Syringoma Removal with Cauterization

We get contacted fairly regularly in regard to the removal of syringoma.  Syringoma are troubling, persistent, fleshy bumps that occur most often below the eye.  The condition is very common in Asian patients.  

Many of these patients ask about CO2 (or other forms) of ablative laser resurfacing.  Laser resurfacing is certainly an option for syringoma, but to use an old adage, we feel that is't analogous to pounding a nail with a sledgehammer.  Although we offer laser resurfacing, it's difficult to resurface just the bumps themselves and it's a lot more time consuming and costly than a good old fashioned hyfrecator.

Hyfrecation is the process of using heated probe to cauterize the syringoma and an example of a recent case of before and after pictures for a Los Angeles patient is below. To leanr more, contact the office today.

  

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Posted by administrator on Wednesday, October 22, 2014 3:13 PM
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Why we're not currently using Voluma by Allergan 10/20/14

We've had many requests for Voluma over the past few months in response to the launch Allergan's newest dermal filler product.  The strategy of our organization has always been to let new products earn their place in our practice by proving, over a year or two in the market, that they are worth the hype.

And that's what product launches are - hype.  The manufacturers of lasers and injection products have to hype their products with huge PR campaigns to try and make a name for their brand in an already cluttered cosmetic dermatology marketplace.   They get consumers really excited when appearing on shows like "The Doctors" and "Dr. Oz".  The problem is that the reality of the product is usually quite far off from the hype and Voluma is a perfect example.  

In the FDA study used for the approval of Voluma in the cheeks, the AVERAGE patient used 6.5 CC's of product in the cheeks.  Now, if you know anything about injection product, you know it's very unusual to use this much product.  In fact, most patients at our practice get a maximum of 3-4 CC's in the cheeks.  To give you an idea of how much this would cost in today's market, Voluma is selling for between $750 and $1000 per CC.  So that 6.5 CC average patient from Allergan's study would have paid between $4,875 and $6,500 for their injections.  We don't know many consumers willing to pay that for their injections.

On top of this fact, if you inject 6.5 CC's of ANY dermal filler, you are going to get a lot of duration, just because there is so much product in the cheeks.  Voluma claims a 2 year duration, but Juvederm XC also claimed 18 months when they originally came out and if you know Juvederm, you also know it doesn't last for 18 months.   We believe that it's very realistic for Voluma to achieve 12 months of duration, but beyond that we are skeptical and will let consumers weight in over the next year as to whether the premium cost of Voluma is worth it.

 


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Posted by administrator on Monday, October 20, 2014 2:21 PM
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Why All Fractional Resurfacing is Not the Same

We get calls regularly from patients that are frustrated with the results of their fractional laser resurfacing treatment at another office.  In over 90% of the cases, we can trace the reason for their disappointment back to the depth of the resurfacing treatment.

Fractional laser resurfacing is not the same everywhere.  The depth of the resurfacing matters, coagulation matters (heating of the tissue) and how large the fractional holes are matters.  There are a lot of determinants to set when performing a fractional laser treatment and how well your practitioner knows these determinants and how they will affect your case will determine your results.

Most patients are not told (nor do they ask) how deep their resurfacing will be.  This is important because for acne scars, fine lines and sun damage, the deeper the resurfacing, the easier it is to resolve the concern.  But with deeper resurfacing, patients feel more pain and thus need more comfort measures.  We always know when a patient has had a very simple fractional resurfacing because they tell us that all they had for numbing is the triple numbing cream that is placed directly on the face.  Using this method alone ensures that the resurfacing must be very superficial, otherwise it would be too painful.  

 
 At our practice, we resurface down to 1000 microns (1 millimeter).  In most practices, they limit the depth to 200 microns.  We know this because when we askpatients that have come from other practices whether they experienced heavy bleening or not, the answer is almost always no.  Once you get past 150-200 microns the bleeding becomes more profound, but so do the results.  To resurface deep acne scars, the treatment needs to go much deeper than 200 microns.  
 
Take a look at the picture below of a typical 7 day recovery process.  You will note that there is much bleeding right after the procedure ends (first photo) and this is indicative of a good, deep, fractional resurfacing procedure.  A procedure that's a little more difficult to recover from, but one that delivers much better outcomes.
 
 

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Posted by administrator on Tuesday, October 14, 2014 4:05 PM
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What's the Best Treatment for Wrinkles Around the Eyes?

