Question: Can a chemical peel be used to smooth the skin on my upper chest? I think years of being in the sun with a bathing suit on has aged this skin. I look pretty bad when I wear a dress or blouse that exposes my chest at all.
Answer: Yes, there are chemical peels that can improve the texture and discoloration of the chest area, but really the only one that is safe to use is a salicylic acid peel and this can take about a week to 2 weeks to recover from. Another option would be to have fractionated laser treatments, such as the ProFractional laser by Sciton in your area of concern. Another, newer option, would be to treat this area with Ultherapy, which is focused ultrasound that can treat the deeper layer of the skin and soft tissue and cause tissue tightening, which can create wrinkle reduction. This is a new technology and certainly a new indication for this technology that we have had relatively good success with at Quintessa Medical Spa.
Question: What is the best treatment for keloid scarring, steroids, surgery, or some other procedure?
Answer: I am not sure that anyone can honestly say what the best procedure for keloid scarring is, but if the keloid scarring is early, I feel that injections of steroid is the most appropriate way to prevent the keloid scar from getting larger and in most cases we can even shrink the early keloid scar so that it ultimately becomes soft and inconspicuous. If the keloid scar is on the earlobe we can also add a small pressure earring that can assist in preventing the keloid scar from forming or getting bigger. Other adjunctive measures, such as silicone sheeting or silicone gel, as well as aggressive massage can also help, but the injection of steroids is really the mainstay treatment for uncontrolled keloids. As a last ditch measure, in extreme circumstances, external radiation can actually be used for keloid scars.
Question: I would like shapelier lips without surgery. Are silicone injections the only option for lip augmentation?
Answer: No, silicone injections are not the only option for lip augmentation and in fact I would caution people against using silicone in the lips due to the fact that it does have a tendency over time to migrate into an area you may not desire and it can be very difficult to then remove. I do; however, recommend hyaluronic acid fillers, such as Juvederm and Restylane since these are relatively easy to inject, they are a soft, clear gel, we can customize the treatment to reshape lips into a very youthful and sexy shape and the results are relatively long lasting, at 6 to 12 months. These injections can be performed in as little as 15 minutes and with the lidocaine that is incorporated into these newer fillers, this procedure can be performed with little to no discomfort. Ultimately, I always suggest that patients seek out a well-qualified injector since I think most patients have seen the results of bad lip injections and certainly do not want to have that happen to them.
Question: I am 54, female, and I have extremely fine white hairs on my neck. Some get really long, over 2 inches. I would like to have laser hair removal of these fine hairs. Can this be accomplished in 1 day or does this type of hair removal require more visits?
Answer: Any type of hair removal cannot be performed in a single visit since hairs grow in various stages and only during the hair’s growth phase is it susceptible to injury by a laser hair reduction system. With that said, white hairs are extraordinarily difficulty to eradicate due to the fact that they do not have any pigment in them and this is what most of the laser hair removal devices target. There are possibilities with the YAG laser to reduce light-colored hair or in your particular circumstance I might even recommend electrolysis. Darker-colored hairs; however, are typically treated very successfully with laser hair removal systems.
Question: Are there any fillers that provide permanent or longer lasting results and what can they be used for?
Answer: Historically, there were permanent fillers available in the United States under the name of ArteFill and I believe these are coming back out once again at the time of this blog. These are made of methylmethacrylate, which is a similar chemical to superglue and it is an extremely small bead-like spheres that are in gel matrix that can be injected into lines and folds. Other possible permanent fillers are injectable silicone, which is not FDA approved for injection in the face, but can be used off label for this purpose. My personal philosophy with permanent fillers is that I try to avoid them at virtually all costs due to the fact that they are truly, literally permanent. What I mean is that they do not just last 10 or 20 years, these products last for the rest of the patient’s life. I certainly do not know what some of my patients are going to look 40 years or 50 years from now and I therefore do not want to place a filler that will still be present that many years from now. It would be great is the filler was available that could last for around 5 years and there certainly is one, called Sculptra, that can do this, though the only drawback I see with Sculptra is that you rely on the patient’s inflammatory response to give the volumetric enhancement and you therefore cannot use it like the other fillers where you see what you get immediately. I think Sculptra is great for overall volumetric enhancement of the cheeks, but I personally would use it cautiously in other areas of the face. Otherwise, for the cost, ease of use, safety, and efficacy, I feel that the hyaluronic acid fillers are by far and away the best fillers at this time.
