Skin Center FAQs

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General FAQs
  • Q1 :

    What are the risks of these elective surgeries/procedures, and how can I minimize those risks?

  • All medical treatment carries risk, and you should be aware of and understand fully the risks associated with treatment overseas. It is important that you know and understand the policies of the hospital AND make certain to take practical steps to ensure your own well-being and safety.

    Please see the procedure FAQs below for specific information and risks for the procedure or treatment you are considering.

    To minimize risk, please read the following:
    1. If you are a new patient, you will be asked to complete and submit a medical survey, which will be kept in your secure, electronic medical file. It is vital that your physician be informed in advance of any medical condition that you have as well as medication (prescription and non-prescription) that you are taking.
    2. Smoking is a health risk and is a contraindication for surgery. If you are coming to Bumrungrad for surgery, it is imperative that you stop smoking completely at least 2 weeks before surgery.
    3. You are encouraged to ask questions in your consultation and to make certain that you understand the risks of surgery and the likely outcomes.
    4. It is important that you are realistic about what cosmetic surgery and treatments can and cannot do. Your doctor is in the best position to address these issues and for that reason frank and open dialogue is recommended to avoid any misunderstanding.
    5. Before undergoing any procedure here at Bumrungrad International, you will be asked to sign a consent form, which essentially states that you have been informed of the risks involved in the treatment. No procedure will be performed unless you sign the consent form, which indicates that you understand and agree to the risks. This is for your protection and safety, and we strongly encourage you to review a sample of the informed consent before traveling.
    6. The hospital is fully insured against accident and injury and all physicians are required to have medical malpractice insurance.
BOTOX
  • Q1 :

    What Causes Frown Lines & Crow's Feet?

  • Those unwanted frown lines and crow's feet are what doctors refer to as "dynamic" wrinkles, meaning that they are caused by the repetitive movement of an underlying muscle. As we age our skin is less tight, and this repetitive movement caused by squinting, worrying, etc., eventually causes our skin to crease or wrinkle.
  • Q2 :

    How Does BOTOX® Reduce The Signs Of Aging?

  • BOTOX® is a purified form of the botulinum toxin. It is injected in miniscule amounts into the appropriate muscle causing the muscle to relax and thus diminish or eliminate the dynamic line or furrow. BOTOX® has been used for over ten years to treat ophthalmological disorders, and is fast becoming the chosen non-surgical treatment to reverse signs of aging. After treatment, a patient treated with BOTOX® can still frown and smile, but the expression wrinkles around the eyes and forehead are diminished when they do. Normal facial expression is unaffected. Correction with BOTOX® is very natural, and most patients treated feel that they have a more wide-eyed, rested and less angry look.
  • Q3 :

    What Areas Can Be Treated With BOTOX®?

  • Most commonly BOTOX® is used around the eyes (crow's feet) and on the forehead (frown lines) to reduce dynamic lines and furrows. It can also be used to treat prominent neck bands or cords. Although great results are obtained on the upper face, we have also seen success after the treatment of upper lips, marionette lines and chin rippling. BOTOX® injections are also highly successful for the treatment of excess sweating of the palms, soles and armpits.
  • Q4 :

    How Long Does BOTOX® Correction Last?

  • BOTOX® correction lasts an average of four months. After repeated injections the results may be even longer lasting.
  • Q5 :

    What Can I Expect From The Procedure?

  • BOTOX® treatments are merely a simple injection. Most describe the injection sensation as feeling like a bug bite. The treatment is performed literally in a matter of minutes. No specific care is needed after the treatment.
  • Q6 :

    Are There Any Side Effects?

  • The most common side effect of BOTOX® treatment is a temporary bruising at the injection site. This generally goes away within a couple of days, and can be covered up with makeup. In rare cases the BOTOX® can travel, causing a droop in an eyelid. The effects are completely temporary.
  • Q7 :

    How Soon After Treatment Will I See Results?

  • The effects of BOTOX® become apparent in the first three to five days after treatment.
  • Q8 :

    Is BOTOX® Safe?

  • Yes, BOTOX® is safe. It has been used for over ten years to treat ophthalmological and neurological disorders.
  • Q9 :

    Can BOTOX® Be Combined With Other Facial Rejuvenation Procedures?

