Question: Since I have had bad experiences with surgery in the past, I am very interested in the nonsurgical alternative to a facelift. Do they really work as well?Â
Answer:Â I will be very honest with you, I do not feel that nonsurgical alternatives work nearly as well as an actual facelift but, considering that they are not a surgical procedure, we have been relatively impressed with what a nonsurgical, noninvasive technique can provide regarding a patient’s rejuvenation.Â
At Quintessa Medical Spa, we are one of the few facilities in the United States that has the Ultherapy device. Ultherapy uses ultrasound that is targeted to a specific depth beneath the skin, and all of the ultrasound energy heats up the tissue at that specific depth in very small thermal injury zones. This causes denaturization of the collagen, which then sets up the healing process which, in turn, adds new collagen to the tissue and this, in turn, then causes tightening and lifting of the surrounding structures. At this time, Ultherapy is FDA approved for browlifting and is the only nonsurgical, noninvasive device to ever been given a lifting indication by the FDA. We also use it in the mid and lower facial regions to help improve the jowls and submental laxity.Â
Though I feel it is not nearly as effective as an actual facelift, it is in my opinion one of the best options for nonsurgical rejuvenation regarding facial laxity. We are just starting to evaluate its effectiveness outside of the facial region and are very excited to see if we make some significant improvements in skin and soft tissue laxity of the body.
Question: After 10 years of teaching high school, needless to say, I have developed quite a few wrinkles. I cannot quite afford surgery but less invasive options might work on my budget. Will a chemical peel soften my well-earned wrinkles after a few treatments?Â
Answer: Yes, there are certainly chemical or laser peels that can be used to soften wrinkles and improve the texture and coloration of the facial skin. At Quintessa Medical Spa, we have various treatment options from chemical peels to more sophisticated lasers, such as the ProFractional laser by Sciton that lasers small channels in the skin that create new collagen, wrinkle reduction and, overall, improve the texture and discoloration of the skin. Oftentimes, we combine various treatment modalities in one session in order to maximize the effectiveness of the treatment. One of these is where we combine broadband light with ProFractional laser resurfacing as well as a Micro Laser Peel, and we call this the North Shore Reveal. It can be extraordinarily effective at improving fine lines and wrinkles, skin discolorations, and rough surface texture. It has approximately two to three days of some mild downtime but the result is well worth the effort and cost. For significant skin problems, we will recommend a series of three treatments spaced four to eight weeks apart.
 Question: I am a creature of comfort and I am terrified of how badly my laser hair removal will hurt afterwards. Are there options for numbing agents for patients having laser hair removal treatments?
 Answer: Depending on the area of the body being treated, there certainly are ways of numbing the area as long as it is a relatively small portion of the body, as when we try to numb overly large areas, the numbing agent can actually become toxic and there have been reports of deaths due to large amounts of numbing cream being placed on large portions of patient’s bodies.Â
Fortunately for us, we have the new Duet laser hair removal system, which combines multiple diode lasers with a suction apparatus and for large surface areas such as legs and backs, the treatment is nearly painless and certainly much less uncomfortable than the previous technology. For smaller areas like the lip or chin, we can certainly apply some numbing cream to that area to make your treatments much more comfortable. Most patients however do not need this as they find the treatments easy to tolerate and certainly after the treatment is over, there really is no discomfort whatsoever.
Question: The hairs that grow on my chin and upper lip are so hard to constantly pluck and wax. Can laser hair removal be safely used in more sensitive and visible areas like the face?
Answer: Absolutely. Laser hair removal is an excellent option for patients with excessive upper lip and chin hair as these are typically coarse darker hairs that patients dislike and the laser hair removal systems available today are extremely effective at ridding the patient of these unwanted hairs. Whereas waxing and plucking can sometimes only irritate the skin which can cause ingrown hairs leaving unwanted scars or pigment changes in the skin. The only difficulty that we get into occasionally is when the hairs are very gray or blonde as these hairs are much more difficult to eradicate.
Question: I have had my bikini line waxed in the past, but I am ready for a more permanent solution. Will I need to grow my hair slightly as I have to do when having my bikini line waxed?Â
Answer: Yes, you will have to grow the hair slightly so that there is actually a hair shaft within the follicle so that the light energy that is used for laser hair removal has a target to destroy. In other words, if you have recently had a bikini wax, you would not be a good candidate for laser hair removal since you have just pulled the hair from its follicle and you would then have to let the hair grow out slightly. Usually this is only necessary on the first appointment and then after you can trim the hair prior to any laser treatments. We tend to clip off the excess hair as we do not want a significant amount of hair outside of the skin showing as all it will do is essentially burn during the treatment and this is unnecessary. Have a discussion with your health care professional that is performing the laser hair removal to assure that you have given this enough time for adequate hair growth, but usually 1 to 2 months is long enough.
