Question:

Hi, Dr. Garcia. I had a fully ablative CO2 to my face six months ago. (It was a long healing! Just now coming back to a normal color.) I have a lot of AK`s on my arms and neck, so my dermatologist is recommending Efudex this winter. I`m not looking forward to that -- seems pretty gruesome. I`m wondering if you think that the CO2 to the face will eliminate the need for Efudex on the face down the road; that is, if I have AK`s on my arms and neck, I obviously had them on my face as well. Did the CO2 take care of that? If so, will they come back at a later date? I hope not! Have a good weekend.

Answer:

Unfortunately the good effects of the CO2 will not be permanent and the future need for Efudex on the face will remain as there are skin issues that are deep in the skin that were not treated by the recent laser.You will get new ones, not regrowth of the old ones. They can lie dormant deep in the skin and arise with time. Not much you can do to stop that. Sorry. JG 7.12.13

Question:

Is it ok to have a laser treatment on the face in summer months?

Answer:

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Question:

In reading this site, I see that you`re not a fan of fractional resurfacing. My surgeon uses the Sciton CO2 fractional device. He says he`s aggressive with it, inflicting about 75% of the tissue damage he used to use with the standard CO2. He chooses to use the fractional simply because, even used aggressively, it still offers a quicker healing than the old CO2. He finds that his patients are back to normal in 8-12 weeks as opposed to the typical 6-12 months with the full CO2. So I have a few questions for you! 1) What do you think of the Sciton CO2 fractional laser? 2) Does my surgeon`s strategy make sense to you -- that is, using hte fractional device more aggressively than it is designed for to achieve nearly the results of a full CO2? 3) Do his recovery time predictions seem right to you -- 2-3 months for the fractional, 6-12 months for the full? Thanks for your help!

Answer:

his opinion and my opinion differ. Yes, yet still get some of the fractional benefits but it is not a fully ablative laser, so even by what he is saying, there is a compromise. Compromise is fine as long as you understand that for less you get less, nothing wrong what that, so it is just a matter of managing expectations. He is using the fractional aggressively as the normal non-aggressive setting yield results that were not to the satisfaction of his patients, otherwise he would have continued with the regular non-aggressive approach. I think the recovery time seems about right, but I could do a totally ablative laser on you and have you healed in the same amount of time if I turned the energy down too. My fully ablative CO2 laser patients were pink for 2-6 months but after that they were essentially done with their healing. Hope that helps. JG 4.19.13

Question:

I have some deeper wrinkles and crepe skin in inner corners of my eyelids. Would CO2 laser resurfacing results be permanent? I mean would the skin thee be a little smoother years after the procedure compared to if I never had it done? In other words, is the procedure worth it or will it not do any good in the long run?

Answer:

no, it might give you a couple of years at most. JG 4.17.13

Question:

what do you think of the vbeam candela laser for spider veins on cheeks, nose, etc? I have very sensitive skin. I have rad some horror stories on the realself blog. Would you try this or something else and what is the best setting if i did try this for sensitive skin? is there any value in doing a test on one spot or would that not really be a good indicator of the rest of the face? thanks so much.

Answer:

I think there will be a little temporary discoloration but it should work well. I think what you read on the internet are only bad cases, people that have good experiences don`t take the time to post things on the internet. I think test spots are not really predictive as the skin is different all over the face. As an alternative you can also try an Nd:YAG laser for the areas of concern.Best of luck. JG 4.12.13

Question:

Thanks very much for your quick reply to my inquiry. How many weeks would you let lapse before determining if more passes with the CO2 will be required? You seem to be guessing that damage I have now is more superficial than deep. Just how likely is that? I`m guessing that it is in fact superficial, it may be easier to correct.

Answer:

I would wait 6-8 weeks in order to evaluate the degree of improvement before doing another session. If you had deep scarring the skin would be stiff and not pliable and I am assuming that is not the case with you, instead one of texture only. If it is superficial it is easier to correct, yes. JG 4.10.13

Question:

Two years ago I had CO2 resurfacing, full face (2 passes), done by a plastic surgeon. I did it to tighten my skin a bit. It didn`t tighten the skin that much but it did ruin my skin`s texture. It`s incredibly rough. It actually feels and looks like sandpaper now. What do you think happened? I`ve seen two dermatologists who specialize in laser treatments (at two different teaching hospitals) and they both believe aggressive fractional resurfacing is the only remedy -- one uses Fraxel Repair and is proposing 6 passes; the other uses Lumenis Total FX and is proposing 5-6 passes. What do you think of their proposals? Thank you.

Answer:

well,it seems kind of strange to suggest more laser when the first laser is what caused the problem, I think it was likely due to some aggressive settings causing some element of superficial scarring would be a guess, but hard to say without knowing more.I think doing as many passes as they are suggesting takes all of the safety away from the fractional laser it makes it closer to a totally ablative CO2 laser like you had previously. I think if they are going to do fractionated lasers, I would do one or two passes and then come back weeks later for more if needed. I wish you the best. JG 4.9.13

Question:

How often does one need to get CO2 laser resurfacing under eyes to maintain results of smoother texture?

Answer:

about every 18 months. JG 4.5.13

Question:

Hi Dr. 3 questions 1) my PS recommended dermabrasion+Profactional for addressing fine lines and smoothing the surface of my skin (52 and minor fine line issues). What do you think about this approach? 2) I`ve been reading about Portrait Plasma via your website--do you do it and would that be a good/better option? 3) the PS also discussed the idea of doing IPLs 2 or 3 times per year for aging prevention. They referred to a study that likened it to exercising the cells. Thoughts on this? Thanks so much for your service--really appreciate it.

Answer:

seems overkill to do both dermabrasion and Profactional in my opinion as you are eliminating the safety of the Profractional with the dermabrasion. I am no longer doing Portrait but I think it is slightly better than the Profactional and much better than dermabrasion. As to the IPL and prevention, nope, it will help with spots but it will not slow or prevent anything.I wish you the best. JG 4.3.13

Question:

I just found this blog. What a terrific service! Thank you, Dr. Garcia, for taking all these questions. You must be a really great person. My mother, who is 53 and English (very, very fair skin), had CO2 resurfacing done in December. She was a real mess for 2 months. Her skin finally settled down in March, but it`s now extremely blotchy, which it never was before. Is this normal? (She`s afraid that she may have ruined her skin for life.) She had 2 VBeam treatments in London and they helped a bit, but didn`t restore the evenness of her skin`s color. How long does it usually take for everything to look not only normal but actually better than the baseline? Her doctor told her the results last 18-24 months. At this rate, she`ll be lucky if she recovers fully in time enough to enjoy a week or two the benefits!

Answer:

it is normal and can take an additional 3 months more, and in some cases even more than that for the blotchiness to fade entirely. VBeams can be repeated and they will continue to help. Not sure why she is still blotchy at this point if he did a light enough laser that would only last 18-24 months. The numbers I said above are for lasers that should give improvements for 3-5 years. I think some more VBeams in her case are in order. I wish her the best. JG 4.1.13

Question:

Hi Dr. Garcia. I am 49, Caucasian white ( polish ) and am thinking about having a deep double pass CO2 treatment for my acne scarring. In the past, I had Rosacea like redness and irritations on my front cheeks since I was a teenager ( possibly caused from acne cream stimulating growth of blood vessels to the surface of the skin ). Since I had Vbeam treatments 7 years ago, there has been no return of these symptoms, with my cheeks only showing mild discoloration when I smile. So, is there any chance the CO2 treatment will result in a return of my previous Rosacea like condition on my cheeks. If so, would another Vbeam treatment return my cheeks to the current good condition and how long after a CO2 treatment would you recommend having a Vbeam treatment and how early is it able to tell if there is a complication ( Rosacea returning). Also what is the risk of lighter skin and additional scarring with a double pass and deep CO2 treatment with a person of my skin type. Thank You

Answer:

I am afraid that the redness will return for a period of time and it might require VBeam sessions afterwards.I would wait at least 6 weeks after the CO2 to have the VBeam. Best of luck. JG 4.1.13

Question:

How long do effects of full Co2 laser resurfacing last in tear duct area to smooth the texture? Also, do you usually do one or more laser passes under the eyes? And is a setting of 3 or 4 on full CO2 laser a good setting for the eye area?

Answer:

might last 6-12 months. I do only one pass on eyelid skin, as to the setting you are speaking of, I am not sure what CO2 laser is being used but those setting do not make any sense as there are many more variables involved in the setting. JG 3.29.13

Question:

I have a certificate for an IPL Photofacial OR Laser Genesis Treatment. Which of the two treatments would you recommend? I`m 50 years old but look younger. Thank you for your advice!

Answer:

One treatment with either one will not give much of an improvement, it is usually done in a series. Between the two you will get more from the Genesis though. JG 3.25.13

Question:

What are your views on the gemini laser? What is the normal downtime one can expect from it? Will I need time off work?

Answer:

good for spots, one or two days down time if high settings used. Usually does not need time off work, mild and slow results. JG 3.25.13

Question:

So very sorry. I promise to stop asking questions! But I didn`t understand part of your answer about the CO2. You say that the color will fade first and then the tone should follow. By tone, do you mean texture? I was using the word tone to refer to my skin`s color, which was previously completely even and very fair but is now bright red. It would give me hope to think that you believe that the color will fade first and then the texture should improve. Is that what you meant? Honestly, you`re probably considering getting a restraining order to stop me from bothering you! I`ll try. Thank you again. Gratefully, your Red-Faced Friend (in all senses)

Answer:

No restraining order, but yes, by tone I meant texture. The color improves first and then the texture. JG 3.20.13

Question:

thank you so much for your (as always) rapid reply to my questions about the CO2. At your suggestion, I only used squalene oil -- constantly -- in the weeks following the resurfacing, and I had no break-outs or infections. But I may indeed have had a sub-clinical infection that is prolonging this. My surgeon is as baffled as you are. I did one V Beam treatment last month and it seemed to make the erythema slightly better, but not much. Would you suggest I try that again at this point? Again, thank you, Dr. Garcia. I hope one day to meet you in person. Happy spring to you!

Answer:

The V Beam might require a couple more sessions, worth repeating. I wish you the best and maybe the spring will bring out the new you. JG 3.20.13

Question:

Well, it`s the fully ablative CO2 lady again, 14 wks out. I`m still bright, bright red and my skin`s texture (the reason I did this in the first place) is now much worse than before. My PS pulled up my pre-op photos last week and was astounded by how much worse the texture is. I`m writing to you to ask two things. Do you think the tone will ever get back to normal? My skin used to be completely even, even porcelain. Now it`s a blotchy red mess. It looks like I`ve been mauled by a wild animal because the laser left clawlike marks all along my lower face. Aslo, what do you think happened to my skin`s texture? My surgeon said he`s never seen it get worse instead of better. I was trying to improve the estasticity of the skin on my cheeks, which had begun to have lines and wrinkles. I`m only 50 and I fear I`ve ruined my face for life. Thank you so much for being a steady source of information, encouragement and truth. God bless you!

Answer:

I think it will, but your case is taking much longer than expected so I cannot guess as to how much longer it will take. I am not sure what has occurred in your particular case. I do think the color will be the first to fade and then the skin tone should follow. I am wondering whether you had an adverse reaction to some of the topical ointments used after the laser, had some sub-clinical infection that has caused this problem, I am really baffled. I have seen cases of burns due to a laser but from what you have stated I do not think that is the case with you. I wish I had more for you. JG 3.20.13

Question:

If you recently had sculptra injections in undereye hollows, then you had CO2 laser resurfacing under the eyes, would the CO2 laser melt/dissolve the newly formed collagen from the sculptra

Answer:

The CO2 laser should have no effect on the Sculptra. JG 3.12.13

Question:

What is the maximum number of passes you have done with CO2 resurfacing?

Answer:

all depends on the setting, but I would not go any deeper than 200-250 microns, it can be done in one pass or with several. JG 3.2.13

Question:

Yes, it was a fully ablative CO2: 2 passes and scrubbed after each pass. Is that considered deeply for maximum benefit ? Thank you very much for your help.

Answer:

Yes it would. JG 3.213

Question:

Hi, Dr. Garcia. It`s the fully ablative CO2 lady, bothering you again with another once-monthly question! So it`s now been 9 weeks. The reason I did it was chiefly to address the wrinkles and texture issues on my mid-cheeks. While they do look a little better, to tell the truth, they`re still there, just flattened. It looks like the wrinkles were pressed down into my face -- like a shirt whose wrinkle haven`t been ironed out so much as ironed in. That skin also feels a little rough to the touch. Is this what it`s supposed to look and feel like at this point? Will it improve or is this pretty much the end result? Thanks as ever for all your help. Have a great weekend, Dr. Garcia.

Answer:

That will depend on how deep they went, the less deep they went the more you can see more shallow lines, the deeper the go, the longer the downtime but the more effacement of the lines.The body will grow new collagen though for 4-6 months so I think you will continue to see further improvements compared to what you are seeing now for that period of time. Hang in there a bit longer. JG 2.8.13

Question:

How long after CO2 resurfacing can Retin-A be started again?

Answer:

If it is a totally ablative, miderate to deep laser I wait at least 6 weeks. JG 2.4.13

Question:

Hi Dr. Garcia, I am considering a fraxel type procedure and i understand your perspective on it. Still i`m trying to find the right physician to do it and the right laser/approach; it`s very confusing as there are so many options and nuances. Do you have a recommendation for a bay area physician and what laser/procedure should i be on lookout for to address fine lines? In other words, which does the best of what i know you feel is a not such a great procedure. Thanks much for you service!

Answer:

the greater the amount of surface area treated the better the result , am not familiar with the doctors in the area yo live that are doing laser resurfacing though.Sorry. JG 1.30.13

Question:

Thanks, Dr. Garcia, for answering about the Mixto laser on my neck. Sorry about the typos .. it is now 5 days out and I luckily had the weekend but am facing work tomorrow. The skin on my neck has peeled but is still very tight and raw. The only thing that seems to bring any relief is coconut oil, but I obviously can`t wear that out of the house. The doctor said I could return to work the same day and just wear a scarf around my neck, but putting anything on that skin while it is healing just seems unbearable. How long can I expect to stay in this condition? He said 3-4 days but it is now 5 and I`m nowhere near healed. You might be right, sadly beneath the all the splotchy pink marks the wrinkles look like they are still there :( (Thanks for helping us .. it is wonderful to have you here.)

Answer:

The way it seems to be healing, maybe another 4-5 days, might suggest squalene oil as it has no odor and quite helpful, sold at most good health food stores. Try to avoid things rubbing on the skin from your clothes.Hang in there. JG 12.27.13

Question:

I had the Mixto laser done on my neck and upper chest area three days ag. The doctor said it was a medium treatment, and that I could go to work the next day. I tried going to work but my neck looked so horrendous I tried to cover it up with a loose turtlneck, but that didn`t work. It is now day 3 and my neck is firery red and very paimful. The doctor sayz this is normal. If it is, why don`t they let us know how painful this is up front? Also, the very scary part, when I lift my arms my neck looks worse than before, the wrinkles are heavier and very pronounced. Very depressing ... could this mean the treatment was a failure on me? Sure seems like it ...

Answer:

Well, it will heal in time, not sure why the doctor did not tell you what to expect, and as to the end result, most likely in time it will go back to the way it was, but it might take a few months. It is not a very effective treatment for those areas in my humble opinion. JG 1.25.13

Question:

My sister had an aggressive Fraxel treatment in early December. She is still very red. Her dermatologist told her that at this point, her skin is healed and the redness is just inflammation. He is recommending VBeam treatments to reduce the redness. She`s never had any cosmetic procedures before, though I have. She is reluctant to do this for fear that it may damage her skin. I thought we should ask you before she proceeds. Thank you kindly for your generous assistance, Dr. Garcia. And a happy and healthy new year to you!

Answer:

I think the VBeam will help settle the redness down and I think it is a reasonable option for her. I wish her th3e best. JG 1/16/13

Question:

Hi, Dr. Garcia. It`s the CO2 lady again. So sorry to bother you, but I think you can answer a question that my dermatologist can`t. At 4.5 weeks out, are copper peptides still useful to the healing process or are they only good for first two weeks? My dermatologist (who didn`t do this procedure) isn`t that familiar with fully ablative resurfacings. I`m just trying to do all I can to heal this as carefully and as expeditiously as possible. Thank you so much, Dr. Garcia.

Answer:

' '

Question:

Hi, Dr. Garcia. It`s the CO2 lady again. So sorry to bother you, but I think you can answer a question that my dermatologist can`t. At 4.5 weeks out, are copper peptides still useful to the healing process or are they only good for first two weeks? My dermatologist (who didn`t do this procedure) isn`t that familiar with fully ablative resurfacings. I`m just trying to do all I can to heal this as carefully and as expeditiously as possible. Thank you so much, Dr. Garcia.

Answer:

they likely will help to a lesser degree with time but as long as the skin is red, they help. JG 1.16.13

Question:

Thanks for your recommendation. I was screened at a hyperbaric center this week for tx following CO2 resurfacing. I was rejected due to a pre-existing ophthalmic condition that could be aggravated by the pressure. So, any other suggestions to hasten the healing? At nearly four weeks, the erythema is still extremely pronounced and cannot be covered by make-up. I`m using squalene oil and copper peptides and, of course, complete sun protection. I`m guessing that you don`t have any other tricks up your sleeve to recommend, but I thought I`d ask. Thanks so much for your help, Dr. Garcia!

Answer:

I an afraid there is not much else,just letting time pass. JG 1.13.13

Question:

Thanks for the answer about the make up. I hope it will work next week. Would hyperbaric oxygen treatment speed along the healing and the resolution of the erythema at this point, or is that only helpful very early on, prior to the reepithelialization? Thanks so much.

Answer:

no, it can still help if you access to it. Idealluy 5 dives. JG 1.8.13

Question:

I`ve read here that you don`t advise petroleum-based moisturizers following laser procedures in order to avoid comedones. I had a Fraxel Repair on Wednesday, and my surgeon, like you, advises against Aquaphor for just that reason. Instead, he always recommends Bacitracin, with which he says his patients have good luck. But isn`t that petroleum based too? He said the antibacterials in it prevent the outbreak of acne.I tried the copper peptide you recommend but it stung so badly that I couldn`t handle it and it made my skin turn even brighter red, so I washed it off with Cetaphil and went back to the Bacitracin. What do you think? Thank you!

Answer:

yes, I try to avoid that too if at all possible. The pimples that form from it are not acne but are plugged pores, so it will still happen. Cetaphil has a skin cream that you might be able to tolerate. Otherwise I might suggest squalene oil from the health food store. All the best. JG 12.21.12

Question:

Hi, Dr. Garcia. Well, I did it! I had the fully ablative CO2 yesterday, two passes. Is that number of passes considered standard, mild or agressive? I don`t look nearly as bad as I did after my Fraxel Repair, which was done with 8 passes. That turned out to be not all that effective, so I`m worried that this fully ablative resurfacing won`t be nearly as effective as the fractional due to the few number of passes. Thank you very much for your help and encouragement, I couldn`t have done it without you. A happy and healthy New Year to you and all those you love.

Answer:

I think it is pretty deep, but no way to know unless they tell you the joules they used. Give it time. Trust the surgeon and remember the totally ablative has more coagulative effect and will look bad later than the 8 pass Repair. JG 12.29.12

Question:

So sorry to ask another question about capillaries and CO2, but I don`t think I asked my previous question clearly enough. I do understand that the risk of short-term temporary redness is 100% with either fractional or full CO2. What I`m wondering is this: What is the risk of serious PERMANENT aggravation of this problem with the full CO2 and with the fractional CO2. I guess I don`t understand the underlying physiology of what causes this problem in the first place and the mechanism by which resurfacing would make it worse either termporarily or permanently.I know that the fractional is less effective with the wrinkles, but is the risk of permanent worsening of the redness about equal with either the fractinoal or the traditional? If the side effect of permanent redness is significantly less with the fractional, then I might choose that even if the wrinkle improvement won`t be so great. Thank you for bearing with me. Again, I`m sorry not to have been clear.

Answer:

Sorry for my confusion, the risk is only temporary, not permanent, but the problem that existed before will remain. JG 12.18.12

Question:

Thanks for your answer about the capillaries and the CO2. Would you please explain why they resurfacing would make the vascular problem worse? And does it ALWAYS do that, even for people who have never had visible capillaries before; that is, what are the odds of this happening in general, and in particular with people who have a history of visible redness? Would fractional resurfacing eliminate that risk or does it pose the very same problem as the full resurfacing? I thought that all resurfacings were supposed to redress the problems of aging skin, not make some of those problems worse. Your information and caution here is very helpful to me because I HATE managing my constantly red and flushing skin and I really don`t want to make it worse. Thank you for the explanation and for the odds!

Answer:

The laser will create new collagen and will aggravate the cappilaries short term but the tendency you have will remain. A Fraxel laser will yield less redness but less wrinkle reductuon. The risk of short term redness is essentially 100% short term. Sorry. JG 12.17.12

Question:

What a great service you offer, Dr. Garcia! This is a terrific site. I`m in my late 50`s and have very fair skin. Through the years, I`ve needed IPL treatments almost monthly to manage my enlarged capillaries. My plastic surgeon has recently recommended CO2 resurfacing to improve my skin`s texture and to build the collagen. I know, of course, that this treatment will leave me very red for a long time, but I am wondering if it will aggravate or alleviate my underlying vascular problem. I don`t have a clinical case of rosacea, but I can occasionally get near to looking like I do. Obviously, I don`t want to elect the resurfacing if it will make that miserable problem worse. Have you seen that happen with your own patients? Thank you for your generous guidance. A blessed New Year to you.

Answer:

I do thiink the capillary issue will ger worse with the CO2 so you will still need the ipl after you are healed enough, its a trade off for the fines line issue. I wish you the best and thank you for the kind words. JG 12.17.12

Question:

My daughter is going through a series of four Fraxel Repair treatments in the course of one year to address her acne scars. She`s had two already and there has been some improvement. Her next one is coming up. She`d like to avoid the secondary acne that has erupted after her past two treatments due, we think, to the Aquaphor and copper peptide cream (CU3) she has to keep on her skin for a full two weeks after the treatment. I remember reading here, but can`t find in the archives, that you have your patients use a different product after laser treatments. What is the name and manufacturer of that product? And do you have your patients use that from the first day of resurfacing and keep it on the way her doctor has had her use Aquaphor and the copper peptide cream? Thank you so much for your help!

Answer:

try some squalene oil, sold at health food stores, instead of the Aquaphor, the copper peptide is OK to use.we use the copper peptide form Neova, but GHK is also good. I wish her the best. JG 12.12.12

Question:

Hi, Dr. Garcia. It`s me, the CO2 lady again. Can you direct me to a website that will have photos of the recovery process for a fully ablative resurfacing so I can have a better idea of what to expect? The only photos I can find (and I`ve searched extensively) are from fractional resurfacings, and they can`t give me a realistic image. My own surgeon doesn`t have photos of his patients in recovery; only befores and afters. Thanks so much!

Question:

I am scheduled to have a Fraxel Repair treatment next week, and I just read the note on your site from the patient who had the (much milder) Fraxel Restore with terrible results. Now I`m terrified. My plastic surgeon uses both fractional and total resurfacing lasers. Is the fractional resurfacing more dangerous than the total resurfacing? If you were me, would you refuse the Fraxel Repair and choose the total resurfacing? If so, why? I am white, blue eyes, middle-aged, British descent, thin skin. I have researched these treatments quite thoroughly and am in the hands of a competent surgeon, but I don`t want to find myself with my hands shaking writing you a note of desparation like the other person. (God bless you and heal you, whoever you are! Be of good courage.) Thank you, Dr. Garcia.

Answer:

I cannot say why that happened to that patient, in general the Repair should be lighter and safer than the totally ablative. JG 12.4.12

Question:

You say that the downtime for C)2 resurfacing is 4-6 weeks. The plastic surgeon I met with last week said that after 2 weeks, his patients can use a medical mineral make-up (he recommends Jane Iredale) to cover the redness and return to work. Would you agree with that? Do you let your own patients do this? I can`t take 4-6 weeks off from work. Thank you very much, Dr. Garcia.

Answer:

depends how deep they go, if they go deep, as is usually done for acne, it is longer and initially the make up does not cover it well. The can return to work usually in three weeks but the make up is not a great cover yet at that time. JG 12.3.12

Question:

When you say that downtime before outside with pink skin is weeks or so, how many weeks is typical? And how many days does it usually take for the skin to reepithelialize?

Answer:

skin should re-epithelialize in 5-10 days,typical down time is 4-6 weeks. JG 12.2.12

Question:

I have extensive but superficial acne scarring on my cheeks. I know that this is a notoriously difficult condition to treat. I`m considering CO2 resurfacing but fear that 1) it might be a lot of downtime for very little improvement and 2) it might inadvertently create additional scarring. What is your own experience with this? Is the amount of improvement achieved worth the invasiveness of this procedure? I know the improvement is temporary. Would it have to be redone every two years or so? Also how often does additional scarring occur from the procedure itself? Thank you very much.

Answer:

Have not seen additional scarring when properly done. The older you are, the sooner it will need to be redone, 2-5 years. Downtime before outside with pink skin is weeks or so. Best if luck. JG 12.2.12

Question:

PS on the question about the CO2 resurfacing below: Maybe another way to ask this question is, What depth is considered most superficial and what depth is considered most aggressive? I just don`t know the typical ranges and want to understand better what is being done to me. Thank you.

Answer:

75 microns is superficial, 250 is medium, 300 microns is very deep, cannot be done over certain areas like the eyelids. JG 11.28.12

Question:

Hi, Dr. Garcia! I`m coming up on my long-awaited CO2 resurfacing in two weeks. Very excited and a bit scared. I`d like to know what I`m talking about with my surgeon, so can you please tell me the usual range of depths at which the resurfacing is typically done for moderate photo-aging (Type I skin)? I`d like to know when he tells me the depth he is intending to achieve where on that normative spectrum his choice will fall. Thanks so much! Have a great day.

Answer:

for photo aging I think 75 microns should be more than enough, in severe damage 150 microns.Best of luck. JG 11.28.12

Question:

How soon after erbium laser at 150 microns can Retin A be used? I didn`t use it before but have in the past. Should it be the lower percentage or does it matter?

Answer:

I would wait until all the redness has gone and start at a low concentration and work up as tolerated. JG 11.28.12

Question:

What sort of improvement can be expected from erbium laser at 150 microns on face? It has been almost 2 weeks, still pinkish but seems like new skin.Why is skin texture rough and how long will it take for this to smooth out?

Answer:

should have less fine lines and a more even skin tone, it might take another 2-4 weeks for the skin to smooth out though at that depth. JG 11.28.12

Question:

Thank you for your answer about the CO2 resurfacing. I had it done about 7 or 8 years ago and found it very helpful, but it`s time for another round. (I`m not looking forward to this!) One plastic surgeon I consulted said that the recovery from a second resurfacing is likely to be easier than the first, but he didn`t explain why. Has that been your own clinical experience, Dr. Garcia? If so, I don`t understand why that would be the case, since ablation is ablation whether it`s the first, second or third time around. Thanks for clarifying that for me. You`re the best.

Answer:

it is at times easier as there is not as much skin damage as there was previously so we do not need to go as deep as the time before. I have found it to be so also. Al the best. JG 11.5.12

Question:

Dr. Garcia, I wrote to you a while ago regarding a small (slightly raised) mole just under my eye that has come up a couple of years ago. You recommended that I may need to get it cut out. However I tend to scar easliy and so I decided to not to worry about it. (I have had it checked and everything is O.K. However the silly thing is slowly getting bigger and now is becoming more noticeable so purely for aesthetic reasons I would like to get rid of it. Is there any other procedure you can recommend to get rid of it. Thanks so much. Incidently it has been awhile since my last visit and I am enjoying your new blog section, very informative. Cheers and I hope your having a lovely day

Answer:

thanks for the kind words, as to other options, maybe just have it shaved down flat and then cauterized, it will leave a smaller scar, should heal well, and the only thing is since it is not entirely removed you can just repeat the procedure again. Just another option. I wish you the ebst. JG 11.5.12

Question:

What is your usual fee for a full face CO2 resurfacing? And what do you charge for partial face resurfacing -- that is, do you charge by region and, if so, how much? Thank you!

Answer:

we very rarely do segments due to the potential difference in color of the skin. Our fees for the full face, all inclusive, under general anesthesia is $4,300.JG 11.5.12

Question:

My question I posted doesn`t show an answer so I am posting again. :) Do you do laser hair removal on Fitz IV with melasma? Will it make it worse? And if you do it, what laser hair removal laser do you like best? I have the option of GentleYag OR A Yag/Alex Combo? Thank you Dr. Garcia!!

Answer:

we no longer do hair removal in our office, but when we did I would not treat Fitz IV skin with lasers for that. It can cause hyper or hypopigmentation. We do use an Nd:YAG for the melasma but the degree of improvement is mild as we cannot use a large amount of energy due to the skin type. If you are only talking about armpit and pubic region h, it might be OK to try with the Alexandrite laser, but remember,it is not permanent. I would not use it on the face for hair removal. All the best. JG 11.2.12

Question:

When you have your patients prepare for CO@ resurfacing, how long in advance of the procedure do you have them used Retin-A and hydroquinone? And how before the procedure do you have them stop using those products? Thank you.

Answer:

we do pre-treatment for 4 weeks. We stop the creams the day before. JG 10.26.12

Question:

So sorry! One more question on the CO2 laser: I`m having him treat my whole face because I don`t want lines of demarcation, but I have the most damage under my eyes, on my cheeks and on my forehead. Can he adjust the laser to treat those areas more aggressively and treat the other areas less aggressively while still being able to blend the areas?

Answer:

Yes, that is what is done. JG 10.23.12

Question:

PS on the CO2: I had a conservative rhinoplasty (tip only) 4 years ago, but it left me with a small pocket of skin where the excised lower lateral cartilage had been--an artifact of the original defect. Could the CO2 tighten that nasal tip skin so that it will finally be smooth, matching the underlying tissues?

Answer:

It will help some but not a complete correction. JG 10.23.12

Question:

I`m scheduled for a CO2 resurfacing in December. I`m 54, fair, blue eyes. I`m pretty nervous about the possibility of scarring and hyper or hypopigmentation. My plastic surgeon has been doing this for 25 years and reports only very few minor complications throughout the years. What is the percentage of complications with this procedure? Would you yourself elect to have it done if you needed it (which, from your photos, I can tell you clearly don`t!). Also, I had a facelift earlier this year, but still have pouches beside my mouth. Kind of depressing. Is it unreasonable to hope that the resurfacing might tighten the skin enough to improve that problem a bit. Thank you so much, Dr. Garcia.

Answer:

Problems are rare, maybe 1-2%. If I had skin like yours I would have it done but I am olive toned. I do not think the pouches will get better though. I wish you the best. JG 10.23.12

Question:

I had a fractional CO2 resurfacing with my dermatologist early last March. It made a bit of a difference but I still have horizontal lines on my mid-cheeks. I`m scheduled for a full CO2 resurfacing in late December with a plastic surgeon. Is it safe to proceed after 9+months? I have Type I skin. Thank you for sharing your opinion. Have a lovely weekend!

Answer:

yes, safe to proceed and I think this laser should be able to correct the line issue for you. Best of luck with it. JG 10.191.2

Question:

When I search for ProCyte Copper Peptide Cream, I get this: http://www.beauticreams.com/prcrdalaco.html?gclid=CMDyw-KeibMCFUQw4AodPj... Is this the product you use? I also get directed to CU3 Copper Peptide Complex, which has as its primary ingredient petroleum, so that can`t be what you`re recommending. If I don`t have the right website, would you kindly direct me to a site where I can purchase the items you use? Thank you kindly, Dr. Garcia.

Answer:

that is it! JG 10.18.12

Question:

Thx for your answer. What ointment do you recommend then? It has to be kept moist, so I used aquafor last time as directed, but it`s petroleum based.

Answer:

we use a copper peptide cream from ProCyte. JG 10.17.12

Question:

Hi, Dr. Garcia. I had a CO2 resurfacing 14 months ago. My PS and I agree that it could have been more effective, and we`d like to try it again. Is it safe to do so now? i.e., what is the minimal amount of time that has to pass before doing it again? Also, any tips for dealilng with the miserable post-treatment cystic acne? That was the worst part of thw whole thing last time. Thank you so much!

Answer:

I like to wait a year, so you are likely OK to proceed. As to the acne, I think trying to avoid any petroleum based ointments is a must. All the best. JG 10.17.12

Question:

I had my 4th laser hair removal treatment last week (wednesday). The first 3 were great but at the same energy, this last one left me with red raised marks in a design like the shape of the probe all over. The redness and swelling went down, there was no open wound or blistering but now the marks still there, lighter but bruisish and purple (I can`t tell if its the blood vessels or dark marks). There is some very light sbabbing (barely visible) in some areas over the marks. Is this bruising that will resolve or hyperpigmentation? Will they go away or should I do something about them? I am olive skinned.

Answer:

should resolve without problem as long as you do not expose it to the sun.All the best. JG 10.15.12

Question:

Dr. G, What does Velashape do and do you recommmend it? Thank you!

Answer:

it is supposed to reduce fat on the torso and legs using a non-invasive laser and suction device that is all external, nothing dramatic in terms of the changes from what I have seen. JG 10.15.12

Question:

Hello Dr. My PS is now offering Ulthera (sp?) for skin tightening. I believe I read on your Q&A that there is a chance of this device affecting fat in the face ... but would this be a good option for tightening body skin (ie, upper abdomen and arms? Thank you as always for sharing your knowledge.

Answer:

have not seen anything visually dramatic on the body with Ulthera, especially past a few months after the session JG 10.15.12

Question:

I recently read about a treatment called Ultherapy in the wall st journal. Could you please tell me what you think and if this is something that you do. Thanks

Answer:

I do not offer it in my practice, I think there are possibilities for fat loss in undesirable areas with the treatment and I know the procedure is painful to have done, it is relatively expensive from the local prices I have seen, and no one really knows how long the results will last. JG 9.18.12

Question:

Hi Dr. G. For minimal skin laxity that is not enough for a tummy tuck, for instance, what laser will work best? Thank you.

Answer:

I do not think lasers work for that, sorry. JG 9.3.12

Question:

I have under eye wrinkling, what could help to tighten the skin with minimal downtime??

Answer:

maye a light laser, but the less downtime, the less time it will last. JG 8.5.12

Question:

Hello. I am 25yr old and have moderate-severe acne scarring. I just had rhytec plasma lower energy done on Friday by the esthetician because I could not afford the high energy doctor version. She did 2 passes at 1.6 joules then 2 more passes concentrating on problem areas at 2 joules. I have not seen much information about using 2 joules rather than the normal 1 or 3/4. What is your opinion on multiple passes at this medium level? Should I see results comparable to the Low energy tx or more like the high energy results because she did so many passes? I also plan on repeating this procedure when i have down time un december if i like results. Thank you!

Answer:

The second or third passes at higher energy can be done on certain areas safely. I am afraid ,though, that you will get nowhere near what a deep pass can do. Multiple lows do not equal one deep. JG 7.22.12

Question:

I have lines forming on the sides of my chin (if I lift the skin up they dissapear) so it`s more like the skin is starting to sag a bit..I have been using filler with fairly good results in these areas ,but on my it only last 2-3 months. But having to have filler done every dfw months is costly so I`ve been looking into laser to tighten these areas but with all the various lasers out there I don`t know which one (if any) would give me a more lasting results..I live in Hawaii and there are a limited amount of PS here who use lasers. Mahalo Linda

Answer:

I think you need a CO2 based laser and the greater percentage of the skin treated, the better the results. So lasers such as the Fraxel might need to be don a few times months apart as it does not treat the entire surface, but they allow faster healing times. I wish you the best. JG 6.29.12

Question:

whats your opinion of laser genesis tx? will it help vertical lip lines?

Answer:

mild degree of improvement. JG 6.26.12

Question:

How effective is the Syneron elos laser for smoothing and tightening the face? Any complications such as lipodystrophy?

Answer:

I feel the results are very minimal at best, but I have not heard of fat loss with their technology. JG 6.25.12

Question:

Dr. Garcia, I have had three dot laser treatments over a period of two years. One year between the first and second and six months between second and third. This was primarily for upper lip wrinkes. I got the most improvement after the second--not so much the third. My doctor now refuses to give me a fourth treatment. He says that maybe in five or ten years!! I am 62. He also said that he has resurfaced most of the lip area and I would get no collagen if I had another. I think he is afraid that I will get hypopigmentation because I had a little lightening after the third treatment. It is hard to tell because I got some hyperpigmentation around the lip area. He tried restylane and it worked for one side. But the other two lines are dynamic and it just didn`t work. Is he correct in what he says? I thought you had to keep up lasers for maintenance? Thank you much.

Answer:

I think he is disappointed in the results he has gotten with his laser and does not want to charge you for more sessions that will continue to disappoint. Done properly, there is no reason to stop the sessions. JG 6.4.12

Question:

Thank you for your answering about the rippling post-CO2 resurfacing. You say it can be treated in reverse. How? What can be done and who can do this treatment for me? And...might my skin texture improve a bit on its own with time or am I pretty much stuck with what I have now until and unless someone intervenes with a reverse treatment? Thank you so much for your help, Dr. Garcia. I really apprecait

Answer:

Hard to say how much better it will get on its own. By reverse I meam going deep on the raised skin that was treated more lighly and less on the deep areaa where they went deeper. JG 6.12.12

Question:

I had a Mixto laser treatment on my mouth and chin areas this morning. My upper lip has now swollen excessively despite icing it. The doctor doesn`t know what to do except tell me to take an anti-inflammatory. In 1990, I had this same reaction when my upper lip was hiked up, and it lasted over 3 months! But this wasn`t surgery, and over a year ago I had an erbium laser that didn`t do this. The erbium didn`t get the acne scaring, which the Mixto is supposed to do, so I tried it. But now I`m petrified because of my upper lip. Do you know what is causing this, and what I can do?

Answer:

It is a normal reaction to a deeper laser session, might want to get your doctor to give you some oral steroids to help get the swelling down. JG 6.10.12

Question:

I had a very light CO2 resurfacing in mid December. I like the results but I am still red -- my skin blanches on pressure, so I know it`s vascular. It`s faded a bit, and I`m using squalene oil. At this point, might VBeam treatments help? Anything else? Thank you very much.

Answer:

Yes, VBeam is a good option. JG 6.9.12

Question:

How much do you charge for full facial CO2 resurfacing? How long do out of town patients need to stay in Las Vegas for this procedure? And how long before one can return to work with make-up? Thank you.

Answer:

our fee, all inclusive, is $4,275. I would ask that you stay here 7-10 days at least. Usually the patient can wear make up in about 3 weeks, but it will not totally cover the redness at that time, for that it might take 4-5 weeks, depending on how deep of a treatment is done. JG 6.4.12

Question:

My mid-cheeks multiple fine superficial lines that make the skin look currogated. I`ve used Scultptra for years and don`t want any more filler there, since it would make me look swollen. Would CO2 resurfacing erase those lines? I live in Ireland and have the characteristic Irish skin. I`ve used sunscreen and then, when it finally became available, full spectrum sunblock for the past 25 years (too late for a 51 year old who got too much sun for the first 25 years of her life, but better late than never) and hats and I always avoid the sunlight. Should I have my whole face done to avoid uneven color, or will it blend into the rest of my face? How long before that blending is complet? Thank you for your kind advice. God bless.

Answer:

I think the Co2 laser woudl be better than more Sculptra and I would also do it on the entire face to avoid lines of demarcation and a greater tightening effect. All the best. JG 6.3.12

Question:

I had fractional CO2 resurfacing in the last week of March and have been left with deep redness in the treatment areas. I am of Swedish descent and have very white/light skin. My dermatologist says it`s post-inflammatory hyperpigmentation. She prescribed hydroquinone and retin A. I`ve been using it for 2.5 weeks and the redness isn`t budging, I think, in part, because both of those products can increase erythema. I thought hyperpigmentation was brown in color, not red. Could this just be post-treatment erythema rather than hyperpigmentation? If so, what would you recommend to speed along its fading? Thank you, Dr. Garcia.

Answer:

well, post-inflammatory hyperpigmentation is brown so I disagree with that. i think you have persistent erythema due to a likely over-treatment or superficial infection. Retin-A and hydroquinone will not help and will actually make it worse. I would stop those creams, use squalene oil as a moisturizer,totally avoid sun and all products with retinols and glycolic acids and if it does not improve I would consider using a Nd:YAG laser to settle the redness down. I wish you the best. JG 6.3.12

Question:

I had laser resurfacing back in February and developed PIH despite pre- and post-treatment with HQ and Retin-A. (I`m white and extremely fair.) Since my forehead didn`t need resurfacing, we stopped just below my temple. I have been left with dark lines of demarcation 2/3 of the way up my face and around my mouth where the surgeon didn`t overlap. My surgeon, of course, is assuring me that this will fade in time; and of course I`m still using the Retin-A and HQ as well as sunblock and practicing sun avoidance. What is the longest amount of time you have seen PIH last, Dr. Garcia? I`m coming up on 4 months. Any other measures you suggest I should take? Anything dietary, for instance? Thank you very much!

Answer:

well, I have seen it go away in as little as one month, but it can take 6-8 months in other patients. I might suggest some very light IPL or ND:YAG laser sessions to speed it up, they have little risk of PIH. I wish you the best. JG 5.29.12

Question:

I has co2 laser on my face, neck and chest 7 days ago. I am ok with the recovery process but noticing red bumps on my chest almost like an allergic reaction. Is that normal?

Answer:

might be just normal skin cells making new skin cells, the neck will not heal as well or quickly as the face. JG 5.28.12

Question:

Is the Profractional laser the same as Fraxel Repair? I expect they`re the same kind of technology--fractionally ablative--and I see you don`t favor that. But even though you don`t like it, is the Fraxel better than, worse than, or the same as the Profractional? Also, a general medical question for you tonight: Is adhesive capsulitis (frozen shoulder) always self-limiting? I`m 15 months into a bout of it, and my orthopedic surgeon tells me that it always cures itself; but I`m beginning to doubt that. (I have no other shoulder injuries, no arthritis, etc.) Thank you so much for your time and expertise, Dr. Garcia! Good night.

Answer:

The Repair uses CO2 whereas the profractional uses erbium, will get more tightening with the CO2. As to the adhesive capsulitis, it will need lots of therapy at least, otherwise it will stay frozen. JG 5.15.12

Question:

Hi, Dr. Garcia. It`s me, the really aggressive Fraxel Repair lady again, now almost 2 months out. You said that the wrinkle, creases and holes that developed (for the first time in my life) under my eyes and on my mid-cheeks were from the swelling. Now that the edema is gone, the wrinkles and creases are in fact better but they are still there! I never had this problem before. Is it possible that the resurfacing traumatized my skin so much that it created these creases and wrinkles so that they are now permanent? I`m getting discouraged. I know that what I see at this point is pretty much the peak of results I can expect from this and that my skin will start to deteriorate again soon. If that`s the case, then I spent 2 months recovering (I`m still bright red, by the way, with intersecting paths of white across my face where the surgeon skipped treatment)) and I am now in worse shape than before I started in terms of texture. Thank you again for all your advice and guidance. You are an angel.

Answer:

Since they went so deep, I think you still have a way to go for total healing, so I would expect more improvement. You skin likely needs a lot more moisture due to the depth of treatment. Might suggest some squalene oil, can be purchasd at health food store. Hang in there. JG 4.25.12

Question:

Hi Dr. Garcia, I am a 32 yr old female of Cuban descent with very white skin and dark brown hair. I have some scarring from cystic acne to my cheeks and jawline. Most of it is bearable and can be disguised with makeup but on one cheek I have two, half an inch long indentations that look like deep scratches that I would like to remove. I was told by my derms assistant that fraxel would give 50% improvement after 6 to 7 treatment. (700 dollars a treatment) Is this my best option for those two scars? If not what would you recommend? Would hydro infused dermabrasion help at all? Thanks, Anna

Answer:

well, I think lighter laser treatments are likely safer in you than a single deep one, so I think it is worth it. I do not think the hydro infused dermabrasion will do much, sorry. JG 4.24.12

Question:

Hi, Dr. Garcia. It`s me again--the almost-fully ablative Fraxel Repair lady at 7.5 weeks post. Thank you so much for all your consolation. You have helped me a great deal -- physically and psychologically.. I am finally beginning to turn a corner, starting to look very, very dark pink instead of deep, dark red, so I`m feeling hopeful. But of course, I now have a new development this week that leads me to you yet again: the emergence of distinct petechiae along my jaw and across my cheeks. At a distance, they look like enlarged capillaries, but on close inspection, they appear to be small purple-red bruises. Is this to be expected...and at this stage of the healing, in particular? (What might their emergence at nearly 8 weeks tell you about the depth/efficacy of the procedure itself? Is this healing process similar to your own patients` full CO2 recovery? It seems far longer and more complicated than anyone I know who has had just a fractional resurfacing.) Anyway, do these petechiae resolve on their own--and if so, how long do they take to go away--or, like enlarged/aggravated blood vessels, are they here to stay and will require a whole new set of treatments (like IPL or VBeam) to keep them at bay? Have a great weekend, Dr. Garcia. Thank you for all you do.

Answer:

They are areas where the skin is thin, usually over boney areas, and it bruises or tears the skin. They heal in time and do not need to be treated, but a YAG or VBeam can be used if desired. It is similar to the fully ablative CO2, hopefully you will get that same amount of tightening as it does. It is not uncommon for them to form at this point. JG 4.21.12

Question:

Hi, Dr. Garcia. You`ve been so helpful to me in the past 2 months. Thank you! I`m the one who had the very aggressive Fraxel Repair seven weeks ago. I`m still dark red, very wrinkled under the eyes on on the mid-cheeks and continue to have milia outbreaks; in fact, the breakouts have never stopped. 2 questions for you this morning: 1) Should I ask my surgeon for a prescription for an antibiotic like Keflex to help with the milia, or would that be useless? 2) You said the wrinkling, lines and pitting were an after-effect of the edema, but I`ve still got them all. I`m beginning to wonder if I was burned beyond a safe point; could these tiny holes and big creases be true and lasting burns rather than side effects of the edema? If so, any suggestions for repairing them? This has turned into a really, really big ordeal. Thank you for guiding me through it, Dr. Garcia.

Answer:

I do not think oral antibiotics will stop the milia, they do not form for the same reason that acne forms. I do not think your symptoms are those of being burned too deeply, but they went deep and all of your healing will be prolonged I am afraid. It is a matter of time, but your skin will make new collagen and smooth those out, slowly. You got to keep the faith and hang in there. I wish you the best. JG 4.17.12

Question:

I`ve read different estimates on the lenght of time one stays red and raw-looking following CO2 resurfacing. Some say 6 months; others say 2-3 or 3-4 months; still others say a full year. In your extensive clinical experience, what`s the average amount of time you have seen? Thanks so much.

Answer:

it depends on the depth used on the patient, that is why the averages are all over the place. If you were to ask me based on average depth, average number of passes, and average patient, my estimate is red for 3-4 weeks, after that dark pink fading to light pink, that process taking 2 months, some mild pink in the deeper areas like around the eyes and mouth might continue for 4-6 months in some cases. Hope that helps. JG 4.16.12

Question:

I had a Total FX fractional resurfacing two years ago and have been very pleased with the results. My friend liked my results so much that she found a highly reputable plastic surgeon in California, where she lives, and elected to have a Fraxel Repair with him, since he didn`t offer the Lumenis platform. Although Fraxel is CO2 rather than erbium based, it`s pretty much the same technology. Is that correct? Well, he treated her two weeks ago and we just talked by Skype. Good heavens!!! She can`t even open her eyes! Her face is bright, dark red and swollen to twice its usual size. The surgeon told her he did 7 passes. I had just one pass with the Total FX, though we both had only mild solar damage. (We`re both white and 46 years old.) Did her surgeon essentially end up doing a fully ablative CO2 resurfacing on her? Is seven the standard/suggested number of passes for Fraxel Repair, or is it just one, like I had, to keep it truly fractional ? Or if it`s more than a single pass that`s recommended, what is considered the standard number? I guess our biggest question is whether multiple passes with a CO2 fractional in one treatment is essentially the same as a single pass with fully ablative CO2. Thanks for helping to solve this mystery for us, Dr. Garcia. It looks like my friend will need to be out of work for a long, long time instead of the single week she had scheduled!

Answer:

The greater the number of passes, the closer it gets to a totally ablative session. I am unsure why 7 passes were used. That is more the usual I have heard but there is no set standard. I am afraid her healing will be like the old CO2 laser, likely 2-3 weeks before makeup will help. I wish her the best. JG 4.14.12

Question:

Good morning, Dr. Garcia. I had an aggressive Frexel Restore around my eyes 4 weeks ago. Despite icing and sleeping with my head elevated and avoiding sodium, I am still incredibly swollen and bright red. Is this normal? How long should it take to resolve? I don`t see my dermatologist for another 2 months. Should I make an appointment sooner? Do you think anything is wrong here? Thank you very much for your kind help.

Answer:

well, whenever a treatment is done in a more aggressive fashion, all of its purported advantages of quick healing and little down time go out the window, so what you are seeing is normal for what you have had done. I think you should schedule an appointment to be seen again by your dermatologist as what was done was beyond the usual session parameters. I think it will eventually heal, but it might take another 3-6 weeks. I wish you the best. JG 4.11.12

Question:

Hi dr.Garcia..First of all i`d like to thank you for your expert help to all patients requisting your advice.Realy milion thanks from my heart. Dr,I had 2q switched nd yag laser sessions on nevi to lighten them and 6non ablative 1064 nd yag laser on acne scars.During treatment(4 months)i applied sunblock (titanium 10%,zinc 2.5%) generously once per day for 7 morning hours.I donot know if its effect diminish with time, if so then it was about 200 hours totaly i wasnot protected during which i was exposed to indirect sunlight (Morning light)when indoors,in car ,in shade and Minimal direct sun(NOT MUCH).What are my risks?Is there any serious risk(cancer) on lasered skin or nevi due to my history and non frequent use of sunblock during healing after laser(as the skin is vulnerable to sun during its healing)? I know much sun over years is bad but my question is about healing period spcificaly.Also in how much period laser related complications manifest itself so that if this period pass smoothly ,a patient can consider himself safe.?I am now 4 months after last session without complications,can i consider myself safe now?AGAIN MILION THANKS DR GARCIA

Answer:

I think your risks are small, the adverse hyperpigmentation would have shown up by now and there is little risk of any other negative side effects. Laser complications usually will manifest in 3-6 weeks, after that, it is almost unheard of. All the best and you are welcome a million! JG 4.10.12

Question:

Hi, Dr. Garcia. You`ve helped me a lot in the past 4 weeks since I did a Fraxel Repair (5 passes). Thank you so much for all your good advice. I have a couple of new questions for you, of course. This week, I developed a rosacea-like break-out all over my face, but especially under my eyes and by my mouth; there are dozens of tiny pimples that seem embedded/stuck in the upper layers of my skin. My skin is still bright red, but under my eyes now, the erythema is about 6 shades deeper than the rest of my face, and I have crescent shaped malar bags -- which are distinctly wrinkled (something I never had before!) as well as covered in pimples. Very pretty! The aesthetician at my plastic surgeon`s office unclogged my pores two days ago, but in truth, that seems to have made the situation worse. I am now covered in large, inflamed red bumps where she attempted extraction (not always with success). My questions for you: 1) What is up with the WRINKLED, bright red malar bags? The skin there looks like crumpled tissue paper. Yikes! I never had undereye wrinkles in my life. I`m horrified by this development. What`s going on and what can I do to fix this? Will ice help this situation? Topical cortisone? A brown paper bag over my head? 2) What do you recommend for this terrible case of acne? (The squalene oil seems to have contributed to the clogging of my pores, so I`m taking myself off that for a while.) Gosh, I elected to do this procedure to take a few years off my appearance, and instead, I look like a wizened octogenarian sporting a bad case of a 13-year-old`s acne! Thanks for any help you can offer. Have a great weekend, Dr. Garcia. (I think I`ll need to get a REALLY big Easter bonnet to hide under! Ha!)

Answer:

the wrinkled bright red malar bag is due to swelling or edema and should go away when all is healed. I think ice on the malar area will help some at this point, but it is more tincture of time. Topical cortisone will not reduce the swelling, can make the redness in this case worse, so I do not advise that. As to the recurrent milia, it is the skin making oil in order to heal itself. Usually best to apply warm compresses and let the pores open on their own as to reduce the potential scarring from needle holes for the extraction. Maybe a little warm steam to the face. Hang in there. JG 4.5.12

Question:

I had a Fraxel Repair on March 15. Will it be OK to have HydraFacial on April 16 to improve the hydration of my skin? Thank you.

Answer:

should be fine. JG 4.2.12

Question:

Hi, Dr. Garcia. I had a CO2 resurfacing a month ago. Of course I`m still red, but I`ve now developed a very rough, sand-paper-like texture to my skin. I thought that this was supposed to smooth the skin. Is this a normal part of the healing process? How long does it last? Thanks so much for your help.

Answer:

it is normal, new skin still being stimulated, it will get better on its own in time but lots of moisturizing with squalene oil helps speed it up. It can last 4-8 weeks, the deeper they went, the longer it takes. Best of luck. JG 4.1.12

Question:

The doctor put eucerin on my face immediately after phenol peel and told me to continue for 7 days. You said the eucerin is ok after superficial skin is healed. Would you recommend using squalene oil instead of eucerin since I do not have copper peptide? I am 4 days post peel. Sorry for the confusion and thank you.

Answer:

You can likely switch to the squalene in 12-14 days. JG 3.31.12

Question:

I have a small indented scar from a shaving accident while shaving my genitals. It`s very small (2/3 mm by 4/5 mm), but in a conspicuous location. What options do I have to treat it? I was thinking of Fraxel Restore as an option.

Answer:

I can`t say I have read about any lasers being done on the scrotum, the most efficient opton might be an excision and closure. JG 3.29.12

Question:

Likely Wow! Thank you for such a speedy and helpful answer about the yeast infection. I`ve resumed the vinegar soaks and have called my surgeon`s service requesting to be seen sooner than 7 days from now. I can`t tell you how much I appreciate your help. You have likely saved me from some serious disfigurement. What an amazing service you provide in dispensing your wisdom and experience to strangers. Thank you! Just one final question: what are the likely topical anti-fungals that I might expect to be prescribed? Good night, Dr. Garcia.

Answer:

something like Monistat or similar. I wish you the best.3.19.12

Question:

Hi, Dr. Garcia. I had CO2 resurfacing 9 days ago and have developed little yeast colonies on three areas of my face. Is this dangerous? I suspect that, at the least, it will impede the healing process. Anything I can do to overthrow the colonization of my face?! I`m in a revolutionary mood. I`m seeing my surgeon again next Tuesday. Do you think I should contact him before then? Thanks ever so much for any suggestions you can offer me. Happy spring to you, our favorite doctor!

Answer:

It can allow deeper penetration and potentially scarring so they need to be treated aggressively. I think contacting him soon and seeing him is imperative so they can start treatment. Might be something as simple as vinegar soaks and a topical anti-fungal, but you need to have it looked at soon. I wish you the best. JG 3.19.12

Question:

My dermatologist is treating me for increased pigmentation. He had me do a light peel (a V peel) 2 weeks ago and he`s following it up with Fraxel Repair later this week. Is that safe, in such close succession, in your opinion? Thank you, Dr. Garcia. I hope you`ll have a great week.

Answer:

Should be OK to do, I am sure they will do the Fraxel repair at a lighter setting. all the best. JG 3.19.12

Question:

Hello, Dr. Garcia. I saw the post yesterday from the patient who had Fraxel Repair last week. I`m in the same boat! I had it done on Wednesday and am still extremely swollen -- and bright red. After the first 48 hours, am I just wasting my time with the ice packs? I believe that icing an injury doesn`t work after two days. Is that right? And will Ibuprofen have any effect this far out? Finally, I have another unrelated question. I have minimal but annoying back fat -- too little for liposuction. Might mesotherapy help that? I think I remember reading that you are not a fan of it, but I wonder if you think it might be helpful for small, focal areas of fat. Thank you for your time and help, Dr. Garcia.

Answer:

I think after 48 hours the ice will only help a small amount. Ibuprofen is certainly fine to use though. I am not a believer in mesotherapy,neither small or large sorry. JG 3.19.12

Question:

Good evening, Dr. Garcia. I had Fraxel Repair (4 passes) done on Tuesday. It is now Saturday night and my eyes are still swollen almost completely shut -- and my face is purple-red. Does this sound normal to you? I`m using ice packs, sleeping with my head elevated, using NSAIDs and drinking plenty of water. Anything else I should be doing? I see my surgeon next Thursday, by which time I assume the situation will be bit more settled. I hope that this turns out to give me some amazing results because this is a LOT of damage! In fact, I look like I`ve had a fully ablative CO2 resurfacing. (Again, does that sound right to you for just a Fraxel Repair?) Thanks so very much for all your help to all of us who have found you through this blog. You are amazing.

Answer:

Not uncommon with 4 paases, got to hang in there. Best of luck. JG 3.17.12

Question:

Is squalene oil good to use following Fraxel Repair? Thank you.

Answer:

It can be used after a few days, not right away. JG 3.12.12

Question:

I am 54 years old and have been contemplating a CO2 laser resurfacing for several years. My overall skin is in decent shape, on the oily side, with enlarged pores in the T-zone area. Have some fine wrinkles surrounding eyes, above lip and marionette lines. I use Retin-A, glycolic acid, have light monthly peels and have excellent homecare, but would like to start building collagen now to help my skin as I get older. I`ve read your posts and know you feel that the CO2 is the gold standard for skin improvement, but my plastic surgeon has 3 levels, standard, moderate and deep. Are there settings on the CO2 that allow for various depths? Can you tell me which setting is appropriate for light wrinkles? I do want to get the most out of the procedure and I realize that the deepest level also produces the most down time, but can you still reach the dermal level using a moderate depth? Thanks so much for your reply! You have kept me a well informed patient! Best regards.

