Archive for the ‘Chemical Peels’ Category

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Can chemical peels and photofacials be done every 2 weeks alternating?

Friday, January 22nd, 2010

Yes you can do this but you need to be careful and not be too aggressive. Chemical peels that are combined with photofacials need to be light and superficial. It all depends on what condition you are trying to treat. If it is melasma, being to aggressive can sometimes aggravate the condition. This same principle also applies to hyperpigmentation. It also depends on your skin type too. If you have darker skin, being more cautious is important. chemical peels that are done every month should be more superficial. Deeper chemical peels require a longer interval otherwise scarring could occur.  The benefit of doing chemical peels and photofacials together is that chemical peels work on more superficial elements of the skin while the photofacials can concentrate on deeper structures.  The combination of the two however is rather in its infancy stage and there are not a lot of solid scientific evidence regarding using them. The research however will continue to find new ways to benefit our patients.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Chemical Peels, Intense Pulse Light | Comments Off on Can chemical peels and photofacials be done every 2 weeks alternating?

Difference between co2 laser resurfacing with Lumenis and their active fx / deep fx / total fx / max fx technical advances explained

Monday, December 7th, 2009

active_deep_totalfx

skin anatomy

skin anatomy

A knowledge of skin anatomy can help with understanding resurfacing (laser peel, laser skin rejuvenation) of all types including laser, chemical, dermabrasion.  Taking a look at the cross sectional area of the skin, you can see that the skin is broken up into basically two areas, the epidermis and dermis. All resurfacing progressively take away layers of skin and by doing so remove skin lesions, unwanted pigmentation, wrinkles etc.  What happens is that the deeper skin cells located in the depth of the hair follicle eventually resurface and repopulate the skin.  during this process a layer of scar tissue and collagen is formed under the new basement membrane.  This new layer of collagen is thought to be responsible for some of the benefits of resurfacing including tightening of the skin and maintaining the decrease state of wrinkles.  The basement membrane is the connective tissue floor that the stem cells rest on where they reside and repopulate the more superficial layer of skin cells.  Active Fx essentially takes away more superficial layers confined to just above or just below the basement membrane depending on how many passes are done, what power and what density is chosen.  The basic principle of active fx is the use of a fraction of the spot size.  When you look at the picture above you can see that active fx has some wide dots, wider that the deep fx.  But the key are the areas in between the dots that represent untreated skin.  This untreated skin allows a faster recovery and less down time.  The goal is to get some of the effects of resurfacing without the downtime.  To help with the results of active fx, deep fx was added to create more tissue tightening to a deeper level.  Notice in the picture that with deep fx the dots are thinner.  Deep fx is thinner but it reaches to a deeper level heating up deeper layers and leading to more tissue tightening to a thicker amount of skin.  When deep fx is combined with active fx you can get better results than when each are used alone and this is done with less downtime than traditional resurfacing.  Total fx is when active fx is combined with deep fx.  Traditional resurfacing can be explained by active fx and that approach.  The difference is that the dots are much closer together and depending on whether you increase the density of the dots the dots may overlap to a varying degree.  When the dots start to overlap at a density of 4-5 you start to get into more traditional type of resurfacing where all parts of the skin are taken away or ablated per spot.  This approach does not leave healthy skin in between the treated dots, so the downtime is like older approaches. This use of active fx with dots touching or overlapping is more appropriately called max fx, or traditional co2 resurfacing. One thing to remember is that the more aggressive you are the more results but also the more risks are involved.  Total fx tries to get more results than you would normally get with a certain amount of risk. Here is a live demonstration of my use of a co2 laser and laser resurfacing.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Acne Scar Treatment, Chemical Peels, Dermatology, Laser Resurfacing, Microdermabrasion, Scar Removal / scar reduction / scar revision / scar treatment, Wrinkle Treatment | Comments Off on Difference between co2 laser resurfacing with Lumenis and their active fx / deep fx / total fx / max fx technical advances explained

Should I do a chemical peel under the eyes or a filler first.

Tuesday, November 17th, 2009

Aging is in a large part due to a volume loss within the face.  As we age we lose fat within our face, our bones get smaller and our skin thickness goes down too. A simple way to look at it is that we change slowly from a grape to a raisin.  Resurfacing in my opinion should always be done after you volumize or reshape a certain area.  This is more applicable to more permanent or semi permanent filling and reshaping procedures such as face lifting and fat grafting to the face.  But I generally follow that same principle even with Facial Fillers.   Many times you will find that you will need to do less resurfacing after these more permanent procedures and semi permanent procedures. Also after these reshaping procedures, the wrinkles are less prominent and also respond better to resurfacing procedures like chemical peels and laser resurfacing because more of the surface becomes exposed.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Blepharoplasty / Eyelift / Eye Lift / Dark Circles / Eye Bags, Chemical Peels, Fillers / Facial Fillers, Laser Resurfacing | Comments Off on Should I do a chemical peel under the eyes or a filler first.