  • BOTOX® is the ideal adjunct treatment to other facial rejuvenation procedures including laser skin resurfacing, cosmetic fillers, ThermaLift Non-Surgical Facelift and Laser Skin Rejuvenation.
  • Q10 :

    How Do I Find Out If I Am A Candidate For BOTOX®?

  • Our staff will be happy to discuss BOTOX® treatments with you.
Carbon Dioxide Laser Treatment
  • Q1 :

    What is the CO2 laser?

  • A laser is essentially a machine which takes electrical and electromagnetic energy and converts it to a beam of energy. Lasers are defined usually by the type of material or materials which are used to generate its energy. In medicine, and in particular, ophthalmology, several different types of lasers are used, each for a specific application.
  • Q2 :

    How does the laser work?

  • The new technology associated with the CO2 laser has to do with its use for resurfacing.  The problem in the past was that the laser could not be applied without causing heat buildup, which results in scarring of the tissue, instead of simple tightening.  With new technology, we are now able to deliver a pulse of energy so fast that heat is not allowed to build up in the tissues.   Thus, we are able to remove the top layers of skin and tighten it without causing heat buildup and unwanted scarring.
  • Q3 :

    What does the CO2 laser treat?

  • The other categories of patients who will benefit from the laser are those with wrinkles of the face or other irregularities from such things as acne scarring or previous trauma.  In this instance, the laser is used to remove the top layer of skin, and then to tighten the underlying collagen layers.  This is where the tightening occurs, and the reduction of wrinkles or scars.
  • Q4 :

    Are there possible complications?

  • As with any surgical procedure, there are always risks. Though the risks are low, the most common ones for laser skin resurfacing are infection, activation of herpetic lesions, and scarring. Antibiotics are administered and protective ointments applied to avoid infection. Antiviral medication is given to prevent a cold sore flare-up. Scarring is avoided by careful surgical technique and appropriate expectations
  • Q5 :

    What are the alternative treatments to the CO2 laser?

  • In considering the laser for skin resurfacing, there exist several other alternatives.  When one has facial wrinkles, the traditional approach has been to conceal them by using cosmetics and creams to fill in the cracks and wrinkles, giving a smoother appearance to the skin.  With the trend more toward a natural look, people are looking for a more permanent smoothing effect.  Chemical peels (acid peels) and dermabrasions (scraping of the superficial skin) are two similar methods, in that they both remove the top layers of skin.  However, they are not as precisely controllable as the laser.  Also, they do not appear to tighten the skin as well as the CO2 laser.

    Probably the most common alternative to the CO2 laser for facial wrinkles is the traditional facelift, or rhytidectomy.  This can offer the advantage of removing large amounts of excessive skin from the face, but has disadvantages as well.    The incision from a facelift can often be noticeable around the ears and side of the face and it also carries with it the risk of cutting one of the facial nerves during the surgery.  The main advantage of the laser to facelift surgery often has to do with the "refreshed" look of the laser patient, versus the "surgical look" of the facelift patient.

  • Q6 :

    Who is a candidate for the laser?

  • Almost anyone is a proper candidate for the CO2 laser.  Lighter-skinned and very dark-toned patients tend to heal the fastest.  Those with olive skin will usually have the redness last longer, but are still excellent candidates for the resurfacing.  There are some conditions which will preclude the performance of a resurfacing operation.  Medical conditions such as keloid formation or other autoimmune disease must be approached with extreme caution.
  • Q7 :

    What should I expect before, during, and after the laser resurfacing procedure?

  • After your initial consultation with the physician, you will be given several papers with which to familiarize yourself. These include consent forms, and pre- and post-operative expectation forms. If you then decide to schedule a laser procedure, you will need to come in to the office to finalize your pre-operative preparations. At this time, you will also consult with our esthetician and receive several necessary prescriptions.

    A few days after the procedure, and while the skin is rebuilding from the bottom up, some weeping will occur as new collagen is formed by the dermal layer. Minimal to moderate postoperative swelling will occur. Dressings or ointments are used to cover the treated areas and speed the healing process. As the skin heals, the fresh new skin will have a pink quality which will fade over a period of several months. This is easily camouflaged by makeup which can usually be applied in 6-10 days, depending upon your skin’s response to treatment. All laser resurfacing procedures are performed under local anesthesia on an outpatient basis.