Answer:

Moderate sounds like what you need. All the best. JG 3.7.12

Question:

Hi Dr Garcia, I have superficial burn scar on my stomach and on my left hand index finger. The scar on my stomach is going be a year old this march.The scar on my finger is still fresh it has been only four months. I have been two med spas. One med spa recommend me to go for Co2 laser resurfacing. However, i am little skeptical about it as i have olive skin( indian). Nurse practitioner at other spa told me not go for co2 laser surfacing because it can cause Skin pigmentation issues with your skin type. She wants me to use hydroqunione and rentin a for month and then Certified Esthetician will perform TCA peel on my scars.I have been using hydroquinone 4% on my stomach scar.I do see little improvement on my scar. This scars are really bothering me. please guide me in what should i do.

Answer:

well, I partially agree, I do not think a CO2 laser, which is another burn, will ever help I think the Hydroquinone and the Retin-A followed by a Q switched YAG laser is best. I think the TCA peel, which is another burn, will also not help. Sometimes people suggest the technologies they have, eventhough there might be safer and more effective options.All the best. JG 3.7.12

Question:

What is the meaning that the skin will be sensitive to sun after laser resurfacing? Does that mean the skin is prone to develop cancer after minimal sun exposure following laser treatment (even indirect sun)? What happen if sun block is not applied regularly after treatment?

Answer:

No increased cancer risk but more sensitivity and more easily burned and spotted. JG 3.3.12

Question:

hello,i have taken 2 q switched nd yag laser sessions on some nevi to lighten them and 6 non ablative nd yag laser sesssions on post acne scars.During the period of teatment (6 months) i couldnot apply the sunblock regularly and it was about 200 hours collectvly of indirect sunlight exposure coming from the window as well as heavy flourescent light at night and very minimal direct sun exposure. SO What are the risks of such sun exposure on lasered skin or nevi and my careless use of sun block after my treatment? THANKS DR.

Answer:

well,the nevi will redarken with time, not much effect on the acne scars though. JG 3.2.12

Question:

I am trying to do my homework after being burned by treatments that don`t work... so, I decided once again to pick your brain. In Pittsburgh, there is a limited variety of laser treatments available. Which one do you believe will improve wrinkles and skin texture, Fraxel II, Fractional 1540, Refirme, Titan?? Thanks so much.

Answer:

on that list, I would say Fraxel II, but have mild expectations, all the best. JG 2.13.12

Question:

I am considering a light laser peel. Do you thing it would work well for me,considering my skin isn`t real fair? I guess I would be called medium complexioned. I don`t want to risk having different skin tones on my face. Thank you

Answer:

I think light settimgs used to avoid pigment issues will yield little improvement, JG 2.10.12

Question:

Oh and one more thing: you say not to use petroleum or mineral based creams. Isn`t Aquaphor, like Vaseline, petroleum based? Should I stop using that. Sorry for all the questions!

Answer:

I would stop the Aquaphor, yes.JG 2.912

Question:

Thank you for such a fast and thorough response to my question about Fraxel damage to my hands. I will look for the squalene oil. In the meantime, I also use Environ`s AVST Body Oil all the time too. (I have it on my desk at work, in the car, and my kitchen and bathroom.) Is that helpful? Finally, I have NO idea what fat with platlet enriched plasma,PRP, (but not PRP alone) even is. I am not in an area where plastic surgeons don`t do much but the basic stuff, and I am certain that none of them is doing platelet enriched plasma with their standard fat injections. Is this something you yourself do? And how much would it cost? I GREATLY appreciate your time and help, Dr. Garcia.

Answer:

sure, use that until you can get the squalene oil at your local health food store. I do use it on some of my surgeries. I think the PRP would enhance the fat injections but there will likely still be a benefit without the PRP.I usually use the PRP in the surgicenter an not in the office, and I feel you fat injections could be done on the office under local anesthesia. I would have to ask the company what the in office charges for their material would be.JG 2.9.12

Question:

Hi, Dr. Garcia. At the recommendation of my PS, I had Fraxel RePair on my hands a year ago. Het set the energy very low (even lower than he uses on the neck) due to the extremely thin skin. He has had very good results with this tx on his other patients. For some unknown reason, rather than having a beneficial effect on my extremely mild wrinkles, the tx seems to have caused the skinactually to detach from the underlying fascia. While I previously has a few small wrinkles and mild textural irregularity, at least the the skin actually looked attached to my hands; that is, it stuck down to the tissues and skeleton below. Now, from my wrists all along the dorsum of each hand, the skin looks about 3 times too big. I can actually pick it up and, without pulling at all, raise it about an inch. It is also EXTREMELY crepey and looks incredibly dry although it is constantly hydrated. I use Eucerin a few times each hour (and EVERY time I wash my hands or use hand sanitizer), and I sleep with gloves and Aquaphor on my hands. I am 45 years old and now find myself with the hands of (no kidding) an 80 year old. Actually, I`ve begun looking at very elderly women`s hands and I have yet to see any as damaged as mine. Their skin is thin and their hands frequently look skeletal, but none has redundant tissue that hangs off their hands in bunches AND has the texture of a parched desert landscape. My PS can`t figure out what happened. He`s actually recommending another tx! I don`t think I`ll be doing THAT! What do you think happened? And (I bet I know the answer here), what would you suggest I do now? Nothing, I`m guessing. Wow. For a laser that is supposed to be only marginally powerful when it comes to ameliorating problems, this thing seems to have limitless power when it comes to causing damage! Thanks for your help, Dr. Garcia.

Answer:

I think what has happened is that the laser caused enough damage to the oil and sebaceous glands of the skin in your hands that the amount of normal moisture and oil your skin used to produce has dwindled. That can accelerate the aging process quickly, just like wind/sun blown skin on a sailor looks. I think you have done most of what I would say. I might suggest using squalene oil, it is the closest OTC oil sold that is the most similar to the oils we normally make in our skin. I think also limiting the hand washing would be a good idea as the water, soaps and cleansers will also dehydrate your skin. I would also use cool or tepid water only, not hot water to wash your hands I would avoid all creams with mineral oil or petroleum in them as they will not help and can aggravate the problem. I agree, I would pass on more lasers. One last suggestion, although I am not a big believer in fat injections to the hands, as I feel the plumpness you get is short lived, I will say that there are mesenchymal cells in the fat that can help the texture and quality of the skin at times. I think if your scenario is that bad, I might suggest some fat injections to your hands to see if your own cells might help. Combing the fat with platlet enriched plasma,PRP, (but not PRP alone) will add even more growth factors. I wish you the best. JG 2.8.12

Question:

If done correctly, can CO2 laser resurfacing under eyes cause hypopigmentation or lighter shade of skin? Are one or two passes used under the eyes?

Answer:

It can happen with one pass if the energy setting is high enough. JG 2.7.12

Question:

Hi, Dr. Garcia: I just found your website and have to say you clearly are a very generous person to provide this kind of Q&A opportunity to non-patients. I am 51, blue-eyed, brunette, fair, and freckled, and I`m sorry to say did not take good care of my skin for decades, having been a sun worshipper (plus living many years in the arid Colorado climate). In 2007 I had a microlaser peel, as well as some IPL treatments. The IPL got rid of hyperpigmentation (which, of course, has since come back), but I can`t say the micropeel did anything remarkable. In 2009, I had profractional treatment. I really can`t say that I got any great result from that, either, and have wondered if it even made the uneven surface of the skin on my lower face even worse, and perhaps increased the laxity of my neck skin. Last week I got two syringes of Juvederm and two syringes of Restaylane in various parts of my face including the orbital area, and I think the outcome is very nice. I have used fillers previously with good results. (By the way, even though I love the effect of Botox, I have given up on it because it only lasts about 6 weeks! No joke.) The RN who did the recent fillers suggested I see someone for more laser work. I went for a consult yesterday, and was recommended by the technician to do SkinTyte, Microlaser Peel, and Profractional. She said if I wait two weeks, doing this will not degrade my fillers, and should give me great skin improvements. I really want to improve my significant wrinkling, sagging, and hyperpigmentation, but given my previous experience with lasers, I am a little skeptical. I`m willing to do the downtime and spend the money again if I`m reasonably sure of a good outcome. But if not.... Also, I don`t want to run the risk of prematurely degrading my fillers. I wonder if I should just find someone who will do CO2, or wait until I am brave enough to have surgery for the wrinkles and sagging. Maybe I should consider TCA for the hyperpigmentation? Your thoughts? And thank you so very much in advance. I wish I lived closer to you, so that I could schedule an appointment.

Answer:

I think you likely will get little with the suggested. I think a TCA peel will help the discoloration though. The chemicals and lasers will not affect the fillers. I wish uou the best. JG 2.7.12

Question:

Hi Dr. Garcia, I got a v-beam treatment a week ago for a relatively light pink/brownish spot under my eye. Though it was slightly swollen for a day there was no purple bruising, but for the last week it has been a much darker reddish/brown color to the point where it looks like I have a black eye. Is this likely to fade to its original color, or does this sound like a hemosiderin stain? Thanks

Answer:

It should fade with time, got to hang in there. JG 2.4.12

Question:

Hi Dr. Garcia, I`m 37 years old and am starting to see fine lines appearing on my forehead and around my eyes. More noticable wrinkles around my neck and decollete. I have very fair skin. What treatment would you recommend? I`ve been trying to do my own research and it`s been very confusing with all the different methods of treatment. Thank you for your time.

Answer:

At this point sunblock not sunscreen, no cologne on your neck or upper chest, Retin-A to the areas, start at night only and progress to twice daily as tolerated. Possibly a little Botox to weaken the muscle of the forehead and around the eyes to slow but not stop the aging process and lessen the degree of muscle and therefore skin flexion. Avoid smoke if possible and maybe in the future some light fractional lasers might be worth it. All the best. JG 2.3.12

Question:

Hi Dr. Garcia, I got a vbeam treatment earlier this week on the tip of my nose, and for the first few days after treatment, the pigment was the same color as beforehand. Then 4 days after the treatment, my nose became pink in the area where I got v-beam. Is this a common reaction to get delayed pinkness? And will the pinkness fade?

Answer:

It is common, and yes, it will fade in time. All the best. JG 1.28.12

Question:

Hey Doc, I had Fractional Erbium Laser at the end of August last year. I still have this tingling in my face that comes at random times. Around the temples (mostly left side) and sometimes forehead. Usually more towards the end of the day. Or sometimes when I drink beer or work out or get hot...but definitely not always. My dermatologist explained that this was collagen production, but I have my doubts. Since it`s been this long, should I have any reason to worry. Is this possible nerve damage. I`d appreciate any help you can provide. Thank you.

Answer:

more likely is nerve covering irritation from the deeper pixels, should get better with time, not a very common problem, but I would not worry, might take a year to totally go away. JG 1.26.12

Question:

Dr. Garcia, I have developed a very small mole or sun spot, just under my lower eye area that over the last year or so has now become quite visible. I know that this area can be quite fragile, what would you suggest to get rid of it or minimise as much as possible. I am from a Danish heritage if that helps. Thanks

Answer:

Start with Retin-A, progress to a light chemical peel or a YAG laser series. JG 1.12.12

Question:

I`ve had a blepharoplasty and canthoplasty but still have some bags under my eyes. My surgeon is suggesting CO2 resurfacing to tighten the skin. Do you think that will help? Thank you!

Answer:

it depends on where the bags are, if they are herniated fat pockets or a festoon, I do not think the CO2 laser will help. If it is persistent fat pockets, it needs more surgery, and if it is a festoon, it will also likely need more surgery, but not through a blepharoplasty. Sorry. I wish you the best. JG 1.19.12

Question:

I had dot laser for entire face six months ago. His setting were 1300--previouslyl I had a treatment of dot at 800 and had no problems. This time I had a lot of trouble healing. My upper lip area is very slightly different in color and texture--a tiny bit chalky looking. Is it risky to have the upper lip treated again even at a lower setting? Thanks a lot, as always.

Answer:

I would wait 6-12 months to see what happens before considering another session, even at the lower settings. You need to make sure what has happened has healed before trying anything again. JG 1.10.12

Question:

Hello again Dr. Garcia, If you do not think laser resurfacing is a good option for acne scarring, what do you think is a suitable option, other than fillers? Especially for texture, because that is what I am concerned with most. I am less annoyed by the random pits as I am by the texture of my skin due to some of the more superficial scars.

Answer:

well, I do think lasers are OK for acne scarring in pale skinned patients, but not in fair skinned Latinos, Asians or African Americans. JG 1.9.12

Question:

Hey Dr. Garcia, Thank for answering my questions so quickly. Why are lasers only temporary? If the point is to make new collagen, why doesn`t this collagen last?

Answer:

be cause the body`s aging process, environmental causes, personal habits such as smoking or sun exposure are constantly breaking down collagen. Usually the amount of collagen formed form laser, especially fractional lasers is minimal and it is quickly gone. JG 1.9.12

Question:

Hello Dr. Garcia, First of all, thank you for taking the time to do answer these questions, they`re very enlightening. I am a 23-year-old Asian male with acne scarring on the cheeks as well as various PIH acne redness in various spots on my face. I do not know what particular skin type I am, however, I do get pink pretty easily (I have been pretty much a standard pink my entire life). I had a Lux 1540 to treat the acne scars back on November 30, 2011. So far, I`ve had some results, some of the scars have gotten softer, though I am suffering from some mild post-inflammatory hyperpigmentation (asking around, I appear to be the only one that notices the PIH at all). The PIH seems to be mostly making my skin redder than anything else, not really darker, but there is noticeable demarcation. The PIH occurred even though I had been using a zinc dioxide-based sunblock (SPF 30). I generally don`t wear the sunblock indoors, but I always have the curtains drawn shut when indoors + I always take care to put on sunblock even if I`m going to get the mail. I asked the doctor and the skincare specialist at the office about the PIH, and they both did not like the idea of using hydroquinones because it could irritate my skin and make it even redder. I had been taking Lux Vs (IPL) before my Lux 1540 to handle some active acne, and I took a PDT on December 28, using Metvixia as the topical treatment and a Lux V treatment as the activating light source. Both the Lux Vs and the PDT have has great results on my existing acne, and I have been happy with that process. I believe the PDT also helped with my PIH redness, though that may be a subjective observation. I am scheduled to take another Lux 1540 around January 21. My acne scars are mostly boxcar. Some of the scars looks almost like wrinkles or cuts. They are very soft, and aren`t visible at all under certain lights. In fact, they disappear completely if I stretch the skin taut. A few questions: 1. Do you think Lux 1540 is good for treating acne scarring (other than icepick scars)? 2. What can I do to help prevent more PIH from future Lux 1540s? What can I do to treat existing PIH? Is IPL an option for my PIH, considering that I actually responded pretty well to it? 3. I came upon this study a while ago: http://www.thefreelibrary.com/Evaluation+of+clinical+improvement+in+acne... It seems to suggest that Lux 1540 is actually pretty good for treating and preventing acne outbreaks. Would you agree with that assessment? 4. I read earlier that you didn`t think laser treatments of any kind were permanent, that, in fact, many of them were temporary. Is that really true for acne scars? I`ve heard from various sources that laser treatments for acne scars are either permanent or only temporary. I`m really confused as to what this means. The most in-depth explanation I`ve heard about it is that collagen loss does occur eventually as you get older, but because laser treatments stimulate new collagen growth, the way the loss occurs will not make your scars come back, rather it would be an even loss of collagen across the entire face (and body). This assessment was from a random doctor online, not from my own doctor, though my own doctor later told me a similar assessment. But I am not sure if I can trust that. What is your opinion for the longevity of laser treatments for acne scars? Again, thank you for taking the time to answer my questions. P.S. I am surprised to hear from you that Lux 1540 is actually partially ablative, despite the fact that other lasers of similar wavelengths are not. In fact, this is the first time I have heard that Lux 1540 was ablative anywhere, and I`ve done a lot of extensive research on the topic.

Answer:

hydroquinone will not help with the redness, that is a matter of time, I would not use too much topically as it could irritate things, if anything, you could use some copper peptide creams to assist in speeding the healing. I do not think any laser is good for ice pick acne scars and in Asian skin, I would be very apprehensive about using lasers for acne scarring to to the depth required to see an improvement and the attendant risk potential. As to avoiding PIH brown spots using hydroquinone before is an option, but besides using a lesser setting, there is not much to avoid the redness, it is normal healing from a laser. No laser will help prevent acne break outs as no laser can affect the causes, at most it might decrease the bacteria in the skin is about the most you can expect. I think any benefit with lasers for acne scarring will be even less long lasting than for wrinkles as the problem is much deeper. All the best. JG 1.8.12

Question:

Hello Dr Garcia although 47 !!! i still have active acnee..they want to lazer co2 resurface my face and injec fat(from lipo to my thighs) in my cheeks and noselabial under general anestesia..oh and lipolift in my jowls.i m worried i will look weird for more than two weeks i m also concerned about getting my face looking like a pancake...i temporarily canceled it..i sugested to put radiesse first to see if i like it!!!

Answer:

Good thinking, that they ate proposing could leave you puffy for 4-6 weeks. JG 1.7.12

Question:

My plastic surgeon is recommending CO2 resurfacing under my eyes and at the lid-cheek junction. I know that there will be a long recovery and months of redness, and I`m not too thrilled about that but am willing to do it for the long-term improvement. I`m concerned though that the surrounding skin will never match the color of the resurfaced skin once the wounds heal. Is that common? I`m afraid of looking like a raccoon. Has this ever happened to your own patients when you do a partial face resurfacing? (My surgeon doesn`t want to resurface my whole face because he thinks I don`t need it, and I agree with him.) I am British and extremely fair--almost translucent I`m so white. Thank you very much for your kind help, Dr. Garcia. I hope the people in your life are as unfailingly generous to you as you obviously are to others.

Answer:

Thank you for the kind words. As to the segmental laser, as long as you have fair skin, it should be safe and there should be equal skin tone once healed. Happy New Year. JG 12.29.11

Question:

Hi Dr. Garcia, I received vbeam treatment a couple months ago, and in the past week, some darker red/brown spots which had been eradicated by previous vbeam treatments came back. Is this delayed hyperpigmentation part of the healing process? And should the darker spots eventually fade? Thanks!

Answer:

this far out it is just a recurrence of the prior spots, nothing will remove them permanently, in time, with sun exposure and florescent light exposure they will come back. You will not see any further fading of the spots from the prior VBeam this far out. JG 12.27.11

Question:

I had CO2 resurfacing around ten years ago with (after prolonged healing) very good results except the Dr. went all the way down my neck. He said that he would feather it and there would be no line of demarcation. Well there is a line that is mask-like. Is there any way to diminish that line?

Answer:

Maybe a series if chemical peels to remove more layers. JG 12.26.11

Question:

Hi Dr. Garcia, I got a v-beam treatment about 6 weeks ago, with a week of subsequent bruising. I still have some light brown PIH where I bruised. It`s nothing too terrible, but I was wondering if this will continue fading and eventually return to the color of the surrounding skin. Thanks.

Answer:

yes, using a little Retin-A and some hydroquinone, along with avoiding the sun by using sunblock will help it along. All the best. JG 12.21.11

Question:

Hi Dr, I was wondering what you think the best lazer is best to remove wrinkles and some light discoloration on the hands and neck and chest area, I dont mind the downtime, just want to do it once and get it over with. Thanks

Answer:

well, lasers cannot be done very strongly on the off face area, a fractional laser might be safer, but in time, with sun exposure, all of the spots/wrinkles will come back, there is nothing that will remove them forever, sorry. JG 12.21.11

Question:

My plastic surgeon is trying to stall on doing a CO2 resurfacing around my eyes, which we both agree I need. I`ve done 3 fractionally ablative treatments in the past two years (with dermatologists, not at his office) with very, very minimal results. He doesn`t own any fractionally ablative lasers because he doesn`t think they`re effective. Instead, he had me use Cutera`s Pearl handpiece (which isn`t even as powerful as fractionally ablative treatments), using three passes. Nothing. I didn`t even turn pink, and I lost another $1,000. How can I convince him that it`s time for the CO2? I don`t think he should charge me for it either, since I`ve wasted yet more money at his practice at his insistence. Does that seem fair to you? I`m 53 years old, by the way, so I don`t know why he thinks we need to wait to do this. Thank you for your opinion, Dr. Garcia.

Answer:

It will be tough to get him to do something he does not want to do. You might have to see someone else. JG 12.20.11

Question:

I am a olive complected Indian female. I have done well with V-beam and IPL on face. I want to have hair removal done on my legs. The aesthetician wants to use the Alexandrite; will that pose any major risks? Should I take any precautions? Also, what do you think of the e-matrix for the face?

Answer:

I would mot use either one due to the natural color of your skin, for fear of hyperpigmentation. Sorry. JG 12.21.11

Question:

Hello Dr. Garcia, I just got a single spot v-beamed yesterday. It was a blemish that had healed about a week ago, but there was still a red spot that hadn`t yet faded. Anyway, today the red spot is even redder/pinker than it was before the vbeam procedure. I`m not very familiar with v-beam. Is it common for red spots to get redder/pinker the first day or so after v-beam before eventually lightening? Thank you in advance for your response.

Answer:

it is common for them to get worse first, yes. It will get better over time, slowly. Best of luck.

Question:

Thank you for your answer about the CO2 resurfacing. Very informative and helpful. I just want to be sure that I understand one of the points you made. You say that pigment cells don`t migrate upward, but my dermatologist has led me to believe that the sun damage below the skin will eventually rise to the top and become visible. I`m asking this because I have very little visible pigment now due to my vigilance and regular IPLs and fractional resurfacings. I`m scheduling the fully ablative CO2 prophylactically, to head off the appearance of the damage my dermatologist is predicting I will soon see; but your answer below leads me to think that it might be an expensive, painful and unnecessary waste of time and money if I don`t see the pigment now. Can you clarify that for me? Thanks so much, Dr. Garcia!

Answer:

I think prophylactically doing the laser is not wise, can cause post-inflammatory hyperpigmentation(read new worse spots)and is not needed, will not get you much better from what you are describing, and will only put money in the doc`s pocket. If you have little visible pigment, now is NOT the time. JG 11.30.11

Question:

Hi, Dr. Garcia. I`m scheduling a fully ablative (not fractional) CO2 resurfacing next month. If I understand this procedure correctly, it removes the entire epidermis. Is that so? If yes, I`m assuming that the pigment from previous solar damage will be eliminated, since pigment only forms in the epidermis. Is that correct? I`ve been using full spectrum sunblock 365 days/year for over 2 decades now, but it wasn`t available in the first 25 years of my life. I had a UV photo taken ealrier this year, and what it revealed was horrifying. If I don`t do the CO2, I`m assuming that all the pigment I see in the UV photo will eventually rise to the surface of the epidermis. Is that correct? And having the procedure will eliminate all that damage? Since I have almost no sun or flourescent exposure now, I`m hoping that once that pigment is gone, it won`t come back. Thank you very much for your guidance!

Answer:

yes, it does remove the epidermis, and the upper part of the dermis, depending on how strong the settings are. The pigment from prior sun is in the epidermis and the dermis, so not all for it will be gone I am afraid. Pigment cells will not migrate upwards, and the other thing is that fluorescent lights also can have effects on pigment. There will be significant improvements but likely not total removal of pigement issues. Sorry and all the best. JG 11.30.11

Question:

Hi Dr. Garcia, Thankyou for helping all of us with our questions I had 1 IPL treatment on my face, 2 weeks ago to remove sun damaged age spots. Just with one treatment, it appears that my age spots got darker and none faded. Is it possible for the IPL laser could make age spots darker?? I am hesitant to have any more IPL treatments. What do you recommend I do?

Answer:

Getting darker is common before it fades, you will need a series of sessions and in time it will come back. JG 11.8.11

Question:

Hello Dr Thanks for your prompt response to my quest. I am the 70 yr old female that wrote-in on 11/3. I would appreciate an opinion on what you would suggest for the various problems I indicated. Thank you so much for your time. It is very appreciated

Answer:

if you could send me some pictures to drgarcia@lvcosmeticsurgery.com and your concerns in terms of priority, I would be happy to respond to you directly. JG 11.4.11

Question:

Hello Dr. Garcia. Thank you for this forum. I am a very young-looking 70 yr old - really. I had an excellent natural looking face lift when I was 60. No one knew as always had good features so just looked better for some reason. I`ve taken excellent care of my skin since the age of 12 and it shows. I have had radiesse around the nasel labial folds a few years ago and it lasted about 2 years. I am now noticeing puffiness under the eyes, the upper eyelid needing more elasticity. I also have sagging thighs now. My decollete has sun damage. (this is the one spot I was not educated about in my youth but I am now constantly reminding my granddaughters about it) My Dr. has suggested Fraxil Repair for the eyes and chest and radiesse for the nasil labial area. He has suggested Thermage for the thighs. He Fraxil he said would have social down time of about a week. He intends to do the work on the face only once. I`m concerned about what does this do exactly to my face. I wish I could see pictures during recuperation. He said this is somewhat painful but he will make me comfortable; the same for the Thermage. What do you think? I really appreciate your feedback

Answer:

I think the Fraxel will help the eyelids for a while, but it will be short lived, a few months. I think Thermage for your thighs will be a disappointment, but Radiesse for the nasolabial fold is a reasonable option. JG 11.3.11

Question:

I know you`re not a supporter of fractional resurfacing. I just want to know if Cutera`s Pearl Fractional is as powerful as Fraxel`s RePair or Lumenis`s Total FX. I ask because my plastic surgeon allows his nurse to do the Pearl Fractional, but in other area practices, the plastic surgeons are the ones who do the Fraxel or Lumenis fractional resurfacing. I`m guessing it`s because Cutera`s is much less powerful. Is is, like the others, fractionally ablative or is it entirely non-ablative (like Fraxel`s ReStore)? Thank you!

Answer:

The Pearl is less strong but still fractional, not totally ablative. JG 10.13.11

Question:

I`ve had both Reliant`s Fraxel RePair and Lumenis`s Total FX, both times aggressively. Instead of the predicted 7-12 days of recovery, I had 5-6 weeks of redness followed by about 4-5 weeks of pinkness. (I`m so fair I`m almost transluscent.) Since neither of those fractional resurfacings made much of a difference, my PS is now recommending the old school fully ablative CO2. He thinks I`m likely to have the same length of recovery with this treatment as I had with the others based on my skin type and recovery history and based on the fact that 12-16 weeks is about the length of time it usually takes people to recover from the full CO2. But I`m wondering if it may actually take longer for me to recover from this than that standard length of time because it took me longer than the usual amount of time to heal from the fractional CO2. He says that my previous recoveries are a good predictor of what to expect this time around, but I`m not so sure. What do you think? Thanks so much!

Answer:

I think it will take longer as a larger surface area will be treated and there will be more thermal injury caused, which is good in the long term but adds to the healing time. JG 10.9.11

Question:

Just a follow up on the Q-switched Yag vs. CO2 resurfacing. You said the Yag is safer. which I know it is. But I`m 54 and in addition to wanting to get rid of pigment, I also have a fair amount of wrinkles and textural damage I`d like to improve. Would you still recommend the Yag over the CO2?? I thought that the totally ablative CO2 was the gold standard. Thanks for your help.

Answer:

no, I was suggesting the YAG if the only was only pigmemt, the YAG will not give much wrinkle reduction, for the both issues combined, then it is a CO2 laser. All the best. JG 9.26.11

Question:

I am having a hard time finding doctors who perform CO2 laser resurfacing around the eye area. I am not looking for the Total FX laser. I am looking for the original CO2 laser. Do you know if there is a website or company that would have a list of participating CO2 laser doctors?

Answer:

I would suggest Laments.com. You would want a doctor that has an ultra pulse and then they have to set it with a high density pattern. JG 9.25.11

Question:

In late July I had fractional CO2 to get rid of a few wrinkles and dyschromia. The only thing I got rid of was a LOT of money. What a waste of cash! So now I`m looking into the full-ride, which scares me but seems to be the only way to go if I want real improvement. How many months do I need to wait until I can safely do it? Thank you for your help and time.

Answer:

Sorry to hear about that, I would give it 3-6 months. All the best. JG 9.14.11

Question:

I`m scheduling a CO2 resurfacing (not fractional), and I need the hard truth about how long I`ll need to be out of work. My surgeon is saying 2 weeks because I can use mineral make-up at that point, but I`ve seen some of his patients at two weeks and let me just say, YIKES! Even with make-up, I can`t imagine I`d be anywhere near presentable at 2 weeks. In your experience, what can I REALLY expect? And when do your patients usually see the red turn to pin? And then how long, typically, before the pink turns to white? (By the way, I`m almost translucent I`m so white! 54, non-smoker, sun-phobic/full-spectrum sun-block-wearing-365-days-per-year female who has a LOT of solar damage from the first 25 years of her life when sunblock didn`t even exist and when we all thought the sun was good for us). Thank you, Dr. Garcia.

Answer:

closer to three weeks, and then , the make up will need to be reapplied or touched up every 4 hours or so. Red to pink depends on how deep you go, but it happens at 4-6 weeks. As to the pink fading to normal, it is 3-5 months. JG 9.11.11

Question:

Hi, Dr. Garcia. Sorry to send the same question twice, but I don`t think you saw it in the list you`ve recently answered Does fully ablative CO2 resurfacing improve pore size as well as wrinkles? Thank you!

Answer:

no effect on the pores. JG 9.10.11

Question:

Thank you for your informative answer about the CO2 resurfacing. You`ve convinced me! I`m electing that option. Thank you so much for your help. One thing about your answer confused me. When I asked if I should request a more aggressive treatment, I meant a more aggressive setting of the ablative CO2 rather than a lighter setting of it, even though the surgeon thinks I need just a light treatment. You say both that there is no need to treat deeply if it doesn`t appear that I need it AND that you would bite the bullet and go for the more aggressive treatment. Which should I request? I don`t mind a few extra weeks of redness if it`s going to pay off in a better, longer-lasting result; but if it doesn`t make scientific sense (that is, if I won`t get a better, longer-lasting result from a more aggressive setting because that`s just not how laser resurfacing works), then I obviously shouldn`t request it. Sorry for the extra question! I was just confused by your answer. Good night, Dr. Garcia. (Do you EVER sleep, by the way?! It seems you don`t!)

Answer:

I think it best to get what you need now, it can always be repeated a few years down the road, no sense in going deeper than you need as degree of tightening is not needed at present. Get what you need now, the future will come and we might have better things when you need the next one. As to sleep, yes, I love it, great time to dream! JG 9.5.11

Question:

Hello, Dr. Garcia. I`ve been on two consultations with two different plastic surgeons about laser resurfacing. I see from reading this blog that you favor fully ablative CO2, and I`m leaning in that direction myself. One of the surgeons I saw says he only does fractional resurfacings now not only because of the reduced risks and shorter recovery time but also because he finds he can achieve better skin tightening for his patients because the fractional technology, while only partially ablative, goes deeper than the traditional CO2 and therefore is able to stimulate more collagen growth. It sounds like if I chose that option, I`d be trading less surface improvement to my skin for greater tightening, and if I chose the tradition CO2, I`d be getting greater surface improvement but less tightening. Is that right? Also the surgeon who does the traditional CO2 said that the length of recovery time depends on the strength of the treatment. He says I`d fall into the category of patients he would treats more lightly than others. (I`m 50, extremely fair with blue eyes, have moderate fine lines, some textural changes on my cheeks and only very light scatterings of pigment.) Does his assessment of me sound right to you? If so, when you treat patients more lightly than others, how much shorter is their recovery time? Should I just bite the bullet, opt for the longer recovery, and ask him to be more aggressive now to achieve a greater and longer-lasting improvement, or does it not work that way; that is, is the strength of the treatment determined only by the current, visible damage on each individual patient or can it be made stronger to be preventive and longer lasting despite the level of current, visible damage ? So sorry for all these questions, but you can see I need some guidance! Thank you very much for your assistance. Good heavens, I hope YOU have some people who are as helpful to you as you are to all of your readers, Dr. Garcia. You are lovely.

Answer:

I disagree with the fractional going deeper and therefore causing more tightening, a fully ablative laser can go as deep as desired, leaves no skip areas and it is the total surface of dermis injured which affects the amount of tightening, so when you injure less, you get less tightening. I think the shorter healing is a few weeks, but no need to go deeper unless it is needed. I personally would bite the bullet. All the best and thanks for the kind words. JG 9.5.11

Question:

Thank you for the suggestion about the ultrasound for the periorbital edema. My surgeon recently purchased Ulthera, which of course is an ultrasound technology. Do you think that might help?

Answer:

Certainly worth a try. JG 8.28.11

Question:

I had Fraxel Repair in July and healed well, but I have been left with an immense amount of swelling under both eyes. The fluid extends from my lower lashes to the lid-cheek junction and is raised about a half centimeter above the rest of my cheeks. It looks like two plastic bags of water -- well, bags of water is exactly what this is -- were installed under my eyes. My PS says he`s never seen this reaction before. Of course, I`m sleeping sitting up, avoiding sodium, icing, etc., but it`s not going down. I`ve also tried gentle massage to see if I could stimulate lymphatic drainage, but it`s not helping. My surgeon suggested when I last saw him that the treatment may have tightened the skin enough to create an inflammatory reaction that could trap fluid beneath it permanently, which is a scary possibility. What do you think? Any suggestions? Thank you for your help, Dr. Garcia.

Answer:

I do not think it will be permanent, might consider topical ultrasound to the area, the machine they use physical therapy, can be don`t 3 times per week. Best of luck. JG 8.27.11

Question:

I have the same problem as the other person who just wrote about acne after laser resurfacing, though my case seems milder. I`m 12 days post procedure and am remembering an old home-remedy from the `70`s that I used as a teenager: crushing aspirin and making a paste with a drop of water to smear over the lesions. The principle, of course, is that aspirin is an anti-inflammatory. Is this helpful, harmful or just useless in your opinion? Thanks so much for helping out us middle-aged lasered acne sufferers! I guess we wanted to look younger, and boy, we are, aren`t we? Hope you`re having a great weekend, Dr. Garcia.

Answer:

It will work, it creates salicylic acid, same as what they use in MediSpas. Best of luck. JG 8.20.11

Question:

Thank you, Dr. Garcia, for your reply about acne post laser resurfacing. You say that my pores will need to be opened and drained. I`m sorry to ask such a basic question but what would that involve and where would I have that done? I can`t imagine that my plastic surgeon would spend what I assume would be an immense amount of time hovering over my thousands and thousands of clogged pores! And would opening the pores mean cutting the epidermis?! Wouldn`t that leave scars? And how are they drained ? Are they aspirated with a needle? Vacuumed? Sorry to seem so stupid, but I was under the impression that acne should not be physically tampered with due to inevitable scarring. Thank you for your incredibly generous service to folks like me, Dr. Garcia. You are obviously a great human being.

Answer:

an aesthetician at a MediSpa can do it with microdermabrasion or a small lancet to open and express the material. It is actually part of many facials and is not to much money.The epidermis is not cut, just the keratin waxy layer plug that is covering the pores themselves. They are vacuumed or pushed clear. All the best and thanks for the kind words. JG 8.20.11

Question:

I can`t imagine how you can stand all of us with our endless questions! You must have many days when you regret opening this site. So I had a fractional resurfacing two weeks ago and now have a raging case of cystic acne all over my face. Where I don`t have a huge, imbedded lesion, it seems almost every other pore is clogged with a blackhead. My face is a complete mess. I`m sure it`s mostly due to the copper peptide compound I was given; I haven`t had acne in 25 years. Now what? It isn`t showing signs of abating. I went on Keflex for five days last week and that didn`t help. EpiDuo isn`t doing a thing either. Any suggestions? Thank you for any help you can offer. It`s really frustrating to have spent all that money for what I knew would be a modest improvement at best to my wrinkles and skin texture only to find myself with a face that resembles a relief map of the Appalachians...or like a scrim of an adolescent`s tortured skin on the face of a 50 year old woman. Unbelievable.

Answer:

You need to get the pores opened and drained. Once healed enough, microdermabrasion other IPL should help. Can also use Retina A if healed enough. Sorry to hear about all of it. All the best. JG 8.18.11

Question:

I see from your answers to many questions that you don`t think fractional ablative resurfacing is particularly effective, but I`m wondering if you think it`s potentially harmful to the skin. I`ve had it done twice in the past four years and the skin on my forehead and cheeks has developed a mildly corrugated effect, which wasn`t there before. Of course, I`ve gone from 47 to 51 in the intervening years; the textural changes may be mostly due to aging -- and perhaps I would have looked worse if I hadn`t had the fractional resurfacing done -- but I`m wondering if you think that the resurfacing may be the primary culprit here. Would a fully ablative CO2 resurfacing take care of this problem in your opinion. Thanks.

Answer:

it would be only harmful if the patient reacts with post-inflammatory hyperpigmentation, otherwise what can happen when trying to use too much energy or too many passes to try to get a more dramatic result, that can lead to dilated pores and in some cases, the cobblestone skin you seem to have. A fully ablative resurfacing should correct that, but not any dilated pores. All the best. JG 7.31.11

Question:

What is your opinion of the micro laser? Is it worth time or money; say $600.00 per treatment? Also is there any risks of scarring or other damage to facial skin? Thank you

Answer:

minimal texture improvement, very little new collagen produced. low risk though, gives the skin a healthy glow . JG 7.25.11

Question:

I sent a question earlier regarding the co2/fractionated laser leaving white pigmentation loss on the lower portion of one cheek. Would an IPL be able to feather the area or could I have the pigment removed in the lower portion of both cheeks

Answer:

That is how I would start and go from there. JG 7.5.11

Question:

I had co2/fractionated laser on my face and have been left with three white demarcation or pigmentation loss lines on one side. I have a ruddy but fair complexion is there any solution to this problem

Answer:

if it is true loss of pigment, there is not much you can do, if it is a relative loss because the surrounding areas are still sun damaged, then more laser or chemical peels might help smooth the areas out to match better. JG 7.5.11

Question:

For a 51 year old with frown lines, few lines around mouth, slight preorbital wrinkling. Not bad wrinkling - typical for my age. Not too much sagging (mini facelift a couple years ago), would you recommend one full face Erbium Laser Resurfacing or several Pixel Laser Treatments? Do you recommend IV sedation with the Erbium?

Answer:

Between those two it will likely be better with the erbium, I would not perform the erbium indeed sedation for fear of the patient moving and the laser hitting an unintended spot. JG 6.6.11

Question:

For a 51 year old with frown lines, lines around mouth, and fair skin, which procedure would give you the most bang for the buck - phenol peel, dermabrasion, or ebrium/CO2 full face laser resurfacing?

Answer:

I would do the CO2 out of those choices . JG 6.4.11

Question:

Thank you for the answer about the burns on my cheek. They were from a dermatologist who followed a VBeam with a 1064 to try to address enlarged capillaries. The skin instantly blistered and then scabbed over. I kept the wound moist with a topical antibiotic and then with Aquafor for weeks but I was left with burn scars. I guess I`ll continue to look for someone near me who is still doing the CO2 resurfacing. Like many of your other readers, I can`t find anyone. When you attend your next professional meeting, perhaps you can appeal to your colleagues to bring back the CO2? Everyone`s using the fractional modalities these days. I did it a few years ago and didn`t find it especially helpful. Do you accept out of town patients for this procedure, Dr. Garcia? If so, how long must one stay in the area? (10 days or so?) And how much do you typically charge? Thanks so much for all you do for all of us! God bless you.

Answer:

I do accept out of town patients, and I like them here for at least 7-10 days to make sure they are over the infection risk stage, but in the meantime, you can have a fractional laser and avoid the spots, it should help some, and done in a series should be almost as effective. JG 4.17.11

Question:

I was wondering if it is typical for the face to have shine to it after Co2 fractional laser work? I know of this woman who`s face is extremely shiny, she is 74 and has not a wrinkle on her skin. Anyone who has seen her has remarked about all the plastic surgery she must have had. Is the shine from a face life (?) or lasers? I would like the laser work done, but without the shine! Thank-you.

Answer:

being shiny is very normal with laser resurfacing, the deeper they went, the longer the shineyness takes to get better, that is just form the oil in the skin cells working to moisturize the skin. The shiny part after a laser should be gone in 6 months though, so she might be having something else going on. JG 4.10.11

Question:

Dr. G: My PS only offers Thermascan for laser toning and I`ve read your site enough to know you don`t think too much of it. I noticed you list the MedliteNon-ablative laser toning with the Medlite Q-switched Nd:YAG laser in your treatments. What is the difference between the two? I`ve been using Renova for years and don`t have many wrinkles and am just starting to sag a little. I get injections of Restylane and Botox. I could use some smoothing and evening out of a slight scar or two. What would you suggest? ML, Springfield, IL

Answer:

Thermascan works with infrared light to attempt to get some skin injury, mild in nature, so the skin creates new collagen. The Medlite YAG laser is a true laser that focuses energy onto a certain color and heats the skin therefore to diminish the color and create a small amount of new collagen at the same time. Neither one will help with sagging, the YAG will help a mild amount with the fine lines, but it sounds like they are not an issue for you. For smoothing out of a scar I think a CO2 laser is best. I wish you the best of luck. JG 3.29.11

Question:

hello had erbium laser jan 7th to perioral area and he did it deep ablative. when does the collagen start to come back? what am i looking for, am i supposed to be seeing more plumpness and increase in density to the nasolabial region? thankkyou

Answer:

the new collagen that is placed during the first 4-6 weeks will start to tighten after 6 weeks and progress for about 3-6 months, the deeper the laser was performed to, the longer time for the final result and the more improvement.I think lasering the perioral area might help the fine lines in that area but will likely do nothing for deepening nasolabial folds, sorry. JG 3.29.11

Question:

I know you`re not impressed by fractional ablative resurfacing due to its less than impressive results, but do you think it`s generally good/healthy for the skin? I`ve done it twice in the past several years and have found it helpful for tone and texture and am considering doing it again but don`t want to repeat it if doing so will somehow be harmful to the skin. My dermatologist believes it`s only beneficial, but we all like to check these things with you before proceeding! Thanks so much, Dr. Garcia.

Answer:

I think the less time the improvements last, with any laser, the less effect it will have on skin health. Once you start exfoliating the skin deeper with a laser compared to Retin-a type creams, you do increase the potential new collagen but you also increase the risk of post-inflammatory hyperpigmentation. Also,as you age, the reaction to the laser will not be as robust, so you will get less, due to the body`s lessened ability to create collagen. So its not wrong, but can get expensive for what you get. JG 3.2.11

Question:

Hi Dr.Garcia, I am two weeks post a fractionated co2 laser treatment. I have a bump that has formed on the bridge of my nose, it goes straight across pretty much.I never had one there before. Is this normal to occur and will it go away or has my doctor messed up and if so what can be done about this? Thank you

Answer:

most likely will go away, but it might take another 2-4 weeks, hang in there. JG 3.9.11

Question:

Hello, Dr. Garcia. 4 months ago, I had a CO2 resurfacing. My skin now looks like it`s corrugated (a visibly rippled, almost wavy texture), particularly on my forehead and cheeks. Is this common? What do you think happened? What can be done to correct this? (I am extremely fair, blue eyes, 49, non smoker, athletic -- a devout user of sunblock 365 days/year). Thank you for your time and help. You are a blessing to so many. Thank you.

Answer:

it can look like that the first month or two but it is not normal this far out from a CO2 laser. Hard for me to say what can be done without at least seeing pictures of you. It would also help to know what type of laser was sued and how it was done. You can send the photos to drgarcia@lvcosmeticsurgery.com JG 3.6.11

Question:

had erbium laser jan 5th to perioral only still today very red and splotchy.. is it normal? elected not to do the led treatments post

Answer:

should be getting better by now, need to see your doctor to make sure you do not have an infection, the LED sessions I think are more hype than anything. Best of luck. JG 3.6.11

Question:

Hi Dr.Garcia, I am a 29 year old caucasian female. I had a deep Mixto Fractionated CO2 done seven days ago. I am wondering about how long it will take for the swelling from the laser to completly go down. I find I have lines and such from the laser when will my face return to normal? Thank you.

Answer:

could take another week, maybe a little more. Normal should be about 4-6 weeks, all the best. JG 3.2.11

Question:

Which is better for pores between TCA peel of Sciton Microlaserpeel?

Answer:

microlaser peel, but it will only last a few days to weeks. JG 2.22.11

Question:

Dr. Garcia, How effective is Lasergenesis for improving skin texture and collegen production? Is it as effective as CO2? Is it good for Asian skin? Thank you.

Answer:

mild at best and less so in Asian skin as the settings have to be lower, therefore less improvement. A totally ablative CO2 laser should not be done on Asian skin though as the risk benefit ration is not good. JG 2.7.11

Question:

Hi, Dr. Garcia. Like so many of your other correspondents, I`ve found it impossible to locate a plastic surgeon or a dermatologist in my region of the country who performs fully ablative CO2 resurfacings anymore. I did a fractional CO2 resurfacing and, as you always claim, found it only minimally helpful. I`m writing to ask how much you typically charge for a light CO2 resurfacing. I imagine others who read this blog will be interested to know too, since so few surgeons are doing them. It may well be worth our time to travel to Las Vegas. How long would out-of-state patients need to stay in town following the procedure -- one week? Also, is the recovery from a light resurfacing the same as an aggressive one -- 3-6 months of downtime from the erythema? (I was bright red for 7-8 weeks from Fraxel Repair, which is about as long as the benefits lasted! By the time I was presentable again, I looked pretty much as I had before the procedure. I have Type I skin -- extremely white, extremely fair -- in my early 50`s.) Thanks very much, Dr. Garcia. I may actually be meeting you in person soon for this!

Answer:

I like patients to stay at least 10 days as I like to see the skin close to being healed enough to avoid a herpes break out, the prep time is using Retin-A and Hydroquinone for 2-4 weeks, twice per day, the higher the risk for hyperpigmentation, the longer the pre-treatment. Our fee for the procedure is $4,150, all inclusive, we perform it under general anesthesia. A light one will have redness/pink faded in about 6 weeks. The bright red is gone in about 4 weeks. All the best. JG 2.7.11

Question:

Dr. Garcia, I had an ablative erbium treatment on my hands 1 week ago. This was the first of three treatments. My hands still look very dry and wrinkly. Is this normal? Thank you.

Answer:

normal and don`t be surprised if after the swelling goes away that you see no difference except for a short term improvement in brown spots.JG 2.3.11

Question:

perioral ablative laser 3 weeks ago still very red and some red sores more like splotches, not raised or anything. wondering if normal

Answer:

can be normal but I think seeing the doctor to make sure you do not have an infection, viral or otherwise, that could produce irregular healing. Best of luck. JG 1.29.11

Question:

Dr. Garcia, Does ablative erbium laser treatment really help to tighten the pores and the skin and promote collagen production? How long does it generally last? I really don`t have any wrinkles, but just want to rejuvenize my skin. When I went for a consultation, the doctor told me that I wouldn`t notice the full effects for several months after treatment. I just wanted to confirm if this is really the case. Thank you.

Answer:

I think they do create limited collagen because there is an injury but it is not as dramatic a production as a CO2 laser because the erbium does not cause heat and that augments the collagen production along with collagen tightening. As to pore reduction, maybe a little in the very short term but nothing that will last any significant amount of time. If it is done too deeply the pores can actually look bigger because the surrounding skin will tighten and cause the pore to open even more. As to the full effects, that is correct, it will take a few months to get to the final point, the deeper they go, the longer it will take to see the end results. All the best. JG 1.25.11

Question:

In your experience, do the results from a fully ablative CO2 resurfacing typically last 1.5-2 years? Do you often perform repeat procedures on your patients? If so, after 2 years? Thank you, Dr. Garcia. Have a great week!

Answer:

around the eyes and mouth typically about 1.5 to 2 years, yes and longer on cheeks and foreheads. I have performed repeat procedures on my patients if desired, yes. All the best. JG 1.24.11

Question:

Hi Dr., Thank you for your response RE fractional laser. I just want to clarify: Are you recommending (1) a series of 4, followed by once every 3-4 months? If yes, how long after the series of 4 do I have to start the maintenance program of once-every 3-4 months? Or are you recommending (2) forget the series of 4 and just have the treatment once every 3-4 months? Thank you!

Answer:

if you are going to spend your money on the fractional laser to begin with, yes do the series first, I think you will need to continue with it every 3 to 4 months after the initial series. Start the maintenance 4 to 6 months after the last of the initial series. Best of luck. JG 1.5.11

Question:

Happy New Year, Dr. G! I had the first of 4 in a recommended serie of fractional laser. I actually like the result of this one better than the Fraxel I had over 5 years ago. You had said you don`t believe once a year to maintain (after the serie of 4) will do any good. Do you think having the treatment once every 3 months or so (instead of doing a serie of 4) would be a viable option? If not, after the serie of 4, how often would I have to keep up with this treatment thereafter to maintain the results? Thank you and bless you for your generosity!

Answer:

In my opinion, i think a repeat treatment would likely need to be done every 3-4 months. Also understand, that as you age, the degree of new collagen formation will lessen, so you will not get the same degree of improvement two years after the first one. JG 1.4.11

Question:

hello Dr Garcia can you please tell me what you think about ulthera do you do this thank you bets

Answer:

I think it is slightly painful to have done and there are no long term studies to show how long the results last past the 3 months data given to the FDA to obtain approval, I would personally, not perform it on a patient for fear of disappointment in money spent. JG 1.3.11

Question:

Three weeks ago I had one of those fractional CO2 resurfacings you don`t like because I couldn`t find anyone who does the fully ablative procedure anymore. All went well but I was left with distinct white lines of demarcation around the anatomical points where the surgeon altered the depth of the treatment. I have white lines at the lid-cheek junction and a big white square around my mouth (n-l folds and l-m folds). He is suggesting the Cutera Genesis to reduce some of the pinkness in the treated areas, thereby making the white lines less noticeable by contrast. Is it too soon for this? He thinks not? Thanks for your help. Happy New Year, Dr. Garcia!

Answer:

well, much of that will fade in time, the redness is normal, another laser to control the redness can be done, but it might also decrease the amount of beneficial collagen you were trying to achieve. I might suggest riding it out for another 3 weeks and see how it looks before doing another laser. Best of luck and Happy New Year to you also. JG 12.27.10

Question:

Hi Dr. Since you`re not a fan of fractional laser, what laser do you suggest for general improvement and maintenance - better clarity, tone, firmness? And do all lasers have the potential of causing hyperpigmentation as a side effect? Thank you.

Answer:

all lasers and chemical peels, if done deeply enough to cause a change have that risk. As to general improvement, I use a CO2 laser, totally ablative, depth depending on need, along with continued Retin-A for maintaining it.JG 12.19.10

Question:

Hi Dr. G., This is a follow up to my Q about the fractional laser. It was recommended to me that a serie of 4 (spaced 4 weeks apart) will yield optimum result. Thereafter, once a year for maintenance. Is this right? Also, does it matter in terms of results that the machine is not made by the Fraxel folks but by Palomar? And what are the potential side effects of fractional laser? Happy Holidays ... I hope life will give back to you what you give to all readers of this forum. Heartfelt gratitude!!

Answer:

I seriously doubt that once a year will maintain things, in my opinion. I think the fractionated lasers are equally unimpressive in their results and equally impressive in their hyperbole of claims. As to the side effects, there can be hyperpigmentation, scarring and little improvements. As you can see, I am not a believer in the treatment. All the best for the Holiday Season. JG 12.18.10

Question:

Sorry to post this question twice, but you didn`t answer it below. Hi, Dr. Garcia. I just had a CO2 resurfacing. WOW -- what a mess I am! Would you please explain the beneficial effects of the vinegar water? My surgeon says he used to have his patients use it but now doesn`t think it`s all that helpful. I see that you sometimes recommend it. What exactly does it do? Gosh, I hope this turns out to be worth the disfigurement. Does this usually turn out to be one of those infamous long runs for a short slide or are the results of most resurfacings usually pretty much worth their requisite downtime in your experience? Thanks very much for your help. Happy Holidays, Dr. Garcia! We all love you.

Answer:

the vinegar water is used if the patient is having a hard time removing the ointment that is applied to the face, at times the skin debris sticks and the vinegar makes it get looser and allows it to fall off. I do not use it on all patients. I know it can look horrible for a bit, but in order to injure the skin enough to get good collagen production and contraction, that is what is needed. Anything less would give less of a result. I feel it is more of a long run for a long slide. I find resurfacing with a totally ablative CO2 laser certainly worth the downtime, if you can put up with it. I wish you the best. JG 12.17.10

Question:

Hi Dr. G., Please excuse the duplication(s) if you have already addressed this question previously. Can you please tell me what the benefits of fractional laser are (I am realistic in my expectations and know the aging process continues), and what the downsides might be. Thank you!

Answer:

the benefits are that it heals faster than a totally ablative laser, the downsides are that as it only treats a fraction of the skin, the results will be mild and likely not last more than a few months, the older one is the less beneficial it is. JG 12.17.10

Question:

Yikes, that`s what I was afraid of. Would a 12.5% TCA peel be better than the pearl fusion laser for acne scars around the chin area? Or a series of TCAs? I just want to make the right choice. Thanks. Your site is a Godsend.

Answer:

Well, the TCA would be safer but it does not help acne scars much due to the deep dermal tethering which is not helped by most chemical peels. JG 12.8.10

Question:

I`m sorry, I`m a bit confuseed about what you meant when you wrote don`t expect much improvement past 6 months or so in regard to my question about the pearl fusion laser earlier. Does that mean you only get about 6 months of worth it results from the procedure, or that you have to wait 6 months before you see the full results? Thanks.

Answer:

that the improvements will likely not last past 6 months. JG 12.7.10

Question:

Thank-you for your kind answers, Dr. Garcia. I read through your posts, and saw that there is a Dr. Ron Moy in LA who uses the Yag laser and that you recommended him to someone for PIH problems, so I made an appt for a consultation. I noticed you mention the yag several times, so you must trust it. I don`t think my skin can tolerate the high-dose hydroquinone, so I`m going to just protect it the best I can and maybe switch back to the 4% for now. I will post an update on how the treatments go. Thanks, again!!

Answer:

great, let us know how it goes. JG 12.7.10

Question:

Hello, Doctor. I have a question about applying the high concentration hydroquinone cream 8% mixed with tretinoin. Do you only apply to the hyperpigmented areas, or to the whole face? I`m concerned that I will get whitened areas and the doctor told me to put a thin layer all over my face. You were right. It`s very irritating. I only put a very small amount on, and my face does not like it. I would like to check out the yag laser, I`m just scared of lasers now, based on results. Thank-you,

Answer:

I suggest the whole face. The Nd: YAG is a safe laser in experienced hands. JG 12.7.10

Question:

thank-you for the response about laser/pih. I found a doctor down here in Orange County, Ca who has a q-switch yag. Would that work? thanks,

Answer:

yup. JG 12.7.10

Question:

Dr. Garcia. I can attest to the fact that the fractionated laser is less effective than C02, with the same risks, based on my results, which to date have not been good. Now I have some PIH spreading across my cheeks. I have been bumped up to hydroquinone 8%/0.05% trenitoin to be applied all over face at night. Have you seen any effectiveness with this? Or is there a faster (hopefully, safe, too) way to help? As always, bless you for your patience and advice.

Answer:

if applied early, it can help, yes. I will also say that at that concentration of hydroquinone, it can be irritating also, which then makes treating the PIH difficult. Might need to seek out a Nd:YAG laser for some sessions to help fade it. All the best. JG 12.6.10

Question:

Dr. Garcia, Thanks for your response. If the Fraxel is a factional laser, how does it compare to the Pearl Fusion? Have you heard of fractionals actually damaging the skin and causing more wrinkles? That`s what some people on the Web are claiming happened to them. Just trying to make an informed decision, which your site helps us do.

Answer:

Pearl fusion claims to be better because it combines a fractional part and a light superficial completly ablative part, goes to show you that they are admitting that a pure fractional treatment is not enough. As to causing new wrinkles, I have not seen that happen once the healing phase is complete and the dehydrated skin has sloughed off. I will say that they claims made by the companies and many doctors with fractional therapies are overstated and the actual results are not nearly as good as they would like. The fractional lasers arose because people did not want to accept the healing time with traditional CO2 lasers, so they treated less of the skin and got less, patient acceptance was high, of course, because who would not want less downtime. So what we have seen is the fractional laser companies almost on a yearly basis claiming their new technology is the best, yet they keep coming up with new and improved versions to sell. In experienced hands, the are safe, just don`t expect much improvement past 6 months or so. Best of luck. JG 12.5.10

Question:

Dr. Garcia, What is the difference between Fraxel and fractional lasers, or is there a difference? Some people on the Net are claiming that Fraxels have worsened their skin. Also, how painful is the fractional laser treatment, specifically the Pearl Fusion laser? Thanks.

Answer:

a Fraxel is a fractional laser. As to pain, most doctors perform it in the office and use local anesthesia, that is why it hurts. I do laser resurfacing in the operating room under general anesthesia for greater patient comfort. JG 12.5.10

Question:

Sorry to post again about resurfacing, but I meant to ask you if resurfacing (whether fractional or fully ablative) reduces the white peach fuzz facial hair that is so common for post-menopausal women. I would imagine that it might, but I may be wrong. Thank you for all your kind and generous help. You`re a wonderful human being, Dr. Garcia.

Answer:

the hairs will be burnt off but they will return, the follicles are not damaged, sorry. Thank you for the kind words also. JG 12.5.10

Question:

Thanks for answering my question below about resurfacing, but I wasn`t clear enough. I know you prefer totally ablative (not fractional) CO2 resurfacing; but I can`t find any plastic surgeon or dermatologist within 500 miles who does that anymore. I am wondering if you think one kind/brand/platform of fractional laser is better than any other, since these are the only options I have to choose among now? (I expect you`ll say that they are all equally ineffective, but I thought I should check.) Thank you so much!

Answer:

I do not find that one factional laser is any better than the rest, although I prefer a CO2 based fractional laser over erbium. All the best. JG 12.5.10

Question:

Hi, Dr. Garcia. I know you`re not a fan of fractional laser resurfacing, but do you think any one modality or laser is better than another -- CO2 or erbium platform/Fraxel Repair or Total Fx, etc.? Thanks for your advice. Have a great weekend!

