aesthetic plastic surgery procedures

Top 10 Tip #4…Combination Laser Peel plus ProFractional

Posted on June 24th, 2014
Posted by Julene

Our Sciton laser was designed to be able to deliver two of our favorite laser treatments to face and neck in a simultaneous treatment session…the laser peel for smoothing, and the ProFractional for tightening. This is a very popular combination treatment for our patients, and the results from combining skin smoothing with tightening are even better than when each of these treatments is performed alone. There is a little down time with both the peel and the ProFractional, but the down time is not that much longer for the combination (usually 3 to 5 days).

The laser peel is called a “Microlaser Peel” if the depth chosen is less than 40 microns, and the recovery for this depth peel is anywhere from 1 to 3 days. The deeper the peel depth in microns, the longer the recovery, but the more smoothing that can be achieved. For peels over 40 microns (up to 120 microns can be performed awake in our office), one can add 1 to 3 days of downtime. In other words, if a patient tells us they have a certain number of days of down time that can be allowed, we can design a peel that fits that desired recovery period. Since the Sciton laser uses erbium energy, it works more by an evaporative effect than by a heat driven “burning” effect, so there is much less redness in the recovery period, and the recovery period is far shorter, than with traditional CO2 (carbon dioxide) laser devices, which work via a process of coagulation (more heat).  Patients look like they a sunburn and do not peel or scab over as with dermabrasion or CO2 lasering procedures.  Fine lines, large pores, and deep wrinkles can be resurfaced with the peel modality.  Patients are given some relaxing medications, the skin is pre-chilled, treatments take approximately 30 minutes and are performed in sequential passes over the face and neck.  Acne scars can also be resurfaced.

ProFractional is a skin tightening tool designed to deliver vertical micro-columns of energy to a fraction of the skin’s surface.  Since erbium works via ablation rather than coagulation necrosis (as do other technologies, which leave scar tissue in their path), this ensures that the tissue within the micro-column is ablated (gone or evaporated), such that the undisturbed surrounding normal skin can then “fall together” to fill the column resulting in a tighter skin appearance on the surface.  Since only 1 to 2% of the skin’s surface is actually heated, the recovery time is marked more by a little swelling and bruising than by a really red or “burned” appearance.  Again, patients are very comfortably treated awake with a little relaxing medication, and are usually healed within 3 to 5 days or less depending upon the depth of the treatment chosen.

When performed together, peel and ProFractional results really “pop’ in my opinion! Skin smoothing and tightening together may even decrease overall the number of individual treatments it takes for most patients to be happy, and they aren’t much more uncomfortable than each performed alone.  Down time for the combination patient is increased by a couple of days only, and total treatment time is still within an hour. Patients use a little over-the-counter aqhaphor or Catrix (a prescription healing cream) or other post-procedure topical provided by my office for a week, and are usually able to apply make-up within 5 to 7 days…again depending totally on the depth of treatment chosen.

This combination laser treatment is my absolute favorite skin maintenance treatment to be performed on an annual basis after other skin problems are corrected.  We usually do a little bit of prepping of the skin before a combination laser peel and PF and then resume these same  products after healing, both to add to the laser results as well as to maintain them long term.  The best way to prepare the skin for a combination laser treatment is with a cleanser, a toner, a retinol or Retin-A and hydroquinone (or other bleaching agent) to decrease the “blotchies” seen in a typical healing period.  The best laser result can be evaluated approximately 3 months after the treatment and the overall skin care program will be adjusted accordingly.

So you can see that with this approach to the health and rejuvenation of the skin, each patient gets an individualized treatment plan, depth recommendation, and follow-up care tailored to their specific needs by myself and my skin care and laser personnel.  All of the treatments are performed by either me or my nursing staff depending upon the overall depth of the treatment and how invasive it is designed to be.

Tune in soon for Tip #5VASER Shape!

Best regards,



Top 10 Tip #3: Forever Young BBL with Skin Tyte or ProFractional

Posted on June 18th, 2014
Posted by Julene

Tip #3 is really cool!  Every time I or my nurses do this procedure for someone, I am amazed how much difference it makes in texture, tone and tightness.

Forever Young BBL (Broadband Light) involves using laser light filtered at different wavelengths to address pigmentation problems…redness, vessels or brown pigmentation.  It is a trademarked application of the Sciton family of lasers, which we own, and has no downtime associated with it.  Patients feel a warmth during treatment that is very comfortable, and they leave slightly pink after treatment.  Dark spots will appear darker for a couple days and then just seem to fade away.  Red patches or spots fade immediately.  All red and brown pigment may require re-treatment if the pigment is deeper, and certain skin conditions such as rosacea may require a series of recurring treatments, since rosacea is an ongoing skin disorder with relatively unknown cause or cure.  The Sciton laser is a very effective way of dealing with these common problems and is meant to be a stand-alone treatment, although we often combine various skin care products to add to the laser results that enhance the final result as well as reduce the number of laser treatments needed over time.  We often add skin lightener agents or retinol/Retin-A to be used before, during and after laser treatments and discuss this with each patient at their consultation in our office.  Additionally, BBL treatments can be used for pigment spots (brown or red) of the face, neck, decolletage area or extremities, including legs and hands.  When doing BBL treatments, we often do one pass with the brown filter and one pass with the red filter for patients who have issues with both at the same time.

