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Q: I have one deep lip line due (I think) to facial trama. I know there have been "filler" procedures available in Europe & have been waiting for their use in the US. Is Restlylane such? Posted on 10/22/2003

A: Restylane is a wrinkle filler derived from hyaluronic acid. It is a non-animal derived, natural substance that is specifically designed for reducing wrinkles and facial folds, enhancing facial contours and scultping lips. Unlike other substances, it does not require a skin test and injection-related adverse reactions are extrememly rare. Results are immediate and may last 4-12 months.

Restylane is widely available in Europe, Canada and Latin America where it has enjoyed tremendous popularity. Currently, in the United States, it has had limited use.

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Q: Dear Dr. Mafong, Hello, how are you? I am a patient of Dr. Cole Willoughby and saw him a few weeks ago for a growth on my eyelid he removed. I also purchased a product M.D. Forte facial cream. I used it twice both times after using my own soap free facial cleanser and it itched and burned. The sample for the serum for my eyes also reacted in the same manner as did the sample of the facial cleanser. My mother who happened to be visiting used the facial cream only and didn't have the reaction I had, it appeared to work well for her. I am assuming this reaction I had means these products aren't for me? The sample of the sun screen SkinCeuticals did work well for both my mother who is in her 70's and for myself aged 46. There was no skin irritation, burning or itching with this item.
Your feed back in this matter would be greatly appreciated.

Patty Sherman


Posted on 12/12/2003

A: Dear Ms. Sherman,

I am sorry to hear that the MD Forte facial cream resulted in an adverse reaction on your skin.

As with any skin care product that causes irritiation, we recommend that you discontinue its use, at least temporarily. The facial cream uses glycolic acid (an alpha-hydroxy acid) to effect a gentle daily exfoliation of the skin, that over time helps to impart a healthy, vibrant quality to the skin. It does take some getting used to the product and many people find that they have to ease into the regimen. Please let us know if it continues to be a problem.

Any product placed over irritated skin may cause burning. Again, we recommend that you discontinue use of the eye serum until the skin has an opportunity to recover. Usually 2-3 days.

I am glad to hear that you have had success with the SkinCeauticals sunscreen. It is one of the finer products available.

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Q: I'm a 21 male. I've been in and out of the hospital for 2 months now. That means I was under medications such as vicodine, morhpin, and other pain killers because I had chest tubes and surgery. I've never really had skin problems but ever since I came out, I have dry skin, acne, etc. When I go out in the sun, my skin gets irritating, not so much now. This irritation also occurs when I eat spicy food. I'm sure this is because of the toxins. Is there any way to return to normal quicker? Posted on 12/12/2003

A: It sounds like you are recovering from a significant medical condition.

Please note that it is difficult to fully assess and evaluate a skin condition without a clinic exam, but here are a few thoughts...

It is not uncommon for the skin to become neglected during an extended hospital stay. This may be manifested as dry skin, folliculitis and subsequent skin irritation and inflammation.

Any activity that increases the bloodflow to the skin (ie sun exposure or eating spicy food) can exacerbate the symptoms of irritated skin.

We like to recommend our patients to utilize a high quality moisturizing cream, applied once or twice a day to help the skin and regain its functional vitality.

Good luck with your recovery.

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Q: I have substantial acne scarring and I am looking for a procedure that might improve the appearance of my skin. I am in the military so I am looking for a cost effective treatment as well. Thank you very much. Posted on 01/02/2004

A: Acne scarring is a common problem and consists of a variety of characteristics. This includes alteration of the skin's appearance in that ranges from atrophic, depressed scars, "ice-pick" scarring, and keloids to discoloration in the form of redness, hyperpigmentation, or hypopigmentation.

The best treatment is prevention. Any active acne should be addressed first.

Acne scarring is a difficult condition to treat but there are several options. This depends on the kind of scarring that is present.

Chemical peels and microdermabrasion can help with the discoloration. Additionally, peels help the skin look and feel smoother. However, they DO NOT remove the scars. Generally, several treatments are required to achieve the optimal result.

Lasers can be helpful in the management of acne scars. Laser resurfacing with the CO2 laser can help reduce the appearance of acne scarring. It is one of the gold standard treatments for severe acne scarring. This procedure is more invasive and does require some recovery time.

The recent advances in "non-ablative" laser treatments continue to be developed and may offer an alternative to resurfacing. The results tend to vary and can be somewhat subtle and inconsistent. These treatments may be an option for certain individuals.

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Q: I am turning 30 on Friday and have wrinkles around my mouth that look like smoker's lines, however, I've never smoked! My skin is fair and dry. I think plastic surgery at this time is a bit severe...is there anything topical I can use to reduce/eliminate these lines. Also, how about the ones below my eyes (not crow's feet, just fine lines)? Or, would you recommend peels?
Posted on 01/22/2004

A: Happy Birthday! The fact that you have never smoked benefits not only your overall health but also the health and appearance of your skin.

Lines around the mouth (periorbital radial lines)are not necessarily associated only with smokers. These lines can become more pronounced in smokers due to the premature aging effect of smoking as well as the constant pursing motion of the muscles around the mouth. Periorbital lines are largely a function of dynamic muscle movement and elimination of muscle movement in this area, unfortunately, is not a practical solution.

A variety of treatments are available for the treatment of fine lines around the mouth. These include wrinkle fillers such as collagen and restylane which serve to plump up the skin locally. Laser resurfacing using the C02 and/or the erbium laser can have a dramatic difference in lessening the appearance of the lines. Resurfacing does wound the skin and requires minor wound care and healing time. Considering that your skin is fair, laser resurfacing may be an option for you. Microdermabrasions and certain moderate superficial chemical peels can make the skin look and feel smoother but do little to address the actual wrinkles. Usually a series of about 4-5 treatments yield better results.

Topically, the options include certain prescription and specialty products (eg. retin-A, retinol, Vit C) that can encourage the skin to attain a healthier appearance and texture. Again, these treatments can lessen the appearance of the lines but do not eliminate them.

The same general principles apply to the the fine lines around the eyes.

Overall, the right treatment for you depends upon the characteristics of the fine lines and the degree to which you are willing to go to improve them. The best treatment is one that is tailored specifically for you.

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Q: I am in the military and looking for a cost effective treatment which is applicable for me. I have deep scars from acne. I am looking for a procedure which will improve the appearance of my skin and smoothen my face. How many days should I allow for the healing. Please advise. Posted on 01/22/2004

A: Please see the previous question on acne scarring. It is very similar to the question that you asked.

The number days for healing depends on the procedure. For Laser resurfacing used for acne scarring, you can expect about 7 to 10 days of dressing changes and wound care. After this time period it is possible to resume normal daily activities. The redness tends to fade over 4-6 weeks. Improvement in the acne scars tends to be almost immediate.

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Q: do you provide the TCA-CROSS method of chemical peeling?

also, how much would you expect a sequence of spot treated 35%TCA on shallow acne scars help? Posted on 01/29/2004

A: TCA-CROSS (chemical reconstruction of skin scars) chemical peels is a procedure by which scars are individually treated with extrememly high concentrations of tri-chloroacetic acid. The individual scars are treated while uninvolved skin is spared.

Our office offers a variety of treatment options for improvement of acne scars including Jessner's chemical peels, punch grafting, scar elevation, subscision, and laser resurfacing. Each treatment has certain advantages and when used appropriately, may lead to marked improvement.

Specifically, TCA-CROSS method of chemical peeling is not one of the first-line acne scar treatments offered at our office due to the success and safety of the other treatments available.

Responses to any treatment is variable and many factors come into play, including type of acne scars and patient skin type. Also, it is important to understand that everyone is different and it is not always possible to accurately predict or qunatify the degree of improvement in acne scars for a given individual.

In general terms, some patients may experience up to 30% to 70% improvement in the acne scars with the treatments available.

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Q: I would like to know some information about a new procedure called Thermacool. If you practice it, and what are the benefits and riks of such precedure. Posted on 02/04/2004

A: Thermacool is a radiofrequency device that has recently been promoted as a method to tighten skin. Targetted areas include the eyebrows, jowls, laugh lines, forehead, marionette lines, and neck. It uses electric current and the resident resistance properties of the surrounding tissue to produce sustained heating of those tissues.

I have participated in the early studies of such a radiofrequency device. The results varied by individual but some patients did experience some degree of skin tightening.

An advantage to this treatment is that itis a relatively non-invasive alternative. Treatments can be accomplished in an office visit.

Some patients may experience moderate discomfort during the treatments despite topical/local anesthesia. Results are delayed and may take several months to manifest themselves. Additionally, the effect varies and can be subtle. Consult with the treating physician for further details regarding risks and adeverse events.

Our office currently does not utilize a radiofrequency device based upon our experience and our interpretation of the available information. This is a relatively new technology that continues to be improved and may very well have an important role in the future.

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Q: What do you think of Restylane?? In your studies/practice does it seem to work? Is it something that is noticible after it is done, and you need recovery time for it to "settle"? Can you provide a ballpark figure for the cost of the "marionette" lines?? thanks!! Posted on 02/21/2004

A: Restylane is an excellent wrinkle filler and recently approved by the FDA in 2003 for use in the United States. It has an excellent saftey profile and does NOT require any skin testing prior to use.

Our experience with Restylane is extremmely favorable and it has largely become one of the more popular wrinkle filler procedures administered in our office.

Results are immediate with little or no down time. Patients may return to their daily activities later the same day. Occaisionally, patients may experience temporary swelling, redness, or brusing.

The response to Restylane has been overwhelmingly positive and our office has a great deal of experience with its use.

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Q: I am concerned about the premature aging of my skin. My skin is dry, fair, and lacks elasticity. I am close to 40 years old and have deep wrinkles around my eyes, mouth and neck. In addition my eyes are sagging giving me a tired appearance always. I am seriously considering plastic surgery, not only for my face, but for my abdomen, which was heavily scarred in the area above the belly button after two pregnancies (c-sections). In the meantime, I am applying a product called StriVectin-SD (Striadril) to the stretch marks on my stomach as well as the wrinkles on my face. I would like to know if this product is indeed as efficient as it is marketed or if I am wasting my time. What is your suggestion? Posted on 02/22/2004

A: Several options exist to address the issues that you mentioned. Surgical and non-surgical procedures (ie. laser, skin treatment regimens) are alternatives that you may want to consider.

At our office we make our recommendations based upon well established experience and knowledge, supported by research in reputable peer-reviewed journals in the medical literature.

The product that you have mentioned has featured prominently in many magazines and has been aggressively marketed. Claims of benefit are supported by the company's own funded research.

To our knowledge, few if any independent definitive studies have been done. Due to the lack of objective data and information we are unable to confirm any of the claims made by the company regarding their product.

It is our experience that any product or agent that has an important role in the maintenance of skin health and beauty will also have a vast amount of well designed clinical research to support its use. Take for example products such as Retin-A, Vitamin C, and Botox. These products all benefit from elaborate studies, independently demonstrating safety and efficacy.

We would expect any future products to follow suit accordingly. It may be that such information is forthcoming.

Overall, we would presume that there is little risk in using such products; only time, expense, possible lack of efficacy, and the rare allergic skin reaction.

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Q: I was wondering if there was a way to lighten or some how "erase" some freckles that I have.I am 22 years old and I have nice skin, no acne but over the years I have developed some dark freckles. I have very fair skin and people always ask me if they are moles because they are dark. I have been trying to see what options I have, and so far I keep hearing of chemical peels. It doesn't sound like something I would need since I only have a few of them and they are not all over my face. I wanted to know if there was any other way to get rid of them? Posted on 02/27/2004

A: Many different treatment options exist for brown spots, freckles, and hyperpigmentation. These include lasers, bleaching agents, certain chemical peels, and surgical procedures.

Not every treatment option is appropriate for every kind of lesion. A freckle and lentigo are treated differently than melasma, post-inflammatory hyperpigmentation, nevi, birthmarks or even melanoma. All of which can look like a brown spot or "freckle". Incorrect treatment may not be effective, delay treatment or even worsen the condition. Therefore, it is extremely important that the correct diagnosis is made by a qualified provider prior to having the lesion treated. When and if the lesion is treated, we recommend that it is done specifically by a physician or under the direct supervision of a physician.

A chemical peel is unlikely to be highly effective for the lesions that you describe as appearing like "moles because they are dark." While useful for large areas of faint to light hyperpigmentation, a chemical peel in our office is not used to treat darker, distinct lesions.

Typically, such lesions may respond to laser or other surgical options. Again, depending upon the diagnosis.

One last note. It is a good idea to have newly developed pigmented lesions evaluated by a medical professional, particularly for fair-skinned individuals. Most of the time the lesions turn out to be benign but early detection is key.

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Q: I have had these flesh colored bumps under my eyes for 20 years and they have never gone away. I just went to a dermatologist and I believe he said they were called syringoma and there really isn't much that I could do about them. I'm so embarassed about these bumps that I don't like when people stand to close to me, especially in the sun. I heard that laser treatment may or may not work. Do you have any treatments that can take care of this problem? Posted on 03/05/2004

A: Syrigomas can appear as skin-colored papules or bumps in the area around the eyes. Generally they are 1-2 mm in diameter. These lesions are derived from glandular components in the skin and are mainly of a cosmetic concern.

In our office we utilize a variety of different treatment options to either remove or improve the appearance of these lesions. It depends on the size, number, and type of skin that is being treated.

In many cases, an Erbium:YAG laser can make a nice difference and minimize their appearance.

As with any procedure, the right diagnosis, expertise, and post-treatment care are the keys to success.

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Q: I am a 27 year old male i am considering surgery for acne scarring (pitts)i am a little confused on the diffrent procedures and am a little scared because i don't know what to expect. could you tell me the down time for the punch and other procedures that are similar, or other procedures that you may know will work also a general price range for these procedures . when i was in high school, i have a school picture i had beautiful skin . after the tenth grade i had really really bad acne .i am a licensed cosmetologist and learned about the layers of the skin and the effects of acne in the textbooks . i have been working on my skin for the last 2 years by cleansing ,exfoliation , and toning and using alpha lipoic acid serum because i have read the healing properties of this serum to help the healing process of the skin i have seen an improvement but the deep scars are still visible . i want to have the same beutiful skin i had before my tenth grade year. please give me some information on what i need to know about skin surgery and procedures . thank you, david Posted on 04/28/2004

A: Acne scarring can be an extremely challenging condition to treat. Unfortunately, no single universal or perfect treatment exists than can completely restore the skin completely to its pre-acne condition. A variety of different options do exist to help improve the scarring.

It is good to hear that you have been able to improve the condition of skin with the current regimen that you are using.

The deeper scars may require more invasive or extensive procedures to effect an improvement in the appearance of the skin. The down time depends on the treatment rendered and the healing of the individual. As you know, everyone is different. You can expect in general, approximately 5-7 days of healing with punch grafts and scar revisions. With Laser resurfacing, the down time is about 7-10 days.

Please refer to Acne scarring questions and answers posted on the "Ask the Experts" page on the following dates:

1/02/2004
1/22/2004
1/29/2004

The information in those responses may be useful regarding acne surgery treatment.

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Q: I'm an African American woman with fair to medium skin color. I have minor ance but alot of dark spots on my face. I have used various skin bleaching cremes, creams that contained Retin-A, and alot of facial products that did not help. Several months ago I had a glycolic peels that seemed to lighten the spots, but I experienced burning to my face. I would really like to have clear skin clearer but getting depressed about all of the treatments I have that have not worked. I heard about this laser procedure called photofacial that could possibly. Do you think this type of treatment or would you suggest another type of treatment that help with my problem? Posted on 05/08/2004

A: Much of the success or failure of different treatments depends upon the type of "dark spots." Bleaching creams may be useful for hyperpigmentation due to melasma and some sun-induced lesions. Retin-A may be useful in that regard also. Chemical peels help to even out skin tone.

I am not sure what exact procedure you referring to when you mention "photofacial" because the term "photofacial" is generally associated with an intense pulsed light (IPL) system that is NOT considered a laser. Technically, it is a light source. It has been our experience based on feedback from patients and other practitioners that such treatments can be somewhat helpful but often lacking in complete success. Our office has chosen not to employ an IPL device. Instead, we utilize a full array of state-of-the-art lasers, tuned to the specific condition that we are aiming to treat.

It is important to keep in mind that not all people respond the same way to a given treatment. Various factors come into play such as type of lesion, skin color, and post-procedural instructions. That is why it is essential that a qualified, trained and experienced professional is administering your care directly.

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Q: I am a 28 year old woman who has been suffering from Melasma for 5 years now......Is there anything that can get rid of this condition once and for all? I have tried hydroquinoin creams, tca peels and scrubs to exfoliate but after everything I try it comes back worse...I wear spf50 sunscreen everyday, i dont take birth control anymore and I amm siick and tired of caking on foundation to try to hide this awful curse....One thing I haven't tried is lasers. I heard that lasers will make it worse? Can you give me some sort of direction pleeeeaaaase. Posted on 07/11/2004

A: Melasma, a condition characterized by hyperpigmentation of sun-exposed areas usually on the face, can be a difficult and frustrating condition to treat. As you may already know, melasma is commonly attributed to the combination of hormones and sun-exposure. Melasma occurs in many normal individudals or may occur during pregnancy or in people taking birth control medications.

Generally, Melasma may improved if appropriate treatments and strict sun avoidance is maintained (use of hat and/or effective sunscreens). Hydroquinone creams available by prescription are helpful but may require several months to effect a noticeable improvement. Additionally, chemical peels may also be helpful in improving the appearance of the affected area. These have to be repeated periodically to be effective.

Generally speaking, laser treatment of melasma is not widely successful. You are correct in being concerned that inapproriate treatments can make the condition worse. In our office, laser treatments for melasma are not a first line alternative.

It is our experience that the best results come from combining a variety of treatment modalities, aimed at lessening the hyperpigmentation. This is accomplished with the use of a customized prescription strength compound of hydroquinone and other ingredients, a sunscreen with a physical barrier, strict adherence to sun avoidance, and periodic chemical peels. We find that these options used together yield better results than any one of them used separately.

With appropriate treatments and some patience, melasma can be remarkably improved.

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Q: I am a 32 year old African American women with deep wrinkles under my eyes from stretching the skin are there any procedures out there that could help me get rid of the wrinkles? I look ten years older than my actual age. I am desperate. Posted on 07/11/2004

A: Wrinkles and lines around the eyes can be due to a variety of reasons. These may include the underlying hydration status of the skin, muscle movement creating the lines, or protruberances of the local fat pads to name a few. Treatment is directed toward the cause of the lines.

It is always important to try and maintain the good health and condition of the skin around the eyes. This can be accomplished with a variety of prescription and non-prescription topical products.

Botox injections may be useful in softening the lines and "opening" up the appearance of the eye. Especially for lines that have a strong muscular or dynamic component.

Additionally, lax or loose skin around the eye can be improved with certain laser procedures. Great care must be taken to avoid any pigmentary alterations, particularly in individuals with darker skin.

In the case of "bags" under the eyes, a surgical procedure may be helpful in removing a certain portion of the fat around the eyes, restoring a more well-rested appearance.

As always, any treatment should be uniquely tailored to the individual and complete consideration of the risks, benefits, expectations and alternatives should be discussed.

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Q: Do you provide treatment with Relume? I'm looking to get rid of stretch marks. I was told by someone at a clinic, that basically there is no solution for mature "white/silvery" marks. Lastly, do you necessarily have to be a doctor to do Relume treatments? Posted on 07/18/2004

A: Striae or "stretch marks" can be the result of rapid stetching or expansion of the skin in certain areas. Conditions such pregnancy, rapid growth or change in weight may lead to the development of striae.

Early striae can be red and sometimes pruritic. Overtime, these lesions tend to become hypopigmented or lighter in color than the surrounding, unaffected skin.

Laser treatments may have some success in treating striae during the red or early phase; although complete resolution is unlikely despite early treatment.

Older lesions, in our experience, are less likely to respond despite a vast array of treatments. Including topical and laser/light treatments.

It is highly recommended that anyone undergoing treatment with a laser, light source, or similar medical device have an evaluation by a medical professional with experience and training to make the diagnosis and appropriate recommendations. Medical devices should always be performed either by a physician or under the DIRECT supervision of a physician. Patients should not accept anything but the highest level of care.

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Q: I have dark under-eye circles and am starting to get bags under my eyes. I am also getting jowels. What can be done to improve these? Posted on 07/18/2004

A: Dark cirlces under the eyes can be due to several causes. The most common being hyperpigmentation and vascular congestion in the blood vessels located in the region.

Hyperpigmentation is generally a hereditary trait. Occasionally bleaching agents may be helpful.

Vascular congestions in the area may be due to lack of sleep or allergic conditions. Improvement in the underlying causes may be useful in decreasing the congestion.

Classcially, jowels can be improved with a face-lift.

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Q: I was curious to know as to what I can do to get rid of bags under my eyes. I spoke once with a dermatologist and he said they were hereditary. I also want to know about varicose veins. My wife is pregnant and her veins on her left leg have swelled so much that she has 2 inch and a half clots. Posted on 07/18/2004

A: Bags under the eyes may be due to prominence of fat pads located immediately around the eye. The bags can become more prominent with time and can be hereditary. That is not to say, nothing can be done about them.