Answer:

totally ablative, non-fractional CO2 laser. JG 12.4.10

Question:

Thanks for answering my question about IPL vs YAG. But if Yag is a real laser then isn`t like CO2? Again, being Asian and having PIH wouldnt I be at risk with YAG too? And how can YAG help my PIH? Lastly, I would love to go to Vegas, but I dont go as often as I would want. Do you have any dermatologists/surgeons in Los Angeles you would recommend to fix Asian with PIH?

Answer:

no, a CO2 laser reacts to water content, whereas a true Nd:YAG for example,can be tuned to a certain color. Erbium lasers act like a CO2 laser though, with no color specificity and should not be used on Asian, or African-American skin types. Would suggest seeing Dr Ron Moy at UCLA for your issue. All the best. JG 12.2.10

Question:

First, thank-you for your patience in answering these questions. So helpful.. I read about dilated blood vessels around eyes and laser can make them more pronounced. I think this has happened in my case on one eye. Is there any help for this? Thanks,

Answer:

Can use a YAG or VBeam laser, those lasers are specific to the color of the blood vessels, but in time, they will all come back with the aging process. JG 12.1.10

Question:

Hi, Dr. Garcia. I had always been apprehensive about c02 laser, because I`ve seen people with white faces and necks that are darker. Does this still happen now with c02? Also, is there a chance you might have uneven skin results? If you were to consider it after having a not so good result with fractionated laser, how long do you think you should wait before doing one and what are the names of the lasers that would be good to consider? Thank-you

Answer:

if you have a lot of sun damage and you have a deep CO2 laser, it can leave a line of demarcation because the neck cannot be treated as deeply as the face, that goes for lasers and chemical peels of all sorts, so potentially, in severely sun damaged skin, no matter what machine you use, if you go deep, it can happen. If you go lightly, there is much less of a chance, but also less improvement. If you have not been happy with a fractional laser, a new laser can be used after maybe 6 months, but whether it is warranted depends on why you feel the fractional laser did not yield the desired results. JG 12.1.10

Question:

Hi Dr. Garcia. Your site is amazing and you are so wonderful to answer all of these (often repetitious) questions! I had a consultation regarding the Portrait Plasma facial today and am interested primarily in having wrinkles above my lip done. The doctor said he would go very deep -- how deep would that be? I noticed you mentioned a range of 1.5 - 2 joules in one response (I think that was light) -- just want to make sure I don`t get fried, so what would your strongest recommendation be? I am a fair-skinned female, 44 years old. Also, you said it could last 13 months or more. Do you mean all the same wrinkles will emerge again, probably within 2 years? If so, is there anything more permanent?

Answer:

In fair skinned individuals, I consider 3.0 to 3.5 joules as strong, I do a nerve block for comfort along with topical numbing cream, 1.5-2.0 joules is relatively low and not too effective for lines around the mouth unless you do a series if three, three weeks apart, but three lighter ones do not equal one deep one. The wrinkles will come back I am afraid as the aging process has not been stopped, the deeper the wrinkles are to start with, the faster they come back. A CO2 laser might last an additional 50% longer, but has more risks and more down time, so there is a trade off, there is nothing that will last longer than 2-3 years, no matter what, as that skin folds frequently and in areas that do that, recurrence comes back sooner than in less active areas.Best of luck. JG 11.30.10

Question:

Hello, again, the `rash` person grateful for this website.. what is the squalene oil you mention? do you put it on your skin prior to a copper peptide or is it a supplement? thanks again

Answer:

it is applied instead of the copper peptide, it is an oil to be applied to the skin. JG 11.30.10

Question:

Thank-you for answering all of my question. You have no idea how reassuring it is to have your input. You mentioned neocutis copper peptide cream for post laser. Is this the `biorestorative cream for post procedure?` I`m not sure what to buy. Thanks again,

Answer:

that`s the one for your issue, best of luck. JG 11.30.10

Question:

Thank you for answering my question about my CO2 procedure inducing PIH. You said that HQ could help, time and sun avoidance and IPL wouldnt. You recommended YAG. I thought YAG was a type of IPL. Why would that work vs. IPL?

Answer:

no, IPL is a want-to-be laser, it is actually just a filtered light source pretending to be a laser. A YAG is a true laser. JG 11.30.10

Question:

I am scheduled for a fractional laser treatment in about two weeks. I`m someone who seldom, if ever, visits doctors because I never get sick. I watch my nutrition carefully, exercise, do what it takes to stay healthy. Because I never get sick, I never take medication, and my body actually reacts negatively to most drugs. They want me to take a lot of antiviral and antibiotics for this treatment. It seems like a lot of pills, and I`m wondering how much of this is actually necessary? The nurse (who is doing the treatment) said I must take it all - but it actually looks like a mini-pharmacy from where I stand. Prescription drugs, again, make me sick to my stomach and I end up throwing them out. Your thoughts, please.

Answer:

I think it is very necessary because an infection after the laser, not an uncommon thing if unprotected with antibiotics and antivirals as the normal skin protection the skin has, the epidermis, is removed during the procedure. I always have my patients take them until healed. JG 11.29.10

Question:

Hi, Dr. Garcia, hope you had a nice thanksgiving... I had emailed you about a `rash` post active fx. I did see a dermatologist who stated everything is OK, and just healing after the procedure, which is now 8 weeks past. I do have a grid like pattern on my cheek which is not fading and I`m wondering how long to wait to start fading this, if at all possible. Seems my skin is very sensitive to hydroquinone and reddens from it. Have you heard of any luck with microdermabrasion to help even things out or fade these marks? thanks so much for your input. It can be quite depressing to look in the mirror seeing grid marks when you had wanted an improvement. Also wondering if the real C02 laser would make a better improvement if I waited a time. Scared of laser now, though. thanks, again.

Answer:

Thanksgiving was great, got to see my two young nephews, thanks. If the skin has healed so there is enough intact skin over the grid it is usually OK to proceed with attempts to improve it, but in your case, if hydroquinone is still irritating, it might not be ready yet. Using copper peptide creams from NeoCutis is a good idea at this point. I think if your skin cannot tolerate the hydroquinone, it likely will not tolerate the microdermabrasion, at least for now. I do not think microdermabrasion help the grid patters too much though. At this point, besides the copper peptide, I would suggest sunblock and patience, sorry about your trials and tribulations. Hang in there, it will get better, just slowly. JG 11.29.10

Question:

thanks for the note about the rash. I agree. It sure doesn`t seem `good` to me.. I made an appt with a local dermatologist. I sure hope it`s not going to scar. Should I continue with the hydrocortisone cream til I see the doctor?

Answer:

Just to be safe, you have only used it short term. Best of luck. JG 11.19.10

Question:

Hi and thanks for answering my question today about a post active fx `rash.` When I saw the doctor, he said it is a good thing that the skin is having this reaction. I did notice that the rash started after some sunblock, but maybe I will see another doctor next week. Guess I`ll stop the cortisone cream. thanks for the advice.

Answer:

All the best, I do think seeing a different doctor for a fresh interpretation is a good idea. If it is a rash, there is nothing good about that, I actually cannot see why after a fractional laser that having something that looks like a rash be a good thing in the long term. JG 11.19.10

Question:

Hello, Dr. Garcia. I had active fx done 5 weeks ago, rather aggressively. My eyes are still very red and a rash has developed under both eyes. I have hydrocortisone 0.05 cream, got a steroid shot last week, and 5 days of prednisone. Rash is still present. Would this be from the laser? Have you had any experience with such rashes? I am regretting having this laser done, as I still cannot cover everything with makeup and was told 3 weeks recovery. Thank-you

Answer:

Hard to say, a rash is very unusual, unless it is a reaction from the creams that were applied. Another issue might be a superficial burn from the laser,burns can look like a rash and take a long time to heal, in a small percentage of cases they can scar, an undesired thing. I think if the rash has persisted with what they have done, the possibility of it being a rash is not high. I would go back and see the doctor and see what they say. Best of luck. JG 11.19.10

Question:

Thank you for that excellent and thorough reply to my question about CO2 resurfacing! I really appreciate it. Thanks for the clarification about the issue of pores. So...do you have any magic remedies to unclog them when they are deeply clogged? (If you did, you could probably patent it and retire today, right?!) I never had this problem when I was younger, so I`m puzzled about why it`s happened now that I`m in my early 40`s. Thanks again. Amazing site. Amazingly helpful. With a grateful heart.....

Answer:

for the pores, I feel microdermabrasions and IPL sessions at a medi spa help, along with a good facial cleanser and retinols also help as they tend to the thin the oil and make it easier for it to come out of the pores. Hormones change as we age and oil production is tied to that. All the best, and just try the things I mentioned for the pores, understnading that it is a battle to be fought and never won. JG 11.2.10

Question:

I see that you advised one of your readers that CO2 resurfacing doesn`t help with pore size. My own ps thinks resurfacing will improve my skin`s texture, pore size and wrinkles. Do you think it will help with any of that? Sounds like you may not. If not, why would you perform this procedure? I`m particularly confused about the Why matter of pore size. My ps tells me that pores enlarge due to collagen loss and that the resurfacing will help with new collagen production. Is that not the case? Also, he thinks he can improve a very old chicken pox scar on the bridge of my nose with subcision. It`s about 25 years old. Have you ever seen a scar that old respond to treatment? Might the CO2 resurfacing help that too? Thank you, Dr. Garcia. Peace and health to you and those you love.

Answer:

it will help skin texture and wrinkles, the pores, might, and I repeat might, look better for a very short period when there is a large amount of swelling, but not past that. I perfrom CO2 laser for wrinkles, the texture will improve, although what one defines texture as will depend on how much it is changed. If you mean rough skin, yes, that improves, but since the aging process is not halted, that will come back, as will the wrinkles, with time. Pores enlarge due to them being plugged down deep and the pore cannot close. The skin has millions of pores, they are normally closed. Pore size has nothing to do with collagen loss, if you doubt that, look at a 16 year old boy`s nose with acne, he has plugged pores and lots of collagen making his pores quite visible. Subcision and CO2 laser might help the chicken pock mark, but it depends on how deep the mark is and how deep the CO2 laser goes. All the best and thank you for the kind wishes. JG 11.2.10

Question:

Have you seen much improvement in pore size with CO2 resurfacings in your practice?

Answer:

no, would not expect it to either. JG 11.1.10

Question:

Hello Dr Garcia, You always give good advice and this website is a lifesaver! Wondering if you have any thoughts on the fractional laser called Naturalase, made by Focus Medical. My dr says it will take 10 years off with only 3 days downtime. I am 54 and have crepey under eye skin, lip lines and some laxity in my jawline following menopause. I am mostly looking for wrinkle reduction vs skin tightening. Regarding the softened jaw line, I am not overweight and do not believe I need a face lift. How is lax neck and jaw skin best corrected? I would like to have my well defined jawline back! Thank you so much for answering these two questions.

Answer:

well, firstly, let me thank you for the kind words. As to the Naturlase, it sounds to me like the doctor is a car salesman duing the cash for clunkers program.I STRONGLY disagree. Show him a picture of you from ten years ago and ask him that if he does not achieve that look that he will refund yoru money and see what happens. As to the lax neck and jaw skin, it will require a neck lift at least, and possibly a facelift if there is both horizontal and verticla neck skin excess. All the best. JG 10.21.10

Question:

Hi Dr. Garcia. I am looking to get CO2 laser done for my medium depth scarring on my cheeks. I am caucasian white(polish). How much risk in terms of hypopigmentation and scarring would I have if 3 passes are done? I also wanted to know the benefits and risks of doing a CO2 treatment without removing the debris (char) between passes and after treatment is completed? Would there be less risk ( of hypopigmentation or scarring ), less downtime, and less redness or more chance of unwanted overlap(stacking pulses), thus increasing the chance of hypopigmentation and scarring?

Answer:

the risk of pigmentation is more dependent on the energy setting used rather than the number of passes. You can have loss of pigmentation with just one pass if done at a high setting. I think it is more effective to remove the char to get a more reliable known depth of penetration as the char will absorb some of the energy but the amounbt is unpredicatable. I remove the char. JG 10.17.10

Question:

Hi Doctor , still swithering about whether to have some laser work done under the eyes.What would the down time be for the various lasers( CO2 , Lighter lasers etc.) In the UK and I know you dont like to do referrals etc but do you know anyone here that does laser works well , also do you if there is anyone that still does portrait over here? All the best to you and yours.

Answer:

a regular CO2 will have the longest downtime, 2 weeks of no make up and then pink skin for a couple of months and it might give you 18 months or a little more of wrinkle reduction. All of the other lighter lasers will heal faster and the improvements will also go away faster. I am sorry but I am not aware of who is doing the Portrait anymore nor do I know who is doing CO2 lasers in the UK. I do know a plastic surgeon, Jeya Prakash on Harley street who is palstic surgeon, just don`t know what lasers he uses. All the best. JG 10.8.10

Question:

Thanks for your reply about malar mounds and CO2 below. So, is there a commonly known procedure for suturing those muscles together to eliminate the cause of the fluid accumulation? Is this a procedure most facial plastic surgeons perform? Anyone in New England you can recommend who does it? Do you perform such a procedure? Thanks for your help! Have a beautiful weekend.

Answer:

no one I can recommend, but cutting it out and suturing the muscles can be done by any plastic surgeon who is familiar with the anatomy there, and they all should be familiar with it. Just like cutting out a deeply seeded skin cancer. All the best.JG 10.1.10

Question:

Have you ever seen any improvement in the reduction of malar mounds with CO2 resurfacing? Can it occasionally tighten the skin over the tissue, reducing the sagging a bit?

Answer:

in 16 years of using CO2 lasers, I never have. The sagging cannot be improved without fixing the cause which is the accumulation of fluid in the area due to a seperation of the muscles allowing a watershed area to be created, sorry. JG 9.30.10

Question:

I have very bad sun damage on my legs. I had IPL with levulan done. The results were terrible. The treatment gave my legs red marks and more brown spots. It has almost been 1 year since the IPL procedure & the red & brown marks have NOT faded. Any suggestions/treatment what I can do to improve my legs would be sincerely appreciated. Thank you for your reply.

Answer:

not sure why they would even have tried that, not a wise choice on their part. I might suggest some YAG laser sessions to slowly try to fade the spots, but it will be a series and likely not all will go away, sorry. JG 9.29.10

Question:

Hi Dr. I was trying to read all your infomation pertaining to totaly ablative co2 laser. But I still have 2 questions...can it be done on the neck and is there any pain during/after the procedure? Thank you so very much!

Answer:

should not be done on the neck and I perfrom it under general anesthesia because it does hurt. JG 9.24.10

Question:

Have you ever repeated the CO2 on a patient? I assume there is a limit to the number of times it can be safely done, and of course its efficacy decreases with the patient`s ages. What are your thoughts? Any particular downsides/risks to repeating the procedure that aren`t present the first time around? I`m considering having it done again. (I`m 49, fair, thin skin.) Any reason to think it won`t provide some improvement? I`m reluctant to do the fractional CO2 based on your own estimate that it`s a waste of money, but it`s really hard to find a plastic surgeon or dermatologist who isn`t pushing fractional resurfacing these days. Few are doing the fully ablative procedures any more. Thanks for your help, Dr. Garcia. Welcome back. I hope you had a very restful (well deserved) vacation!

Answer:

I have done it more than once and yes, the efficacy or results decrease with age, so one will not get as much improvement with the subsequent session. The rsks are the same, no different. I know about the docs not wanting to do the fully ablative and trying the fractional sessions, I jsut find that what you get for what you pay is not a good trade off,but it is easier to sell it to patients and less hassle for the doc. They will continue doing so as long as patients keep going back and not complaining. Thanks for the kind words, Alaska was great and the fishing was awesome, but its nice to get back home and in the saddle once agaan. Best of luck with the repeat CO2. JG 9.14.10

Question:

Thanks Dr. Garcia for your prompt answer on scar depression in skin. Other than scar revision is there any topical treatment that may help? I`ve heard Rosehip oil could help indented scarring. If you know of anything that might help, I would appreciate it. Thanks.

Answer:

afraid not, it will be fillers or surgery I must opine. JG 8.30.10

Question:

Hello Dr. Writing from Ontario Canada. I have 1 inch scar on my left cheek from a sebaceous cyst removal many years ago. It is not flush with the skin, but indented. I`ve had Versapulse laser on it years ago to reduce the redness and various fillers that never worked. I don`t know what to try next. It has next to ruined my life. Can you recommend any other procedures that might help. A plastic surgeon years ago said a scar revision might make it worse so I stopped trying. Fraxel has been recommended but I don`t want to take on additional risks of worse scarring. Your advice would be appreciated. Thanks.

Answer:

I think scar revisions always have risks but cutting the scar out and advancing the tissue below to avoid the depression is the best option,very common for cysts to cause tissue atrophy below the scar from their long-standing presence. I think Fraxel will do nothing as it will have no effect below the skin, which is the problem you are facing now. Fraxel will not hurt,but will not help. JG 8.29.10

Question:

I had restylane filler under my eyes last week. How long should I wait before having a co2 laser resurfacing treatmnet done, so as not to ruin the effects of restylane? Thanks!!

Answer:

you can proceed now at your leisure, best of luck. JG 7.23.10

Question:

Dr. Garcia, I had a dot laser done. Pretty much went as he told me except I had some hyperpigmentation where the grids were. I am on hydroquinone (sp.) for that. The laser helped one lip wrinkle pretty well and seemed to get lesson some forehead lines. But my forehead and lip lines were mild to begin with so hard to tell how much improvement. You had me prepared for the very subtle improvement so I wasn`t disappointed. BUT can you tell my why when a laser removes that skin, why can`t your skin stay like that. I think you said the skin remembers, but is this true with the co2, also? It just seems like you could start new again once all that old junk is off. Thanks for your info especially about fractional.

Answer:

it is true with the CO2 also but the deeper the laser, the longer the improvements will last.When I say remember, that relates to the pigmentation and not the wrinkles. As to the wrinkles reforming, there is nothing that can stop that because nothing will halt the aging process. New collagen can be formed but the aging process causes loss of collagen so the skin will age. Along with that, there will be small amounts of swelling for a while after any laser, and swelling will make wrinkles look better when in reality they are the same, just swollen and not able to be seen as easily. The laser does remove skin, but the amount of new collgaen that can be recreated will never be as much as what was there once, and the older you are the less robust the collgan creation can be, no matter what technique. All the best. JG 7.15.10

Question:

JG 7.8.10I had a nonablative fractional resurfacing done on May 14 and still have that lovely waffle-like imprint on my forehead. At this point, do you think I can still hope that it may continue to fade, or do you think I am stuck looking like an ad for breakfast the local IHOP for the rest of my life? Thanks for your help, Dr. Garcia. Hope you`re having a great summer!

Answer:

well, for starters, I guess you got some ablation if you have the waffle appearance at this time. I suggest using some hydroquinone 4% mixed with Retin-A 0.1% to help it fade, also total sunblock and seeing the place that performed it for you to get the prescriptions, I do not think it will go away on its own, but if treated, should not be permanent, funny about the IHOP though. JG 7.8.10

Question:

What is the difference between fraxel and Portrait? which offers the best results. Are the costs approx. the same? Are the number of treatments involved the same? Should it be done before a cheek lift, after or in lieu of one? I have a lot of sagging at the jowl area, and surprisingly (as I have avoided the sun since college) a bit of sun damage. Sorry to ask so many questions, but I always trust your advice. B

Answer:

I feel Potrait is better as it treats all of the skin rather than leaving numerous skip spots untreated but the Portrait company went out of business and there are only a few of us that still have the tips to treat patients. It should be done after the cheeklift and neither one will replace a cheek lift, as to how many treatments wil be needed, it depends on how badly damaged the skin is. Best of luck. JG 7.1.10

Question:

Hi Dr Garcia. What is your recommended regime following C02 resurfacing? How long should I wait before using Retin A? Cheers

Answer:

after 4-6 weeks we use Retin-A and hydroquinone until healed to avoid hyperpigmentation and then we go the usual moisturizers and sunblock. JG 6.27.10

Question:

Hi Dr. Garcia. I`ve been reading your posts about fractional CO2 resurfacing and would agree with you that the results are modest in comparison to the fully ablative CO2, but I did it last year and was very pleased with the improvement I saw in my skin. I am considering doing it again -- and perhaps occasionally in the future after that to maintain the improvements I have experienced and maybe even to achieve a small degree of further improvement. My question is how far apart can these fractional ablative resurfacings be safely spaced and is there a limit to the number of times one can do them in a lifetime? Thanks so much for your answer. Hope you and your family have a safe and happy summer, Dr. Garcia.

Answer:

I suggest longer than 6 months, preferably 12 months or longer, all depends on how deep they go. Also, there is a law of diminshing returns, as you get older you will get less from the repeated treatments, no matter fractional or not, it is related to your skin`s ability to create new collagen. As to the limit on the number, the deeper they go, the fewer the number that can be done but there is no set number of treatments one can have as skin thickness varies from patient to patient. All the best. JG 6.24.10

Question:

Would fraxel work to even out mottled skin on arms? If not, is there anything worth considering instead?

Answer:

I would use a YAG for spot treatments rather than a Fraxel. JG 6.21.10

Question:

Thank you Dr Garcia. How much downtime is needed with a co2 laser resurface, I live in the UK otherwise would come in to see you, would it be possible if I could send a photo of the area via email so you can more evaluate the problem?

Answer:

likely, if on the nose alone, about 7-10 days before make up can be applied to hide it, it will be red for a few weeks too. You can send the photos to drgarcia@lvcosmeticsurgery.com, if you would like. JG 6.8.10

Question:

Thank you for your reply Dr Garcia. With the C02 laser you have suggested how many treatments do you think this indented scar on my nose would require and how much downtime do you think there would be? Also with the filler Restylane, I had this a few months ago and it made no difference at all, can you clarify as you have suggested this as well. Very much appreciate your opinion.

Answer:

it is hard for me to give very specific answers without seeing you, but a guess woudl be one or two CO2 laser treatments, more if they are a fractional or pixelated CO2 laser. As to the filler, it is an option for indented scars but is not permanent, there are longer lasting fillers but I suggest trying something like Restylane first as if it does nto work well it can be easily dissolved. In some cases the most expeditious option is to accept a scar and have the spot cut out and sutured closed, it is quicker and reliable in most cases, but does leave a permanent scar. JG 6.8.10

Question:

Hello Dr Garcia. I have posted you several times and you have been very helpful. I am still very distressed with the indented scar on the tip of my nose from Diolite laser treatment. When I last spoke with you I had started a course of peels and microdermabrasion without crystals but as you predicted it did not help at all and I stopped treatment mid way before wasting anymore money. When you last replied to me you said it may need a laser resurface? I am waiting to see a Consultant Dermatologist in August. Can you tell me what you think is the best treatment for this please, what type of laser etc or if in your opinion a filler may be suggested. I have already had Restylane months ago but with no effect. Thank you.

Answer:

I think a CO2 laser would be best if you are going to try a laser. As to fillers, I suggest trying Restylane first. You might need both. All the best. JG 6.7.10

Question:

Dr. Garcia, Could you please tell me what you think of the Active FX, Deep FX, and Total FX Co2 laser skin resurfacing treatments? Thankyou.

Answer:

well, the honest truth I do not think very highly of any of them, lots of hype and little return for the investment. JG 6.3.10

Question:

I guess the answer to one question stimulates another. sorry. 1)So if the scar prominance comes back, then am i ever better for having done the tx other than the temporary effect of skin swelling and tightening (i.e. is the depression actually better off long term)? 2)Does the scar depression extend to subcutaneous fat or is it confined to the pore origin in the dermis? If into fat, then I see why only treating to dermis would not perminately fix.

Answer:

well, yes, if you never have a reset at a better level, you will look worse, better to get worse from a better point than build further aging on no improvement. The depressed scar in many if not all cases extends to the fat, that is why it is tethered. JG 6.1.10

Question:

First of all, Thank you so very much for your depth of knowledge and goodness of heart to help so many. Your Q&A has helped me understand so much. 1)My acne scars are prominant and concentrated on my cheeks and temple. Can subcision be used on entire areas as opposed to spot scar tx. 2)Would autologous fat transfer coupled with subcision help fill depressions. 3) Your interview on acne.org you state a person would need long term annual tx of fully ablative co2. Why? Is it for continued improvement or because progress is lost? 4)I live in Iowa, would you consider co2 tx if I came to you. Thanks for your candid responses.

Answer:

more effective if done on spots, to be honest. Your own fat can be used, likely not too different than other fillers. The need for repeat treatments is because as the person ages, the skin gets looser and that makes the visibility of the scars re-appear. It is more for maintainence than progressive improvement as there will be a point at which no further improvement can be achieved. I would be happy to have you come here for a treatment but I think you can likely find someone that can do the treatment much closer and save you the costs of travel and hotel. Thnak you for the kind words too. JG 6.1.10

Question:

Guy getting married with scared fiancé` again here...thank you so much for your quick response. What you`re doing here is amazing...thank you. Well, we`re certainly relieved to hear that you`ve never heard of a case where acne scarring got worse permanently from a Lux 1540. Assuming everything returns to normal in a few weeks (and is hopefully improved), what do you recommend she does to improve the acne scarring for the wedding? Do you think fillers are useful? Thoughts?

Answer:

fillers are hard to get right, maybe a series of microdermabrasions is about the safest thing I can suggest at this point. JG 5.25.10

Question:

My fiancé had two Lux 1540 non-ablative laser resurfacing treatments to address acne scarring she has. The first one didn`t do much, but the second treatment seems to have made her scarring worse (more pronounced and some additional pock marks). It has been two weeks since the second treatment and she is still a little bit red and itchy. Have you ever heard of a case where a non-ablative laser resurfacing made acne scarring worse permanently? Our wedding is in 4 months and she is terrified. Do you have any thoughts as to whether or not this is permanent and if not how long it may take to resolve? What else should we do?

Answer:

anything to make it look worse is rare, and should get better in time, I have not seen any cases of fat loss with a 1540 laser and that would be the only thing that could make it worse long term. Should be better in another 2-6 weeks. Not much you can do at this point except sit and wait I am afraid. Congratulations and best of luck with the wedding, hang in there for now. JG 5.25.10

Question:

Thank you for your feedback on bipolar RF. In your experience, what is the optimum frequency for multiple tx of CO2 Deep fx for acne scaring? Thank you for what you do.

Answer:

I honestly cannot say because I would never use a CO2 laser that is fractionated as I think it skips too much area for it to be effective past the time interval of swelling. If I were to use a laser for acne scarring it would be a completely ablative CO2 laser, not pixelated or fractionated. sorry. JG 5.25.10

Question:

How is Fraxel (re:store), I believe that is the mild version, non-ablative on olive, Indian skin for acne scarring, texture and redness problems? Is IPL comparable? Also, should one do Accutane first and then the Fraxel or IPL or after?

Answer:

I think in Indian skin with those problems you will get little improvement with either the Fraxel ReStore or the IPL as they cannot be used too strongly. It is best to do the Accutane first to control the acne, wait 6-12 months for the skin to regain its ability to heal and then do the treatment. If you break out after the treatments then there will be new scars that will not have been improved with the treatment. JG 5.25.10

Question:

I had a fractional resurfacing 2 weeks ago. Today, a rather large petechial rash appeared on two areas of the treated skin. Is this common and to be expected, or is it an outcome of the treatment having been too aggressive? Thank you for your guidance, Dr. Garcia.

Answer:

not common, should see the doctor to make sure it is not some type of bacterial or viral infection that needs treatment. If it is and is not treated it could affect the outcome, best of luck. JG 5.25.10

Question:

I have prominant acne scaring. I have had four fraxel re:store. Some improvement. Currently on accutane. Want to try Lumenis Ultrapulse. Is six months ok or should I wait twelve after accutane? PC recommends CO2 spaced 3 months apart. Wondering if that is too quick? Why is cost so much more than fraxel? What do you think of ematrix i.e. bipolar Radio frequency? They are touting impressive results. Thank you for what you do.

Answer:

I suggest waiting until the skin regains its normal moisture and oilyness to allow it the best chance to heal with no scarring. The pricing for the treatments is set by the doctor so I cannot say why the difference. I would not use bi-polar or uni-polar rf for anything on the skin. It has been around for a long time and has been a resounding failure at living up to the claims. JG 5.25.10

Question:

I had a fractional resurfacing done last month and was left with a small but noticeable hypopigmented spot on my cheek. (Type I skin, extremely fair) Any chance that it might improve in time? I`m afraid I know the answer to this question: no. Once the melanin is destroyed, there`s nothing that can be done, right? Just thought I`d check. Thanks, Dr. Garcia!

Answer:

yes, it might, but it could take time if the treatment was not too deep, with time and a litle sun exposure it might come back. JG 5.23.10

Question:

Hi, Dr. Garcia. I see that you`ve advised other people who have had fractional resurfacing that the waffle- like pattern imposed by the handpiece eventually fades. I had the Palomar 1540 6 days ago. The doctor who performed the procedure predicted that the pattern would be invisible within 2 days, but if anything it`s grown more apparent as the week has passed. I`m *quite* red and peeling, keeping myself covered in lotion and full spectrum sunblock, of course. About how long would you expect the imprint to remain visible in typical cases? Thank you very much for your help, Dr. Garcia. You`re a beautiful human being, offering your expertise, advice and comfort to all these strangers. God bless you.

Answer:

from what you are describing I think a more realistic time to fade wil be 3-4 weeks I am afriad. He might have gone deeper to get a better effect and that has made it go the way it has. All the best and hang in there. Also, thank you for the kind words of encouragement. JG 5.17.10

Question:

Last week, I had a Palomar 1540 treatment, which I see you are not a fan of. Oops. I was swollen and red for only a few hours after, but it seems to have dried my skin, which (temporarily, I hope) only exaggerates the wrinkles and texture problems I was hoping it would treat. I`m covering myself in Aquafor at night and a thick moisturizer and full spectrum sunblock in the daytime (which is my daily habit anyway), but that hasn`t helped so far. I have three questions for you: 1) Why does this laser make the skin so dry? 2) Although I now see that you do not support nonablative fractional resurfacing, can you explain why those who do believe in it would think it could improve skin`s texture when the laser appears (at least initially) to deteriorate the texture? 3) As I read your posts to others, it seems that you are opposed to fractional resurfacing, especially of the nonablative variety, simply because it doesn`t do much. Is that right, or do you oppose it because you find it dangerous? If so, in what way? Thanks so much for your time and guidance, Dr. Garcia! You`re wonderful.

Answer:

the laser has that temporary effect until the new skin comes to the surface, part of the procedure and expected. When one is trying to stimulate new collagen production you need to go through a destructive process first, for lack of a better word. As to my opposition, it is because the claims made are over inflated and they also market it as essentially risk free and I have seen and heard about too many disasters from non-ablative therapies to agree with that. They are feeding on the patients` fears and desires for a profit. Don`t get me wrong, we need to make a profit,but you should give the patient something significant in return.Some patients are quite happy with the results, but then one needs to ask, were their expectations so low that anything would have made them happy. JG 5.12.10

Question:

Hope this isn`t a dumb question, but when a laser is used,either fractionated or co2, there is burning of the skin. When you get a sunburn, that damages the skin and makes it coarse and leathery looking. How can lasers which burn not do the same thing as the sun? Thanks.

Answer:

it is the slow damage that occurs with the suntan that is worse, the quick burst from a laser vaporizes the skin and causes no long term damage to the DNA of the skin cells, not a dumb question at all. JG 5.11.10

Question:

Sorry. I need to clarify. I posted the question below about Fraxel v. 1540. I meant to say that I`d had 3 Fraxel Restore (not Repair) treatments a while ago; that is, they weren`t ablative. So is the 1540 essentially the same as the nonablative Fraxel? Thanks for your time.

Answer:

the Palomar 1540 is pixelated and is abalative in smal spots, not entirely surface abalative though, essentially the same as what you had. Calling the Polamar 1540 non-ablative is a lie, it is used for marketing only because it creates numerous microbeams or holes, read ablative here, that go into the skin with untreated areas around them. JG 5.5.10

Question:

Hi, Dr. Garcia. Is Palomar`s 1540 laser the same as Fraxel Repair? I ask because I had 3 Fraxel treatments a few years ago and it seems to have made my skin`s texture significantly worse rather than better. What do you think happened that it damaged the skin`s tone and texture rather than improved it? I should think that, at worst, it would simply have made no difference at all. In any case, my dermatologist thinks the 1540 might now help. My skin is currently rough, many fine wrinkles, uneven pigmentation, etc. (I am 45, very fair, blue eyes. I use Retin-A and hydroquinone, your peptide cream and SkinCeuticals moisturizers, full spectrum sun block, also lots of IPL.) If the 1540 is essentially the same thing as the Fraxel, I`m reluctant to do it; I obviously I don`t want to make things worse. My dermatologist claims the 1540 is more like a fractionated IPL than it is like the Fraxel, which is fractionated resurfacing. Can you clarify this for me? Thanks so much for your time. I really appreciate your guidance.

Answer:

it is essentially the same. As to what happened, if it was done too deeply or at too high a setting it could have burned the skin slightly causing the textural changes too. I would proceed with much apprehension. JG 5.5.10

Question:

Hello Dr, Is there any fix for hypopigmentation caused by c02 laser? I was considering Fraxel or IPL. Thank You

Answer:

not much help I am afraid, and Fraxel and IPL will likely not help and could make it worse, just think about what those machines are marketed for, treatemnt of hyperpigmentation and spots. JG 5.5.10

Question:

Oh my goodness, I just saw the post below about the Q-switched YAG for PIH. My plastic surgeon did this on me just yesterday for the exact same problem -- PIH post fractional CO2 because HQ and IPL weren`t doing anything --and I am now absolutely covered in dark brown spots that are in a striped configuration, which of course makes the PIH look about 200% worse! Is this what is supposed to happen following Q-switched YAG treatment? Does this response bode well or ill for the ultimate improvement of the PIH? If well, how long should it take for the brown spots/stripes and the initial, underlying hyperpigmentation to fade? If ill, how much worse have we made things? Thank you for your always insightful and honest guidance, Dr. Garcia. (By the way, I am extremely fair-skinned.)

Answer:

although it can happen, it is not supposed to happen, it all depends on what energy levels were used. That striping in most cases falls off in a few days, but it is not needed for the good effects to be seen. I cannot say whether it bodes ill or good as I am not sure of the settings used, but as long as the skin did not burn and flake off it is likely going to be OK. Best of luck. JG 4.16.10

Question:

I had laser resurfacing done when it was a new thing - some years ago. It was done around my eyes. It was great for a few years. For some time now I have had what I can only explain as white cobblestone effect under my eyes (more by the inside area of my eyes) - I don`t think it`s milia because it`s not hard. I know it`s hard to say without seeing, but is there anything I can do to get rid of this - is it from trauma? Any info would help greatly. Thankyou.

Answer:

it is likely from the lasr and the controled burn, short of more laser to try to smooth it out I am afraid there is not much to offer, sorry. JG 4.16.10

Question:

Hi, Dr. Garcia. In mid January, my dermatologist treated several AK`s on my thighs with liquid nitrogen. Three months have passed and I still have dark reddish-brown spots at the treatment sites. How much longer should it take for these to fade? (I have Type I skin.) He initially said about 2-3 weeks, but when I saw him last week, he said it could take up to a year. Hydroquinone isn`t doing anything to fade them. Might IPL help? Anything else you can suggest? Thank you very much for your time and advice. What a kind and generous soul you are! God bless you, Dr. Garcia,

Answer:

if they went deeply, it ca take months as essentially, it is a burn, or frost bite if you will. I think hydroquinone will likely make it worse, as will Retin-A, best to let it heal, you can use some copper peptide cream or aloe if you desire. I think IPL will likely just aggravate it and make it not heal any faster. JG 4.11.10

Question:

My dermatologist thinks that a series of Cutera`s Genesis treatments would improve my skin`s tone, pore size and texture. What do you think of this particular laser? Thanks for your help!

Answer:

probabaly, for a short period of time, and then he will need to sell you another series of treatments. JG 4.11.10

Question:

hi, i am in the uk and had traditional co2 laser resurfacing done on NHS 9 weeks ago(deep full face apart from eyes)for acne scarring,i still have some mild swelling in lower cheeks, that flutuates and sometimes i get a feeling of pressure in these areas, is this normal and also i keep getting petechia in random areas(mainly around hairline,edges of cheeks) i seem to wake up with them, i am still very pink/red, why am i getting them, what can i do to avoid them, i am being gentle with my skin? thankyou so much

Answer:

all normal, the petechia can occur for the first 6 months as the skin is thin and can tear from minimal shearing, even from your pillow case, that will also get better in time as the skin continues to heal. The healing period will take at least 6 months. Best of luck. JG 4.11.10

Question:

If you are considering fraxel laser surgery by a plastic surgeon for the face...I believe it is a fraxel ablative co2. If your results are good and there is an improvement in acne scarring would a second continue to erase the scarring or is this a procedure that cannot be repeated. Also, what is the best procedure for arm tightening as well. The only thing that has been suggested to me about arm tightening is the tumescent lipo. I am in fairly good shape and am in my mid 40`s.

Answer:

it can be repeated, yes. Tumescent liposuction will only remove fat, if you are lucky enough to have good skin quality, the skin should shrink back down well, but removing fat will not, in and of itself, tighten the skin. If the skin sags, the only solution is to have the skin cut out with the resultant scars. JG 4.9.10

Question:

One last question (from me, anyway) on the portrait facial resurfacing - what is the price (range) to have the full face high intensity done at your office, and is this done by you personally? When I called the office, the person on the phone was unsure of the answer and before coming in for a consult I would need to have an idea whether it`s possible or out of the question for me. Thank you!

Answer:

a deep one under general anesthesia is $4000. JG 4.5.10

Question:

Then what do I use. Do I stick with the peptide cream and that`s it. My PS is not concerned and has now gone on vacation till May. I am not too concerned (really) just confused about what to and what NOT to use. I hope you know how much i appreciate all your help and hope that i am not frustrating You. nite doc.

Answer:

stick with just the peptie and hang in there for a bit, all the best. JG 3.29.10

Question:

Good evg. Dr. This your regular Canadian..once again...Jan 29th CO2, still somewhat resemble Homer Simpson but slowly getting there as I know I have sensitive skin to begin with. Question,. could i benefit from having the Vitamin C procedure done at a MedSpa. Vitamin C is infused into the skin - last time i had it done, it tames redness in the skin. Would it be ok to do on my lasered areas. Thanks and have a great week. I am currently using Cellex C topically and peptide cream all over the face and Tretinoin 0.1% on unlasered areas. Any better suggestions as to what i may do or should be using. jacquie

Answer:

I think any procedure like that will just slow the healing, taking Vitamin C orally is OK, but topically, it is just an acid. It is OK for intact skin but not on recently injured skin like yours I am afraid. I understand your frustration, but just hang in there a little longer. JG 3.28.10

Question:

Hi Dr. Garcia. I had a Fraxel restore done this past August for wrinkles under my eyes (I am 38). I think the dermatologist was too aggresive, after a few weeks I noticed significant hyperpigmentation which has still not resolved (he had me go on triluma, which did not help). A few months later, I noticed that my eyelids are pulling down and when I smile, the skin folds under my eyes, I can no longer wear eyeliner on my lower lids because of that. I have been doing a lot of research on-line and think I have cicatrical ectropion. Is this common with Fraxel? I went to three different doctors for consultations before getting the laser and none of them mentioned this side effect when I asked of the possible complications. Also, are there any non-surgical alternatives to correct the ectropion or am I likely to need surgery and a skin graft? Thanks for your help.

Answer:

it is possible if a too aggressive treatment is done. In some small number of cases injections of kenalog or 5FU will help, there are also cases where in a short term fillers like Restylane will support the lid until it softens, but I think the filler is likely not an option in your case. If the injections of kenalog does not help, you will likely need a skin graft procedure. I am not sure why the other doctors did not mention the possibility, it is rare, but can happen. All the best. JG 3.28.10

Question:

Welcom Back...missed u. Canada girl again. Still look somewhat like Homer Simpson (CO 2 upper lip/chin area) - not as red but still would not go without make-up yet. I was wondering if IPL would be ok to do on those areas..would it help the redness or make it worse..Use sunscreen faithfully. CO2 was done Jan 29th. Thanks Dr. G. jg-ONT Canada

Answer:

I suggest letting time heal it and avoiding further irritation that would increase risks of hyperpigmentation, got to give it time is all. JG 3.22.10

Question:

please tell me what teh difference is between erbium, co2 and YAG lasers? Plus.. is the genuine dermaroller tecnique superior to peels and laser???

Answer:

the genuine dermaroller is not as effective as a laser. As to the lasers, the CO2 is strongest, the erbium is less so, and the YAG is used mostly for discolorations of the skin and not skin tightening. JG 3.15.10

Question:

i have boxscars/crater scars on my face . whats the best treatment out there? They are quite deep. Im undergoing an obagi peel soon..how many of those wud i need? or shud i have spent my money on having fraxel/pixel? Or are deep peels better and cheaper? Finally ..ive ben told that thepearl fractionated laser is a one off treatment and its deeper than many sessions withpixel, is this true? thanks

Answer:

I do nto think chemical peels will help long term. I think in most cases the scars need to be undermined with a process called subcision and then lasered, but it woudl need a traditional CO2 laser for the difference to be significant. I do not use nor perform pixleated laser treatments as I am not a fan. JG 3.15.10

Question:

Dr. Garcia, Do you still perform the Rhytec Portrait procedure? I recently read where the company that produces the wand that is used in the procedure filed backruptcy. If you do not have this equipment what is your suggestion, short of C02 laser resurfacing, that would produce the same results for acne scarring?

Answer:

I stil have a few heads left and am doing it on select patients, I am not a fan of the other lesser invasive pixleated lasers enough to recommend them, especailly for acne scarring, for that I almsot always do a CO2 laser resurfacing to make it worth the treatment. JG 3.14.10

Question:

Morning Dr. Had CO2 5 weeks ago, still have redness (moreso on the chin area)...no infections or anything just redness - chin area was more aggressive, elsewhere as well but not as much. I believe that this is still normal???

Answer:

yes, still normal, hang in there for a bit more. JG 3.10.10

Question:

Evg. Doctor. Thank you for your response to my MLAB questions and all my questions/panic moments in the last month re my laser resurfacing. I wish you were here in Canada...not sure you could handle the cold - lol. I`ll be chatting back in the future i`m. Bless you and yours big much. Jacquie...Canada

Answer:

I lived in Chicago for 27 years so I know a little about the cold, but not Canada cold.All the best. JG 3.7.10

Question:

Dr. Garcia, I had Active and Deep FX done two weeks ago, Deep FX was done on my cheeks for moderate acne scars. The post redness seems to be fine one day, but gets worse the next. I am also feeling burning sensations on different parts of my face, especially the cheeks that come and go, and sometimes can last for several hours. I am also starting to see tiny red spots here and there on the left side of my cheek. My face has also become very sensitive to warm temperatures and turns even more red. Is this all part of the healing process?

Answer:

yes, I am sorry, it can be normal. JG 3.7.10

Question:

I have olive skin and acne scarring only one part of my face but they are raised scars and bother me so much... my doc said she could do laser feathertouch/silk touch and wont do it so deep...what is your advice?

Answer:

well, just be sure they treat you with bleaching creams before and after to avoid post-inflammatory hyperpigmentation and understand that since they cannot go too deeply for safety reasosn, the results are not going to be super dramatic. JG 3.4.10

Question:

what exactly is a YAG laser compared to IPL?? is it more dangerous in terms of making brown spots darker?? thanks

Answer:

well, possibly more risky but lots stronger and more effective. JG 2.28.10

Question:

Hi Dr. what is your opinion on the BBL (broad band laser)? Thank you

Answer:

lasers become effective only when used in a narrow band, some machines offer multiple wavelengths, but when it comes to the use, it needs to be focused narrowly. JG JG 2.23.10o

Question:

Hi dr garcia I am namboory from UK.I have an asian skin and severe scars on my face due to acute acne.I had 3 sittings of Erbium Yag laser(setting 500)six months ago but did not come out with expected result.1)What do you think about Co2 laser?2)Will that work where erbium failed?3)will it affect Asian skin when go deep?4)Can you suggest me any other treatment that can cure my scars?Please help me in this.I heard you give valid advices.Thanks.

Answer:

I would not perform a CO2 laser on Asian skin. In view that you have already tried an erbium and had disappointing results, and because I think that is already more aggressive than anything I would suggest, I am afraid I really do not have anything effective and safe that I can recommend, I am sorry. JG 2.17.10

Question:

Good evg. Dr. Garcia. Canada comes calling again. I had the CO2 done (under eyes/upper lip and chin)about 2 and a half wks. ago - am still very red....is this normal. Am going back to work in two weeks - hope it lessens by then. Anything i can do to tame the redness or speed this healing up.. Two passes done on chin/u lip. Appreciating you again..big much. jg ottawa

Answer:

with CO2 that is very normal yes. Patience is about all I suggest now, anything else can aggravate the skin at this point, but I think the next two weeks will surprise you as to the degree of fading.All the best and congrats on the Canadian Gold Medal at the Winter Games!JG 2.16.10

Question:

Hi Dr. Garcia, I have a slightly drooping lower right lid. Would Fraxel Repair help tighten and lift the lid or make it worse? I previously had a successful lower blepharoplasty, restylane around eyes & juvederm below cheeks to help hide with malar bag. The slightly drooping lower right lid was there before but only bothers me now because everything else looks better. Will Fraxel Repair or any other laser/non-surgical treatment help tighten the lower lid? I would prefer to avoid surgery. Thanks!!!

Answer:

no, it likely needs to be repaired surgically for it to be even, skin alone will likely not do help and more likely would make it worse. It can be due to normal aging or from the previous lower eyelid surgery. JG 2.14.10

Question:

I just read your posting to another reader concerning IPL and PIH. About 4 months ago, I had one of those fractional CO2 resurfacings you don`t like and was left with a stubborn case of PIH. I`ve done the usual things -- hydroquinone, Retin A, and a series of IPLs. It`s faded a bit (about 25%), but not nearly as much I would have hoped by now. Prior to the procedure, I had only minimal problems with pigment; now I`m covered in brown, with highly defined lines of demarcation from the resurfacing. (I have extremely fair English skin.) In your clinical experience, is PIH always temporary, eventually fading on its own, or is it ever permanent? I`m beginning to get very discouraged. Thank you so much for your help, Dr. Garcia! You must be the most generous and kind physician in the country.

Answer:

well, in some small number of cases, it can be very long lasting. I think I would suggest some YAG laser treatmetns to fade it, that is how we handle those cases. All the best and thnak you for the flattering words. JG 2.14.10

Question:

Hi Dr.Garcia - I`m back again, still trying to get my plan together. I have no other option for the wrinkly/crinkly/creapy/creepy eye area except the Deep FX and the Active FX. So -I`m going for it. Before that I will have bunion surgery ( 9 days before ) the FX. Do you think this will be too hard to recover from by having these so close together? Thanks as always and stay warm !!!

Answer:

should be OK by then, best of luck and keep the fires burning! JG 2.11.10

Question:

What is post-inflamatory hyperpigmentation and does it go away on its own. Thanks again.

Answer:

it is the reaction of the skin due to an injury where it gets darker in order to protect itself from further damage, it usually can get lighter some on its own but in most cases needs medical treatments with creams. JG 2.10.10

Question:

Evg. Dr. Had CO2 11 days ago. When could i have IPL to address the broken capilaries around my nose. Laser was under eyes, chin and upper lip areas. Also, when can i start to wear sunscreen - still am using vaseline at this point. Thank you.

Answer:

all depends on how deep they went, the IPL can likely be done in 4 weeks and the sunblock in 3. JG 2.10.10

Question:

Dr. Garcia, I had CO2 laser under my eyes about 10 years ago and really want to get this done again. No PS in my area uses the CO2 laser anymore and wanted to know what your opinion is of the Affirm Fractional laser. I understand the long term results aren`t as good as the regular CO2, but is this particular laser safe? Thanks so much for your time!

Answer:

well, it will not work as well as the CO2 did for you in the past, but I guess something is better than nothing. I think in general it is safe, yes.JG 2.6.10

Question:

Hi Doctor. Canada girl again. Thank you very much for your time, patience and making someone you have never met, sleep better tonight. You truly are a stand out in your field. Good night. jg ottawa

Answer:

stay warm and get some rest! JG 2.2.10

Question:

Good evg/afternoon Dr. I have another question, how would you tell if you did get an infection after laser. What would be the signs...you are already red, so that wouldn`t tell you much. As for the vinegar solution, is not the idea to keep the treated area moist - vinegar is a drying agent.... just curious. Thank you for all your wisdom .. you truly are appreciated... jg ottawa

Answer:

they would be similar to any other time you get an infection, redness, a pimple or a bleb that has pus like material.The vinegar is used to dislodge the dead skin off the healthy healing skin below it, prolonged and extended use would cause skin dryness, yes, but you will only be using it for a few days JG 2.2.10

Question:

I am soo sorry to bother you again. How often do you do the vinegar/washcloth and for how long. Just on the crusts? I just did it, pressed the washcloth into the areas - probably hit other areas too..Am i ok. jg ottawa

Answer:

for 1-2 minutes and 3-4 times per day. Over the entire face. JG 2.2.10

Question:

Thanks Dr. It is three in the morning here and i have one final question. I had this lasering done on Friday, am i not too late to be soaking the washcloth and still trying to take this off. Is it in warm vinegar and water or cold.. I am trying to type this in the dark so as not to wake up my family. u have no idea how much i appreciate you right now. xxx jg ottawa canada

Answer:

it is warm and no, it is not too late. Best of lcuk and get some sleep. JG 2.2.10

Question:

Evg Dr. This is the concerned Canadian girl who had laser to chin and upper lip area. Saw PS today but he said I had not been cleaning it hard enough so a for lack of a better word on my part -film has covered it so instead of being red it has this like- coating. He tried to take some off and told me to do the same today. When i did try, it did not come off easily and i started to bleed in many areas. He told me if i could not get it off that it would come off anyways at some point but that for bacteria sake, it would be better if it came off. Am I paranoid Dr. - does this mean i will be scarred or I am headed for an infection. Tonite i treated it with polysporin. The meds he started me on right after surgery are Apo-cephalex 250 mg 1 tablet 4x day and sandoz-famciclovir 250 mg twice a day. (I have no history of herpes or cold sores etc). Sorry to bother you again but i am scared. (He also did under my eyes (forgot to mention that previously) but he only did one pass, so my aftercare was easy for that area. Thank you Doctor. jg. Ottawa Canada

Answer:

no, it should not scar, you can take a little water and put a teaspoon of vinegar in about 16 oz and then use that to soak a wash cloth, lay it on the area, and that will help loosesn the crusts over the areas so they fall off easier on their own. You need to always wipe the ointment off totally before applying more over the area. I think the medications are appropriate, just hang in there, it wil heal in time. JG 2.1.10

Question:

Sorry Dr..but it is the Ottawa, Canada girl again. Just wanted to say, that in my previous posts I mentioned that i seem to have what looks like little whiteheads, but really i am not sure what i see...other than yellowish, brownish, raw messy skin..is this normal too and thank you so very much. jg, ottawa Canada

Answer:

yes, all still normal. JG 1.31.10

Question:

Morning. I had CO2 done Friday Jan 29 on my chin and upper lip area. Am dabbing with cold water and washcloth carefully however, i noticed that a bit of the skin seemed to krinkle on my chin and i cannot get it to lay flat. Should i be concerned ..i am afraid that if i rub it, and try to remove it, it will affect the area around it. Am using vaseline and also seem to have tiny white bumps - are these blocked pores. I know this is only my second day and i have had this done before, but not to this area. Hope this ddoes not mean that it will form a scar. The rest looks fine (at least at this stage of the game). Thank you and hope you enjoy your warm weather...thanks from chilly Ottawa, Canada (PS i see my surgeon Mon for followup - hope i am not too late).

Answer:

no, let it heal and it will get better on its own. I would suggest trying not to force it off. Just follow up with Dr Mon, all sounds normal, best of luck. JG 1.31.10

Question:

Dr. Garcia, I have several questions as follows: (1) Can phenol be used directly under the eyes, (2) What is the longevity of results of a phenol peel, (3) Is a phenol peel more efficacious than a 50% TCA peel (I know the risks, btw), (4) What mechanism of action is responsible for the results seen in a phenol peel (ie. scarring or what?) (5) CO2 laser peel - what is the efficacy and how long do the results last (specifically, under the eyes), (6) Do you know of any promising research or studies that show long-term (say, 4 or 5+ yrs) results for tightening skin & eliminating wrinkles (I think patients are growing weary with all the hype & promises out there that never come to fruition - nevcer show expected results), (7)I had TCA some yrs ago & it did permanently remove extremely mild lines - still fairly mild but less so now, and TCA doesn`t seem to have much effect - why a lesser effect as one ages?, (8)CO2 laser - is it safe to repeat or will that thin the dermis? (I had one about 7 yrs ago - full face & very deep), (9) Does ANYTHING restore elastin amount, quality, and arrangement? THANKS MUCH!!!!!

Answer:

1)yes. 2) impossible to say, maybe 2-5 years. 3) yes. 4) induction of scarring into the dermis. 5) good, maybe 2 years. 6)no. 7) you are incorrect as you are saying it was permanent but now it is less, it lasted because you were younger and as you age the length of time of correction will be less. 8) safe and it thickens the derms. 9)not at the present time. JG 1.28.10

Question:

Thank you again, sorry to ask another question Dr Garcia, but how much time would one expect to see any improvement, as I said it is coming on to 4 months post treatment. Would any massage over the depressed area help and can I ask if Retinol will be helping this? Thank you again.

Answer:

most of the improvement will be there by 6 months, the last 20-25% will be a year. Massage will not help the depressed area, sorry. JG 1.25.10

Question:

Hi, Dr. Garcia. I am 9 weeks post a fractional resurfacing (which I see you don`t endorse). It seems to have made some improvements in the skin`s texture, but it left the skin on my chest with a stubborn case of PIH. I`m using hydroquinone and Retin A, which has faded it a bit but not much. I`m wondering if another laser might help at this point. Alexandrite? V Beam? Something else? (I doubt IPL will be useful, since the pigmentation is not in discrete spots but is uniform--solid brown in the entire area that was treated.) Do you think it will fade on its own? When? Thanks so much for your help!

Answer:

might suggest a YAG laser to help them fade some. It will likely fade but any sun exposure will make it come back in time, and don`t forget the sunblock all the time, best of luck. JG 1.25.10

Question:

Hi again Dr.Garcia - Still trying to get nmy plan together If the plastic surgeon says I will get 60% improvement for the wrinkles around the eyes using the ActiveFX and the DeepFX, then in your opinion, what % would the Feather Touch laser give? I want the most bang for my buck, down time is not an issue...thank you, thank you , thank you

Answer:

well, this will get into a matter of religion, because if I assume what he is saying is correct, then Feather Touch will give you 100%, but I believe since I think the Active Fx will likely give you at most 20-30% after 6 months I think the Feeather Touch will give you about 50% after 6 months. JG 1.25.10

Question:

Hello Dr. Garcia I had Active FX on my face and eyelids on December 19, 2009. I still have red splotchiness so I fear hyperpigmentation. What concerns me even more is my lower eyelids.One of them looks like when you scratch yourself bad and the skin raises is a little hard were it`s raised it feels like it could be a vein. The other eye looks like the veins are bulging a little and they are really dark undernieth. The person I went to I found out is not a doctor so I fear that she could of damaged my skin or veins under my eyes. The office prescribed 2.5% hydrocortison cream, biafine and Methylprednisolone tablets. I am scared that what is going on under my eyes will be permanent. Do you have any sugestions or have you ever heard of such a thing happening from the laser? I would love to come see you but I`m in Santa Cruz. Could I email a picture of video of my eye, and possibly get your oppinion or maybe have a phone consult? Thank you very much Jeanine

Answer:

red splothces can turn into hyperpigmentation, but it likely is just a deep burn, the brown should have occured by now if it were to happen. I suggest you see a doctor in order to prevent permanent scarring as things should be healed by now with that technology, and report the person to the local medical board or practicing medicine without a license. JG 1.24.10

Question:

Thanks for your response about the Feather touch laser. I had a consultation today and he wants to use DeepFX and Active FX now. You`re not a fan of these correct? Thanks Dr. Garcia

Answer:

correct, not a fan. JG 1.22.10

Question:

Hello - again The best laser treatment that I can find in my area is the Feather Touch Laser. Cannot find anyone that does the old CO2 which I have had and liked the results. I have had a face lift, am 54 years old and have dry thin skin.I do not see any info on your website about your opinion. Would you please give me your thoughts kind Sir? Thanks a mill

Answer:

reasonable one to use, best of luck. JG 1.21.10

Question:

I am 42 year old female with fair skin. I want to know the best treatment for making my skin as perfect as it can be. I have some fine lines around my eyes (even after botox) which I think is from sleeping on one side of my face and brown spots from sun damage. I want even line free skin! BY the way I already use botox which is great!

Answer:

I would start with a Retin-A and hydroquinone regimen and then possible a light laser peel, but the lines will progress with aging. JG 1.18.10

Question:

Hi Dr. How soon before CO2 laser should you stop taking ibprofen or does it matter as I have been taking it for some muscle discomfort and am due to have C02 in 2 weeks. Thanks a million times over...

Answer:

with a CO2 laser it is not anything to worry about. Best of luck. JG 1.13.10

Question:

Hello, I am considering rhytec, deep fx or another laser called the DOT co2 laser. I want to eliminate sun damage and wrinkles, especially upper lip and under eyes. I am 52 years old and not overweight. Can you discuss your opinions of these three treatment options? I presume downtime for all of them would be 10 days-2 weeks. Thank you so much!

Answer:

I think all of those will give relatively nice results for the sun damage, but less for the wrinkles, especialy on the upper lip. The upper lids will look better for a bit but will not last too long either, I do think that healing is quick and downtime is minimal, but there is always a trade off or those things. JG 1.13.10

Question:

What is the Cynosure facial laser that the celebrities are using? There is a celebrity cosmetic surgery website that shows how they are doing, who`s had what done, etc., and that laser was mentioned many times. Thank you!

