I had Fraxel Restore 5 weeks ago and now have tiny short diagonal lines on my cheeks and large pores all over my face. What happened and will it go away?
Fraxel Restore is a non-ablative treatment that injures (doesn’t destroy or vaporize) tiny tunnels in the skin. Occasionally both the ablative and non-ablative fractionated treatments can leave temporary depressions in the skin that may look like large pores. Fortunately there is really no way for the treatment to create large pores, and the side effect that you have experienced will most likely go away, though I will say that I have seen permanent depressions left by such treatments. I would therefore recommend you schedule a consult with me or one of my laser specialists at Quintessa Medical Spa (myQspa.com) at our new Mequon location 262-242-QSPA (7772) We can evaluate your concerns and develop a customized treatment program to give you the skin you desire.
There are several modalities to consider when treating dark spots after a TCA burn. These are due to postinflammatory hyperpigmentation and this type of pigmentation can be very difficult to completely eradicate; however, with multimodality treatment, we can very successfully improve the appearance of these types of lesions. Treatment includes regular and judicious use of sunblock. Do not confuse sunblock with sunscreens. Sunblock would have titanium dioxide and/or zinc oxide in the ingredients and this would be a sunblock preventing any significant UV from damaging or causing further pigmentation to the skin. This is by far and away the most important step in a treatment regimen for postinflammatory hyperpigmentation. Other additional treatment options would include hydroquinone applied at least daily if the skin is able to tolerate it. If hydroquinone tends to irritate the skin, this can further produce postinflammatory hyperpigmentation and I would therefore place the patient on Tri-Luma, which has hydroquinone and Retin-A as well as a steroid to reduce the inflammatory reaction. Broadband light or intense pulse light can also be used on postinflammatory hyperpigmentation, but must be used in combination with the aforementioned treatments to prevent further pigmentation from the injury. Ultimately these areas will greatly improve over time, but there really is no quick fix for postinflammatory hyperpigmentation and most patients will take at least several months to show significant improvement and possibly six months or even longer for resolution of these lesions.
That depends on where the Botox is placed. If Botox is purposefully placed in the lower lid, especially into the pretarsal muscle, which is just below the eyelashes, this can indeed, make a droopy lower eyelid worse. If Botox is placed out in the crow’s feet area or in the forehead or area between the eyebrows, this really should not affect a droopy lower eyelid in any way.
Yes, laser resurfacing can be performed in patients with a pacemaker and in fact, procedures that are performed in the spa setting can be performed on patients with pacemakers without any difficulties. Obviously, when laser resurfacing is performed in the operating room, certain precautions are taken for patients with pacemakers, but this mainly is due to the anesthetic and not so much the actual laser resurfacing procedure itself. The bottom line is that patients with a pacemaker can feel comfortable having laser resurfacing should they desire.
It is safe to remove lumps in the lips caused by ArteFill when performed by a highly skilled facial plastic surgeon. ArteFill is a permanent filler material composed of methylmethacrylate and if placed in the lips, can commonly cause bumps or nodules. These nodules can be a very difficult problem to completely rid the patient of, but the more dominant nodules can be treated by making small incisions in the lip itself and removing these nodules. When performed very precisely and meticulously, these nodules can be removed with very little if any visible scarring. I would; however, recommend that you seek consultation with a board certified facial plastic surgeon for adequate treatment of this unfortunate complication. Looking back on this predicament, ArteFill is contraindicated in the lips as are virtually all other injectable filler materials other than hyaluronic acid type fillers, which have an extremely low complication rate.