  • Q8 :

    How long does it last?

  • Laser Skin Resurfacing is a relatively new technology, with only five years of clinical follow-up. And while we know that it is a safe procedure when performed by experienced hands, the long-term results are not known. The estimate that seems appropriate is that it should last ten years, depending on the care and protection your new skin receives in the coming years. Many patients say that they look like they did TEN YEARS before the procedure!
  • Q9 :

    Can other areas be resurfaced, such as the neck or chest?

  • No. The necessary skin elements for proper regeneration after resurfacing are abundant on facial skin. However, the neck, chest, and other areas of the body do not have the ability to heal properly. Scarring will likely result if these areas are lasered using current resurfacing technology.
Chemical Peel
  • Q1 :

    When can a Chemical peel be performed?

  • A chemical peel can be performed whenever there is damage to be removed. The age limit is usually the early teens.

    It is best performed in the winter when sun exposure is at a minimum and usually after a rigorous skin care regimen.
  • Q2 :

    What is a Chemical peel?

  • A chemical peel is the use of chemicals such as AHA's, trichloracetic  acid (TCA) or phenol to remove layers of damaged or aged skin to reveal newer, softer, younger looking skin.
  • Q3 :

    What does a typical Chemical peel consultation entail?

  • After a full skin type evaluation and skin elasticity check, you will discuss your many options with your Skincare Specialist.
  • Q4 :

    How is a Chemical peel performed?

  • The need for sedation depends upon the depth of the peel.

    After the skin has been primed through skin care or microdermabrasion, it will be scrubbed and a mild toner used to remove the natural surface oils.

    Layers of the acid are gently and expertly applied to your skin. Ahe timer is set and the physician or skincare specialist neutralizes the acid and removes the product. The skin is then cleaned and moisturizered.

    Sometimes a membrane is applied to help with comfort and healing - but these are usually reserved for more intensive peels (phenol, obagi Blue, laser, etc.)
  • Q5 :

    Will it hurt?

  • You may experience a warm or tingling sensation and depending upon the strength of the peel, a stinging sensation.
  • Q6 :

    When will I be able to see the results?

  • You will start noticing pink, fresh skin emerging from under the peeling, damaged skin.  Do not pull or rub the damaged skin off. Within a few weeks the pinkness will fade for most, light peels.

    Depending upon the depth and type of the peel, you may have lingering pinkness resembling mild sunburn or flushed appearance.
  • Q7 :

    What are the risks of a Chemical Peel?

  • If you have oral herpes, gain the approval of your primary physician and seek a prescription for oral acyclovir. If you have a break out during your healing period, it can spread to your entire face and result in severe and permanent scarring.

    Be careful of crusting or excessive weeping.  In AHA peels you may think this is normal but there is a borderline appearance that you must watch out for.  Ask your skincare specialist for specifics regarding what to look for.  If for a typical AHA peel, you should feel and look normal within 3-4 days.  For deeper peels your downtime may take weeks and then months for complete recovery.

    If you experience pain in areas of the face, contact your surgeon or skin care specialist immediately - particularly if you are prone to cold sores - blisters that form will need to be treated immediately.

    Hyperpigmentations (excessive coloration) and hypopigmentation (lack of pigmentation) can be problematic of misdiagnosed skin types, failure to reveal any skin problems or ethnicity and improper post-peel care.  Infection is uncommon but possible so keep an eye out for redness and pain.

    Scarring is a problem if the above is experienced so please adhere to your post-peel instructions to decrease your chances of long-term or permanent, visible signs of damage.

  • Q8 :

    Are the results permanent?

  • You must take good care of your skin after the procedure. If you stress the skin by sunbathing, smoking or not taking proper care, etc, your skin will become damaged. Taking care of your skin and using quality maintenance and prevention products like a high SPF sun block will most certainly help you retain the rejuvenated, more youthful appearance.

    You will of course, continue to age, but your wrinkles will be softened and your appearance made fresher depending upon the depth of the peel.
  • Q9 :

    What are glycolic peels?