BBL treatments can be combined with skin tightening laser treatments as well, and this combination is very popular amongst our patients who also desire to deal with facial and neck aging.  Skin Tyte is perfromed using a clear BBL filter, and feels like a gently increasing heat as multiple passes are made in each area of the face or neck.  The goal is to do as many passes in an area before moving on to a new area as is comfortable for the patient.  The heat in the dermis layer of the skin causes a process called collagen remodeling, which in lay terms on the skin surface causes an immediately tighter look.  The results after a series of 6 Skin Tyte treatments is tighter, smoother skin with improved surface texture.   Although we allow single treatment pricing, a series of 3 BBL’s and 6 Skin Tyte treatments is a very affordable way to deal with the early aging changes seen in the 30’s and 40’s and even the older patient who doesn’t mind being treated in a series to gain the advantage of absolutely no discomfort or downtime.

For any age patient who can allow a little discomfort and downtime (oral medication and 2 to 5 days of mild swelling or bruising), BBL with ProFractional is quite popular.  The skin’s surface is fractionally heated with this technology, so that there is no true peeling of the surface of the face or neck, the heat is directed downward in a microscopic diameter vertically oriented column of tissue, and the tissue effect is one of truly ablated tissue (ie, the tissue is evaporated, and not left as scar tissue).  The ultimate effect of this is tightening of the entire skin surface as the microscopically ablated columns fall together, leaving intact skin surface, to give the appearance of tighter skin overall.  The effect around especially the eyes and mouth and jowls is spectacular.  Since the depth of the ablated columns varies with the settings chosen, so does overall downtime.  We can effectively vary laser depth in ProFractional mode according to the patient’s desired downtime, although the deeper we go, the more tightening that is able to be achieved.  Most patients doing at least some regular skin maintenance can get away with interval ProFractional treatments according to age.  This might be an annual treatment, or a series of treatments might be desired to create an additive amount of skin tightening.   ProFractional treatments may also be combined with skin smoothing treatments (ie, MicroLaser Peel or Laser resurfacing) to further eradicate wrinkles…see Tip #4 coming soon…

Come see us soon to discuss how Forever Young BBL can fit into your busy lifestyle and your pocketbook!



Julene’s Top 10 Tip #2

Posted on June 13th, 2014
Posted by Julene



Since wrinkles are formed at least in part by crinkling of the skin in the same places over and over due to the activity of the muscles under the skin, it makes sense that we can delay the onset of wrinkles by weakening the muscles themselves.  The skin wrinkling process begins even with just “resting muscle tone” actually.  Over time, unopposed resting muscle tone and muscle activity cause the thin skin of the eyelids to become “crepy” and allow wrinkles to deepen.  In my opinion, even though Botox and Dysport are not permanent in their effects, this does not diminish their overall value as maintenance skin therapy because these agents keep deep wrinkles from forming and have great preventive benefit.

We don’t have to completely paralyze the muscles to relax them, and we can still look normal in animation as a result.  It is an absolute myth that Botox or Dysport used correctly “freezes” the face.  The goal is to soften the wrinkles at rest, so some wrinkles will actually still appear when squinting or smiling or when elevating the brows or frowning, because again, the muscles are “weakened”, not “paralyzed”.  But if you consider how thin the skin is in the face, especially the lower eyelid and crow’s feet area, it is quite easy to understand how the skin begins to look a little crepy in most 30 year-olds.  I like my patients to begin to think in a preventive fashion in their early 30’s, or when they begin to see lines around the eyes or on the forehead, and to use Botox or Dysport at that time.

There really aren’t too many side effects of Botox or Dysport.  Slight bruising occasionally at the injection site, change of brow position, sagging eyelids are all reported, but fortunately are pretty rare.  We do expect to change brow position when we inject the forehead however, so we discuss this with our patients and try to change it in a positive fashion…elevate the outer brow or treat asymmetric eyebrow positions…a “chemical browlift” can be performed.

The cost for Botox or Dysport is about $12 to $14 per unit, and most patients will see effects that last up to 3 or 4 months on average.  If a patient keeps up with their injections when they wear off, the results can start to stretch to 4 to 6 months duration.  Typical dosage amounts are frown…24 units; crows’ feet…22 to 32 units; forehead…22 to 24 units.


Stay tuned for Tip #3 soon…


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