Answer:

sorry but I do not have that information. JG 1.13.10

Question:

How soon after C02 laser can you get Botox and Perlane. Thank you.

Answer:

I would wait 2-3 weeks fot the Botox and 6 weeks for a filler.JG 1.12.10

Question:

Hi. How soon after CO2 on the face can you resume full workouts including cardio. Thank you.

Answer:

if it was deep we ask them to wait three weeks. JG 1.11.10

Question:

Dr. Garcia do you stil use the Rytec Portrait procedure in your pratice? Since they filed bankruptcy is anyone making replacement parts for there machines? Also is there anything that closly resembles that procedure that is not as abrasive as a co2 laser?

Answer:

I stil have some heads that I have been able to but from other doctors, a light CO2 is pretty close to the effect, maybe a little more down time though. JG 1.10.10

Question:

Dr. Garcia, Four days ago I had pixel laser resurfacing done to my entire face, including upper and lower eyelids. I wore no eye protection whatsoever for this procedure and now my vision seems blurry and my eyes are watering and get light sensitive after awhile and my head starts hurting. I kept seeing a white flash as my eyelids were being done but I was told it was normal. My husband thinks I just got cream in my eyes after the procedure but I`m starting to get worried. My question is. Is it safe to get pixel laser resurfacing done to both upper and lower eyelids while not wearing any protection? Thanks in advance! Sincerely, Mrs. Kelly Brian

Answer:

it could be cream and it could be swelling, but I think using corneal shields with that type of laser is important. JG 1.10.10

Question:

I had fractional laser on my face 7 months ago for acne scarring. I still have facial redness - mainly in a streak across my lower cheek. My skin still feels like it is sunburned in the red areas.My dermatologist has tried antibiotics, atrylyne, and now finacia. Nothing has helped. Am I going to have this forever??

Answer:

I am sorry, but it is hard to say, sounds like burns that are not healing, injecting steroids directly into the streak might help but run the risk of tissue atrophy below the skin. JG 1.9.10

Question:

Morning Dr. Guess my question yesterday got lost. I am having CO2 done and wonder if doing part of the forehead is feasible. Over each eyebrow I have a line that sort of forms a C from above the brow to the side of the eye (from expressional movement no doubt). I would like these lasered or is it best to do the whole forehead. I am having under the eyes, chin and around mouth done too. How soon after laser can you get botox and dye your hair. Thanks again. jg

Answer:

it can be done, but I would never just treat the wrinkles alone, the surrounding areas also need to be treated to get the wrinkles to soften, lasers do not work like fillers. I suggest doing the entire face. Best of luck. JG 1.7.10

Question:

Morning Dr. Is it ok to have CO2 around the eye area if you have severely dry eyes. Thank you and Happy NY. jg

Answer:

should be OK to do. Happy New Year to you too. JG 12.29.09

Question:

I have had cancer twice and on chemo for 6 mo the first time and 12 months the second time (with WEEKLY treatments). My skin did not look too bad at first but about a year after the 2nd protocol my skin seemed to deteriorate at an exaggerated rate. I had always been considered to look far younger for my age and all of the sudden (I feel) that I actually look a bit older. I feel that cancer took too much from me already & I want my face back witht eh eight years it also took from me. I want desperately to have my youth back. I don`t just want to look my chronological age but I want to look my emotional age. I am currently in very good health & seeking the deepest lazer resurfacing possible for my face. I am very self-conscious about my appearance. I am not wealthy as I have paid through the nose for my cancer. I am hoping for a reasonably priced option that will actually work.

Answer:

well, hard to say without seeing you but it might be a CO2 totally ablative laser that you ae looking for, best of luck. JG 12.28.09

Question:

Merry Christmas Doc from Canada. Laser resurfacing - I am scheduled to have C02 laser resurfacing around the eyes, mouth and chin the end of Jan. This PS has done this before on me around the eyes and it has been quite successful. From your posts, am i correct in assuming that you do not like this method or have i misunderstood. If not, why. Thank you Dr. G. jg

Answer:

I like CO2 laser, just not a fan of the fractional ones as I feel the degree of improvement is not great. Merry Christmas, Happy Channukah and a Prosperous New Year. JG 12.21.09

Question:

I am one of those people who has had a fractional CO2 resurfacing because I honestly could not find any plastic surgeon or dermatologist in my region (a major metropolitan area, 15 teaching hospitals within 15 miles of my home, etc.) who does full resurfacing any longer due to the risks. I see that you don`t approve of these procedures because you find them not especially effective. Sigh. I hope it won`t turn out to have been a complete waste of my money. In the meantime, I am one month post op and have developed a pretty aggressive case of PIH on my neck and chest, which I know heal more slowly than the face. How long would you predict this will take to clear up? (Type 1 skin, extremely fair). Hydroquinone may help this to speed things along a little, I know, but it`s not been especially helpful to me in the past. Any correlation between PIH and the effectiveness of the treatment? That is, am I futilely consoling myself if I think that the degree of PIH indicates the degree of effectiveness of the resurfacing? Gosh, this seems like a lot of damage if this procedure wasn`t particularly worthwhile, as you believe. May you and those you love have a truly peaceful and healthy new year, Dr. Garcia. You deserve nothing less.

Answer:

with the use of sunblock, Retin-A and Hydroquinone it might take 6-12 weeks, all depends on how high the energy was on the laser. I guess you are now seeing that the risks those docs did not like for the full CO2 are still there for the one they felt was safer. I would also never have done a laser resurfacing on your neck or chest due to what you are seeing and the high potential of scarring. I have never seen any correlation between PIH and effectivenss I am afraid. Just do the above thinsg and in the vast majority of the time it will get better, gotta hang in there for a bit though. Thank you for the kind words too. Merry Christmas, Happy Channukah and Happy New Year. JG 12.17.09

Question:

Hi Dr.Garcia, I`m wondering if it is safe to have portrait or fraxel or any kind of laser over the restylane in my face. I want to do it, but I m afraid that the laser might move some of the filler into another area because my skin is very thin. Or perhaps it could make the restylane hard and lumpy. Do you do laser when a patient has filler underneath? thank you so much!

Answer:

it is safe and most likely will not affect the filler in any way. Merry Christmas, Happy Channukah and Happy New Year. JG 12.17.09

Question:

Dr. Garcia, I had a Fraxel Restore procedures done about 3 months ago that ruined the texture of my skin. Now my face has a strange crepey/bumpy texture and my pores are huge. Is there any way to fix this? I was using Retin-A prior to having the procedure done...might that have caused the problem? My dermatologist is recommending Lux 1540....but I`m afraid that will just make things worse. I`d like to have more trust in him, but I think he`s more interested in $$$$ than patient health. Thanks, Amy

Answer:

I would not try anything for at least another 3 months. Retin-A would never cause that to occur. Give it time and do not do anything for a while. JG 12.12.09

Question:

Hi Dr Garcia. I had Erbium resurfacing to my face for acne scars 4 days ago. Lookiung food and healing well, although vaseline is irritating. I was wondering, would there be benefit in lightly massaging the scar areas? Cheers

Answer:

no benefit from massaging with lasers, best of luck. JG 12.10.09

Question:

I have had CO2 done under the eye area at 42, 46 and am now 53 and would like to do it again. It is about the only option i have as I have severe dry eyes and was told that a Bleph could cause me serious eye problems. My upper lids are fine. Thks from snowy Canada. jg

Answer:

I think it is possible to reepat the CO2 laser there, all the best. JG 12.9.09

Question:

I`m 2 weeks post-op from a CO2 resurfacing. Sorry to be so graphic, but I`ve been producing an excessive amount of nasal mucous ever since, and it`s been consistently bloody. What causes this? Any reason for concern? I haven`t had any active nosebleeds. Thank you for our guidance, Dr. Garcia.

Answer:

I will be honest, I have never seen that happen after a CO2 laser and do not see how the skin resurfacing would cause that. It can certainly happen when the air is dry though. JG 12.7.09

Question:

Hi Dr. Garcia, I just had a Microlaser peel at 10microns, a profractional at 75 microns and a BBL at low settings (on my face), how many days after is it safe to shave?

Answer:

I am sory bvut it is nearly impossible to tell as it all depends on the individual`s skin. I would guesstimate that it would be about 10 days or so. JG 12.3.09

Question:

Thanks for your advice about the clogged pores following CO2. You said a teaspoon in 2 cups of water... but a teaspoon of what? (You obviously have to type very fast to answer all the questions you receive!)

Answer:

oops, sorry, Vinegar. As to typing fast, luckily, yes, I do. JG 12.2.09

Question:

I`m a little under 2 weeks out of a CO2 resurfacing (brutal, by the way!) and have now developed an aggressive case of acne for the first time in my life. This is from the peeling skin clogging the pores, yes? Is there any remedy you would suggest at this point in the healing phase or does this post-procedure acne just clear up on its own? Thanks for your advice! You`re amazing.

Answer:

it is from the ointments causing the pores to plug, not uncommon and does not continue after the skin is healed. I suggest a teaspoon in 2 cups of water and soaking a cloth on your face with that solution and they will open up. In most cases, as the skin heals, all the pimples go away, even with nothing being done. Best of luck. JG 12.2.09

Question:

Thanks so much for the swift and encouraging reply about the erythema post CO2 resurfacing. You mentioned that Neocutis products may help. Which of their products in particular would you recommend for the redness? Thanks again!

Answer:

the Bio-restorative cream for what ails you. JG 12.1.09

Question:

I am 9 days post-op from a fractional CO2 procedure which I see, now that I`ve found your blog, you do not endorse. Sigh. I wish I had come across your blog before I had this done. I have such a pronounced case of erythema that my plastic surgeon is having me come to his office every other day so he can check on me. (I have blue eyes and extremely fair Type 1 skin, which is now fire engine red, ripped/raw in appearance and hot to the touch. It looks like I`ve had a full CO2 ablative resurfacing within the past few hours.) My surgeon has done approximately 450 of these procedures (deep and active FX, Lumenis) in the last two years and has not seen the kind of reaction I am having in any other patient in his care. Just my luck! By the way, he is a highly reputable, careful and surgically conservative physican who has been in practice for 35 years. I don`t think he did anything wrong here; in fact, he told me he used only moderate settings. I think I may just be presenting an idiosyncratic healing process. Two days ago, he took me off the copper peptide topical he had given me and put my on hydrocortisone, to little effect so far. My questions for you are: 1)In a case like this, would you prescribe an oral steroid, like prednisone, to complement the topical steroid? If not, why not? And what else would you recommend? 2) In your experience of doing full ablative CO2 resurfacings, have you ever seen such aggressive erythema as I have become permanent? Whether or not you have, about when would you expect to begin to see a noticeable improvement in the erythema in most of your full ablative patients? 1 month? 6 months? 1 year? I knew I was signing up for a bit of redness for a while, but I had no idea it would be this bad or that it would be so persistent. I fear that it is promising to go on for a long, long time. 3) I am concerned that such an extended period of inflammation will result in PIH. Should I resume using hydroquinone now? (I`ve been using it for the past 5 years.) 4) Do you have any other recommendations for me, besides wearing a paper bag over my head? Thank you very, very much for your time and help, Dr. Garcia. I wish I lived near Las Vegas so you could be my surgeon. From reading your posts, you seem to be unfailingly generous, kind and smart. All of us who turn to you are extremely fortunate to be the recipients of your knowledge and care. May abundant blessings come to you in your life.

Answer:

redness will likely not get better with oral or topical steroids, the skin has essentially been burned and it needs to heal, it will take time, cold compresses and avoiding spicy foods should help, but it is mostly a time issue. I have never seen that type pf redness become permanent but in totally ablative cases I have seen the redness last for 6 weeks or more and then the pinkness might last for 4-6 months. 6 weeks is when I see patients turn the corner with regular CO2 laser resurfacing. I would hold off one the hydroquinone until a little more healed as it will irritate the skin and cause delay in the resolution fo the redness, just stick with the sunblock. Might want to try Neocutis products, they have helped me on many occasions with such issues. Hang in there, thank you for the kind words and I wish you the best. JG 12.1.09

Question:

So, the regular CO2 laser is good for laser resurfacing under the eyes. I know you said the fractional CO2 will not give you the same result, but what if you had multiple fractional CO2 laser treatments (and how many treatments would you need)? Would you eventually get the result of a one time CO2 treatment with multiple fractional CO2 treatments? Is the regular CO2 laser the best method for underete resurfacing?

Answer:

I cannot say that a series of fractional lasers will ever equal a totally ablative CO2. I think the totlaly ablative is far superior. JG 11.29.09

Question:

Hi Dr Garcia, which type of moisturizer to apply after a microlaser peel? any recommendations on brands

Answer:

Oil of Olay, Cetaphil are good OTC. JG 11.29.09

Question:

Hi Dr. Garcia, I have very deep frown lines. Is there a non-surgical procedure that can be performed to fill in or soften the lines with long lasting results or is laser resurfacing the way to go? I`m olive complected and am concerned that if I were to have the procedure done will cause the pigment of my skin to look different. It`s irritating to me to look like I`m angry/frowning all the when I am not. Thank you for your time and reply.

Answer:

well, fillers will last a few months and in olive complected skin, lasers can be risky in terms of pigmentation problems, may want to see someone for possible fillers and in addition Dysport or Botox. JG 11.24.09

Question:

I had aggressive laser peel using the Profractional laser a little over 48 hours ago. I had quite a bit of pinpoint bleeding, which was resolved by the next morning. However, my face began swelling almost immediately and is now completely swollen to the point that my lips are distorted looking and my head appears completely round. Are there any treatments for this that I can do other than ice packs and elevating my head? Also, how long does it normally take for this severe edema to pass?

Answer:

it can take 10-14 days, your doctor could try giving you some oral steroids to help too, we use them prophylactically on our deep lasers. JG 11.23.09

Question:

I am thinking about c02 around my eyes for fine lines. I am 42 with fair skin. Would you recommend for fine lines. I want something that will last. Also what is the recovery/downtime for this?

Answer:

I would recommend it but expect about 18-24 months if done as a totally ablative CO2 and less if fractional. Recovery will be about 10-14 days before make up will hide it. JG 11.23.09

Question:

Dr. Garcia, My entry is just a couple down where I had the dermabrasion about 20 years ago. Is there any laser you would recommend for my acne scarring? I have been getting fillers injected but wanted something more permanent. Please think about moving to Houston!!!

Answer:

I find fillers very disappointing for acne scarring in general and the laser I typically use is a totally ablataive CO2 resurfacing laser. JG 11.19.09

Question:

Hi Dr. Garcia, I had dermabrasion about 20 years ago for acne scars (only one treatment) and was very unhappy with the results. Made my skin look worse and pores look much larger. Do you think the Co2 laser would give me better results? How are the two different? Thank you.

Answer:

better skin tightening by comparison but will not help shrink the pores and it will be harder now due to the previous dermabrasion as the skin has some additional scarring from that. Sorry. JG 11.19.09

Question:

I am confused by your answer to a recent post about CO2 resurfacing. You claimed it dilates the vessels and, so, worsens rather than improves one of the major symptoms of aging skin; yet you -- and the four dermatologists and five plastic surgeons I have consulted -- all insist that it`s the only real way to effectively treat aging skin (texture, pigment and vascular irregularities, overall tone). I have had many IPL, YAG, Alexandrite and VBeam treatments over the years and have experienced mild improvement but not enough for to produce a significant result. I am very worried; I am scheduled for this procedure in 2 weeks and am now thinking I should cancel my appointment. Can you please clarify why you regularly perform (and strongly suggest) this procedure on solar damaged and aging skin when you also claim that it worsens one of its major presenting symptoms? (By the way, all the doctors who examined me told me it would be an excellent treatment for my skin -- Type I; blue eyes, 49 years old, dyschromia, dilated vessesls, roughening texture, fine lines, enlarged pores.) Thank you so much for your time, Dr. Garcia.

Answer:

what I said is that it will not improve dilated blood vessels, it will never make them better.In some cases it can make the dilated blood vessles worse in terms of makeing more of them visisble. If you are trying to correct dialted blood vessels then the CO2 laser is not for you, if you are trying to improve agng skin it is the best choice but it can make the dilated blood vessels worse. There is no one procedure that will correct all of the symptoms of aged skin, they can be treated in sequence though, CO2 first for the aging and then a VBeam for the dilated blood vessels. JG 11.13.09

Question:

today is 7 days from the day i had erbium to perioral, when can i start wearing makeup or atleast concealer?

Answer:

the skin has to be healed so I cannot say without seeing you, sorry. JG 11.12.09

Question:

me again with erbium perioral last thursday they gave me acyclovir and cephalaxin ive been taking each 3 times a day.. now experiencing extreme insomnia and heart palpitations.. im really thinking that is the acyclovir.. can i stop taking it do yu think and just keep on with the antibiotic.. im also on zoloft 50mg..

Answer:

well, if you do you can break out with herpes over the laser areas so I suggest staying on it until the skin is healed, I think it is something else besides the acyclovir though. JG 11.10.09

Question:

its me again who had erbium laser only to the perioral area thursday.. today i have eyeshadow and little lipstick on and concealer under the eyes only, i have no base or other makeup of course near the perioral area, is this ok? thank yu

Answer:

yes. JG 11.9.09

Question:

had erbium laser thursday, doing my cremes, antibiotics, etc today notice white heads about a cluster of them .. is this normal? thank yu

Answer:

it is normal, just plugged pores that will open up in time, make sure you see your doctor for follow up, JG 11.8.09

Question:

Dr. Garcia, I have read everything on here about fractionated co2 and have asked you countless questions. I have a dot laser appointment scheduled for next Friday--I am cancelling. The first time I met with my doctor he said he could get 50% improvement. The last time it was 30. I just read somewhere on the internet that the fractionated treats only 30% of the skin--so is this how they come up with 30% improvement? If the results last only about a month or two, I figure I may as well get a mild peel every now and then (I like them--it does make skin look better for a short time)and continue with fillers. Is there anything I can do to keep my mild lip lines from getting worse--peels, microdermabrasion, etc.? I just don`t want to throw down a $1000 for a month or two of looking refreshed. Thanks so much for being honest even though I really did want to believe in the dot.

Answer:

yes, that is where the percentage comes from. I think the peels and fillers are a good idea and as to the lip lines, you need to purse your lips as little as possible, so no smokng, no drinking out of straws or sports bottles, nothing like that. Best of luck. JG 11.7.09

Question:

Hi Doc. Are you doing the co2 fractional laser? I`m hearing it` only a 3 day downtime and then beautiful skin emerges....sounds too good to be true. Light olive skin is what I have, half hispanic half German. thank you.

Answer:

I use a CO2 laser, but not in a fractional way. It is about 3 days downtime, and then beautiful skin does emerge and then in a few weeks it is all gone.Sorry. For the non-believers in the audience, ask the doctor to show you a picture 6 months after a series of fractional CO2 lasers and compare it to the before, I think you will find it very educational. JG 11.6.09

Question:

had nice results with erbium laser, afraid of the co2, what words do i tell the doctor to get me as close to co2 as possible... is it 100 percent total ablative,non pixilated, non fractional and as deep as possible. thank you?

Answer:

Well,although I feel a totally abalative is superior to a fractional or pixelated laser, and I feel a CO2 laser is beter than an Erbium laser, I do not feel a totlaly ablative Erbium will ever give anything close, at least in the long term, to a CO2. The reason is the Erbium generates no heat while the CO2 does. That is the diference that makes the CO2 better as the heat causes shrinking of the collagen causing a significantly greater degree of tightening. JG 11.4.09

Question:

I am scheduled for fractional laser in two weeks. Is stopping smoking two weeks before enough. If not, I will cancel. Thank you.

Answer:

likely enough, yes. JG 11.1.09

Question:

I am scheduled for a CO2 resurfacing. For years, I`ve received injectable fillers (hyaluronic acid, Radiesse, Sculptra). What complications, if any, might this pose, and do the complications vary according to the injectable material? Do you have your patients wait until their fillers have dissolved before doing this procedure? (In my case, that might be even more unsightly the recovery from the resurfacing; alas, I am extremely thin and need a fair amount of face caulking!) Thanks so much for your advice!

Answer:

there should be no problems with the fillers and the laser. Best of luck. JG 11.1.09

Question:

hi there Doctor, i had asked you about Dr. Richard gregory in Celebration Florida about doing the original CO2 laser, and you recommended him highly.. I had my under eyes done and got very bruised worse than anyone ive ever gone to.. so now alittle hesitant about the CO2.. they also use aquaphor for only for cleaning up (after care) im used to the erbium laser where i had to do vinegar rinses, laser cream, etc.. it was very intense.. Gregory only see ms to use aquaphor with out vinegar rinses, etc.. so im just alittle scared.. im only interested in the perioraal area just for alittle bit of creases... do yu still recomemend i use him since he does use the original Co2 laser vs. the other docotr i went to who did erbium which really didnt prove great results..and the little lines i had came back.. thank you

Answer:

I would still see him and the vinegar is not used as much in the CO2 as it heals differently, the effects of the erbium will likely never be close to the CO2. JG 10.30.09

Question:

hi there Doctor, i had asked you about Dr. Richard gregory in Celebration Florida about doing the original CO2 laser, and you recommended him highly.. I had my under eyes done and got very bruised worse than anyone ive ever gone to.. so now alittle hesitant about the CO2.. they also use aquaphor for only for cleaning up (after care) im used to the erbium laser where i had to do vinegar rinses, laser cream, etc.. it was very intense.. Gregory only see ms to use aquaphor with out vinegar rinses, etc.. so im just alittle scared.. im only interested in the perioraal area just for alittle bit of creases... do yu still recomemend i use him since he does use the original Co2 laser vs. the other docotr i went to who did erbium which really didnt prove great results..and the little lines i had came back.. thank you

Answer:

I still recommend him and Aquaphor can be used and is a good alternative, the Erbium and CO2 will heal very differently and I think the CO2 will always give better longer lasting resutls. JG 11.1.09

Question:

HI Dr. Garcia, OK, here`s the big question, do I have Rhytec done (I`m 32, marionette lines, heavy upper eyelid, but otherwise decent skin) or do I hold off a few years and do something more dramatic (say an upper eyelift, deeper laser)? What would you do to get the most out of your money? Thanks so much, you are fabulous. And also, as I`m certain many of your faraway fans would like to know... could you do an eval with photos to set up a procedure (to minimize the cost of traveling twice)? Again thank you, if a Nobel Prize for Cosmetic Surgery Humanities existed, you would be the first honoree.

Answer:

hold off and wait. I would be happy to look at pictures for you, you can send them to drgarcia@lvcosmeticsurgery.com, please send straight on, three quarter views and profiles, both smiling and not. I apprecaite your kinds words and I am humbled. JG 10.30.09

Question:

In your experience, is CO2 resurfacing a good treatment modality for poikiloderma in patients with Type I skin? Does it successfully address the spots of hypopigmentation associated with this condition? I know that IPL is recommended; I have had 20+ rounds of that, but I still have a fair amount of visible damage. Thanks, Dr. Garcia.

Answer:

I think it can be effective but since it will not cure it, I find it to be a bit too aggressive of an approach. Not much will treat the hypopigmentation, but an IPL or a YAG laser will remove the sun damage from the surrounding area so the difference is less visible. Best of luck. JG 10.26.09

Question:

Hi Dr....Love your blog.I had Portrait laser done on my face. In the process of doing around my eyes, the dr. took off some of my eyebrows. It has been months since having the procedure & the missing eyebrows have not grown back. With you knowledge & experience,do you think the eyebrow will ever grow back?? What can I do to expediate the growth of eyebrows. Thanks.

Answer:

I have not seen the hair loss be permanent, it does take time though, could try some Rogaine to help it along a bit though. Thanks for visiting. JG 10.26.09

Question:

Hi Dr Garcia- If you were closer I would not hesitate for one minute to take advantage of your services. I think most posters would agree that you are very generous and very acknowledable. Do you think there would be a problem if I have laser skin resurfacing above and below the eye area while recently being diagnosed with lattice degeration and a retinal hole in one eye? You are an angel - and so much appreciated

Answer:

we typiclaly put corneal shields over the eye when doing that so it should not be a problem, all the best and thanks for the kind words. JG 10.25.09

Question:

hi dr garcia what are your feeling of micro fractional c02 laser tx how effective is it I just want alittle skin tightening and brighting the surgeon I went to said Im not ready for surgery yet my biggest concern is eye area slight bagging can this laser be done on eye area? thanks again for your great service I only wish I lived closer to you however Im in nyc. Sorry one more quick question what are your thoughts on tubeesent lipo (think I really blew spelling on that one) for abdoninal area is it effective? thanks again

Answer:

not a believer, sorry. If what you need is a very small improvement, then it might be OK. JG 10.25.09

Question:

Dr. Garcia, I am the one with the thin face that asked you about the facelift. Would either fractional or co2 laser cause my face to look thinner with their tightening effects? Or would the tightening be so minimal, especially with fractionated, that it wouldn`t matter? I hear these fat loss stories everywhere from laser, but I just don`t know. After I had ipl series twice, I wondered if my sagging could have been for that. But I really think it was just getting older and menopause. Anyway, just wondered your thoughts on laser for someone with thin face. Thank you so much.

Answer:

typically lasers, will not make that change apparent because the degree of tightness is not as much as what surgery can accomplish. There will be less tightening with fractionated technology, yes. The fat lss stories are really from radiofrequency treatments that are at times combined with minimal ablative lasers to try to make two minimally effective treatments appear better, but I remain unconvinced. I have not seen legitimate fat loss from an IPL unless there was a deep burn of the skin. Lasers will improve mostly just the fine tiny lines and not shrink skin enough to simulate a facelift, they compliment one another, not replace. JG 10.23.09

Question:

Hi!! Do you still offer the Rhytec? Thanks!!

Answer:

yes, I stil have a few heads in my possesion. JG 10.22.09

Question:

How long does collagen formation from fractional CO2 laser last? Like if you had laser resurfacing over raised scar- how long would collagen formation (which minimizes appearance of scar) last?

Answer:

well, to be honest, if the scar was raised, it was raised because it already had too much collagen so there is a strong possibility that in a few months it will look absolutely the same, the use of a fractionated laser to correct that was more wishful thinking than science. JG 10.16.09

Question:

What is your opinion of the pearl laser? Is it good for fines and wrinkles? Thank you

Answer:

I am unimpressed. JG 10.9.09

Question:

I am 39 years old with a fair amount of sun damage to my face showing up in wrinkles, fine lines, a few sun spots and poor texture especially near my smile lines. I feel like I`m pre-aged compared to others my age. I also have quite a bit of melasma from 4 pregnancies. I`m also getting adult acne. What would be the best laser for my concerns. Would retin-a help at all? Thankyou for your time.

Answer:

I would start with Retin-A and hydroquinone and then maybe progress to a light chemical peel or a YAG laser. And always use Sunblock when outside or under florescent lights. JG 9.29.09

Question:

Hi Dr. Garcia, What are you thoughts on E Matrix Radio Frequency Treatment for acne scars? Any major side effects? Is it successful in improving the appearance of acne scarring? Thank you.

Answer:

I would not use it. JG 9.28.09

Question:

Hi Dr. Garcia. I`m scheduled for a co2 laser treatment in five weeks and I have a couple of questions for you. I use Retin-A...when should I stop using it prior to the treatment? My doctor hasn`t mentioned Retin-A in connection with this treatment to me so that`s why I`m asking you. Also, do you recommend the use of bandage on the skin after treatment or not? Thanks so much for your time, it`s greatly appreciated.

Answer:

we personally go rigth to the day of resurfacing with the Retin-A. We also do not use bandages, just our ointments and leave it open so you can monitor for the very rare infection. Best of luck. JG 9.21.09

Question:

I asked about the acne scar fillers earlier. Is the YAG better for raising acne scars or better for reducing the red/brown color or pigment in them? As always, thank you for your honesty and wonderful service.

Answer:

I think a YAG will not help the depressed acne scars, and it will work for the disoclorations, but only after a series of sessions. JG 9.15.09

Question:

What is the best laser for severe sun spots and freckling on the back? I have a consult with a derm. who has the Pearl. Do they use it for this area? Thank you.

Answer:

well, considering that no matter what laser you use they will all come back in time, I suggest having one that does not cost you too much. JG 9.11.09

Question:

Dr. Garcia, One of the posters talked about telangectasies after a fractional. What is that? I was scheduled for dot laser in November, but now am getting very scared. I cannot find a co2 doctor who will use this on mouth area--they all suggest fillers which will not work with me. Two of them were concerned about the pigment change in mouth area. I don`t have deep lines --I tried the fillers and they made them more obvious it seems since he really wasn`t filling anything--lines were on surface. The doctor who suggested the dot said he is getting 50% improvement with the dot, but would give me a free one if it didn`t work the first time. My main concern is fat loss of the face--I have none to spare. What does that thermal heating mean? Do all lasers do this or is the dot too new to determine if fat loss can occur? I also noticed one poster who is having co2 perioral done in Orlando. If I understood correctly she said her erbium only lasted four months!! Why would that be? Do the non co2 lasers just cause swelling and camouflage the wrinkles? I am sorry for so many questions, but it certainly appears that the fractional lasers are about as temporary as fillers. Do you think the dot is worth a try for surface lip lines? Thank you so much for all your answers to my many questins.

Answer:

telangiectasisas are small superficial broken blood vessels in the skin, they can appear from lasers, from sun exposure, from many skin treatments like microdermabrasions, from normal aging, genetics, acne, rosacea, lots of reasons. The pigment changes can be significantly reduced by using lesser energy so the CO2 does not go too deeply to damage the melanin cells. I do not think the dot will cause fat loss in the face though. The fat loss has been reported only with radio-frequency machines like Thermage. I know of no real lasers that have caused facial fat loss. The Erbium, especailly if done in a pixelated fashion takes a very weak skin tightening laser and makes it even less effective by the fractionation. You are right about the post laser swelling showing the degree of improvement. I think showing laser results at anything less than one year is disingenious. If I thought the dot laser worked I would have bought one long ago, it is easy to use, heals quickly, benefits from patients wanting short healing tiem, but fails to deliver a worthwhile return on investment. JG 9.1.09

Question:

I know you are not a fan of fractional resurfacing, prefering CO2; but what do you make of the Total FX ? From the descriptions, it seems to combine fractional and CO2 technologies-- deeper than Fraxel, less ablative than CO2. Have you heard of any long-term damage from this treatment? A friend of mine developed horrible, treatment-resistant telangectasies after three rounds of Fraxel treatments, while others I know have seen little to no benefit from it, if no damage either. I know of two people who have experienced excellent results from the Total FX, but I am reluctant to try it in light of the damage that I`ve seen the Fraxel (apparently, a less powerful laser) do. And I`m terrified of CO2 resurfacing. (I have extremely sensitive Type 1 skin with a fair amount of sun damage--pigment, texture, tone. IPL, hydroquinone, Retin A etc. hasn`t helped much over the years.) What do you think of the Total FX? Thanks for your time and help!

Answer:

the Totla FX is stil a fractionated laser or pixelated laser, it just went from using the erbium to the CO2 laser to try to improve its effectiveness.It limits the effects of the CO2 by using fractionated technology. I have seen severe complications including visible scarring and have also read about them in the laser literature when fractionated CO2 lasers have been used. There is no laser that is 100% safe. I remain not a fan of the Total FX or any fractionated laser. JG 8.31.09

Question:

The relationship between birth defects and accutane is well documented but I also keep reading about infertility and accutane. However, this seems to be from sources other than medical research. Is there any truth to this connection? Also, should I get nd:yag treatments for red scarring before accutane or after the completion of the course?

Answer:

there have been anecdotal reports but no one can say whether it was the Accutane or the birth control method that was used while on the Accutane that caused problems. JG 8.30.09

Question:

Hi Doc..Love you posts!!! I am having some laser (alex & VBEAM) procedures on my face. Do you think Arnica Montana by Sinecch (500mg capsules) work for reducing swelling. If so, when & how long are you suppose to take them? Do you have another brand that has been successful for your patients. If so, what brand and when & how much do you take?? Thanks for your time

Answer:

I think it would be worth using, start a couple of days before and continue until swelling and bruising has gone. Sinech is a good brand. JG 8.30.09

Question:

hi im the one that is going to richard gregory in celebration for perioral the real co2 laser... it is a lot of money compared to the erbium i used last april.. so im wondering if i spend this kind of money will the results last longer than the erbium did (whicch was about 4 months..) i know if i spend big money with gregory which the procedure only for perioral is about 1600 and the erbium for perioral i did in april was only 700 i want to see somee big results and longer results in regards to smoothing out the face and a slight wrinkle on the chin.. etc

Answer:

yes, I think the results will be much more dramatic and worth it. JG 8.30.09

Question:

Hi Dr. Garcia, I`ve heard of the Portrait Skin Regeneration Procedure and wanted to know if you have ever seen or had patients experience over production of collagen on certain areas of the face, causing imperfect results or disfigurement. I`d love to try it, but read some beauty blogs on the internet reporting these kinds of results. Their surveys noted that over 70 % of the people who had this procedure done did not recommend it and in some cases, the patient`s were permanently scarred or disfigured. How would this be possible? It seems like this is being touted as the new and safe regeneration procedure. Your input and time is greatly appreciated! Thank you!

Answer:

any resurfacing treatment can cause scarring as you allude to,from chemical peels to fractionated lasers and the Portrait. Done in an appropriate manner, the risks of that are quire small though. I think one needs to always be careful with blogs though as people with positive experiences rarely post anything but those with bad experiences usually do, so the impression you get is soemwhat biased. Done too weakly the results can be disappointing as they are very mild too. In general, the patients I have treated have been quite happy, but I make realistic claims and do not hype things past what is possible on a routine basis. JG 8.17.09

Question:

Thank you for your responds..just one more question:I have dark skin pigmentation around my eyes (especially inside corner of eye near nose)Even my eyelids are dark skinned ..what do you recommend to treat dark pigmentation skin around eyes .

Answer:

Retin-A and hydroquinone is all I would suggest. JG 8.13.09

Question:

Hi Doctor G, I have large blue veins under my eyes just above my cheek bones in the soft tissue About 6 months ago, I had my cosmetic dermatologist, laser under my eyes because I have large blue veins that make me look like a raccoon. My dermatologist told me that I might need more than 1 treatment. After the first treatment I saw improvement, & my dermatologist said we needed to watch that the veins did not come back & if we saw them coming back do another laser treatment. Unfortunately, when the veins started to come back, I was not in a position to be able to continue the laser treatment. Now, 6 months later the veins under my eyes look worse. The large veins are still there but it also look like smaller veins are now shooting out from the large veins. I am considering further laser treatment, because my doctor told me that by continuing the laser treatment we would collapse the veins, including the feeder vein & hopefully the vein will not fill up with blood again. I did see improvement after first laser, so should I consider doing the laser procedure again, but this time continue with multiple laser procedures until the veins no longer come back. What do you recommend I do now?? Can a laser collapse blue veins? Also,I have dark pigmentation at the inside corner of my eyes..what do you recommend to treat dark pigmentation skin around eyes near nose. Thanks you so much for taking the time to help me. You are the BEST!

Answer:

I think most likely the effect you saw after the first treatment was due to swelling pushing the veins lower, collapsing the veins with lasers is not a very reliable thing and I do not recommend it. Usually I use fillers like Restylane to plump the skin and hide the darkness and the veins. JG 8.13.09

Question:

I have large pores and some indentations from kenolog injections, acne scars and laser treatments on my nose. My PS suggests a CO2 laser just on my nose which he says will smooth out and thin the skin. I am scared that I will have a red nose for months and then be left with a nose that is lighter than the rest of my face. What do you think? Any other suggestions for these problems? Thank you!

Answer:

the nose skin does tend to fade faster in terms of the redness compared to the cheeks so it might be your best option. JG 8.13.09

Question:

in re: to dr gregory, he is only doing the perioral area only..not whole face under local and he said it would be no problem..wht do yu thik

Answer:

if it is just the perioral, then I think that is OK, a good block with local anesthesia should work well in that area, but not on the entire face. JG 8.5.09

Question:

Please help, I had stretch marks on my abdomen treated with a Pulse Dye Laser to remove the redness. A week after the treatment a section of the stretch marks formed scabs, which when they came off left scars. When i went back to the laser clinic, they started to give me free Fraxel treatments, but they burnt my skin again, which left more scarring. What recourse do i have against the clinic, and what else could i consider doing to remove the redness from the stretch marks/scars? Thanks

Answer:

might try an IPL or a YAg laserfor the redness, as to a recourse against the clininc, short of filing a medical malpractice suit, there are really not many options I am afraid, sorry to hear about all the issues.I wish you the best. JG 8.5.09

Question:

ok, finally found someone to do the old fashioned co2 laser , he is going to do it non fractionated, non pixiated and total ablative, he wanted to do under general, but i opted for local.. as i did erbium laser under local dnd no problems.. so is this really a risky thing the real mccoy co2 laser, i dont mind the sideeffect s and length of time for healing, i just hope that it is safe dr. richard gregory of celebration florida does it in case anyone asks

Answer:

well, I understand wanting to do it under local, but CO2 is not erbium. I NEVEr do a CO2 laser unless it is under general if I am treating the whole face. It is not a matter of the side effects, it is if the local is not enough, then they will not be able to do the procedure as it should be done, and if you move due to the pain and the laser hits something it should not, then it is not good either. I know Dr Gregory and you are in excellent hands. JG 8.4.09

Question:

I know you do not offer dermabrasion so am thinking you have good reasons not to. What are the dangers of this for upper lip lines? Is co2 on mouth area a safer bet? Thanks.

Answer:

unpredictable depth as the variables are too great, you can end up having skip area, areas that were treated too deepluy, and scarring.I feel CO2 laser is much better, yes. JG 8.2.09

Question:

When you explained to the one poster about the laser not taking all the wrinkled skin away, I finally get it. I had always wondered the same thing--why would the old ones come back instead of new ones. I still think with the results you are getting from the co2 that it looks pretty darned close to completely eliminating them! It also kind of explained why you don`t recommend the dot which is what my derm recommended to me to soften upper lip lines. That softening is going to last what --maybe a few months? Thanks so being so honest with us. (even though it hurts!)

Answer:

the softening lasts a few months, correct, that is why they choose the word soften, since they can always fall back on that, what defines a softer wrinkle, who knows. All the best. JG 7.31.09

Question:

ok so i finally found the old fashioned laser, YAY so the ultrapulse luminese is good? what do i tell them ? not to skip, ablative or not, and how deep should it go, and non fractional right if that can be altered? i just want to improve marioneette lines, and perioral area only? thank you..

Answer:

just tell then you do not want a fractionated or pixelated treatment and that you want total surface ablation. The laser will help the fine lines around the mouth but likely not much for the marionette lines as they are there due to sagging cheek tissue that no laser will significantly improve for very long, you need surgery for that. JG 7.30.09

Question:

Hi Dr Garcia I am 10months post fraxel CO2 procedure and have been using hydroquinone for the past six months to try to rid myself of the post inflammatory hyperpigmentation I was left with. This is not working. I have a mediterranean background. Is PIH permanant. What do you suggest I do? Thank you

Answer:

could be long standing, suggest adding Retin-A to the hydroquinone for better penetration, best of luck. JG 7.29.09

Question:

ok how about ultrapulse laser by lumenis? what do yu think of that one compared or in lieu of the original co2 laser can you tell me the brand of laser and the name of the one you so recommend (that origianl co2 laser that most docs just dont use anymore, im desparealty trying to find someon e in florida that will use the good co2 laser that yu so give alcolades about .. thanks

Answer:

that is essentially the old fashioned CO2 laser, as long as the pattern is set correctly without skip ar eas. I had a Sharplan and a Lumenis CO2 laser, no difference. JG 7.29.09

Question:

Hello, I had Sciton laser resurfacing on my lower eyelids? What do you think will be my recovery time and result? I had wrinkles and discoloration. 54 years old.

Answer:

no way to tell without knowing which Sciton laser was used the energy settings and the numbers of passes, but likley will be healed in 2-4 weeks. JG 7.29.09

Question:

I read one of your replies in which you told a poster that microdermabrasion is of little value for upper lip lines--more prevention. My derm. said mine were mild moderate . Would it be of any value to have a series of microderm. to keep them from getting worse? He wants to do dot laser to soften them. The restylane only lasted about two months. My big problem is there is a lot of fat loss in upper lip area. He said he couldn`t just put filler in the lines without doing borders and adding volume. Am I always going to have to have volume added even with a co2 resurfacing? Sorry for so many questions and thank you.

Answer:

I would not suggest you do it unless you have money to burn. I think the dot laser effects will be short lived too. If you have volume loss, you will continue to need fillers, yes. Wish I had better news for you. JG 7.29.09

Question:

Hello Dr Garcia. Could you tell me approximately how many microns deep into the skin does a double pass high energy Rhytec penetrate? Also could you tell me, if you wanted to perform a CO2 treatment that penetrated approximately 150 microns or slightly more into the skin, how many mJ would the laser be set at each pass and how many passes would be required? Thank You

Answer:

well, the doctor can make the high energy anything between 3-4 joules so there is no way I can answer that question, but 2 passes at 4 joules would be pretty close to 150 microns I would guess. As to your second question, that is something the doctor needs to know, not you. JG 7.26.09

Question:

hi i know you say it is best to get as close to a co2 laser as possible. my choices are the erbium laser or the juvia laser by ellipse which claims to be co2, any suggestions

Answer:

if the erbium is totlaly ablative, I would chose that, if not, either one. JG 7.24.09

Question:

The pictures of laser resurfacing on your site are amazing. Are these done with traditional co2?

Answer:

all traditional CO2 laser, yes. JG 7.12.09

Question:

I have read on some sites that laser resurfacing of upper lip can help restore a flat cupid`s bow. Is this possible? If so, does it have to do with building more collagen? Thank you.

Answer:

all hype, it will create more collagen and skin tightening but no effect on the cupid`s bow. JG 7.12.09

Question:

Hi Doc, Hope your summer is going well. I live in OC Ca.and have some acne scarring, (not very deep). A dermatologist suggest having thermoscan laser. Said 4-5 treatments should improve it tremendously at $400. a treatment. What is your opinion?

Answer:

I would save your money. Sorry. JG 7.7.09

Question:

Hi, About 6 months ago, I had my cosmetic dermatologist, laser under my eyes because I have large blue veins that make me look like a raccoon. My dermatologist told me that I might need more than 1 treatment. After the first treatment I saw improvement, & my dermatologist said we needed to watch that the veins did not come back & if we saw them coming back do another laser treatment. Unfortunately, when the veins started to come back, I was not in a position to be able to continue the laser treatment. Now, 6 months later the veins under my eyes look worse. The large veins are still there but it also look like smaller veins are now shooting out from the large veins. I do not want to look like a raccoon for the rest of my life. I did see improvement after first laser, so should I consider doing the laser procedure again, but this time continue with multiple laser procedures until the veins no longer come back. What do you recommend I do now?? Thanks you so much for taking the time to help me. You are the BEST!

Answer:

well, if it worked on you I think it might be a good option, although I will say that lasers for large blue veins on the lower eyelids does not work in the majority of patients, but no need to argue with success on an individual basis. I would keep it up when you can do it. JG 7.2.09

Question:

Thanks so much for all your help. What is the status of Rhytec Portrait....is it available anymore? If not, what is the closest type treatment like Rhytec Portrait, that is available? Thanks

Answer:

the company closed, I stil have a few tips and am stil treating patients, we are awaiting a company to produce more tips in the future. I think the next best thing is a light CO2 laser. JG 6.23.09

Question:

hi doc, Im planning on having tca peel and after that IPl treatment. Is this a good method for someone that wants to help very fine lines who has dull skin with some capilaries and pigmentation problems?? can you suggest anything else if it doesnt sound right...? Im a younger patient. thanks

Answer:

I think the peel will do nothing for the fine lines and might aggravate the capillaries that were improved with the IPL. I would likely do the IPL alone. JG 6.9.09

Question:

how long will tca peel effect last? can you give me approx. length of time please? thank you

Answer:

3-6 months, maybe. JG 6.8.09

Question:

I am young and looking to adress some superficial fine lines from sun exposure. Will Erbium laser help?would Erbium work as well for superficial texture?

Answer:

it is very mild so it might be enough for your case. JG 6.8.09

Question:

Dr. Garcia, I had restylane for the lines above my upper lip. It helped. I asked him about co2 for them and he said I wasn`t ready for that. I don`t know why because he classified mine as mild moderate . He said he could soften them with the dot laser. He would do the whole face and do it stronger on the the perioral region. He told me I would be down for 7 days with the settings he was going to use. I have no intention of doing this because my skin is so sensitive I have rosacea outbreaks from sunscreens and some common skin creams. My question is: can`t he do the perioral region only? I thought I read on the internet where that was the advantage of the fractional lasers--they don`t leave the demarcation lines. By the way, he suggested botox along with the restylane. I said absolutely not thanks to your previous advice. Thanks .

Answer:

the peri-oral region can be done alone, in some people with lots of sun damage on the entire face we like to do the whole face so there is more even healing, but since the dot laser is so weak, doing the area around the mouth alone is certainly commonly done. Gald you took my advice about the Botox too. Best of luck. JG 6.5.09

Question:

Hi Dr.Garcia, I will be going in for a series of profractional treatments. The thing is, I have facial hair, light beard and mustache which I enjoy but needs to be shaved for treatment. Will these treatments have any effect on my facial hair and/or it`s ability to grow thereafter? Thanks.

Answer:

no, it will grow in time. JG 6.1.09

Question:

I have large pores, texture and some sun damage. I am 44. It has been suggested that I have the fraxel laser done to address all of these issues. It is pretty expensive. I cannot afford the down time of a C02 laser. Thanks for your advise.

Answer:

I think it might improve the texture to a mild degree and also the sun damage if it is light and recent but will do ntohing for the pores past a few weeks. Neither will the CO2 laser. JG 5.30.9

Question:

Good Evening Dr. Garcia, 5 days ago, I had my 2nd fraxel treatment on 4 spots (eraser size) on my face (not the whole face). The rough layer on the spots has already flaked off completely, and they are just pink now. Thanks :)

Answer:

sounds good. JG 5.26.09

Question:

Just recently read about the fractional carbon dioxide resurfacing. What can you tell about the results from this type of treatment and your general opinion of it if you have one Aloha Kauai Wahine

Answer:

much weaker than the traditional totally ablative CO2, I am not a fan, except maybe for recent sun spots. JG 5.26.09

Question:

I`ve written to you several times. I appreciate you answering the many questions I`ve asked. I was planning on having co2 laser resurfacing, but I now have decided not to. I am scared of all of the complications that can occur with this laser as well as all of the other lasers out there. I realize if I had had it done and everything would have gone well, it would have been just a temporary fix. I would like to know if there is any type of cream or thing to do that will help your skin`s appearance. I know I`ll use sunscreen or sunblock from now on. What do you recommend?

Answer:

Retin-A is your best and least expensive option. JG 5.25.09

Question:

What is portrait express treatments? Is it like the plasma Rhytec treatment? If wanting improvement, but not going too deep would Plasma Rhytec, Derma-K(co2 and erbium) or medium co2 be the best?

Answer:

it is a very light Rhytec Portrait session. Hard to say what would be best without seeing you, medium CO2 migth be best though. JG 5.23.09

Question:

Hello Dr Garcia: I`m trying to put together all of the different, helpful information you have given here - bottom line what is the best laser option for skin texture, collagen building and tightening, for skin that is 45-50 years old?

Answer:

CO2 laser. JG 5.23.09

Question:

My derm suggests a series of portrait express treatments-about 6 - a few weeks apart to treat textural problems especially around the mouth. I am 54 with mild to moderate sun damage. Do you think this is going to improve at all? or maybe I should ask how much? thank you.

Answer:

I prefer to do a single deep one, it is more effective. JG 5.18.09

Question:

What is contour lasering?

Answer:

by Sciton, an Erbium laser used to peel skin, I am not a fan. JG 5.17.09

Question:

What is the difference between thermage and co2 laser resurfacing?

Answer:

I am not a believer in Thermage but it leaves the skin intact and tries to rely on deep heat being delivered beneath the skin to cause tightening. The CO2 is the gold standard but does remove the skin in order to create new collagen. JG 5.17.09

Question:

What do you think of the derma-k laser or the plasma laser? Could you have light or medium co2 laser and have some improvement to your skin? Would the pigmentation problems, scarring, etc be less likely to happen? I have heard so many horror stories. I would like a scar smoothed out and some smoother skin, but if i still have some wrinkles that will be ok

Answer:

The plasma laser or Rhytec I think is a good option for milder skin ablation, less down time than the CO2. The Derma-K combines CO2 with Erbium and I think adding the Erbium adds little positive in terms of results or healing times. I also want you to understand since none of the techniques mentioned stop the aging process, in time, the appearance will return to its previous state. JG 5.17.09

Question:

what do yu think of ellipse juvia co2 laser? i just had the erbium about 5 weeks ago, not that happy when can i do laser agaain, how long do i have to wait

Answer:

I would wait 3 months but do not expect much from the Ellipse as fractioanl lasers in general show little improvement and only for a short period of time. JG 5.14.09

Question:

If you have a little puffiness under one eye, would co2 laser resurfacing correct it or would lower and upper eyelid surgery be best?

Answer:

the CO2 is only for fine lines so it will not help, you likely need surgery to remove the fat pocket. JG 5.13.09

Question:

I`ve read where you say the co2 laser results are just temporary. If sun damage, lines and wrinkles are removed or made better and you use sunblock in the future it looks like you would always have some improvement. I know there are certain facial movements that will make lines reappear and I understand that. I just hate to have such a drastic thing done if it won`t make the appearance of the face better from then on. If I have it done I would hope to not have to have it done again. Maybe some other procedure to help the face later.

Answer:

no, becasue the body`s ability to create new collagen and elastin starts to peter out and the skin degenerates even if you avoid the sun, doing those things will slow the progression down but not stop it. You would always be better than if you never had it done, but the wrinkles would not stay away forever. JG 5.5.09

Question:

Dr. Garcia, For how long will wrinkle reduction beneath the eyes (no crows feet) last with a CO2 LASER? Also, what degree of improvement can be expected?

Answer:

in most cases, 18-36 months, depends on the quality of the skin and how deep the laser is performed to. JG 4.30.09

Question:

Dr. Garcia, can a phenol peel around the eyes eliminate wrinkles and crepiness directly under the eyes (mostly in the area where dark circles occur). Also, can it tighten loose skin in that region to any appreciable degree? Lastly, if phenol were to work under the eyes, for approx. how long would the results last? Thank-you!!

Answer:

it will help, yes. I think the improvement under the eyes might be 3-5 years, depends on your skin and the amount of damage, but phenol peels have risks, like loss of pigmentation. JG 4.30.09

Question:

Hello, I was wondering what is the best laser for acne scarring. I am thinking of doing the smoothbeam laser because i think the fraxel laser is too strong?

Answer:

I think you will likely be disappointed with both after a few months once the swelling goes down. JG 4.29.09

Question:

When does the shiny look go away from C02 laser resurfacing. Is it possible to have that look permantely?

Answer:

it is permanent only in rare cases of scarring, it goes away as soon as the skin has healed enough that it does not need to overproduce oil to help the healing process. JG 4.29.09

Question:

What are the symptoms of your skin being damaged by a C02 laser?

Answer:

textural changes that do not resolve with time, stiff and hardened visible scars are the most common. JG 4.27.09

Question:

I have hypopigmentation for C02 laser resurfacing x 12 months on my nose. Could the skin be very thin in this area. What are your recommendations to correct this.

Answer:

about all you can do is try to get it exposed to the sun and see if it darkens. JG 4.27.09

Question:

My previous question didn`t post. You have been very helpful with your replies, thank you. I had a co2 laser about 6 months ago. Lot`s of problems. No weeping after laser. Now I am having problems with lots of texture on my cheeks, lips and chin. I don`t like the looks of it but the texture is very painful once it breaches the skin surface. Texture looks like a coarse facial line with dots. This is happening all over my face except forehead. I was referred by my plastic surgeon to to a neurologist and dermatologist to evaluate my skin. Neurologist said I didn`t have a nerve problem and dermatologist said my problem was that my expectations were to high. When I told him I resented his statement because I was there for pain not expectations. He told me to go buy some hot pepper ointment and rub it on my face and the nerves would eventually die. Anyway, I paid him $100 for about 5 minutes worth of obnoxious behavior. My plastic surgeon has said he would relaser, put filler in or I could use retinal products. Those were my only 3 options. I am scared to do anything until I find out what is happening now. Have you ever heard of this problem after lasering. Could this texture that is breaking on the surface of my skin be damaged dermal elastic fibers? I have no idea where to go or what to do. Should I find another dermatologist? I am very concerned. Thank you for your assistance

Answer:

hard for me to say without seeing you in person. I think though that texure alone might be able to be improved with more lasers or retiniols to some extent. The problem though is the breaking of the skin and the pain, with that happening I would be apprehensive about further lasers until that has totally resolved. If the skin has been demaged by the CO2 laser, that can happen in rare cases, then further lasers would only make it worse. I do think using things like Capsacin cream, which is the hot pepper cream can help in some cases. You can also try Emu oil and I have had some people get better with topical DMSO, sold at most large health food stores. Wish I had more to offer you. JG 4.26.09

Question:

Will co2 laser resurfacing help get rid of red capilaries? Will it help with lines, wrinkles, surgical scars, sun damage etc on the face? Will it tighten the skin? Will the 3 ingredient cream help prevent discoloration and help the healing process?

Answer:

no, it will not help the red capillaries. It will help the fine lines, might improve the scars by smoothing them out and will remove sun damage in most cases. As to tightening the skin, also yes, but not to the degree a facelift would. The Triple Mix does help reduce hyperpigmentation risks. JG 4.25.09

Question:

hello im the one that had laser (ablative 300 microns done 10 days ago on the perioral area, and so now i see the result, i definitly look more refined, but still see that oral commisure on the left of my mouth and wondering if i can now step up to C02 laser and ask the doc to only do it on the one commisure ?? how early can yu do laser again after you just had it 10 days ago.>>??

Answer:

wll, the honest truth is all you are seeing at this point in time is swelling and much if not all of that will go away for the next 4 weeks, at that point the new collagen will have been laid and then it will take 4-6 months for its maximal tightening to occur, so you will be on a little bit of a looking better roller coaster for now. I would not consider doing anything else for at leasst 6 months and preferably 12 months in order to let the skin heal and avoid scarring from to much burning. JG 4.24.09

Question:

There are so many lasers...what is your opinion of the scitcon for the under eye area (not sure if I spelled correctly)

Answer:

not sure which of the Sciton lasers you are speaking of, if it is a fractional laser, I am nto impressed. JG 4.24.09

Question:

What are marionette lines? Are they straight down lines on the face? I don`t know if I have them. I thought I had an ok face until I got a magnifying make-up mirror. I now see alot of sun damage etc. I plan on having co2 laser resufacing, but do not want to take a chance of going too deep. I will go over all of this with the PS two weeks before I have it done. I hope medium laser or mild deep will correct most of my problems. I am scared of this procedure, but hope I`ll be glad I did it.

Answer:

they are the folds that are from the corners of your mouth down to your jaw, they are formed from the tissues if the cheeks sagging and falling downward. Hard for me to say whether a laser will help your scenario without seeing you in person. JG 4.21.09

Question:

Where do you get copper peptide cream? I`m not having laser resurfacing until the Fall. But I want to get all of the necessary items I will need a few weeks before I have it done.

Answer:

dermatology or plastic surgeons often carry it, otherwise the internet, we use CU3. JG 4.20.09

Question:

fractionated CO2 laser resurfacing what do you think of this please dr garcia.

Answer:

sorry, not a fan. JG 4.20.09

Question:

so what is the physiological answer you can give about why the laser to the face for fine lines ,,,,,,,,,that it takes about 2- 6 months to see a difference.. why is this?

Answer:

because the intent of a laser is to incite damage in the deeper laers of the skin and then the skin heals by the creation of new collagen, the new collagen is laid down in 4-6 weeks but it is disorganized and will take 4-6 months for the collagen bonds to form from one strand to another to get the maximum amount of skin tightening. Sounds like whoever sold you on the laser and performed it on you did not give you much of an explanation before you had it done. JG 4.18.09

Question:

had very deep ablative laser one week today for perioral area which subtley has minor lines. i peeled fine, but now i look in the mirror, and dont see any i mpprovement of the lines... when if any will i see a change after the treatment, does it still take awhile?

Answer:

it will take 2-6 months to get the maximum resolution of those lines, if you were not told that, they should have. JG 4.17.09

Question:

Hi Dr Garcia: I was wondering which laser is the best for 50-year-old skin - I have almost no lines but am starting to see a bit of sag and would like to even out the skin tone, improve texture and stimulate collagen. Would retin -a do the same as laser but more slowly? or are lasers more effective? and, if so, which is the right kind? Thank you, thank you, thank you as always for your generosity

Answer:

I would always start with Retin-A, it will help the texture and stimulate collagen to some degree. I think there are lots of lighter fractionated lasers that claim great results with no downtime, as I am sure you can figure out, if it sounds too good to be true, it ususlaly is. When the time comes it will likely need something with some downtime JG 4.17.09

Question:

Dr. Garcia, I am interested in the CO2 fraxel laser for my face and neck. I live in San Diego area, who would you recommend for this type of treatment. My 26 year old daughter also is interested in the CO2 fraxel laser for acne scars. Would this be the best treatment? Thank you

Answer:

I am sorry but I am noe a believer in the effectiveness of the fractionated lasers so in good conscience, I cannot recommend anyone. JG 4.17.09

Question:

im the one with the ebrium laser that was on last thursday, i wanted it to improve the appearance of the oral commisures, and a fine line on my chin and a slight nasolabial fold. since then idid peelall the way, but dont see any correction with the areas i wanted, is it too soon to tellor something? i told him to use as close to a co2 laser as he could , ablative and non fractional.. and he went 300 microns deep

Answer:

well, the CO2 would have gotten a better result for the fine lines over the erbium as the heat the CO2 geneates helps that but erbium has no heat, even if done to the same depth. As to the oral commisure and the slight nasolabial folds, no laser will correct that, that is surgery or filler. Lasers will never be able to long term tighten the skin enough to correct that. JG 4.16.09

Question:

had ebrium laser last thursday, should i be still doing the vinegar routine after this much time.. doc says dont have to now, just wanted to be sure this is ok

Answer:

I only use it in order to remove the cream we apply only if it does not come off when washing the face, otherwise we do not use it routinely, it is only as needed. JG 4.15.09

Question:

Is there anything that can be done for hypopigmentation? Would a dematologist or your PS be a better person to advice you on what can be done for burning and hypopigmentation?