  • Glycolic peels are acids used to exfoliate the skin. These peels have been shown to improve fine lines and wrinkles, smoothen mild acne scars, reduce the appearance of light brown spots, and give a refreshing glow to your skin. After the peel, your skin will be red and you will have a sunburn feeling, but you are able to return to normal activities. It is recommended that makeup not be applied for 24-48 hours. For information on gentler peels, visit our Comprehensive Skin Care section.
  • Q10 :

    What is Involved? Will I Need further treatments?

  • Peels begin at a strength of 30% glycolic and increase in percentage over the course of your treatment up to 70%. The physician assistant will determine the right program for your skin. Generally, a series of three to six treatments are required for optimum results. These are spaced two to three weeks apart. The results of the peel are quickly evident.
  • Q11 :

    How long does the procedure take?

  • The medical peel process takes about 15-20 minutes. Although the results are usually not permanent, maintained improvement can be accomplished by periodic treatments.
  • Q12 :

    What should I expect post operatively?

  • The skin will feel sunburned and tight.

    Excessive or widely exaggerated facial expressions should be avoided as it can result in the tearing of the skin and bleeding and therefore scarring.

    The skin should be left to heal naturally. Do not tug at any skin that may peel from the face. This can result in scarring.

Filler Injections
  • Q1 :

    What Are The Available Cosmetic Fillers?

  • Over the years a variety of filler agents have been successfully used. Each filler is a different material and the duration of filling may vary between the different substances.

    Bovine collagen (Zyderm® and Zyplast®) was approved by the FDA 2 decades ago. It was the first filler agent to become very popular in the United States. Typically it is used for smile lines and other wrinkles, lip enhancement and scar correction  because bovine collagen is derived from cow collagen, skin tests on the arm are required in an attempt to determine collagen allergy. Results, after treatment, typically last 2-6 months.

    Human collagen (Cosmoderm® and Cosmoplast®) is used much like bovine collagen. Typically human collagen is used for smile lines and other wrinkles, lip enhancement and scar correction. These materials are among the more popular filler agents for lip enhancement or for the patient who likes collagen, but prefers not to have bovine collagen. In contrast to bovine collagen, human collagen treatment does not require skin tests. Results typically last 2-6 months.

    Among the newer filler agents are those containing non-animal stabilized hyaluronic acid . This sugar-like material is highly popular in Europe and Canada. Recent FDA studies have been undertaken for 2 different hyaluronic acids (Restylane® and Hylaform®). Generally skin tests are not required. The material is soft and is very popular for the treatment of smile lines. Results typically last 3-8 months.

    Radiance® is a filler agent made up of calcium material called calcium hydroxylapatite. This material is approved by the FDA for vocal cord injections and has also been used for the treatment of wrinkles. It is unique among fillers in that results can last up to 2 years. This agent is very popular for those patients with deeper smile lines who want longer lasting results.
  • Q2 :

    What Are Cosmetic Fillers?

  • Fillers are materials that are placed into deeper lines and wrinkles. Filler agents typically are used for those wrinkles that are too deep to be treated with lasers. Most commonly filler agents are used for smile lines wrinkles, between the eyebrows, sagging cheekbones or to enhance the appearance of upper and lower lips. Acne, chicken pox and other depressed scars can also be improved.
  • Q3 :

    What Kind Of Reactions Can Occur After Cosmetic Filler Injections?

  • Reactions to filler agents are rare and generally resolve with time. Some common injection-related reactions might occur, such as swelling, redness, pain, itching, discoloration and tenderness at the implant site. They typically resolve spontaneously within several days after injection into the skin. Other types of reactions are very rare, but occasional patients do experience localized reactions thought to be of a hypersensitivity nature. These have usually consisted of swelling at the implant site, sometimes affecting the surrounding tissues. Redness, tenderness and rarely acne-like formations can be seen.
  • Q4 :

    What Can I Do To Optimize Cosmetic Fillers Results?

  • Filler agents are ideally combined with BOTOX® injections that are used for wrinkles caused by too much muscle tone. Wrinkles such as frown lines, crow’s feet, marionette lines and vertical lip lines are better treated with BOTOX® than a filler agent. Ideally anti-aging skin treatments will include not only filler agents and BOTOX®, but also skin collagen improvement lunchtime laser procedures and skin tightening Thermage Non-Surgical Facelift treatment.
  • Q5 :

    How Do I Find Out If I Am A Candidate For Cosmetic Fillers?

