supports the upper layers of skin can lose volume and the collagen and elastin that form the building blocks of our skin become less plentiful.  Thinning skin combined with the loss of collagen and elastin leads to the appearance of pesky age spots (also called liver spots or sun spots). Q-Switched YAG lasers are an excellent answer to this common problem by resolving pigmentation as well as improving skin texture.  These treatments are safe for all skin types and have no downtime involved.

However, what can we do for our hands when we’ve lost volume?  As volume is lost the hands start to show "ropey" looking veins and protruding ligaments.  In addition, the voids between veins and ligaments become hollowed.  Although lasers are great for getting rid of age spots, they are not so good at restoring volume.   This is where dermal fillers come in.  Restylane, Perlane, Juvederm and other dermal fillers can have an immediate effect on making hands look younger.  By plumping the hands, filling voids and make the veins and ligaments less noticeable, we are able to turn back the clock on aging hands. 

Until recently, we had not been impressed with the techniques and products that were being promoted for injection hand rejuvenation.  We have since found a much better way to use our dermal fillers (hyaluronic acids such as Juvederm, Restylane) to create a less expensive but still dramatic solution for the problem of aging hands.  Injection benefits are immediate and outcomes continue to improve over a two week period.  Results typically last for a minimum of six months.

Lori Haney, RN, MEP-C

Certified Medical Laser Safety Officer

Laser tattoo removal is a safe and effective method for removing unwanted tattoos.  Unfortunately, the process may take numerous treatments, even when done correctly.  Patients often have to wait a period of 1-2 years to complete the process because of the time it takes the body to remove tattoo ink that has been broken down during a laser treatment.

The expectation we set for our patients at Celibre is that the average tattoo will require between 5 and 15 treatments.  The number of treatments depends on the skin type, the type of ink, the laser used, the laser energy used, the skill of the practitioner and the depth of the ink.  A common misconception among patients (and some practitioners) is that it is better to use consistently higher laser energies with each treatment to speed the removal process.  While it is true that less treatments may be required to completely remove the tattoo when using higher (ablative) energy levels, this method also carries risk.  The problem is that using extremely high energy to "carve out" the tattoo ink can lead to scarring or depigmentation (lightening of the skin) at the tattoo site once it is removed.  Your skin type will have a large effect regarding the risk of scarring with darker skin types more prone to scarring or depigmentation.  At Celibre Medical, we do not perform treatments in this manner because we want to remove the tattoo with no permanent scarring or skin lightening left behind after it is removed.

In some situations, a tattoo may become unresponsive to lasers after repeated treatments because the ink has faded so much as to make it difficult for the laser to interact with the ink.  At this point, most patients will continue to observe excellent, continued fading over time as their bodies continue the remove the pigment over time.  See photos (there were no laser treatments between the second and third photos, just fading over time).

At Celibre, we utilize two types of Q-switched lasers for tatto removal.  Because we use two different machines, we have the ability to access much higher energies (using the Medlite C6) if and when when tattoos become unresponsive due to fading.  Although uncommon, tattoos may also become unresponsive to even the most powerful Q-switched lasers.  When this happens, our bodies take over to continue the fading process over time.

Lori Haney, RN, MEP-C

Certified Medical Laser Safety Officer

Bikini shaving bumps (razor bumps) is a very common problem for women.  When growing in, coarse, curly pubic hair can often curl before it exits the skin causing the hair to "burrow" into the upper layer of skin, causing a razor bump.

Los Angeles Laser Hair Removal Removal Free Consultations. 

 Los Angeles, CA Laser Hair Removal Before and After Pictures.    

The only permanent treatment for bikini razor bumps is laser hair removal.  Removing bikini hair permanently with laser hair removal makes shaving unneccesary thereby eliminating razor bumps.  Contrary to waxing, laser hair removal is generally more comfortable, only needed every six weeks, is a better financial and time investment in the long run, and is better tolerated by the skin.  Laser hair removal to the bikini area is one of the most common treatments we perform at Celibre Medical.

When doing your laser hair removal research, make certain you find a laser practitioner that has the right technology for your skin type and is trained in this service.

Lori Haney, RN, MEP-C

Certified Medical Laser Safety Officer