Question:  Before surgery last year I had to cease using certain medications one to two weeks prior. I know laser hair removal is less invasive, but are there medications I should avoid nearing my treatment.Â
Answer: I would contact the professional that is going to be performing the laser hair removal to assure that you are not on any medications that are photosensitizing. These are medications that you would have been cautioned to not use if you were going to be out in the sun or when they prescribe them, they would recommend that you minimize your sun exposure and wear sunblock daily to prevent any sort of skin irritation secondary to the medication.  There are multiple medications that are sun sensitizing and I would therefore just recommend you contact the professional that is performing the treatments and relay all medications that you are on to assure that none of them are photosensitizing.
Question: I am in my mid 20s and still have raging acne. No wash or prescription has been able to quell my blemishes. Are chemical peels recommended to treat chronic acne problems?Â
 Answer: Yes, chemical peels can certainly be one treatment option in a combination approach towards chronic acne. I do not personally feel that chemical peels are going to rid you of your chronic acne problem but they certainly can help when in combination with prescription-strength medications. I would highly recommend a consultation with a board-certified dermatologist to see if you are a candidate for Accutane as, if you have already failed other various prescription-strength treatment options, this may be a good option for your particular acne. Accutane is an extremely aggressive approach towards acne but is also extremely effective. Certainly, once your acne is under better control, regular chemical peels can be a good approach towards future prevention of the recurrence of acne.Â
If you end up with acne scarring from your former active acne, there are various treatment modalities available at Quintessa Medical Spa that can do a wonderful job of minimizing the appearance of these undesirable facial scars. Ultimately, I would start with a comprehensive consultation at Quintessa Medical Spa and, if we feel the need, we will be happy to refer you to a board-certified dermatologist in order to get your acne under control.
Question: My legs have some spotting from years of summers spent out in the sun. I know that peels are usually for the face but could a chemical peel also even out the skin tone on my leg?Â
 Answer: Yes, there are some chemical peels that can be used on the body such as salicylic acid peels. We also have various lights and lasers that are in my opinion more effective, and we have therefore tend to recommend broadband light or fractionated laser treatments on the body for pigmentary issues. We have had very good success with all areas of the body whether it is the décolleté or the arms or hands or even the legs using the aforementioned intense pulsed light or broadband light as well as fractionated laser resurfacing such as the ProFractional laser by Sciton. Those treatments have very little, if any, downtime and, overall, are extremely safe and effective.
Question: As a chemistry teacher, I am always trying to prevent my students’ contact with acids and bases, so when I found out my chemical peel was an acidic derivative, I became a little nervous about the safety of my treatment versus the benefits. Will the chemical peel run the risk of a chemical burn?Â
Answer: Realize that there are countless different acids and bases out there, as I am sure that you already know as a chemistry teacher. The acids that we use for chemical peels are typically relatively mild acids and are carefully applied to the skin so that they will only penetrate to a certain depth and, therefore, prevent any true burn of the skin and certainly any scarring. In essence, a chemical peel in and of itself does cause a very light chemical burn of the skin, and this is what then causes some of the superficial layer of the skin to slough and to reveal the more youthful layers of skin below this.Â
Some of the more aggressive peels will actually cleave the skin below the epidermis, and these will require 5 to 7 days to heal, and there will be a significant amount of visible sloughing of skin from these types of chemical peels, whereas some more superficial chemical peels may not even have any visible peeling of skin but more of a pink hue to skin for a day or two. Ultimately, I would make sure that the person performing any sort of chemical peel on you is well educated, experienced, and qualified to perform these types of procedures.
Question: I am a lifeguard and even applying sunscreen regularly has not shielded me completely from the sun damaging my skin. After I have a chemical peel to correct my sun-damaged skin tone, when can I return to lifeguarding?
Answer:  The answer to that question really depends on what type of a chemical peel or laser peel you have performed. If it is very superficial, you can most likely apply a sunblock and go back to lifeguarding the following day. If it is deeper and requires a period of time to heal, then you need to wait until the healing process is complete before you can apply the sunblock and then go back to your lifeguarding. For instance, some of our chemical and laser peels require a good three days of the use of a greasy-type occlusive emollient as, during that time period, there tends to be some weeping and oozing from the skin; we do not want this to dry and crust.Â
 After those three days are up, we can then apply a sunblock and you can resume your activities outdoors. Other even deeper peels can require six to seven days of downtime, during which you would not be able to be outside lifeguarding. Even after these deeper peels heal, you may even want to take one more week off due to the significant sensitivity of the skin before you go back outside. Even after you return to lifeguarding, you are going to want to wear a wide-brimmed hat and a very effective sunblock to prevent any unexpected and unwanted pigmentary changes to the skin. So, in essence, depending on which chemical peel or laser peel is performed, you may or may not have any downtime or could even have downtime up to two weeks.Â
 Ultimately, we provide rather detailed postoperative instruction sheets for patients, and we discuss these issues prior to the actual procedure so that they are fully prepared for any downtime that is going to be expected.