  • Our staff will be happy to discuss Cosmetic Filler for Wrinkle treatments with you.
Laser Hair Removal
  • Q1 :

    Are there any other precautions that I should know about?

  • Optimal results will be achieved with the laser if you are not suntanned. It is also recommended that you avoid exposing the treated area to the sun or cover the area with sun block that has been approved by your physician. Because pigment is often closer to the surface of the skin than the blood vessels of a lesion, a lot of pigment, such as in "tanned" or deeply pigmented skin, may act as a barrier to prevent the laser light from reaching the lesion. Therefore, the laser is most effective in lighter skin types.
  • Q2 :

    Are there any side effects?

  • Unlike other methods of treatment, the laser greatly reduces the potential for scarring or changes in the skin texture. You will, however, experience some temporary discoloration of the skin around the treatment site. This blue-grey discoloration is called purpura and usually resolves in 5-7 days. When treating leg veins, however, the purpura may last from 7-14 days. Also, depending on your skin type, and the site and size of the lesion treated, some patients may experience a temporary brown discoloration of the skin for a few weeks following treatment. It is always transient, however. These side effects can often be minimized with proper preoperative and postoperative care. The laser can be used with much less purpura but additional treatments might be necessary.
  • Q3 :

    Should certain precautions be taken after the treatment?

  • Immediately following treatment, some patients find the application of an ice pack to be soothing to the treated area. Some patients may require the application of a topical antibiotic cream or ointment. In addition, care should be taken in the first few days following treatment to avoid abrasive skin cleansers and not scrubbing in the area should take place. A bandage or patch may be helpful in preventing abrasion of the treated area.
  • Q4 :

    What does the treatment involve?

  • Treatment with the laser varies from patient to patient depending on the type of lesion, and the size of the affected area. Some lesions, like small broken vessels, will require only a few pulses, while others, like port wine stains, will require many more. Leg veins will sometimes require more than one treatment.
  • Q5 :

    What kind of vascular lesions are treated with a laser?

  • The vascular laser can treat vascular lesions such as telangiectasias or spider veins, port-wine stain birthmarks, and strawberry hemangiomas. Leg veins up to 2 mm. in width can also be eliminated. All of these conditions made up of abnormal blood vessels in the skin. They all vary in severity for example, telangiectasias, or broken blood vessels, usually involve single vessels and are often harmless. Port-wine stains, on the other hand, tend to grow with the patient, usually infants, darken in color and will never go away if left untreated. Hemangiomas grow very rapidly after birth but often go away with time. Some, however may impair vision or breathing and should be treated before they are allowed to advance to this stage. In addition, warts, red and raised scars and inflammatory lesions such as psoriasis can be treated by targeting their rich vascular supply.
  • Q6 :

    Why is treatment with a laser safe and effective?

  • The laser is safe and effective because of its unique ability to selectively treat the blood vessels of a vascular lesion without adversely affecting the surrounding tissue. Thus, it will eliminate many lesions while leaving the surrounding skin intact. In fact, the laser is so safe that it is recommended for the treatment of infants as young as a few weeks old.
Non-Ablative Laser Resurfacing
  • Q1 :

    What Is Laser skin rejuvenation?

  • Laser skin rejuvenation treatment is a revolutionary way to combat the signs of aging. This non-invasive procedure stimulates smoother, healthier looking skin without the extensive investment of time and money required by other skin resurfacing treatments.
  • Q2 :

    How Is The laser skin rejuvenation procedure different than other anti-aging treatments?

  • Laser skin rejuvenation treatment is unlike any other skin resurfacing treatment. Your skin is not subjected to harsh chemicals or the intense aftercare of other facial rejuvenation procedures. Patented technology protects the sensitive surface layers of your skin, allowing the laser light to penetrate to a deeper level and stimulate new collagen growth.
  • Q3 :

    How does The laser skin rejuvenation procedure work?

  • Laser Skin Rejuvenation employs a revolutionary approach to skin rejuvenation which combines a cooling cryogen spray and a laser to give you  optimal results with the minimal inconvenience. The protective cooling spray is applied to the skin, allowing Laser Skin Rejuvenation light to pass harmlessly through the upper layers of your skin, stimulating the cells deep below the surface that produce natural collagen. The collagen and elastin fibers continue to multiply after your treatment, and you will continue to see improved results over the months ahead.
  • Q4 :

    What does the procedure do?