What are the bumps that can form after you have a laser resurfacing procedure?

Friday, October 16th, 2009

This is a question I answered for a patient who had laser resurfacing (laser peels / laser skin resurfacing / active fx / deep fx / total fx / max fx / ultrapulse / co2 laser resurfacing) and bumps a couple of months after the procedure:

They could be milia (clogged pores / acne / plugged ducts / facial bumps / plugged hair follicles). Which are small plugged cysts within a hair follicle. These can be extracted individually. There are also other options including using retin A, topical antibiotics can help and prevent more from forming.  Also microdermabrasion and superficial chemical peels can be done as soon as your skin is healed. At this point for you, being 2 months out you can do microdermabrasion, chemical peels, and before this I would have you start on a cleaning regime exfoliation and retin A. The Retin A will stabilize the skin cells and prevent the pores from cloggin up. From there, the microdermabrasion and the chemical peels (chemical resurfacing / chemical facials / skin resurfacing) will open up the pores and milia and clear the skin.

Here is a live demonstration of my use of a co2 laser and laser resurfacing.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Chemical Peels, Dermatology, Laser Resurfacing, Microdermabrasion | Comments Off on What are the bumps that can form after you have a laser resurfacing procedure?

Fillers, Botox or Lasers for the Under Lower Eyelid Area?

Thursday, October 15th, 2009

This was a question I answered for someone recently:

Restylane is a filler and can be used to fill in the lost volume that is really the cause of the majority of the reason why your lower eyelid looks the way it does. Fat injections, the YoungLift, Juvederm, Perlane, Radiesse are other fillers that can be filled into the lower eyelid area.  The temporary fillers last from 6 months (restylane) to a year or more (radiesse) with perlane and juvederm in between.  Fat injections can last much longer but this isn’t guaranteed but is the best shot for a long term correction.

Botox prevents the muscle around the eyes from squinting which can make the wrinkles less noticeable. Dysport (or botox / bo tox / botulinum / neurotoxin / disport) is a great option.  But these do nothing for the surface quality of the skin and neither does the filler. But the fillers can decrease the amount of wrinkles by filling up the volume.

This is where the co2 laser or other resurfacing procedure (erbium yag, active fx, ultrapulse, deep fx, max fx, total fx, traditional co2 laser resurfacing, laser peel) can help with by decreasing the wrinkles and actually tightening the skin.  A small amount of volumizing also occurs with lasers with their creating of a thin collagen layer deep to the skin.

I hope that helps some!

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Botox, Dysport, Botulinum, Chemical Peels, Fat Transfer / Fat Injections, Fillers / Facial Fillers, Juvederm, Perlane, Radiesse, Restylane, Wrinkle Treatment, YoungVolumizer | Comments Off on Fillers, Botox or Lasers for the Under Lower Eyelid Area?

Microdermabrasion is generally more superficial and lasers can be more aggressive

Wednesday, September 30th, 2009

This is a question that I answered from someone:

I am confused between Laser Resurfacing and microdermabrasion. I have lines on my face which are not at all deep and I want to get rid of them. What should I do?

Microdermabrasion can help very small lines gradually improve over time.  This procedure is done through a machine that uses diamonds or crystals to take the superficial layers of the skin away.  Varying the pressure and the number of passes with the microdermabrasion can make it more or less aggressive.  The more aggressive the more results that you can attain. The laser resurfacing, such as with co2 lasers, can be the most aggressive of them all except maybe when you compare them with dermabrasion and phenol peels.  Laser resurfacing can handle some of the deepest wrinkles and scars that microdermabrasion would not be able to improve significantly.  Co2 resurfacing entails using co2 gas and the laser it produces to ablate the progressive layers of the skin.  The small lines that you have can be improved by microdermabrasion, chemical peels or co2 resurfacing.  The more aggressive you are with each modality the more results you will get. I use active fx / deep fx from lumenis lasers.  In terms of which one to do, it really depends on how deep the lines are and how much downtime you are willing to take.  The deeper and the more downtime the more aggressive you can be.  The progression starts with microdermabrasion then to null (lighter to stronger) and then to co2 resurfacing / or erbium yag resurfacing.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Chemical Peels, Laser Resurfacing, Microdermabrasion | Comments Off on Microdermabrasion is generally more superficial and lasers can be more aggressive

What are the risks of Chemical peels?

