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Filed under: Hyperpigmentation,Skin Resurfacing — Dr. Andrew Campbell

Question: I have got very bad spotting and sun damage on my decollete (I am a 41-year-old woman.) It makes me look a lot older than I am. I have heard that laser peels can be used to treat sun damage on the face. Could a laser peel also treat sun damage of the decollete?

Answer: The short answer to that question is yes, a laser peel can definitely be used to treat the decollete area, but we need to be extremely careful in this area and it is not typically done with standard lasers. Standard lasers injure 100% of the surface of the skin and we can do this in a very light fashion across the decollete area, but it would not be as effective as if we could go deep, which we cannot in that area.

The face can be treated very aggressively with laser peels due to the fact there are numerous sebaceous glands, sweat glands, and hair follicles spaced very close together on the face and this helps the area heal extremely quickly.

The chest area has the same skin structures, but they are spaced far enough apart that if we ended up treating that area with a deep laser peel, it would not be able to heal before scarring would occur.

An exciting relatively new technology allows us to treat areas like the decollete area in a very successful manner. This is where the laser is fractionated or separated into small tunnels of injury that are spaced far enough apart that we leave normal skin between these small tunnels of injury. At Quintessa Medical Spa, we personally use the ProFractional laser by Sciton and have been able to treat sun damage to the decollete area extremely effectively with this device. There are only a few days where the skin is irritated and possibly oozing and we do typically recommend a series of three treatments spaced approximately one month apart, but we can do a wonderful job of getting rid of the unsightly pigmented lesions as well as improving some of the textural qualities of the decollete area.

An exciting new technology called Ultherapy is an ultrasound based device that we have used in the decollete area to cause tightening of the tissue and we have seen some rather significant wrinkle reduction in this area with the use of this device. Currently we are exploring the use of both Ultherapy and ProFractional laser peels concurrently to not only treat the overlying skin, but also improve upon the integrity of the deeper tissues in hopes of providing an extreme rejuvenation to this otherwise difficult to treat area.

Filed under: Hyperpigmentation,Skin Resurfacing — Dr. Andrew Campbell

Question: I am an elderly Asian male with very blotchy skin. I would like to get this taken care of and thought microdermabrasion could be a potential solution. Any advice on the subject?

Answer: Microdermabrasion alone will most likely do very little to improve upon your skin discolorations, but I certainly feel that microdermabrasion can be part of a treatment plan that will overall greatly improve the quality of your skin, but this would also need to involve good skin care, excellent sun protection, and consideration of various other light and/or laser treatments.

Microdermabrasion gets rid of the dead superficial layer of skin, which then allows products to penetrate better and even some of the laser treatment to be more efficacious. That is why I feel that it could certainly be part of a treatment plan, but in and of itself would only provide small amounts of improvement in your overall skin quality. I would recommend that you seek out someone who is experienced in treating Asian skin and has multiple different modalities available to treat your concerns so that your expectations can be met and your outcomes maximized.

Filed under: Chemical Peel,Hyperpigmentation,Laser Resurfacing — Dr. Andrew Campbell

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? 

 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.

As far as I know, virtually all photorejuvenation laser systems use some form of intense pulsed light. Intense pulsed light has been around for many years, but they have made some significant improvements in the technology, specifically the BBL System by Sciton, which stands for broadband light, seems to be distinctly superior over our previous technology of intense pulsed light in that it has a significant amount of “punch.” In essence, the broadband light seems to be much more efficient at treating vascular and pigmented lesions and we therefore tend to turn down the power setting quite a bit compared to our prior intense pulsed light technology. This allows us to treat in a much safer and more comfortable manner and yet we end up getting superior results when compared to intense pulsed light. We have had several employees that have extensive experience with intense pulsed light in the past and now have been trained on our new broadband light or BBL technology. These employees have been extremely impressed with the BBL therapy as it seems to provide a more efficacious treatment with less discomfort and less risk of any complications. At Quintessa Medical Spa we will frequently combine BBL technology with other laser systems such as the ProFractional laser and/or micro laser peels to not only rid our patients of unwanted pigment and vascularity, but also to improve their overall skin texture and provide for wrinkle reduction.

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.