Answer:

I think the burning is likely due to some element of scarring and the hypopigmentation might get better with a little sun. I think either a plastic surgeon or dermatologist could see you as long as they have laser experience. JG 4.13.09

Question:

What causes hypopigmentation with C02 laser resurfacing? Should you feel a burning sensation for a year? What would cause that?

Answer:

if it is done too deeply it can injure the melanocytes that create the pigment. The burning sensation is not a normal thing. JG 4.13.09

Question:

hi Dr. Garcia, im the one that just had the ebrium laser on thursday.. to perioral... area i was told to use a teaspn of vinegar... to 1cup of water, but i thought it said 1 cup of vinegar to 1 cup water and i stung like mad for 2 days in a row, and did this regimen 4 x a day.. for cleansing antiseptic purposes.. but im still red as heck and wondering if using this much vinegar caused something bad like more redness etc.. as i am still red very!!

Answer:

that is too much vinegar, decrease it to the prescribed amount and it should get better. JG 4.12.09

Question:

had erbium laser with ablation very deep like 300 microns on thursday, been using the vinegar washes 4 times daily and the post creams.. had it done to perioral area only very red still, how can i tell this is healing.?? im 37 yrs old.. thank you

Answer:

that is normal for that depth laser at this point, got to hang in there. JG 4.12.09

Question:

I am the 55 year old woman. I have seen two doctors. One uses the co2 the other uses the erbium. From what I have read the co2 will be more effective. I know the co2 will remove the entire epidermis. Would this be enough taken off to make a difference in your skin? Should you go to the dermis into the papillary layer? I just don`t want to go too deep. I`ve read of so many complications that people have had when the laser goes too deep. Would medium resurfacing do enough to improve my skin? I have some sun damage, fine lines and a surgical scar I want to smooth. Also, I am on the 3 ingredient cream to help prepare my skin for the lasering. Will this help my skin not lighten up drastically afterwards. I read the skin on your face will be lighter than your neck etc. I just don`t want to have a big difference. I work out of the home and down time is not a big issue. But I know the deeper you go the more time it will take to heal. If I go a medium depth will the down time be much less? I know I need to trust the doctor and realize he will not want me to have any complications and will do only what is needed. I just don`t want to make things worse. Do you think most people are pleased with the results of co2 laserinG?

Answer:

light chemical peels remove the epidermis, if you desire wrinkle reduction you need to go into the dermis. My preference is CO2 as it is ablative and also heats the colagen to shrink it which the Erbium cannot,therefore the erbium heals fasetr and the improvements are not as dramatic. The tripel mix cream will help avoid the potential hyperpigmentation that can occur with both CO2 and erbium. I always do a TCA peel on the neck to help the color of the face blend in better with the neck when I do a facial laser. I tried the erbium technology long ago and abandoned it as I was disappointed with the results. Best of luck. JG 4.9.09

Question:

in Reegards to the laser co2, the doctor told me that it is easily controlled and there were lots of trouble with it years ago, and that permanent risks are involved.. burned, and no makeup covers it, many malpractice suits on it, etc.. im just concerened. the new lasers are more refined and easily controlled

Answer:

I do not feel the new lasers are more refined, they have been dialed down in terms of energy, and therfore likewise in their effectiveness. It is all a matter of depth and experience on the surgoen`s part. JG 4.6.09

Question:

Dr. Garcia, I have been asking you so many questions on the vertical lip lines. When I went to a surgeon about the co2 light that you suggested, he said there was nothing that could be done for vertical lip lines. Mine are not bad as of yet. He said lasers no matter what kind leave a telltale mark that looks ridiculous and that the same goes for phenal and dermabrasion. He said fillers were no good. I just don`t understand--I see pictures on the internet of good work--fillers as well as different kinds of lasers. He said he is honest and the rest is just hype. Should I be depressed or is this just someone who doesn`t want to work on this area? I was hoping fillers might help for a bit before the co2 plunge. Thank you as always.

Answer:

we use fillers all the time on vertical lines, are they 100% gone, no, but they are usually substantially improved. The injection results do depend on the skill of the injector though. JG 4.6.09

Question:

hello i asked my docctor about doing deep co2 laser and he said that he doesnt use it anymore, and the ebrium is the one he uses.. he said he can adjust the machine to non fractional and can do it at 300 microns.. will this be good enough compared to the co2 that you rave about? want to make sure im getting the right thing thank yu

Answer:

to some degree yes, but the advantage the CO2 has is that it heats the collagen which causes it to shrink and tighten and erbium is a cold laser so it would never be the same, even if the same depth is used. JG 4.6.09

Question:

Dr. Garcia: Do you perform Rytec Portrait treatment and is the result of having it done in your estimation worth the time and expense. If done to deep depth what are your estimates of the amount of downtime before i could comfortably go back in public. I am a man so makeup is not an option. thanks.

Answer:

I am still doing it as I stil have some tips left, I feel the results are better when done deeply, it would allow you to be in public but pink after 10-14 days but in male skin the resutls are mild, whether it is worht it depends on the severity of your wrinkles and I cannot tell that without seeing you in person, sorry. JG 4.5.09

Question:

I am the 55 year old woman who plans to have co2 laser resurfacing in the Fall. I have the 3 ingredient prescription cream already because at one time I was going to do it in the Spring. I have two refills for the cream. I have been using the cream at night and probably will use the cream day and night starting in July or August. I hope to have laser resurfacing either the last part of September or first week of October. Will it be ok to use this cream for that long before the laser resurfacing? I am to be put on antiviral medicine before the resurfacing and will be given at least 3 weeks supply of aquaphor to keep my skin moist afterwards. I was told I would need to wash my face with white vinegar and water also during the healing. What do you have your patients do after co2 laser resurfacing?

Answer:

OK to use the cream for that long, and I think you need to be on it twice per day for 4 weeks before the CO2 laser. What they have told you is about the same as what we do, best of luck. JG 4.5.09

Question:

hello, having co2 laser deep ablation to lower half of face on thursday. will i be able to wear makeup 4 days after the treatment.. i think i heard you can use mineralls makeup

Answer:

if it is deep, by that I mean a non-fractioanl CO2 with a depth of 150 microns, there will likely be no makeup for 10-12 days. JG 4.4.09

Question:

I have a friend that is going to have pdt treatment done on her face. Does that do much? I plan on having co2 laser resurfacing. I know this is alot more evasive. You seem to think the co2 gives good results normally. what results do you get from the pdt. She plans to have two treatments a month apart.

Answer:

I am not a fan of PDT, I feel it is an attempt to get a deeper exfoliation with a method that has less safety and predicatbiity than other tried and true methods. JG 4.4.09

Question:

What is the lastest status/update with Rhytec Last post (JG 1.13.09) you stated: I have all of my remaining tips spoken for treatments already, I am waiting to hear from Europe about obtaining some more before I can book any new patients though. I still have my machine though. Can other doctor get them from Europe or you just have your own contact! Thanks for all your help..we all luv u

Answer:

I have a couple more tips that another US doctor sold me, I have not been able to get anymore though. JG 4.4.09

Question:

Sorry meant to say there he doesnt believe in pre treatment with creams before c02 lase

Answer:

well, that is his choice, I would never do a CO2 laser without pretreatment. JG 4.3.09

Question:

Hi Dr. Garcia, Will any laser treatment help repair or rethicken skin that was thinned somewhat from topical steroid use on the face specifically in the tear trough regions. It is not chronically thinned but thinning is apparent. Will fraxel help at all? Thank you

Answer:

no, likely not. JG 4.2.09

Question:

What is skin needling for wrinkles and scars? Does it work? Thank you

Answer:

it is a waste of time. JG 4.2.09

Question:

I have decided to have co2 laser resurfacing in the Fall. I want smoother and younger looking skin, but I do not want to go to deep to cause scarring etc. How deep do you go? I am thinking in the upper papillary dermis and still having some epidermis cells also left. I want some results but every imperfection does not have to be erased. Will it tighten the saggy skin above my upper eyelids? What does the 3 ingredient prescription cream do to help prepare the skin for laser resurfacing?

Answer:

well, CO2 laser is ablative so if you go to the pappilary dermis, there is no epidermis left, that rebuilds in time from the basal layer, certainly one can go deeper or shallower, all depends on your skin thickness and the area being treated, not all areas on the face are the same thickness. The tightening of the skin of the upper lids will be there but mild. The three ingredient cream helps to get the skin into the healing process and also helps to decrease pigment formation both before and after the resurfacing. In most cases I will go to a depth of about 150-200 microns, less on the lids, in some patients I will go as deep as 300 microns, but not commonly, how deep that is varies from patient to patient. JG 3.31.09

Question:

Dr. Garcia, I had just about decided on co2 for upper lip ines. One dermatologist told me that there is too much risk for a white square or line of demarcation to do it alone. Do you ever just do the upper lip area lightly? How do you avoid that white area? Thanks.

Answer:

I would only do the whole cosmetic subunit which is the entire upper and lower lip in order to make it easier for make up to hide the full segment. JG 3.31.09

Question:

Hi Dr. how deep should a cautery machine go to safely remove syringomas for a good period of time without causing scarring? My dermatologist lightly cauterised mine (he said it was on the lowest setting) but they came back within weeks. He said he isnt prepared to set it any higher for risk of scarring. Could something like fraxel provide safer long term solutions?

Answer:

sorry, but not always, it is depth dependent, but with deeper treatment, the greater the scarring risk. JG 3.31.09

Question:

Dr. Garcia, You recommended a rhytec portrait or a light co2 for my upper lip lines. Though they aren`t as bad as some I have seen on internet, they certainly are there--a total of four or five. Would the Sciton profractional have an effect on these? The doctor said they give them in a series of four starting conservatively. He also said it is done along with the microlaser peel. Should I just accept the fact that co2 is the only way? Also, what kind of downtime is there with a light co2? Thank you so much

Answer:

yes, but milder than the Rhytec I feel. A light CO2 in that area would have you wearing makeup in about 7-8 days. JG 3.30.09

Question:

If you have very sensitive skin and have had several outbreaks, possibly roscea, should you have C02 laser resurfacing? What are the possible side effects? Does the skin pigmentation, skin moisture come back after C02 laser resurfacing and do you not have that shiny wet look after C02. Does C02 laser work on white scars?

Answer:

the CO2 will likely make the Rosacea worse for a period of time but not permanently. If done properly and if no complications arise, the moisture and pigment should all return to normal in time. The CO2 will not repigment white scars though. JG 3.30.09

Question:

I have very fair skin (Fitzpatrick 1) with rosacea. I had Portrait at 4J, double pass almost a year ago. I still have significant redness and have had a difficult time healing. I`ve recently read that Portrait may not be good for inflammatory conditions like rosacea, is this true?

Answer:

I do not think Portrait helps Rosacea and can worsen it temporarily it. I do think 4 Joules for two passes is higher than I would ever use. If you are not healing now, it is due to scar tissue. JG 3.16.09

Question:

For a person that has skin on the Fitzpatrick Skin Scale of 1 or 2, would you perform C02 laser resurfacing?

Answer:

probably, as long as they are not on any medications that will cause healing problems . JG 3.16.09

Question:

Is there anything to help heal scarring from C02 laser resurfacing? What type of skin should not have C02 laser resurfacing?

Answer:

at times a VBeam can hide the redness, but nothing will remove the scarring, kenalog injectiosn in dilute amount or 5FU can also be tried. I would not resurface darker skinned individuala or Asians. JG 3.16.09

Question:

Dr.Garcia. Question about MDB with crystals: 1.can you do it on neck and chest area (same as on the face), 2.how often it can be done, and how many session, 3.can you do IPL right after, the same day? Thank you.

Answer:

it can be done on the neck and chest, yes. I would say it could be done monthly in most cases. IPL can be done after but the energy might have to be reduced. JG 3.16.09

Question:

How do you tell if you have any type of scarring from C02 laser resurfacing?

Answer:

the skin would remain red and stiff long term. JG 316.09

Question:

What is the highest microns you can go with co2 laser resurfacing? What is the lowest?

Answer:

you can adjust the depth to just about anything you desire with most lasers by adjusting the energy and dwell time. JG 316.09

Question:

Why would somone turn red, have burning and flush more easily a year after C02 laser resurfacing

Answer:

might be due to some degree os scarring or maybe irritation from a skin care cream being used. JG 3.15.09

Question:

I`ve tried to post this question several times. I wrote to you recently. I am the 55 year old woman who was prescribed a cream with 3 ingredients to help prepare the skin for co2 laser resurfacing. A year ago, a PS did a Z-plasty on a hair follicle. This doctor did not inform me of this procedure and I had never heard of such a thing. It was not necessary and he did not care. It was a mess, I went to a good dermatologist and was told to massage the knots and puckered up area and in time they might improve. I did this with my fingers, the Z-plasty fell apart. I want to do laser resurfacing on my entire face to improve it. I especially want to try to improve this area. The cream I`ve been using may have aggravated this area because it got puffy and a knot formed where I think the skin flaps were tired down. I`ve started using an antibiotic ointment on this area and it is improving it. I saw a good PS who says he can smooth the skin in that area and correct some sun damage etc on my face. Do you think the co2 laser will help this area? Will it tighten the saggy skin above my upper eyelid some? Would it be better to do this in the Fall than the Spring? I know you have to avoid the sun. I plan to use sunblock in the future on my face. I want to improve my face, but I don`t want to go to deep to cause complications. I believe I read one of your answers and it said above 150 or 175 was getting in the deeper settings. I want some results, but not to go to deep. What is a safe setting for some results? The doctor I am seeing has had good results. Thank You

Answer:

I think the CO2 is a good choice and should give you some degree if improvement for the entire face. I try to do resurfacing in the fall as it is easier to avoid the sun, but as long as you are good about avoiding sun and using sunblock, it is OK to proceed. I think to get any degree of worthwhile improvement, I suggest at least 150 micorns. Best of luck. JG 3.15.09

Question:

What can be done if C02 laser resurfacing has aggrevated roseca and your skin burns constantly?

Answer:

hard for me to say without identifying the cause, sorry. If it is due to dermal scarring there might not be much, maybe topical DMSO or an ibuprofen cream. JG 3.13.09

Question:

I had a consult with Dr. Fitpatrick today a Derm in La Jolla for my neck that has wrinkles and some crepe like texture. I wanted Fraxel(the one with less down time) but he suggested the CO2 Fraxel Laser resurfacing. He said I would get the best results. Do you agree or is there a better procedure?

Answer:

better than a regular Fraxel but I think, personally, that the results will be mild and shortlived. JG 3.11.09

Question:

I`ve heard that pearl fractional darkens asian skin.....is this true? What are the after effects and how long does the darkness last?

Answer:

that is certainly a possibility, no bad side effects from that except it can be uneven and permanent. JG 3.11.09

Question:

Hello, Dr.Garcia. Will IPL sessons help to produce collagen and elastin? What kind of laser or other procedure may help? Thank you.

Answer:

personally I feel the only laser that will stimulate collagen to any visible degree is a CO2 laser, IPL will have little to no visible effect on skin tightening. JG 3.10.09

Question:

Hello Dr. Garcia. What credentials would you recommend I look for in a physician doing CO2 laser resurfacing? Thanks!

Answer:

should be either a plastic surgeon or dermatologist board certfied in that specific field and might ask to check that because there are many pseudo-boards that doctors can pay to get a fancy certificate, ask them how long they have been doing CO2 laser resurfacing and about how many pateitns they have treated and then ask to speak to a patient or two. Best of luck. JG 3.10.09

Question:

Is the NLite laser still being used? It sounded too good to be true. Any effect whatsoever on mild upper lip wrinkles? Thanks a lot.

Answer:

still being used, and still disappointing in its results, other companies have made their versions under different names. JG 3.10.09

Question:

I have a scar from stitches for well over 3 years now on my cheek. The scar has a tendency to get red very easily. I have seen two dermatologists. One has used the vbeam laser and versapulse laser, neither of which have helped. The other dermatologist says that an IPL laser would be better. I am trying to understand the differences between the two but don`t quite get the scientific jargon when I look up the specific functions of the lasers. In your opinion, is there any difference between IPL and vbeam in getting rid of redness (in my case caused by blood vessels)? I`m trying to decide whether going through with the IPL might prove to be a waste. Sorry for the long question, thank you very much.

Answer:

well the IPL is really not a laser, it is a lighter treatment but works on a similar basis as the lasers do. The VBeam is a true laser and I will say that if a VBeam did not do anything, the IPL will certainly not help. Best of luck. JG 3.7.09

Question:

Thanks for earlier response regarding lower lid potentially pulling down after CO2. If it happens, how long would you expect it to last? Is it ever permanent? I don`t want more problems!!!! Anything to mitigate the chances (e.g. stitches or tape to hold lid in place)? Thanks again Dr. Garcia you`re the best. You`d be even more awesome if you would relocate to the east coast ;)

Answer:

I do not think it will be permanent if it resolved previoulsy but it might take 4-6 weeks to get better. A temporary suture laterally in the eyelid or a week 10 days to keep it closed will help some but not entirely. Best of luck and thnaks for the kind words. JG 3.9.09

Question:

I am considering CO2 for crepey skin undereyes. The crepey skin is thanks to a lower bleph I now regret having. My left eye had significant healing issues after the bleph, with lid being pulled way down. Looks pretty normal now, but it still feels like scar tissue tugs a little. My question is...with the CO2 skin tightening...does the skin tighten up or down? In other words, is there a chance my lid can get pulled down again like it did after the bleph?

Answer:

it tightens in all directions so with your history I can say that likely for at least a short period of time, the lid will be pulled down again. JG 3.8.09

Question:

Dr.Garcia how long I have to wait after I had IPL session if I plan to have plastic surgery? Thank you.

Answer:

no need to wait for the surgery of the IPL is done first, if the surgery comes first I would wait 4-6 weeks for the IPL to be done. JG 3.8.09

Question:

Is C02 laser resurfacing considered a third degre burn?

Answer:

no, second degree. JG 3.6.09

Question:

I`m the 55 year old woman again. I got a prescription cream done up that contains 4% Hydroq, 1% HC, 0.05% Retina will this help in the preparation if I decide to have laser surgery. I don`t want to go too deep, I would prefer to do medium depth. What do you recommend?

Answer:

I think the cream is fine and as to the medium depth, I would use a CO2 laser for that. All the best. JG 3.5.09

Question:

I am 55 years old. I am considering co2 laser resurfacing. I have some sun damage, mild wrinkles, but I have a surgical scar on my face. I saw a plastic surgeon and he said it was not that noticable, he said he can smooth the area around it and make it appear better. I know I won`t get rid of it completely but will it make it worse?

Answer:

no, the CO2 will make it look better. Best of luck. JG 3.5.09

Question:

Is there a difference in C02 laser resurfacing. I have read about different machines - Silktouch, Feathertouch and Sciton. Do you think it matters if you don`t pre-condition your skin before C02 laser resurfacing. Can that delay your healing?

Answer:

we precondition the skin before with Retin-A and hydroquinone and as to the makers of the CO2 laser, as long as the energy delivered, the surface area treated and what is called the dwell time is the same, they are the same. Preconditioning with Retin-A actually speeds the healing as it kicks the healing elements into gear. JG 3.5.09

Question:

Would C02 laser resurfacing bring out roascea. Should people that flush easily or have roascea have C02 laser resurfacing?

Answer:

it usually will aggravate it it, yes. I would avoid usng it in people with Rosaea. JG 3.4.09

Question:

How do you feel about Collegen Induction to heal possible scarring from C02 laser resurfacing? Is it possible to have scarring by not using the right products following your C02 laser resurfacing?

Answer:

scarring already has collagen, it is abnormal collagen, but there is no lack of collagen so I do not think what you are suggesting will help. As to scarring after a CO2, it is not due to incorrect products unless you have an allergic reaction or an infection. JG 3.3.09

Question:

Please tell me the status of Rhytec Portrait Bankruptcy. Is any other company going to buy Portrait? Can doctors still get the tips need for the procedure. Thanks

Answer:

from what I have been told, there are companies out there that are in discussions to purchase the technology. There are companies out there selling refurbished tips but I would not use them for fear they are not properly constructed. I think there will be some time before someone steps in due to the general economic issues and the decrease in cosmetic procedure spending, but many companies with newer technology go through these issues and continue to survive. As to when, I am not sure about Rhytec`s emergence, but I am hopeful. There are some physicians that had tips and are still doing the procedure and some physicians have sold their tips to others, so it is still out there. JG 3.2.09

Question:

Please tell me the status of Rhytec Portrait Bankruptcy. Is any other company going to buy Portrait? Can doctors still get the tips need for the procedure. Thanks

Answer:

no one is selling new tips yet, and Rhytec`s technology is stil out there, but with the economic issues as they stand and the decrease in cosmetic procedures, no one knows for sure when things will turn around. JG 3.2.09

Question:

What type of sunblock do you recommend that does not leave a greasy feel and look that can be worn under makeup? What makeup do you recommend. You can still particpate in outdoor activities with total sunblock after C02 laser resurfacing correct.

Answer:

we use Total Block by Fallene. We do not give make up recommendations though as all people like different things. As long as you have sunblock on, then it is OK to go outside after a CO2 laser session. JG 3.2.09

Question:

What is the ropey look to your skin after C02 laser resurfacing that I have read about? Should you skin not be extremely smooth with no abnormal look?

Answer:

you might be referring to a scar from a laser that can occur in very rare cases, because normally the skin heals smoothly if there are no problems. JG 3.2.09

Question:

Hi Dr Garcia you told me you wasnt familiar with the co2 laser I told you I was having , I have contacted the surgeons secretary and its Carbon Dioxide co2, what is your opinion on that, im having a light one as he feels that will be all I need, can you tell me side effects etc and if you think this will work. Sorry asking you again but your opinion is what I have followed up to now. thank you so much

Answer:

I do not have enough information to help you I a afraid, CO2 laser can be a totally ablative procedure and it can be fractionated. If it is fractionated it is safer than a totally ablative, but the effects are much less. I cannot say whether the light procedure will be enough in your case without seeing you in person. JG 3.2.09

Question:

I was talking to a physician (well known for fat transfers) about C02 laser to tighten skin under eyes. She is not a fan because she said its easy to tell who has had that done because of the red, shiny appearance of the skin. Is that the case in your experience? Thanks!

Answer:

no, that happens if you go too deep and develop some slight scarrring, but in general that does not happen long term, while healing it does, just like any other peel with laser or a chemical. JG 2.26.09

Question:

Will the smoothbeam laser have any effect on the beginning of fine lines above lip? If not, what is the best way to go before they become deep and more noticeable? Thanks so much.

Answer:

very little to none. I think a deep Rhytec or a light CO2 will do much more. JG 2.26.09

Question:

What causes extended burning and sensitivity after C02 laser resurfacing? Why do doctors state that your products just lay on top of the skin after C02 laser resurfacing?

Answer:

the extended burning and sensitivity is usually from the laser going too deep, if that has occurred and there is some element of scarring, then make up might not absorb and hold as well. JG 2.25.09

Question:

How long does it take skin texture, pores, freckles and sensitivity to return to normal after C02 laser resurfacing. After your skin is healed you should not have to worry about dry skin is that correct?

Answer:

the vast majority if it is within 3 months, in some cases 6 if the procedure was done deeply. Once healed, your skin should return to its previous moisture and oil content. JG 2.25.09

Question:

Hi Dr ARCIA I TOLD YOU MY SURGEON ONLY USED CO2 LASER NOT GOLD OR ULTRAPULSE THIS WAS YOUR ANSWER.. Answer: not sure why he would nto use the Ultra-Pulse, that is what is considered the totally ablative, no-fractional ablation using CO2 with a computer generated scanner to minimize dwell time and control penetration. SORRY DOCTOR IM NOT SURE WHAT YOU MEAN, ARE YOU SAYING IT WONT WORK OR HE MAY BURN ME?

Answer:

no, he will not burn you and it shoudl work well and I agree with him that the totally abaltive is beter than the fractional treatments. JG 2.20.09

Question:

I am 60 years old with severe acne scarring. I am middle eastern with olive skin. I read that you avoid treating olive skin with co2 laser. What treatment, if any, would you recommend to improve the appearance of my skin?

Answer:

about all I can say is Retin-A, sorry. JG 2.20.09

Question:

Ooops dr garcia also meant to say he said its not gold or ultra pulse co2 just co2 is that as good/ thank you

Answer:

not sure why he would nto use the Ultra-Pulse, that is what is considered the totally ablative, no-fractional ablation using CO2 with a computer generated scanner to minimize dwell time and control penetration. JG 2.19.09

Question:

Why would someone burn and skin is really tight post C02 laser resurfacing 10 months? What could help?

Answer:

most likely becasue the treatment went too deep, might suggest squalene oil or skin care products from NeoCuits. JG 2.19.09

Question:

How long does the burning sensation last from C02 laser resurfacing. Why would someone have extended burning sensation and sensitivity to the environment.

Answer:

should not last more than a couple of weeks, and if kept protected with creams, should not burn much at all during that time. JG 2.19.09

Question:

You should be able to have a normal life after C02 laser resurfacing just use sunscreen? Is that correct? No burning, no redness, don`t easily flushed, products and makeup go on you skin like before the procedure. Does heat affect your skin after you are healed? How long does it take the oil production from your skin trying to heal to stop.

Answer:

well, yes, but I prefer sunblock, rather than sunscreen, it should be a complete sunblock. All should go back to normal in time after the procedure, yes. As to oil production and normal skin moisture, that depends on how deep they went and how old the patient is, the deeper and the older, the longer it takes. JG 2.18.09

Question:

In reading questions from the last week, there seems to be alot of questions about C02 laser resurfacing. I know that you are a big supporter of this procedure. Could you please briefly describe the procedure and healing time, the limitations, scarring, makeup. How long does the shiny look last that I see in pictures and people describe. How long does the tightness last. How long does the red last. Are you more sensitive to the environment after this procedure. Is your skin really dry after this procedure. What products do you recommend. I am interested in this procedure, but I am confused. I don`t want to do anything that drastically changes my busy lifestyle, but would like to do something about scarring that I have.

Answer:

it is essentally a controlled burn of the skin, like a chemical peel. In most cases it is healed enough to wear make up in 2-3 weeks, and the skin remains pink for 2-4 months, depending on the depth it is perforemd to. Skin texture normally returns to normal, it works well for fine lines and sun damage. Freckles will eventually come back, pores will return to their previous state. Shinyness usually is gone in 6-8 weeks or so if no make up is worn, otherwise the make up can cover it sooner. No difference in terms of skin sensitivity afterwards in most cases and the skin will tighten for 6-12 months afterwards. We have a line of skin care products that we use but any good quality moisturizer after it is healed is enough. JG 2.18.09

Question:

How can you avoid the sun and have a normal life?

Answer:

sunblock, you need to choose between faster skin aging and your described normal life. JG 2.16.9

Question:

hi Dr. sorry last two questions. to quote you: # Hi Dr, I had lots of milia cauterised under my tear troughs about two and half weeks ago, it scabbed over very nicely, the scabs dropped off for very nicely and the majority of milia were gone and skin looks good. but in the last three days the skin has suddenly gone very red and dark. Is that normal? should i be concerned yet or is this something that happens, and how long will it take to disappear? Thank you! Answer: should be temporary, just stay out of the sun for now. JG 2.11.09 How long should i expect this redness to still last for? and does going in the sun do permanent damage or just delay healing?

Answer:

might be there a few weeks, the sun will just prolong the time of redness. JG 2.16.9

Question:

How long should I stay out of the sun?

Answer:

actually, forever, or at least wear sunblock for the rest of time when outside. JG 2.16.9

Question:

Dr.Garcia, Why would you choose the original Co2 over the fractional Co2 for acne scarring, texture and tightening? Apparently from what I read the fractional can be better? And I`ve noticed from reading on this website people are mentioning all sorts of problems post the original Co2 and you have said that it`s from going to deep? A surgeon that I saw for a consult had suggested a deep Co2, which at the time was what I wanted to hear, but now I`m having concerns. Are you basically saying the Co2 is good, but if not done deeply? But, isn`t that the whole point if the skin isn`t looking too good? Or would you should go a little lighter and have the process repeated? How frusterating!!! Regards,

Answer:

I would always choose the original CO2 over a fractional one. I think the only thing the fractional is better in is less downtime but the rsults cannot compare to the original in terms of improvements. Going too deep with any laser, fractional or original can lead to problems so an experienced doctor and care must be taken. Frustration happens at times I am afraid when the patient`s desires are not able to be met in a safe fashion, if you push the envelope you can have problems. Not all that is desired is acheivable. JG 2.15.09

Question:

I meant to say that it does not seem like the products absorb into my skin and leave a shiny look. I am also more sensitive to heat. Will this fade it time. Thank You

Answer:

in most cases it should. JG 2.13.09

Question:

I am nine months post C02 laser resurfacing. I have some dry skin on my cheecks that looks dry and cracked. Also it does seem like the products get absorbed into my skin and leave a shiny look. My nose is still becomes oily throughout the day. This never happened before C02 laser resurfacing. Any recommendations. Thank You

Answer:

only time and maybe different moisturizers or squalene oil for the face. JG 2.13.09

Question:

One you have C02 laser resurfacing, does your skin go back to the same texture and mositure or do you burn more easily from the sun? I have always heard avoid the sun, but what about wind. It just seems you whole life changes once you have this procedure done. Is it really worth it.

Answer:

it should go back and should not be any different in terms of its sensitivity to things. I think for most people, when they heal well, it is very worth it, yes. JG 2.12.09

Question:

What type of allergic reaction can you have from C02 laser resurfacing and why would it last more than six months. Can anything be done?

Answer:

well the allergic reaction would not last 6 months, but if one of the ointments caused an allergic reaction early on, it can cause the depth of the laser to go deeper and prodcue scarring. JG 2.12.09

Question:

When the doctor has gone to deeply and there is scarring from C02 laser resurfacing is that negligence on the Doctor`s behalf? Which you have indicated is shiny, burning, waxy plastic look to the skin after six months.

Answer:

not always negligence. It can happen from adverse events after the CO2 laser too, like infections or allergic reactions. JG 2.12.09

Question:

I am nine months post C02 laser resurfacing. My doctor tells me that the products you apply set on top of the skin up to a year and they are not absorbed into the skin. So I have a sweaty, shiny look. Also my nose still seems oil when I am exposed to heat. I still feel tight and dry. I don`t mind putting products on my face if they would absorb into the skin. So I would not look so unnatural. Can you tell me your thoughts on this and when does the cobblestone look go away?

Answer:

seems like a long time after the procedure for that to be happening, that should normally all be gone after 6 weeks in most cases, might have some scarring that is slowing teh process down some. JG 2.12.09

Question:

Is the cobblestone look a sign of going to deep. What can be done to heal the skin. My doctor told me going outdoors in the environment will help the shiny look go away. I can`t be scarred for life.

Answer:

this far out, yes. Not much you can do except let it heal on its own and see. Going outside will do nothing to get it to heal any faster.JG 2.12.09

Question:

Hi Dr Garcia I saw a surgeon who was doing Rytec and he said a light one would work for me, fine lines and wrinkles I asked you and you said the deeper one would work but the light one is a waste of money. I looked on some message boards about Rytec and there are people saying it doesnt work even the deep Rytec, some say they look worse. You told me co2 is even better but noticed some people on here are saying they have a waxy look or scarring. Im confused as what to do im seeing this surgeon again next wednesday he also does co2. What should I ask him Dr Garcia?Also are some people more prone to scarring I have sensitive skin and a tendency to get pigmant just from a scratch. Would really appreciate your advice have taken it up to now. Thank you

Answer:

well, patients can at times be dissatisfied with the degree of improvements due to unrealistic expectations, as to problems, any laser or surgery can have those and remember, what you read on blogs is usually just the negatives as people that do well do not post happy things on blogs. As to the degree of improvement from a single light Rhytec, I think it is very small. The company promoted the treatments, if doen lightly, to be done in a series of three, three weeks apart. I think you can ask the doctor what he will do if you follow his advice and do the ligth Rhytec single treatment and it does nothing to visually improve the wrinkles and fine lines. Some people do have a genetic predisposition to hyperpigment their skin after an injury and lasers of all kinds are certainly considered an injury and can cause the hyperpigmentation. Best of luck. JG 2.12.09

Question:

Hi Dr. Garcia, I am confused about the two different lasers, FX Laser and Fraxel laser... Many people say that the Fraxel laser leaves your skin plastic and shiny looking, what do you think?

Answer:

from what I have seen and heard from patients that have come to see me after both of those treatments, they are both disappointing in their improvements and the plastic and shiny look comes from it being done too deeply too many times. JG 2.12.09

Question:

Dr. Garcia, I forgot to mention in my last email that I am Asian. I also need to ask if photo light treatment will work to lighten brown spots caused by the erbium 2940 laser - or would it just make everything worse? How about retin A and bleaching cream - better? I can be patient if I knew for certain that the dark spots will eventually go away - right now I`m scared! -Barbara

Answer:

the IPL might work and the risks of that hyperpigentation are much higher in Asian skin, so you need to go low with any light or laser therapy. I think bleaching cream and Retin-A are a good addition. I would do them and the IPL both. They should go away, but impossible to tell, in some rare cases they can last forever. JG 2.11.09

Question:

Dr. Garcia, I recently had erbium done to tighten skin around my eyes. The doctor then told me he could do my jowls also when i was in the chair to correct a little scarring from co2 done 7 years ago. He used a 2940 machine here in Panama. I am left after 3 weeks w/ dark red and some dark brown spots. Will this ever go away? Thank you for your answering service! - Barbara

Answer:

might suggest some Retin-A and hydroquinone and no sun, should get better in time. JG 2.11.09

Question:

What are the signs of C02 laser resurfacing that has gone to deep. What type of skin can this be performed on safely. Thank You

Answer:

I avoid olive, black and oriental skin. As to knwoing if it went too deep, often you cannot tell until after, at least from the patient`s point of view, prolonged healing is the first sign. The doctor should be able to have some signs during the procedure but it is not always able to be seen. Always better to err on the side of caution. JG 2.9.09

Question:

Dr. Garcia, I truly enjoy reading your website, but was amazed that you told the lady that had C02 laser resurfacing that her skin may not get better. Reading her questions it seems that she is reaching out for advice and help. There has to be something she can do to get better. I am sure this had changed her life not in a good way. Can you explain what you mean by to deep and scarring. Thank You

Answer:

a laser, no matter what type, if done too deeply is like a flame burn, if it is burned too deeply, the scar will develop and like scars all over the body, in most cases, there is little that can be done. At times in the attempt to improve things, it can be made worse. With the degree of scarring she has, which by comparison is slight but enough to cause her the problems she is experiencing, not much can be done except what I have suggested. I a sorry you were amazed that I told her that nothing can be done, but that is the truth. Unfortunately, there are times when some side effects are permanent, and keeping that information from the patient and having them hold out hope and trying things that will hurt them more is worse than the truth. I know many people wish there were solutions to every problem, frequently saying that with all of the advances out there, that there must be something that can be done, but I am afraid that is not always the case. She has a difficult problem, that luckily affects only a small number of patients but it happens I am afraid. JG 2.9.08

Question:

Hi DR Garcia I am 36 years old with fair skin, and had the fraxel CO2 re:pair laser for some fine lines under my eyes, but when I was on the table my doctor told me it was better to treat my entire face otherwise you would be able to see where I was treated and where I wasnt. I now have post inflammatory hyperpigmentation all over my face (I originall had very good skin (porcelin type skin-envied by many). What are my treatment options please.

Answer:

Retin-A mixed wth hydroquinone, light chemical peels, spot treatments with a YAG laser, and sunbock and no sun exposure. Best of luck. JG 2.9.08

Question:

If 4% hydroquinone fails to remove post inflammatory hyperpigmentation post CO2 laser, what are my options?Will erbium fraxel laser help? Thanks

Answer:

those lasers will likely make it worse, could try a YAG laser to fade the brown spots. JG 2.9.08

Question:

Thank You for answering my questions. I really would like to help my friend to get better. What can she do concerning the possibility that the laser was done to deep, when advice from her physician he told her that it could take a year for the skin to absorb the products that she is applying. Her skin feels very tight and looks dry, she acutally looks older now due to the very tight skin and dry look than she did before the surgery. Does she need to apply mositurer more than twice a day. What sunblock do you suggest. She is very pale, even with makeup, can she put a sunless tanner her face, is there a certain kind you suggest. I want to try to get her out and back to the life she enjoyed before this surgery. Thank you in advance for answering my questions. It just seems that her doctor his less than compassionate.

Answer:

might suggest the NeoCutis skin care products and squalene oil too. As to the sunblock, I like Total Block by Fallene. Self tanner can be used but I am not sure how well it will work. I have no personal preference on the self tanners. Wish I hade more to offer, but if it is due to scarring, it might never get better. JG 2.8.09

Question:

What are your thoughts on doing small test spots on the skin prior to CO2 resurfacing as you never know how ones skin will react?

Answer:

not worth it as the skin of the face is different from one area to another so a spot test does not predict how the skin will react in a different location. JG 2.8.09

Question:

My friend had C02 laser resurfacing 10 months ago and I have been considering it. She has a waxy shiny unnatural look to her skin, is this normal? Her doctor tells her she can use the same products as before her surgery and I have noticed on your website you have stated that you have special products. Can you tell me what you recommend to your patients for skin care and suncare. Do the products set on top of your skin or are they absorb in your skin like before the surgery? What type of counseling to you give your patients before this surgery? We both live in California so it is very hard to avoid the sun. Thank You

Answer:

no, that is not normal, sounds like it might have been done too deeply or her skin was just not the right type for that procedure. I think at 10 months you should be able to use the skin care you used previously, it is just that I have my own skin care products that I formulated that I like my patients to use is all. Before the procedure we pre-treat with Retin-A and hydroquinone for 4 weeks, afterwards we use a topical antibiotic for a few days then switch to a copper peptide cream, once healed we start the sunblock, add the Retin-A in again with the hydroquinone if there is any hyperpigmentation, and then slolwy get them back on their normal skin care regimen. Best of luck. JG 2.7.09

Question:

will 4% hydroquinone with abscorbic acid rid my post inflammatory hyperpigmentation post CO2 laser (I have fair skin)

Answer:

should improve it, cannot say it will remove it 100% though. JG 2.7.09

Question:

I posted a question a few days ago and do not see it listed so I thought I would try again. What would cause the skin to look worse after a laser than before. Is it possible for the new skin to be in worse condition than the old skin. Also, I am having a problem with my newly lasered skin splitting. I have splits all around my mouth and now on the chin. Plus more texture. I am not sure if the texture is splitting or the skin. Have you ever heard of this. What would cause this. It really is painful. Is there anyway to correct this. Thank you

Answer:

short term it can be from the reactive dryness or pigmentation issues, long term it can be from going too deeply with the laser.If there is some scarring, it can look worse than the original skin at times. The skin cracking can happen the first couple of months as the skin is tight but that usually is gone after a couple of months once the skin regains its normal moisture and oil content. In time it should get better. JG 2.7.09

Question:

Thank you for your answers. Sorry to ask a couple more questions, Will you be more sensitive to heat and the sun after the procedure. Can you exercise and lead a normal life after the procedure. If the waxy look happens, is there anything that can be done. Do you have to use special products for skin care. Thank You

Answer:

if all heals well there should not be any difference in sensitivity to heat and sun, but I think if you are doing it for wrinkles, you should not be going out when it is like that. Exercise if fine too. I have our own skin care products that we use afterwards. JG 2.6.09

Question:

I had C02 laser resurfacing a year ago and I still have heat sensitivity and a waxy look. My face still feels very tight and dry and turns red when I am near heat or in the sun. My skin doesn`t seem to absorb the products I use which is the Obagi line. I live in Florida. Is there anything I could do to correct this unpleasant look and feel?

Answer:

might suggest some squalene oil from the health food store or soem skin care from NeoCutis, your doctor should be able to get it for you. JG 2.6.09

Question:

Hi, Thank you for your time! Will a series of 3 portrait express really do anything for wrinkles? Also, is the downtime for this procedure really just 2 days? I know everyone is different, just wondering in general. At day 3 will anyone be able to tell I had something done? Will they see redness, swelling, etc? Do most patients breakout with bumps and pimples? Thanks!

Answer:

I think it will, but only mildly, one deep yields more than three lighter ones. The lighter ones downtime is usually 4-5 days unless done really light and then it is likely not going to do much at all for the wrinkles. No breakouts typically but usually at 1.5-2 joules, the usual setting, it takes 4-5 days before make up will come close to covering it. JG 2.6.09

Question:

I have been considering C02 laser resurfacing, but have some questions. I understand that the laser treatment takes off the top layer of your skin. My questions are as follows: Does it change the texture of your skin? Does it decrease your moisture content? I notice that alot of people complain of shiny, waxy skin, does the products that your put on your face not soak down into your skin? Can you go outside and enjoy the sun? Does it take away your pigment and are you very pale? What is the oily look that alot of people discuss? How long does it take your skin not to turn red? I am trying to decide if this is the best procedure for me. Thank you for your answers.

Answer:

if doen properly the skin texture should be normal once healed. It does not go deep enough normally to affect the moisture of the skin long term. The waxy feel is when the laser has gone too deep and I suggest using sunblock if you decide to go outside in the sun again to avoid the aging effects. If done deeply enough, there can be irregualr pigmentation of the skin, yes. The oilyness is your skin going through the healing process and is usually not permanent and the length of time it takes to have the redness go away depends on how deep they go, the deeper the laser is done to the longer it takes to go away. Best of luk. JG 2.6.09

Question:

Should I be scared to have v-beam laser done for a scar under my eye?will it cause purpura or bruising.What exactly does it do and how long are the side effects?Would an IPL be just as effective for getting the red out.

Answer:

it might cause bruising and purpura, yes. There are no negative long term effects. I think the IPL will not be as effective though for the improvement of the scarring. Having said that, the only improvement would be for redness, it will not remove the scars. JG 2.5.09

Question:

Hello Dr Garcia, I had CO2 done 2 years ago and i am left with a waxy cast to my skin will anything help with this such as an IPL ?

Answer:

I do not think anything will help that, it is essentially a light layer of scarring and further treatments have little chance to improve and a greater chance to worsen it. JG 2.5.09

Question:

I have a small linear scar under my eye.A board cert. plastic surgeon suggests v-beam laser and microdermabrasion.Will this improve the scar itself or just redness?The scar is approx. 7 months old.I know v-beam addresses the broken capillaries does it stimulate collagen and help scar tissue from reforming ?

Answer:

I think the microderm will do little and the VBeam will only fade the red. Nothing will eliminate the scar totally though. JG 2.2.09

Question:

I have a small scar on my chin and I wanted to know what type of laser would need to be used to rid it completely, how many treatments and cost. I have provided a link to the scar on my chin. http://img155.imageshack.us/my.php?image=paint101bk6.jpg

Answer:

sorry, it can never be removed completely, no matter what you do for it.Improved, maybe, but never removed. JG 2.2.09

Question:

Hi Dr.garcia, I am wondering if you could recommend a good doctor that does the co2 laser for acne scars in Vancouver b.c, and or in B.C. Also I have some broken blood vessels around my nose that won`t seem to go away with the v-beam or Ipl lasers, do you have some other suggestions on a procedure to eliminate them? Thank you

Answer:

CO2 laser wil not remove the broken blood vessels, sorry. Might suggest a diode laser, but I think the best option is to go to the University departmenr of dermatology. Best of luck. JG 1.29.09

Question:

what do you think of CO2 lasers for olive skin?

Answer:

I would not use it for olive skin, fractional or totally ablative. JG 1.27.09

Question:

hey dr garcia I am from India and I am light olive skinned. I was looking at some before and after laser resurfacing pictures and am truly amazed at how it makes your skin firmer clearer and even toned with an added glow. but as i was reading about it I found out that olive skinned ppl r not great candidates for this.. is it true? and it so, then what treatment laser wise can be used in replacement of this?

Answer:

it is true, it is potentially risky in olive skin. I am afraid that the only thing out there safe would be Retin-A, at least for now. JG 1.27.09

Question:

Hi Dr. Garcia, I am 3 days post Sciton Profractional, BBL and Sciton Microlaserpeel @20 microns. They were all done at one sitting. I had minor acne, moderate sun damage and had several broken capillaries as well as dull looking skin. After my treatment, I followed the post care directions by the book-using distilled water, cetaphil and then applying CU3 cream. Pimples started showing up, some smaller whiteheads and then a few medium sized blistery looking pimples. I stopped the CU3 and was given a multivitamin moisturizer but today still having breakouts. Why is this occuring, is this a normal side effect and what do you recommend I use? I have a follow up with the Dr in 3 days but worried these will scar with this `new skin` I am growing! Thanks for your time.

Answer:

the pimples are there because the top layers of the skin were removed and the pores of your skin are getting clogged while healing, it is normal. I do not think the small pimples will scar though. Best of luck. JG 1.24.09

Question:

Dr. Garcia, I am thinking of getting the ThermaScan photofacial treatment on the Sciton Machine. What do you think of the results and how long do they typically last? I am 56 years old, and have very good skin with the exception of the marionette lines. I have had previous injections of Perlane , Radiasse and Collagen and the results varied, but only lasted 3-5 months. I was hoping the laser treatments were longer-lasing. JP in Asheville , NC

Answer:

I cannot recommend it for your issues, sorry.JG 1.24.09

Question:

Dr. Garcia - thank you so much for your time. Two more quick questions: 1) Should my application of Tri-luma on my face include the hypopigmented areas? 2) Can you recommend a dermatologist or plastic surgeon for my situation who`s in the Washington, D.C. area? Too bad I`m not in Las Vegas! :) I really appreciate your dedication to our questions on this board. Take care, and thanks again.

Answer:

I think if you can aavoid the lighter spots it would be best, but not a problem if it gets some too. Might suggest Dr Tina ALster, a well known dermatologist. Best of luck. JG 1.24.09

Question:

how long before pink/redness from co2 fades and texture becomes what its going to be? and when can self tanner be applied to lasered skin and not take too dark or uneven?

Answer:

all depends on how deep they went, no way for me to tell. Usually after 3-4 weeks one can apply the self tanner. JG 1.24.09

Question:

Hi Dr Garcia what do you think of the pearl laser? I was told it removes wrinkles and fine lines. Gives the skin a lovely glow.The surgeon I saw said he is trying it next week and if it works he will buy the lazer. I told him to let me know if it works then I would do it. I value your opinion more though.

Answer:

I am not impressed with the results, sorry. JG 1.24.09

Question:

Hi Doctor: What exactly, does a CO2 laser treatment do for your skin? I get the sense, from your answers to various questions, that this is one of the few laser treatments you actually approve of. Thank you for your time!

Answer:

tightess the skin, reduces fine lines, improves pigment problems. All the best. JG 1.21.09

Question:

I had C02 laser about 12 years ago with impressive results. I have in the past 2 years had Restylane injections, which lasted only 10 or ll months. They were painful. I am 77 and looking for a permanent fix. Could I repeat the CO2 laser?

Answer:

could repeat the CO2, it will not be permanent though and it will also not be as dramatic of an improvement as it was in the past as your body`s ability to make new collagen is not as good, sorry. JG 1.21.09

Question:

Good morning Dr.Garcia. Please can you advise what would be the best solution , ideally permanent to the following problem. Upper lip wrinkles , my Dr. said botox , but i question this ? Would artefil work or laser treatment?

Answer:

I think lasers will yield the longest lasting result, but nothing is permanent, I would never inject Artefil around the lips for fear of permanent lumps and I would never inject Botox either for fear of weakening the lip muscles and having you look like you had a stroke. JG 1.21.09

Question:

Hi Dr. Garcia, I had a problem getting my question to post so here goes again. I had a CO2 laser done in October. Not a fractional laser. I have more lines and texture on my face than I did before. The Dr has before pictures and this has not been denied by the Dr. He now says I should try an erbium laser or filler. My question if the CO2 left me with more lines should I expect any improvement with the erbium. My expectations were realistic and I am very upset with the outcome. Between CO2 and filler I have spent about 4800 since October. He said it was nothing he did. That either I slept on my cheek or scratched my face with my nails. I did neither plus I totally followed his directions. This was not my first experience with a CO2 laser and I must say my results before rated good to excellent. As I wrote before, my skin did not weep this time. Should I continue with the erbium or get a second opinion. If the skin can`t be fixed, there is no reason to keep putting money into it. What would you do in my shoes. Thank you.

Answer:

well fillers will never do it, the Erbium might help as the skip areas might not need as deep of a treatment as the CO2. I would likely do another CO2, very lightly everywhere except on the skip areas. What has occured is all technique related due to the operator, and not the machine. I have to respectfullly disagree with him though, skip areas can occur and are due to inadequate spacing by the placement of the laser by the operator. I think it can be fixed but will require more surgery, in careful hands. Best of luck. JG 1.20.09

Question:

I am a 32 year old whom has a scar across her forehead that was caused by a tight tourniquet from surgery. Color discoloration is gone, but slight indendation is still visible. what laser treatment do you recommend.

Answer:

Not sure laser will do much as it is indented, might suggest a filler to raise the surface to match the surrounding skin. JG 1.20.09

Question:

It is clear from your postings that you are not a fan of any fractional laser treatment, including Active FX. Other than CO2 lasers (which have significant downtime and greater risk of complications etc.) are there any laser treatments you do recommend? I had active FX a year ago, and it did significantly improve the crepiness under my eyes. I am not likely to ever do surgery (I am 49), so I am curious what you would recommend in the resurfacing category if anything (i.e. peels v. lasers etc.) Thanks

Answer:

well, if the fractional laser gave you some improvement, you can continue, but in time it will likely not be enough. I like the CO2 laser done lightly which mitigates the downtime or a Rhytec Portriat but the company is closed and we are all awaiting for a new company to sell the tips. I find chemical peels ot work well for discolorations but not skin tightening as once the swelling is gone, so are the improvements. All the best. JG 1.19.09

Question:

you are so kind to answer our questions. I appreciate it! I had Active FX on Friday afternoon, being told that the downtime would only be 4 or 5 days. Today is Monday (4th day) and I still look TERRIBLE! I am SO red, like a tomato, and my skin is just now starting to flake. But the bad part is all the pimples that I am getting on the fresh layer of skin underneath. They have white heads on them and I am tempted to squeeze them out, I did squeeze out a couple of them, but it made more red spots appear, so I stopped. I have to go to work tomorrow (5th day) and I look red as a beet, there is no way I can show my face. I also have white lines down one of my cheeks as though the doctor missed a few spots. I look awful right now and I`m really worried. How long does this really take to heal? My doctor said that Gentle Waves will help the healing process but I will have to go out to his office again and risk being seen in public looking like an oompa loompa. Do you think Gentle Waves will help? Will my face be beet red for months? This was only fractional CO2. Will the Active FX help the appearance of the acne scars that I have? That is why I got this procedure in the first place. Thank you so much!

Answer:

I do not think the Gentle Wave will help, and I am also afraid what you expected to get in terms of improvement from the Active Fx will also not happen, just apply some warm moist soaks and let the pimples open, they are just plugged pores, do not pick at them. I do not think it will be red for months, but likely about another 4-6 days from what you are describing.Best of luck. JG 1.19.09

Question:

I had fractional lazer done to my whole face: by a PA. She told me after the procedure was done, you have some broken capilaries, but those will go away . My face was so swollen for three days. I viewed your 3D video and noticed that cheeks were not done. Have had IPL done to my cheeks to remove broken capilaries prior to lazer treatment. Is it normal to have what looks like needle sticks and broken capilaries? After watching your 3D video, I question if the procedure was done correctly. I have 2 more visits left.

Answer:

yes, the fractional laser will not help and will actually worsen the broken capillaries, they will need to be treated later with a YAG, a VBeam or IPL laser. Best of luck. JG 1.15.09

Question:

What are your thoughts regarding the new CO2 DOT laser (Dermal Optical Thermolysis?

Answer:

I would not waste the money on the machine and I would not offer it to a patient. JG 1.14.09

Question:

What is your opinion of the affirm laser? Could you be specific? I respect your opinions and thank you for your generous service.

Answer:

I honestly have not been impressed with the results that I have seen, I am sure a few patients have nice results, but the vast majority of the ones I have seen show little to no improvement. JG 1.13.09

Question:

Hi, Can you do only the above lip area or just certain spots on your face with the Rhytec? Would you be able to tell the difference from the rest of the face, color, texture, etc.? Thanks, Sheryl

Answer:

the upper lip can be doen alone, yes. Usually with the Rhytec the color difference is not seen. JG 1.12.09

Question:

Hi, I had portrait plasma high energy done on my face. I have lifetime (age 59) severly sun damaged skin. It has been 3 months since the procedure. Areas of my face still show sun damaged brown spots so my dermatologist has used the Alexandrite Laser to try to remove the remaining brown pigments & age spots. After one treatment, I still have brown spots & in a few places my face bleed. Now in the areas that bleed, it looks like a scar area ( indentation in my skin & red veins are showing) Also, some brown spots just got darker. What do you think about my situation & what do you recommend? Thanks for caring and your time.

Answer:

might suggest trying some Retin-A with Hydroquinone and then a series of medium to light chemical peels to even out the pigmentation. Also need to always use sun block. Best of luck. JG 1.12.09

Question:

I read that the company that makes the Rhytec Portrait regenerator has gone out of business. THe machines` tips are disposible, and no more are available, so what will you do instead for a laser? Is there another laser that`s at least as effective as the Portrait regenerator?

Answer:

I am using a low energy CO2 lasaer until the tips are avialable again, I am pretty confident another company will but the technology. JG 1.11.09

Question:

Hello and Happy New Year! I had a co2 laser in October. My skin did not weep as it did on the two previous lasers. This did concern me but the plastic surgeon told me not worry. I followed all his directions to the t . I had alot of texture on my face, huge pores and lines. After the laser, the rt side of the face was all rippled. He said it was because my skin was holding water. Well I have more lines on my face than before. I have three nice size grooves on my face. One goes from above my lip onto my cheek. The other two are on my chin. The texture is worse. And now, the large pores are all reopening. Plus it still looks rippled. To say the least, I am upset. I saw him after Xmas and he said it would improve. Well it is getting worse. I did not expect to have flawless skin but I sure didn`t expect it to look worse. I have had several people already tell me that! Do you know why the skin didn`t weep? Is it possible I have no collagen and that is why it isnt improving? I am 59 years old. From the time I was a teenager until I was maybe 30 years old, I laid in the sun and used a sunlamp. (for acne) I did have some major sunburns. Is it possible the skin beneath the surface is worse than old skin. I have no idea what went wrong with this laser. The Plastic Surgeon I used is well respected in the area. Do you have any suggestions for improvement? I hate the way my skin looks. Thank you

Answer:

hard to say and at this point I suggest no further treatments for 6 months after the laser. As to why it did not weep, it might be because of the depth of the laser. As to the ripples, that can happen from swelling, yes, but since so much time has passed it is more likely that some areas ended up having a deeper treatment than others and resulted in a depression. This can happen from inadvertent overlap during the procedure. Although the laser is attemtping to create new collagen, the amount and quality of your own collagen would not cause these things. If the redness has faded you could try some ligth Retin-A now for the pores, not much more I can say I am afraid without seeing you in person. Best of luck. JG 1.7.09

Question:

My daughter had acne after pregnancy and a laser center recommended that she have 6 treatments of the spectra laser. She is caucasian and Italian, probably light/medium complexion. Not really dark. They told us that it gives an 80% improvement in acne scars. She has a couple icepick scars too. Will this spectra laser help heal her acne? What can be done for icepick scars? What is the best laser for acne scarring and approximate costs? Thank you,

Answer:

I think at best 30% improvement. It will not help the acne heal, it will just smooth out the skin and will never prevent it from continuing to occur. The ice pick scars can at times be cut out and stitched to leave a smaller flatter scar. I find the regular ablative old fashioned CO2 laser the best for acne scarring. JG 1.4.09

Question:

Hi Doctor, I have had portrait plasma on face & fractional co2 on neck & chest. My doctor recommend fractional co2 on neck & chest for better results because neck/chest sensitivity. Needless to say, you are right..plasma on my face got much better results than neck/chest!! Because of your honesty & experience, what treatment do you recommend for extremely sun damage skin on arms & legs. I am 58 with a history of skin cancers. I want to know is there any treatment (laser or light-IPL) that can improve my skin on all arms & legs to increase the chances of not having a re-occurance of skin cancer (AK`s & basals)Thanks from a foolish 58 yr old former sun lover!!!

Answer:

well, I will at times do some lighter TCA peels on the body, but the body having peels is not as safe as the face, hard problem to improve I am afraid. JG 1.4.09

Question:

I`m considering the portrait at a high setting to treat textural issues and fine lines especially around my mouth. I`m 53. What kind of improvement should I expect? And how long does it last generally speaking? thank you-Happy New Year!

Answer:

30-50% I would say it might last 18 months to three years in many cases. All the best. JG 1.4.09

Question:

Hi Dr. Garcia, I had an acne scar excised about two years ago. The scar still gets red frequently and the doctor claims that it is because of blood vessels that remain there. I have had multiple vbeam treatments which have not helped with the redness. The doctor says that a light CO2 treatment will greatly help with the stitch marks that remain from the excision. My question is do you think the CO2 will help with stitch marks and also will the CO2 make the persistent redness of the scar worse, better, or maybe have no effect? I am thinking some of the blood vessels causing the redness are superficial so perhaps an ablative laser might help. Any thoughts or advice you might have would be greatly appreciated. I hope you have a wonderful weekend. Thanks

Answer:

I think it will do little for the stitch mark and at best will leave the redness the same, likely not improve it though. If the VBeam did not work for the redness, the CO2 will not either I am afraid. Best of luck. JG 1.3.09

Question:

My dermatologist suggest doing a procedure to diminish the blue veins under my eyes. I look like a raccoon. He is planning to use 1064 laser. He told me that I might need up to 3 treatments. Question: Have you had any success with blue veins under the eyes???...I read you have to treat the feeder vein or the vein will continue to come back? What kind of bruising/side effects would I have with this type of treatment? Will the top of my skin over the vein be effected by the laser treatment? Thanks so much Happy New Year!