Tuesday, September 15th, 2009

There are many risks with chemical peels (trichloroacetic acid, jessners peel, salicylic, rescorcinal, lactic acid, vitalase, retinoic acid, etc) including but not limited to, scarring, hyperpigmentation, hypopigmentation, acne flares,  eyelid malposition, infection, poor results.  There are many levels of peels and their is alot information out there that helps surgeons determine how deep they are when they do chemical peels.  Knowledge of the depth of the peels helps you determine how aggressive you are and also to avoid problems.  The more you know the better and the safer your chemical peel can be.

Thanks for reading !!

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Chemical Peels | Comments Off on What are the risks of Chemical peels?

At home chemical peels on dark skin?

Friday, September 11th, 2009

null (TCA, trichloroacetic acid, jessners, salicylic, retinoic, lactic acid, phenol, rescorcinal) can cause dark skin to darken even more.  Chemical peels and any surface type of surgery / procedures including dermabrasion, peels, and laser resurfacing is risky with dark skin.  They can cause hypopigmentation and hyperpigmentation both of which can be very noticeable.  You can white splotches like vitiligo and dark patches with any of the above procedures.  Having someone with experience is a very good idea.  There are many peels that you can use in someone with dark skin.  Some have even used Active fx CO 2 resurfacing on type 4 and 5 skin.

At home chemical peels utilizing glycolic acid in 5-20% is a great option for routine skin care.  This addition to your regular maintenance can speed up your skins turnover to help lighten dark spots, normalize your skin, improve skin tone, and also help with fine wrinkles.  We have a great skin program that has been scientifically proven by other researchers.

Thanks for reading, Dr Young!

Dr Young is located in Bellevue near Seattle, Washington

Posted in Chemical Peels | Comments Off on At home chemical peels on dark skin?

What is a Jessner’s Peel and what is it made up of?

Friday, September 4th, 2009

Jessner’s is made of the following:

14g resorcinal- is a chemical compound from the dihydroxy phenols. It is the 1,3-isomer of benzenediol with the formula C6H4(OH)2

14g lactic acid 85%- also known as milk acid, is a chemical compound that plays a role in several biochemical processes

14g salicylic acid is a beta hydroxy acid. This colorless crystalline organic acid is widely used in organic synthesis and functions as a plant hormone.

All of these are in ethanol to make 100cc is an alcohol that is a short chain molecule and allows the peel to penetrate

All ingredients above work by removing your skin cells.  Essentially the peels work together to take away the more superficial layers to allow deeper cells to resurface the treated areas and hence replenish the skin.  It allows each agent to be less concentrated to decrease complications but increase effectiveness. Over single and multiple treatments, these peels are likely to induce collagen production under the skin stem cells to improve pore size, tighten the skin, remove unwanted pigmentation, and improve skin texture.  It is a very superficial peel and is safe.  You need to be cautious with darker skin types like Asians, Hispanics and African Americans as with other skin treatments.

Thanks for reading, Dr Young!

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Chemical Peels | Comments Off on What is a Jessner’s Peel and what is it made up of?

What is the best chemical peel for Melasma?

Monday, August 10th, 2009

Melasma can occur in many different layers of the skin.  Most of the time the melasma is located in the epidermis which is the layer above the bottom layer of skin cells where the stem cells reside.  There are times when the pigmentation gets deposited into the dermal layers, or the layers beneath the stem cells.  Peels differ in the level that they penetrate.  10-20% tricholoroacetic acid null(TCA) usually stay in the epidermis but if applied more times can go beneath the stem cell layer.  20-35% TCA peels tend to go a little deeper and can go below the stem cell layer and get some of the deeper pigmentation.  One thing to remember is that the deeper you go with chemical peels the more time it takes to heal and the more risk.  10-20% TCA peels take 3-5 days to peel and heal. Where as 20-35% will take from 4-7 days or more to heal and peel. A woodslamp can help determine the depth of the pigmentation: contrast in epidermal pigmentation is increased while contrast in dermal pigmentation is decreased under Wood’s lamp illumination compared to ambient visible light. Chemical peels include the vitalase peel, Jessner’s peel, salicylic acid peel, rescorcinal peel, lactic acid peel, glycolic acid peel, phenol peel, retinoic acid peel.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Posted in Chemical Peels, Dermatology | Comments Off on What is the best chemical peel for Melasma?

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