A bleapharoplasty is a specialized surgical procedure that can improve the appearance of the "bags" by trimming excess tissue in the area.

Varicose veins are common during pregnancy. Many resolve after delivery of the baby. In the meantime, the mainstays of conservative treatment include leg elevation and compression stockings to provide support. Please consult with your Obstetrician prior to undergoing any treatment during pregnancy.

Varicose veins in non-pregnant patients can be treated with a combination of the above as well as injections, lasers and surgery.

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Q: I have facial blushing which sometimes burns like a sunburn, anything sets it off: laughing, stress, heat and certain foods. I also have acne, but not the sort of acne that comes with rosacea (I have been told by a dermatologist that I don't have rosacea). I am in my 30's, this all started happening in my early 20's. I also suffer from extreme oilyness on my face. Is there anything that may help? Posted on 09/08/2004

A: The signs and symptoms that you describe, facial blushing, acneiform/acne-like lesions, and oily skin are conditions that are commonly found in people with roscea. You may or may not have rosacea but it is not possible to make a diagnosis at this time.

It is important to understand that rosacea consists of a spectrum symptoms, including the ones mentioned above.

It sounds as though the facial blushing is a major component of your symptomatology. Many different treatments are available including topical and oral therapy. Sometimes, laser treatments may be helpful particularly in addressing the persistently dilated blood vessels present near the surface. Lifestyle modification to avoid exacerbating factors are useful too. However, keep in mind that often times it is not possible to completely eliminate the condition but it can be managed through various treatments recommended by a health care professional.

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Q: what do u think of using the mohs precedure on the scalp? (for pigmented basal cell of the scalp -3mm) Posted on 09/08/2004

A: Mohs micrographic surgery is an advanced procedure usually indicated for squamous cell carcinomas and basal cell carcinomas. Ideally, it should be performed by a formally (fellowship-trained) trained Mohs Micrographic Surgeon. Occaisionally, Mohs surgery is performed for other kinds of skin cancer at the discretion of the physician.

Mohs surgery is a tissue sparing technique that allows the surgeon to remove the existing cancer while removing the least amount of healthy tissue. The mohs surgeon uses a microscope to look at the removed skin to make sure that cancer does not remain. This process may take several stages or "levels" to complete.

Additionally, Mohs surgery has one of the highest cure rates of the treatments available. Some studies have demonstrated a recurrence rate of less than 1%.

Mohs surgery is recommended under the following circumstances:

1. Any place where tissue preservation is important. Such as the head, face, ears, hands and even lower leg area. For the scalp, Mohs surgery is helpful to maintiain a smaller wound and allowing for a simple closure with less complications.

2. Recurrent squmaous cell carcinoma and basal cell carcinomas should be considered for Mohs surgery.

3. Larger lesions (usually greater than 2 cm) located anywhere on the body should can also be considered for Mohs surgery.

In general, Mohs micrographic surgery is an excellent treatment option for a pigmented basal cell carcinoma located on the scalp (regardless of size). It will offer an extremely high cure rate with the least aggressive surgical excision. As always, a proper evaluation and review of the treatment plan and options should be discussed thoroughly with the treating physician prior to initiating any treatment.

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Q: I'm a 30 yr. old female with very fair skin. When I was 18 I got a tattoo that I'm considering having removed. The tattoo is mostly red & green (rose). What is the process to have it removed? What is the likelyhood of scaring? What sort of costs would be involved? Posted on 09/09/2004

A: Tattoos can be removed by a variety of methods. In our experience, the best results of tattoo removal have been with the use of lasers (Q-switched type). Some lasers had been limited for use in lighter skin types, but other Q-switched lasers have been developed to allow treatment of all skin types; therefore skin color is no longer an obstacle for tattoo removal. At this time we do not recommend skin-grafting, intense-pulse-light treatments, or traditional dermabrasion as first-line treatment for tattoo removal in our office.

Generally, tattoo treatments involve multiple treatments to obtain the best results, with each treatment optimally being a month apart to allow healing and dispersion of the tattoo pigments. It is impossible to give a reliable estimate as to how many treatments will be necessary as everyone responds differently to laser tattoo treatment based on a variety of factors (range between 1 to 10 treatments). Some of these factors include:

1. Type of Tattoo (professional vs amateur, amount of ink used etc.)
2. Color
3. Age of the tattoo

Amateur and older tattoos typically respond better to laser removal than recently, multi-colored, professionally placed tattoos. The latter may require additional treatments. Green pigments tend to be one of the more stubborn colors to treat but do respond to some degree. Red pigments tend to respond well but require a specific laser wavelength. Black pigments responds the best to laser treatment.

As with any procedure, certain risks exist with each treatment. They include but are not limited to temporary pigmentary changes in the skin (hyperpigmentation or hypopigmentation), infection, and scarring. Fortunately, complications resulting from laser tattoo removal are uncommon when performed by an experienced physician and rarely result in long-term effects.

Treatment with the laser tattoo involes tracing the tattoo with the laser. This leads to the formation of a thin white crust over the treated area immediately following and some pinpoint bleeding. In our office local anesthesia is administered to the area prior to each treatment to increase the patient's comfort level. The treated area will then require some daily light wound care to prevent infection encourage healing. Typically the area is healed in about 8 to 12 days.

Cost of the procedure varies with the size and type of tattoo. Expect to spend about 5 to 10 times or more to remove the tattoo than it cost to have it put in your skin.

Overall, tattoo removal can be accomplished quite successfully with the appropriate laser treatments. The current state of technology allows for the treatment of a variety of different tattoo colors in a variety of skin types.

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Q: I would like to have a TCA peel but don't want to put up with the pain. Do you offer any solutions to reduce the pain with TCA? Posted on 09/09/2004

A: TCA or trichloroacetic acid peels are one of several types of chemical peels. The degree of pain or discomfort depends to a large degree on the concentration of the TCA peel.

Relatively low concentrations of TCA offer a superficial peel with mild discomfort generally well tolerated and offer a superficial peel. Only mild to moderate burning is experienced during the treatment and quickly subsides after neutralization of the acid.

Higher concentrations of TCA are associated with deeper exfoliation and higher risks of pigment alteration, scarring and pain. These TCA peels may even require sedation or even general anesthesia.

I am not sure what concentration of TCA you are referring to in your question but there are some general things that we have developed in our office to increase our patient's comfort level.

1. optimization of skin condition and health prior to the procedure. A pretreatment routine is recommended to ensure appropriate hydration and priming of the skin's healing mechanisms

2. Use of prophylactic medications to prevent infections and outbreaks such as staph or fever blisters.

3. Constant monitoring of skin reaction to TCA and immediately neutralization when clinical endpoints are reached (ie. frosting).

4. Occaisionally, local anesthesia may be used either in the form of a topical cream or by direct injections to the area.

In general, the lower concentrations of TCA peels are well tolerated and can effect in nice improvement in skin tone and texture.


The health of the skin is

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Q: I am pregnant and want to know what skin care products are safe for me to use. I normally have combination type skin but now am more oily than usual. Posted on 09/09/2004

A: Congratulations on your pregnancy.

It is not unusual to have a temporary change in your skin condition during pregnancy. This is a result of the many changes and adjustments ocurring throughout pregnancy. Including the change in hormone levels.

Generally speaking, most over-the-counter (OTC)products are safe to use during pregnancy but always check with your obstetrician or gynecologist before using any products or medications during your pregnancy.

Any mild cleanser can be helpful to reduce the accumulated oil on the skin. Examples include Cetaphil cleanser, neutrogena foaming facial cleanser, or the neutrogena clear bar.

I would recommend the avoidance of any OTC product containing retinol, benzoyl peroxide or any or the retinoid derivatives. Topical use of the retinoids may be of little or no harm but nonetheless, our office does not recommend their use during pregnancy.

Again, when in doubt please consult with your physician or obstetrician/gynecologist regarding the use of any medication during pregnancy.

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Q: I am 28 years old and I have been struggling with hyperpigmentation on my face left over from acne that has cleared up. I have been to a few dermatologists who have prescribed Hyroxyquinone 4% (Triluma, Glyquin) which I have been using for the past 4 months, with no results. Although I am Asian and I tend to tan easily, I have also been using appropriate sun protection daily. I've read a lot about laser treatment for hyperpigmentation. Is this procedure right for me? And if so, will it cost me a lot? Posted on 09/09/2004

A: Post-inflammatory hyperpigmentation due to acne scarring is a difficult problem to treat. The bleaching agents are useful for treatment of hyperpigmentation due to excess or abundant melanin production. For acne scars they may help a little. Hyperpigmentation due to acne is multi-factorial and unlikely to be caused solely by excess melanin.

More commonly, a portion of the darkness in acne scars may be due to other pigments left behind after the inflammation has dissipated. These pigments (hemosiderin) do not respond to hydroquinone and unfortunately neither respond to laser treatment in our experience.

You are on the right track in terms of using sun protection and hydroquninone. This will allow the hyperpigmentation to gradually improve over time and not worsen. The body will slowly clear the darkness from the area. This, however, may take several months to years to fully resolve.

Laser treatments in our experience have been all but disappointing for the treatment this kind of hyperpigmentation. I don't know that you will get the results that you are looking for from a laser treatment. Additionally, there is always the risk that the laser may make the condition worse.

Patience and time are your best allies.

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Q: Hi, i been trying to get rid of my acne pit scars on my cheeks for the last 5 years.. I have tried artecoll fillers 3 times, restalyn filler once, microdermabrasion a dozen times, overall i would say it helped maybe 20%-30%, What do you think would be the most cost effective and best results for my case? Im considering fat transplants,laser, or punch grafts.
Also how do i get a price quote for these procedures?

Thanks! - James
Posted on 09/21/2004

A: Acne scarring is one of the most common problems that we are asked to address.

Filler substances such as collagen and restylane may be helpful to address the space defect present in certain acne scars. Unfortunately, periodic retreatment may be necessary to maintain the desired effect.

Microdermabrasion is useful for improving the look and feel of the skin in a general manner. By itself, it is unlikely to change the nature of the condition but many people find microdermabrasion a useful adjunct to improve the tone and texture of their skin.

Fat transplants are similar to using filler substances. Some people have had slightly longer-lasting effects with autologous fat transfer. A large degree of individual variance exists.

Lasers are yet another option. Laser resurfacing and Non-ablative laster treatments have been used to improve the appearance of acne scars. Resurfacing can result in moderate improvement but does require significant "down time." Also, CO2 laser resurfacing is limited to individuals with lighter skin tones due to concerns about hyperpigmentation and hypopigmentation. Non-ablative lasers offer modest to subtle improvement and can be done with very little post-operative "down-time."

Punch grafts offer yet another individualized treatment option for acne scars and can be utilized for "boxcar" or depressed acne scars.

Any of the above treatments may be helpful to improve the appearance of acne scars. Many times, the best results are obtained when several treatments are done in combination with one another. It is important to note that acne scars may be improved with these treatments. The goal is NOT scar removal. That is not possible at this time.

The appropriate treatment will vary, obviously, from patient to patient. Our recommendation is for the patient to obtain an evaluation from the treating physician and after thorough discussion of goals, risks, benefits, alternatives etc. reach a REALISTIC treatment plan.

Acne scarring can be a challenging condition, but the availble treatments today can make a nice difference for many people.

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Q: I was aondering if you removed moles? And where your located. Please e-mail me asap! Thanks Posted on 09/29/2004

A: Our office performs mole removal and we are located in Chula Vista. Our address is on our web page.

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Q: Hi Doctor! I am a 25 year old lady with severe hypopigmentation all over my face due to laser resurfacing. IS getting micordermabrasions to even up my skin the wrong thing to do! i have heard of the new Relume Laser... have you heard about this@! I am in desperate need.Thanks so much! Posted on 10/02/2004

A: Although laser resurfacing is a safe and effective treatment for facial rejuvenation and acne scars, hypopigmentation can occaisionally result after ablative laser resurfacing (ie CO2 laser). It may occur months to years after the procedure and is somewhat correlated with the number of passes performed during the resurfacing. But it can also be unpredictable.

Microdermabrasions may help with slight color variation in the skin due to melasma, sun damage, or even post-inflammatory hyperpigmentation. However, microdermabrasion alone is unlikely to effect any major changes in skin tone or color, especially for hypopigmentation due to laser resurfacing.

Relume is a device that produces ultraviolet light energy. Early reports had raised hopes for this kind of technology to aiding various types of hypopigmenation since ultraviolet light therapy is useful for psoriasis, vitiligo, and several other dermatologic conditions. In our experience, laser ultraviolet treatments (like Relume, Excimer, ClearLight) may lead to a modest improvement of post-surgical hypopigmentation. Unfortunately, the effects may be transient and often require ongoing treatments to maintain the effect. Some have raised the concern about chronic exposure to ultraviolet light.

Overall, hypopigmentation arising from laser resurfacing is difficult problem to address. The perfect treatment for this condition continues to elude us at this time but many are working to find the answers. In the near future it is quite possible that there will be better alternatives for treatment.

Don't forget to wear sunscreen!

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Q: im 9 moths pregnant, i noticed that my neck,chest and underarm has a lot skin tag lately . is it normal? do u guys removed them? Posted on 10/02/2004

A: Congratulations on the pending blessed event.

Many skin changes occur throughout pregnancy as you may have already noticed. Examples include development of acne, skin darkening in certain areas, stretch marks and yes, development of skin tags.

It is not uncommon for pregnant mothers to notice an increase in the size and number of skin tags during this time. It is unclear exactly what the cause is since it is not seen in every expecting mother.

Some have postulated that it is due to hormone levels associated with the growth and development during pregnancy that encourage the growth of these skin tags. Heredity also may play a role.

Skin tags can easily be removed in a dermatologist's office with minimal discomfort and inconvenience. However, I would recommend that you wait until after the pregnancy to have the skin tags treated.

Again, best wishes for you and your family.

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Q: I would like to inquire about skin bleaching. My underarms turned dark after my pregnancy I would like to know if you do underarm bleaching and how much will it cost me. I also have a big birthmark on my inner thighs. Is there something that could be done about this? Please tell me how much will it cost Posted on 10/05/2004

A: Hyperpigmentation may commonly develop during pregnancy. It is thought to be due to the influence of the elevated hormonal state during this period.

Often times, the hyperpigmentation subsides post partum. This may take several months to years.

Sunavoidance is recommended to aid in the resolution of most transiently hyperpigmented areas. Occasionally the use of topical bleaching creams with various ingredients may be helpful to hasten the improvement.

With regard to the birthmark. It is difficult to give relevant information about treatment options without a proper evaluation as birthmarks comprise a broad category lesions.

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Q: I had a restalyn treatment two months ago.The restalyn has not filled in and lumps remain in theinjected areas. What would cause this and what is the solution Posted on 10/11/2004

A: Restylane is a non-animal stabilized hyaluronic acid (NASHA)gel that is used for tissue augmentation. Primarily of the lips, nasolabial folds and lower half of the face. Restylane does not require skin testing and has the further advantage of longer duration when compared to other similar products.

It is difficult to accurately comment on results from procedures NOT performed in our office as many factors may affect the outcome. Also, individual variances may occur.

In general, some lumpiness has been occaisionally observed in patients who received restylane. We have found that gentle massage of the areas can be helpful. Typically, Restylane is absorbed slowly over the course of several months. Persistent lumps or "pearls" may require further treatment.

Seek the guidance of your health care professional if you develop increasing pain, swelling, tenderness or redness of the area.

Restylane is considered one of the leading tissue augmentation materials by most cosemtic and aesthetically oriented medical offices. It has the advantage of a long record of safety and exceptional efficacy and convenience.

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Q: Why would bruises suddenly appear on the skin for no apparent reason? Posted on 10/12/2004

A: Bruises represent localized areas of typically small amounts of bleeding beneath the skin. This can be due to a variety of reasons. Most commonly bruises are due to minor trauma, often times these are imperceptible occurences from daily activities.

Certain medications, such as aspirin or blood thinners may make it more likely for brusing to occur in the skin. The extremities (arms and legs) are commonly affected. Women also tend to manifest bruising more commonly than men. Elderly patients tend to have more small vessel fragility and may also have a tendency to exhibit bruises due to minor trauma. In rare cases, bruising can be associated with a genetic condition or a vitamin deficiency. If one suspects either one of these conditions, consult your physician.

In general, bruises tend to resolve over a 5 to 10 day period and may exhibit color changes as the blood components in the skin are metabolized. Greens, reds and purples are common. Occaisionally, persistent brown or dark hyperpigmentation may be present that fades over the course of weeks to months.

Unfortunately, no laser treatment or cream exists that can reduce the healing time or prevent the development of bruises.

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Q: I have PIH from previous cystic pimples. The marks are not indented, just reddish/pink macules. How can I topically treat these to go away? I am scared to try laser, or anything abrasive. Please help! Posted on 10/21/2004

A: PIH or post-inflammatory hyperpigmentation generally tends to be brown or tan because as the name implies, it is due to pigment deposition as a result of inflammation. The discoloration may be due to melanin, hemosiderin (blood pigments) or both. The best treatment for PIH is sun avoidance and time. It tends to improve slowly. Occaisionally bleaching creams may be helpful.

Reddish pink macules occurring in areas of prior cystic acne lesions may be early scars. The color tends to also fade with time. But treatments exist that may help the appearance of these lesions.

Not all laser treatments are abrasive. In fact, the V-beam laser, a pulsed-dye laser, may be used to address the red color and may also be helpful for early acne scars. This laser does not injure skin; it specifically targets blood vessels, decreasing redness. This laser is generally well tolerated without the need for any form of anesthetic. People can return to work or their daily activities almost immediately.

Topically, options are somewhat limited. However, some prescription based creams may be helpful to improve the appearance of the skin while addressing any active acne issues.

Most importantly, any active acne should be addressed to prevent the development of any further discoloration.

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Q: I have vitiligo.....compeletly covering both hands, and alot on my right forearm and starting on my left. I have read that the Relume laser can greatly improve this condition. How successful have you found this treatment to be? Look forward to your reply...Thanks, Nancy Castle Posted on 10/21/2004

A: Vitiligo is a condition where the affected part of the skin loses its natural pigmentation imparting an ivory white appearance to the affected area. Treatments include topical corticosteroids, immune modulators, and phototherapy (ultraviolet light). Recently, several ultraviolet lasers have become available.

In our experience we have found that the ultraviolet lasers and light sources (eg. Excimer, Relume, ClearLight) can be helpful for treatment of vitiligo. They are not necessarily more effective than the other treatment alternatives, in our opinion. As with any treatment for vitiligo, ongoing response requires multiple treatments and adherence to a maintenance schedule.

Several recent reports have demonstrated efficacy of the use of ultraviolet lasers in combintation with topical treatments. Again, I would caution any patient that continued responses generally require sustained treatments.

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Q: Hello, I have moderately fair skin and have used tanning salons for several years. Recently I 've noticed that skin around one eye has thinned out and visable brusing / blood vessles is quite noticeable. It has been a few months with no signs of healing - is there a treatment?
Thanks Posted on 10/25/2004

A: Thin superficial blood vessels (telangiectasias), particularly red ones near the surface of the skin on the face can be treated successfully with the use of a vascular laser. Several treatments may be necessary.

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Q: Hello Doctor, I'm 42 and skin is sagging near the corners of my mouth. Someone told me fillers might work but it doesn't make much sense to me to put more flesh where it really shouldn't be. I can see that these folds might eventually become jowls. I don't want a full face lift because this is the only problem I have with my face. What do you suggest? Posted on 10/26/2004

A: Loss of volume at the corners of the mouth is a common theme and one has several alternatives to consider.

Fillers provide a manner to restore some of the lost volume. Choices include collagen, hyaluronic acid gels (eg. Restylane, Hylaform), and even autologous fat transfer. The degree to which the area can be corrected with fillers varies and depends on many individual factors. We advise our patients that at least some improvement can be accomplished, but at times an alternative procedure is recommended.

Typically Jowls and pronounced "marrionette lines" can be helped not only by fillers, but also with a face lift. This procedure addresses the issue of laxity that is causing the more advanced changes in the face.

Recently, much publicity has been given to the "non-surgical" options for a face lift. Results vary and may be somewhat unpredictable. Also, it may take several treatments and months to see any benefit, if at all. We currently recommend this procedure only to those wishing to absolutely minimize invasive treatments at all cost.

Remember, many choices are available. All have certain advantages and disadvantages to consider. Make an informed decision and assure that care is administered by a qualified professional.

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Q: Hi Doctor! Can you please tell me if the XTRAC laser helps with hypopigmentaiton. i ahve it severly all over my face due to laser resurfacing. I have an apponitemt to see a docotr in Dallas. I've done tons of reseach and it seems this is the only thing that might work. Any feedback would be great! Posted on 10/28/2004

A: Although laser resurfacing is a safe and effective treatment for facial rejuvenation and acne scars, hypopigmentation can occaisionally result after ablative laser resurfacing (ie CO2 laser). It may occur months to years after the procedure and is somewhat correlated with the number of passes performed during the resurfacing. But it can also be unpredictable.