Answer:

I doubt the change will be much, there is not much that can be done for them. JG 1.2.09

Question:

Thank you so much for the reply regarding Armica Montana. I do respect your opinion greatly. I am confused how often/the timeframe & how much the dosage I should take. What do you recommend/any specific brand or is Arina montana tablets all the same. What is dosage amount? How long do you take it before & after procedure ?

Answer:

I use the regular Arnica Montana sold at the health food stores, the small little tabelts that dissolve under your tongue, we suggest 4 tablets under the tongue 4 times per day and take the whole bottle, about 14 dyas worth. We usually start it 2-3 days before the procedure. Best of luck. JG 12.31.08

Question:

I wasn`t that thorough in my previous question about the Pearl laser, sorry. You said you were not in favor of it, but may I ask why? It seems to have gotten some positive reviews (if one can trust them). I absolutely love this site. You really help us make more informed decisions.

Answer:

the comments in th audience at national meetings where plastic surgeons see presentations is that most of us cannot tell which is the before and the after photos, I just do not think you get much result for what you spend. It is due to the technology being used. JG 12.31.08

Question:

Hi, I am schedules to have Portrait plasma done on my face. To help reduce bruising & swelling, I have seen info on the internet on Arnica Montana (a Herb for reduction of bruising and swelling and to shorten the recovery period after physical trauma.)Based on your extensive experience, do you think that Arnica Montana works? Has it worked for any of your patients? There is a physician strength capsule manufactured by SinEcchâ„¢ - Package contains contains 12 capsules and is designed to treat one patient for one surgery. The capsules are taken three times a day for four days, starting the day of surgery.However, there are also Arnica Montana tablets, you can get at Vitamin/Health/supplement stores. Would these type tablets be better? Your opinion is greatly appreciated. What do you recommend/any specific brand/dosage? or is Arnica Montana just hype and does not work!Happy New Year

Answer:

I do use Arnica and I do think it helps bruising and swelling, but it is relatively short lived swelling on the Portrait and really no bruising to speak of, so I am not sure it is worth using it for that case. I have bene using Arnica Monta for over 12 years. JG 12.30.08

Question:

What is your opinion of the Pearl laser?

Answer:

not a fan. Merry Christmas and Happy New Year. JG 12.27.08

Question:

MERRY CHRISTMAS TO YOU SIR. My doctor recently was offering a free laser treatment with the fraxel co2 laser continginent upon the results he recieved from 2 other patients he had treated. Well apparently he did not get glowing results that the manufacturer had perdicted as he has decided not to futher pursue that thing. In my research on it i feel the Rytec Portrait would be the best path for me to pursue. My question is this - does the intensity of the treatment vary and when dealing with acne scars that have previously been treated with punch floats what kind of possible results could i expect from this treatment.

Answer:

yes, there are a variett of different setting and typically for acne scars a deep setting needs to be used. I think if the float procedure was done long ago it will work about the same as no procedure being done. If the float is done 4-6 weeks before I feel it gives a better result though. Best of luck. Merry Christmas and Happy New Year. JG 12.27.08

Question:

hello: I have come across some drs. who are using accent, alma for malar bags, reportedly with some success. The area is so small, I don`t know how they would keep the want moving as is required and how they can avoid a build up of heat. At any rate, the price tag is high. I wonder if you have heard of this and can give an opinion. Malar Bags are so hopelessly difficult. thank you

Answer:

I have heard it, there have been many attempts with different methods of heating and I think overall the results are unpredictable, especially when one considers the cost. I would not suggest it. sorry. JG 12.22.08

Question:

The Doctors in my area NYC do not recoment the co2. If you had to recomend one knowing it was not your first choice would it be the plasma or fractional co2 repair? Just for skin texture small acne scars sun damage etc thnk you.

Answer:

Rhytec Portrait Plasma. JG 12.22.08

Question:

Hi, Dr. Garcia. You`ve answered a few questions of mine & I very much appreciate it. Is there anything that can be done about lax abdomenal skin. I`m very fit & have a small waist but it`s just a little loose skin that bothers me. I look great in fitted clothes, but if I wear a bikini, it bothers me. Thanks again.

Answer:

I am afraid the only thing would be to have the skin cut out with a tummy tuck or a mini tummy tuck, sorry. JG 12.21.08

Question:

I have read that Rhytec is officially bankrupt. Will this effect your further use of the Portrait Plasma, and if so, do you have any plans to use any existing resurfacing lasers as a replacement or are you sticking with just the C02?

Answer:

many companies have gone through bankruptcy lately, even ones like Fraxel, and emerge under different management. I am still using the Plasma in my office and their European branch appears poised to keep us supplied with nozzles. I am stil using the CO2 laser when indicated though, and when patients are willing to deal with the downtime. JG 12.19.08

Question:

Wow how right can you be. I had fraxel 3 years ago. 5 times 5k. Very little improvement if any and that quickly went away. The Doctor told me I had unreal expectations. Most of them HE had put in my head. They are Doctors they have done this before they know results nothing more than stealing.

Answer:

that would be one word for it, yes. JG 12.18.08

Question:

I respect you and thank you for your time. I am taken back however that you are really stating that 1,000`s of doctors around the country are just being salesmen and overstating results of products just to make a buck. Did they not take an oath? IE fraxel etc.

Answer:

well, I guess that at least some of them have been duped, I certainly have been, I bought a Theramage machine because surgeons I trusted told me it was a great machine and I had to sell it because almost all of my patients, and myself, were unhappy with the degree of improveemnt for the pain and cost. I am sure there are some patients that have good resutls, and that handful is on all the brochures, in fact, most of the time when you see results pictures in doctor`s offices they are supplied by the company and are not the doctor`s pictures. In most cases when the patient comes back disappointed the doctor then tells them they had unrealistic expectations. I just find it hard to recommend something that costs alot of money when the results are unpredictable. JG 12.18.08

Question:

Thank you for taking the time for my question. Would you say that fractional co2 is a waste of money? Is is better or less effective in general for just general skin tone tighting pigmentation small acne scars etc than plasma? Is plasma a waste of money? Is non fractional co2 the only thing you recomend?

Answer:

personally, I think it is, I see too many patients that were promised dramatic results and that after even a series of treatments see little difference. I feel the plasma, as it is a totally abaltive technology, yields a better result than any fractional treatment, but slightly more downtime. At present the non-fractional CO2 is the best, followed by the Plasma a few steps behind. JG 12.17.08

Question:

Dr. Garcia, I have a quick question. I have a small pitted scar on my chin, less than an inch in length, but it is fairly deep. I received 3 or 4 Palo 2 treatments for it at my dermatologist office, but the scar is still here. The aesthetician then explained I would only need about 4 treatments for it to be gone completely, and now, 8 months later it looks the same. I spent $250 for each treatment and dont see much results. I also received a extraction, which was a waste of money because I found out the asthetician didn`t even do the correct procedure. I have been thinking about coming into your office, and get a consultation, but I wanted to write you on here first. With the extraction I have many blackheads and whiteheads deep in my chin area that have been there for years, and the extraction didn`t help, well at least the way she did it. What would you charge for my scar and extraction, and what type of procedure would you recommend?

Answer:

The scar revision, by cutting it out, might run about $500 and we do not have an aesthetician in the office to do extractions, sorry. JG 12.12.08

Question:

What is the best procedure for getting rid of large pores? Also what is a genesis laser, does that help sun damage skin?

Answer:

any thing you do for the pores is very temporary and as to the Genesis, I am not a fan. JG 12.11.08

Question:

Sorry but after reading more I cannot tell if the ultapulse encore is fractional or not. I thought it was not.

Answer:

it is not fractional. JG 12.11.08

Question:

What do you think about the Ultrapulse Encore with the new liteTM setting for mild acne scars and sun damage? Does it require bandages for weeks as stonger co2. And of course I would expect less improvement.

Answer:

the lighter the setting the less the improvement but the faster the healing time. No bandages, but ointment until healed. I think it should work fine though. JG 12.11.08

Question:

Well I guess I am stuck. Mine is minor acne scars and sun damage. Just looking to make it better. But to risk coming out worse well I guess I will have to live with it. Again down time not a problem in short term problem for long term gain but if the other lasers do not work at all and I do not live in your area to see you I am not willing to roll the dice with someone who may not be that good at it with such a powerfull tool.

Answer:

I am sure there is a dermatologist or plastic surgeon in your area that has experience with a CO2 laser that can help you, call the local county medical society for a referral. Best of luck. JG 12.10.08

Question:

If you could say oh well way less than 1% for your work, who I would think of as an expert, what about the guy who does one a month or just stated 10%. It just seems the risks are too great. I sure would like to get the benefits of it but if there is unknown % that come out worse how can you recomend it. It is not a heart operation not life threatning.I can take the down time can take the pain but to end up worse off I just do no see it. That is why everyone is looking for something else.

Answer:

people are always looking to get the same benefits with less risk and downtime, it is human nature, but in this realm it does not work. If I thought fractionated lasers worked, I would own one, but I do not. JG 12.10.08

Question:

What do you think of the Sciton TRL 51 vs CO2 for mild acne scars sun damage(brown and red spots) and just general skin tone. Read so many bad things on CO2 is it the laser or the Doctor? Thaanks

Answer:

I think the CO2 is far superior, there are limitations with it but most times, if done properly all heals well, albeit with some downtime. JG 12.10.08

Question:

Thank you in advance for your wisdom & experience. Have you heard of RioBlush CO2 for skin tightening & fat reduction? I saw some before & after photos that were very impressive.

Answer:

my personal opinion is tha it is a waste of time. JG 12.8.08

Question:

Dr. Garcia, I know you are not a fan of Fraxel and prefer CO2 lasers but what are your thoughts on the Fraxel restore which couples Fraxel with CO2? I am 45 and have fine lines around my eyes and on my forehead. I`d like to find an option where I stimulate collegan and reduce the lines without a 2 week downtime. Would you recommend the CO2 Ultrapulse instead?

Answer:

the Fraxel CO2 takes away all of the advantages of the CO2 so I remain not a fan of any fractinated technology, it is merely a marekting attempt to get people to sign up for something that they found did not work with the inital Erbium based technology and now want to sail on the coat-tails of the CO2 without acknowledging that they are weakening the CO2 to such a degree that it renders it ineffective. I think the unfortunate thing is that one has to compromise when you impose downtime, if you limit the downtime you will limit the improvement, at least with any technology now in use or in the pipeline at present. I think the Ultrapulse is the way to go if you want substantial improvement worth your investment. JG 12.8.08

Question:

Hi Dr. Garcia. I have one shallow saucer shaped scar on my cheek that I would like to improve. I consulted with a Doctor and he suggested that I have Deep FX done on the one scar. Does this sound like a good treatment plan. After doing some research, I have read that some people have been scarred from the Deep FX procedure (is that common?) Thank you for your time.

Answer:

I think that it would not be worht it. I think the scarring potential is small but I think it will not generate enough of an improvement, I think a subcision and filler is a good option. JG 12.7.08

Question:

One prominent plastic surgeon in my area is offering the Triniti renewal system. It consists of 3 treatments- first the ipl, the refirme, and the matrix/ir. What are you thoughts on the efficency of these lasers??

Answer:

waste of time three times. JG 12.7.08

Question:

I meant to add Dr Garcia this surgeon has many years practice doing the fillers so will that insure the fillers dont go in lumps, he said only my midface needed treatment and this was a non surgical face lift..

Answer:

well, the risk is less but never 100%. JG 12.7.08

Question:

Dr.Garcia, I was scheduled to start a series of the Rytec Portrait lasers when my esthec. called and said they were having trouble with their machine and on top of that said they could not get the part they needed because the company had went bankrupt. Are you familiar with this? I wanted to have a treatment that could address several of my issues at once. I`m 42 and want to address issues of pores, mild acne scarring and discoloration, uneven skintone, some lines around the lips, dark circles. I have gotten botox for deeper forehead lines and lines between the brows. What do you recommend as far as the most effective treatment that would address my issues? Thank You, MaryJ

Answer:

the company has recently declared bankrutcy and there are attempts to have someone take the company and the assests over. The same thing happened to Fraxel last year and they were bought up by Thermage. In theses financial times, things like this are unfortuanately common. I think a light CO2 laser is still an option in one sitting. JG 12.7.08

Question:

What is a fotofacial? Is it good for fine lines, and is it a laser that stimulates collagen production.

Answer:

a high intensity light, not a true laser, good for brown and red spots, needs multiple sessions, does not do mcuh for fine lines, collagen production or wrinkles. JG 12.4.08

Question:

Is IPL good for wrinkles? Have a Happy Thanksgiving - and thank you for your advice!

Answer:

I do not feel it is, no. All the best. JG 11.26.08

Question:

Hi Dr What type of treatment would you suggest for shallow acne scars. As I have aged (I am 40) many many more shallow scars have shown up causing an uneven look to my skin. Would Plasma help with this? Thank you

Answer:

Plasma would be relatively mild, I likely would suggest subcision and CO2 laser for the most dramatic improvement, the shallow scars respond well to that. JG 11.25.08

Question:

hello, I am a dark brown skin african male who has been suffering from hyperpigmentation/melasma for awhile now, i have done many treatments out there from chemical peels both glycolic and tca to bleaching creams to triluma and im now using hqra8% which has helped some but leaves me irritated. I was thinking sbout doing the fraxel laser for my hyperpigmentation and texture. but im kinda unsure if its safe or unsafe for my skin. my doctor ms debra atkins here in atlanta tell me oh its no problem, ill put you on desiwyn for two weeks prior which will put your melanytes to sleep or something to that effect. can you please offer me some advice. I also have heard about the medlite laser, any advice on what i should do or if i should just take a different route all togehter. thanks

Answer:

I think the Medlite laser is sgnificantly safer, I personally would not perform the Fraxel, no matter what the pretreatment. Best of luck. JG 11.22.08

Question:

Hi Dr. Garcia, I had the plasma rejuvenation done by a plastic surgeon in Chicago 5 days ago. As he was performing the procedure, I noticed that his technique seemed to be pretty random, in that he seemed to be missing parts of my face. I mentioned it to him and he said that he got the whole thing. Now, 5 days later, I can see that he missed large sections of my face (where there were lines and wrinkles) and concentrated on other area. I have random dots all over and there doesn`t seem to be any pattern. It looks like I had a bad case of the measles. I called his office about it and sent pictures and was told that all was fine. I don`t see how this can be the case. They also sold me a moisturizing cream to use after the first day (instead of vaseline). It burned immediately upon application and I removed it and didn`t reapply. I called his office and they told me it contained AHA which, in their opinion, would help turn over the skin. They told me I must be sensitive. This just doesn`t make sense to me. Can you tell me if the way the procedure was performed is typical and if the recommendation of an AHA is standard as well? Thanks in advance.

Answer:

well, when done lightly the skip areas can happen and they end up blending in well, when done deeply it is more important to get a smooth cover, I would never use anything with AHA in it for at least 4 weeks as you want to allow the skin to heal before irritating it anymore. JG 11.22.08

Question:

Dr. G: Is their any other type of procedure to tighten skin under the eyes besides the Co2 laser. One of the PS I went to to was going to do an upper and lower eye lift(is what i wanted) and he mentioned skin tightening : for under my eyes - I;m not sure he used those exact words but he metioned nothing about a laser _ what do you think he was talking about?

Answer:

well lasers help skin quality and surgical excision improves skin quantity, so it depends on what the problem is with your lids. Hard to say without seeing you in person I am afraid. JG 11.20.08

Question:

I had a under eye TCA peel and the reults did not last - My PS gave me a erbium laser w/ profraction(free of charge) and hearing about how this laser w/ profraction is useless _ and I am begginning to see some wrinkles reappearing and the skin don`t look as tight - If I am not happy with this should;nt mr surgeon correct this with a better type of laser....free of charge. Would`nt a reputable PS honor this - Would you? )i had my tca peel back in May and then had the erbium last month)

Answer:

well, I cannot speak for your surgeon, I think believing a TCA will tighten skin for longer than the period of swelling is wishful thinking and I am not a fan of fractional lasers and do not perform them. Some surgeons believe they work but I have never seen photos that show reproducable effects in the majority of patients. As to what he should do, I think that is up to the individual surgeon, some are more helpful than others. JG 11.20.08

Question:

How long does a Erbium laser w/ profraction last and if having a second treatment would I see better impovement.

Answer:

I think the second treatment will give you some degree of further improvement but I personally have not been impressed with the fractional treatments. JG 11.20.08

Question:

I don`t do well with general anesthesia...could I have a Co2 laser under mild to moderate sedation(IV) - not totally unconcious.

Answer:

I personally would not do it that way, one flinch and you get burned somewhere where you do not want it. JG 11.20.08

Question:

What is an Erbuim laser good for? and is MicroLaserPeel by Sciton and Erbium? if not, what is it?

Answer:

personally, I do not think it is good for much and the laser you speak of is an Erbium I believe. JG 11.19.08

Question:

How is C02 any better than Erbium in the long run given that studies show the tightening caused by the additional heat of C02 (which can also cause hypopigmentation) relaxes after 12-18 months and the results between the two are basically the same at this point. Is the added risk and downtime really worth it for a short term benefit?

Answer:

well anything you do will relax as the aging occurs, for the first month or so they look about the same but the CO2 will give you the improvement for much longer than the Erbium. In the long run, nothing is great, not even surgery, you need to understand that these are all incremental attempts to slow the process of aging down, nothing will stop it and that is why it is not an option for all people. I think the added risks, in experienced hands that can decrease the risk certainly are worth it, not all patients lose pigmentation, but it depends greatly on the amount of sun damage they have. JG 11.19.08

Question:

I was told the contour was not fractional but dual pulse with both long and short pulse allowing ablation and coagulation. Ablation 5 to 200 coag 25 to 100. Againn as he said best of both worlds. Really really last question.

Answer:

no problem with the questions, I just do not feel it is the best of any world due to its low effectiveness. JG 11.18.08

Question:

I am so thankfull for your time but I have been to 3 docs and got 3 stories. One last question how about the Sciton Contour. Doc says it has the all the good of CO2 skin firming and tissue building but still safe as Erbium. Thank you.

Answer:

well, I think what you have just found out is that none are right and none are wrong, there is dissention among the options because there is no clear winner. I think your last doctor has oversimplified the issue though. The degree of firming comes from heat, which the CO2 does give and the Erbium does not but a discontinous surface allows less tightening. Think of a drum skin versus a pair of lady`s nylons pulled over a drum head, the solid piece when tightened will lead to greater tautness whereas the nylon will stretch and not tighten as much because there are holes in it. For the greateset degree of tightening you need a continuous and not pixelated or fractionated surface treatment. As to safety, maybe, but then the degree of effectiveness goes down too. JG 11.18.08

Question:

So for a 46 yoa male fair skin non smoker with minor sun damage minor acne scars and small wrinkles you would go with the CO2? Thanks a lot

Answer:

that would be my first choice, yes. JG 11.18.08

Question:

Why are you not a fan of the Erbium?

Answer:

well, after having used it, my patients and I have been consistently diasappointed with the reliability of its degree of improvement. JG 11.18.08

Question:

Thank you Dr. Would you go so far as to say it would be a waste of money and time.

Answer:

as to the Erbium, yes, I sold my Erbium laser long ago. JG 11.18.08

Question:

hi dr.garcia, thanks for your advised about co2 an erbium laser so what would you recommend?

Answer:

I am sorry but for darker skin and acne, I have nothing safe, maybe subcision and fillers is about all, or when one is older a minifacelift will give improvements for awhile. JG 11.18.08

Question:

Hi Dr.Garcia, I am a brown skin Indian. I would like to know how well does Co2 an Erbium laser works on our skin type for ance scar? also which give a better result for mild ance scar.Does Erbium is best for pitted scar? Thank You

Answer:

I would shy away form an abaltive laser, both CO2 or Erbium in darker skinned patients, so I would not suggest it for your condition of acne scars. JG 11.18.08

Question:

Hi Doctor I know you are not sold on Fraxel repair CO2, but I noticed on their website and read some testimony that it was good for under eye repair. Any thoughts on this specific area for Fraxel vs Plasma? Would you still choose plasma over fraxel? Thank you

Answer:

I still would choose the Plasma over any fractional laser, I would expect the company to say it is effective for many areas on their website. JG 11.16.08

Question:

Hi Dr Garcia thank you for telling me CO2 ultrapulse laser is a good choice, im seeing the surgeon on the 5th of december he gives an hour for consultation and I have been told to write down any questions I may have, would you mind telling me what I should ask please and also what side effects if any there are. Thanks Dr Garcia for spending so much time helping people.

Answer:

just ask about your specific concerns, if they pretreat the skin to avoid hyperpigmentation, and how long the post teatment redness would last in your case. Best of luck. JG 11.15.08

Question:

Hi doc, you are not a fan of fractional lasers bec they vaporise only a fraction of the skin. What then do you think of multiple sessions of fractional CO2? Thanks!

Answer:

still not a fan, although it is better than a single one. Imagine this, you want to tighten the skin on a drum using the torque screws around the rim, you tighten one or two, close your eyes, spin the drum, and then tighten two more, you have no way to know the new two tightened are the best ones, one always gets the best degree of tightening when the entire surface is done at the same time so there are no skip areas and the tightening is uniform and smooth. JG 11.14.08

Question:

Hi Doctor arcia, Why do you not like fractional lasers and what is the best laser out the to get rid of wrinkles and tighten the skin (also help with dark circles under the eyes).

Answer:

no laser will help the dark circles unde the eyes, I like a CO2 laser the best and a Rhytec Portrait second for the wrinkles, I do not like the fractionated lasers because they only treat a percent or a fraction of the skin, therefore it leaves a lot of skin untreated and thereby does not give as significant of a result, that is why they are called fractionated lasers. JG 11.13.08

Question:

Dr. Garcia--When looking at doctors who treat acne scars, is it best to see a plastic surgeon or a dermatologist? Does it matter which? I noticed that both types of doctors can perform the same functions.

Answer:

I think they can both do a good job. JG 11.13.08

Question:

Dr.Garcia besides a laser treatment what chemical peel would you recomend to treat mild acne scaring, and sun spots.How effective is it and how long would the results last? Thank you so much for your time

Answer:

I personally would not attempt any chemical peel for acne, I think the results are not worth it. JG 11.13.08

Question:

How long does erbium laser w/ profraction last? I had it done under my eyes and I was told as the months go on my skin under my eyes will continue to get tighter and better for up to 6 months. I had this done 2 weeks ago and though under my eyes look good, my skin doesn`t look as tight as it did. Will it continue to improve or is this as good as it gets? Also would it be benfeficail to have another one done.

Answer:

it creates new collagen for somewhere between 2-6 months, the deeper they went the longer it makes new collagen. I am not a believer in factional lasers though. JG 11.12.08

Question:

Hi Dr Garcia still looking into the right treatment for me what do you think about this NLite We offer an NLite service for the treatment of acne, acne scarring and the reduction of fine lines and wrinkles. This is a non invasive treatment and the recommended course can take on average 3-4 treatments. NLite can be combined with a course of microdermabrasion to achieve optimum results. This laser works by being selective to the P. Acnes bacteria on the surface of the skin and also by stimulating natural collagen production in the skin by up to 85%. thanks Dr Garcia

Answer:

I think NLite would be a waste of time for acne scars. I think combining it with microdermabrasiosn adds very little, the laser is certainly not selective to one bacteria over any others and the degree of collagen stimulation in most cses is not seen by the average observer. JG 11.10.08

Question:

Hi Dr. Garcia, I`m a 53 year old woman who has a fair amount of sun damage especially around my mouth. I`ve been using your peptide cream for almost 2 month`s but have not seen any improvement as of yet.My depression over my skin is getting pretty bad and am seriously considering the rhytec with a local derm. in CT who claims to have a lot of experience.After reading some nightmare scenario`s with uneveness and healing issues-I`m somewhat afraid but at the same time I really feel the need to do something. I`m half scottish/irish half italian. Any advice for me? I appreciate your time and opinions, thank you.

Answer:

I think there are always negative reports on blogs on the internet, but also understnad that happy patients do not go on the internet to praise things, so if you are in experienced hands, it should be good, all the best. JG 11.10.08

Question:

I am a 58 year old male. I take plavix & aspirin daily for heart problems, stent, bypass, etc.. Am I a candidate for Fraxel Repair and or Rytec Portrait? I had the regular Fraxel procedure done three times with poor results and much ozing and a fair amount of bleeding. If I wanted to have both Rytec Portrait and Fraxel Repair CO2, which one should be done first? and how far apart between procedures? Also, at what levels for moderate box car acne scars on cheeks and minor wrinkles? Thank you

Answer:

the blood thinners will not affect the ability to perform either ablative skin treatments. I will say that the FRaxel repair will likely bleed much more than the Rhytec. If you are intent on doing the combo, I suggest the Fraxel CO2 first and then finish with the more complete Rhytec. As to the time between, I suggest at least 6 weeks. For the Rhytec for acne scars I would use between 3-4 joules on the cheeks, or a double pass at a slightly lower setting, as to the Fraxel, I am not a believer in it so I cannot say. Best of luck. JG 11.9.08

Question:

Hi Dr. Garcia...I had a high energy Rhytec Plasma done on my face done 3 weeks ago. I am 58 white women with lots of sun damage. Question:My doctor has given me SkinMedica TNS recovery complex & TNS Ceramide treatment crean to put on my face. I have noticed that my face is oily & my pores are much large than before the procedure. Are getting larger pores expected from this procedure..is this normal or is it my skin reaction to the procedure? In your experience, what can I do ...will my pores shrink in time? Face become less oily? Thanks for your time?

Answer:

the larger pores can be temporary and also the creams might be clogging the pores, migth want to ask him about changing the creams. The oilyness comes from your skin trying to heal itself, might consider trying some squalene oil topically, that should help moisturize the skin without you creating more oil. JG 11.7.08

Question:

Hello Doc. have you heard of the co2 Lumenis? My sister is thinking about this laser. Good? Bad? What brand of co2 laser do you use or recommend? Thank you for your time!

Answer:

it is a good laser, yes. The laser I have was made by the company Lumenis bought. JG 11.4.08

Question:

what exactly is the theory behind fraxel lasers, the pin pricks, in particular? I have seen some real pics of real people who have had it done, on the Make Me Heal website, and they seem to go thru the same healing period as a regular laser, with decent results, tho healing is shorter. When you get this done, do you leave with actual pin pricks with blood beads all over, or just red and lasered looking? If you get a series of these over time, is it possible to get good results? I would think so, because each time, more/different skin is actually treated, the fraction may eventually end up being the whole face, if that makes sense?

Answer:

yes, there are millions of small pinpricks but they do not bleed for very long. In my personal opinion I think the results of a series of them will never reach the degree of improvement from a complete continguous ablataive laser, becasue some pin holes will be treated multiple times and some areas of skin will be missed. JG 11.1.08

Question:

Is the Active fx and deep fx like the portrait rhytect laser? what do you think about the Active fx? Thanks

Answer:

I do not think they are close at all, I feel the Rhtyec, if chosen to be used that way, is much stronger. JG 10.31.08

Question:

What is your strongest objection to the FRAXEL C02 Repair procedure. It has the power of the C02 but less down time. I realize that the results won`t the as strong as the C02 laser alone. But wouldn`t the Fraxel c02 be the best choice if you don`t want the Rhytec? What are your major objections to the FRAXEL c02 REPAIR procedure & results?

Answer:

well, it has the power yes, but it will treat a very small surface area, that is what makes it fractional, so you have a large percentage of the skin that remains untreated and therefore, although it heals quickly, that is because so much of the skin is not improved or treated. I think because of the fractionated surface it will be less of an improvement than the Portrait treatment. My major objection is that of large percentage of patients with disappointing results. It is not me that objects, but the patients that spent money and do not feel they got enough for what they spent and went through. JG 10.28.08

Question:

Hi Dr. Garcia, Realistically, how long is the healing time for a PSR 3 treatment for a 60 year old fair skinned woman?

Answer:

12-18 days before makeup. JG 10.25.08

Question:

Thanks for your answer regarding the PSR and my acne scarring. The most of my scarring is on my forehead and much are flat and not the ice pick kind. Anyway, I will remain optimistic that I will see some improvement but understand that it may not turn out they way I am so hoping. That said, at what point do I wash my face? I had the first treatment on the 21st and have not washed my face yet and I really want to by now! Thanks for your advice.

Answer:

we allow patients to wash after 24 hours, but you shoudl ask your doctor as they may do things differently. JG 10.23.08

Question:

Hello Dr. Garcia, the last question was mine... What specific laser would you recommend???? Thanks so much!

Answer:

CO2 laser for something dramatic, Rhytec Portrait for something less but with less downtime, on the order of totally back to normal skin in one month.JG 10.22.08

Question:

Hi Dr. Garcia. First, I want to say THANK YOU for taking your time to answer our questions! What a priceless gift to us that are scrambling to find answers. Okay, now my questions. I was on Accutane on and off for about 2 yrs due to severe cystic acne. I have much scarring as a result. Went to see a dermatologist that is trained in Plastic Surgery to have a mole removed off of my face that had gotten a cyst behind it and never was the same (the cyst never really went away). This was about a month ago. The Dr. mentioned to me the PSR treatment for my scarring. I had long ago thrown in the towel that there was anything out there that could help me so this was a true blessing to hear of this new technology. I have signed up for 6 low-dose treatments but my concern is (and I have expressed this more than once to my Dr.) is that the low energy level won`t be enough to really do anything to improve my skin. What do you think? Am I wasting my money? I had my first treatment yesterday at one full face pass and set at at 1.5 I believe. The Dr. has said that he will up the gun to a 2/3 if need be but to wait and see how I do with the low dose. I did choose the low dose b/c it was less expensive as well the fact that I am a SAHM with 3 young children and cannot be out of commission even for 2 wks with the high energy (not mentioning the cost of 5K). I just don`t want to get dupped into buying more down the line, you know, b/c the low energy was not the right treatment plan to begin with. The Dr. did mention me getting the high level but the cost factor is just not feasible at this time in our lives. Today my face is slightly blotchy and my eyelids are sore. I am hoping this is normal?! I am to go back for the 2nd treatment on 11/17. When should I wash my face? I also signed up for lip injections but I would like to wait to have that done when the PSR treatments are complete. Does that make sense for me to wait or should I get them done at my next visit? Thanks for your advice!!!

Answer:

personally, if you have had to use Accutane for that period of time to control your acne, it is likely you have deep scarring and I seriously doubt light treatments with PST or other technologies will help, even with the really deep CO2 lasers, improvements are limited as the problem is below the surface of the skin and lasers work best for wrinkles. The treatments will likely be safe, but will not control your acne, will yield minimal scar tissue improvements and may not be worth your investment. JG 10.22.08

Question:

I asked you if the shallow dents caused by Thermage can be laser resurfaced, and you said it would only look better as long as there was swelling. Do you say this because the scar is caused from fatloss? Or do all pock like type scars react the same to laser and only look better while there is swelling?

Answer:

there is really no scar, just fat loss and no laser will replace the fat. All pock marks look better if the skin is tightened but since it is not release the pock scar tissue as time goes on its appearnace returns, lasers work well for wrinkles but less well for pocked skin due to the scar that was caused by the infection and inflammation, not related to the Thermage. JG 10.21.08

Question:

I am a 39 year old female with type 4, light olive skin. I have rolling acne scars on both cheeks that seem to have gotten worse over the past 3 years. I have been to 3 ps and have gotten different advice from each. One said a co2 treatment, but that I could possibly lose some pigment. #2 said a deep erbium or 5-6 fraxel treatments and another said 8 fraxel treatments, four aggressively for the acne scarring and 4 lightly for the brown pigmentation. #1 doctor also has the portrait plasma, but did not mention it. #2 only has CO2, and was unimpressed with fraxel. I am at a loss. I battled acne for 19 years and now have rolling acne scars, only 2 ice pick. I really want to do something to make them appear smoother. I realize that I will not have the smooth skin that I covet, but would like to make the right choice. Thank you

Answer:

well, here is the thing, firstly, the scars are looking worse because your skin is begining to loosen, no matter what you do, it will worsen with time, the CO2 laser will give you the most change with the longest improvement but with risks, all of the others are essentially interchangeable as the results will be mild at best and short lived. There is at present nothing really good I am afraid for your skin type. JG 10.21.08

Question:

I know you are not a fan of Profractional Lasers, but could you please explain how exactly, they r supposed to work? I have seen videos and understand that holes are poked into skin, but how on earth are you supposed to look good after something like that? Supposedly, my PS office did tons of research on what machine seemed to produce the best results, and Sciton was it. It is done by technicians, not PS. PS would do ablative laser(c02) if thought necessary. (i am the one who sent pics regarding nose bump and necessity of lower bleph) In my case, he thought the Sciton would do what i wanted. You can see in the picc the cheek lines and vertical lines. If you could explain the way it supposedly works and if you think on me, that is all that is needed, i would appreciate it. Thanks. JR

Answer:

they are supposed to work by removing pieces of the superficial skin and then getting the body to create new collagen to tigthen the skin. JG 10.19.08

Question:

How is a dermaroller any less effective than a treatment like Fraxel or Profractional when it uses micro needles up to 2mm deep to puncture holes in the skin, when fraxel uses an erbium laser to puncture holes in the skin as well and erbium generates no heat = no thermal damage, so essentially it`s different means of accomplishing the exact same injury.

Answer:

well, I feel they are all ineffective but the lasers have a lesser chance of introducing infection into the skin as the tissue is vaporized and no needled where surface bacteria can be introduced. Also the number of punctures per square inch is much much more with the lasers than with the dermaroller. JG 10.19.08

Question:

Hi, I am thinking about having Co2 laser on upper lip area. WHAT ARE THE RISKS with CO2 around lip? Can you get a Low energy CO2 so that the risk is minimize? Can the doctor do something to minimize risks? Would you recommend high energy Portrait instead & using Portrait how long will it take before the wriinkles come back with Portrait?Thanks

Answer:

the risk are that of segmental loss of pigmentation at least partially, leaving a line of demarcation between that and the untreated skin. The lesser the energy the lesser the degree of improvement. I think Portrait is safer only becasue it does not go as deep and therefore is like the low energy CO2. As to how long it takes to come back, anywhere from 1-3 years, the older one is the faster they come back, the lighter the treatment, the faster they come back. JG 10.16.08

Question:

How long lasting is Co2 laser on upper lip area and arond mouth? my PS is planning on doing this during lower face/neck lift. I have heard that the vertical lip lines in particular always come back. Is this true, if so, how soon? Also, realistically, how long before driving after a neck lift? My PS said 8 days but dont you have to keep neck straight for considerably longer if possible?

Answer:

the older one is the less time it lasts, cheeks and foreheads can last 5 years but the area around the mouth and eyes,maybe 2-3 years or so. As to driving, we ask patients to wait two weeks so they can turn their heads easily after the surgery to look for traffic. JG 10.14.08

Question:

I have read on your website and other websites with Rhytec plasma portrait at high energy settings that there are risks of burning & scaring & hyper pigmentation. Under what conditions with portrait cause burning & scaring & hyper pigmentation, how does that happen? Is it the doctor`s techniques or the patient`s skin? Thanks for your help!

Answer:

well, the thinner the skin the greater the chance of those problems at higher energy, that is why in inexperienced hands I always tell patients to be conservative. High enery is not to be used on thin skin like eyelids but some people have thinner cheek or forehead skin than others. Once you select the energy, it is all dependent on the skin. I do go to high energies, at times as high as 4, but only on thicker skinned patients like men as their skin is at least 10-15% thicker than females. Best of luck. JG 10.13.08

Question:

will micro dermabrasion have any affects on botox and restylane injections? it has been over a month since i have had the injections, would like to have the dermabrasion to smooth out my face and remove some dried skin...

Answer:

I do not think it will affect it in any way.JG 11.12.08

Question:

Dr. Garcia, I have a LOT of Restylane and some Cosmoderm around my eyes. I`m also getting wrinkles under my eyes (there`s a lot of loose skin under there), but no wrinkles laterally. Would it be safe to do a laser peel with so much Restylane/Cosmoderm around my eyes? I`ve had people tell me the laser would not only remove the wrinkles - that it will also help to smooth the Restylane (it`s very lumpy and also looks like I have very noticeable bruises - Tyndall effect I believe since the Restylane & Cosmoderm were placed about a year ago - and not dissipating very quickly). I`m also considering Vitrase (had a little this summer), but it seemed to dissolve the Restylane (obviously no effect on Cosmoderm) unevenly, which made everything look lumpier. I`m also considering having the excess skin surgically removed around my eyes vs. having a laser peel in the area. Given my particular situation, what would be your recommendation regarding removing the wrinkles (laser or surgically)? Also, what would be your recommendation for the Restylane (& Cosmoderm) lumps and discolorations (laser, Vitrase for the Resty, or just leave it alone knowing I`d prefer not to go another year waiting for the fillers to dissolve - BTW, I know the fillers aren`t supposed to last so long, but they are and there was a lot of filler injected). Thanks in advance.

Answer:

I do nto think there is any problem doing the laser with the fillers in place. I do not think the laser will reliably affect even the superficial fillers causing the Tyndall effect. Best of luck. JG 10.12.08

Question:

I am a 59 yr. old white women. sun damage brown spots, aged fine lines.I have a very thin face, no extra fat. My veins & bones are visible in my face because my skin is so thin. Went to a dr. & he is suggesting I have Portrait done on face at high energy number 4 setting. Is this level of intensity-4 too high for my face because it is thin skinned ? What are the side effects of Portrait on my type of thin skin? I have read on your website something about burning & scaring & hyper pigmentation Under what conditions does burning & scaring & hyper pigmentation happen? Is it the doctor`s techniques or the patient`s skin? Thanks for your help!

Answer:

I think somewhere between 3-4 is where I would treat you also, the skin should do fine with that settting, just not on the eyelids. Hyperpigmentation can happen but much less chance in fair skinned people. If concerned you can pretreat with hydroquinone. I think as long as there is not alot of overlap of the sections it will be fine. Best of luck. JG 10.11.08

Question:

Portrait side effects:I have had portrait done on my face. It appears that my pores are larger & my face seems oily. Is this a common side effect of portrait? Will my pores evenually becomes smaller & my face less oily. Thanks

Answer:

in some cases that will happen while the skin is healing and trying to regain its normal moisture, it should subside in time, can use a moisturizer to help your skin moisturize and that way it will not need to make as much on its own. JG 10.11.08

Question:

I got a keloid scar from getting a piercing through my cartilidge when I was younger. I have heard that this is very common in these piericing because the cartildge is not supposed to be pierced. Do you think having this keloid will rule out my canidacy for getting full face CO2 resurfacing in the future as keloids are a contraindicitation.

Answer:

not necessarily a contraindication, no. JG 10.11.08

Question:

Hi Dr. G....thank you so much for all your info..I have been reading your opinion on ryhtec so I have a question for you. I am scheduled to do my face with portrait high energy joules setting 4.0 -1 treatment with Dr. Richard Fitzpatrick, one of Rhytec medical board members & clinical trial doctors. He has been doing Portrait since 2005!I am 58, very bad sun damaged brown spot and Ak`s plus fine line. Dr. Fitzpatrick told me he was going to do 1 treatment at 4.0 joules...does that seem too high? Of course I am concerned about scaring & hyper pigmentation.I had portrait done once before at 3.0, 2.0. 1.0 triple pass-1 treatment & the results were minimal.Have you ever done Portrait at 4.0 jules? What is downtime & what do you think of 4.0 joules? Also,he is going to do my neck, but he is going to use Fraxel Co2 rather than low energy Portrait. Dr. Fitzpatrick said Fraxel C02 was better because of the sensitivity issues with the neck? Does this sound reasonable? What procedure is the best results with minimal risk for lines over the lip C02, portrait, Fraxel c02? Thanks so much

Answer:

in some people that is what I do too, not on the eyelids but on the remainder of the facial skin, yes. I have done it at 4 and the downtime is about 12-14 days. I still prefer the Rhytec over the CO2 Fraxel on he neck though. I think for the lip lines I would do the deep Portrait. Best of luck. JG 10.10.08

Question:

I`m half italian/half scottish. Olive skinned but I do not hyperpigment when I get a cut or pimple. Any need to pretreat with hydroquinone before a 20 micron erbium peel?

Answer:

I pretreat everyone, in this case maybe two weeks. JG 10.10.08

Question:

What are your thoughts on prepping the skin with lighter peels before undergoing heavier laser resurfacing?

Answer:

do not think it is worth it. JG 10.10.08

Question:

Pixel®CO2 OMNIFIT handpiece and the Pixel CO2 machine provide fractionated (rather than pulsed or CW) output and significantly better results with less than three days down time.....What do you think? I think these are by Alma Lasers

Answer:

sorry, not a fan, better results compared to what other ineffective over-priced over-hyped machine on the market? JG 10.9.08

Question:

How shallow is the shallowest you go with the C02 peel? Can a shallow C02 be safely used on olive skin types.

Answer:

it can go as low as 30 microns but I would not use it on olive skin. JG 10.8.08

Question:

Hi, If I wanted to come in and do the lighter series of the rhytec, approximately how much down time each time? thanks!!

Answer:

each one has about 4-5 days before you can wear make up and then the next one is done two to three weeks after the treatment. JG 10.6.08

Question:

is Rhytec Portrait laser always done under anesthesia? if not, what is used? Should it be done only by a PS?

Answer:

when I do it lightly we use a topical anesthesia and when done deeply I put the patients to sleep. I think a plastic surgeon or dermatologist are good choices for the procedure. JG 10.6.08

Question:

Fractionated lasers drill tiny holes in the skin that can go much deeper than pure ablative treatments like CO2 (up to 2mm) but still provide much less of a result because the entire surface area is not covered. Do you see any point in going so deep for people with shallow wrinkles which are only a couple hundred microns deep? I have heard a lot of people complain about pin like atrophic scarring and hyperpigmentation caused by these deep fractional treatments. I would go for a Plasma treatment if I needed it and thought my skin could handle it, but my skin is already good, young, but sensetive and fitz type 3-4. I`m just looking for subtle results in texture and tone. Do you think a series of profractional treatments at no more than 150-200 microns in depth will drastically reduce the risk of hyperpigmentation and scarring but still do the same to help with the shallow texture issues I want to improve?

Answer:

well, I inherently disagree with your first sentence, if the CO2 laser is set to the strength you desire, it can go just as deep as the fractional laser claims, it is a matter of settings, not the machine itself. I strongly recommned not going any deeper than the skin so in many cases 2mm is way too deep. I persoanlly would not recommend the fractional laser, I think subtle resutls will likely be an understatement. If you do not need something like a Rhytec maybe you should stick with topical agents like Retin-A. JG 10.6.08

Question:

Dr. Garcia: I am scheduled to have a co2 Fraxel treatment next week. If the results are not good (and I hope thy are) how long would I have to wait to have a Rytec Portrait treatment, and would having the Fraxel treatment prevent me from having the rytec at a later date?

Answer:

I would suggest you wait about one month. Having a Fraxel should not prevent having another procedure in the future. JG 10.5.8

Question:

What do you think of the Sciton erbium for ablative resurfacing. It`s the only erbium available that allows for coagulation and you my doc says you can get some tightening with it like CO2 because of the coagulation.

Answer:

Erbium offers no coagulation and will not give the degree of improvement that a CO2 laser would, I do not agree with what you have been told. JG 10.4.08

Question:

Dr.Garcia: I am going to be having a full facial laser treatment done with the new co2 fraxel laser. My dermatologist says it goes 6 times deeper than the previous model and so far he has got good results from it. I am looking to have some acne scars smoothed out after having a series of punch floats done about 6 months ago. Originally I was leaning toward the rytec portrait but the downtime is less with the co2 fraxel. In your opinion is this worth the time, and will it smooth out the scars on my face. Since the punch floats were done they are much less deep than they previous were. How much downtime in your estimation am I looking at and do you think it will smooth out the scars to a good degree? As always Thanks for your expert opinion.

Answer:

Less is less, so in my opinion, especially for acne scars, if you want a visible degree of improvement, you need to have downtime. I cannot say to what degree your scars wil improve without seeing you in person but with a deep Rhytec, expect 10-12 days of downtime. Best of luck. JG 10.2.08

Question:

Which procedure will give the best results for skin tightening & wrinkles? FRAXEL C02 or RHYTEC. I have ruled out the plain c02 and I am trying to make a decision.

Answer:

I personally think the Rhytec will because it treats a larger area of skin. JG 10.1.08

Question:

hi again so sorry to bother you always but you have been great help. Today i went in to see my doctor for my pigmentation that i have gotten with the first fraxel treatment apparently she told me it not pigmentation, which is riduculous because she perscribed me Obagi C with 4% hydroquionne which is for hyperpigmentation. Also perscribed a coritisone which says on label 50 clind 2%HC1/2%moistrel. What is that exactly? I had some raw areas on my chin that inflammed so i assume for that but what is it really? And the redness does it just get worse from here or is it going to settle. They want be back in for 2nd fraxel in three weeks im freaking SCARED!!! They keep saying if i want to look tighter and younger which im only 32 that they have to do mediumm aggressive but i just want the fine lines and shallow scars smooth. So frustrated. Thanks!!!

Answer:

the cortisone she prescribed to you appears to be a combination with some hydrocortisone in it,also possibly clindamycin and the moistrel, I am not sure. I would agree that she is likely tyrying to treat the inflammation with it. As to giving you a bleaching cream and then telling you that you do not have pigment problem, I think you figured it out correctly. The redness should settle though. I would not do another treatment until all has healed without any problems. Best of luck. JG 10.1.08

Question:

I need skin tightening and wrinkle help for fine lines over my mounth and some crepy skin on my cheeks. Should I just go for the CO2 laser or will the top power of the Rhytec be the best for me. What is the recovery times on the 2 procedures. I want the best bang for the buck.

Answer:

well the CO2 will yield more dramatic longer lasting results but with more downtime and more risk, the Rhytec done deeply is a good option but will yield a lesser result.The recovery for the Rhytec is wearing makeup in 2 weeks and pinkness gone in one month, the CO2 is wearing make up in 2-3 weeks and pink for 2-3 months in many cases. JG 10.1.08

Question:

Hi Dr. Garcia, I am 44 yrs old with fine lines and some uneven skin tone. I have been in for a consultation for elos Skin Rejuventation and a skin tightening procedure. Both procedures are done by a technician at a spa. I am wondering if this type of procedure should be done by a plastic surgeon and also your thoughts on these types of procedures or better options.

Answer:

I think you should see a doctor like a plastic surgeon or a dermatologist to have the procedure done in oreder to get teh most drmatic worthwhile investment of time and money. JG 10.1.08

Question:

Hello, why are people claiming that they get fat loss from using fraxel or any other laser for that matter? Also is it better to take care of hyperpigmentation sooner than later after fraxel treatments and in between, thank you

Answer:

I am not sure to be honest, I can only surmise that is happened after the laser treatment and they are temporally related but not causally related. Maybe they were treated by a machine that they were told was a laser when it actually was a radiofrequency machine and they were not told correctly what they were having done. As to the hyperpigmentation, sooner is better, and prevention is even better. JG 9.29.08

Question:

hi ,thanks for getting back to me. Actually i meant if i use bleaching cream before and after treatments, i heard that effects the collagen remodelling and i would be adversing the effects of the treatments. Is this true/ My face isnt stiff and for the most part my face has all peeled does this mean hyperpigmentation? THANKS

Answer:

I have actually never heard or read that, it is commonly done to prevent and treat hyperpigmentation and it does cause irritation but I have not read anything in a scientific journal that says it lessen collagen formation. JG 9.25.08

Question:

hi, i just had fraxel about 12 days ago. Im super depressed about the bronzing is still there. If it is hyperpigmentation should i stop all the treatments. i have 3 more left only did one. All the websites say it can last 3 14 days if i go over 14 days am i pigmented. What if they my technician tells me otherwise should i continue. And i have sensitive skin and say they tell me to use bleaching cream will i be affected with using them as far as damaging my skin or fraxel not going to work effectively after. Thank you

Answer:

if it is uniformly bronzed and still stiff, I doubt it is hyperpigmented, just that the dead skin is still attached, got to give it a little more time. Bleaching cream works well for hyperpigmentation only and will not affect future treatments but for now, just use sunblock until the skin peels off. Best of luck. JG 9.25.08

Question:

Hi I posted the question on having a touch up with portrait plasma. If I understand correctly you are saying it is safe to have this touch up 4 weeks after first treatment. It has been 2 weeks post treatment. Can I have the touch up now? I have another 9 days off work and would prefer now if this would be safe. I had the high intensity psr3 with two passes done. And for anyone reading this, I am so extremely happy with the portrait plasma. The results are fantastic! Had terrible discoloring, melasma and white acne scars. My skin looks one color. I am truly amazed! Thanks again!

Answer:

I think it is safe to do it now as long as only the non-treated areas are covered with the Portrait, the surrounding area heat should not cause a problem this far out, and the longer you wait, the harder it is to see the areas that were not treated. Best of luck. JG 9.21.08

Question:

I had Portrait Plasma using the psr3. There is one square on my cheek that was missed and a strip across my jaw. The Doctor is going to do a touch up on those two areas four weeks following my first treatment. Is this long enough time to wait? My first treatment was high intensity and I am concerned about damage to the surrounding areas. I think I understand correctly that the beam of heat spreads out, meaning some of the all ready treated area will be exposed again. Is there any risk of damage having this so close together? Thank you!

Answer:

yes, it could even be done sooner. JG 9.20.08

Question:

hello Dr Garcia what do you think about elit laser? how go is it ?

Answer:

sorry, not a fan of it. JG 9.20.08

Question:

I was told I had to do my entire face with a CO2 laser and all I wanted really was to tighten the lower eyelids. I was told I will have permanent skin lightening. It will be the same shade as my buttocks or breasts, which have no sun damage. I`m afraid of looking like a permanent white ghost. Is this going to look natural?

Answer:

well, it is easier to match skin tone of the whole face is done and the tightening will never be permanent, maybe a couple of years, no matter what technique is used. JG 9.18.08

Question:

Hi Dr. Garcia.. I already had my face done with rhytec high energy.Now,I plan on having my neck laser re-surfaced. Based on reading websites, I understand that the neck is very sensitive and only low energy Rhytec can be used on the neck. (1)In your opinion, do you think Fraxel Re:pair will give me better results than Rhytec at lower intensity? What procedure do you recommend to be the BEST for the neck?(2)What procedure do you recommend for lines on the upper lip area? Thanks

Answer:

no, I think the Fraxel Repair will do less than the Rhytec. For the neck I use a lighter Rhytec or a chemical peel and educate the patient that their expectation of neck skin improvement needs to be tempered and is usually not dramatic. At times what you want is not possible. For the perioral wrinkles we use fillers, Rhytec ad CO2 laser. JG 9.18.08

Question:

Hi Dr Garcia, What do you think of the Pearl laser for wrinkles under the eyes? Thanks!

Answer:

I do not think too much positive of it I am afraid. JG 9.17.08

Question:

I have decided against all lasers. I`m thinking of just plain dermabrasion maybe-- will it help the fine lines above my lips? Also, does dermabrasion affect or improve collagen production?

Answer:

it helps by scarring the skin, if you are not willing to use lasers I am not sure why you would elect to have a procedure done that is more risky in all aspects than a laser would be. JG 9.16.08

Question:

Hi Dr. Garcia.. I already had my face done with rhytec high energy.Now,I plan on having my neck laser re-surfaced. Based on reading websites, I understand that the neck is very sensitive and only low energy Rhytec can be used on the neck. (1)In your opinion, do you think Fraxel Re:pair will give me better results than Rhytec? What procedure do you recommend for the neck?(2)What procedure do you recommend for lines on the upper lip area? Thanks

Answer:

Rhytec is better than Fraxel I feel. For upper lip lines I usually use fillers, then a Rhytec Portrait and then a CO2 laser. JG 9.20.08

Question:

Hello Dr. Garcia, is there a difference between N-Lite and other photorejuvination lasers? I have a friend who swears by N-Lite, but my derm dr. uses another brand. thanks for your guidance.

Answer:

I feel there is little to no difference. I personally think they are a waste of money. JG 9.5.08

Question:

I had Rhytec portrait done about 4 weeks ago-low intensity on my neck & face. Not real happy with the results so I re-thinking my decision to stop the lower intensity treatment & then go with a High intensity treatment instead. Is it too late to change to high intensity? how long would I have to wait to have a high intensity treatment. thanks

Answer:

high intensity treatments can be done on the face but not on the neck, sorry, but you can do a series, also, there will need to be about 3-4 months to see the new collagen form, so it is too early at 4 weeks to make a final decision. In most cases in weathered skin, it will take more than one treatment for the neck though. JG 9.3.08

Question:

Good Day Doctor Garcia....I have 2 blue nevi on the side of my face-near temple about 3 apart from each other. I have a history of skin cancer so I am thinking about having these 2 nevi removed & biopsied. My dermatologist wants to do a PUNCH and then 1 or 2 stitches to close up. Since it is on my face...do you think a plastic surgeon can do a better job with stitching techniques etc. to make the scar looks less noticeable. My dermatologist has no plastic surgery training so I think the he will just stitch it up with no special stitch etc. What would you do to minimize the scar if anything? Then is there any laser that can improve the scars? Thanks for your knowledge & opinion!

Answer:

I think the plastic surgeon will likely use more sutures at different levels and it might result in a better quality scar long term. There is no laser that removes scars, but they can fade rednesss if the right one is used. JG 9.1.08

Question:

I am in late 50`s and thinking about having a procedure/s done for severly sun damaged Skin on my NECK. The brown spot on my neck are so many that my NECK always looks tanned. I have read that the neck is very sensitive and care is need with any procedure. My NECK is tight so I only have a problem with skin.What treatment/laser/ etc would get me the best results on my NECK.

Answer:

A TCA peel, 30-35% or a Rhytec Portrait Plama treatment. JG 9.1.08

Question:

HI Doc..thanks so much for helping all of us out! You`re an angel.I am thinking about procedures for my face & neck...age: late 50`s white women...I just read some information on the new FRAXEL REPAIR . Is this a new machine? or using the old FRAXEL machine with different technique? It sounds like it does everything that Portrait plasma does (tightens skin, improve tone, rids brown spots & wrinkles)or is this just Marketing HYPE!!!. What do you think is better....Fraxel Repair or Portrait plasma? What are the side effects of Fraxel Repair compared to Portait..

Answer:

just another modification of the previous one that has proven not as effective as they claimed so they keep coming up with the new and improved. I think the likely side effect is being disappointed with the degree of improvements. JG 9.1.08

Question:

I am in late 50`s and thinking about having a procedure/s done for severly sun damaged Skin. The brown spot on my neck are so many that my tan always looks tanned. I have read that the neck is very sensitive and care is need with any procedure. What treatment/laser/ etc would get me the best results on my neck. My neck is tight so I only have a problem with skin.

Answer:

the only treatments I would do on the face for that is either a Rhytec Potrait Plasma or a TCA peel, no CO2 laser and I think the fractional lasers are not effective enough to warrant their use. JG 9.1.08

Question:

Dr. Garcia. Can IPL laser have same effects as the pulsed dye laser on a hypertrophic scar?

Answer:

yes, to a milder effect, but yes. JG 9.1.08

Question:

Should laser work be done by a plastic surgeon or is one of those med spas supervised by a doctor ok?

Answer:

some technicians in spas are experienced, you need to check it out, in some states, like California is can only be done by certified nurses or docotrs, if doen in a spa,makes sure the supervising doctor does the procedure as part of his normal practice and not just as a far away non-practicing cosmetic surgeon. JG 8.31.08

Question:

Hi Dr...In your opinion what skin conditions on the face and neck can be corrected with a YAG. Laser? Can YAG laser tighten skin? or improve skin tone? Can you treat the hole face & neck with a YAG laser? Like Fraxel & Porrait?Also, what are the side effects on the face & neck after YAG laser treatment>like redness, peeling, etc. How long does it take the side effects to get better? Thanks..you are the BEST!

Answer:

it helps brown and red spots, melasma, and maybe tiny little lines in younger patients is about all, no skin tightening to any appreciably visisble end. Are only pink for a few hours and the neck can be treated. Best to you. JG 8.29.08

Question:

I was wanting to know which laser you would prefere between the thermascan laser and the affirm laser . or if you think they are alot alike ect .. if they help rebuild collagen would that mean you would have to continue treatment regularly ? or is it a permenent thing ? i was really considering several of the thermascan laser treatments , mainly for a small scar and pigmentation . Thankyou Your The Best ! AS

Answer:

I would not suggest either, I do not think the amount of collagen they produce is orth the money spent. If it did improve collagen, since collagen is constantly degrading in the body, you would need to continue the treatments and the older you are the less the degree of collagen production would be for each treatment. JG 8.29.08

Question:

What are the lighter rhytec treatments used for?

Answer:

skin discolorations mostly. JG 8.28.08

Question:

Dr. Garcia, this isn`t a question, I just want to thank you so much for all your help. I almost wish I lived in Las Vegas so I could come see you, but I am afraid Vegas would cause my Melasma to go beserk! You are such a good doctor to take time out of your day to answer question. Thank you.

Answer:

thank you for the kind words and all the best to you and yours. JG 8.27.08

Question:

I was about to get the Rhytec Portrait Plasma treatment when I ran across this web site with the most negative and frightening comments I have ever read on a procedure. Have you seen it? http://www.medicalspamd.com/the-blog/2007/4/25/portrait-plasma-skin-rege...

Answer:

no matter what the intervention is there are always risks, if the procedure is done with the requisite safety precautions and in experienced hands the risks are reduced and complications are quite rare overall. JG 8.25.08

Question:

How long can you return to work after C02 laser resurfacing under eyes and on eyelids?