We get asked this question all the time and there is no one single answer.  One of the follow up questions we ask is "Which wrinkles?  Is it the crow's feet on the sides of the eyes that wrinkle up during the smile?  Is it the frown lines between the eyes that appear when frowning or is it fine lines and/or loose skin below the eyes.  We have options for all of these, but they vary depending on the area.  

Frown Lines:

Your best bet for frown lines is always going to be Dysport or Botox.  Botulinum Toxin Type A relaxes the muscles that cause the frown lines.   The area smoothes out nicely for 3-4 months after a proper dosage, leaving you looking very relaxed.  In rare instances where the frown lines are very deep, we will use a small amount of Hyaluronic acid based filler such as Restylane to improve the area.  We do not recommend laser resurfacing in this area because it does not generally help.  See photos below.

 

 
Crow's Feet (smile lines):
 
For the crow's feet lines on the sides of the eyes, Dysport or Botox are also our go to treatments.  Laser resurfacing has more benefit in this area than between the eyes, but the fundamental cause of the wrinkles, (muscle contraction) is not changed by laser resurfacing so the lines usually return fairly soon after the resurfacing.  We love Dysport and the duration would be in the same 3-4 month range.  See photos below.
 
 
Tired Eyes and Dark Circles (Tear trough):
 
Finally, the area under the eyes (the tear trough) represents the most difficult area to treat.  In this area, for patients without too much excess skin, we normally opt for a dermal filler such as Restylane.  Often the issue in this area is hollow eyes or dark circles in addition to fine lines.  Restylane can help with all three.  And when the skin is a little loose and the texture needs improvement, we reach for the Sciton Profractional for fractional laser resurfacing. See photos below.
 
 

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Posted by administrator on Thursday, September 25, 2014 5:33 PM
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Brown Spots and Bruising after Injections and Eye Surgery

A little known side effect of injection procedures, including dermal fillers and sclerotherapy, is hemosiderin staining.  

Hemosiderin staining is a long term bruise or brown discoloration that occurs deep in the skin in response to bruising or bleeding below the suirface.  It occurs most often during sclerotherapy treatments with darker swkin patients such as Hispanic, Asian, Middle Eastern and African American.  Sclerotherapy injections are used to treat and remove blood vessels and small veins, usually in the legs.  If the solution used to close the blood vessels leaks outside of the vein itself, it can cause a darkened area which looks like a brownish bruise.  This is hemosiderin staining.  The same type of brown staining can occur in dark skin types after bruising related to dermal filler injections in the face or from lower eyelid surgery.  

In all of these instances, q-switched lasers are a quick, easy and effective way to get rid of the discoloration.   Q-switched lasers are designed to remove tattoos and birthmarks, but we use these lasers to treat all types of dark pigment including long term bruising and dark scars.  Call today to learn more about how q-switched lasers can remove hemosiderin staining.

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Posted by administrator on Wednesday, September 17, 2014 2:52 PM
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How can I get rid of Red Scars?

Scars come in many sizes, shapes and colors.  One type that we see a lot of are red scars.  The redness associated with trauma scars is most often linked to the inflammatory response and the blood flow that are normal during the initial healing stages of the scar.

For many patients, they cannot get rid of their red scars fast enough.  And that's where our pulsed dye lasers come in.  Our V-Beam and V-Star pulsed dye laser are designed to close the small blood vessels associated with the redness.   This returns the area to the same color as the surrounding skin and makes the scar much less noticeable.  To learn more about lasers and other types of treatments to remove your scars, call the office today.

 

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Posted by administrator on Friday, September 12, 2014 4:54 PM
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Asian Nose Shaping with Radiesse Injections

Over the past several years, it has become more commonplace to treat patients for non-surgical nose shaping.  In many cases, the patient does not necessarily have an issue that is well suited to surgery, or the patient does not prefer surgery for one reason or another.  

We use Radiesse in situations where a patient needs non-surgical nose shaping.  An examples of the work is below for "Asian Nose Shaping".  This patient was tryign to achieve a straighter line between the forehead and mid nose.  

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Posted by administrator on Wednesday, September 10, 2014 4:22 PM
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What is Photodynamic Therapy for Acne?

Photodynamic Therapy (commonly referred to as PDT) is a treatment for acne that involves using a medication and a light based treatment together to reduce inflammatory acne.

One of the contributing factors for acne is the amount of sebum (oil) production.  Generally speaking, acne patients have heavier sebum production than those patients without acne problems.  There is more than one way to treat overactive oil glands and Accutane is a very common method.  Accutane is a very effective drug, but does have many side effects that make it difficult for patients to stay on.  So, when accutane is not an option, photodynamic therapy becomes a great one.