The Xtrac laser is a device that produces ultraviolet laser energy. Early reports had raised hopes for this kind of technology to aiding various types of hypopigmenation since ultraviolet light therapy is useful for psoriasis, vitiligo, and several other dermatologic conditions. In our experience, laser ultraviolet treatments (like Xtrac, Relume, Excimer, ClearLight) may lead to a modest improvement of post-surgical hypopigmentation. Unfortunately, the effects may be transient and often require ongoing treatments to maintain the effect. Some have raised the concern about chronic exposure to ultraviolet light.

Overall, hypopigmentation arising from laser resurfacing is difficult problem to address. The perfect treatment for this condition continues to elude us at this time but many are working to find the answers. In the near future it is quite possible that there will be better alternatives for treatment.

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Q: Hi, I am a 27 african american female (light complexion) with very dark skin between my upper inner thighs. It's been this way for many many years without treatment. This has bothered me for a long time now. Would bleaching cream or laser treatment be my options? If so, is it a cream I could purchase over the counter? I am considering lipo in my inner thigh to prevent them from rubbing. Should I start treatment for the coloring first, or should I get the surgery first? About how long would it take to correct this problem? Thanks Posted on 11/02/2004

A: Hyperpigmentation can result from chronic rubbing and irritation of the skin. Laser treatments and topical applications are unlikely to help unless the underlying problem is addressed.

Unfortunately, hyperpigmentation may be persistent for several months to years after the inciting event or events. Sunavoidance in those areas is also helpful to speed the resolution.

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Q: Hi Dr. Mafong,

I have a number of facial scars that resulted from a bout with teenage acne. What would be the most effective and cost efficient solution for this?

Posted on 11/02/2004

A: Recommended treatment for facial acne scars varies greatly according to the type scars present (ie. atrophic, depressed, ice-pick, boxcar etc.), skin-type (light or dark), and expectations. No single recipe exists for the treatment of acne scars.

Several questions in this "Ask The Experts" section have reviewed the different options available. They include microdermabrasion, chemical peels, laser treatments (non-ablative and resurfacing). Please review those questions at your leisure.

Also, note that treatment for acne scars is not a perfect science but with the right combination of treatments and appropriate expectations, a nice improvment can be achieved.

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Q: Hi,i was wondering if co2 laser is a good treatment for steatocystoma multiplex, several little fluid filled sists on the face and arms???thanks Posted on 11/07/2004

A: The condition steatocystoma multiplex is a condition characterized by several cyst-like structures. A hereditary component exists.

Treatment options include aspiration and surgical excision. At least 2 articles exist in the medical literature that report the use of CO2 laser for the treatment of this condition.
Although, it is not one of the more common treatments for steatocystoma.

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Q: Hi. I recently had laser surgery on a little fatty, raised bump that has been on my face since as far back as I can remember. I am 38 years old. The doctor lasered it three weeks ago, and instead of having a raised bump, I now have an "indent"--and it is located between my nose and eye....I am very vein and very upset. I keep putting Bacitracin on it, and Mederma, but it isn't going away. What can I do? I am very worried. I am a model, so I am worried about pictures, as well. Can you provide me with any insight? Thank you! Posted on 11/10/2004

A: It is difficult to provide you with specific information without knowing the initial lesion or the kind of laser used to treat you.

As with any procedure, a little down time and healing should be expected. It may be very well that the lesion will resolve or improve greatly with time. 3 weeks is hardly enough time to make any definitive conclusions.

Regardless, several alternatives may be available to lessen the impact of the appearance of "indent" if the lesion persists.

In any case, I use strongly encourage you to contact the treating physician, as he/she should be able to best provide you with the necessary care during the post-procedural period.

I would expect everything should turn out just fine.

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Q: Hi, I'm 27 years old (latina) and have been battling with acne and oily skin since puberty. This year I went through 4 months of oral (antibiotics) treatments and my acne subsided quite a bit. I was very pleased with the results. But its 3 months later and I've noticed the acne is coming back and the oil content on my face has now increased dramatically. I'm also getting breakouts on my back, something I've never had before. I haven't changed anything in my daily cleansing routine or my makeup. I'm getting married next year and I really want my skin to look its best. What kind of treatments do you recommend for my skin? Posted on 11/11/2004

A: The management of acne requires a long-term committment to a treatment regimen. Partilculary for those suffering from chronic adult acne.

Treatment startegies include topical medications, oral antibiotics and other oral medications that may require closer monitoring. Any of the above treatments or combination of treatments may be useful to treat acne, depending on the type of acne lesion, location and response to previous treatments.

It is important to treat acne at any age and at any stage to avoid the development of potential scars.

Stress, lack of sleep, poor nutrition and poor overall skin care can exacerbate acne. Therefore it is important to optimize the care of your skin, sleep hygiene, and eat healthy.

To keep you looking your best for the big day, it is advisable to start as soon as possible in the treatment of your acne. It may often take several weeks to months to get your acne under full control. The earlier you start the more options you will have at your disposal.

Other treatments that can make your acne treatments work better include chemical peels, microdermabrasion, and certain kinds of laser treatments. These are considered adjunctive treatments. We use them with other established acne treatments to improve the response and improve the appearance of the skin.

An early start with the right combination of treatments is the key to having your skin look its best when it counts.

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Q: Hi, my name is Alex. Is it correct to apply a non-comedogenic moisturizer to the skin before applying benzoyl peroxide, or should I apply the peroxide to the skin before the moisturizer? This is a common concern between many of my friends; including me. Any information would be greatly appriciated. Posted on 11/15/2004

A: Overall, it should not make much of a difference on the order of moisturizer and benzoyl peroxide.

We, recommend our patients to apply any topical medications on a clean dry surface. Followed by any other cream of moisturizer after about 15 minutes.

Either way is acceptable.

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Q: Hello,

I have freckles on my face and my arms and am interested in removing them using laser sugery, or any other method that will completely get rid of them. Just want to ask a few questions to help me with my decision to visit you or not.

1. Does laser surgery completely remove the freckles or just fade them? and do they come back after a period of time?

2. What is the estimate cost of laser surger to my face and arms.

Thanks! Posted on 11/22/2004

A: Freckles, or any mild to moderately pigmented flat lesions located on the skin may benefit from laser treatments. While it is always the goal to completely treat the lesions in the first visit, occaisionally it is necessary to have additional treatments. Many factors contribute to the final outcome including but not limited to the type of lesion, type of laser, and type of skin being treated.

The permanence of any treatment is difficult to predict but overall, most patients are extremely satisfied with the results. Laser can be a minimally invasive manner to make a nice difference.

Unfortunately, we are unable to provide cost/pricing specifics through this venue.

We hope you find this information useful and wish you the best in making your decision.

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Q: about a month ago i had an intralesion corticosteriod injection for a pimple on my cheek. since then i have developed an indent about the size of a quarter where i received the injection. it's also purple in color.
is this ever going to go away? it's horrible looking and the only thing i've been told to improve it's appearance is to have a soft-tissue filler injected. i live in asia and it's very difficult to communicate with the doctor's here. Posted on 11/23/2004

A: Intralesional corticosteroids are one of the cornerstones of dermatologic treatment, useful for a variety of conditions.

Occaisionally, it is possible to develop atrophy and/or slight hypopigmentation in the area. In most cases, atrophy (the indent) and the discoloration improves steadily with time. However, it may take several weeks to months to resolve if the indent is due to the corticosteroid injection. Corticosteroid atrophy of the skin due to intralesional injections is generally not a permanent condition.

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Q: Hi. Four weeks ago I had electrocautery done to remove small warts on my face and syringoma under my eyes. wounds around my face healed beautifully, but pock marks resulted under my eyes. two weeks after the cautery, i went back to my doctor to show her the pock marks and she suggested we have tca peel done to flatten them. the brand she used is easy tca from skin tech. the following day i noticed large brown stais on my jaw line. my doctor reassured me that these will peel. now, two weeks after she did the peel, i am left with brown stains on my jaw line. how do i reverse this side effect? my doctor is insisting we do another session of the tca peel. but i am now afraid to have it done. is this a scar or hyperpigmentation? i was not given any regimen to use after the peel. i only used mild soap and gel based mosturizer. please help. i had generally good skin, but now i have a lot of discoloration on my face. and the pock marks under my eyes are still there. help. thanks. Posted on 11/23/2004

A: Electrocautery ablation is a good and effective way to treat syringomas.

Chemical peels (Jessner, Glycolic, Salicylic acid, and TCA) are commonly used to improve skin tone, texture and appearance. Occaisionally it is possible to experience hyperpigmentation following a peel. Generally, these areas do peel or exfoliate over time. In some patients, the hyperpigmentation may be more persistent and may take longer to dissipate. For more persistent discoloration, use of a bleaching agent may be useful.

Mild soap and a moisturizer is an important part of any good skin care regimen. Use of a cream based moisturizer is generally recommended in our office as they tend to be less drying than gels.

Unfortunately, it is not possible to provide more specific information regarding the procedures and possible outcomes associated the treatments that you received. Many variables must be taken into account to provide you with accurate information and that is difficult to accomplish in this type of format.

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Q: Hello, you are so far from Vegas where I live. Do you know of anyone in this area who treats ice pick or enlarged pores with the tca, and would you say over all the tca is a "more than not" successful way to treat this problem? I understand you must really have to see exactly what I'm talking about to give an exact "fix" but very enlarged pores, what besides tca might you think would help shrink or eliminate them.
Thank you Posted on 11/30/2004

A: Enlarged pores are a common problem. Generally, associated with an oily complexion and sebaceous gland activity and enlargement.

We are unware of any "truly" effective and long-lasting treatments for enlarged pores. This includes the use of lasers, topical medications, and even oral medications. Occaisionally, surgical interventions may be useful to remove an enlarged pore and suture the skin.

Any board certified dermatologist should be qualified to evaluate and offer possible treatment with a chemical peel.

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Q: Great website! Thanks. Can you tell me what early results you have had for the SmoothBeam Laser. I was in for a consult and I am considering the procedure for acne scarring. Is there a possibility of dark spots developing? Is a spot test recommended? How effective have the treatments been for acne scarring and overall smoothness and collagen regeneration in your clinical experiences. Posted on 12/06/2004

A: The Smoothbeam laser employs technology categorized by many as "non-ablative" laser therapy. It is FDA approved for the treatment of acne but many laser centers have used this laser and other "non-ablative" lasers for the treatment of acne scars and fine lines on the face.

I hope that during your recent consultation you had an opportunity to review the nature of the procedure, risks, benefits and alternatives for your condition.

As with any laser procedure a limited degree of risk exists, which may include but is not limited pigmentary alterations, scar, discoloration, etc. In general, the development of permanent side-effects is rare.

For the Smoothbeam, and many of the other lasers that we use, a spot test is usually unnecessary.

Recent medical articles report an improvement in acne scarring of approximately 10 to 30%, of course this varies greatly according to the individual.

In our experience "non-ablative" lasers can impart an improvement in the overall smoothness of the skin. These improvements tend to be modest but an important step forward in treating a very difficult condition. To many people, even this modest improvement is worth the effort.

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Q: Hello, I am 21 and I am suffering from ance. I have try topical gels and creams. I have already been on actutane once. I clear my face up and now it has came back. Is there any other treatment I can have done without haveing to take pills? Like a type of laser treatment. And so, how long would it last for?

Posted on 12/16/2004

A: Topical and oral medications have long been the standard treatment for acne and have been used with great success.

Several lasers have received FDA approval as medical devices for the treatment of acne. That, however, in no way guarantees greater efficacy or duration of response. Generally, speaking, few reliable and well-designed studies exist to support the wide-spread use of lasers for the treatment of acne. Even less information is available about the duration of any response that a patient may experience.

In our experience, a patient may experience a modest improvement in the severity of his acne after one to several treatments. Laser therapy does offer the advantage of not requiring oral medication or repetetive applications of topical medications.

In deciding to undergo laser treatment for acne, a patient should consult with the treating physician and review the relevant risks, benefits, alternatives and realistic expectations. An honest review of options is the most important factor in reaching a well-informed decision for a treatment plan.

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Q: I am a light-skinned african american woman with acne scars , I have had laser rejuvenation with no success . The scars are not too deep , would injectable fillers work or shouls I try punch grafting ? Posted on 12/26/2004

A: Acne scars are a challenging condition to treat. Many questions in this forum have addressed the various treatment options available.

Injectable fillers are useful to improve the appearance of depressed acne scars. Generally, the risks with fillers are limited to relatively rare allergic reactions and transient bruising from the injection. Of course, it all depends on the type of filler being used. Fillers usually have to be repeated periodcially to maintain the desired effect.

Punch grafting is helpful for ice-pick scars or other well-demarcated lesions. The disadvantage is that with puch grafting, the skin is slightly injured during the procedure and post-inflammatory hyperpigmentation may follow, particularly in medium to darker skin types.

Both injectable fillers and punch grafting can be used successfully to address the problems of acne scarring. It is important to be well informed of the risks and benefits of any procedure.

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Q: Yes Im 26 years old male and i really have bad dark cirlces under my eyes. A lot of people ask me if i was hit in the eye at least twice a month. I get plenty of sleep and i eat good. What can i do to fix this. ALso i was in a car wreck in 1996 and i broke my check bone, did i do any damage to nerves and thats why i ahve dark circles. Posted on 12/30/2004

A: Dark cirlces under the eyes can be due to several causes. The most common being hyperpigmentation and vascular congestion in the blood vessels located in the region.

Hyperpigmentation is generally a hereditary trait. Occasionally bleaching agents may be helpful.

Vascular congestion in the area may be due to lack of sleep or allergic conditions or injury. Improvement in the underlying causes may be useful in decreasing the congestion.

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Q: I am asian and considering Smoothbeam. Have you had any problems with post hyperpigmentation? How about the success rate of treating acne with Smoothbeam? Posted on 01/07/2005

A: The Smoothbeam laser is a diode laser that emits at a wavelength at 1450 nm. It is FDA approved for the treatment of acne.

As with any treatment, patient response varies greatly and is often difficult to predict. The same holds true for treatments with the smoothbeam.

In our experience, the smoothbeam is mild to moderately effective for the treatment of acne and even effective for some patients with rosacea. Often times, it may be recommended as an adjunctive treatment, alongside other medical acne treatments. That is to say, that it can be useful to augment the response to traditional acne treatments. It can also be used alone, as a single treatment option for acne, but results can vary.

Any laser treatment has specific risks that must be considered. Post-inflammatory hyperpigmentation is possible with any laser treatment. It is occaisionally seen in patients receiving treatment with the Smoothbeam, but it is not the norm. Generally, with the appropriate settings, this complication can usually be avoided; although not always.

The Smoothbeam is a relatively safe and effective way to improve acne when administered by a qualified health professional.

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Q: hi! what are the disadvantages of skin bleaching, are there side effects? Posted on 01/08/2005

A: Hydroquinone is the active ingredient in most "skin bleaching" creams used over-the-counter, as well as by prescription. Commonly, it is useful to treat melasma, post-inflammatory hyperpigmentation, brown spots, and lentigines.

Many different formulations and brands are available. Typically, it is availabe in 1% to 4% concentrations and may be combined with other agents to aid in the "bleaching" process.

Other Bleaching agents are available but are not FDA approved for use in the United States.

One should be aware that alll medications and treatments have potential side-effects. In general, with the bleaching creams, mild to moderate irriation or allergy can occur. This may manifest as erythema, redness, itching, peeling or other symptoms on the skin. If misused, hydroquinone can rarely result in a paradoxical hyperpigmentation of the skin. Fortunately, this is extremely rare.

It is best to disuss with your health care professional what the specific characteristics are of skin bleaching agent recommended.

Any skin bleaching treatment works best by avoiding unnecessary sun exposure.

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Q: I suffer from malesma and I have tried many products with little success. The last one I used was Tri-luma but the hyperpigmentation recurred after stopping treatment in 8 weeks. Now I want to try laser treatment. Kindly advice on the role of Laser in the management of malesma? Also what else can I use? Thank you. Janet Posted on 01/10/2005

A: Melasma is a condition characterized by hyperpigmentation of the face. It is due to the interaction between hormonal influences in the skin and sunlight. Usually, the makrs are light tan to brown macules or patches, located on sun-exposed areas. These include the cheeks, forehead and upper lip.

Treatment of melasma may include strict sun avoidance, bleaching creams, chemical peels, microdermabrasion, and other topical treatments.

At this time, we do not currently recommend any lasers or light treatments for melasma. The hyperpigmentation associated with melasma may actually worsen if inappropriately treated. It can be confusing because many lasers and laser systems work on brown spots or even tattoos, but in our experience, lasers are not likely to improve melasma remarkably.

Ultimately, it is important to get the correct diagnosis prior to initiating treatment with any laser to assure that the appropriate options are offered to you.

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Q: I recently injured my chin which required laser resurfacing. I had the non ablative procedure done the first week of December 2004, and another treatment in the beginning of January. It has been three weeks and I have noticed hyperpigmentation in this area. Is this temporary? Should I consider bleaching creams, or maybe another laser treatment targeted for hyperpigmentation? Posted on 01/10/2005

A: Hyperpigmentation due to injury or a procedure is likely to improve over time, although in some cases it may take weeks, months or even years. It depends to a large degree on the baseline skin color with lighter skin resolving quicker. It is important to try and avoid sun exposure to the area, as this may retard the resolution of the hyperpigmentation.

Bleaching creams (containing hydroquinone) may be of marginal benefit. Typically, they work my inhibiting normal melanin incorporation into the skin. This may be beneficial in conditions such as melasma or brown spots due to sun exposure. The hyperpigmentation due to injury or inflammation may have a different component to the discoloration and therefore not respond as readily as expected.

Lasers are not typcially recommended in our office for the treatment of hyperpigmentation.

Please refer to the office where you received the your recent treatment as they should be able to guide you specifically since they are familiar with the type of laser and settings used.

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Q: i was told that african americans have an 80% chance of developing keloids after laser removal of tattoos especially in the neck area. is this so? are there any new lasers being developed for afriican american skin Posted on 01/10/2005

A: Keloids represent an exaggerated growth of thick fibrous tissue in response even minor injury of the skin. Common areas affected include the chest, back , upper arms, earlobes, and nuchal (neck) area. Although, any part of the body may be affected. Keloids can occur in anyone but tend to be more common in certain races including Asians, Hispanics and Blacks.

It is not always possible to determine who will develop a keloid after an injury, surgical or laser procedure.

Laser tattoo removal offers a relatively less invasive manner in which to remove an unwanted tattoo. The laser energy specifically targets the pigments in the ink while largely sparing the skin, thus lessening the chance of a scar or unwanted hyperpigmentation.

Several different lasers are available for tattoo removal. Some are used for light skin and others may be used successfully in darker pigmented skin.

All laser treatments require an acceptance of some risks which include but is not limited to bleeding, infection, scar, pigment alteration, and/or no improvement. Fortunatley, these side effects are unusual.

It is important to understand both the risks and benefits prior to embarking on any elective medical procedure. Your local qualified health care professional should be able to guide you in the right direction.

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Q: I AM A 52 YEAR OLD WOMAN AND RECENTLY I HAVE NOTICED THAT WHEN I GROCERY SHOP AND COME HOME TO UNLOAD MY GROCERIES AND HANG THE BAGS OVER MY ARM IT CAUSES A BRUISE ALMOST LIKE A BLOOD BLISTER OR AND OLD FASHIONED "HICKEY", LIKE THE BLOOD HAS BEEN BROUGHT TO THE SKIN. I AM BLONDE AND MEDIUM COMPLECTED AND HAVE ALWAYS HEALED VERY FAST FROM ANY WOUNDS...YET THIS WILL REMAIN ON MY ARM FOR QUITE A FEW DAYS AND I WONDER IF MY DIET OR LACK OF VITAMINS MAY BE THE PROBLEM OR IF I SHOULD BE CONCERNED. Posted on 01/13/2005

A: The condition that you describe is a common one.

Minor trauma can result in development of ecchymoses or "bruises" in those areas. These lesions are usually due to small vessel/capillariy fragility. Unfortunately, this fragility increases slowly with time. When disrupted, these vessels allow blood to escape into the skin, showing up as a discoloration on the skin that is more apparent in lighter skin types.

It is unlikley that a nutritional deficiency is responsible for the lesions if you are in otherwise good health and eat a healthy diet. However, an evaluation by your primary care physician is strongly recommended if you suspect that you have a medical problem, condition, or ailment.

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Q: Hi,
I've been using Triluma for 4-5 weeks to help clear a post inflammatory hyper pigmentation induced macule on my nose that resulted from a cystic pimple. My dermatologist said the Triluma should have cleared it up within two weeks. It doesn't seem to have gone down much. Please help. Posted on 01/17/2005

A: Hyperpigmentation due to an inflammatory condition is likely to improve over time, although in some cases it may take weeks, months or even years. It depends to a large degree on the baseline skin color. It is important to try and avoid sun exposure to the area, as this may retard the resolution of the hyperpigmentation.

Bleaching creams (containing hydroquinone) may be of marginal benefit for post-inflammatory hyperpigmentation. Typically, these creams work by inhibiting normal melanin incorporation into the skin. This may be beneficial in conditions such as melasma or brown spots due to sun exposure. The hyperpigmentation due to injury or inflammation may have a several components to the discoloration and therefore not respond as readily as expected.