Answer:

depends on how deep they go, 7-14 days before make up. JG 8.22.08

Question:

Hi Thanks for you help in advance My friend is 58 white women. She has lots of sun damage, fine lines, smile wrinkles. She wants to improve her skin tone & texture...getting rid of sun damage & of course wants SKIN REGENERATION! She had portrait done 90 days ago. Portrait treatment was done at PSR3 ( 3 passes one at 3 joules, one at 2 joules, then 1 joules) It has been 90 days since she got portrait. Her faced peeled just a little and was pink in some areas after she peeled.The peeled area shows some improvement. Other areas of her face did NOT peel with minimum improvement-still lots of sun damage in these areas...at best, the brown spots might be a little lighter..some brown spot never lightened. If you looked at her face, you can see areas of sun damage/not just a few brown spots. So the areas on her face that peeled look better than areas that did not peel after the procedure. Question A.: Will the skin underneath in the areas on her face that did NOT peel, improve with more time? Does the skin have to peel to regenerate the skin? Anyways, that results she got were disappointing now that she waited 90 days. In the areas of her face that did not peel, she see little improvement if any. Question B. When do you think would be a safe time frame to do another portrait? What intensity joules would you recommend for her face and for her neck. Since the neck is so sensitive, what is the best improvement she can hope for on her neck....her neck has a lot of sun damage. Thanks so much for taking time to respond.

Answer:

I think the area that did not peel will likely reduce a small fraction of the fine lines that remain at this point but will not remove any more sun damage spots. In my experience the skin needs to peel for a dramatic effect. I think another Portrait after 6 months is fine, but if one did not do it, the second might disappoint also. Might want to consider something stronger like a CO2 laser, but that cannot be done on the neck though. As to the neck the best you can hope for is spot removal, the neck might be well treated with a TCA peel otherwise for the spots. Best of luck. JG 8.20.08

Question:

My sister had Rhytec Portrait done on her face & was disappointed with the results. She wants to do the procedure again with High intensity PSR3. Question #1: Not sure if the first Portrait procedure was low or high intensity portrait, so how long do you recommend she wait to have the procedure done again ? if she had low intensity?or if she had high intensity? Is the waiting time different depending upon the intensity(joules) that she had done the first time? Question #2: My sister also wants to have her neck done with Portrait because the first time she had Portrait done, she only did her face? Is the neck more sensitive and what intensity/joules level do you recommend?I have read horror stories on doing Portrait on necks! Thanks for your advice..you`re awesome!

Answer:

I usually suggest waiting 6 months before the next one. If she had a series of three light ones I would wait 6 months, and likewise for a single deep one. But if she had a deep one already I see no reason to repeat something that did not work the first time. The neck cannot be done as strongly so the changes will not be as dramatic. You have to go light on the neck, so it is more for spots than wrinkles there. All the best. JG 8.18.08

Question:

GOOD DAY Doctor Garcia...My friend ( age 59)is considering having Portrait plasma for her face & neck. In terms of BEST RESULTS for skin regeneration, sun damage, fine lines, etc..if she chooses PSR1 or Psr2 having a series of treatments can she achieve the SAME results as having 1 treatment PSR3.( NOTE:She prefers lower intensity treatments because of downtime & pain factor.) If not, what improvements can she expect with PSR1 or Psr2 having a series of treatments. Will she have any skin regeneration at the lower intensity levels with a series of treatment. Thanks

Answer:

well, a series of light ones will not equal one deep one, I think the deeper she is willing to have the better. I understand that she has concerns about pain and downtime, etc, but she needs to understand that therefore there will be compromises in the results too. There is no free lunch. JG 8.18.08

Question:

Hi Doctor G. It has been 6 weeks since I had Portrait PSR3 on my face. I am very frustrated with the results because my doctor missed areas of my face with the plasma heat. Large area missed on my cheek, middle of the center of my noise & between center of both eybrows, areas on side of my face near temple, and a few smaller areas on my face. It seems to me that he missed to many areas & it is very noticeable. My old skin was very sun damaged with lots of brown spots so it is very noticeable with my new skin. The missed areas are not blending in with my new skin because my old skin is just so bad. I am upset because of everything I went through with the post operative recovery and now the results are not very good. My doctor has not suggested anything to improve the results of the missed areas. What would you recommend?

Answer:

sounds like you will need another treatment done, it is usually best to wait 6 months but can be done sooner as long as you do not go too strongly. All the best. JG 8.15.08

Question:

I had Rhytec portrait PSR3/high intensity. on my face (face:thin skin, severe sun damges skin, with lots of brown spots -age 58) on Tuesday, 3 days ago.My doctor first did a 3 jules first pass, then 2 jules second pass, then 1 jules 3rd pass. Question #1: what is your opinion of the jules setting he used? Would it had been better to just use a high jules setting and do 2 passes to get better results? It is starting to become apparent that there are areas on my face with batches of my old skin (batches look like old skin-old skin not red, old skin nor peeling) that were not effected by portrait...some bathes are larger than others on my cheek, nose, I think that the redness on my face is very uneven, can almost see track marks of portrait plasma. Question #2: How do these batches get fixed . If the doctor has to treat them again with portrait, how soon can I have another portrait procedure on these missed batches? My face is starting to peel. Some of the NEW SKIN stings & burns when washed with Cetaphil gentle cleanser & reapplying Aquaphor. I did not expect to have my NEW SKIN sting & burn? Question 3#- Is this burning & sting of my new sting NORMAL, or did my skin peel too soon before the new skin was ready to come out? Thanks for answering my questions...appreciate your time.

Answer:

not an unusual setting use. Higher settings with lesser passes do not mean a better result, but it does increase risks. The areas you describe are likely skip ares, and should not happen too often when doing a session with multiple passes, those areas in some small fraction of cases might need a little touch up in the future. The untreated areas will likely blend in fairly well in the first month and I would not repeat the treatment for 6 months or so. The burning is normal,just do not try to peel or rub the skin off, let it fall off on its own and it will hurt much less. JG 8.15.08

Question:

Thanks you so much for answering our questions. You are very generous with your time & we all appreciate! I am 58 year old women that just had Rhytec portrait PSR3 (3 jules)done 3 days ago on face. I have VErY THIN skin, severe sun damage on face.... I was hoping the doctor would have used a higher setting because my face is covered with brown & aging spots from the sun.What would you have recommended the highest jules setting to use. Also, now as my face is browning up, I see areas that look like the doctor missed areas because it looks like my original skin..no redding or browning. If this area skin does not peel off & look like old skin with brown spots, etc, does that mean the doctor missed an area or did not hit the area with the same amount of heat/intensity? How does the doctor correct this problem, given he missed an area with portrait? What would you recommend to rectify missed areas? Thanks again!

Answer:

that should be enough to remove the spots. Skip areas are not uncommon, especially if a single pass was done and in most cases it all blends in over time. It will likely not need a touch up. JG 8.14.08

Question:

Hi Dr. Garcia. Had a lower bleph 2 years ago that left me hollow with crepey skin (seems like an epidemic of that going around). I`m in the process of going thru fat grafting (I know you`re not a fan -- I`ll let you know how it works out). I don`t think the fat grafts are going to fix the crepey skin based on what I`m seeing now. I`m thinking laser may be the only option -- is it ok to just get that done under the eyes? Will the skin then look different than the rest of my face? Rhytec laser ok for this? Thanks so much.

Answer:

yes, OK to do there, but that skin is thin so they cannot go too deep whch means it will last a couple of years and then have to be redone. Best of luck. JG 8.14.08

Question:

Thanks for answering my questions. I have fair skin and burn easily if in the sun. I have freckles also. Having CO2 laser resurfacing on entire face, I`ve heard horror stories of swollen and redness lasting months. Is this common. Some ppl have said it has lasted more than a year. What is your opinion.

Answer:

swelling is there for 2-3 weeks, as to the redness, it is depth dependent, the deeper one goes the longer you are red or pink for. In many cases like yours it can last 3-6 months, but can be covered by make up. JG 8.13.08

Question:

With Rhytec Portrait at high level and you are in your mid-sixties, is there a possibility that the damaged collagen from the procedure might not restore itself adequately--would the face sag in the parts of the damaged/non restored collagen? Would you recommend the Rhytec for older skin?

Answer:

I do not think it would cause any scarring. It will either do little, a reasonable improvement, or in a rare case could burn and scar someone. I commonly use it for older skin with the education being that the degree of improvement is not as much as a CO2 laser. JG 8.13.08

Question:

what are any post Rhytec Portrait possible negative side effects for the high power one time procedure? On 60s skin, will the healing process take longer?

Answer:

a burn scar that is permanent. JG 8.13.08

Question:

Sorry to bother you again but you forgot one question: I am the rhytec 58 yr. old women who just had portrait(face & neck). The doctor did my entire neck at 1 jules then did a second pass at 1 jules over the entire neck again QUESTION: Will the skin come off my neck at this 1 jules setting double pass? Thanks for your time.

Answer:

not always, it does in some thinner skinned individuals, but not in all. JG 8.13.08

Question:

What do you charge for CO2 laser resurfacing under eyes? Is it same price to have both eyelids and undereyes done?

Answer:

would need to see you in person, sorry. We charge the same for the entire eye region. JG 8.13.08

Question:

I had rhytec portrait PSR3 with a double pass on my face in some areas. The doctor used 3 jules setting entire face then went back in some areas with a second pass with 3 jules. Then He did my neck a 1 jules and did 2 passes over my entire neck. Then he went back to my face and used a 1 jules over my face again and told me he was feathering so that my face would be even. My face today is a little swollen and not very red. My face feels good & my neck is a little tender. I am 58 with thin skin on face, severe sun damage skin with fine wrinkles. Also, had some pre-cancerous lesions on my face. Question: I am concerned that the intensity/jule settings was not high enough to get the BEST results..what do you think of the jule settings the doctor used?? During my initial consultation he recommended 3.5 jules but for some reason used only 3 jules on my face. 1 jules seems low for my neck-what do you think? Will the skin come off my neck at this 1 jule setting? have you ever gone back to a face & do a final pass with used 1 jules to feather to get even results??

Answer:

those are about what I would have used, higher settings might give more dramatic changes but also has higher risk of scarring and pigment loss. At times I will back off on the energy setting depending on how the patient feels the pain, that is part of the parameter of how we set things, so backing off and then doing a second pass or a third is safer than going too deep, it is a matter of cumulative heat delivered. I do not routinely use the last pass at 1 joule but I have done it on occasion. Best of luck. JG 8.13.08

Question:

I don`t know if CO2 laser resurfacing under the eyes last 3-5 years? If so, should you get the procedure redone every 3-5 years? If you`re older, does your skin stop producing collagen so the laser resurfacing would not work?

Answer:

it needs to be redone if you need it from further aging changes.The older you are the less collagen the skin makes after an injury such as a laser. JG 8.13.08

Question:

I am a fair-skinned 59 year-old. Four years ago I had an erbium laser procedure on my face. When the dr. got down to just above my jaws(on both sides), the laser stopped working and he finished with aCO2 laser. I have curvy, irrigular scars on my jaws that basically have no pigment left. I`ve gone back to the original doctor because another doctor suggested I have Titan laser to repair the discoloration. When I spoke with the (original) doctor he said the Titan would not do the job, and he recommended using a Whisper Erbium laser on the areas to blend them into my normal skin color. Do you agree this is the best solution, and will it be a permanent solution? Thank you, Dr. Garcia!

Answer:

I think since what caused it was the CO2, that will be what wil be needed to correct it and blend the areas in by doing it a lighter settings. The Titan will do nothing and the Erbium is what you used and that left the areas unchanged, you need to use the one that changed the area. Best of luck. JG 8.13.08

Question:

Hi Dr. Garcia, Thanks for replying to my question yesterday about Fraxel Laser Resurfacing. If you don`t reccommend these types of lasers, what would you reccommend? Thanks again...

Answer:

Rhytec Portrait or a light CO2 laser. JG 8.12.08

Question:

Hi Dr.Garcia, I am considering having either the Fraxel Active FX/Restore Laser or the Fractional Non-Ablative Palomar Starlux System done on my face. I have received two different consults on this. I have fair skin, not many wrikles as I have taken good care of my skin. Just want some of the lines above my mouth and rough skin and lines between eyebrows and forehead removed or softened. One Dr. suggested the Active FX laser at $5,000 for the entire face. The other said 3-6 treatments at $200 a piece for the area around the mouth and forehead, eye area. Which laser would be best for me? Also,is it better to have the entire face done rather than just some problem areas on the face? Thank you for your advice.

Answer:

to be honest I think fractional lasers of all kinds are not worth it.I cannot in good conscience recommend either one. Sorry. JG 8.11.08

Question:

Isn`t the plasma Rhytec Portrait just another form of radiation used to resurface the skin? I checked Google and there is Plasma Radiation. So this is just another energy form to burn the top layer and secondary layers of the skin? C02, Yag are only different because of the sources used to obtain the radiation--but aren`t they all using radiation in some form? Thanks.

Answer:

no, it is a hot plasma, no radiation. Rhytec is not a laser where there is radiation but the radiation occurs inside the laser and not on or in the ksin so there are no radiation issues on the skin itself. JG 8.10.08

Question:

First & foremost, thank you so much for taking the time to answer all our questions. You have mentioned in your past answers that after the rhytec PSR3 that it is a good idea to apply creams with Copper Peptides. What do copper peptides do for skin? How long should you use the creams with Copper Peptides.PLease tell us specifically name the brands o these creams. I am scheduled to have my face & necks done with Rhytec PSR3 high intensity. My doctor is more a medical dermatalogist rather than a cosmetic dermatologist so he has not told me anything about follow-up SPECIAL creams & moistures for my face. Right after the procedure he only told me to put on aquaphor on my face/neck until the skin comes off then put Cetaphil moisturizing cream for sensitive skin on my new skin. Please tell me the names of the products/creams etc. that you recommend for your patients after Rhytec PSR3. In your experience, can any specific creams make a difference in the final outcome & results of the new skin? Thanks so much.

Answer:

Copper peptides have been shown to help speed the heaing process of the skin after a surface injury like a sunburn or a laser. We use them until the skin has totally healed, so for about 10-14 days, it can be used for one month if desired though with milder benefits after the two weeks. I think NeoCutis is a good brand but is sold only by physicians` offices. Nothing agianst your dermatologist, I am sure he is a fine physician, but I think it might be better to see a dermatologist who does these all the time. It is not that he cannot perform it well, it is more of knowing what is normal healing and what to do if something happens, you are better off with someone with experience on the cosmetic end. JG 8.8.08

Question:

THANKS FOR THE info on Rhytec Portrait. In your answer, you mentioned that there are many more common issues that are more worrisome in relation to the procedure. Could you share some of these worrisome common issues? I see nothing on Rhytec`s web site in regard to other issues.

Answer:

could you please refernce the question you asked previously as I want to make sure I refer to the proper Rhytec question. Or repeet the entire question wihth the additional points of new questions. JG 8.8.08

Question:

on Rhytec Plasma laser--what are the carciogenic/potentially cancer properties on humans from exposure to the thermal plasma gas that is used and/or any other properties on Rhytec procedure that could be harmful in the long term. Originally low levels of radiation were thought to be safe but of course now we are being warned to stay away from even too many dental xrays. I realize that Rhytec is not the same element--but what about thermal plasma?

Answer:

it is for milliseconds so the heat is doubtful to cause any cancer, there are many more common issues that are more worrisome. There is only heat and no radiation that I am aware of. It is more like hot water, very hot water. JG 8.7.08

Question:

on Rhytec resurfacing--have you ever seen it take longer than to heal up--say on older people-- than the 10 days? Does the skin turn brown even on the lower levels? When does the brown go away? What are any known complications?How much post opt pain is involved.

Answer:

it can if you go very deep, yes. The skin does turn brown with the lower levels but it comes off faster and there is less underlying pinkness. Minimal post-op pain after the initial 4 hours and the complications come only when the settings used are too high and a burn occurs, then you get all of the bad effects of the burn, such as thick skin and texture changes. JG 8.7.08

Question:

Your reply to my question regarding sunburst scar your Answer: I am afraid the only thing would be to excise the scar and skin graft it, injections might soften it but thats about it. JG 8.7.08 Question: What kind of injection? Would the redness go away? I am a runner so I do not want the downtime going through a skin graft!Thanks so much for your time.

Answer:

kenalog and or 5FU injections, the redness will fade a little with the shots, or a YAG laser could help with the redness too. JG 8.7.08

Question:

I had a skin cancer/melanoma (WLE) removed on the top of my left foot 3 years ago. I did not have a skin graft but let the WLE just heal no stitches. Now, I have a scar that is a sunburst shape. It is approximately 1 x 1 scar, raised and red. I am very fortunate that the doctor caught the skin cancer in time. Is there any procedures or anything that you can recommend to improve the scar.

Answer:

I am afraid the only thing would be to excise the scar and skin graft it, injections might soften it but thats about it. JG 8.7.08

Question:

My daughter has scars on her arms from cutting herself with a razorblade. Some are not raised and are even lighter than her skin color. Others are red and raised. I`ve gone to two laser spas. One said they use a Palomar Starlux lazer 500 with a 1540 arm. The other uses a combination of microdermabrasian and IPL FA. I dont` know what either of these things mean. What would you suggest?

Answer:

I think for the redness I would suggest an Nd:AYG laser or a VBeam laser, I think the microdermabrasions with IPL will do little good and the same for the Stralux in most cases. The scars wil be permanent, the best you can hope for is the redness to fade some. JG 8.7.08

Question:

Will several passes a lower intensities with Rhytec Portrait achieve the same result as the high intensity one pass? With high intensity pass underneath the lower eyelids, is there a danger of inverted lids if the skin is very thin? If so, how could it be prevented?

Answer:

I used to think so but now as time has gone on I feel the single deep will give you more than a series of lighter ones, at least for wrinkles and scars. I do high energy passes to the lids and that should not be a problem. JG 8.6.08

Question:

What do you recommend to your patients to put on their face after Rhytec PSR3 (high intensity) to keep face moist while waiting for the skin to peel off

Answer:

we use a copper peptide cream from NeoCutis right afterwards. As to moisturizers, we suggest using one that has no glycolic acids or retinols in it. Best of luck. JG 8.6.08

Question:

You mentioned a post-op kit in one of your answers.If the doctor performing the portrait procedure does not have a post-op care kit, I would be interested in purchasing the products myself. What is items are specifically contained in a POST-OP KIT? Thanks for giving us your time.

Answer:

it is Cetaphil cleanser, a copper peptide cream (NeoCutis) and and a bottle of atomized water spray(like Evian), he can get all of that for you, no need to buy it from us. JG 8.6.08

Question:

WHAT IS THE GENERAL PRICE RANGE FOR A FULL FACE HIGH ENERGY RHYTEC TREATMENT?

Answer:

$4500 plus the post-op kit. JG 8.5.08

Question:

OOPS, forgot to ask,,,if eyelids are done with portrait plasma, do the eyes need some sort of protection because the skin is so thin on the eyelids?

Answer:

typically no. JG 8.5.08

Question:

I am planning to have Portrait psr3 (high intensity) performed on my face and neck. When the doctor does portrait plasma around the eyes (crows feet) and below the eye brow area,,,,are doctors also doing plasma on the EYE LIDS or is that area too sensitive. Do you do the eye lids?

Answer:

I perform it there as well. JG 8.5.08

Question:

Thank you so much for the free info you give people...your are the best. I am a 58 year old women with very sun damaged skin. I am planning to have Portrait PSR 3 done to face & neck. Some drs. tell me that they will use eye shields that go into your eyes like contact lenses for the PORTRAIT plasma procedure. Are the eye shields necessary? Some other dr.s do not use them? What is your opinion? Do you use them for portrait plasma. Also, I have 2 blue nevi spots on my face. I raised & one flat. What will happen to the blue nevi & the skin over the blue nevi spots? Will skin grow back over blue nevi?

Answer:

I do not use them but use a protective barrier over the lashes and to avoid any gas blowing into the eye. The corneal shields are certainly OK to use, too. The nevi will likely be a little flatter and darker for a little bit but eventually return to the way they were and the skin over them will heal well. JG 8.4.08

Question:

Hi Doc. You are so kind to offer free advice.Which do you prefer the fraxel co2 or the plasma for hyper-pigmentation and laxity of the lower face with smoker lines on the upper lip. I am 54 and ready to do something but fearful of negative outcomes. I am a photo type II with thin skin. Help!

Answer:

Plasma, but the improvement for the laxity will be mild, no laser will do much there except a real CO2 done deeply, the Fraxel will not do it even if it has CO2, if it is going to work, it has to be totally ablative for the tightening. JG 7.31.08

Question:

I have had cystic acne for many years which worsened with early menopause at 45 and saw worsening of cysts. Went on Doxycycline, Spironolactone, Duac gel and Retin A. Have some ice pick scars, Recently underwent many punch excisions and 3 other areas where actual cutting was done to remove the inflammatory cystic abcesses, These are in chin area and one down the cheek. Prior to this I had 5 fraxels done with very minimal improvement, After scars healed the PS just did high energy Portrait Plasma. I see probably about a 35-40% improvement in the scaring. Definite tightening, less wrinkles and smoother texture (had a orange peel like texture before) I am now almost 3 weeks post laser - I apparently have a rather thick and dense skin- the PS says that in about 6 months I could do the plasma laser again. What might be your recommendation for controlling the cystic acne (any specific skin care products) meds.. The scars are still apparent. The PS says I could do the plasma again in about 6 months that might give additional improvement, I am at my wits end in trying to get a fresh, healthy glowing skin complexion. What can you recommend???? I do have Lupus, Fibro, and a severe erosive osteoarthritis that I have been having joint replacements as a result. Also have had severe Endometriosis (not been problematic since Menopause) What would your course of treatment be? Thank you so much for your expertise and support

Answer:

can try some progesterone cream and even Accutane for the acne, as for the repeat Rhytec, it is possible, otherwise a CO2 laser would be good. As to the healthy glowing skin complexion, I am afraid that will not be possible with anything you due to the damage already done. Sorry. JG 7.31.08

Question:

Hi Dr. Garcia, I got photo facial rejuvenation a week ago, and right around my cheekbones there`s redness that wasn`t there before. The doctors told me there might be redness for a few days, but it`s been a week now and it has not decreased. Is it possible that the laser could have burned the skin and that this redness is permanent? Thank you.

Answer:

the burn is a remote possibility, in most cases that will all go away in a few more days, stay out of the sun in the meantime. JG 7.31.08

Question:

I have another question re: the puffiness caused from laser resurfacing. I was told that cold laser might possibly work on the swelling. Do you think this could help along w/ the ketoprofen cream even though the last laser resurfacing was almost two years ago. Could the swelling get better over time even on its own? Thank you for your helpful information - SLT

Answer:

I do not think it will do anything, sorry. JG 7.29.08

Question:

I have another question re: the puffiness caused from laser resurfacing. I was told that cold laser might possibly work on the swelling. Do you think this could help along w/ the ketoprofen cream even though the last laser resurfacing was almost two years ago. Could the swelling get better over time even on its own? Thank you for your helpful information - SLT

Answer:

I have not seen laser help with swelling and the ketoprofen will not always work, it is more for pain than anything. In your case especially since it is so long from the injury. JG 7.29.08

Question:

What is the difference between fraxel repair (the co2 one) and the deep fx? Is one better than the other for any reason? I know you not a fan of these fractionated lasers but which one would you choose, the repair, deep fx, or total fx?

Answer:

no real difference, prety much the same, neither very effective. The Fx CO2 is stronger but since there are so many skip areas it will not do much either. It is not the type of laser used that makes fractional lasers ineffective, it is the amount of non-treated skin. JG 7.27.08

Question:

I had a CO2 laser in the mid-90`s--good results. I had 5 fraxel treatments in 2004--big disappointment. I am now considering a fractional laser treatment. Is it safe to have that many laser treatments? Thank you for your help.

Answer:

depends greatly on you skin and age, I think you will likely be disappointed with a fractional laser as that is exactly what the Fraxel is, a fractional laser. JG 7.26.08

Question:

Dr.About 15 years ago I had Dermabrasion on upper lip I was left with lighter skin. Is there any was to reverse this? Thank You

Answer:

sorry, but no, there is not. The melanin cells have been damaged and there is not much that can re-establish that for you. JG 7.22.08

Question:

Thank you dr garcia if IPL wont get rid of wrinkles what other treatment would be ok as I have rosacea, is there any other laser to help which wont hurt my skin.. I was told to have fraxel by a surgeon but have heard its not very good.

Answer:

I think any laser, no matter what they tell you, if it is going to help the wrinkles, will make the Rosacea worse for awhile, if it does not, it will not do anything for the wrinkles, sorry. JG 7.21.08

Question:

Hi Doctor, Thanks for giving us your time. I have naturally fair to normal skin but now have hypopigmentation from a bad ebrium laser procedure on my face about 2 years ago. Couldn`t I just tan my skin to bring the pigmentation back rather than paying a lot to lighten the darker spots which aren`t very dark?

Answer:

well, if the melanin cells in the skin were damaged, exposure to the sun might make the unaffected skin darker and not allow the damaged skin to get darker and it could make the scenario even worse, sorry. JG 7.21.08

Question:

Dr. Garcia in reading your responses to questions refering to laser resurfacing you seem to be more in favor of the CO2 laser and the Rytec portrait than the others. In your opinion how much downtime and redness will the the Rytec produce, and is it a good laser to use in smoothing acne scars. Also what is a ballpark price for the procedure?

Answer:

I think the improvement from a deep Rhytec for acne will be maybe 50% at most and the redness will be gone in one month. Prices will vary from office to office but usually about $4500 or so. JG 7.19.08

Question:

Hello Dr. Garcia, I had one very aggressive and expensive fraxel re:pair treatment done under my eyes 3 weeks ago. I still have redness and puffy bags under my eyes. Is this normal? When can I expect thing to improve? Sue

Answer:

well, if done too agressively , that can be normal, as to how long it will last, it will probably take weeks but I cannot say as there are variations from patient to patient and it also greatly depends on the depth of the treatment. One has to wonder why the doctor would do a very aggressive Fraxel treatment when the technology is marketed as a minimal downtime procedue. Seems to me that he had one hammer and you became the nail. A more appropriate technology along with better preoperative preparation for post operative healing should have been entertained.JG 7.19.08

Question:

Hi Dr. Garcia, I was curious as to what you think about the smooth beam laser on individual very shallow acne scars and if you think it will help. Also I have heard that if one was to stay on a retin a regime for a lengthy period that it could help improve the apperance of acne scars, is this true? Thank you

Answer:

I am unimpressed. Retin-A does help control the acne and does improve scars a mild amount. JG 7.18.08

Question:

Dr. Garcia I am planning to have laser surgury(Erbuim) in the next 2 weeks. What I want to know is will this sufficently smooth out acne scars that I have on my face, and how long will the improvement last. Three months ago I had punch floats done to reduce pitted scars on my face and this worked well, except as you know a pitted scar has been replaced by a semi raised scar. I am 53 years old also so would that have any effect on the outcome. Also lastly how long will my face be red given that the doctor is using a moderate amount of exposure to the Laser. Thanks.

Answer:

once the swelling goes down, I have never seen Erbium yield a worthwhile improvement for acne scars. The redness will vary on the depth it is performed to, I would guess one month or so with a moderate depth application. JG 7.18.08

Question:

Hi Dr. Could you please tell me, what % of improvement one can expect after a Erbium Yag Laser treatment ? How many times/treatment ? How long will the results last ? I am looking for a younger smoother skin texture Thank you

Answer:

maybe 10-15 %, might last 18 months after one deep treatment. JG 7.16.08

Question:

Hi Doctor. i have small pock marks on my face, they look like big pores/little holes. i`m not sure if they are deep or not, but they don`t look very deep, i think...i just got a treatment with the Palomar Lux1540 Fractional Laser which i was told would help fill in these little holes. i was wondering if this was true? and if there are any short term or long term side effects? and whatever suggestions you have would be appreciated. thank you!

Answer:

I am afraid that you will be disappointed. No short or long term negative effects though. Might be better with punch excisions and then a CO2 laser. JG 7.14.08

Question:

I am 40yrs.old and have deep acne scarring. I have always been self-concious so I went to a ps about 5yrs. ago in hopes of improving my look. He performed punch excisions and laser resurfacing(C2O) Little results. Last year I opt for dermabrasion(different ps) there was absoutley no results.(except a white line under my nose) I then suggested excision of some of the bigger holes. I assumed he would do punch but he did scapel excision instead.Now I have long linear lines on both of my cheeks. I was trying to improve the appearance of scars and now I look worse! Honestly, I don`t know what to do. He suggests doing a second dermabrasion. This has me really depressed and I am tired of wasting my money with no results. What do you suggest for me to do? Thanks so much for your advice.

Answer:

I do not perform regular dermanbrasions anymore due to too many variable, I only do excisions and CO2 laser as you have had done I am afraid. JG 7.12.08

Question:

Dr. Garcia, What are your thoughts on the outcome when using C02 laser resurfacing for surgery scars after they have flattened out and faded somewhat in redness if scar revision is not an option? Thanks.

Answer:

well, my honest opinion is that option has never made any biological sense to me. CO2 lasers work by essentially heating the tissues to shorten collagen fibers and try to create new collagen to tigthen the area. In a scar, there is injured tissue and the ability to develop new collagen or tigthen what little collagen exists is severely depressed. It might appear to help in a small subset of cases where the CO2 laser causes swelling and makes it look smoother, but once it heals, the best you can expect is likely the same result you would have gotten without the laser. In some cases, it will actually burn the scar and create an even worse scenario. I would not do it myself. JG 7.10.08

Question:

Hi Dr. Garcia, I am contemplating getting Fractional C02 for some scars on my face. I am Indian and darker skinned. I will be getting a test spot done first to see if I have any hypopigmentation problems or hyperpigmentation, I am more worried about the hypo. My doctor has told me that different parts of the body would react differently to fractional CO2 I believe because of the thickness of the skin in different areas. I do not want the test spot done on my face. Is there any place you would recommend (back, chest, arms, etc) that might give similar results in pigmentation upon getting fractional CO2 as the face. I have done quite a bit of research on this on the internet and I realize that the face is different than the rest of the body. Nevertheless, any information/insight you could provide would be greatly appreciated. Thanks and have a great day.

Answer:

well, I think a test site is totally wasted as not all of the skin on the face is the same thickness so you cannot genralize one spot to the entire case. I also think that the effects you might get will be very minimal, in fair skinned individuals where they can go more aggressively, the results are minimal once the swelling has resolved. In your case, since the nergy has to be decreased,the results will be even less. JG 7.9.08

Question:

Hi Dr. G, Again thank you so much for this web page. You are such a helpful resource. My question is regarding Fraxel Repair Co2 Laser. I was told that is the new great procedure to get rid of wrinkles and have your skin looking years younger. What is your opinion on this laser treatment? Are there any adverse side effects? How long does it last? How effective is the procedure in reducing wrinkles? I would like to have my face, neck and chest look much younger. Do you think this is a good choice for me. I just turned 46. Would I still need to have Botox and fillers after Fraxel Repair c02 laser treatment? I was told the procedure is preformed only one time with amazing results. Thanks so much! LL

Answer:

I am not impressed with the degree of improvement to be honest, the results are dramatic, but not predictable I feel, in many patients the degre of improvement is disappointing. I think the fillers and Botox will still be needed in addition, yes. One more thing about Botox. It has come out that the education that injectors were given since the beginning of Botox release was incorrect. The bottle is to be used for a single patient. That means that a bottle should not be shared between multiple patients. The company that makes Botox has known about this but has never issued an alert to doctors or patients. The risk is that of the bottle becoming contaminated and passing a communicable disease like HIV or hepatitis from one patient to another. There are no known reports of disease transmission in the use of Botox, but it has not bee looked at yet in order to determine that issue. For that reason I strongly urge you to demand that a new bottle be used when you are treated and then observe the injector destroy the remainder of the bottle. If that is not done I urge you to contact the local board of health for the violation. Ask to look at the box it comes in and you will see the single patient, single use wording. JG 7.5.08

Question:

Ive had 3 fraxel treatments approximately 4 months ago and have noticed that my skin has a greyish tone that was not present before the laser. Also my capillaries seem to be very sensitive and my cheeks flare up everytime I am in a slightly warm environment. Any advice on how I can get rid of the greyish skin tone and desensitize my capillaries. Thankyou.

Answer:

might want to try a series of YAG lases to improve all of that. JG 6.30.08

Question:

I am a 53 year old female, fair complexion. My skin condition is very good but I have a fair amount of laxticity and lots of perioral/lip line wrinkles (which I think were perpetuated by electolysis done years ago; My face at a glance: -slight hooding of upper eyelids; left eye more severe -one dominant line under left eye and more visible crows feet at rest at left eye -deep tear troughs, loss of volume along periorbital bone up to eye -slight jowling and slightly loose neck on left side I have had a consult for a full face deep pass Rhytec (cost $3800...seems like a lot of money); full face combo of Active FX and Deep FX (cost $2800); erbium around perioral and under eyes($2000); or perioral CO2 ($1500) along with option to address undereye hollows with lower transconj bleph with SOOF technique or try first to fill in with Radiesse. Also Upper bleph or lateral browlift to address upper eyelid hooding; My brow position is good. I`m also considering a mini/quick-lift (skin and SMAS only) or minituck (skin and deep plane). Your opinion would be sincerely appreciated.

Answer:

If you have lost fat then the surgical lifting will not help the fullness aspect, just the skin. Might be best to have the Rhytec and then Sculptra to fill the cheeks back up. JG 6.28.08

Question:

My tummy tuck scar is 2 years old and still has red and hard places in it. About 2 months ago my PS injected cortisone in the scar tissue to soften it. It has helped a lot but I feel he should inject it again. He said though that it didn`t need it and it will continue softening. I have seen on this website that it should be done every 6 weeks.. So my question is: My family Dr. has offered to do the injections into the scar tissue to help speed the softening process. Do you think I should wait to see if it continues softening or let my family Dr. do it? Can there be a bad consiquence for doing this besides infection etc? Shes also going to be going over it and the belly button scar with a laser for the redness using a yag laser. Thanks for your advice. :)

Answer:

well if it is still hard I think proceeding with more injections is OK, just have the use a dilute concentration is all. JG 6.28.08

Question:

Hi Doc. I`m so confused. Regarding poikiloderma and your suggestion of glycolic acid, is that to help redness? Because I really only have redness, not brown. Secondly, is the risk of lasering that area that it could be performed by a person who isn`t skilled or is the risk still high even with a skilled person? Thanks!

Answer:

not, to settle the small lumps, it will not affect the redness. The risk of the laser is not due to the person performing it, it is the laser itself as that skin does not heal well from lasers. It might for the redness if doen very lightly, but not anything for the small red bumps. JG 6.24.08

Question:

Hi again Dr..........I just wondered....Is laser resurfacing the way to go for around the eye wrinkles. And is it safe to have this procedure if I have rosacea. Also.....is it painful and how long is the healing process.

Answer:

I think it is the most effective, safe to do with Rosacea too. The healing proces and pain is all dependent on the depth, the deeper you go the greater the pain and recovery but the greater the improvement too. JG 6.25.08

Question:

dr. i asked you earlier about the birthmark,and the hyperpigmentation that occured. you say to go for stronger , but isnt` that what caused the hyperpigmentation in the first place? is a yag the only laser you would recommned? is there another laser that is safer and non invasive? what clearing bleaching cream would you recommend meanwhile, over the counter store creams are not helpful!!

Answer:

yes, but you will need to go through that to eventually get it to lighten, there is a trade off, I would use the YAG, yes. As to the bleaching cream, I suggest hydroquinone, but it is a prescription. JG 6.24.08

Question:

Hi Dr. Garcia, A little over a year ago I had CO2 resurfacing done for acne scars on my face. Is it possible that the procedure could uncover scars that weren`t visible before? Because I have a couple of new ones that look just like my other scars but weren`t there before (I have pictures before and after to compare). I also feel like the scars I had look even more visible! Is this possible? Have you ever heard of CO2 creating hypertrophic scars or accentuatig old scars? When CO2 does scar, what does it look like? I`m very disappointed to feel like I look even worse than before :(

Answer:

I have never seen nor heard of CO2 allowing unseen scars to surface, and although most patietns do see improvements of their scars, it all depends on how deep the laser was performed to. If not deep enough, the results will not be visible. If CO2 lasers scar they are typiclaly seen in 6-8 weeks and are raised and red, like a burn scar. JG 6.24.08

Question:

Dr. Garcia, i did a a couple yag lasersfor a lesion that i thought was a hyperpigmentation, it turns out it is a birthmark. they did the yag laser on it, however for this last time it turned darker or hyperpigmented more. know the nurse practioner is asking for me to go to a dermatologist to make sure lasers are safe for it. What would you recommend? I believe doing a lighter laser would reverse the condition right? i believe the last setting was too hight. Please give me some piece of your expertise. i really feally so horrible at this point. is this reversable at least to its original condition?

Answer:

I do not think a YAG laser will harm it in the long run, and it will likley need a longer series of treatements and likley stronger than the YAG, not lighter. You might have some temporary post-inflammatory hyperpigmentation, not uncommon with lasers. Should get better in time and avoiding sun.JG 6.24.08

Question:

Hi again. One more question about my poikiloderma. It sounds to me like I`m stuck with it. Or do you sell or know of any products that will help it to fade or is there anything at all I can do to help myself (besides sunscreen, which I`m doing like crazy) Thanks again :)

Answer:

it is a chronic thing, can be contolled, but never cured. Typically glycolic acid products do well with the control, both cleansers and topicial creams, all OTC, no one brand better than others. JG 6.23.08

Question:

Recently I had a small test spot done on my face about the size of a postage stamp with the FX Fraxel laser to see if there was any improvement to a scared area of my face. I also had an Erbuim laser used to smooth a few scars on the other side of my face to see which one showed the most improvement. As of now the Erbuim seems to be the best as I can not tell much of anything changed with the FX. My question is first would you recommend the Erbuim or possibly an Portrait Laser for its smoothing ability. And secoundly and of equal importance how long would the redness last with the Portrait, as for now I know how long it lasts with the Erbuim? Thanks.

Answer:

I would suggest the Portrait as more effective, especially if doen deeply. The redness with the Portrait, as with all lasers, depends on how deep one goes, in most cases when done deeply, the patient can wear make up in 10-12 days and the redness is gone in one month. JG 6.23.08

Question:

Hello Doctor, Is a light treatment of the Lumenis Encore laser(fractional CO2) safe for Asian Indian skin for scarring on the face? Have you ever used a CO2 laser in people of darker complexions. My doctor said that the Encore laser is safer than the original CO2 laser. I am worried about hypopigmentation. Any advice you have would be greatly appreciated.

Answer:

well, safe is relative, I would not do it myself. I think it is safer than the older CO2 but the degree of improvement is also much much less. JG 6.23.08

Question:

What are the portrait express procedures supposed to accomplish? Do you recommend a series? How far apart? Also does this affect previous fillers? thank you!!

Answer:

as to whether a single deep or a series of three lighter ones is indicated depends on the patient`s needs and limitations, I prefer one deep one but it has more down time, it helps with fine lines and brown spots, It should not affect the previous fillers though. JG 6.10.08

Question:

Hi Dr. Garcia, Thanks for answering my question. I was the one who is finding my face getting red while exercising and while in the sun one year after my last of three fraxel treatments. The doctor I went to hasn`t done a good job of explaining why this is happening and he is now recommending Vbeam for the redness. Do you know what might possibly be causing the redness (I assume it is from the fraxel however I dont quite understand what is happening). If I am informed of this I think i can make a better decision regarding whether to go ahead with the vbeam because the steroid creams and plexion washing solution he gave me is not working at all. Thanks so much for you time.

Answer:

I think the steroid cream will not help, and could make it worse. I think a series of IPL treatments is safer than the VBeam and would try that first, the VBeam might be needed if not, but I would suggest going with the least risky option first. It certainly could be a reaction to the Fraxel and millions of little holes made in the skin. Also avoid any skin irritants like Retin-A and retinols too. Best of luck. JG 6.9.08

Question:

Hello Dr. Garcia, I was wondering if I`ve already had the PSR3 done on my upper lip a couple months ago and it doesn`t seem to have made a big difference (if any at all) in my lip lines... What would you recommend to fix them? They are not deep but they bother me! Do you think another Rhytec PSR3 would help or something else?? thanks so much!

Answer:

I would step it up to a CO2 laser. JG 6.5.08

Question:

Hi Dr, i`m the woman who asked about the obliteration of pores due to a dermabrasion, and you replied saying that is was essentailly a scar, does this mean that the doctor went too deep and left me with areas of scar tissue, or is this essentailly what dermabrasion does anyway? many thanks

Answer:

sorry, but that is correct. It is not what dermabrasion is supposed to do, the risks of that are much higher with dermabrasion than it is with laser resurfacing. JG 6.5.08

Question:

Hi Dr.Garcia, I have fairly good skin except for I seem to get a number of deep whiteheads imbedded beneath my skin, what are your recommendations for eliminating these, I do have fairly sensitive skin and a mild form of rosacea. I am also wondering if there are only a few small areas of acne scars on my face can the co2 laser just do select areas or will it be uneven with the rest of my skin?Thank you.

Answer:

they are probably related to the Rosacea and they will be difficult if not impossible to treat with topical treatments if they are below the skin. As to the acne scarring, yes spot treatments of CO2 laser can be done but the color there will be red for months and will be difficult at times to hide with make up. JG 6.4.08

Question:

Hi Doctor, I had three fraxel laser treatments the last of which was in April `07 for acne scarring/bad skin. I stopped after realizing the treatment was utterly useless. My problem now is that I am finding that my face gets red extremely easily, especially when I am exercising or am out in the sun even with sun tan lotion on. The doctor gave me desonide cream, which did`nt do much. Now the doctor says that 1 or 2 vbeam laser treatments should help. I have Asian skin, not sure if this makes a difference. I`m kind of stuck, don`t know what to do, and getting red all the time is really starting to bother me. Thanks a lot, you are a very knowledgable and generous person.

Answer:

the steroid will not help and I think the VBeam, done lightly is certainly an option. Best of luck. JG 6.3.08

Question:

Hi Dr. Garcia, To avoid less down time if I were to have a series of psr 1 treatments for my acne scars would it work out to be the equivalent to one big psr 3 treatment?I am fair skinned and 26, with mostly shallow acne scars. How much more improvement do you see on acne scars with a co2 laser procedure versus the psr procedure? Thank you.

Answer:

sorry, but a series of weaker ones does not equal one deep one as the heat is needed for collagen formation and shrinkage. I think the CO2 laser yields about twice the improvement as the deep PSR. JG 6.2.08

Question:

Hi Dr.Garcia, I am 26 years old and have a problem with acne scarring. My scars are mostly shallow with the exception of about five ice-pick scars. I have had four fraxel treatments, a number of ipl, smooth beam, micro-dermabrasion and v-beam treatments done over the years and nothing seems to work very well. I was wondering what your best suggestions would be to eliminate the scars the best?I was considering some psr treatments or coollaser treatments. Thank you for your help.

Answer:

excision of the ice pick scars followed 6 weeks later by a CO2 laser. I would not have expected any of the options you have had done to yield much improvement. Save your money as to the Cool Laser, the PSR will help some, less than the CO2 though. JG 6.1.08

Question:

if no light or radiation hits the patient in laser resurfacing--why is protective eye gear required. I also read an article that said the reason nurses did most of the lasering is that the long term effects of being near the lasers with the radiation inside them could have negative outcomes. Thanks for your patience. a

Answer:

because there is a focused light that is set to hit a certain color and if it hits your eye the retina can be damaged. If you understand radiation, you would know that lead will block the radiation and no eye protection worn is made of lead. Teh reason nurses do most of the lasers is that in most cases it is for financial reasons, not anything to do with radiation. JG 6.1.08

Question:

you state previously that lasers have no radiation ; yet, in many articles-- such as this one describes a laser as a device that stimulates atoms or molecules to emit light at particular wavelengths and amplifies that light, typically producing a very narrow beam of radiation. The emission generally covers an extremely limited range of visible, infrared, or ultraviolet wavelengths. How do you account for this defination? My consultation on laser resurfacing said it was a form of radiation. Please explain. Thanks.

Answer:

that all occurs inside of the machine which is shielded and never is applied to the patient so it has no effect on the patient. JG 5.31.08

Question:

What is the reality check on the amount of radiation /microwave/radio energy that comes from facial laser devices? Just recently on Larry King, the cell phone useage was noted as a possible threat of brain cancer. Isn`t radiation--radiation--from where it comes from? Do we have any long term studies on the Co2 laser and any cancer connections--nose, mouth, skin, etc....? something to think about. Is any dose of radiation safe?

Answer:

there is no radiation from a laser. JG 5.30.08

Question:

When doing co2 laser resurfacing, how many passes do you do?

Answer:

it will depend entirely on what I am trying to achieve and the patients needs and skin quality along with their age. JG 5.30.08

Question:

Hi Dr. Garcia, With a Co2 laser treatment - what is the minimum micron depth for the skin to receive a tightening effect?  Or put it this way - what is the micron depth when the skin starts to tighten, if you were using Co2 ?

Answer:

likely 150 microns. JG 5.30.08

Question:

Hi Dr Garcia, My upper cheek/eye area was slightly burnt by a peel in January, and I think I have made matters worse by using retin a. `Chunks` have been coming off my skin and now I have a lumpy bumpy/liney appearance on quite thin skin. I am seriously considering getting portrait in this area. Is this procedure okay on thin skin? Do you think it will be helpful to treat what I have? Is one deep session okay for thin skin? Thanks very much :)

Answer:

I would stop all irritants and use a copper peptide cream before continuing to irritate it with plasma or lasers, let it heal as much as it can on its own first. JG 5.30.08

Question:

Hi ive had 3 fraxel treatments for acne scars. Im confused as my skin appears to have a purple reddish appearance which gets darker as the day goes on. Any advice for treatment?

Answer:

I think you need to stop the treatments and let the skin heal totally before considering anything else. It is due to the trauma from the laser used. JG 5.28.08

Question:

hey doc, will co2 help with the small capillaries on the face? i have some small ones on my top cheeks..

Answer:

nope, might make them worse. JG 5.28.08

Question:

What is the pros and cons of potrait plasma rejuvination?

Answer:

brown spot and fine wrinkle reduction is good, at times though, if the skin is very damaged, the degree of improvement is not as much as desired. Shorter healing time versus a CO2 laser. JG 5.27.08

Question:

hi, You say that with co2 laser or with rhytec you will have to go deep to get the best results. However later to my understanding from what you said , the risks are very high in getting scars or other problems with the skin if the setting is too deep ... I like the way you explain any treatments... can you please simplify this for me? does it mean that you`ll need to take the risk for good results and something wrong can happen if its too strong?? thankyou

Answer:

well, since CO2 is stronger and can go deepr, the chances of scarring and loss of pigmentation are greater. For that reason the CO2 laser is usually done to a depth where the improvement will occur but lessen the risk of the problems. The Rhytec is safer as it is weaker, the CO2 can be done at a weaker setting to simulate the Rhytec but then the results are closer to the Rhytec. In short, if you want dramatic resutls, you need to accept the risk. JG 5.25.08

Question:

helloo dr garcia.... WHen asking for laser treatment of any sort like co2 or rhytec do patients need to know how deep or what strength the ps suppose to perform the treatment.. because i never had a laser treatment and i really want to but i dont know anything about what to ask for?? i mean, i was reading and it says you have to know what part your face you want to work on...etc well i want all equal improvement at its best on my entire face if im getting it done. Do i have to just say i want it done more on my eye area? when asking for a entire facial laser treatment wouldnt you want a high quality performance on your face?? and who wouldnt want a tighter skin all over there face? do they ask these questions to trick the patients or to work less on the other parts of the face???

Answer:

the depth required is based upon the expereince the docotr has with the laser and your skin`s needs. I do not ask trick questions but if you have specific areas of concern, you need to tell the doctor of that before they do the procedure to make sure what you desire is atainable. JG 5.25.08

Question:

Hi Dr. Garcia: This question regards using an IPL to remove what my doctor now says is broken blood vessels under my eye resultant from recent facelift. Since I have already had a phenol peel under the eyes plus a full face CO2 laser resurfacing, I am terrified that this reddish-blue area under my eye (about the size of a nickel) will look even worse. (I had terrible hypopigmentation on my right jaw and ice-pick scars on my left temple from the CO2 laser). My dr. said to wait 6 more weeks to see if this area fades before we do the IPL. What do you think the risks are if he sets the temperature at a conservative setting and only does one pass? Also, exactly - in your opinion - is a conservative approach? Lastly, if I can get to Las Vegas could you look at it? Thanks alot. 5/25/08.

Answer:

I think the IPL is a good idea and should not result in loss of pigmentation. I can look at it for you, or you can send me some photos to drgarcia@lvcosmeticsurgery.com JG 5.25.08

Question:

Dr.Garcia - My name is Donna Babson. I am 62 years old. I was burned in a fire when I was 3 months old. I finally would like to see if there is some tyoe of cosmetic surgery, i.e. lazer or Potrait that would diminish, or eliminate wrinkles and some scaring on my face. I have been told that co2 lazer would be the best for me. What about the Potrait procedure? Would it be just as effective, but with less down time?

Answer:

Portrait is less effective than a CO2 laser but is safer in most cases. What can be done will depend greatly on where the skin was burned and where the wrinkles are now. JG 5.25.08

Question:

Hello Dr. Garcia, I have two questions. My dermatologist put me on accutane 1 pill every 10 days. I am 58 years old and still have breakouts. But after my 4th pill my skin became very dry and even though I am using moisturizer it is becoming more lined. I have very textured skin and deep pores. The Dr. also said it should close the pores. It has to some extend but some of the pores have created a deep line where 5 pores have sunk on my cheek in two places. I recently had the pores filled because when I smile this line of pores opens up and it looks terrible. The dr. said it was a rolling line or rolling pores. Anyway, I had it filled with collogen 3 days ago and it looks worse. Is there any way to get rid of these rolling lines I am really self conscious when I smile. When I called to say this area looked worse, I was told to come back in 3 weeks once the collogen settled. My first question is can the accutane being ccausing this problem with the pores because my skin is so dry? 2nd question, is there any surgery to fix these lines that roll on my cheek. I have taken 4 accutane pills in about 5 weeks. How long would I have to wait if surgery or laser is possible. Thank you, MG

Answer:

it is very difficult to tell without seeing you in person what I would suggest to improve your problem. I think that regimen of Accutane is unusual to say the least. I also think whoever suggested filling in the pores with collagen is confused, that will not work and can make the scenario worse. Also, collagen does not need to settle, it is there at the end. Accutane can in some people help reduce new dilated poes from starting but it does not really help the pores that are aleady plugged. The Accutane is certainly causing the dryness and irritation but likely not the pore issue. I think if you were contemplating surgey or a laser, since the amount of Accutane you have taken is low, a few months is all that would be needed to wait. JG 5.24.08

Question:

Shoot! I`m really having a problem posting my question. About the Copper Peptides. The first product was the Neova Therapy Copper Mask. Would that be better than the Neova Serum for the strange texture from IPL. Sorry for all the questions!!!

Answer:

whichever lists more copper. JG 5.22.08

Question:

Sorry, the first part of my question got chopped off. I just asked a question about the copper peptides. Yesterday you kindly answered that Copper Peptides may help a strange textured spot that appeared after IPL. I wondered which Neova Copper product would be best from the list below. Thanks again and now again!

Answer:

the greater the copper content, the better it is. JG 5.22.08

Question:

I`m considering having the co2 procedure done; will I have to be sedated for this? I am 65 but healthy. Will they need to remove my dentures? How long can I expect the results to last? What do you think of the creams and serums that say they can do things like botox?

Answer:

I only do CO2 laser under general anesthesia. Dentures can stay in place. The results at your age could last 3-5 years in most cases. I do not think at present any OTC cream can do what Botox can do. JG 5.21.08

Question:

For my belly button your Answer: you might be able to improve the redness with either a YAG laser or a VBeam laser. If I`m having IPL laser on my face for acne and broken blood vessels would that laser work as well? What will the laser do? Remove the top layer of skin?

Answer:

yes, but not as storng so it will likely take more treatments, it might remove the top layer of skin but it does not need to do so for it to help with the redness. It will attempt to clot the small blood vessels that have overgrown and caused the rednesss and doing that will reduce the redness. JG 5.21.08

Question:

Hi Dr. Garcia, some quick questions: a) have you ever heard of one session of fraxel laser giving hyPOpigmentation? b) can hypopigmentation occurence be delayed in that it only shows up a year after treatment? c)is this hypopigmenation generally permanent or does it disappear with time? d)if it is permanent are there any treatments available that work? thanks for your time!

Answer:

I have seen Fraxel causing loss of pigmentation, yes. It can show up after a single treatment, yes. In most cases it will get better but the more treatments are done the greater the chance that it will be permanent. If it is permanent there is not much that can be done. JG 5.20.08

Question:

Regarding Fraxel. I know you`re not a fan. Do u think the profractional by Sciton is better? why don`t you like it? thx

Answer:

I think all lasers that are fractional in results and will limit the results. JG 5.18.08

Question:

Dr. Garcia I am going to have laser resurfacing on my face in a couple of weeks with a Erbuim laser. In your opinion will the procedure smooth out scars or just reduce the size of them. Also how many passes over my face are required to get a smooth result, and how long will it remain red. Thank you.

Answer:

it will only reduce the size I feel, Erbium is a relatively superficial improvement and as it generates no heat, the degree of collagen fiber contraction is small to none. It will stay red for weeks, how many weeks depends on how many passes and also the number of passes to some degree affects the results, the more passes the more the improvement but the greater the downtime. JG 5.15.08

Question:

Hi Dr. Garcia, I have hyperpigmentation on my face and I`ve tried the hydroquine creams and bleaches but I have had little success. It seems to make the hyperpigmentation darker? the Dr. I saw suggested I use a tazarac cream but so far it remains the same. I would like to get fraxel on my face but I am worried that the side-effect of hyperpigmentation may make the hyperpigmentation worse. What are your thoughts on the fraxel treatment? and what do you suggest for me to have done to correct the hyperpigmentation?

Answer:

I think Fraxel offers little improvement for the risks incurred, I am not a fan, I think a YAG laser would be better, but no matter what you use to fade them in time, they will all come back. JG 5.14.08

Question:

Dr. Garcia what is the best regeneration for 65yr thin skin I am worried that after a year or so. my skin could get thiner, and sagie. I have seen before and after of active fx. co2 on older people on emabracemedspa.com looks alittle to good to be true. I heard that if you go to deep one can lose fat and I need all the fat in my face if I even have any. thank you Linda

Answer:

well, honestly, the degree of improvement in older skin is not as much and not as long lasting, while you are swollen all looks good but the older one is the less collagen is made from these procedures, so I cannot tell you that it is a good long term option. JG 5.8.08

Question:

hello Dr Garcia what do you think about Active FX CO2. deep fx .compared with portrait?

Answer:

I think Portrait is more predictable and works better. JG 5.8.08

Question:

thank you Dr Garcia, have one final question! What is your general opinion of Lumenis One and would the clinician have started with the yag laser module or the IPL head, you obviously know the system and just wanted clarification on the stages of treating this vessel on my nose. Would just like to thank you again, have been very helpful.

Answer:

I think most physicians would start with the IPL head as it is less risky, and then move on from there, I will tell you, even if the YAG head is used, it will take a series of treatments. A VBeam laser might get rid of it in one setting or it could be hyfercated to remove it, old fashioned and low tech but effective. JG 5.6.08

Question:

I had a couple of fraxel treatments 3 months ago and have had many complications. The main one is that my skin overall seems to have a tanned appearance which gets darker a the day progresses. I talked to my derm and he told me that the laser was just healing deeply. Do you agree with this or is there another explaination? Thankyou

Answer:

I think you have post inflammatory hyperpigmentation, the laser is long ago healed and that is not the cause. You might need some bleaching creams and sunblock all the time when outside. JG 5.4.08

Question:

I am considering doing Active FX. It was recommended by a board certified dermatologist who does alot of laser treatments. I have some acne scarring, sun damage, and wrinkles. I have talked to two people who had it done by this MD and are very happy with it. Should I be concerned for any reason?

Answer:

I think it will help with the discolorations and not much else once the swelling is gone. JG 5.4.08

Question:

What is the average downtime for co2 laser resurfacing on the whole face? Could a person expect to be out of work one week or should the plan be two? Thank you for your help.

Answer:

depends on the depth, but if they go to the usual depth, 2-3 weeks out of work. JG 5.1.08

Question:

Hello Dr. Garcia, Are you familiar with a lasar called Active F/X for treatment of wrinkles? Do you have any opinion on this, especially as compared to the portrait? I had portrait 3 years ago and have been told that the Active F/X can have similar results but less downtime. My downtime with the portrait was almost 2 weeks with lots of redness after that (although I don`t think the doctor who did my portrait was very skilled at it).

Answer:

I am familiar with it and I think it is not as good as the Portrait treatment. There is no free lunch, if you need improvements, there will be downtime, and the older one gets the lesser the improvements from the lesser procedures. JG 4.29.08

Question:

Just wondering whether pih after fraxel will eventually settle without treatment.Its been 2 months since my last treatment and my derm prescribed me some hydroqinine cream. However all it did was make my face more red and burn, as i have sensitive skin. Is there anything else that could be used for the pih? If not will the pih eventually fade untreated? If so approx how long will it take?

Answer:

it can, but if it is was deep, it might need bleaching creams at least. Could try a series of IPL treatments to help fade it too. JG 4.28.08

Question:

Dr. Garcia, I have been browsing through some other questions looking for info on the Palomar Lux 154o laser, my derm recommended this laser on a small part on my chin. She is charging $250 per session and she said I will need 2-3 sessions. My question is for just a small scar on my chin (maybe 1 inch wide)is this laser appropriate? Also the scar is pitted. Do you recommend a different laser? This is my first time getting anything like this done, and I just don`t want to pay money for something that isn`t best for me. Thank You Dr.