Question: I have heard some fillers like Radiesse, can cause lumps in the treatment area. How can this be avoided?
Answer: I personally have definitely seen lumps from Radiesse injections and this is usually when we are trying to fill a relatively small crease or wrinkle and we are placing the filler in the actual dermis of the skin. Occasionally we may hit a hair follicle or a sebaceous gland and some of the filler then tends to try to go up towards the surface of the skin. This can lead to a very small, sometimes red nodule that essentially needs to be expressed for it to resolve. This can be avoided by using the Radiesse for deeper folds or for volumetric enhancement of the face where the filler can be placed quite deep in the soft tissue and the risks of having any of these nodules is virtually eliminated. I would then use a hyaluronic acid filler for the smaller lines and folds since the risks of these nodules is extremely small with this type of filler material.
Question: What are some of the risks associated with getting either Botox or Dysport?
Answer: In essence, there are 3 things that can happen with the use of Botox or Dysport. One, is the injection is placed in an area where there is no muscle and therefore there is really no effectiveness to the treatment. The second is that it can be placed into the muscle that we desire to relax and they can get an excellent result. The third is that some of the Botox or Dysport can either be injected into or leach into a surrounding muscle, which is not intended to be relaxed and this can therefore give a side effect, such as a droopy eyelid. Otherwise, there is some remote risks of injection site irritations and bruising, but overall in well experienced hands, both Botox and Dysport have an extremely small risk of any sort of complication.
Question: Who do you recommend to have a chemical peel? I have a lot of fine wrinkles around my mouth and a few new age spots I would like to remove. I am 48 years old, male, and a smoker.
Answer: Virtually anyone with a skin condition can be a good candidate for a chemical peel, as long as they do not have acute inflammation in the skin or any signs of infection. There are; however, countless varieties of different chemical peels and these can therefore be customized for each individual’s needs and desires. I will mention that in order to get significant visible wrinkle reduction, you have to go to some pretty powerful chemical peels and the lighter peels are really a waste of time if your goal is wrinkle reduction. For dark spots, many different chemical peels can do a wonderful job of helping with pigmentation and textural irregularities and ultimately I always recommend patients seek out an experienced provider that is comfortable using a variety of different methods to achieve your specific goal.
Question: I am in my 20s and have exceptionally terrible acne scarring from my teen years. Will a scar revision procedure eliminate or help to reduce their appearance?
Answer: I would have to personally evaluate your acne scarring to determine what procedure would be best for you, but for certain individuals a scar revision surgery would be appropriate if the acne scarring is exceptionally deep. This will only improve the area so that other adjunctive procedures, such as ProFractional laser resurfacing can be used to further improve the appearance of the acne scarring. Most of my patients have acne scarring that is not significant to warrant any sort of surgical intervention and therefore most of my patients we simply treat with the ProFractional laser, spacing treatments about a month apart and performing a series of 3 treatments. We allow this to then heal and the far majority of patients get a very significant improvement in their acne scarring, though I do caution patients that they cannot expect the acne scarring to be completely gone, but rather our end goal is a significant improvement of somewhere between 50% and 80%. If they would be happy with this, then more than likely they will be extremely happy with the results that we can achieve.
Question: My sister recently had a microdermabrasion treatment which caused her face to look red, blotchy, and dry. Are these side effects common in patients?
Answer: Most patients that get a microdermabrasion have a very subtle pinkness to their skin and otherwise have a very refreshed glow, but certainly no red blotches or significant dryness. I question whether the microdermabrasion may have been performed too deeply and caused irritation to the skin or your sister may have had a skin condition that was unrecognized that created more blotchiness due to the irritation of the microdermabrasion. It is obviously very important to seek out someone well trained in microdermabrasion with the vast experience treating various skin types so that some of these issues do not occur.