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Q: Hi, I recieved laser hair removal with an Epilight laser 3 month ago on the front of my neck. After I got the treatment my skin swelled up and became very red. Then a couple days later scabs formed in a pattern where the laser was used.THe scabs took 2 weeks to fully heal, however the skin underneath was of darker pigment, and was very noticeable.The Technician told me it was hyperpigmentation and there was nothing I could do but wait. Its been three month and I cant tell if its fading, is this a permananent scar or will it fully go away with time? And also is there another procedure(another laser, chemical peels, or microdermabrasion) I can do to remove this hyperpigmentation in a faster manner? Posted on 01/17/2005

A: It is unfortunate to hear that you experienced an adverse outcome to your treatment with the Epilight for hair removal.

It is our policy in this section not to comment on procedures and subsequent specific outcomes received from those treatments performed by another facility. Many variables must be taken into account to provide you with accurate and helpful information and that is not possible without a thorough evaluation.

Our office utilizes several laser systems for laser hair reduction including the Alexandrite, and Nd:Yag (long-pulsed) lasers based on their proven efficacy and safety profile when used appropriately. Such lasers include the Gentlelase and Gentleyag.

We have chosen not to employ the Epilight, IPL or other light sources as part of our aesthetic armamentarium at our center.

Additionally, we advise that all procedures be performed by qualified licensed health professionals, preferrably a physician whenever possible.

In general, post-inflammatory hyperpigmentaion, regardless of the cause, tends to improve with time. How much time?... Is generally the key question, and that is difficult to say; maybe weeks, months and sometimes even years. It is doubtful that laser treatments can improve hyperpigmentation. Sunavoidance and time are the best treatments, although topical treatments with chemical peels and bleaching agents may provide some benefit.

Best of luck for a full recovery.

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Q: I am a thirty year-old white male. Over the course of a few years, I had developed an extremely faint, but noticeable red line in the middle of my forehead stretching from the top of my eyebrows to my hairline. I did two pulsed-dye laser treatments (specifying to the doctor that bruising was not acceptable), which resulted in limited succcess. I decided to go for a third treatment, and this time instructing the doctor that bruising was acceptable. And bruising I got.

It has now been 4 weeks since the treatment, and I still have an extremely ugly reddish (with some brown) line covering the entire treated area that does not seem to be improving. It is about one quarter inch wide, stretches from eyebrows to hairline, and is FAR worse than my original problem. I am extremely distressed and worried that the problem may be permanent.

The doctor who did this has downplayed the problem. He said I've developed a pigment problem, prescribed Epiquinn hydroquinone, and said it would clear up in a week or two. Obviously, that hasn't happened -- in fact, I don't see any improvement. I consulted another highly-regarded dermatologist who said I had "matting" and said the problem would "probably" clear up in 3-6 months, but that I should re-evaluate at that time. He doubted whether the hydroquinone would have much benefit.

I have since consulted my original doctor's partner. He described the problem as "residual redness from the treatment." He disagreed with the diagnosis of "matting." He indicated that the red discoloration was in part caused by hemosederin and recommended that I continue using the hydroquinone and also prescribed hydrocortison valerate cream (2%) for dermatitis.

I am very distressed and would appreciate answers to the following:

(1) What is my diagnosis?
(2) What is my prognosis?
(3) What is the chance it is permanent?
(4) Any other treatments that should be considered, such as arnica?

Thank you very much. Posted on 01/17/2005

A: The pulsed-dye lasers are generally used for the treatment of lesions with a vascular component. Such lesions include, port-wine stains, telangiectasias (commonly referred to as 'broken blood vessels'), hemangiomas, venous lakes, and even warts, to name a few lesions.

Initially, pulsed-dye lasers universally caused bruising or purpura. Later models developed non-purpuric settings while retaining efficacy. That has been one of the big advantages of recent pulsed-dye lasers, the Vbeam from Candela (Massachusettes) being one of several pulsed-dye lasers available.

Some people have used arnica for the treatment of bruising both related and unrelated to laser procedures. Our office currently does not recommend the use of arnica for bruising.

Unfortunately, we are unable to provide you with a diagnosis and prognosis to your well written and detailed account as it is still impossible to fully appreciate the extent and nature of the original and resultant lesion without a complete evaluation, including a visual inspection. It sounds as though you may have a complex condition seeing how several dermatologists have offered differing opinions.

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Q: I am a 35 year old Asian-American woman who has had bags under my eyes for the past two years. My mother has them which leaves me to believe it is a heriditary trait. However I would like to hold off on surgery as long as possible, can you recommend any effective eye creams to minimize the bags?

Thanks for your help,
Sophia Posted on 01/17/2005

A: The appearance of "bags under the eyes" may have many causes. These include edema or swelling due to an accumulation of water, skin laxity, and changes in distribution of fat around the eye. The latter is somewhat a hereditary and age-related event and is part of the reason why it is associated with looking old or tired.

It is difficult to effect a large change in the appearance of the "bags" with the use of a topical cream. Identifying and treating an underlying medical condition for the rentention of water is key. For others with skin laxity, a laser resurfacing procedure can improve skin tone, tightening the area and decreasing the appearance of lines and wrinkles. Lower lid blepharoplasty can be helpful to remove the excess lower lid fat that protrudes and thus contributes to the appearance "bags."

To see what you can expect to look like after you address the problem of "bags", look in the mirror (handheld) while sitting upright, then look in the same mirror while laying flat on your back. The latter image should provide you of a preview of what to expect after surgery and whether it would be beneficial.

Hope this is helpful.

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Q: Hi! I would like to know what procedure would be the fastest for hyperpigmentaion for my underarms, and if possible the proce estimate.


Salina Posted on 01/19/2005

A: Hyperpigmentation in the axilla may be caused by many different conditions. Treatment involves identification of the underlying cause and then addressing the discoloration.

Causes include inflammation, dermatitis, infection, hormonal influences, and other associated medical conditions.

The discoloration can be improved by first addressing the cause and then trying to address the hyperpigmentation. This can be done with topical agents (bleaching creams) and occaisionally with an ablative laser.

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Q: Do you have any collegues or associates that you could recommend in New York? Posted on 01/20/2005

A: New York is home to several excellent Academic Dermatology Departments as well as world leading Dermatology, Cosmetic and Laser Centers.

For general dermatology, NYU has always provided leadership from its distinguished faculty.

For Cosmetic Dermatology, Mohs Micrographic surgery and Laser Procedures, the Laser & Skin Surgery Center of New York headed by Dr. Roy Geronemus, is among the best. You are assured at getting the best care from one of the leaders of the field.

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Q: I am a 53 year old woman with fair, sensitive skin and suffer from acne. I was treated for five years with Minocin with great results. However, I received 4 treatments of Epilight while on the Minocin and was told by the physician to stop taking it for a week prior to treatment. About a month following this treatment I developed blue/black hyperpigmentation patches on my face.

I have recently been prescribed TriLuma to treat the hyperpigmentation along with microdermabrasion. However after doing research on TriLuma I notice that one of the side effects (though rare) can be blue/black hyperpigmentation which is exactly what I am trying to get rid of. I also have read that after ceasing the TriLuma the hyperpigmentation can return and often darker than before.

In your opinion would you recommend trying TriLuma or just waiting until the hyperpigmentation I have currently fades. I have been off Minocin for a year and have seen slight fading. Any help would be greatly appreciated. Thank you.

Posted on 01/20/2005

A: The discoloration described may or may not be related to minocycline. But at least it allows us the opporutnity to discuss this type of medication induced hyperpigmentation.

The most common type of discoloration associated with minocycline is a blue-black staining occuring in areas of previous inflammation, injury or scarring. Typically this is not a dose-related occurrence.

Fortunately, the skin discoloration due to minocycline tends to fade slowly upon discontinuation of the drug. Treatment with certain lasers have been helpful for some patients.

Discoloration from minocycline can also be seen on the teeth, eyes, ears, nails and mouth; but is quite rare.

It is strongly recommended that you consult your treating dermatologist regarding the use of Triluma as much of the information that you have come across is applicable only with clinical correlation. That cannot be accomplished in this forum.

It is encouraging to hear that the discoloration has been fading upon discontinuation of the medication.

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Q: I have scars on my cheeks, and I am considering smoothbeam. I wouldn't really consider them really deep scars, but they are noticeable. Anyway, I was wondering about something. If I lost weight, do you think my skin would stretch out and they would be less noticeable? I'm being realistic here. I know that scars are hard to work with, but do you think dramatic weight loss would help the appearance of my skin? I'm still planning on getting smoothbeam and if possible other procedures with it. Thank you. Posted on 01/20/2005

A: A dramatic change in bodyweight may have an effect on the appearance facial features including acne scars.

Typically, with substantial body mass reduction, a commensurate decrease in facial fat follows. This actually results in mild to moderate volume loss in the face that may lead to actual accentuation of acne scars. Volume augmentation, in the form of collagen or restylane, for example, is used to improve the appearance of acne scars.

The Smoothbeam theoretically increases volume in the affected area by stimulating collagenesis (new collagen growth) microscopically, thereby improving the appearance of acne scars modestly.

Weight loss towards ideal body weight is certainly better from a health maintenance standpoint and may improve blood pressure, cholesterol and other health parameters. It may, however, have a slightly negative effect on the appearance of acne scars.

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Q: HI-- I have what i think is a broken blood vessel scar on my nose. It looks like a small red pimple but it's not raised, it's just an annoying tiny bright red dot on my nose. It's been there for about 5 years now and i always thought it would go away but it hasn't. Is there any way to get rid of it through laser treatment?? If so, could you provide me any details on this procedure and the general cost of it?? Thank you! Posted on 01/25/2005

A: The pulsed-dye laser or Vbeam laser is an excellent choice for vascular lesions, particular lesions that contain the color red. Lesions that can be treated with this laser include telangiectasias, hemangiomas, cherry angiomas, port-wine stains, and red tinted scars.

Occaisionally, two or more treatments may be necessary but typically one treatment results in marked improvement.

The treatment is generally well tolerated and feels like a quick rubber band snap.

Some people may experience bruising or hyperpigmentation temporarily. But, this is rare.

Overall, the vbeam laser offers an excellent treatment option; both safe and effective.

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Q: I am a African American considering laser treatments for ice pick scarring from acne as a teenager. I also had cystic acne as a teenager. Would you recommend laser treatment. I am concern about discloration of the skin. Posted on 01/25/2005

A: Laser treatments can be useful to improve the appearance of acne scars. But it is important to be concerned about discoloration when inquring about different treatment options.

The CO2 and Erbium lasers are among the ablative lasers that can be used to drmatically improve the appearance of acne scarring. It is important to note that these lasers do not remove scars, they improve the appearnce of acne scarring. No treatment available, removes scars completely. While useful, the ablative lasers tend to be used for lighter skin types, as discoloration is a concern.

Recently, non-ablative lasers have been used for the treatment of acne scarring. Modest improvement in acne scarring can be obtained after several treatments with this laser. Generally, patients can experience a 10 to 20% improvement after a series of treatments. Patients may notice improvement in as little as 2 to 3 months. The advantage of this laser is that no significant "downtime" is required. Patients have the procedure done and return to their daily activities that same day. Additionally, it can be used safely in nearly all skin types.

In our experience, neither ablative or non-ablative laser treatment is very helpful for ice-pick scarring. Other surgical options may be considered such as punch-exicisions, subscission, and filler substances.

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Q: Posted on 01/25/2005

A: Laser treatments can be useful to improve the appearance of acne scars. But it is important to be concerned about discoloration when inquring about different treatment options.

The CO2 and Erbium lasers are among the ablative lasers that can be used to drmatically improve the appearance of acne scarring. It is important to note that these lasers do not remove scars, they improve the appearnce of acne scarring. No treatment available, removes scars completely. While useful, the ablative lasers tend to be used for lighter skin types, as discoloration is a concern.

Recently, non-ablative lasers have been used for the treatment of acne scarring. Modest improvement in acne scarring can be obtained after several treatments with this laser. Generally, patients can experience a 10 to 20% improvement after a series of treatments. Patients may notice improvement in as little as 2 to 3 months. The advantage of this laser is that no significant "downtime" is required. Patients have the procedure done and return to their daily activities that same day. Additionally, it can be used safely in nearly all skin types.

In our experience, neither ablative or non-ablative laser treatment is very helpful for ice-pick scarring. Other surgical options may be considered such as punch-exicisions, subscission, and filler substances.

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Q: I am a 21 year old female and have always been self-concious about my birthmark in the middle of my lower neck. Its a little smaller the a dime size and its brown. I was thinking laser treatment, but I am a student and a ittle low on money. How expensive is it actually? Do you suggest laser treatment, and is there anything else I can do to make it disappear? Please let me know. Than you for your time. Posted on 01/30/2005

A: A laser is unlikely to make a large impact upon a birthmark that is pigmented. This kinds of lesions can be congenital nevi, cafe au lait spots, spitz nevi or a variety of other pigmented lesions. Occaisionally a vascular lesion may appear dark in coloration.

An alternative consideration is excision of the lesion. Smaller marks are ammenable to excision which should leave a linear mark instead of the birthmark.

A proper evaluation by health care professional is recommended to assess the lesion, review treatment options and costs.

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Q: I know you have recently had the Smooth Beam in your office and are planning to get it back in the office soon. Do you think you will have it in the next 10 days? I noticed an earlier post said the manufacturer says "theortically" it stimulates collagen. What type of proof of this claim have you seen. I notice you always state the results to be about 10-30% with conditions such as mine-acne scarring and ruddiness in the skin. I know there is not a perfect solution, but I hate the thought of spending thousands of dollars for such a minimal result. Will you visually be able to tell me what I could reasonably expect from a Smooth beam procedure.
Thanks, Posted on 02/03/2005

A: The availability of the Smoothbeam in the office unfortunately is in the hands of the laser company. As of late, their response has been somewhat disappointing and inconsistent. We anticipate having the laser in the office within the next 2 weeks based on the information provided to us. Thank you for your patience and consideration.

The efficacy of non-ablative lasers has been demonstrated by several reports in the medical literature using this and other similar lasers. Some studies used optical cameras to measure smoothness and others had tissue biopsies to demonstrate new collagen growth. What that translates into in terms of improvement for acne scars is somewhere between 10 to 30% increase in smoothness. Those are the straight facts.

Clinical improvement (ie. visible improvment), however, is a subjective paramenter that is different to each individual. Some people are happy with 10 to 30% while others are not happy with 50 to 60% improvement. Additionally, variability to laser treatment exists.

Overall, it is not possible to give you an exact prediction on the degree of improvment after treatment with the Smoothbeam or any laser. We can only state what is possible based on what the studies and our experience has shown. Armed with that information, we strive to provide you with a guide to appropriate treatment alternatives, based on the state of technology.

The value of the treatment and benefit resulting from such treatments is up to the individual to evaluate and consider.

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Q: I have had stretch marks for 17 years and have had a tummy tuck to pull them off. Unfortunately there are still alot of them on my stomach. I am actually thinking of another tummy tuck (now 6 years later). I have heard about Vbeam and was wondering if you know what the success rate is for this procedure on stretch marks? I am real excited to know that there possibly could be another solution to these awful scars other than another surgery. Thanks for any information you have Posted on 02/06/2005

A: Stretch marks or striae are ammenable to treatment with the Vbeam (pulsed-dye laser) if they are erythematous or reddish in color. These tend to be newer striae. The pulsed-dye laser targets the small blood vessels in the stretch marks and can help fade the redness out. It will not remove stretch marks, but it may improve their appearance.

Unfortunately, other striae do not tend to respond as readily to treatment with the pulsed-dye laser.

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Q: When my daughter was 15 she was diagnosed with a staph infection below her knees on both legs. She has taken several rounds of antibiotics to cure this. Ocassionally a lesion will still reoccur. She has light olive skin. The lesions left dark pigmentation spots that look bruise-like. Is there any type of laser treatment that may help lighten these areas? Posted on 02/10/2005

A: please see the questions regarding hyperpigmentation.

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Q: I have some small growths around my eyes that almost look like "white-heads"--although they're not, and they can't just be pinched and "popped". Are they deposits of fat due to oily skin? How would these be removed? Thank You. Posted on 02/11/2005

A: As stated previously in this section, it is not possible to make accurate diagnoses over the internet.

The lesions occurring around the eyes may one of several lesions listed below.

Skin tags - are fleshy growths that are either skin colored or lightly pigmented. They can be easily removed with a blade or electrocautery.

Syringomas - glandular remnant located in this location thought to be derived from sweat glands. They too can be treated with electrocautery or laser.

Milia - skin-colored, dome-shaped papules that actually represent minute forms of cyst. Easily removed by extraction with a comedone extractor.

Dermatosis pigmentosa nigra - generally darkly pigmented lesions similar to skin tags located around the eyes and removed by similar means.

Sebaceous gland hyperplasia - as the name implies, these lesions represent enlargement of existing oil glands. Generally, these lesions are yellowish in color and can have a central umbilication or pore.

The lesions described above are of a benign nature. The list is not meant to be comprehensive nor be inclusive of lesion that are of a malignant or infectious nature. Any lesion that is changing in size, character, color, shape, irritated, inflamed, or otherwise symptomatic, should be brought to the attention of a health care professional.

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Q: How do you explain the anecdotal evidence reported on many internet message boards by people claiming positive results in treating their acne scars with the less mainstream methods such as TCA cross and Needling and negative results from methods such as ablative laser considered to be mainstream by the medical profession? Posted on 02/13/2005

A: A somewhat philosophical question.

Acne scarring is a subjective issue. Each person responds differently to different treatments. It also depends on having realistic expectations for each treatment.

A 10% improvment may be fantastic for one individual while a 60% improvement is insufficient for someone looking for complete resolution of all acne scars.

For each procedure, many factors affect the outcome inlcuding but not limited to the type of acne scars, the color of the skin (not all treatments are acceptable for all skin types), adherence to wound care, the individual response to the treatment, and the expertise of the provider.

While message boards, forums (this forum included) etc. provide an important resource of information, it is recommended that any medical or cosmetic decision be made with the help of a qualified health care professional enlisted in your care.

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Q: I would like to know how effective Smoothbeam is on treating atrophic acne scarring. I have some shallow scarring on my cheeks and was thinking of getting Smoothbeam done for those. Posted on 02/13/2005

A: plase see previous questions regarding acne scarring, specifically non-ablative laser treatments.
Thank you for your interest.

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Q: i have a question about a year ago i got a tatto and know i want to remove it my friend says to try what is called hydrquinone and i want to know if its a product safe to use and if it will remove it or what is my best way to go i need it removed asap Posted on 02/15/2005

A: Hydroquinone is unlikely to remove a tattoo.

Laser tattoo removal is the recommended manner to remove unwanted tattoos.

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Q: can rosaea be cured and completely gone ?or how can i get rid of it ? Posted on 02/16/2005

A: Rosacea is a condition that may be managed, not necesarrily cured.
Several medications, creams and treatments are available to help improve this condition.

Lasers can help with a component of rosacea, ie. redness and telangiectasias.

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Q: I am a 30 year old white female. I have rosacea and would like to have some of the redness decreased. What lasers could you recommened to help with this. And does your office do these procedures? Do you think IPL could be good for this? Any thoughts would be gratly appreciated!

Thanks Posted on 02/18/2005

A: Our office recommends and currently treats facial redness with a pulsed-dye laser which is currently regarded as the best option by many experts.

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Q: I have alopecia areata I am going for corticosteroids injections once a month for the small patches of hair lost, they seem to be working. It is true if one stops the injections will the new hair fall out again? Posted on 03/01/2005

A: Alopecia areata is a condition of patchy hair loss affecting pigmented or colored hairs. Gray hairs tend to be spared. Aloepcia areata is largely thought to be due to an immune response directed against parts of the hair follicle resulting in loss of hair in the affected area.

Several treatments have been tried throughout the years to manage this condition. These include the use of topical corticosteroids, sensitization agents, oral and intralesional cortcicosteroids injections.

Potentially, any successful treatment may result in long-term hair regrowth. It should be noted also, that cessation of treatment may lead to a relapse in the condition; either locally or in a different area.

It is quite possible that the hair regrowth may remain but it has also been reported that any "rescued" hair growth may be subject to falling out after treatment is stopped.

As is our custom, it is recommmended that you consult your treating physician regarding the specifics of your case and wish you success in your course of treatment.

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Q: Good Afternoon,

Can you please tell me if your physician/office performs surgical excisions on tattoos?

Much appreciated,

Valarie Thomas Posted on 03/01/2005

A: Tattoo removal can be accomplished by a variety of means. The method recommended by most dermatologists is laser removal of tattoos. The reason for this is that the laser energy specifically targets the tattoo ink or pigments while relatively sparing the surrounding skin. Thus, leading to less scarring poitential and pigmentary alteration.

While surgical excision will remove the tattoo, the resulting scar can be unsightly when compared to the original tattoo. Therefore, surgical excisions are reserved for cases where laser tattoo removal has been unscuccessful or impractical. Surgical excision of a tattoo will remove the tattoo undoubtely, but a scar will be be the result. This alternative should be chosen only after careful consideration of the alternatives, risks and benefits.

Our office gladly offers this information and a full array of treatment options for tattoo removal.