PDT uses a medication called Aminolevulanic acid (also referred to as ALA) and a light therapy called the Blu-u to reduce sebum production by targeting the oil glands specifically.   The liquid medication (ALA) is palced on the skin and the patient "incubates" for a period from 3-8 hours.  During this period, the medication sinks into the skin and becomes preferentially absorbed in the quickly reprodcuing cells of the oil glands.  Because the medication is highly photosensitizing (reacts to light and is highly absorbed), when the patient is placed in front of the blu-u device, the reaction is similar to a very bad sunburn and occurs regardless of what skin type the patient is.  

 

The ultimate outcome after 2-3 visits is that a mjority of the patients we treat see a significant reduction in the amount of active acne after 2-3 PDT treatments.  If you are in the Los Angeles or Orange County, CA area and are interested in treating problem acne, call today to find out more about photodynamic therapy.

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Posted by administrator on Thursday, September 04, 2014 3:23 PM
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Is Picosure the best laser for Tattoo Removal?

We've had many patients inquire about the Picosure laser for tattoo removal over the past few months.  What makes it difficult for consumers to get the whole picture regarding which laser is optimal for their situation is the technical aspect of laser dermatology.

A Picosure laser is a good piece of laser technology.  The challenge is that the wavelength of the laser (755 nanometers) is not the same as most other tattoo removal lasers (Nd:Yg is most common at 1064/532 nanometers).  What this means is that the IDEAL color for treatment with the Picosure laser is green.  This is a less common color with most tattoos and for this reason, in many cases, the Picosure laser is not the best laser for tattoo removal.  Below you will find an excerpt from Wikipedia, which details the 755 (Alexandrite) wavelength for q-switched laser tattoo removal and the challenges with this wavelength.

 "Q-switched Alexandrite: 755 nm. The weakest of all the q-switched devices and somewhat similar to the Ruby laser in that the Alexandrite creates a red light which is highly absorbed by green and dark tattoo pigments. However, the alexandrite laser color is slightly less absorbed by melanin, so this laser has a slightly lower incidence of unwanted pigmentary changes than a ruby laser. This laser works well on green tattoos but because of its weaker peak power it works only moderately well on black and blue ink. It does not work at all (or very minimally) on red, orange, yellow, brown, etc. This laser wavelength is also available in a picosecond speed with anecdotal claims that it removes ink faster."  

** Reference http://en.wikipedia.org/wiki/Tattoo_removal.  

The bottom line with laser tattoo removal is that certain lasers (wavelengths) are better suited to certain colors, so the "best" choice of laser technology depends on the color of the tattoo.  Your results, on the other hand, are determined both by the type of laser technology AND the experience and skill of the person doing the treatment.  For best results, find out which wavelength of laser is mst appropriate for the color of your tattoo and find an office with lots of experience treating patients with your skin type and tattoo color.

 

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Posted by administrator on Thursday, September 04, 2014 3:04 PM
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Fractional Laser Resurfacing for Forehead Scars

Since launching fractional laser resurfacing in 2013, we have had incredible results and feedback from our patients in treating traumatic scars.  As an example, the patient below suffered multiple lacerations to her forehead and had to be stitched up to close these.  After the stictches dissolved, she came to us concerned about the lines left in the forehead.  

Look at the results after three Profractional laser resurfacing treatments.   

 

  

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Posted by administrator on Wednesday, September 03, 2014 6:11 PM
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Hyaluronidase for Juvederm Reversal

Because of our expertise in using Vitrase (Hyaluronidase), we will often get patients contacting us about reversing injections that were done at another office.  The following Hyaluronic acid based products are suitable for reversal with Vitrase:

Restylane, Juvederm, Perlane,  Voluma and Belotero.

Vitrase works quickly by breaking down the molecular structure of hyaluronic acid based fillers.  This means that the products will dissolve almost immediately when the Vitrase is injected.  

An example of a Juvederm reversal for injections under the eye.  This patient was injected superficially with too much Juvederm and had bags under the eyes because of it.  The pictures were taken only minutes apart.

 

 
To learn more about Juvederm reversal with Hyaluronidase injections, call the office today. 

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Posted by administrator on Tuesday, August 12, 2014 11:46 AM
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Do lasers work for Stretch Marks?

We get calls often from patients that want to know how well stretch mark removal with lasers works.  The simple answer is great for some folks and not at all for others.  

Part of what we do as a laser dermatology office is "pick" patients.  This means we have the responsibility of deciding which stretch mark candidates have a chance to do well in our program and which ones do not.  