  • Laser Skin Rejuvenation treatment uses either lasers (CoolTouch Nd:YAG, Smoothbeam Diode) or light sources (Photorejuvenation Intense Pulsed Light) to rejuvenate your skin from the inside out. There are no harsh chemicals. No long recovery times. Just younger looking skin.
  • Q5 :

    How long does a treatment take?

  • Laser Skin Rejuvenation treatment is so quick and easy, that many patients come in for treatment during their lunch hour. The procedure takes between 15 and 30 minutes, and there are rarely any side effects. You can reapply your make-up right away and carry on with your day.
  • Q6 :

    Can it be combined with other procedures?

  • Laser Skin Rejuvenation is an ideal complement to Microdermabrasion, BOTOX®, filler agents, laser skin resurfacing, and Thermage non-surgical facelift for an overall facial rejuvenation.
  • Q7 :

    Is the procedure painful?

  • Laser Skin Rejuvenation treatment can be performed on any facial area - around the eyes, mouth, cheeks, chin - with minimal discomfort. A topical anesthetic cream can be used on extra sensitive areas, but no injections are needed.
  • Q8 :

    How long will it take to heal?

  • One of the most outstanding features of  laser skin rejuvenation treatment is that there is virtually no down-time associated with the procedure. After a session, the area may appear red for up to an hour. However, make-up can immediately be applied. No wound is created, therefore there is no healing time required!
  • Q9 :

    How many treatments are needed, and how long will it last?

  • Clinical studies suggest that several treatments are needed to stimulate new collagen growth. We also recommend regular touch up treatments to sustain the continued growth of new collagen.
  • Q10 :

    What are the side effects?

  • Laser skin rejuvenation lasers and light sources are among the safest units on the market.
Pigmented Lesions
  • Q1 :

    What causes pigmented lesions?

  • Pigmented lesions, birthmarks, brown spots and age spots are created from an excessive concentration of melanin in the skin. Melanin is what gives our skin its color. Everyone has a different amount of melanin in his or her skin. Your physician will evaluate your skin and inform you of the specific type of skin lesion. High concentrations of melanin can be due to various factors. Some types are present at birth, but most occur with age or as a result of overexposure to the sun's damaging rays.
  • Q2 :

    Which pigmented lesions can be treated with laser?

  • The most commonly treated conditions are solar lentigines, also known as "age spots," "liver spots" or "sun spots"; cafe' au lait birthmarks; and freckles. These benign pigmented lesions are due to an excess of pigment in the skin, usually due to sunlight exposure and congenital factors. Age spots may appear as enlarged light freckles on the face and hands. Cafe' au lait birthmarks may appear as light brown markings anywhere on the body and can be quite large.
  • Q3 :

    How do I know what kind of pigmented lesion I have?

  • Classification of congenital vascular birthmarks has historically been confusing. The medical literature has been inundated by an assortment of terminologies, including hemangioma, nevus flammeus, "stork bites" and port-wine stains. Hemangioma became the generic term used to describe a variety of acquired and congenital vascular lesions. Because this classification was so broad, however, it led to confusion regarding prognosis.

    Lesions that develop by undergoing an initial phase of rapid proliferation followed by cessation of growth and involution are classified as hemangioma. Vascular birthmarks that persist throughout the patient's lifetime and grow commensurately are classified as vascular malformation; this group includes port-wine stains.

    Hemangiomas tend not to be present at birth but appear during the first few days to weeks of life, often as single small macules. These lesions grow rapidly, becoming red and raised. The lesions increase in size during the following weeks to months, until the child reaches about 12 months of age, when growth stops. Hemangiomas occur most frequently on the face or neck and tend to vary in size from a few millimeters to many centimeters in diameter.

    The fully developed hemangioma is often dome-shaped, ranging in color from bright red to dark purple. Approximately 50 percent of hemangiomas spontaneously involutes (diminish) by the time the child is five years of age. Vascular malformations (port-wine stains) are almost always present at birth and occur with equal frequency in males and females.