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Q: I have a lot of small scars that´s old and som new acne scars as well. But they are all very small and shallow. Not deep and not red in colour. Just in some light you see
a bad structure. So it´s look more like damaged pores than big scars.
Which treatment do you recommend
Posted on 03/03/2005

A: We recommend a consultation with you local dermatologist to fully evaluate your condition.

It is difficult to get an accurate idea of any condition through this forum.

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Q: Are there any permanent or long-term injectible fillers suitable for hollow cheeks? And if so, which would you recommend? I am a 58-year old female and too slim to have my own fat transferred. Posted on 03/19/2005

A: A variety of tissue fillers are currently available. These include collagen (human and bovine), hyaluronic acid gels and more recently Poly-L-Lactic Acid.

Bovine collagen (eg. zyderm, zyplast) requires skin testing prior to use and generally lasts 2 to 4 months. Human collagen (cosmoderm, cosmoplast) does not require skin testing but lasts about the same. These products tend to be less painful to inject as they contain an anesthetic.

Hyaluronic acid gels are excellent fillers (Hyalaforma and Restylane) No skin testing is required. Restylane may last up to 6 months or more. It is commonly used in the nasolabial folds, marionette lines, and lips. Occaisionally it is used on the cheeks. A related product, Perlane may be used if more volume correction is required.

Poly-L-Lactic Acid (Sculptra) was approved for use in the US last year. It is a synthetic material that is injected below the surface of the skin in the area of fat loss. It provides a gradual and significant increase in skin thickness, improving the appearance of folds and sunken areas. It has been reported to last up to 2 years in preliminary studies.

Other fillers exist. Some even touted as permanent fillers but we recommend careful consideration prior to using a filler that may have long lasting benefits as well as side-effects.

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Q: I am a 29 yr old female, type p4 skin, mild to moderate acne, oily skin, some moderate ice pick scarring on cheeks and large pores .Looking for your opinion: will 5 treatments of IPL help my acne, tighten pores and improve appearance of scars (by collagen activation)? I worry about the price tag for 5 treatments and unknown results. Warm regards, Natalie Posted on 03/23/2005

A: It is assumed that by IPL, you mean intese pulsed light.

In our experience, IPL may lead to modest improvement in redness and some brown discoloration.

Your concern about "unknown results" is well placed. Different people respond differently to various procedures. We (Dermatology & Laser Center of San Diego) have not been overly impressed with the clinical results from similar treatments or specifically its use to tighten pores, improve acne or resultant scars. Our interpretation of the existing clinical data in peer reviewed medical journals leads us to believe that any benefit may be modest at best. However, any improvment for some, is a gain.

Overall, it is a decision that is best reached together with the guidance of your health care professional.

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Q: I am a 24 year old African American male with hyperpigmentation around my eyes and no history of acne. When I tried to use Hydroquinone 4% I had an allergic reaction. I have had this condition for about 4 years and do not know what to do. I want to get rid of this discoloration by any means possible. I am tired of cremes because they do not work. Is laser therapy the best option for me? Posted on 03/30/2005

A: It is unlikely that a laser treatment will lead to much improvment of hyperpigmentation around the eyes.

You may consider chemical peels or microdermabrasion and other formulations of bleaching agents available through your local dermatologist.

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Q: I am a african american female and i have acne scarring i have been told previously by dermatologist that is not very deep and the scars are shallow, i was told to use retin A, which i have been doing for the last 3 months, and to me it seems like my skin has been breaking out more since i begin using the Retina, i am also taking acne pills which were prescribed by my dermatologist, my question is without seeing my skin what types of peels or laser would you recomend i consider that could reduce the appearence of the acne scars by at least 20-30%,mind you I am a darker skinned african american and skin discolorations is big concern for me, i dont expect a miracle but a reduction of about 30% would drastically improve my self esteem, i plan to continue to use the retina and pills in the meantime. Posted on 03/30/2005

A: Acne scar treatment are a common problem and a large source of questions in this forum.

Unfortunately, it is not possible to provide accurate information without seeing the lesions and having an idea of your skin characteristics.

A 30% improvment in the appearance of acne scars is somewhat ambitious with the present technology available. Although, attainable in a few patients, realistically 10-20% improvement can be attained via a variety of non-ablative laser treatments, chemical peels, and surgical treatments.

It is important to continue with acne therapy maintenance as the best treatment is prevention of further acne scars.

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Q: I have suffered with acne since puberty (I am now 40). Since my twenties, I've had it on my back, chest, buttocks and even legs (folliculitis). As far as treatments go, you name it, I've taken it. From oral antibiotics, topical prescription and otc creams and gels, to several courses of accutane, nothing has permanently cleared up my skin. After seeing numerous derms, the consclusion is that I have a hormonal imbalance which affectively overwhelms any medical treatments ability to combat this problem. Birth control pill have't seem to had much affect either. Do I just cover up and give up? arrggh! Posted on 03/30/2005

A: Chronic persistent adult acne can be a challenge to treat, let alone cure. But with the right regimen and perseverence, it may be managed to effect a significant improvment. Complete erradication is not always possible.

Our best advice is to consult with you local board certified dermatologist to completely evaluate your skin and medical profile. If a hormonal etiology is suspected, perhaps your dermatologist may refer you to a specialist to jointly manage your acne. Through a series of trial and error, careful adherence to recommendations, and patience, it just may be quite possible to effect an improvement in your stubborn acne.

Challenges are the spice of life!

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Q: I have a lot of skin tag/skin tag around my eys, face and my neck. Can this be cured by some facial creme or minor surgery? How much is your consultation fee? Posted on 04/06/2005

A: Skin tags, if that is indeed what they are, can be address with an in office procedure with excellent results. It is unlikely that a cream will improve skin tags.

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Q: Do you treat psoiasis with lasers in your practice? Posted on 04/11/2005

A: The lasers that have been used for psoriasis include the Excimer/Xtrac laser and the ClearLight. Both are ultraviolet lasers.

These devices can be useful to help manage the lesions of psoriasis but require multiple treatments and even a maintenance schedule. Not unlike phototherapy with ultraviolet lights used in many medical centers.

Our Laser Center currently does not employ the use of these lasers to treat psoriasis. You may wish to contact the companies that make the lasers PhotoMedex and Lumenis respectively. They should have information regarding physicians in your area.

Good luck!

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Q: Dr Mafong,
My three year old daughter fell and hit the corner of a cabinet. She has a 1/2 inch vertical mark on her forehead. Her doctor said it didn't need stitches. It's been about four months and it's healing great. I've used a silicone gel on it that seems to help. There still is a faint pink line there. How long does it normally take for the pink to fade away?
Thanks so much Posted on 04/12/2005

A: Redness or erythema of scars may take several months to nearly a year to improve.

Treatment with a vascular laser may improve the appearance of the lesion.

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Q: I have a tattoo of a rose on my chest Can TCA (Trichloroacetic Acid) be used to get rid of the tattoo? Posted on 04/12/2005

A: Laser Tattoo removal, in our experience, provides the most effective manner to lighten and hopefully remove most tattoos. Even rose tattoos.

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Q: I am a 44 year old Asian female with light olive skin. I have had two electrocautery procedures done over a course of two years to remove multiple syringomas around my eyes. It has helped somewhat but is still noticeably there. I also at this time have letingo and they are scattered throughout my face. I am also beginning to notice that my skin's texture is rougher and color ruddier. All of these skin issues, I was told, are probably a normal progression of skin as it ages My question is, Is CO2 laser the answer? From you're answers to previous questions it sounds to be the likely answer to take care of all these problems. Is it? or am I over simplifying it. Can the CO2 laser be set to target varying depths of the skin to "take care" of each of these problems? And should I do the entire face? Should I be concern of uneven skin color results if I treat multiple areas of the face? I would appreciate some advice on what I should do and how I should go about searching out for a Dr. with
experience dealing with Asian skin and the aforementioned problems. I live in SF. Thank you for affording me this chance to ask these questions on this wonderful websit. M Posted on 04/12/2005

A: You have several inter-related questions that would best be addressed by a consultation with a health care professional. Academic medical centers in your area generally can provide various options.

In general, I would be hesitant to use a CO2 laser on olive skin.

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Q: Is there any effective treatment for the bruises from schamberg's disease. I've had the marks for 3 years now?They haven't gotten worst or improved over time. I've heard applying Vitamin K Cream can help. Posted on 05/02/2005

A: Schamberg's disease comprises several different clinical presentations of essentially the same condition; inflammation of the capillaries with hyperpigmentation. Other names associated with this condition include: Lichen aureus, progressive pigmented dermatosis, Majocchi's disease.

Unfortunately, no medical intervention has proven to effectively treat the appearance of this condition. Most treatment is aimed at alleviating the symptoms, such as itching or irritation associated with the lesions. Supportive therapy includes avoiding prolonged standing and/or the use of support stockings for individuals with lesions located on the lower extremities.

Vitamin K Creams have been used for help alleviating bruises and purpura. Results vary. It is doubtful that vitamin K cream will make much difference in our experience, but it is worth a try. The only concern would be if someone were to have an allergy to any of the ingredients in the medications applied.

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Q: Hi...Is it safe to have Vbeam laser done when you have vitiligo. I have rosacea and vitiligo and was wondering if there is any danger in treating my rosacea with Vbeam in regards to my vitiligo.Thank you. Posted on 05/13/2005

A: As with any laser treatment or procedure, there is always at least a small risk to be assumed.

In general the pulsed-dye laser (vbeam) is well tolerated and leads to relatively few adverse effects; at least on the settings employed in our office.

Vitiligo can be exacerbated or develop from trauma or injury. Theoretically, a risk exists and therefore care must be taken when doing any procedure.

It is best that you consult with your treating Physician so that any concerns that you have can be addressed specifically.

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Q: Hi,
I just found this page and I find your patience and sincere desire to help those with skin conditions refreshing. I was diagnosed with melasma about a year ago. I have used a small tube of Tri-Luma and I follow sun guidleines but my spots reappear. Is Tri-Luma a maintance method to be used occasionally? What would you recommend as a maintance regiment? (I use Solbar's broad spectrum spf 50 with avobenzene and I wear a 4 inch brim hat religiously.) I don't know what else to do to keep my spots from coming back. Any advice would be greatly appreciated. Thanks so much! Posted on 05/19/2005

A: Melasma can be a challenging condition. Briefly, melasma is a result of combined sun and hormone exposure. It may occur in normal individuals, those taking oral contraceptive medications, hormone replacement, or expectant or recently pregnant mothers.

Three main treatment approaches are generally recommended.

1. Strict sunavoidance: use of a sunscreen (spf 30 or higher) with broadspectrum coverage including Ultraviolet A and B wavelengths. A physical sunscreen, like titanium dioxide or zinc oxide can be useful. A broad-brimmed hat is essential. Even several minutes of intermittent sun-exposure can lead to the developoment of hyperpigmentation characteristic of melasma on the face.

2. Bleaching creams: hydroquinone, available by prescription in strenghts up to 4% can help minimize the hyperpigmentation, but it may take several months to see any improvement.

3. Occaisionally, some patients benefit from the exfoliating action of microdermabrasion or certain modified chemical peels. We recommend our patients to have either of these treatments once a month for several months.

In our experience, laser treatments are NOT indicated for melasma.

Melasma can be a chronic condition to manage that requires daily maintenance. But, with diligence and proper guidance it can be improved and controlled.

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Q: For as long as I can remember, I have suffered from hyperhydrosis. Hands, feet, underarms... the whole package. I've read that the surgery is the most effective treatment but I'm a little nervous in actually considering it. Are there any other recommended treatments that would work just as well and possibly be permanent? Does your facility treat this problem? If not, do you recommend anyone in San Diego county (North County)?
Thanks Posted on 05/19/2005

A: Hyperhidrosis is a condition characterized by excessive sweating of a given area. The most common areas affected are the axilla, hands, and feet.

Treatment options include topical and oral medications. Recently injections with botox have been shown to be effective for this condition for 6 months or more. Generally this treatment is well tolerated, safe and effective.

Surgical intervention has been shown to be effective in some cases, although compensatory hyperhidrosis has also been noted in other areas. The complete risks and benefits of this alternative are beyond the scope of this forum and best discussed with the treating physician.

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Q: Is vbeam a good option to help decrease the redness of rosacea?

Thanks and I love your website!!! Great info. Posted on 05/20/2005

A: The Vbeam is a pulsed-dye laser used to treat vascular lesions.

Rosacea is a condition consisting of facial edema (swelling), papules, pustules, and facial redness. To adequately treat rosacea, all aspects of the condition should be addressed. This includes topical and oral medications. Additionally, behavior modification to avoid foods and other exacerbating factors should be reviewed with any comprehensive rosacea treatment regimen.

The Vbeam will address facial erythema due to telangiectasias or enlarged blood vessels present under the surface of the skin.

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Q: I am and African American woman with acne scarring from hyper pigmentationn on my back. Is there anytype of laser scar removal that can be done for this that will not case additional scarring? Posted on 05/23/2005

A: It is unlikely that a laser will be helpful for post-inflammatory hyperpigmentation on the back

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Q: I am 43 and have been developing quite a few sebaceous hyperplasias over the years. Initially they began to appear in the temple area and have showed up on my forhead and cheaks. I understand that they are benign in nature but they're now starting to appear on my nose. This most recent development is quite alarming cosmetically speaking. Is there an effective treatment available that you recommend? Posted on 05/26/2005

A: Sebaceous hyperplasia are common enlarged oil glands, usually located on the face.

Various treatments are available to treat sebaceous hyperplasia. These include electrocautery, laser treatments, and surgical removal.

The specific treatment depends upon the size, location and characteristics of the particular lesions as well as patient's skin type. An individualized approach, taking into account these and other important factors is the best manner in which to proceed.

The other option is to do nothing as these lesions are generally not considered malignant or dangerous.

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Q: Hi Dr.Mafong, I noticed that you do cosmetic surgery. I am thinking about having liposuction on my stomach & hips due to fatty deposits that I cannot get rid of. Is this the kind of surgery that you do? And if so what's the recovery time for something like this.
Thanks! Posted on 05/30/2005

A: Our office is happy to offer Liposculpture. Recovery varies from person to person but is generally about 7 days of post-operative care and discomfort.

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Q: I am 18 years old and i have rosacea ever since i was 12 years old. Basicly i can't do much, because whenever i do something my face flairs up and i hate how it looks.i also get hot flashes everyday.some are really strong and last hours, but some are small and last secounds. well my question is what laser is requiared to cure/remove ROSACEA??? how much does it cost??? where can i find a close location??? i live in chula vista. thank you for your time Posted on 05/31/2005

A: The condition of rosacea encompasses a variety of symptoms ranging from facial redness and swelling to the development of pustules and nodules. Along with these symptoms, enlarged or dilated capillaries may develop on the face. It is these blood vessels that contribute to facial redness. The laser targets these blood vessels specifically and can improve the redness associated with this condition.

The other questions may be better answered in consultation with your treating physician.

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Q: Hello,
I have very fair skin with even color, and have been very careful to stay out of the sun, but at 52 I have a lot of wrinkles. I've been told I am a good candidate for a laser peel but am alarmed at stories about the pain and extended recovery time. Now that restlylane is FDA approved is it a good alternative treatment for the laugh and lip lines? Posted on 06/02/2005

A: Restylane and laser resurfacing generally address 2 different conditions. Although, lip lines can benefit from either treatment.

Restylane is an alternative for nasolabial folds "laugh lines."

Specific information is better answered in consultation with your treating physician.

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Q: Hello,

(Your page has officially been bookmarked! I love it)I am a 25 year old african american with a medium to fair skin tone. I have been visiting many doctors in the Oklahoma area with hopes of having a ten year old amatuer tattoo removed from my lower forearm. The doctor that I have visit here continously show me scary pictures of extreme lightening in the area of the removed tattoo. They say that this is likely to be permanent. So, I have researched further and located many pages offering a tattoo removal process called Rejuvi, a chemical extraction procedure. Apparently, it does not damage the natural skin pigmentation. I was wondering what it any additional information you have on Rejuvi. Do you think it is a good idea? I really, really want this tattoo removed, but I obviously don't want a huge white spot on my arm either. At the same time though I don't want to rush into something another potentially harmful situation. Posted on 06/02/2005

A: Laser tattoo removal remains the gold standard to remove unwanted tattoos of various colors.

Typically, amateur tattoos respond well to laser treatment. While hyperpigmentation and hypopigmentation are risks, treatments can be successful in eliminating much of the tattoo while minimizing the risks. Several different laser devices are available and should be tailored according to tattoo color, type (amateur vs professional tattoo), patient skin type etc. ie. Certain lasers are more likely to produce hypopigmentation in darker skin types than others.

Our office does not have extensive experience evaluating "chemical extraction" for tattoos. We have seen several patients who have had it done with mixed results and are also receiving laser tattoo removal. Certainly, not enough to make any conclusions regarding its efficacy or safety.

As with any procedure, assure that you receive care from a qualified, experienced and well equipped health care professional. Best of luck.

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Q: can laser treatment cure roseca? Posted on 06/20/2005

A: Rosacea consists of a constellation of symptoms and lesions ranging from facial redness to papules and pustules resembling severe acne.

Vascular lasers address the redness or erythema associated with rosacea. Doing so, can provide symptomatic and cosmetic improvement but not necessarily a clinical cure for the other signs and symptoms of the condition.

With the appropriate clinical managment which may include medications, topical treatments as well as laser treatments, rosacea can be greatly improved.

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Q: I'm an Asian with multiple syringomas on the face. Do you know anybody in the Houston area would you recommend who could help me. Posted on 07/03/2005

A: Houston is home to many excellent dermatologists.

Drs. Paul Friedman, Len Goldberg, Arash Assadi and Ming Jih are located in Houston.

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Q: 1 Hello Dr Mafong! Could you please tell me if massage will make Restylane break down quicker? I do NOT like the results I have in my lips! There are big lumps on the underside and they are too puffy! Please help!! Posted on 07/03/2005

A: It is unlikely that massage will make Restylane break down quicker.

Anecdotal evidence exists that certain enzymatic substances can be used to aid in the clearance of some filler substances.

As always, it is best to consult with your treating physician.

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Q: i was wondering if you perform the botox procedure for excessive underarm sweating. If so how long does it last and how much does the procedure cost. Posted on 07/06/2005

A: Botox is an effective and convenient way to help control excessive axillary (underarm) perspiration. It may not impact the odor production.

Duration varies from person to person, but generallly ranges about 4 to 6 months or more after each treatment.

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Q: My daughter went to the doctor about little warts on her skin. They did a test on her skin and found it to be syringoma, is there any other treatment then laser treatment. She's twenty-two and very self conscious about it. Posted on 07/06/2005

A: Syringomas - glandular remnant located in this location thought to be derived from sweat glands. They can be treated with electrocautery or laser.

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Q: How do I prevent having such terrible facial sweating??
Posted on 07/08/2005

A: It is recommended that you have an evaluation by a physician to rule out medical causes for facial hyperhidrosis.

If all other secondary causes of hyperhidrosis are eliminated several treatment options are avaialble. This include topical solutions, like aluminum chloride. Botox has also been useful to treat hyperhidrosis, depending on the area(s) affected.

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Q: I been having acne for at least 10 years i'm now 35 and tired of it, I have tried several treatments, but nothing last, I was told by a friend that laser is a big help, is this true, what can I expect. Posted on 07/08/2005

A: Response to laser treatment for acne is extremely variable.

In our experience using various lasers for acne treatment, response has generally been modest. It can be helpful for the redness and inflammation.

It is our opinion that treatments with topicals, and oral antibiotics are still the gold standard.

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Q: Do you have a successful treatment for hypertrophic and small keloid scars? Posted on 07/15/2005

A: Hyptertrophic scars, as the name implies, are lesions that form due to injury. Unlike normal, scars, hypertrophic scars tend to be larger, and slightly more protruberant. They remained confined roughly to the original area of injury.
Hypertrophic scars can be raised and can be a source of moderate itching.

Keloids are similar in that they consist of scar or fibrous tissue. However, Keloids extend beyond the initial site of injury. They are often protruberant, nodular lesions, and are firm and often very itchy. Common areas of keloid development include the chest, upper arms, back, and earlobes. Keloids may develop anywhere in the body.

Treatment consists of decreasing the size and appearance of hypertrophic scars and keloids. This can be accomplished using various methods including cyrotherapy (freezing), excision (surgical), and even radiation therapy. These methods are generally plaqued by recurrences as a rule. The mainstay of treatment has been injection with corticosteroid directly into the lesion to help shrink and flatten the scars. Lasers have also been used successfully to decrease the size and appearance of hypertrophic scars and lasers.

NOTHING removes hypertrophic scars and Keloids.

Other adjunctive therapies include silicone sheet application, direct massage, and constant pressure to the lesions.

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Q: I was just told I have syringoma by my dermatologist. My insurance does not cover removal since it is consider cosmetic. I have them around my eyes. I was wondering what my options for removing them are and if it is possible to remove them? Thank you for any info Posted on 07/29/2005

A: A: Syrigomas can appear as skin-colored papules or bumps in the area around the eyes. Generally they are 1-2 mm in diameter. These lesions are derived from glandular components in the skin and are mainly of a cosmetic concern.