Answer:

the fee is about the standard but I am not impressed with what that laser can do for scars. I like the Rhyec Portrait for scars, or a CO2 laser. JG 4.28.08

Question:

Hello Dr Garcia. I am sorry to bombard you with questions but I am lost as to which treatment would provide me with the most effective results for mild rosacea. I am currently taking Tetralysal (lymecycline) tablets and within my first week i have seen some improvement however am still considering having IPL to top this up as i feel this will keep the rosacea away for longer. I am considering going for the following treatments combined. Photogenesis targets the top layer of skin--the epidermis--and clears red patches and blotches and tiny vessels in 3-5 treatments at monthly intervals. The procedure uses Intelligent Pulsed Light technology to target the red areas. It is a quick procedure that involves only a few pinches. Your face will be slightly red afterwards for an hour or so but you can return to your normal activities straight away. Laser Genesis At the same time as the Photogenesis procedure, for more advanced treatment of diffuse facial redness, the Laser Genesis procedure targets the deeper layer of skin. Ideal for background redness of the cheeks, nose and chin, including rosacea, this procedure targets the dermis, a layer abundant with tiny blood vessels and collagen. An Nd:YAG laser is used to deliver thousands of pulses of light at a wavelength of 1064nm to gently heat tiny capillaries, whilst stimulating collagen. The result: less redness and smoother skin. Laser Genesis is not painful and most enjoy the gentle heating sensation. Six treatments of Laser Genesis at 2-week intervals provides beautiful results that continue to improve for months even after the programme is completed. I hope you can reassure me. Many thanks again Ally

Answer:

go with the Photogenesis. JG 4.26.08

Question:

Hi Dr Garcia there is an IPL treatment that I am interested in what i am wondering is: - Using a proprietary pneumatic sequence, the treatment area of skin is stretched to reduce the target pigments.Maybe I am reading wrong but I would have thought that for rosacea treatment this would be counterproductive. Thanks ally

Answer:

I agree, counterproductive as the pressure will diminish the target color red. JG 4.25.08

Question:

Dr. Garcia What are your feelings about the ebrium laser? I recently had a lot of punch floats done and in order to smooth my face out my doctor was going to use this type of laser. I know the co2 laser would produce more dramatic results but the amount of dowmtime I would incur makes it impossible. Are the results from the Ebrium good and in weeks or days what would be the average downtime using this laser?

Answer:

I think it is much milder and will give you some improvement but understand that for less downtime you get less improvement, so your expectations have to be lower in terms of the final result. JG 4.25.08

Question:

Hi Dr. Garcia. I suffered from acne for at least 10 yrs it eventually cleared up by using dianette. Unfortunatley I had an ear infection (a red rash looked sinilar to exemma)no idea how i got this as i dont swim. Anyway main point is i seemed to have developed rosacea (mild) and have red bumps on cheeks, constant burning, redness and flushing. Many treatments on the market IPL/Laser. What are your thoughts on Isolaz to treat rosacea?? i know it is very effective for acne but not much info on its success to treat rosacea. Do you think it would be a waste of time and money to have this treatment solely to treat rosacea? Many thanks Ally

Answer:

I am sorry but I have not had a chance to see anyone who was treated with Isolaz, typically lasers that are effective for acne scars will not be good choices for rosacea though. JG 4.23.08

Question:

Hello, I had 125mm 3% treatment with sciton Pro-fractional laser and developed raised red swollen marks on my face . I am unsure if this will lead to permanent scarring or discoloration. Is there anything I can do to mimimize the effect.

Answer:

copper peptide creams for the healing phase is about all. JG 4.23.08

Question:

Hello Dr. Garcia, When I was 37 years old I was put on a medication and after only a week my skin felt like I had a mild sunburn. After 3 weeks on the medicine my skin felt like I had a SEVERE sunburn. Since the precautions for the medicine said in rare cases it could cause blistering of the skin, my dr. kept me on it. After 3-4 months my hands and feet aged about 10-15 years. I literally watched the wrinkles get worst almost daily. It took nearly 5 years for the burning feeling to lessen. Now I`m 47 with hands that have looked 60 since my late 30`s. Do you have any procedures your office offers that might restore some tightness or resurfacing to get my hands to look say....47? I know you and your work and would not trust anyone else to give me an honest opinion. Thanks for your time!!

Answer:

I am sorry but I do not have anything that will likely help, anything that could be tried, like lasers, might be risky with taht history and even without that history, the degree of improvement on hands and feet is quite mild and likely will not be enough from what you describe.Sorry. JG 4.23.08

Question:

Hi Dr. Garcia! I just wanted to give you an update - I am a few posts down (the recent Fraxel CO2 with prolonged redness).... I had used the hydroquinone 4% to no avail. However, my Dr. prescribed Desonide and SERIOUSLY within 2 hours (after 1 month of redness) my skin is back to normal! Thought I`d post the update for you! I also didn`t wear any suncreens or moisturizer or makeup today when I put it on --- maybe all my products have lanolin in them - maybe that`s why I`ve been red for a month! Thoughts? Thanks for taking the time to post these messages.... your time and opinions are valuable. THANK YOU!

Answer:

well, hydroquinone is for brown spots and not redness do it would never have helped, the topical steroid Desonide is quite strong so you should not use it for more than 5 days in a row before taking a break, prolonged use will thin the skin and cause broken blood vessels. If the steroid worked that fast you were having either an allergic reaction, or a topical irritation/dermatitis, more likely and that will help along with stopping the irritating agent, it could be the lanolin, although that is uncommon. Glad all is better though. JG 4.22.08

Question:

I`m 65, have sun-damaged skin with loose skin on jowls and neck and excess skin on my eyelids. Will CO2 laser help tighten these areas? How long might it last? Is there another treatment (not face-lift) that may be better suited for me? Thank you

Answer:

I think it will not lift it enough in most csases. I think the only thing will be a facelift I am afraid as all non-invasive treatments at your age will not create enough tightening. JG 4/22/08

Question:

Dr. Garcia, I had my first Co2 laser in November for acne scarring, my Derm has made an appointment for my second laser at the end of May. Is this too soon? The treatment is being done free on the National Health (UK) So I don`t really have the option to have it done later. Kind regards

Answer:

that would be the soonest I would repeat it, but it really depends on how deep they went, the less deep they went the sooner it can be repeated. JG 4.22.08

Question:

I recently had Fraxel Co2 (re:pair) under my eyes and although the wrinkles are profoundly diminished, I had an allergic reaction to Aquaphor during the healing phase. It has been a month now and I`m still really really red. My doctor prescribed hydroquinone 4%, but I`m terrified that I have permanently damaged my skin. Your thougths?

Answer:

hydroquinone will never help redness and might actually make it worse, so I am not sure what they were trying to do. I do not think you have permanently damaged your skin, but I would stop the hydroquinone. I have not heard of allergic reactions to Aquaphor causing prolonged redness though. JG 4.21.08

Question:

I went and to my dermatologist b/c I have a bumpy forehead due to enlarged oil glands. She is recomending laser skin resurfacing. She said a chemical peel would not help.Do you agree? The two options I am thinking about are, the mini Co2 or the erbium. What`s the better option. I cannot afford a lot of down time. Thanks

Answer:

I agree but also know that the improvement will not be permanent, how long it will last will depend on how much your skin will rebuild the sebaceous glands after healing. I think if downtime is an issue I would suggest the erbium. JG 4.19.08

Question:

Hi Dr. Garcia - I am scheduled for my first Rhytec (low energy)treatment next Thursday morning. In your experience how much downtime (deep redness/flaking) is expected? I understand taht the pinkness will follow. I am a 38 white male. Thank You!

Answer:

the light treatment should leave you out of commission for 4 days or so. JG 4.18.08

Question:

Sorry Doc, you just answered my question on undereye resurfacing for wrinkles, and you said it would help for a while, well, my question is how long is a while? Thanx

Answer:

depends on which technology, and how deep they go so it is almost impossible to tell, if they go as hard as they can, likely no more than three years. JG 4.17.08

Question:

I have had 3 fraxel laser treatments spaced two weeks apart for acne scarring. It has now been approximately 2 months since my last treatment and my skin appears to have a tanned appearance eveywhere except for my cheeks, which are blotchy red. Is this normal? Also my broken cappilaries seem to be more sensitive. Whenever i feel nervous, anxious, embarrsed my whole face flares up. Is this also normal? Are there any creams or treatments that would help my skin return to normal colour and to reduce the redness? Any advice would be greatly appreciated. Thankyou

Answer:

not normal, you have post inflammatory hyperpigmentation due to the procedure and the lack of adequate skin protection afterwards, it needs to be treated with Retin-A nad hydroquinone along with no sun exposure and complete sun block. JG 4.17.08

Question:

Thank you for speaking out about Fraxel laser. It has ruined my face and my self esteem. I am about one year out from 5 treatments which left me with horrible PIH which is just now almost resolved. I am left with literally hundreds of very small, very fine small pink caps that have not resolved with Vbeam or IPL although IPL did have some benefit at first. The caps are so many that my skin has a discolored appearance. I am DESPERATE to look like myself again. Is there ANY type of laser which can register the color differences I am left with without a very high risk of more discoloration. Please help me Dr Garcia. I feel so ugly.

Answer:

might need to do a light CO2 laser on the entire surface to remove the top layers and get everything to the same depth or surface. Sorry to hear about your problems. JG 4.17.08

Question:

If I were to do 3 rounds of total fx, would that equal a lite co2? Thanks so much.

Answer:

not in my opinion. JG 4.14.08

Question:

I have had sparse sun damage and I have several IPL´s and a couple of 1540 resurfacing lasers to remedy the sun damage. After the last 1540 treatment, I was exposed to the sun and now I notice even darker/larger patches of pigmentation on my forehead that almost look like melasma. So is it possible that after sun exposure that I could hypo-pigment this badly? Also, what can I do about it? Your information would be much appreciated.

Answer:

it is possible, especially if the exposure is soon after a facial treatment, you neeed sunblock all of the time. JG 4.14.08

Question:

Hi Dr. Garcia. I`m having CO2 laser around eyes and Fraxel rest of face. Five weeks later I have a big family function. Should I be ok by then or is it likely I will still look beat up?

Answer:

the skin area will likely still look pink to red, might be hard to cover that up with make up in 5 weeks if done aggressively. JG 4.13.08

Question:

I have Keratosis Pilaris on my arms and legs. Constantly putting medicated creams is becoming annoying. I was wondering if laser treatment would work.

Answer:

not permanent but would likely work for a number of weeks. JG 4.2.08

Question:

Hi Dr. Garcia, To improve/remove general facial wrinkles and brow wrinkles, crows feet, upper lip wrinkles and sagging jowls using CO2 laser; what micron depth would you have to go to?

Answer:

at least 150 microns. And it might take mroe than that in some areas of the face like the lip. JG 4.1.08

Question:

Dr. Garcia, I have dark hair and dark eyes with fair to medium skintone and Italian and Scottish heritage. I`m having my first IPL treatment and am concerned more with hypo-pigmentation problems. How often do you hear of this or see it? thank you!

Answer:

I think the risk of hypo-pigmetnation is never spoken about as it is very very rare. JG 3.31.08

Question:

what do you think of the sciton lazers?

Answer:

not much I am afraid. JG 3.24.08

Question:

Dr. Garcia, Do you have any thoughts/opinions about the Matrix (for smoothing/wrinkles?) and/or Refirm (for tightening?) lasers?

Answer:

not impressed by either I am afraid. JG 3.22.08

Question:

Yesterday, I had my second pro-fractional laser. Everyone was telling me I looked younger after the first one (Nov), so I guess it did something. So I am satisfied, but it seemed to cause some additional crepiness under my eyes. Is this drier skin? Or some thinning/damage to the skin making it permanent? Is there anything you recommend to restore, tighten or strengthen the skin in that area? I am 48 and do look about 10 years younger than this as I have really cared and protected my skin. But my eyes bother me, have minor crow`s feet, but the soft, looser, crepy look under the eyes is nearly more aging to me than the crow`s feet. Please let me know if there is a product, procedure, or even supplement that can help with this lower eye area?

Answer:

no damage, just dry skin that needs more moisturizer. Could consider a DMAE cream or Vitamin C cream for the eye area. JG 3.21.08

Question:

How dramatic is the effect of the CO2 laser for under eye wrinkles in your opinion? I heard you have to make several passes in order to stimulate collagen production. Are you able to do that to the thin undereye skin? I`ve read a couple different articles that say some doctors go over the area with one pass only. Just trying to find out if you think it`s worth spending the money since it is not a cheap procedure. Thanks.

Answer:

It can be dramatic but it does not last more than a couple of years because the skin is thin and it folds so many times per day. Multiple light passes try to get the same as one deep pass, so you need to understand that not all passes are the same, the energy setting is also important. JG 3.20.08

Question:

I noticed with some lasers that some people lose pigmentation and will not tan. I have light olive skin which tans easily. I was told to try portrait plasma for my undereyes and above my lips, or my whole face. My concern is will my skin lose its pigmentation and not tan after portrait plasma? Thank you

Answer:

I have not seen pigment loss with the Portrait because it does not go as deep so it has less risk of damaging the melanin cells. JG 3.20.08

Question:

which laser resurfacing procedure do you recommend that will give the most dramatic results from acne scars and wrinkles. I have had 5 fraxels with little improvement. I have recently gone through several punches and two excisions to remove cystic nodules and deeper ice pick scars to landscape face before laser resurfacing. Is the CO2 more effective or would the portrait be a good option. I have thick/dense skin - wanting to remove wrinkles, acne scars and improve tone and texture. I have plenty of down time so that is not a problem. What is your recommendation for the procedure that will give me the most dramatic effect. Thank you

Answer:

for dramatic chnages it is the CO2. JG 3.20.08

Question:

hi dr. Garcia, Do you think microdermabraion would work better taking away the wrinkles above the lips or is laser better? Thank you

Answer:

laser is better. JG 3.10.08

Question:

Hello, I had CO2 laser resurfacing on my lower eyelids in 2005 and was wondering when I could have this procedure done again. Is there a minimum wait time? Also, can one have pro-fraxel treatments around the eyes if they have had restylane sub-q fillers in the same area? Thanks for your help!! Carol

Answer:

I think you can repeat the CO2, as to how many times you can do it, it depends on how deep they have gone. I think the pro-fraxel over the filler is OK also. JG 3.8.08

Question:

Good Afternoon Dr. Garcia, IPL lady here. I contacted the manufacturer of the IPL machine and was informed the the PIH will resolve on its on without bleaching as the skin sheds and just put sunscreen. Bleaching will just speed up the process. Is this correct? Another thing, I called the doctor`s office and told them that they should advise patients with olive skin that there is a higher risk of PIH with any type of laser, IPL, etc. They disagree and claim that this is not the case and I am the only one who had the side effect. The office treats mostly asians. Now granted that I did sign a form understanding of temporary PIH from 3-6 months or longer, Does the doctor have the duty to explain that the PIH risk is higher on our olive skin tone? They ask me to come in to take pictures but mine does not come out on pictures because it is light. In addition, they insist that it is a shadow even if it obviously a light brown patch (lucky me). My goal is to get my money back. Do I call the derm. medical board as well to advise them that the doctor is not clear on PIH on olive skin due to IPL? Please be upfront and let me know if this is worth pursueing. My other goal is to make sure patients with olive skin are made aware of the PIH risk in his office. They disagree and says they do not have to tell patients this because it is not likely. PIH as a result of IPL is the same for everyone.

Answer:

that is correct on the bleaching cream. I believe he has a duty but judging by their response of it never happens it apperas that doctor is willing to say anything to get a patient to spend money. As to the derm board, I think it best first to speak with the state medical board. Best of luck. JG 3.8.08

Question:

SORRY DR. GARCIA, IPL LADY HERE. I AM NOT LOOKING FOR A LAWSUIT AGAINST THE DERMATOLOGISTS WHO PERFORMED IPL ON ME. I JUST WANT THE PUBLIC TO BE AWARE OF THE RISK INVOLVED. THANK YOU SIR

Answer:

I understand, I just think there are alot of shady scenarios out there and I was just trying to inform the public, I was not implying you should sue the doctor, but when you hear the word never just beware. JG 3.6.08

Question:

Hello Dr. Garcia, Again, I thank you for helping so many with this website. I don`t know of many plastic surgeons who would take the time to answer our numerous questions. God bless you with a long and happy life, which I will pray for. This is IPL lady again. Regarding IPL and any type of lasers (fraxel, etc), why has the government allowed Med spas and inexperienced dermalogists perform these procedures? In the wrong hands, they cause so much grieve and damage to so many. In the plastic surgeons (at least the one I have been to before), all possible side effects from any type of procedures are explained. In the dermalogist office I went to, I signed a form, which I taught was just formality of possible side effects, and I was told that my skin will be more even tone after the procedure and I will be very pleased and there is low risk of any side effects. I got sold IPL. I was told that they have had no patients who had any PIH at all. After, off I go to the table for IPL. I called that doctor`s office, and told them I need to report the side effect to the manufacterer - PALOMAR who manufactured the Lux G. I told them that I want to make it known that PIH is highly possible on dark or olive skin. Do you have any other recommendations, so that I can heard? I read several blogs on people who suffered in inexperienced hands on procedures that is supposed to be simple and w/ no down time. Searching the net, everything is about how great and easy IPL is but not much is said about the possible side effects, except that PIH is supposed to be rare! Yeah right! Please let me know how to proceed. I am looking for a lawsuit. I think that my dermatologist will most likely refund my money. I was already offered my money back on products I bought - Obagi, which did not work for me. I just need to know if there is another way to make sure the people know the risk of simple procedures such as IPL, fraxel, etc. IPL Lady

Answer:

well, to make a long story short, IPL is not a true laser, it is an intense pulsed light, it was supposed to be purchased by a physician and then performed by technicians under the supervision of a doctor. Many med Spas have a doctor who buys the machine and is not trained in dermtology or plastic surgery, but the company cannot refuse to sell it to them. I am a big proponent of having a supervising doctor who actually does the procedures on a regular basis, but there have been threatened lawsuits for not allowing people to perform it. I agree, in the wrong hands they can cause serious damage. I think calling your local medical society is also important and for them to say the IPL never causes IPL tells me they do not know what they are doing or talking about because that is common knowledge of the potential side effect of PIH. Best of luck. JG 3.6.08

Question:

I am coming up on surgury dealing with Punch Floats and suscission. How long will it take my face to return to normal if it ts done on a Monday and I am on leaave from work for 2 weeks. Is this enough time for all the procedures to heal? He is going to do quite a number of them on my face.

Answer:

that should be enough time. Best of luck. JG 3.6.08

Question:

Hi Dr. Garcia, Is Pearl laser the same as what Rhytec has to offer. I was unaware that Rhytec was the company name. I guess my question is finding someone who uses that brand in Louisiana and if I don`t what is comprable. Is Fraxel the same or pearl because that is what the closest person offers. Thank you.

Answer:

The Pearl is not as strong as the Rhytec Portrait, if you can only choose between the Fraxel and the Pearl, I think the Pearl will heal as fast as the Fraxel, and I think the results will be pretty similar. Neither one will give results as strong as the Rhytec though. JG 3.6.08

Question:

Hi Dr. Garcia. My friend uses a candela yag laser to tighten the skin. What do you think of that particular laser? If you don`t mind what is the best for the face to diminish very fine lines and give the skin a new glow. I am 44 years old.

Answer:

I think the degree of visible improvement in skin tightening is very small. I think for fine lines I would prefer the Rhytec portrait treatment. JG 3.5.08

Question:

Hi Dr. Garcia, Will post pigmentation from IPL usually go away or is it permanent? How long before I see results from hydroquinone? I have slight dark pigmentation from IPL on the cheek area. I was surprised to get it because I did not burn or get pink when I had it done on Feb. 4 Thanks again. IPL Lady

Answer:

if treated with bleaching creams, sunblock and at times repeat laser it will help it go away but there is always a tendency for it to try to come back. It does not have to get red for it to be reactive like that. JG 2.27.08

Question:

Good morning Dr.Garcia, I have olive complexion and had IPL Palomar on Feb. 4. I did not burn nor did I get pink on my cheek area with the procedure with the exception of my forehead, which healed well. My problem is that I seem to develop a slightly dark pigmentation or stain on my left check. Is this going to go away? I started using Obagi`s blender w/ tretonine and clear, both which has 4% hydoquinone. The dermatogist insist that another IPL will take it off but I am hesitant to try it again. By the way, in different lighting, the pigment looks worst and not noticeable in some lighting. The doctor nor his assistant insist that it is a shadow of my cheekbone. Will this fade or do I continue w/ hydroquinone. I appreciate your honest response.

Answer:

there is always the risk form a pulsed light therapy or a laser to develop post inflammatory hyperpigmentation which is what you have. I think what you are doing is a good way to go. More light therapy can cause either improvement and also potentially more darkening. JG 2.27.08

Question:

Hi Dr. Do you think that vascular lasers work? I have one or two pretty small purple veins along my orbital rim, I saw a laser specialist who suggested a vascular laser he says day or two max recovery time, quite cheap as well, and a quick procedure. Is this all true and do you feel that the laser helps?

Answer:

well, if they are very small it might work, if they are slightly larger and on the green side, they might not improve at all. JG 2.27.08

Question:

I am a 52 yr old with pretty good skin, little sagging, t am considering a facelift but probably not for a couple years. I have heard that the Fraxel laser may be good for lines and mild sagging and ward off the face-lift scenario for a few more years. Comments pls. thx. jg 25-2-08

Answer:

I think lasers might help some for fine lines, depending on which one is done, but will likely not do much for the sagging. JG 2.25.08

Question:

hi dr. garcia! whats is the difference between fraxel and re:pair and portrait in terms of results?

Answer:

I think Rhytec Potrait is superior to the others. JG 2.25.08

Question:

Hello Dr. Garcia here`s my problem i had red spots all over my face and my derm said i should have an erbium laser done and i did he also said i should use bepanthen and cicaplast and i did in the first 1-2 weeks but then i stopped and now, after 3 weeks and 2 days i cant see any major improvements...i dont know if it`s too early for that...should i use bepanthen and cicaplast again?or something else? thx

Answer:

I think the cicapalst can help healing wounds fade their redness but trying to use an ablative laser like an erbium to remove red spots shows lack of knowledge of the technology of that laser and its effects. Go somewhere else. JG 2.25.08

Question:

Great Site! Thank you.I see that you are very happy with the co2 laser. Can you please tell me if the active fx co2 laser is the same co2 you are talking about. And if not is this laser effective on removing wrinkles around the lips? Thank you!

Answer:

it is not as effective as only microspots of skin are removed with the CO2 laser, and for the best effect you need to remove it all, otherwise the degree of tightening is only a fraction of the result, there in comes the name fractional treatment, because there are millions of skip areas. It does heal faster but you get what you get, which is a fraction of the result. JG 2.23.08

Question:

Hi Dr. two questions: a) Do you think a vascular laser around the orbital rim could help diminish blood vessels, or is it not worthwhile? And b) is a once-daily three week course of moderately potent topical steroids on the face considered long term? Can it do irreversible damage, or will the skin repair itself if any side effects occur? Thanks for your help!

Answer:

it might help some but likely will not remove them all, and if it does work it is likely not permanent. I think 3 weeks of a daily steroid can cause some damage yes, if you are young the skin should be OK long term though. JG 2.19.08

Question:

Thanks for your response regarding the CO2 laser but I just need to know if you would recommend this for someone with oily skin? Thanks

Answer:

no problems there. JG 2.17.08

Question:

I am scheduled for the CO2 laser procedure on 3/10 but am wondering if this if right for me. My ps recommended the laser for making acne scars less noticable, tightening my skin, and reducing appearance of some fine wrinkles. I am worried about the downtime. My ps stated after 2 weeks I would be ready to return to work. I noticed that you state that the downtime is more like 3 weeks. I have to go back to work after 2 weeks. I work at a hospital and attend staff meetings everyday and do not want anyone to know. Do you think this is possible? Also, I have very oily skin and have read some reviews stating that the CO2 laser is not recommended for oily skin. Is this true? Is the laser post-op pain similar to the pain from a dermabrasion? Are the results from a dermabrasion similar to laser? If the CO2 laser results only last for a couple of years are the results and downtime worth this in your opinion? Sorry to ask so many q`s but I am getting very nervous and thinking that I may need request another procedure like the portrait procedure that you recommend. Please advise. Thanks for your time

Answer:

the time back to work all depends on how deep you go, for acne scarring you need to go much deeper than for wrinkles so in my experience, if you are going to give the patient the maximum benefit, it will be closer to 3 weeks, you might be able to wear make up in 2 weeks but there is no way the make up will hide the redness underneath the makeup. Dermabrasion is no comaparison to the laser, the laser is safer and more effective. As to how long the laser lasts, the older you are the less time it lasts, in younger patients it can last 5-7 years, in older patients less, but no way to tell how long. The Rhytec will heal faster but the improvement will be less, that is the trade off. JG 2.14.08

Question:

Hi Dr. Garcia, a couple more question for you. How often is it suggested to have a treatment with the Rytec Portrait? How long does it last? Do you suggest having one every year or so for best results? Thank you for your help.

Answer:

usually 1-3 years or so, but if needed it could be repeated after 6 months. JG 2.10.08

Question:

Is the Fraxel 2 a worthwhile investment for skin tightening?In my area there are no doctors who have the Rhytec Portrait.

Answer:

I do not think so, it will remove skin discolorations though. JG 2.10.08

Question:

Hello Dr Garcia, I am 55 years old. I have a fair skin. Before the laser, I used to use the OBAGI system and RETIN A at night . To get rid of my lines, I had CO2 laser resurfacing on my lower eyelids 5 weeks ago. The area lasered is still red. I was wondering when I would be able to go back to my skin care regimen and when I should use the cream DMAE and the vitamin C serum. Thank you very much, Dr Garcia.

Answer:

I would give it another couple of weeks and then start the creams every other night to see if you tolerate it, the redness will fade but the deeper they went the longer it takes. Best of luck JG 2.9.08

Question:

what will the three Rhytec series do for the skin?

Answer:

improve skin discolorations and fine lines, provide a healthier glow and some mild skin tightening. JG 2.9.08

Question:

What percentage do you think acne scars are reduced due to the rhytec laser? Thanks.

Answer:

25% or so. JG 2.9.08

Question:

Well okay Dr Garcia. Not a very helpful answer regarding pixel or Palomar starlux. Knowing you are not a fan of mild lasers, I will ask in a different way then. I am going to have treatments with one of the two lasers, therefore I am interesting if there is any different between the results of the 2 lasers?. The reason for asking is that the pixel treatment is much cheaper than the Starlux treatment (sorry for the spelling. I am from Denmark) ;)

Answer:

my answer is that I do not think you should waste your money on either one, but if you insist on doing it then go with the Starlux, best of luck. JG 2.9.08

Question:

Which laser do you recommend for reducing wrinkles around the eyes and on the cheeks?.... The Pixel 2940 Erbium Laser, or (IPL) palomar starlux 1540?

Answer:

I recommend either a CO2 laser or a Rhytec Portrait laser, neither one of the ones you are aksing about though. JG 2.8.08

Question:

Dr. Garcia many thanks for getting treatment info in the hands of the public. I happened to see a question concerning the MiXto and the ProFractional. You had said they are pretty much the same, which is a little of the mark. The MiXto is a fractional CO2 and ProFractional is erbium, which you have explained the differences of in past postings. It looks like you love the Portrait, but you should look at the MiXto, it is producing great results at a reasonable price. Have a great day!

Answer:

thanks for the info, I certainly feel there are difference between erbium and a CO2 laser but when done in a fractional method, I think the differences are small due to the simple fact of the pixelation and large areas of skin left intact. I wil take you advice and look into it though. JG 2.6.08

Question:

In your professional opinion: 1. Do you think IPL will assist with bruising, trapped blood, discoloration, dark circles, post tear-trough juvederm injection? Tear-troughs were injected only 4 days ago and in addition to discoloration, swelling is still an issue. 2. My concern if IPL is an option to treat the aforementioned issues, could the IPL procedure potentially cause additional swelling to the delicate eye area? Thank you so much for your time.

Answer:

It might help the blood break up, yes. It also migth cause more swelling, yes. JG 2.6.08

Question:

what is the affect of rhy portrait on previous scar tissue?

Answer:

might smooth them out some. JG 2.4.08

Question:

whats the best non-surgical treatment for skin tightening of face or collagen stimulation? or separate one for each?

Answer:

Rhytec Portrait and then for something stronger a CO2 laser. JG 1.31.08

Question:

Hi Dr. Garcia, How effective is the portrait laser with overall skin texture issues; pore size and mild acne scarring around the mouth? I did some major squeezing when I was younger. Are there any issues with underlying scar tissue? thank you.

Answer:

well it will be mild for the acne scarring around the mouth, maybe 20-25% improvement. The underlying scars from the acne is what makes it less effective than what it is for wrinkles. JG 1.31.08

Question:

What do you think of the Pixel and Affirm lasers for mild acne scarring, redness, and scarred pores in Indian skin? What laser or treatment can you recommend?

Answer:

would not recommend it for that on your skin. JG 1.29.08

Question:

Hi Dr. Garcia,I have to say after reading all the laser questions on your generous website,I`m more nervous than ever.Can you tell me what % of your portrait patients are very pleased with their results/ I`m considering the slower 3 treatment approach. thanks again.

Answer:

well, the amount of them that are pleased I would say is over 95% but I think much of that is because I am very clear with them and educate them on expectations. If someone has high expectations then the Rhytec is not for them, it is a mild improvement for wrinkles, better for skin discolorations but the safety margin is high. Three treatments are likely a little less effective than one deep one in most cases. So I think with reasonable expectations, satisfaction is high. JG 1.29.08

Question:

Dr. Garcia, What do you think about the effectiveness of Lux1540 laser by Palomar. Is this okay for Oriental skin? Thank you.

Answer:

I am unimpressed with its effectiveness and I think there are still risks with a fractional laser in oriental skin. I would likely not suggest you use it. JG 1.29.08

Question:

This is regarding lasers on moderately olive skin (I`m half German, half Spanish). What is the risk of doing a micropeel? what about the Rhytec Plasma? thanks Doctor

Answer:

low risk for micropeel as it is quite light, the risks increase with the Rhytec and the higher energy used the riskier it gets. JG 1.28.08

Question:

Hi Dr. Garcia, I,m seriously considering the Portrait laser-wish you practiced in New England-I have some trust issues after a couple of bad experiences-but refuse to give up.Can you have a treatment following juviderm injections? I have fine lines and crepiness around mouth.Can a fairly light pass help with this? thank you!

Answer:

it can be done after Juviderm injections but I would give it 2-4 days in between to limit the amount of swelling from them being combined too close together. I think you will need a little deeper than a light passs for the oens around the mouth due to the skin thickness there. Best of luck. JG 1.28.08

Question:

In regards to skin tighening, is Beauty Tek or Elos laser effective. Also, are you aware of any laser, etc. treatments that are effective skin tighteners?

Answer:

the only ones I think are effective for skin tightenig are a Rhytec Portrait and a CO2 laser. JG 1.28.08

Question:

FIRST THANK YOU FOR BEING HONEST ABOUT YOUR OPINION ON FRAXEL LASER TREATMENT. SOME DOCTORS WOULD TAKEN THE LOW ROAD AND ENDORSED IT FOR MONETARY GAIN WHERAS YOU DO NOT. RECENTLY I WAS EXPOSED TO A SALES JOB ABOUT FRAXEL AT A DERMATOLOGISTS OFFICE AND THE PERSON WHO WAS GOING TO BE PERFORMING THE PROCEDURE WAS NOT EVEN AN M.D. AND THE RESULTS I SAW IN THE PICTURES WERE NOT IMPRESSIVE AT ALL TO ME. ANYHOW, WHAT IS YOUR OPINION ABOUT THE ERBIUM LASER BEING USED TO SMOOTH OUT SKIN AFTER A SERIES OF PUNCH FLOATS AND SEVERAL SUBCISSION TREATMENTS? THANKS FOR KEEPING THEM HONEST.

Answer:

it is an OK laser, not as effective as a CO2 and works similar to an old fashioned dermabrasion, but should help some, best of luck. JG 1.28.08

Question:

Is Skin Tyte ST effective at tightening the skin? I have not heard anything postive about Thermage. Is this any better?

Answer:

I do not think either one works. JG 1.28.08

Question:

My 19 year old son has a 2 inch diameter tatoo. We met a dermatologist in Cedar City, Utah where we live but he does not have laser technology to help us remove this. What is the best way to remove this? Will this be erased completely and what could be the costs involved approximately? Are there any known side effects to this treatment like skin cancer etc?

Answer:

I feel the Q-switched YAG laser that we use is the best for that. There is no way to predict how many treatments it will take, schedueled every 4 weeks to remove it, and we charge by time, $100 for 15 minutes which should be more than enough for that size tatoo. There are no known side efects from the laser. JG 1.28.08

Question:

I had a 50 micron micropeel on Tuesday. I have been wearing the aquaphor since then. I started peeling yesterday, but really peeling today. Is it necessary that I continue to wear the aquaphor until all peeling has stopped? I do notice after I wash my face, it`s extremely tight, because of the peeling I assume. Just tired of the aquafor.

Answer:

I suggest you continue until the peeling stops, yes. The washing makes it also feel tight due to it being a little dry, that gets better in time. Hang in there. JG 1.25.08

Question:

I had IPL spot treatment in a couple of places 2 wks ago. The areas peppered and peeled as I was told would happen. I see zero difference in the spots. I undertand that it may take multiple treatments. My qustions are 1. does the skill of the technician make a difference as if so I would try someone else and 2. Are the machines different-in other words should I ask the kind of machine or brand of machine and make sure the next person does not use that same machine. Please advise soonest Thanks sw

Answer:

it is not the technician as much as it is the filter and amount of energy used. IPL machines are all pretty standard for the most part, not an appreciable difference. JG 1.23.08

Question:

Hello, Dr. Garcia -- I had great results from CO2 laser resurfacing that lasted nearly 10 years, but now my doc is recommending the Sciton Profractional Laser for perioral lines. You seem to consider this laser inferior to the CO2. Is it because results are not as long-lasting or because they`re not as dramatic? Will I need more than 1 treatment with the Sciton? And how about anesthesia -- will a topical do the trick? Many thanks for your help.

Answer:

actually due to both of the reasosns you cite. I think even with multiple treatments with the Sciton Profractional machine you will likey never get the CO2 type of improvements. The Sciton could be done under local but you will still feel it.Best of luck. JG 1.21.08

Question:

Dr. Garcia, I`m scheduled for a Rhytec Portrait PSR2/3 for treatment of lower lid wrinkles. In your opinion, is this an appropriate level for treatment of these wrinkles? Thanks in advance for your opinion.

Answer:

yes, I think that is appropriate. Best of luck. JG 1.16.08

Question:

What do you think of the VariLite Laser for spider veins on the nose and other parts of the face? It is a diode laser system using fractional (not Fraxel) technology, whatever that means. Is it relatively safe? Thanks.

Answer:

I think it is a good option for the broken blood vessels. It is a safe option. JG 1.15.08

Question:

which laser do you think is more effective the Sciton Profile or the Refirme? thank you Doc (i know you aren`t a big fan of either but if you HAD to choose;)

Answer:

if I have to, the Sciton Profile. JG 1.13.08

Question:

What is your opinion of the effectiveness of the Sciton Profile Laser? thanks Doc

Answer:

pretty mild. JG 1.13.08

Question:

Dr. Garcia, What do you think of the pearle laser? thank you.

Answer:

very mild improvements. JG 1.13.08

Question:

Dr. Garcia, What do you recommend as the best treatment for tightening the skin and minimizing pores? Do any lasers help with the shadows under the eye? I am part Asian. Thank you.

Answer:

minimizing the pores is only temporary so for that likely microdermabrasions. For tightening the skin I think maybe light Rhytec Portrait treatments but it cannot be done deeply so you cannot expect too much. JG 1.13.08

Question:

Hi Dr. Garcia. I am considering doing they Rhytec Portrait and have begun doing research on it. I have read some horror stories of patients who have had bad experiences. They talk about hyperpigmintation that does not go away. Horrible pain, puss dripping into your eyes, face peeling, downtime much longer than advised, skin not healing right. I have also heard positive things about it and the results. I came to the conclusion that it had to do with the doctor who was administering it. Can you tell me the best way to make sure I find the most skilled Doctor in my area (West Palm Beach, Florida) to do this procedure for me?

Answer:

I thik the best thing is to ask to see pictures of patients they have done, possibly tak to a patient or 2 and ask how may they have done and if they do other lasers, doctors that have lots of laser experience in general do well, if the Rhytec is their first foray into lasers, I would seek out someone else. Best of luck. JG 1.11.08

Question:

Hello, I am wondering what will work for stretch marks. Does LED photo modulation work? Does this need to be perfomred by a dermatolgist? Does it cause any future damage to skin down the road? Thanks

Answer:

YAG laser will fade the redness, is about all that anything will do, all else is not worth it. JG 1.10.08

Question:

Hi Dr. Can I get the same result doing several treatments with the Rytec versus doing one deep treatment with it for acne scars. I would like to have good results without the downtime. Is that possible?

Answer:

I am afraid that the series is not as effective as one deep one as the heat generated is less. I think there is no compromise here, sorry. JG 1.10.08

Question:

What do you think of the Erbium Laser? I am doing it for moderate acne scarring. I am just getting it done on my cheeks and am very concerned that my skin texture looks the same once healed. I have seen people whose skin looks plastic like after and I do not want that result. I want my skin to look natural. What would you recommend?

Answer:

I have been unimpressed to be honest. I would use a CO2 laser and if not then a deep Rhytec Portrait. JG 1.8.07

Question:

Hello Dr. Garcia, I want to get several moles removed on my face, most are not raised but flat. Do these still need to be exized out? what are my best options for olive skin, asian american skin. I have had one shaved in the past and the color came back, and have hyperpigmentation scars from acne. I have had one erbuim lazer treatment (2 layers removed) and have not seen a diference overall. I only used retin-a for less than a week before the treatment. could this be why i didnt see a difference? do i go on and have the moles exised then continue with more lazer for discoloration and large pores? i`ll be looking forward to your reply.

Answer:

I think with your skin type the excision is likely the best long term option with continued treatment of the discoloration too. JG 1.5.08

Question:

Hello Dr. Garcia, I see you answered my question regarding putting water on the skin during a Portrait treatment... which is exactly what happened! What should I do now? What do you think putting water on the skin during a Portrait treatment would do? As far as what it looks like now - it just looks like it didn`t work as well? Would doing this make it not go as deep as it needs to? Any extra thoughts would be appreciated!!! Thanks so much!

Answer:

I think at most it will limit the effect, probably nothing bad though. When it is wet the water stops the hot plasma from affecting the skin. JG 1.5.08

Question:

Hello Dr. Garcia, me again, sry... I wanted to restate what I said in the last message about how my face looks now. My face has 2 kinda large blisters/ulcers on one side of my face & the rest just kind of some redish/brownish stripes. So it did work I guess? I just knew that the skin should stay dry while being treated & I want to know what happens when it is treated while it is soaking wet? Do you even know who else I could possibly ask?

Answer:

I think this guy has made this whole thing up I am afriad, I speak with representatives from the company at least once per month and they have never mentioned anything like this. JG 1.5.08

Question:

Hello dr. Garcia, I got a Rhytec Portrait treatment yesterday and during the treatment, the doctor continuously kept wetting my face. He said that wetting my face during the treatment would make the treatment more comfortable for me but would not affect the results. What is your opinion about wetting the face during a treatment? Have you done that & if so, do the results turn out just as well?

Answer:

never heard of such a thing, it might help cool the skin and that is nice, as long as the water does not drip on the skin they are trying to treat at the same time. I use the water sprays after to help cool the skin but never do it during the procedure itself. JG 1.5.08

Question:

I had CO2 laser undereyes, one pass and 2nd pass where needed. 14 days used only vaseline constantly, mild redness nicely faded to pink but had some tiny bumps/whiteheads. Day 14 was given La Roche Posay products: Cicaplast (copper/zinc/manganese + Madecassoside,for epidermal recovery accelerator and then toleriane riche to moisturize on top. Same day used product, concealed with Cover FX makeup and had a massage face down. immediately after I got up and saw deep red colour burn/scar/broken capillary like line and dots all around eye area (skin is smooth where this discolouration is). Am terrified, it is 21 days post. Went to see Dr. who is away for 10 days but saw his esthetician who told me discontinue Cicaplast and instead to use 0.5% cortosol cream and vaseline on top until Dr. returns. Do Is it possible this is an allergic reaction to the product or the makeup, or that the marks are permanent, or broken blood capillaries? What should I do? It is strange that all looked fine after 14 days, mild pinkness only, and now this?

Answer:

the lotion might have aggravated it and I think the steroid cream is OK but not for any longer than 5 days without taking 5 days off, best of luck. JG 1.4.08

Question:

Is laser resurfacing something to be used on raised scars? do they give natural results, and are they expensive? Thank You,

Answer:

it is more effective for depressed scar, raised scars are from too much collagen and can be lessened with lasers like a YAG by decreasing the redness mostly. JG 1.4.08

Question:

Hello! I had PSR3 done 3 weeks ago and, my face was healing fine in most areas but, I also had some areas not healing and very deep. I went back to the Dr. and he put me on Cipro, then after a week he put me on an antibiotic ointment for those areas. Now three of those areas are still really red and itchy, looks to me like they are going to scar. All the moisturizers make my face red and itchy...I`ve tried Cetaphil and two other brands. I can now see brown spots coming back and I have these pink spots on my face from the infected areas...Is this normal? Will it eventually go away? My face looks very uneven and I have to cake on the makeup to look normal. Is it just not healed yet or do you think I`m going to always have the red areas and uneven skin tone?

Answer:

not normal, I think you need to see the surgeon to make sure there is not too deep of a burn that needs to be treeated with topical steroids or something else. JG 1.4.08

Question:

What`s your take on the new mixto-fractinal CO2 resurfacing. It sounds fab. thanks Doc

Answer:

not a fan or a believer in their claims. JG 1.3.08

Question:

Hi Dr Garcia, I am going to be getting a PSR3 Plasma treatment soon. I wondered, how long after the treatment can I go back on Low Dose Accutane (10 Mg/day) and still be safe and get the benefits from the PSR3 treatment. The low dose is for bad oily skin and acne. Thank you! Rick

Answer:

I would wait at least 6 weeks if possible to let it heal as well as it can before the Accutane. Best of luck. JG 1.2.08

Question:

Hello Dr. Garcia, I got restylane put into my tear troughs this morning and he also put a little toward the outside rim of my eyes (above cheek bones)... I have an appointment to get Rhytec Portrait on Friday (2 days after restylane). Should I tell the doctor to stay away from the area around my eyes or would it be ok if he goes right over the restylane that was just put in 2 days before??? Thanks so much!

Answer:

I have not seen any problems from doing a Rhytec over a recent filler injection of the HA types. JG 1.2.08

Question:

Hello Dr. Garcia, Happy New Year! I am going for a second time to get the Rhytec Portrait on Friday... I also have a consultation tomorrow to see a specialist to get (possibly) restylane under my eyes as they need it just a little right in the inside corners. As long as the Rhytec doesn`t go right on top of where I may get the restylane under my eyes - would it be ok to get both of these things done so close together?

Answer:

yes, OK tt do some best of luck and Happy New Year! JG 1.1.08

Question:

I got off accutane 1 month ago and am now using tazorac. How long do I have to wait to be able to get the Rhytec? My skin is still very sensitive.

Answer:

another 5 months or so. JG 12.28.07

Question:

What is the Cutera pearl and also the Actve FX? Thanks!!

Answer:

newer machines that make promises I feel they cannot keep. JG 12.28.07

Question:

I`m sorry i wasn`t clearer in the previous question. How long after a deep single pass high energy Portrait (3-4J) can this procedure be repeated ?

Answer:

I woudl wait at least 6 months. JG 12.27.07

Question:

How long after having a Portrait PSR2 can this procedure be repeated ?

Answer:

I think it can be repeated in 3 weeks. JG 12.27.07

Question:

Hi Dr Thank you for answering questions. I wondered, how many weeks does it take to see skin tightening from Plasma Portrait PSR3 treatments? I am a 40 year old male with skin that is more like someone in their late 40`s in terms of elasticity. I wanted to get plasma for skin tightening and slight acne scars. For instance, yow long before 80% of the final result for will be seen? Thank you and happy new year.

Answer:

maximum improvements are seen after about 4 months. I think you would see 80% at about 2 months. JG 12.26.07

Question:

Dr.Garcia, Just been `toasting` to genuinely wonderful people we have encountered, and of course `you` came to mind. So I could not let this opportunity pass to wish...from me and my precious family to yours, a very merry Christmas and happy new year, God bless.

Answer:

I am humbled by the kind words ansd I wish you and yours a Merry Christmas and a Happy and Prosperous New Year. I raise my champagne glass to you too! JG 12.23.07

Question:

Fractional CO2 Skin Resurfacing was one of the workshops at the Aesthetics Convention in Vegas in May. What is your opinion of that procedure. Tess Mauricio was also a presenter there and I`ve seen her on tv promoting Refirme. Could you offer an opinion on that a well. thanks Doc

Answer:

I think what the pateint gets from the Refirme for what they pay is not a good trade off and as to fractional CO2, it is better than some of the non-invasive treatments but it is only a fractional improvement since most of the surface is not removed, it is better than a fractional Erbium though. Overall, I think again, what the patient sees for what they pay for is not a worthwhile trade off. I think if the patient`s expectations are low they will be happy, but that is the rare exception to the rule, most people want visible changes. JG 12.22.07

Question:

Dr. Garcia, I am 64 years old and I have had Lumenis ActiveFX with UltraPulse Encore done to my face. It has been 2 weeks and I see no difference. Was I told something wrong? Perhaps, this is for younger women & I was not a candidate b/c of my age? Perhaps, I would need other work. Thank you for your time and advice. Ellen

Answer:

I think in younger people it might work better, but I think even in younger people the effects are minimal to none I feel. Sorry. JG 12.17.07

Question:

Which procedure would you recommend? The titan or reafirm skin tightening procedures?

Answer:

sorry but I cannot in good conscience recommend either one. JG 12.16.07

Question:

I am a 53 yr old female with long standing cystic nodular acne; with residual scarring; hypertrophic, ice pick - I also have severe osteoarthritis and systemic lupus. I have a crape like skin appearance, dry and aging wrinkles. I decided to do Fraxel (know you do not think it to be good) however, I thought it to be less risky to see how I did. I have had 4 treatments with some improvement in overall texture as well as some reduction in acne scarring. I am now considering CO2 laser resurfacing after plastic surgeon evaluates progress thus far. Can you tell me your thoughts if having lupus, connective tissue disorder would be contraindicated for the co2 laser procedure> Would healing be problematic - I am tryimg desperately to regain a more healthy looking complexion. I am realistic that it may not get where I want, but any improvements are worth it. Please let me know your thoughts about the laser with my medical condition ( of course i will be consulting with my rheumatologist as well). Thank you so much for your expertise and opinions

Answer:

I think it can be done, just need to maybe go not too deep and consider opting for two lighter ones 6 months apart to make sure it heals well is all, best of luck. JG 12.14.07

Question:

For shallow acne scarring to cheeks would you recomend I get a second Sciton Profractional tx or Portrait PSR3?

Answer:

a Portrait PSR3. JG 12.14.07

Question:

Hi Dr, I recently had a new Plasma treatment done in Upstate NY and I wanted to pass it along. A couple years ago I had done a Portrait PSR3 treatment done with 4 joules. My downtime was 10+ days with pink skin for a couple months+. It was also very painful. Results were good, but I wanted more. The new treatment was 5 joules with NO lasting redness (really!) and looked normal within a day. Also, with the cooling unit, there was no pain, just the occasional snap like a rubber band. I was amazed at the difference in down time and pain. I guess the there was a new handpiece, which allowed delivery of energy without any burning from the Portrait. I did the treatment as part of a study and FDA approval was recent. I dont know the name of the company, I just know it was invented in Russia. My question is, do you know anything about this new Plasma treatment and if so, do you believe the improvement be similar to the Portrait even though there was no redness? Also, do you believe Plasma treatments will equal Co2 treatments soon in terms of improvement in scars and skin tightening? Thanks

Answer:

well, it must have been part of an FDA study because there is no cooling handpiece from Rhytec, as to equaling a CO2 laser effect, if it ever were to get to that point, then all of the things peoeple want to avoid with the CO2, prolonged redness and increased risk of loss of pigmentation, would be there also. JG 12.10.07

Question:

Hi Dr, I have a question on how long it takes to see results from a PSR3 treatment. How many weeks before collagen remodeling begins approximately and how long before optimal results are obtained? Also, does PSR3 provide any skin tightening and if so how long before the results will be seen from that. Thank you.

Answer:

4-5 months. It does provide skin tightening and the results will need that much time to be seen in terms of the final reuslt, the initial results after a couple of weeks is just due to swelling. JG 12.10.07

Question:

Dr. Garcia, I had fat grafting in the lowereye area, and I`m left with coloured spots from bruising and my skin is wrinkled because of the sweling. It`s been 8 months now. Is there any laser who can handle both issues? Thanks

Answer:

might want to try a Nd:YAG laser. JG 12.10.07

Question:

What do non-ablative skin lasers really do? I am confused by the different types. Is Fraxel really a waste of money? Thank you.

Answer:

I feel that they do help with skin disoclorations and that is about it. I feel Fraxel is a waste of money and it is an ablative laser, just that it is only partially ablative, but the holes it creates are all ablative holes. JG 12.10.07

Question:

Hi Dr. Garcia, For Telangiectasias laser treatment are there any benefits of one laser over the other? I am considering the candela vbeam pulsed dye laser and gemini ktp 532 laser? Thank you. DZ

Answer:

of those two I prefer the Candela. JG 12.9.07

Question:

which is better for scars,IPL OR CPL? (putting aside the YAG laser), and how long will the skin look irritated after this procedure?thank you

Answer:

not much effect from either unless they are very recent and still red. The skin will look irirtated for a couple of days each time you have it done. JG 12.9.07

Question:

Hi Dr. Garcia, I live in Texas and have been diagnosed with mild to intermediate telangiectasia in my cheek areas. I have had two consultations, one suggested fotofacial or ipl and the dermatologist I went to recommended a laser treatment using the Gemini KTP 532nm for my condition. I was leaning towards the Gemini laser treatment what are your thoughts about these remedies. My parents are moving to Las Vegas at the end of the month to retire, I will tell them about your website. Thanks for your help. David Z.

Answer:

I think the true laser, KTP 532 at the dermatologist will be more effective. Thanks for visiting too. JG 12.6.07

Question:

Hello,during IPL treatment why is there givn three to four weeks gap between each treatment?

Answer:

to allow some fading of the pigmentation and to allow some of the effects of the heat generated wear off so there is not a constant irritation that can cause problems. JG 12.2.07

Question:

Hello Dr.Gracia, I wanted to ask you which laser surgery is best for the removal of pigmentation marks...in other words stains?Which laser surgery completley removes dark pigmentation?

Answer:

I think a Q-Switched Nd:YAG laser. JG 12.2.07

Question:

WHILE I UNDERSTAND THE REDNESS THAT GOES ALONG WITH LASER RESURFACING ON THE FACE TAKES SEVERAL WEEKS TO HEAL AND RETURN TO ITS ORIGINAL COLOR I WAS CURIOUS ABOUT THIS. CAN THE HEALING TIME BE REDUCED BY THE EXPOSURE TIME OF LASER. IN OTHER WORDS IS THERE A LIGHT LASER TREATMENT OR I WILL BE LOOKING AT A 1 0R 2 MONTH HEALING TIME REGARDLESS OF THE EXPOSURE TIME WHILE GETTING THE TREATMENT? I AM RFEFERRING TO A C02 TYPE LASER.

Answer:

yes, it can be reduced, but in so doing, it wil also reduce the effectiveness. JG 12.1.07

Question:

Helllo Dr. Garcia- I am about 65 hours post-Portrait PSR2/3. I am still bronzed. Still using Aquaphor coverage. There are two spots of concern: 1) a small 3/8 circle of lighter area- no noticeable skin thickness differentiation with surrounding areas. 2) at outer edge of treatment area, an oval shaped red area (not bronzed)clearly demarcated by a ragged`edge`. My doctor indicated normal peeling at this stage, but I am concerned with the difference between the two. Upon further reflection I am thinking I might have scratched the area with the jagged edges. Q1- should I do anything to prevent scarring in this area? Q2- And could the round are be from a bump by glasses when they fell? I know I am not supposed to rub any area of my skin as a red mark can form. Do I need to do anything now to help prevent/reduce any negative marks in this area? Thank-you.

Answer:

all of that is normal, the peeling off of the bronze is never even and there are always areas where the skin beneath is a little more red than in other spots. I think all you need to do is continue the wound care that you have bene using and all of that will balance out in time. Splotches are common for all patients in the healing period and will get better in some areas faster than in others. JG 11.29.07

Question:

Hello Dr. Garcia. For comparison purposes, for reducing acne scarring, if CO2 laser were rated 10, on a scale of 1 to 10 how effective would a high energy Rhytec Treatment be ( 4 Joules-2 passes )? Also for scarring ( large or small, depressed), how many high energy Rhytec treatments would give the same equivalent result as one CO2 laser treatment? Your answer is much appreciated.

Answer:

I believe the two passes might yield a 4-5. I think there would be a combined effect with a series of 2-3 but there is no way to be exactly the same because the CO2 once is so much stronger. JG 11.28.07

Question:

i have been writing to you about the v beam perfecta treatments...i went to a plastic surgeon today who said that the pin point scarring, enlarged pores, and wrinkles were all due to over aggressive treatments with the laser. i guess my skin in extremely sensitive and scars easily with laser treatment. i am two months past my last treatment and in the last five days i have been developing an alarming amount of these pin point scars across my face. each day that goes by it becomes worse! i am praying this will come to a halt before i am completely covered in scars. i know i need to let all of this take its course. my question to you is this: does this mean i would not be a candidate for laser resurfacing because my skin reacts to laser in this way? i am most interested to find out what course of action i should take to get rid of these scars? is there some type of device that lets you examine the skin to see how deep the scars are? how would one know if lasers will get to the root of them? how long should i wait to do anything else? will my face continue to deteriorate? the plastic surgeon i met with today was afraid of doing any type of co2 on my skin for fear of more scarring results. have you ever dealt with this type of scarring and if so, could i send you some photos? thank you.

Answer:

I have never heard of that type of reaction but if in fact that is what has happened I think you should avoid any other laser treatments, I would wait at least 6-12 months before trying anything else. I think if in fact they are scars you might want to contact the FDA and report an adverse event to the FDA and also contact the manufacturer of the laser to get their input. JG 11.27.07

Question:

Thanks for your response on my question on what type of laser to use for acne. How short live is the results? How long after before I can safely do the co2? What do you give to your patients that have a co2 done by you (before and after)? like retin-a, hydroquinone 6 weeks before? What afterwards while in the healing phase? And do you suggest something other then vaseline for the actual healing phase for someone that is prone to breaking out. I appreciate the time you take for answer my questions. And your quick!

Answer:

it depends on how active the acne is, no way to predict that. There is no problem doing a CO2 laser a few weeks after a Blu-Light treatment. We have our CO2 laser patients use Retin-A and hydroquinone before for 4 weeks and then restart that at about one month after, we use a copper peptide cream for the healing right after the laser too. We try to stay away from vaseline if possible to avoid developing milia. We also use oral antibiotics and anti-virals too. JG 11.28.07

Question:

Hi Dr Garcia, In your opinion what would be the best laser to use for acne. I1`ve heard possible Smoothbeam,IPL,Blu-light, or V-Star? How long of a time frame before it would have to be done again? Thanks so much for taking the time to answer. Oh, one more question. I wanted to do a co2 sometime in Jan. How long of a time frame should between the two laser`s?

Answer:

please clear something up, are you talking about for the scarring or an attempt to control the outbreaks. For the outbreaks the Blu-light works but is very temporary no pateint experience with the others you mention for controlling the outbreaks. JG 11.27.07

Question:

Hello Dr. Garcia! I`m currently using a kojic acid cream post CO2. Is it alright to use retin-a cream or another tretinoin topical while using the kojic acid cream. Thanks.

Answer:

yes, they can be mixed. JG 11.26.07

Question:

I had posted an earlier questin about blistering after an IPL. I am a hispanic female. I use the Obagi system. My skin has now healed and most of the right side of my face and part of my forehead have severe hyperpigmentation. I want to now see the doctor to see how severe this is. At this point, I just want to know what options I can now explore. Thank you.

Answer:

hydroquinone and Retin-A mixed together and sunblock. JG 11.26.07

Question:

Hello dr. Garcia, I was wondering if putting too much numbing cream on prior could possibly influence how much energy is absorbed using the Rhytec Portrait. ie.. you said that the drier tissue absorbs more energy?

Answer:

the cream needs to be removed before the treatment, so no, if the skin is dry it can burn, but if it is well moisturized there is only so much moisturization it can have. JG 11.21.07

Question:

I had laser skin resurfacing with a YAG/KTP and IPL combined on Friday. My skin looks terrible lots of pimmples and over all YUK!!! Is this something where you can expect it to look bad and get better over time. The procedure was expensive and I was hoping that my skin would look better. Thank you for your helpful advise.

Answer:

not uncommon, and it should get better over the next few days too. JG 11.20.07

Question:

I have read about a new method of removing stretch marks called skin needling for stretch marks. It is like a tattoo machine but without ink. What do you think of it and will you consider having this type of service?

Answer:

waste of time. JG 11.19.07

Question:

Hi there, I had PSR3 done 3 weeks ago so far things look good. I am only 29 but had some major sun damage and wanted some serious rejuvenation so he suggested the PSR3. I am still a little red but it seems to be fading,however I am very red/pink around eyes and have several broken caps under and on top of lids. He wants to use the V beam on my eye area.Do you think its safe to use there on already traumatized skin as thin as the eye area? Is it to soon? And what caused this? Is it possible my caps broke from over icing my eyes post opp? Also it seems makeup is to irritating still for my skin it just sits on top of my skin and I feel itchy afterwards.When can I use makeup? So far my DR has been way off with timing.