Question: I am a lifetime car mechanic and have had my share of burns and scrapes, leaving my arms especially damaged. Would laser skin resurfacing be a good option for treating such a large area of the body?
Answer: No, laser skin resurfacing really cannot be performed on the body the same way that it can on the facial region due to fact that the body does not heal as quickly as the face and, ultimately, we would just create more scarring on the body before the completion of the healing phase. There are various chemical peels that can be performed on the body such as salicylic acid. We can also treat the body skin with fractionated lasers such as the ProFractional laser by Sciton. I would recommend a complimentary consultation at Quintessa Medical Spa.
Question: I have recently started using Latisse to thicken my lashes. About a week after use, my eyes have become extremely dry and irritated. Is this irritation normal to experience when using Latisse?
Answer: No, I would not expect your eyes to become dry and irritated from the proper use of Latisse. I would recommend that you read the instructions carefully and that you perform the application as directed and, if you still have redness and dryness, you can do one of two things. One would be to discontinue the Latisse to see if, indeed, this problem does go away. The other would be to see your eye care professional, whether it be an ophthalmologist or an optometrist, for a thorough eye evaluation to see if there may be another cause for your dry eye that is unrelated to the Latisse product.
Question: My son is turning 21 next month and has had an awful time with severe acne that has left him with a scarred face. As a birthday present/college graduation present, I want to help him rejuvenate his face and start his career with some confidence. What is the best approach to cleaning up skin that has been riddled with acne?
Answer: Well, the first part of any approach to treating a face that has been riddled with acne is to assure that the active acne is under control. If he no longer has any active acne and we are now dealing with acne scarring, I would still highly recommend that he stay on a good medical-grade skin care line to minimize his chances of a recurrence of his acne, and I would then discuss various treatment options for the visibility of his acne scarring, depending on his evaluation. I have found that many patients, especially younger patients, have a significant amount of redness to the acne scarring, and that draws the eye even more than the depressions that the acne has caused. To treat this redness, we typically recommend intense pulsed light or broadband light, which works exceptionally well at getting rid of the visibility of the redness in the scars. Many times, this is all we need to perform, as the remaining depressions are relatively mild and really do not catch the shadows very well or draw the eye. For patients with depressions that do draw the eye or create shadows, I would then recommend a series of treatments with the ProFractional laser by Sciton, which is an Erbium laser that lasers small tunnels in the skin. These tunnels then cause the healing response to deposit a significant amount of collagen in the deeper dermis and this in turn then tend to flatten out depressions, whether they be acne scarring, surgical scarring, or chickenpox scarring. We have had very high success rates with extremely significant changes to the appearance of the acne scarring for the better. In my practice, this has replaced dermabrasion and deep full laser resurfacing as my treatment of choice for acne scarring as, in my personal opinion, it seems to provide a better outcome for my patients. Ultimately, an evaluation at Quintessa Medical Spa would be recommended so that a customized treatment plan can be created for his specific needs.
Question: I had Juvederm injections in my lips about five months ago and, until now, have been very pleased with the results. I feel like the plumpness is starting to diminish. How long should Juvederm injections prolong lip augmentation?
Answer: I think you are in a typical time range for lip augmentation in that I usually tell my patients three to six months but do mention that some will get a longer-lasting result than that, especially around the vermilion border. So, the fact that you are five months out from your injection and starting to notice that the volume is diminishing, seems appropriate and it sounds like it is time to see you injector again for another syringe.
Question: Because Botox and injectables like Juvederm or Radiesse work differently, I wonder about the differences and effectiveness. What differences in outcome should I expect between these two injections?
Answer: Well, you are right that they work differently as Botox is a neuromodulator, which prevents the muscle from contracting, and fillers are simply volumizing areas in that they improve volume wherever the filler is placed. Botox does not volumize but rather relaxes muscle that the Botox is injected into and this, therefore, softens the dynamic lines that that muscle creates. Expectations after these injections would be that, a week after the Botox injection, the muscle that was injected should be relaxed and unable to fully contract. The expectations after any filler injection would be immediate improved volume and, if we are filling a depression, then the depression should essentially be gone. The only exception to this would be Sculptra that does take six to eight weeks to provide its volumization due to the fact that we are relying on the body’s response to the injection to provide the actual volume.
Question: I read on the Latisse website that it was originally developed as an eyedrop to treat ocular hypertension. If I use Latisse for cosmetic purposes, will it affect my vision?
Answer: When we use Latisse for cosmetic purposes to grow the eyelashes and thicken the eyelashes, one-tenth of one percent of an eyedrop actually ends up in the eye, which is not enough to actually affect your vision and, more than likely, is not enough to cause the side effect of iris pigmentation, though we still discuss this as a possibility to our Latisse patients. Ultimately, when applied as directed, Latisse is extremely safe and also extremely effective at lengthening and thickening as well as darkening the eyelashes. One of the side effects that many patients complain of is darkening of the skin around the eyelashes but, if the Latisse is blotted after applied, this risk is greatly reduced.
Question: I bruise very easily, and I am worried about the marks that the needles will leave when I have my Juvederm injections. How large are the needles that are used for injections like Juvederm?
Answer: Hyaluronic acid fillers such as Juvederm and Restylane are usually injected with needles varying in size from a 30-gauge up to a 27-gauge needle. Certainly, if you are concerned about bruising, the injector can use various techniques to try to minimize any bruising such as using the smaller needle as well as a very slow injection technique, as it seems that the slower the injection, the less likely you are to bruise. We can also provide pressure afterwards and then ice the area for the first 30 to 60 minutes after the injection, and all of these different techniques will help to minimize or reduce the amount of bruising that you will get from a filler injection. Most patients fortunately do not get any visible bruising from filler injections but I have certainly seen my fair share of patients who can have rather significant bruising from filler injections and, therefore, we employ these techniques to try to minimize their risks.
Question: I currently use Lumigan for intraocular pressure. Is it safe for me to use Latisse for cosmetic purposes or will it be a duplicate therapy?
Answer: This would be essentially a duplicate therapy, and I would discuss this with your eye care specialist before using Latisse specifically on the eyelashes and your Lumigan for intraocular pressure. More than likely, it would be completely safe but, as I am not an ophthalmologist or eye care specialist, I certainly cannot condone the use of both products at the same time.
Question: I have seen the commercials for Latisse and would love to try it to lengthen and thicken my lashes but the risks they outline are somewhat disturbing. What percentage of patients experiences the darkening of the iris, which is mentioned as a possible side effect?
Answer: Well, it is interesting that the darkening of the iris has never actually been documented from the use of Latisse and has only been documented when patients were using the same drug as an eyedrop for ocular hypertension. Because such a small amount of the actual product ends up on the eye when Latisse is used as directed, the risks of iris pigmentation are greatly reduced compared to the risks when the same medication is used in an eyedrop form. Furthermore, the risk of iris pigmentation is really only applicable to patients with green or hazel eyes, as patients with truly blue eyes cannot cause pigmentation of their iris, and patients with brown eyes already have pigmentation of the iris. So, we do caution our patients that this is a possible risk but the chances of this occurring are exceptionally small and, potentially, there may be no risk whatsoever at the concentrations that Latisse is used.
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?
Answer: 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.
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.
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.