In our office we utilize a variety of different treatment options to either remove or improve the appearance of these lesions. It depends on the size, number, and type of skin that is being treated.

In many cases, an Erbium:YAG laser can make a nice difference and minimize their appearance.

As with any procedure, the right diagnosis, expertise, and post-treatment care are the keys to success.

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Q: I am a African American woman who has lost weight recently. Althought I have worked and am currently still working hard on my body, I am still plagued with old white stretch marks. I have read about excimer laser which are said to help in fading them and are safe and beneficial for people with darker complexions. What has been your experience or knowledge with them and can you lead me to doctors who are experienced in using them? Posted on 08/01/2005

A: White striae are a difficult condition to address. Many different treatments have been proposed with varying degrees of success.

The excimer laser has been used to decrease the stark appearance of hypopigmented stretch marks. In our experience, the benefit is variable, requires multiple treatments and also may require a schedule of maintenance treatments to sustain the benefits.

The excimer laser emits light in the ultraviolet spectrum and therefore is subject to the characteristics, risks, and cautions associated with its clinical use. The specifics are best discussed with the evaluating and treating physician.

A referral list for a physician in your area is available from the individual laser companies. You may wish to try Photomedex, Lumenis to name a few.

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Q: I'm a 25 year old asian girl, and even though I put on a lot of spf-50 sunblock, my skin still reacts to the sun, getting a burn in just a couple hours at the beach. The next day, my skin gets dark, which I don't like. Why doesn't the sunblock work? I've tried many types. Does skin react to something in sunlight other than UV? Posted on 08/24/2005

A: Several reasons may be responsible for tanning despite the use of sunscreen.

SPF ratings are a relative guide. Generally they protect against sunburn. It is unusual to get a sunburn despite using an SPF of 30 or higher. Consider correct application amounts and locations. Key to sunscreen use is reapplication, especially after water activities or excessive perspiration. Also, make sure that the sunblock is not expired.

We recommend that our patients use sunblocks containing physical blockers such as titanium dioxide or zinc oxide which physically block the suns rays, not merely absorb them like other agents.

Tanning is caused by both UVA and UVB radiation. Sunscreens are relatively good at blocking UVB but less effective with UVA radiation. Also, UVA blockers approved in the United States are less stable and need to be constantly reapplied to be effective.

Since both UVA and UVB affect tanning, you may still experience skin darkening. Again, physical blocking sunscreens with high spfs may be more effective for this purpose.

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Q: Hi, i have recently had IPL - more specifically photoderm, conducted in the corners of both my left and right eyes on recommendation from a highly experienced cosmetic physician. Initially after the treatment the darkness dissapeared entirely. However this was short lived and the darkness soon returned to be far worse. I am desperate for this problem to be solved. What is my next move and are there any lasers or other alternative treatments that would suit this post inflammatory hyperpigmentation?? Posted on 08/24/2005

A: Our office employs the use of Lasers, for the treatment of certain specific pigmented lesions.

Certain pigmented lesions respond well to laser treatments such as lentigines, ephelides, nevus of Ito, nevus of ota to name a few.

Other conditions respond less consistently, including but not limited to post-inflammatory hyperpigmentation, melasma, congenital nevi.

It is important to note that not all lesions are candidates for laser or (as in your case) IPL treatment.

An evaluation with a qualified health care provider in your area would be appropriate to obtain an accurate diagnosis and evaluation of your skin type. With this information, he/she may be should be able to suggest treatment options specifically suited for your case.

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Q: What is the best way to treat syringomas on the face? Posted on 08/26/2005

A: Depends on size, location, skin type.
Options have been reviewed previously in this section.
Thank you for your interest.

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Q: I am a 40 year old female. I have excess/loose skin on my upper eyelid. You can't see if I am wearing makeup because the lid part is covered by the excess skin. My eyebrows are quite high and have not drooped at all. Are there effective, non invasive alternatives to a traditional eyelid lift? Posted on 09/02/2005

A: Essentially, a blepharoplasty, or traditional "eyelid lift" is the best option.
Down time is only several days to a week or so and the results can be dramatic.

Non-invasive alternatives may help a little but are not consistent from person to person. In terms of cost, it almost ends up being the same.

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Q: Where on the body can laser hair removal be done. What is the recovery time and pain? How many treatments are necessary and what are the age requirements? Posted on 09/14/2005

A: Laser hair removal can be performed on almost any part of the body. It is limited only by accessibility of the hand piece to apply the laser the surface of the treated area. Extreme caution must be exercised when treating the face and area around the eyes, as the laser may cause damage to the eyes if they are not apprpopriately protected.

In our office we use one of two different lasers. The alexandrite (Gentlelase) or Nd:Yag (Gentleyag) laser hair removal systems.
Generally, the laser is well tolerated and people are able to return to normal activities immediately. The skin may be slightly red or swollen for 1/2 hour to 2 hours after the procedure. Laser hair removal feels like a warm rubber band snap. Many patients tolerate the procedure without anesthesia. Some opt to use a topical anesthetic cream applied to the area prior to treatment. It helps alleviate much of the discomfort.

Multiple treatments are required to obtained long-term hair reduction using lasers. At least 4 to 5 treatments are recommneded; one month between each treatment.

Our office treats patients of all ages. Patients younger than 18, require (written)parental consent.

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Q: Just over a year ago I had semi-permanent makeup done on my eyebrows which I have regretted ever since. In July I tried Rejuvi, a chemical extration removal, but it did not have very much affect and I am not sure whether or not it has left me scarred. I am absolutely desperate to get rid of these tattooed eyebrows; would laser removal be safe for this kind of tattoo? And would it affect my eyebrow hair? Posted on 09/15/2005

A: Laser tattoo removal can be successful for removal of cosmetic eyebrow tattoos.

Much depends on the original color of the tattoo. Dark tattoos have the best result, whereas red, brown, or green colors can be more challenging.

Typically, laser tattoo removal performed in our office does not affect eyebrow hair regrowth. Some laser removal systems can have an impact on hair growth. It is best to discuss this with the treating physician.

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Q: Hi I am a 31 year old male and just started to get
Sebaceous Hyperplasia marks on my face, how do I treat this I am in sales and deal with people every day
Please advise
PS great web site Posted on 10/04/2005

A: Sebaceous hyperplasia represents an enlargement of pre-existing oil glands. Usually located on the face. These lesions appear as skin-colored to slighlty yellowish papules. Many times a central dell or pore is visible in the center. Occaisionally, sebaceous hyperplasia can be mistaken for other types of lesions including basal cell carcinoma, milia, fibrous papules, acne, dermal nevi etc.

Numerous methods can be used to remove or decrease the appearacne of sebaceous hyperplasia. Much depends on the size, location and skin type of the patient. Treatments include laser, shave biopsy, tricholoracetic acid application. Also, electrocautery (electric needle)application can also be used successfully to decrease the appearance and/or flatten the lesions conspicuously located on the face.

In any case, the recovery time after treatment is generally 3-7 days. The healing time for a minor abrasion.

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Q: I am wondering if fat from my own body can be injected into the lip area for fine lines on the lip line and plumping up the lip as opposed to the other filler materials available? Posted on 10/04/2005

A: Body fat may be harvested from one part of the body and injected to another part such as the lips and face. This is procedure is Lipotransfer or Fat Transfer.

This procedure commonly used in areas where tissue augmentation is employed to obtain a desired aethetic effect (ie. lips, face, nasolabial folds etc.) The advantage of this procedure is that the likelihood of an allergic reaction is very low, given that it is the patient's own fat that is being used. Additionally, some people feel that some of the transfered fat may actually survive the transfer or "take" adding to a more lasting effect.

The disadvantage of this procedure is that the longevity of the transfered material is inconsistent and often involves a moderate amount of swelling, bruising and downtime. Both at the donor site as well as the recipient site.

Other filler materials available can be used successfully for lip augmentation. They also have a relatively small rate of allergic reaction. Using fillers, there is no need to create a donor site as with lipotransfer.

It should be noted that fat transfers and filler materials, each have their own specific advantages and disadvantages. Each substance has its own properties and aesthetic appeal.

The nuances of each should be thoroughly discussed with your treating health care professional.

Our office offers a variety of filler and lipotransfer choices.

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Q: I have a problem with blushing. In many situations, most embarassingly when someone calls on me in class, I start blushing for no reason. Even talking to friends, my face will become flushed. I'm a very confidenct person but allof a sudden my face with blush. Are there any treatments to limit my blushing - it's beginning to hurt me socially as well as in the classroom. Posted on 10/11/2005

A: Blushing can have many causes. These include genetic/hereditary, vascular and neurologic causes, and not to mention foods, medications and a variety of medical conditions.

Blushing or "flushing" (when associated with the sensation of heat) can also be associated with rosacea, another dermatologic condition.

Treatment of blushing involves identifying the principal causes. In many cases oral or topical medications can be helpful to alleviate the symptoms. Lasers have been used to decrease the erythema or redness associated with this condition, although it may not treat the underlying reason for the blushing.

As always, a comprehensive medical evaluation is recommended.

Good luck

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Q: I have enlarged jowls. Not due to any diseases. I just passed a physical with flying colors.
Is there a medication I can take to reduce the swelling (my jowls are not sore and I'm within the required weight for my height) or do I require surgery. Thank you.
Posted on 10/14/2005

A: Jowls are best addressed with a surgical procedure. It is unlikely that a medication can effect significant or targeted skin tightening.

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Q: What is the difference between amatuer and proffesional tattos? I have a tattoo that is all black that was done by a tattoo gun. Also, I am african american. What are the chances out me devolping a keloid scar and what can be done to reduce scarring after treatments? Can keloid’s be removed? Posted on 10/20/2005

A: Amateur tattoos are usually done with commonly available inks or pigments introduced into the skin manually. Profesional tattoo use commericial grade inks applied with a "gun" or specially designed apparatus.

It is impossible to determine the likelihood of developing a keloid.

Generally, keloids CANNOT be removed.

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Q: Hello. I was wondering what mechanisms cause the removal of pigmentation, especially hemosidern deposits, in post-inflammatory hyperpigmentation? Would macrophages/monocytes be the key player, and if so, would stimulating blood circulation to affected areas speed up recovery? And if this is true, do you have any suggestions as to how one may increase blood flow to the affected area, ie heat packs or exercise? Thanks for the help. Posted on 10/26/2005

A: The nature of the question is beyond the intended scope of this forum.

Briefly, the complexities governing the development, physiology and resolution of post-inflammatory are not completely understood. Numerous factors contribute to the appearance of post-inflammatory hyperpigmentation such as melanin, hemosiderin, inflammatory cells, mechanism of injury and consitutional skin type of the individual to name a few. To attribute the macrophage/histiocyte as a "key player" in the process of PIH may not be entirely accurate.

In any case, I am not aware of any study demonstrating the benefit of increasing blood circulation on PIH. Such a hypothesis is creative and may merit further study. Along those lines, it would be interesting to further characterize the differnt intra/inter-cellular mechanisms responsible for macrophage/histiocyte epidermotropism, adhesion, signalling, and ultimately apoptosis.

We wish you good luck in your quest for answers to this enigmatic problem in dermatology

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Q: Hi, i am 20 years old and due to rapid growth of breasts during puberty, i have numerous ugly silvery stretch marks on them...i am currently using RENOVA but it doesnt help older stretch marks?
What treatments can i look into to improve indentations of these stretch marks and to normalise the silvery colour back to my normal skin tone?
I would greatly appreciate your advice
Posted on 10/29/2005

A: Stretch marks are difficult to improve, let alone remove.

Essentially stretch marks or striae are modified scars in response to stretching of the skin.

Some laser companies and health care providers claim to improve or even "remove" striae with their devices.

We are yet to come across a definitive, unbiased, clinical study with an adequate number of treated patients to substantiate or support the use of any treatment to improve striae. This includes lasers, light sources, and even creams advertised widely in magazines and television.

The truth is that a void exists for the complete treatment of white / hypopigmented atrophic striae.

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Q: I am looking for information regarding treatment for hypopigmentation utilizing the 308-nm excimer laser. I have read two articles about a study Dr. Roy Geromnemus, MD, conducted in 2001, but have been unable to locate any other information specific to hypopigmentation. Has there been any further research done, or is this procedure currently practiced anywhere in California?
Posted on 10/29/2005

A: Numerous articles exist in the medical literature regarding the treatment of hypopigmented (and depigmented) lesions with the 308 nm exicmer laser. Many of the medical articles are case-reports.

We recommend PubMed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi) where you may have further success in locating the information that you seek.

The laser companies that make the 308 nm lasers and light sources can direct you to an office in your area.

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Q: What is the best way to remove a keloid scar? Posted on 11/20/2005

A: Keloids represent an exaggerated growth of thick fibrous tissue in response even minor injury of the skin. Common areas affected include the chest, back , upper arms, earlobes, and nuchal (neck) area. Although, any part of the body may be affected. Keloids can occur in anyone but tend to be more common in certain races including Asians, Hispanics and Blacks.

It is not always possible to determine who will develop a keloid after an injury, surgical or laser procedure.


Treatment consists of decreasing the size and appearance of hypertrophic scars and keloids. This can be accomplished using various methods including cyrotherapy (freezing), excision (surgical), and even radiation therapy. These methods are generally plaqued by recurrences as a rule. The mainstay of treatment has been injection with corticosteroid directly into the lesion to help shrink and flatten the scars. Lasers have also been used successfully to decrease the size and appearance of hypertrophic scars and lasers.

NOTHING removes scars and Keloids.

Other adjunctive therapies include silicone sheet application, direct massage, and constant pressure to the lesions.


as always, consult your physician

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Q: Hi Doc, I am a 46 y/o, fair, white female who sometimes feels a bit like a human petrie dish with all the skin growths acumulating on my body...most of which are benign skin tags and seborric(sp?) keratosis. My question is-is their a safe laser treatment that can rid these from my body. I have done the scraping, burning, freezing methods and aside from being painful, I can never get them all. Also, does insurance tend to cover this? I am in San Diego and very interested in learning how I can get rid of these painful irritating things. Tired of referring to myself as Barnacle Bill!
Thank you for your time.
M. Posted on 12/01/2005

A: Skin tags and seborrheic keratoses are common benign growths that usually appear during middle adulthood.

Many methods are available to remove these lesions, including the one previously mentioned. Lasers may also be used but in our opinion are not necessarily the preferred manner which to address these lesions. Typically, a scapel, scissor, or cautery tip can be more precise and effective.

We are sorry that we are unable to provide you with insurance coverage information. It is best to illicit that information from your specific insurance company as coverage varies from carrier to carrier. Perhaps your experience from previous treatments can give you an idea.

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Q: can laser treatment get rid of old scars from a surgery? Posted on 01/16/2006

A: No.
Scars are generally permanent, no matter the cause.
Medical and laser treatment can be used to modify, flatten, and fade a scar. NOT remove a scar.

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Q: I have a mild case vitiligo and Im fortunate that it's only visible if I allow myself to get tan. Even then, it's only in a few spots on my face and fingers. My question is in regard to laser hair removal. I'm seriously considering this procedure but I'm nervous it will cause my vitiligo to worsen. My dermatologist wasnt concerned and said it was perfectly safe, but I feel as though he was trying to sell me the service. I currently use bleach and waxing on a montly basis - would a few months of laser removal cause more harm to my vitiligo than years of my current hair removal methods? Posted on 01/17/2006

A: We defer such questions to the treating physician as is stated in our disclaimer page.

Much depends on the setting, fluence (power), skin type, reaction, post-treatment course, and prior history.

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Q: I have read a little bit about nlite laser treatment to help reduce active acne and also acne scarring. What has been your experience or knowledge with this method? Posted on 02/02/2006

A: N-lite is low fluence (power) pulsed-dye laser. Originally marketed for acne treatment and some acne scar revision qualities.

To briefly convey our experience, our office has decided not to pursue acquiring this laser. We have worked with this laser in the past and have found other methods that can be successful for acne and acne scarring treatment. In speaking with many of our dermatology colleagues who are also familiar with lasers, few have differed in their experience.

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Q: Would you recommend artefill as a permanent filler for the nose-to-mouth lines? Posted on 02/13/2006

A: Our office employs the use of many wrinkle fillers including Restylane, Collagen, Human Collagen and Fat transfers.

Artefill consists of plastic beads in a matrix of collagen. Similar to a prior product by the name of Artecoll.

Based on our experience with wrinkle fillers and patient preferences, we do not offer Artefill in any of our offices today.

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Q: Hello, my son has cystic acne,lumps under the skin. Can you prevent scarring damage that will occur underneath the skin. He had one cysts two mths ago,lump went away in a month,the cyst leaked very little fluid. Does this infection move under the skin to another spot to cause another lump?..the cyst healed took 6 wks, but scarred. Does antibiotics/injections in the cyst help to prevent scarring. thank you :-) Posted on 02/20/2006

A: Acne treatments in general may decrease and/or prevent the development of acne lesions and thereby many of the complications of moderate to severe acne.

Antibiotics, injections and many other acne treatments have proven useful and effective.

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Q: Hello, one more question. I would like a light peel. I have found that gylcolic and AHA breaks me out into a wild case of perioral dermatitis. What is a peel that you offer for someone like me?
Thank you. Posted on 02/24/2006

A: Jessner's

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Q: Hello Dr. Mafong, I'm Asian, type IV skin, and had dermabrasion 7 months ago... I know, tough call, now learning that there are countless cases of pigmentary issues.

What's done is done, so I'm wondering about two issues:
1) A red area almost an inch wide that has not faded in color - will Vbeam be appropriate for Asian skin?
2) Demarcation line (under jawline) - could this be treated with any new lasers such as Fraxel to diminish the appearance of the line?

Greatly appreciate your feedback. Thank you! Posted on 02/27/2006

A: We defer all questions regarding procedures to the respective health care professional in charge of your pre and post-operative care, as per our disclaimer.

Thank you.

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Q: Hi i am 21 years old and eversince i have had dark circles around my eyes. I don't want to wear make-up anymore to hide them. None of the creams i have tried worked. I want to have bleached. I was wondering if that is fine or is there a treatment for that such as laser and a like? Posted on 02/28/2006

A: Dark cirlces under the eyes can be due to several causes. The most common being hyperpigmentation and vascular congestion in the blood vessels located in the region.

Hyperpigmentation is generally a hereditary trait. Occasionally bleaching agents may be helpful.

Vascular congestion in the area may be due to lack of sleep or allergic conditions or injury. Improvement in the underlying causes may be useful in decreasing the congestion

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Q: Hello, Dr. Mafong, I am a 28 year-old asian female. I have a question for you. About 3 months ago, I removed my moles by the product call "wart&mole vanish" but those spots where the moles were turned red and left shallow scars. Now I feel so stupid for what I have done, but it's too late, so I need to do something for those spots. I do understand that you can't remove the scars, but is it possible to get rid of the redness by laser so that I can at least cover them up by makeups? or is it too soon to do some kind of treatments at this moment? Posted on 03/08/2006

A: Laser treatments can assist in allowing the redness to resolve faster.

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Q: Hello Dr.
I am a 36 year old woman with what I believe to be Rosacea, and visible blood vessels, capillaries on my cheeks and nose. I have read about the Vbeam laser and would like to know what the success rate is of treating my condition with the Vbeam, as well as the recurrence rate of blood vessels reappearing on the face. thank you. Posted on 03/08/2006

A: The success rate is difficult to quantify as is the recurrence rate. Both are subject to variability and differs from individual to individual.

Generally speaking the Vbeam laser improves redness from blood vessels and capillaries by one or two grades, in most people.

Many things affect the results including technique, experience and compliance with post-treatment recommendations.

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Q: Hi,

Do you recommend the Vbeam or a standard IPL for treatment of visible facial blood vessels and redness due to Rosacea? Is there a difference between the two? Does one laser seem to be more effective than the other?

Thanks!

Thank you. Posted on 03/08/2006

A: We have used a pulsed-dye laser with success on many patients.

Many differences exist between the two treatment modalities.

We do not routinely recommend IPL treatments.

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Q: Do you offer VBeam treatments? Posted on 03/15/2006

A: yes

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Q: Hi Doc,

i just learned that i have syringomas. They refered me to laser treatment. Is there any other treatments (e.g rubbing cream or liquid)available beside laser. Please advise. Posted on 04/10/2006

A: please see previous posts regarding syringomas. many effective treatments exist

03/05/2004
07/29/2005

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Q: Hello Doctor! I had a test removal done on a cosmetic tattoo yesterday and it turned black. It is on my face. The doctor I went to told me it may still be able to be removed (the black mark), but I will have to wait 8 weeks for the next treatment. Is this true?? Posted on 04/13/2006

A: Please read disclaimer for this section

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Q: I am 25 years old and for the last 10 years, I have struggled with spider veins developing on the sides of my calves and outer thighs. My left calf has very noticable veins. Please provide more insight on whether your office performs Sclerotherapy. Do you have a cost effective plan that may be covered by insurance? Also, I read in Self Magazine, April 2006 issue, that a new treatment replaces saline for glycerin. Do you provide this treatment at your office? Thank you for your help in calming my nerves...I would really love to have beautiful, health-looking legs! =) Posted on 04/19/2006

A: Our office provides treatment for "spider veins" / telangiectasias by a variety of modalities including sclerotherapy and laser.