Overall this generalization about injectables is true. Botox, for the most part, is very effective in the upper portion of the face including the forehead, glabella or area between the eyebrows, as well as the crow’s feet area where as fillers are more effective down in the area of the smile lines and lips and marionette lines. However, there are some patients that would benefit from fillers in the upper third of the face as well as Botox in the lower third of the face such as patients that have very deep creases between the eyebrows. These creases can be filled with hyaluronic acid fillers though one has to be quite judicious in the amount that is applied to these areas due to the fact that significant complications can occur when performed inappropriately. I therefore recommend patient seek someone with a significant amount of experience using fillers in these types of areas. Furthermore, fillers can be used in the lower eyelids quite successfully, but again, this area is fraught with complications when performed by an inexperienced injector. Furthermore, Botox can be used in the lower portions of the face such as into the depressor anguli oris that can help lift the corners of the mouth and prevent the downturned look. Furthermore, it can be placed above the lips in the levator labii superioris to prevent a gummy smile. Botox or Dysport can also be placed in the bands below the chin, which are caused by the platysma muscle and the relaxation of this muscle will visibly diminish these lines or bands. In summary, Botox typically is used in the upper portion of the face and fillers are typically used in the lower portion of the face, but when highly skilled injectors evaluate patients, we can use these products in areas that cannot only enhance one’s appearance and significantly rejuvenate the patient, but can also be used in an extraordinarily safe manor when compared to a more inexperienced injector.
Yes, intense pulse light or broadband light can be used to treat precancerous lesions such as actinic keratoses, but only when used in conjunction with a photodynamic sensitizing agent such as ALA. Intense pulse light or broadband light in and of itself will not adequately treat precancerous lesions, but the photosensitizing effects of ALA will cause these precancerous lesions to be exquisitely sensitive to light and by treating these lesions with intense post light after ALA therapy, we can essentially rid the skin of these precancerous lesions while maintaining the integrity of the otherwise healthy skin cells.
The answer to that question really depends on the patient’s age. If the patient is relatively young and has very elastic skin, there are various nonsurgical treatment options available, but the most productive and most efficacious treatment would involve some sort of fat removal. Classically this is done via liposuction through an extremely small excision below the chin. This can easily be performed in the spa setting and we frequently perform these at Quintessa Medical Spa using just local anesthetic. There is very little downtime as I just place a pressure dressing overnight and this can be removed the following day. I recommend the patient wear an elastic sling in this area as much as possible for the first week and then they can essentially resume normal activities. Most patients do not have any visible bruising from this procedure and therefore, downtime is very minimal. There are newer lasers available that can not only liquify fat, but help to tighten the overlying skin. I have not found these to be horribly helpful in this area of the face and therefore I continue to perform relatively classic liposuction in this area as we get fantastic results with extremely low risk and I have not found that the lasers are helpful. Other nonsurgical options for a double chin are going to be less effective, but there are various ways to tighten the skin in this area.
The most efficacious treatment available at this point in time appears to be Ultherapy, which is an ultrasound based technology that can heat the deeper tissue using ultrasound waves.
This technology is very exciting due to the fact that it completely bypasses the overlying skin and thus creates no injury whatsoever to the skin, but only injures the deeper tissue and then collagen growth causes tightening of the area and visible results can be seen within approximately three months.
We are excited to have an Ultherapy device at Quintessa Medical Spa as we wereone of the first ten facilities to obtain this device in the United States and will be one of twenty-five facilities in their phase one clinical release.
I would recommend contacting us for a consultation if you are interested in discussing Ultherapy or the minimally invasive liposuction.
For new patients that have never had Botox or Juvéderm injections by me or my nurse injector, I highly recommend that they follow up approximately two weeks after the procedure. I recommend this due to the fact that many of our patients have had treatments elsewhere that were either ineffective or less than optimal and I would like to make sure that they not only got an excellent result, but also understand what an excellent result is so that in the future when they receive treatments, they can feel comfortable returning to see us should they feel that the result was not less than excellent. Frequently patients will have unrealistic expectations from fillers or Botox and allowing them to come back for a two-week check will allow us to educate them on the expectations involved with these types of treatments. Also on the rare occasion that the patient does have a suboptimal result from these types of treatments, we can do a touch up at the two-week interval to assure that they get an excellent result and we do not charge any fee for this touch up service. This essentially guarantees our patients at Quintessa Medical Spa will receive excellent results from their filler or neurotoxin injections and should they not, we would be happy to do any sort of additional injections at no cost to the patient.