As stretch mark patients go, the following issues help determine whether we feel a patient is a good candidate for what we do.

- If you are young, there is a better chance for improvement

- If your stretch marks are recent, you have a better chance for improvement 

- If your stretch marks are red, pink or brown, you have a better chance for improvement (white, flat stretch marks are not a good candidate) 

- If your stretch marks are indented (vs. flat), you have a better chance for improvement (flat or raised stretch marks are not a good candidate)

As with all cosmetic procedures, setting proper expectations is important for achieving patient goals.  If a patient cannot understand that the goal for laser stretch mark treatment is improvement, then they will not be a good candidate for our office.  Lasers are a great option, but in many cases the stretch marks will only improve vs. be completely removed. 

 

 
To find out if you are a good candidate for stretch mark removal, call the office today. 

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Posted by administrator on Monday, August 11, 2014 4:52 PM
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How can I get rid of veins on my hands?

Our patients ask us often about how they can improve the appearance of their hands.  They ask "How can I get rid of all these veins and make my hands smoother?"  There's a great option to improve the texture of your hands and make them appear more youthful and it's called Asclera.  Asclera is a painless injection solution used to close small veins in the legs and hands.  It works quickly and easily to remove unsightly, bumpy veins.  

 
If you'd like to get rid of veins on the back of your hands, call us today for a free consultation.   

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Posted by administrator on Monday, August 11, 2014 4:40 PM
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Vitrase for Juvederm Reversal

Every few weeks we get contacted by a patient that is unhappy with the results of an injection procedure at another office.  As long as the injections received from the other practice are "Hyaluronic Acid" based products such as Restylane, Juvederm, Perlane, Voluma and Belotero, we can easily reverse the injections with an enzyme called Vitrase.

When Vitrase is injected into the area where the Hyaluronic acid based product resides, it breaks down the product and the result of the previous injection is reversed.

In a particularly troubling case (photos below), a patient was injected into the lower eye area very superficially (near the surface of the skin) with Juvederm.  There was 2 CC's of product placed immediately under the eye and it led to the area being very swollen and bloated looking.  As you can see from the after photos, within minutes this yearlong ordeal for the patient had been fixed.  We like to see smiles like that on our patients!

  Juvederm Injections Before and After Vitrase reversal

 

  

 

To find out more about injection treatments or injection reversals, contact the office for a free consultation.

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Posted by administrator on Thursday, July 24, 2014 1:13 PM
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What is Fractional Laser Resurfacing?

It used to be that "laser resurfacing" meant one and only one thing.  Before 2005 laser resurfacing was always "full field" which meant that 100% of the skin was resurfaced.  It was the prevailing method for performing laser resurfacing.  But with CO2 lasers dominating the field, the proceudre had several drawbacks.  The first was that it could not be performed on darker skin types.  The second was that it had a substantial amount of downtime - typically 2-4 weeks for recovery.  Finally the procedure often left a shiny or waxy appearance to the skin after it was completed.

 

In 2005, with the introduction of the Fraxel brand, laser resurfacing changed forever.  "Fractional laser resurfacing" was born to address several concerns with traditional CO2 resurfacing.  First, fractional laser resurfacing could be used on all skin types.  Now, darker skin types including African Americans could participate in the benefits of laser resurfacing withouth the risks of traditional CO2 resurfacing.  Downtime with the new method of resurfacing was now limited to 1 week and general anesthesia was no longer needed for the procedure.

 

Fractional laser resurfacing, just as the name implies, on;ly resurfaces a fractiona of the skin.  It pokes tiny holes in the surface of the skin.  The laser practitioner can decide if 10%, 20% or 40% of the skin should be resurfaced by making more than one pass with the laser.  The primary laser is subdivided into thousands of smaller beams that create tiny holes in the skin.  These holes are created when light from the laser is turned into heat as it penetrates the skin.  The heat vaporizes the tissue and small voids are created.  The body's process of repairing thes tiny holes in the skin is what creates an improvement to acne scars, fine lines and large pores.

 

Celibre Medical Los Angeles Fractional Laser Resurfacing.

 

  

 

Los Angeles Fractional Laser Resurfacing Before and After Photos  

 

 

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Posted by administrator on Monday, July 14, 2014 5:47 PM
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What's the difference between tattoo and permanent makeup removal?

Both tattoos and permanent makeup can be removed using lasers.  In fact, both treatments use a device called a q-switched Nd:Yg laser.  Examples of this laser are the Palomar Q-Yag V and the Medlite C6.  