Insurance companies typically DO NOT cover this procedure.

Hypertonic Saline is still the gold standard for sclerotherapy, although several other options exist including but not limtied to glycerin, polidocanol, Sotradecol, etc.

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Q: Hi Doctor,
I am alomost 7 months pregnant and i have some stretch marks which are stil red and i was wondering if there is any treatment to get rid of them and i also wanted to know if they are removable with laser, if so how long after i give birth do i have to wait to get that type of treatment?

please help...thank you!!! Posted on 04/28/2006

A: Stretch marks or striae are a modyfied for of scar in response to rapid stretching of the skin.

Laser treatments are available to improve stretch marks, particularly the ones that are red. Treatments can be initiated within several weeks after delivery and can improve the appearance. However, no treatment exists that completely removes them. Please be aware of this fact. It is unlikely that a cream will remove stretch marks.

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Q: I have a small venous lake on my lip. Ugh! I'm only 49. I am looking for someone that will remove it with a laser treatment (pulsed dye, or carbon dioxide).

Thank-You Posted on 05/04/2006

A: Venous lakes respond quite well to pulsed-dye-treatment. Carbon dioxide will get rid of the venous lake but is more apt to leave a small mark.

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Q: I am a 31 yr. old Laotian, just quit smoking last year, and just had a baby. I want to get rid of my uneven skin tone. What is the best treatment? Is laser ok for asian skin? thanks Posted on 05/25/2006

A: Your skin type and tone should ideally be evaluated by a health care professional to determine with you what the best treatment options are specifically tailored to you.

With regards to laser use on skin of color. Much depends on skin type and the laser being used.

Generally, ablative lasers should be avoided in skin that may hyperpigment. Vascular lasers are usually well-tolerated at appropriate settings. Care must be taken with other lasers and light sources.

Do not discount the benefit of specialty peels and the prudent use of sunscreen.

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Q: Hi,
I had an IPL treament (don't want to name the clinic)for brown spots on my face, and the operator accidentally touched part of my eyebrow. It felt hot when it happened, so she put ice on it, and right after the treatment it looked OK but about an hour after I got home, the hair fell out and the skin was red. Will my eyebrow grow back, and how long will it take? Thanks! Posted on 06/11/2006

A: Unfortunately, as per our disclaimer (see disclaimer page), we are unable to comment.

May you have a quick and uneventful recovery.

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Q: Hello:
I am a Black female 46 years of age. I have dark spots on my face that I would like to have work done on. I am also looking to have permanent eyebrows and eyeliner done. Do you have experience with Black skin and do you do the other cosmetic procedures I mentioned? Posted on 06/13/2006

A: The health care providers at the Dermatology & Laser of Center of San Diego have experience with many skin types. As with any new lesion, a pigmented or discolored should be evaluated by a health care professional.

We do not offer cosmetic tattoos

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Q: I had the Fraxel procedure on some surgical scars on my back two months ago. After the procedure, the area around each scar (approximately 3/4 inch X 1/2 inch) was red. Unfortunately, these "red rectangles" have only faded slightly in the two months and are still very visible. My doctor looked at them a few weeks ago and said they would eventually fade completely. I'm really worried. I have never heard of this happening. Can it take this long to heal? Is there anything I can do? Posted on 06/20/2006

A: "The Dermatology & Laser Center of San Diego regrets that it is unable to comment, diagnose, offer recommendations, treatment or advice regarding procedures and subsequent outcomes performed at other facilities. If you have questions regarding a treatment you received, it is strongly urged that you contact the physician who is familiar with the specifics of your case. "

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Q: i have vitiligo in my legs and arm; i have read that the excimer laser used along with tacrolimus 1% will help get rid of the white spots? is this true and if so, do you have this treatment available at your clinic?? Posted on 06/26/2006

A: Both the excimer laser and tacrolimus (Protopic) have been used with variable success for the treatment of vitiligo. With vitiligo, no one single treatment provides complete response, repigmentation or resolution of the condition.

Unfortunately, we do not employ the Excimer in our laser center. To find a health care provider that has the Excimer laser, please contact the manufacturers of this laser. One such company is PhotoMedex.

Tacrolimus is an ointment available by prescription.

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Q: Do you remove permanent makeup tatoos, I have my eyebrows done and would like to have it removed? Posted on 07/11/2006

A: Cosmetic tattoos can many times be faded or remarkably lightened by the use of laser treatments. As with any procedure, many factors must be considered. These include but are not limited to patient skin type, tattoo color, location, type of ink used etc.

It should be noted that tattoos often require mutliple treatments and at times may not be completely removed despite many treatment sessions. Having said that, many patients have had excellent outcomes for laser tattoo removal in our office.

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Q: After pregnancy, many spots in my body became dark brown such as my armpits, bikini lines, etc. Is there a way I can lighten the color and even it out with laser prosedures?
Posted on 07/12/2006

A: Darkening of certain areas of the skin is a common observation in women beginning during pregnancy and often lasting well after delivery. When located on the face, it is referred to as melasma or the "mask of preganancy." Unfortunately this and other hyperpigmented areas on the skin that develop as a result of being pregnant are not usually amenable to laser treatment.

It should be mentioned that the new onset of hyperpigmentation may also be a sign of other medical conditions. As always, it is advisable to seek the advice and recommendations of your primary health-care provider.

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Q: do you offer laser treatments for the treatment of psoriasis? Posted on 07/14/2006

A: Unfortunately, we do not. You may find a referral from Photomedex, a company that makes a laser to treat psoriasis.

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Q: After IPL on my face, one side of my face which was treated on a higher setting was left with streaks that are visible as white and red markes where the ipl device treated. It has been four weeks and they still remain highly evident. Will these resolve over time or what can I do to fix this? Your advise would be greatly appreciated! Posted on 07/25/2006

A: Please read our disclaimer and contact your health care provider

We regret that we are unable to comment on individual treatments.

Thank you for your interest.

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Q: I am a really thin 31yo; however, when I reached puberty at around 14, my body changed significantly and I have major, obvious white stretch marks at the bottom of my back (above my buttocks). I am an avid exerciser, but of course, no amount of exercise can improve the appearance of these white stripey stretch marks. I have heard of newer therapies for removing old stretch marks. Do you have any insight? Posted on 08/02/2006

A: Striae or stretch marks are linear marks on the skin that represent abnormal collagen formation. Somewhat similar to what is seen in scars. Stretch marks, however, are often depressed.

These lesions are quite common and can result from preganancy, puberty (rapid stretching), change in girth or size (again rapid stretching).

Unfortunately, no consistent treatement exists for the treatment of these lesions, including laser treatment. Many creams over-the-counter and by prescription have been touted to improve or eliminate these marks. However, definitive reproducible results in peer-reviewed medical literature remains elusive. Beware of marketing claims and advertisements.

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Q: Hi Doctors,
I'm a 33 year old woman who's looking for a solution to bikini area hair growth. Waxing and tweezing seem to cause ingrown hairs, irritation and scarring. Also the hair growth seems to be getting worse over the past couple of years. Research tells me electrolysis is the most permanent option, but I'm looking for an expert opinion. Posted on 08/08/2006

A: Many options exist for removal of unwanted hair. Each has its specific characteristics, advantages, disadvantages and of course risks. Electrolysis and laser hair removal are no different.

Laser hair removal is efficient in permanently REDUCING the amount and density of hair in the treated area. Several treatments are required and maintenance treatments may be helpful.

Generally, laser hair removal is well tolerated. It works best on dark, thick, hair against lighter skin. Some lasers are able to address dark hair in darker skin types. Laser hair removal is less effective on red, blonde or gray hair. Scarring is rare when performed by well-trained and experienced health care providers.

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Q: What is the best treatment for fibrous papules on the nose? I have heard of both CO2 laser and cryosurgery. Posted on 10/04/2006

A: Fibrous papules, or angiofibromas, are benign lesions that may occur on the face.

Fibrous papules may be removed electively. Effective treatments include, cutting/shaving the lesion with a scalpel, electrocautery ablation, C02 laser, chemical ablation, and cryosurgery.

The method used depends on many variables including but not limited to size, location, patient skin-type, etc.

It is best to determine which method suits you best with the aid of an experienced health care provider.

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Q: Please explain the difference between Restalyn and Sculptra, and could you please give your opinion on each? Posted on 10/11/2006

A: Restylane is a dermal filler made of hyaluronic acid (non-animal source). Hyaluronic acid is a naturally occurring substance in skin. It is currently approved in the U.S. for the treatment of facial wrinkles and folds, including nasolabial folds. Advantages of restylane include, no skin testing is required, results may last 6 months or more, according to the company, and no animal proteins are contained in the product. Disadvantages noted by some practitioners include that it may cause temporary swelling, local lumpiness and discomfort during injection.

Sculptra is a synthetic material, poly-L-lactic acid, a biocompatible substance. It is currently FDA approved in the U.S. for treatment of facial fat loss or atrophy in people with human immunodeficiency virus (HIV). Advantages of Sculptra include that it does not require skin testing, can be used for larger areas of volume loss in patients with HIV, and duration is reported to be up to 2 years. Disadvantages include multiple treatment sessions required, pre-injection mixing required by practioner can lead to error, limitation of FDA approval.

Deciding on which of either filler substance is right for you is best reached after a thorough consultation with your experienced health care provider.

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Q: I have a nevus of ota under my right eye. There's also a little blue spots in my eye. Do you have experience in treating nevus ota by laser? If so how can I make an appointment? Or if you did not treat nevus ota, do you know experienced doctors in this?
Thank you.
Simcerely,
Rad Posted on 11/13/2006

A: Nevus of Ota is usually a congenital lesion (birthmark) located around the eye region. It consists of pigment located in the deeper portions of the skin. Occaisionally, some pigment may be present in the the sclera (white part of the eye).

Lasers are useful to help decrease the coloration of the nevus. In some cases it can result in remarkable clearance; but not always.

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Q: Do you offer this type of laser treatment for a severe case of Poikiloderma? or what treatments do you recommend? I'm a fair redhead. I found this article that recommends this type of laser the 532 Nd: YAG for the treatment of the vascular,and pigmentary Components of Poikiloderma of Civatte. Have you had any sucess with treating this discoloration?
Posted on 12/11/2006

A: We have had success improving the appearance of poikiloderma with the use of the pulsed-dye laser / Vbeam.

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Q: Hi, I am 27 years old and have had chicken poc scars since I was 14. My scars are white and I had some surgery done to help. Is there any effective treatment for the white discoloration?? Posted on 12/18/2006

A: Hypopigmentation in scars is a difficult problem to address. Some patients have had temporary improvement in the appearance of the hypopigmentation with treatment with ultraviolet spectrum lasers such as the excimer laser. Generally, the benefits are transient and require maintenance therapy. The risks, benefits, and alternatives should be discussed with the treating health care professional.

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Q: Posted on 12/18/2006

A: Hypopigmentation in scars is a difficult problem to address. Some patients have had temporary improvement in the appearance of the hypopigmentation with treatment with ultraviolet spectrum lasers such as the excimer laser. Generally, the benefits are transient and require maintenance therapy. The risks, benefits, and alternatives should be discussed with the treating health care professional.

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Q: I am a 26 year old white female, and have had over 10 surgeries to remove a keloid on my ear caused from an ear piercing at the age of 8. Radiation has been performed, excision and steroids. The keloid is now larger than my ear itself. I've heard about the V-Beam procedure, is this fairly new, and is it more effective than other procedures? Posted on 01/04/2007

A: Keloids are a difficult condition to treat successfully. As you have experienced, many treatments can result in recurrences.

V-Beam or the pulsed-dye laser is yet another treatment option not only for keloids, but also for hypertrophic and erythematous (red) scars. While the V-beam is unlikely to result in complete resolution of the lesions, in many cases it may be helpful. Much depends on the specifics of the case.

Many times, successful treatment of scars and keloids relies upon a multi-faceted approach, utilizing various procedures and treatments. It can be an ongoing and arduous task.

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Q: I suffer from hyperhydrosis of the upper lip and forehead. How effective is Botox in treating these areas? Posted on 01/09/2007

A: Botox (Botulinum toxin type A)is effective in the ongoing treatment of hyperhidrosis of many areas, including the axilla and palms.

Botox essentially interrupts the signal from the nerves to the sweat glands, decreasing sweat production in those areas.

Botox similarly interrupts the signals from nerves to volutary muscles. Hence its effectiveness for the treatment of facial wrinkles primarily caused by movement.

You should discuss the risks and benefits of your particular case with the treating physician.

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Q: My preteen daughter is very self conscious of her cafe au lait birthmark on her thigh. Is laser surgery an option for removal? If so, is this a one time procedure? Is it a painful procedure? Are other options available? Posted on 01/10/2007

A: Cafe au lait lesions are tan to brown patches located almost anywhere on the body.

Results for removal using lasers are variable often requiring multiple treatments and much depends of the lesion itself, skin type, type of laser used.

Other questions are best answered after direct evaluation and consultation with the treating physician.

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Q: I have permenant eyeborw make up. is there any way to remove it. There was nothing wrong with my own eyeberow and i dont know why i had made such a losy decision. if i get rid off this tatto i will be able to grow my own eyebrow. Posted on 01/13/2007

A: laser hair removal may removal part or all of the eyebrow tattoo. Typically, laser tattoo removal does not damage hair permanently.

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Q: I'm 37 with a fair complextion and barely spend any time in the sun at all. I started having several actinic keratosis spots on my forearms and calves appear at age 36. I tried efudex, tazorac, laser and ofcourse cryosurgery. I've recently had 10 to 15 small spots frozen (3-4 weeks ago). How long does it usually take for the redness to subside? Are there any creams to help this process? Posted on 01/14/2007

A: "The Dermatology & Laser Center of San Diego regrets that it is unable to comment, diagnose, offer recommendations, treatment or advice regarding procedures and subsequent outcomes performed at other facilities. If you have questions regarding a treatment you received, it is strongly urged that you contact the physician who is familiar with the specifics of your case"

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Q: Hi, I am an asian female, and I just had chemical peel about two weeks ago. After my chemical peel, I had some red, and brown areas around my sides of my eyes. How do I get rid of them?
Posted on 01/22/2007

A: Thank you for your interest in the Dermatology & Laser Center of San Diego.

We regret that we are unable to answer your question.

Please refer to our first page on "Ask the Experts" specifically to the section that begins with, "The Dermatology & Laser Center of San Diego regrets that it is unable to comment, diagnose, offer recommendations, treatment or advice regarding procedures and subsequent outcomes performed at other facilities. If you have questions regarding a treatment you received, it is strongly urged that you contact the physician who is familiar with the specifics of your case."

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Q: hi doctor! well i have a large cafe-au-lait birthmark on my left thigh i was wondering if there is any way to remove it. I've been with a couple dermatologists and they have told me that is very hard to treat it, that there might be no way. I really want to know of there is a way to make that happened? Posted on 01/29/2007

A: A very similar question and answer has been posted only 4 questions previous to this one.

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Q: Is the CO2 Laser safe to use on African American skin for the treatment of acne scarring? Posted on 01/30/2007

A: The CO2 laser is considered an ablative laser. It can be used to treat acne scarring, uneven scars, and fine lines and wrinkles.

Ablative lasers are typically used on fair or lighter skin tones to minimize the complications and risks.

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Q: i have a dark brown birthmark thats from my middle cheek towards my eye and bout an inch and a half thick. my dermatologist suggested laser to remove it.. my concerns are, can the doctor overdue it meaning making it lighter than my own skin? how long is the recovery? would it be noticable for other people to see while recovering? just reading about this, it seems like it takes 4-6 weeks for it to be normal and is it the best way to remove birthmarks? Posted on 02/02/2007

A: All excellent questions that should be posed to the evaluating physician. Many factors contribute to successful treatment of birthmarks. The include but are not limited to nature of the lesion, type of skin being treated, the type of laser being used, the experience of the provider, care of the lesion after treatment.

No "best" way exists to universally remove all birthmarks unfortunately.

Also, know that it is not always possible to completely remove all birthmarks.

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Q: I’m 44 years old and have noticed a blue vein surfacing under each of my eyes. A friend with the same problem was able to shrink them with laser treatment. I also have a few tiny red veins on my chin. What would you do or recommend? Posted on 02/06/2007

A: Facial reticular veins located periorbitally are a difficult condition to treat. This vessels tend to be about 2-3 mm in width and of varied arborization. Several different laser have been used to try and diminish their appearance with some success. But, a single treatment modality is yet to emerge that offers definitive resolution for this condition.

"Red veins" on the chin may generally represent telangiectasias. Telangiectasias may be treated with a variety of vascular lasers to help diminish the redness associated with their presence. The treatments may include the pulsed-dye, diode, and frequency doubled Nd-YAG lasers to name a few. As always it is recommended that you seek treatment from a qualified health care professional.

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Q: I had a phenol peel almost two weeks ago. I'm pleased with the results, however, the skin above my upper lip is still red,irritated,etc. I can't smile,laugh,eat,etc w/out exp. some discom. My surgeon said to continue using Euercin. Please advise Posted on 02/27/2007

A: We are sorry but our panel is unable to answer your question. The reason is clearly stated in paragraph 5 of the "Ask the Experts" section.

http://www.dermlasercenter.com/bin/experts.cgi

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Q: Hi, I was wondering do you give prescription for accutane? I have been suffering from acne ever sine my teenage years. I am now 22 and want to know if you give accutane prescription? I have somewhat moderate acne but to me its considered severe.Its very emotional for me to cope with. I want my confidence and self-esteem back. I have been to some dermatologist that will not prescripe me accutane. I have tried so many products that has never worked. I need a dermatologist that knows what I'm feeling and willing to give me accutane course and monitor me through it. Most dermatologist I believe don't want to put me on accutane because either they don't want to go through all of the paper work or don't know how i'm feeling. also, what sort of insurance do you accept? thank you , hope to hear from you soon Posted on 02/28/2007

A: Our office treats a variety of dermatologic conditions including mild, moderate and severe acne.

Our practitioners utilize a variety of topical, oral, and other FDA approved medications to treat acne, including isotretinoin (accutane etc). We readily participate in the i-Pledge program for isotretinoin.

The treatment regimen is solely determined on a case by case basis, as you may realize, because everyone's needs and medical history are different. A treatment program is best deterimined after careful evaluation and consulation, weighing the risks, benefits, alternatives, etc.

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Q: What have you found to be the most effective method to treat sebaceous hyperplasia of the face? Spot treating these hyperplasias with an acid has had only limited success. Posted on 03/19/2007

A: Sebaceous hyperplasia are skin colored to yellow papules, generally 1 to 4 mm located predominantly on the face. Occasionally, one can find a central umbilication or dell present, representing the central pore of the oil gland.

Various methods can be used to improved the appearance of sebaceous hyperplasia. Generally, these include destructiove methods using electrocautery, cryosurgery, lasers, and tricholoroacetic acid.

Treatment options depend on the experience of the treating physician as well as the type of skin that is being treated. It would be difficult to classify one treatment as most effective on a broad scale.

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Q: i have a big scar on the middle back part of my right leg. What do you think is the best way to remove it. I'm so desperate that i even considering covering it up with tattoo. Please help.... Posted on 04/09/2007

A: Our recommendation is to have an evaluation by a qualified health care professional as it is impossible to render useful information without a clnical evaluation.

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Q: my daughter who is 6 months old has a strawberry type hemangioma the size of a dime on her left on her cheek not near her mouth or ear. on the side of her cheek. When born it was flat but came raised when she turned 3 months it has not grown since then, can it be treated with pulsed dye laser, at age. Posted on 04/19/2007

A: Cavernous hemangiomas can be treated with a vascular laser such as the pulsed-dye laser. Usually several treatments are required.

We have treated patients as young as 1 month of age in our office.

It should be noted that the natural history of cavernous hemangiomas is for slow but almost total resolution over a period of years. Half resolve by age 5 and almost all by age 10.

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Q: Are there any cases in which hyperpigmentation may be indicative of serious illness? Posted on 04/19/2007

A: Hyperpigmentation can be indicative of a medical condition. Much depends on the history and location of the hyperpigmentation.

Hyperpigmentation can develop after mild local inflammation of the skin or can be seen in syndromes associated with diabetes or hormone abnormalities, to name a few conditions.

Hyperpigmentation may also occur during pregnancy.

Basically, hyperpigmentation can have many causes and associations; some serious and some benign.

A physician can best help you determine or investigate the etiology of acquired hyperpigmentation.

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Q: just want to ask if theres a treatment or cure for steatocystoma multiplex???hoping for your reply as soon as possible..thank you so much Posted on 04/23/2007

A: The condition steatocystoma multiplex is a condition characterized by several cyst-like structures. It can be hereditary

Treatment options include aspiration and surgical excision and even laser ablation of the individual cysts. Options for cure are limited.

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Q: I have a dilated blood vessel reaching out from one nostril. Can your office remove it pretty easily using a laser? Will there be any scaring or redness that would not resolve?
Posted on 04/25/2007

A: Telangiectasias can be successfully treated with a laser treatment. It should be noted that no treatment is absolutely effective in every person and that no procedure or treatment is without risks, including but not limited to the development of redness or scar.