    The port-wine or red color of these lesions is a consequence of enlarged, ectatic (expansion) blood vessels in the dermis, rather than an increase in the number of blood vessels. The incidence of port-wine stains is estimated to be 0.3 percent; 80 to 95 percent are located on the head and neck. Most port-wine stains appear to involve only the skin; however, approximately 5 percent of patients with port-wine stains have concomitant leptomeningeal involvement (Sturge-Weber syndrome) and/or ocular involvement.

    At birth, port-wine stains appear as pale pink macules. They darken with age, becoming red to purple, and often develop small nodules within the birthmark, which give the lesions a studded appearance. In extensive lesions, hypertrophy of underlying soft tissues often occurs. These lesions result from blood vessels which become enlarged (or dilated), such as port-wine stains (red birthmarks like Mikhail Gorbachev's) or spider veins. They can also appear when too many blood vessels grow in an area, such as hemangiomas.
  • Q4 :

    Are The Results Permanent?

  • Most pigmented lesions if completely removed will not return. At times, however, sun exposure may cause café-au-lait spots to return. Permanence can not be guaranteed. You will also continue to develop more age spots and freckles with time, and the appearance of these new lesions should not be confused with recurrence.
  • Q5 :

    What Are The Alternatives To The Procedure?

  • Pigmented lesions and age spots are cosmetic problems that do not require treatment for medical reasons. Topical therapies include the use of tretinoin (Retin-A), topical vitamin-C or fade creams. These topical therapies are an option, but the results are unpredictable and the response time is 6 months or more for improvement. Make-up is also an option. Cryotherapy can improve pigmented lesions, but often leaves white unpigmented areas or small scars.
Pigment-Specific Laser Treatment
  • Q1 :

    How does the laser treat pigmented lesions?

  • The laser will specifically target dark concentrations of melanin using light energy. Pigmented lesions are lightened or removed when the laser light passes through the skin and is absorbed by abnormal concentrations of melanin. The rapid absorption of light causes the melanin to destruct, reducing the concentration of melanin. A laser produces a beam of highly concentrated light. Different types of lasers produce different colors of light. The color of light produced by a particular laser is the key to the laser's effect on pigmented lesions. Particular colors of light are absorbed by specific colors or pigments in the skin. The laser's light energy, which is absorbed by the targeted lesion, eliminates the appropriate pigmented cells. Pigmented lesions vary in color, depending on the type of lesion and the natural tone of the person's skin. This means that not every pigmented lesion absorbs the same color of light. Earlier lasers emitted only one color of light, often requiring doctors to use two or more lasers and repeated sessions to treat pigmented lesions. The VersaPulse C Aesthetic Laser produces short pulses of a wide spectrum of light colors to treat the full range of pigmented lesions. The entire treatment involves no incisions.
  • Q2 :

    Is treatment with the laser painful?

  • Treatment with the laser is more comfortable and requires less recovery time than some other treatment methods. Most patients do not require anesthesia. In some very rare cases, depending on the nature and the location of the lesion and the patient's age, the physician may elect to use some form of local anesthesia. Pigmented lesions that have not been effectively removed by other treatments may respond well to our laser therapy, providing prior treatment did not cause excessive scarring or skin damage.
  • Q3 :

    Why is laser treatment safe?

  • The laser is safe and effective because of its unique ability to selectively treat the pigmented lesion without adversely affecting the surrounding tissue.
Scars
  • Q1 :

    How is scar tissue different from other tissue?

  • When viewed under a microscope, normal tissue can take a couple of different fashions: dense, regular elongated fibers running in the same direction, such as tendons and ligaments; or dense, irregular and loose with fibers running in multiple directions. In either instance, when tissue is damaged, it will heal in a haphazard pattern--or scarring--that results in a restricted range of motion and, very often, pain.
  • Q2 :

    Why is scar tissue a problem?

  • Scar tissue limits range of motion, and in many instances causes pain, which prevents the patient from functioning as he or she did before the injury.
Sclerotherapy (Spider Vein Treatment)
  • Q1 :

    What is sclerotherapy? Can it be used as an alternative to surgery?

