Archive for the ‘Laser Resurfacing’ Category

How painful is dermabrasion? How would you rate the pain level? What are some anesthesia options for dermabrasion?

Monday, January 25th, 2010

Intense Pulse Light is a procedure where a wire brush is used to take down superficial and deeper layers of the skin to reduce scars, improve wrinkles, decrease pigmentary problems, etc.  It works under the same principle as Usually dermabrasion is not done without some type of anesthesia.  The types of anesthesia include local, regional, oral / iv sedation, general anesthesia.  Most physicians use a combination of above to do dermabrasion.  If it is a concentrated area like a scar, local anesthesia can be the only thing needed depending on the normal anxiety levels that a person usually gets in this type of situation.  If the person is likely to get anxious than oral or iv sedation can help.  For the whole face and larger areas, some type of whole body sedation through oral or iv sedation is helpful.  Regional anesthesia where the nerves are anesthetized can help the whole situation.

Thanks for reading, Dr Young

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

Laser Resurfacing with Active fx / Deep fx / Max fx to tighten the face for a non surgical face lift

Sunday, January 24th, 2010

As I mentioned in another blog, Active and Deep fx are techniques using technology to decrease the downtime from laser resurfacing while attempting to get better results. One thing that I mentioned in the last blog was that often times the more aggressive you are the more results you can get but also the more risk you take on.  Active Fx and Deep fx attempts to get  better results by having fractionated more superficial ablation and deeper fractionated ablation.  This technique treats the superficial elements like wrinkles, pigmentation and skin textures in a fractionated manner with the Active fx while trying to tighten the skin with the deep columns of ablation with the deep fx.  This can get subtle to moderate results.  If you want more significant results then max fx is an option to consider.  This is like active fx except the ablation is not longer fractionated and essentially is like more traditional resurfacing.  With max fx you are likely to get more tissue tightening.  Scientific research has shown that the amount of skin reduction that can be achieved with max fx is approximately 1cm squared in the cheeks and 0.5cm squared in the forehead and mouth area with less reduction around the eyes.  There is a limit to the amount of wrinkle reduction from laser resurfacing.  There is a point where the amount of water decreases the deeper you go.  This prevents the co2 laser from getting to deep.  This also prevents the co2 laser from creating scarring but also keeps the affects from working at the deeper wrinkles.  The options then include repeating the laser resurfacing in another year to further improve the results.  The other option which I like is the addition of dermasanding to the deeper wrinkles like around the eyes, between the eyes, around the mouth and parts of the cheeks.  I will talk more about dermasanding in another blog… 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

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

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

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

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

What are the options for reducing the size of your pores. Does a facelift work for this?

Thursday, September 17th, 2009

This is a question that I answered for a client who had questions regarding whether a facelift would work to reduce the pore size as well as acne scars:

Fat grafting, laser resurfacing, ipl are better options than a facelift (face lift/ lifestyle lift / quick lift / lunch time lift / mini lift / weekend lift / s lift / lifelift / thread lift ). Some newer studies and results from physicians more recently are showing that these modalities may be more beneficial to reduce pore size for people.  A facelift will not effectively do this but it can improve your wrinkles to an extent.  Fat grafting (or fat transfer / fat augmentation / facial fat transfer / fat injections) has been shown by some to regenerate the skin including reducing the size of your pores.  Stem cells in the transferred fat can rejuvenate the skin for years.  Laser resurfacing through the creation of new collagen can also reduce the size of the pores as well.  Ipl is another newer treatment for pore size.  Out of all the options fat grafting might be the best option for pore size and acne scarring.  More and more surgeons are using fat grafting as a way to improve acne scarring.

I refined an amazing volumizing procedure called “the YoungLift”. This is an innovative technique that volumizes your face to bring out the younger and natural you without looking like you had something done. This is not a facelift and requires no incisions. Only pinpoint puncture sites are used and these heal imperceptibly. The YoungLift can be done without general anesthesia and without drains, and large bandages. You also have sometimes a lot less downtime and discomfort compared with traditional facelift procedures. I employ the very best techniques from around the world into one volumizing procedure and I use my internationally acclaimed understanding of facial beauty to create the youthful volume you once had. In your case, the Younglift could help fill in the acne scars and volumize your face which will reduce your pore size

Thanks for reading, Dr Young

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

Scarring and whether Photofacials / Intense Pulse Light can help the appearance.

Thursday, September 3rd, 2009

More and more research is showing that scar production has a large contribution from the inflammatory component and that blood flow is a perpetuator.  Intense pulse light and photofacials (or laser scar revision)can be used to target the blood flow to the scar and hence stiffle the blood flow that is feeding the scar production.  Ultimately, this leads to less scarring and a better appearance to the scar.  Timing is important, your scar should be in the inflammatory stage where blood flow plays an important part.  If the scar is mature, the results will be less impactful.  It really depends on how your scar looks.  You may need a formal scar revision (or scar treatment / scar removal / cosmetic scar surgery / scar plastic surgery) with excision and a reclosure of the wound to improve it.

Thanks for reading, Dr Y

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

What is laser neck lift?

Wednesday, September 2nd, 2009

A laser neck lift can mean a form of liposuction that has a laser attached to it that helps shrink the fat and which can lead to more tightening of the skin.  Fair results can be achieved with this technique.  It can also mean using resurfacing techniques with co2 technology that can cause tightening by creating collagen contracture in the more superficial layers of the skin.  The tightening from this can lead to even less neck tightening than the laser liposuction.  Lumenis has technology that can tighten the deeper layers of the skin through their Deep fx hand piece that directs the co2 laser to the deeper layers.  Again this is more subtle in terms of the results.  If you really want tightening of the your neck bands, turkey gobblers, double chin, loose neck skin a formal neck lift (neck lift / platysmaplasty / lower face lift / lower facelift) is the best way to do that.  This can be done with small incisions under the chin and behind the ear which can heal almost imperceptibly.

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

Blue shadows under the eyes and what are the treatments?

Monday, August 31st, 2009

This is an answer that someone had asked me recently:How do you improve the blue hue under the eye with lower eyelid surgery and what options are there?

Options include fat injection (fat transfer / fat augmentation / fat grafting),  laser resurfacing, (laser peel / Active Fx, Deep Fx, Co2 laser resurfacing), lower eyelid blepharoplasty (lower eyelift / eye lift / lower eyelid pinch). It sounds to me that you might have some volume loss under the skin of the lower eyelid which would include skin thickness, collagen and fat in the lower eyelid cheek area.  The result is that the muscles around the eye are seen more clearly under the skin to give it the blue hue that is seen.  the ways to improve this include fat injections that create a layer of tissue under the skin to block the deeper blue colors from showing throw the skin.  Laser resurfacing also can create a layer of collagen underneath the skin to also block the blue from showing through.

The other explanation is that the bulging of fat from the lower eyelid could be causing a shadow under the bulge to cause the blue discoloration. Lower eyelid blepharoplasty which can remove the fat and skin that is causing the shadow underneath.

thanks for reading, Dr Young

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