Having said that, the laser and laser settings employed in our office help minimize the risk while achieving good results on vascular lesions on the face.

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Q: A mole on my forehead recently started hurting when touched. I wanted to know if I need to have it removed or if the pain should go away on its own? Posted on 05/03/2007

A: It is recommended that you seek a dermatologic evaluation.

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Q: I need to have a small abount of frizzy hair removed on what I refer to as the "widows peak." Is the GentleLase as effective as the Gentle Yag by Candela? My hair is dark and coarse.

Thank you! Posted on 05/17/2007

A: Both the GentleLase and the GentleYag are FDA approved for laser hair removal.

The GentleYag is generally used for darker complexions with black hair as it is less likely to cause epidermal injury.

The Gentlelase is used for lighter skin complexions with dark hair.

Our office utilizes both lasers.

In our experience, each laser provides excellent long-term hair-reduction. If given the choice and without contraindications, the Genltelase may provide slightly higher efficacy.

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Q: Hello I am contacting you with a question about my mother. She has always had some dark spots on her face (which I initially thought was from her nerves). Over the years it has gotten worse and now covers approx. 80% of her face. Her doctor told her it was hyperpigmentation and all she could do was cover it with makeup. Is there any type of treatment for this? Should she make an appointment with a dermatoligist? It is really beginning to take a toll on her self-esteem. Posted on 05/24/2007

A: Many causes for hyperpigmentation exist. It is recommended that she seek an evaluation from a dermatologist or other health care professional

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Q: i have a raised scar on my upper lip, underneath my nose. do you offer dermasanding or any other effective methods to diminish the appearance of unsightly scars? Posted on 06/20/2007

A: Our office offers many different treatment alternatives for scars. Much depends on the scar and skin tone.

Unfortunately, no scar can be removed completely. Many times, their appearance may be improved.

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Q: Hello Doctor,
My name is Karla and I am 27 years old and I have facial hair, and I dont know what to do, I was told that laser hair removal is the best option, but i was told that the hair will come back in a cupple of years after the removal, Is this true? Posted on 07/13/2007

A: Unwanted facial hair is a common problem. Laser Hair Removal is a safe, effective treatment option. Generally speaking, multiple treatments are required and typically results long-term hair reduction. Results vary from person to person and from laser to laser. The hairs that remain or regrow, typically are thinner and more sparse in distribution. Often, additional maintenance treatments can be utilized to maintain the area completely free of unwanted hair.

Different laser hair removal lasers are designed to be safer for certain skin types. Using the appropriate laser along with pre and post treatment information and care greatly helps to decrease the incidence of complications.

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Q: My son would like to join the military, but he has a tattoo on his neck that he would like to get removed. How painful is the tatoo removal procedure? and What is the average healing time of the procedure? Posted on 08/10/2007

A: Laser tattoo removal performed in our office is nearly painless. We administer local anesthetic to the area being treated and patients are often quite comfortable and tolerate the treatment well.

Healing time varies from individual to individual. It is not uncommon to have wound take 10 to 14 days.

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Q: Hello Doctor,
My question is regarding the perioral lip lines i am 35 and a non smoker but years of sunbathing has taken its toll, and i am left with fine lines especially in around the upper lip area, what is the best option in order to "turn back the clock"
Posted on 08/12/2007

A: Perioral lines are a common complaint. As with most cosmetic concerns there is not a single best option for everyone. It must all be tailored to the individual, given the specific setting. Age, gender, sun damage, skin type etc., all play a role in determining what the best alternative(s) are to lessen the impact of these lines.

Some treatment options that have been useful include collagen, hyaluronic acid gel fillers (eg. Juvederm, Restylane), other fillers, laser (ablative and non-ablative technology), chemical peels, and even botox. Often, a multi-faceted approach is used to achieve the best results and minimize the risks. Surgical options to address this problem specifically remain limited.

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Q: I'm a 24 year old dark skinned African American female suffering from unwanted facial hair particulary on the chin. I started shaving at the age of 20 and now have dark spots under my chin as well as on the sides of my chin. I'm very self conscious about this. Ive read about different methods to clear this up. What do u recommend would be the best treatment for this discoloration and unwanted hair? Posted on 08/22/2007

A: Unwanted facial hair can be improved with laser hair removal treatments. It is important to keep in mind that multiple treatments are necessary. Routine maintenance treatment periodically may also be helpful to continue the desired effect.

Shaving of facial hair can lead to ingrown hairs and infection; eventually causing hyperpigmentation and scarring. If this has developed in the past, it is recommended to discontinue shaving the area.

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Q: i am 26 yr old male, but my scalp hair has been thinning out since last 2-3yrs. its not baldness but due to extreme thinning it looks like baldness especially when wet. what should be done about it? Posted on 08/30/2007

A: Multiple medical causes may be responsible for hair thinning. Male pattern baldness may also manifest itself in hair thinning in some cases.

If hair thinning is a concern, a medical evaluation would be a good idea to rule out treatable cause.

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Q: Hello,

I have a port wine birthmark on the right side of my face near my ear and upper part of my neck. I am looking to have it removed and was wondering what treatment would be best. I have a caramel/brown skin tone. Also, would such a procedure be cover by insurance. I have a PPO through Blue Cross/Blue Shield. Posted on 09/05/2007

A: Port wine stains (PWS) (birthmarks) or capillary malformations can be treated with lasers to improve, lighten and in some cases resolve the lesions. Note that it is not always possible to completely remove the lesion despite multiple treatments. It is best to treat PWS earlier rather than later as these lesions can thicken and develop nodularity making them more difficult to improve with laser.

Typically multiple treatments are required. In our experience, a pulsed-dye laser (eg. V-beam by Candela Corp. Wayland, MA) have yielded the best results with decreased risks of side-effects, scarring or hyperpigmentation.

A variety of skin tones can be treated with this laser.

Insurance coverage varies. It is best to contact your insurance company as well as the treating medical office to address the specifics of your case with regards to cost, coverage, and personal financial responsibility etc.

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Q: What is the best procedure for nasolabial folds Posted on 09/05/2007

A: Nasolabial folds or laugh lines are a common plaint of patients, young and old.

They can accentuate due to movement and often become more pronounced with the passage of time as the redistribution of facial fat occurs. This leads to areas of volume loss and deepening of the nasolabial folds. Other factors include history of sun exposure, changes in elasticity of the skin, genetics, to name a few.

Many procedures are available to improve the apperance of nasolabial folds. No one best procedure exists. Rather, it is best that a variety of options are considered together with a thorough understanding of the different risks and benefits inherent to each alternative.

Options include but are not limited to collagen injection, hyaluronic acid gel injections, and other wrinkle fillers of synthetic origin. These fillers address the volume loss experienced in this part of the face.

Surgical options include a face lift, thread-left and in some cases, localized facial lipo-sculpture.

With so many options it is best to consult a quailfied physician to review which options or combination of options would be most appropriate for you.

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Q: Hello Dr,
I'm from Ensenada, Mexico. I have an 8 month old daughter with what I think is a strawberry hemangioma below her right eye aprox. the size of a bean. I would like to know what's the cost for an examination of her hemangioma, and if it applies for treatment, what's the cost for it.
I would apreciate any information you could provide. Posted on 09/27/2007

A: We apologize but, as stated in our introductory page, our fee scehdule is NOT available through the website.

We are availble for consultations for various laser treatments for birthmarks, including "strawberry hemangiomas", supericial and deep hemangiomas, port-wine stains, and a variety of other vascular lesions.

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Q: i have a popped blood vessel on my cheekbone that's about 1/2 inch long. it's been there for almost six months! people tell me it will go away on its own, is that true? what other options are there? Posted on 10/10/2007

A: Vascular lasers can be used with success on improving the appearance of a variety of "red" lesions.

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Q: Nearly four months ago I abraited my elbow & forearm by a fall onto very rough concrete. The wound is 2.5" long X 0.75" wide. It has healed & is flat but is still red. It appears that I will have a significant scar (discoloration for the most part. Can the scar's noticebility be reduced (at least the discoloration)? Is this type of treatment something that you can do? Posted on 10/11/2007

A: While no scar can be removed or "erased" by any means, Red scars can be improved considerably many times after treatment with lasers. The scar will almost certainly remain, but its color and appearance can be improved.

Our office utilizes the V-beam laser with considerable success in most patients.

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Q: I have 2 unwanted tattoo's on my body. One is my ex-boyfriends name and the other is a butterfly (in color ink). I am very interested in getting them removed and was wondering what kind of procedures you do? Lasers you use, if you do? And any other information I would need to know about the tattoo removal process. Posted on 11/05/2007

A: Our office offers laser tattoo removal with a Q-switched laser, effective in various skin types.

Generally, multiple treatments are necessary and complete removal is not always possible.

Laser tattoo removal remains one of the safest and most effective manners by which to remove or fade unwanted tattoos.

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Q: Hi my name is Tiffany and I am interested on getting a tattoo removed. It is very small tattoo on my finger.
If i could get some info on the proceedure and cost. that would be great.

Thanks,
Tiffany Parker Posted on 11/13/2007

A: Laser tattoo removal is generally accepted by many as the tattoo removal method of choice. Usually, multiple treatments are necessary and it is important to note that not all tattoos can be removed completely. An important fact to keep in mind. Much depends on the color and type of tattoo being treated.

We encourage all our readers to read the first page of the "Ask the Experts" section. As clearly stated we are unable to provide cost information via this forum.

Thank you for your interest.

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Q: I have a light brown discoloration on my left upper back which is attributed to beckers-naevus. I was wondering what the success rate for this treatment would be. Posted on 11/14/2007

A: A Becker's Nevus is a "congenital" lesion that usually manifest during the teenage years (or second decade) or later. More common in males, it is characterized by a light brown to tan patch or sometime even a slightly raised plaque located in the shoulder or upper torso region. Terminal or thick hairs are often found within this patch. Commonly, Becker's Nevi are not associated with any functional limitation or deficiency. Occasional associations have been made but they tend to be the exception rather than the rule. The pigmentation can become more pronounced with exposure to sun.

Addressing the cosmetic aspect of Becker's Nevi can be challenging. Laser Hair Removal may improve the degree of hypertrichosis or hair portion of the lesion. As usual multiple treatments are necessary. These lesions have also been treated with a variety of Laser's that target varying degrees of pigmentation in the skin. Our experience has been that results are inconsistent but worth considering in case by case basis and after thorough discussion about reasonable and likely outcomes.

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Q: Can you remove Pearly Penile Papules? Posted on 11/20/2007

A: These lesions consist of multiple anigofibromas. Benign lesions. Numerous methods can be employed to remove them including ablation, excision, etc.

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Q: I have RA. On Minocin 200 mg daily (2 years) sulfasalazine 2000 mg daily, plaquenil 300 mg daily. The Minocin has caused blue patches on my legs like bruises but never go away. Can a laser help.
Posted on 01/02/2008

A: Several medications are known to be associated with development of pigmentation.

Minocycline hyperpigmentation can occur with a cumulative dose as little as 100 gm. This pigmentation is often described as blue-black occurring in areas of previous injury, inflammation or in characteristic areas such as the shins. Under the microscope, the lesions appear similar to a tattoo.

Hydroxychloroquine (plaquenil) can also be associated with a nearly identical hyperpigmenation pattern.

Therefore care should be exercised in automatically assigning cause to one medication without a thorough clinical evaluation.

In the case of minocycline hyperpigmentation, laser treatments may be helpful.

To address drug-induced hyperpigmentation specifically, discontinuation of the offending medication should be considered if medically feasible.

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Q: Had a RELUME treatment done on a white, old scar
about 10 days ago. The scar has been and still is bright red.
Will this go away? And how long will this take to turn to normal.
Perhaps you have an answer. Thank you Posted on 11/09/2008

A: Our office DOES NOT comment on treatments performed by or at other offices. This is clearly stated in our disclaimer / information page provided on our website prior to submission of any questions.

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Q: I have genital warts on my scrotum after a night of mistake. I tried every medication nothing seem to help. I was wondering if you guys do laser treatment, and will insurance cover it, if not the average cost and etc. I hope you can help not only get rid of them but give me my confidence back Posted on 12/19/2008

A: Genital warts or condyloma accuminata generally occur after direct contact with an infected area. Commonly condyloma result after sexual intercourse with an affected partner. Generally the lesions are skin colored papules appearing individually or in groups in the genital area.

It is important to seek treatment to prevent further spread of the lesions both to other people and individually. In women, certain strains of condyloma accuminata are associated with the development of cancer and therefore should be treated sooner rather than later. Also, it is recommended that individuals afflicted with one sexually transmitted disease be screened for other commonly contracted STDs including but not limited to HIV, Syphilis, Gonorrhea, Chlamydia etc. Often times the presence of one STD heralds exposure or infection with another STD.

A variety of treatment options exist for condyloma. Generally these include locally destructive methods such as freezing, acid application, electrodesication, medicated topical solutions etc. Another option includes using immunomodulator creams, like Aldara. Lasers can be employed as a locally destructive modality. However, many practicioners do not consider lasers to be the standard of care do to many factors including cost, inconsistent insurance coverage, scarring and possible transmisibilty of viral particles during treatment; to name a few resons.

A medical evaluation is recommended for anyone suspected of having condyloma accuminata.

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Q: i got chicken pocs at the age of 18 and now iam 35 the scars are still on my face i used coca butter vin e but the scars are still there what can i do to get rid of these spots all over my face Posted on 12/25/2008

A: Scars of any etiology are difficult to address. Scars are the end result of a significant tissue injury and are the result of the body's repair mechanisms. Unfortunately, the tissue replacing the normal skin is often of a different characteristic and quality. This imparts an altered appearance and feel to the scarred area.

Treatments can be utilized to modify the scar tissue, not necessarily eliminate or "remove" scars. Most scars tend to soften and flatten over time as "remodeling" of the collagen occurs. Much depends on the nature of the scar, location, patient skin type etc. to determine the best treatment option.

For example, lasers can be used to lessen redness and firmness from scars. Other lasers can be used to smoothen the surface that has been altered due to scarring.

Any treatment has the potential to injure the skin and thus cause additional scarring. Therefore, care and some risk must be assumed prior to embarking with any scar treatment.

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Q: Is there an effective treatment for treating hemosiderin staining around the lower eyes and cheek. I had my lower lids done 6 weeks ago. Is this permanent? How long will it last? I have very thin skin. Posted on 04/14/2009

A: We apologize, but as stated clearly in the terms of use, we CANNOT comment on items relating to any procedures and/or third party treatments,procedures, recommendations etc.

We strongly encourage you to contact your health care professional who is familiar with your condition and can attend specifically to your needs.

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Q: I am suffering from post inflammatory hyperpigmentation post fraxel co2 laser it has been seven months this I had the procedure. I am currently using 4% hydroquinone with little effect. Is PIH permanant if not when is it going to go away? Posted on 04/23/2009

A: We apologize, but as stated clearly in the terms of use, we CANNOT comment on items relating to any procedures and/or third party treatments,procedures, recommendations etc.

We strongly encourage you to contact your health care professional who is familiar with your condition and can attend specifically to your needs.

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Q: Can botox injections help to lessen underarm perspiration? Posted on 05/05/2009

A: Botulinin toxin type A (Botox) is approved for treatment of excessive arm sweating.

It is administered to the targeted area using a small syringe. It can lead to significant reduction in sweating for several months and can be repeated regularly.

Common side-effects following injection include but are not limited to injection related pain, bleeding and bruising.

Many patients find botox injections for excessive underarm sweating to be a helpful method of managing this condition.

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Q: I have been planning to see a skin care specialist to have my "skin tags" removed. One of my friends had a "cauterization" done to get hers out. is this something that you do? Posted on 05/07/2009

A: Our office routinely removes "skin tags." The method employed depends on numerous factors including the the type of lesion, location, etc.

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Q: I have a cyst on my face which is growing and i was wondering if you remove them Posted on 06/16/2009

A: Dermatologists often remove cysts from various locations on the body, including the face.

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Q: Well I just wanted to ask that if there is a service in wich is for the lips, to make them look bigger?
Posted on 06/19/2009

A: Aesthetic lip augmentation can be accomplished using one of several tissue fillers such as, collagen, restylane, juvederm... to name a few.

Each procedure has certain advantages and disadvantages that you should discuss with your treating physician.

Typically, these procedures are well tolerated and result in fuller, enhanced, and more youthful lip contour.

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Q: In your experience, has a gluten-free diet any beneficial effect on psoriasis? Posted on 07/02/2009

A: The understanding of psoraisis and its causative factors continues to evolve. A heredity and genetics appear to play a key role in the development of psoriasis.

Some medications are associated with a worsening of psoriasis in some cases (e.g. beta-blockers, lithium, some NSAIDs, antimalarials etc.). Some have noted that certain diets can trigger psoriasis while other may benefit from a specific diet.

A gluten-free diet has not been shown to universally improve psoriasis in all patients. One may consider a trial of diet modification to see a benefit exists for their particular case.

Gluten-free diets are generally advocated in people suffering from celiac disease and associated skin conditions (dermatitis herpetiformis).

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Q: i have a winestain birthmark on my left arm it is not big like two nickles big and it is kinda brownish not that dark but darker than the rest of my skin.i was wondering if you can take it off it is a bother.! Posted on 07/12/2009

A: It is best to have an evaluation prior to determining whether a lesion is likely to respond to treatment.

In general, vascular lasers have been used to treat various "red" lesions.

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Q: I have a skin growth that looks like a wart on the right side of my nose and I would like it removed. I have tried to remove it before with wart removal and it bleeds a lot when it finally falls off then it comes back. Can you remove it? Posted on 07/15/2009

A: Our office would be happy to evaluate any skin lesion; and if necessary perform a biopsy.

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Q: I have been affected by rosacea for 10 years, marked by flushing with small red bump on the face and chest. I have tried many of the standard treatments (topical, antibiotics) but my skin seems to be resistant. I've even gone through a series of 4 Levulan-IPL treatments to try to help the cause but my condition seems to just get worse as I get older. I just turned 33 and am frustrated. Is there anything that you can recommend that may help. I am tempted to go back to Accutane, something I tried in my early 20s with success. Thanks. Posted on 07/16/2009

A: Rosacea is a chronic condition that can be managed but not necessarily cured; as experience has already demonstrated.

Management of rosacea requires a multifaceted approach looking at clinical history, exacerbating factors, medications, foods etc.

The best treatment is one that incorporates all those factors in the "management" of rosacea. Unfortunately, a universal treatment or regimen is difficult to find.

A dermatologic evaluation is a great place to start.

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Q: I had gotten a tiny tattoo back of my nect in May 15th of this year, so about 2 months ago. And it is very small, smaller than my thumb nail.And it is open spaced heart,so just the outline. I want to remove it. How much would it cost to remove that? Posted on 07/18/2009

A: Our office offers laser tattoo removal.

Cost for treatments and procedures is NOT available through this forum and is clearly stated in the terms of use page.

Thank you for your understanding and for your interest in the Dermatology & Laser Center of San Diego.

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Q: Hi there, I have a question. Does Dermatology Laser Center of San Diego, removes port wine stain birthmarks?. I have 3 small and light of them. And If yes, what's the procedure in taing them off?. I also want to know if I make an appointment to see if my birthmarks can be removed, would you guys charge me? please help me out right here. Thanks Posted on 08/14/2009

A: Our office treats port wine stains / capillary venous malformations and various other vascular lesions according to a fee-for-service schedule.

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Q: Hi,Im 18 years old and I have Lichen Aureus. My question is, Is Pulsed dye treatment effective when it comes to Lichen Aureus? I'm really looking for something to get rid of the mark. Obviously i'm young and want to be able to wear short,shorts and bathing suits, but this mark stretches from one side to the other in the back of my knee caps. Its very very noticeable,and has made me very self conscious. Posted on 08/27/2009

A: The pulsed-dye laser (PDL) is generally used to treat lesion that are vascular or related to the presence of small blood vessels in the skin.

PDL works for conditions such as angiomas, capillary venous malformations, port-wine-stains, telangiectasias, facial redness and some specific kinds of scars.

Lichen aureus is a condition that is not primarily due to prominent blood vessels. Rather, much of is seen is due to processes occurring outside or around the vessels in the skin rendering treatments with the pulsed-dye laser generally ineffective.

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Q: Do you provide microdemabrasion services? Posted on 10/05/2009

A: yes

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Q: Hi, I had VBeam laser on my face for thread veins 11 days ago... {elsewhere} [remainder deleted]... Posted on 01/19/2010

A: We regret that the instructions and terms of use have not been adhered to and reviewed carefully. The question cannot addressed because:

The Dermatology & Laser Center of San Diego regrets that it is unable to comment, diagnose, offer recommendations, treatment or advice regarding procedures and subsequent outcomes performed at other facilities. If you have questions regarding a treatment you received, it is strongly urged that you contact the physician who is familiar with the specifics of your case.

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Q: I have a birthmark on one side of my butt that also covers the top part of my leg. I am interested in seeing if this can be lightened as well as removing veins or making them less visible in this area. Posted on 01/26/2010

A: thank you for your interest in the Dermatlogy & Laser Center of SD. We look forward to meeting you in person at your first office visit. Welcome!