The difference between laser tattoo removal and permanent makeup removal is that the inks used for each are different.  Tattoo inks are very hearty and difficult to remove.  Tattoos are meant to be absolutely permanent and no tattoo artists wants to see his/her work fade.  Artists use good quality ink with deep placement and many passes.

Permanent makeup, on the other hand, is not meant to be permanent.   Most permanent makeup artists will tell you that the useful life of the work is about 5 years.  The inks used in permanent makeup are not as high quality and they are typically easier to remove than tattoo ink (less treatments are required for permanent makeup removal).   

   

There is one curveball when removing permanent makeup.   The ink used in permanent makeup removal can transition (oxidize) after laser treatment to a different color.  The ink can turn orange, pale blue, black or a dark grey.  While this process does not change the plan for the removal of the permanent makeup, it does require additional treatments when it happens, and does pose a challenge fo rthe consumer that has the color change.  The consumer would than have to use lipstick, pencils, foundations or other makeup to cover up the new color.  The process of covering over the new color may last up to several months while the permanent makeup removal process is ongoing.  

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Posted by administrator on Wednesday, July 02, 2014 5:49 PM
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Laser Treatments for Wart Removal

Warts, because they are viral in nature, can be problematic to treat.  Freezing with liquid nitrogen, cauterizing with a hyfrecator and using acids are all traditional methods to treat and remove warts.  But sometimes these methods fail and when they do, there is another option.  

Although the method of action is not clearly understood, it is thought that the wavelength of laser light (the type of light) and the heat generated during treatment both work to destroy the viral infection that causes warts.  As a final option, we have found laser wart removal to be extremely proficient at removing problematic warts after other traditional methods have failed.

See the before and after pictures below for a very large and painful plantar wart that was removed after several laser treatments.

Call today for more information on wart removal!

 

  
 

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Posted by administrator on Tuesday, June 24, 2014 4:07 PM
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Restylane Injections for Textured Scars

In some cases, the scars we treat are not alwyas effectively revised with laser treatments.  Because of hard fibrous tissue deposits or because the shape of the scar is very deep, laser resurfacing can't always create the right outcome.  

For very deep scars that also have some width to them (NOT like ice pick acbne scars) subcision with Restylane is an option.  During this procedure, we use the needle itself to release scar tissue below the depression and then place the Restylane directly underneath the scar to lift and fill.  Doing this over a number of treatments and years can caude the depressed scar to lift more permanently creating a shallower, less visible scar.  

See below for a nice example of treating a depressed scar with subcision and Restylane. 

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Posted by administrator on Wednesday, June 11, 2014 2:19 PM
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Profractional Laser Resurfacing for Birthmark Removal

We have had many birthmarks in the past that are resistent to traditional q-switched laser treatments.  In many cases, this is because the birthmark is textured (bumpy) and the traditional treatment cannot penetrate to the depth required to have an effect.  

More recently, we have begun to use q-switched laser treatments for the removal of deep nevi without excision (surgical removal).  Because we do not have to use surgical removal fo rthese types of birthmarks patients can still get permanent removal without scarring.  Take a look at the pictures below to see what Sciton Profractional Laser Resuefacing can do for a dark textured birthmark.

  

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Posted by administrator on Wednesday, June 11, 2014 1:32 PM
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How is Sculptra different than other Dermal Fillers?

We answer this question all the time...How is Sculptra different than other dermal fillers?

Sculptra is different than other dermal fillers because the "filler" part of Sculptra is simply the body's own collagen that is generated in response to the injection.  For this reason, Sculptra is considered a "biostimulator" rather than a dermal filler.  The product is a powder that is made up of the dissolvable stiches used in wound care.  The stiches are ground into a powder and placed in a saline solution and injected deep into the skin.  The solution then absorbs into the body leaving behind the Fine particles.  

The body surrounds the particles with new collagen over the weeks and months after treatment.  Typically 3 visits are required in the first 6 months and the number of vials of product required varies by the age and needs of each patient.  

Take a look at what Sculptra can do for your cheeks.  Notice how it affects how tired the eyes look at the upper cheeks. 

   

We love Sculptra because it is excellent at adding volume to the cheeks and mid face.  It lasts a long time (up to 2 years) and is probably the most natural looking injection filler that we use.  

To schedule a free consultation  about Sculptra injections, call our office today.   

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Posted by administrator on Tuesday, June 03, 2014 4:24 PM
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Contact us today to schedule a FREE consultation!