  • Sclerotherapy refers to the injection of dilated veins and spider blemishes with medication specifically formulated to cause their disappearance without doing harm to normal healthy veins, the skin or other tissues.  Only the finest and highest quality needles are used and strict asepsis is observed, with everything appropriately discarded immediately after use.  Sclerotherapy however, is not an alternative to surgery.  If you read or are told otherwise, ask questions, be critical and by all means, get another opinion from a qualified specialist.  Be wary of high tech sounding terms such as "echosclerotherapy and ultrasound guided sclerotherapy."  These are not sophisticated techniques known only to a privileged few, nor are they legitimate alternative treatments when surgical intervention is indicated.

    Many cosmetic dermatologists and plastic surgeons and other trained medical doctors treat patients with varicose veins and spider veins as part of their overall practice in which they provide the highest quality care to their patients.  But they always refer patients they know they cannot help to qualified associates.
  • Q2 :

    Is treatment necessary?

  • Varicose veins and spider veins are always abnormal and will not disappear without treatment.  Left unchecked varicose veins can lead to unpleasant and even serious complications as skin discoloration and sores, bleeding, ankle swelling and phlebitis.  Spider veins, not associated with varicose veins, will likely remain only a cosmetic problem although some patients complain bitterly of discomfort for no other apparent reason.  While many persons chose not to treat varicose veins, especially when they are not causing pain or discomfort, in the minority of cases that complications develop, treating the varicose veins after the fact cannot reverse the complications and therefore comes too late.

    The agents used to inject veins during sclerotherapy are drugs; can one have an allergic reaction while having these injections?
    Allergic reaction during sclerotherapy is a very rare occurrence because the drug is generally trapped in the local area of injection. In extremely rare situations, respiratory and vascular collapse (anaphylaxis) can occur, which is life-threatening. If it does occur, your doctor has methods to manage the symptoms, which is most commonly quite effective.

Unsightly Leg Vein Treatments
  • Q1 :

    What are varicose veins and spider veins?

  • The heart pumps blood to supply oxygen and nutrients to all parts of the body. Arteries carry blood from the heart towards the body parts, while veins carry blood from the body parts back to the heart. As the blood is pumped back to the heart, veins act as one-way valves to prevent the blood from flowing backwards. If the one-way valve becomes weak, some of the blood can leak back into the vein, collect there, and then become congested or clogged. This congestion will cause the vein to abnormally enlarge. These enlarged veins can be either varicose veins or spider veins. Varicose veins are very swollen and raised above the surface of the skin. They are dark purple or blue in color, and can look like cords or very twisted and bulging. Spider veins are similar to varicose veins, but they are smaller, are often red or blue in color, and are closer to the surface of the skin than varicose veins. They can look like a tree branch or spider web with their short jagged lines. Spider veins can be found on both the legs and the face. They can cover either a very small or very large area of skin.
  • Q2 :

    How common are abnormal leg veins?

  • As many as 60% of all American women and men suffer from some form of vein disorder, but women are more affected -- up to 50% overall. It also is estimated that 41% of all women will suffer from abnormal leg veins by the time they are in their 50s.
  • Q3 :

    What causes varicose and spider veins?

  • No one knows the exact cause of spider and varicose veins, but there are several factors that cause a person to be more likely to develop them. Heredity, or being born with weak vein valves, is the greatest factor. Hormones also play a role. The hormonal changes that occur during puberty, pregnancy, and menopause, as well as taking estrogen, progesterone, and birth control pills can cause a woman to develop varicose veins or spider veins. During pregnancy, besides the increases in hormone levels, there also is a great increase in the volume of blood in the body that can cause veins to enlarge. The enlarged uterus also puts more pressure on the veins. (Within 3 months after delivery, varicose veins usually improve. However, more abnormal veins are likely to develop and remain after additional pregnancies.)

    Other factors that weaken vein valves and that may cause varicose or spider veins include aging, obesity, leg injury, and prolonged standing, such as for long hours on the job. Spider veins on the cheeks or nose of a fair-skinned person may occur from sun exposure.

  • Q4 :

    Why do varicose and spider veins usually appear in the legs?

  • The veins in the legs have the toughest job of carrying blood back to the heart. The pressure can overcome the strength of these one-way valves. The force of gravity, the pressure from body weight, and the task of carrying the blood from the bottom of the body up to the heart make the legs the primary location for varicose and spider veins.
  • Q5 :

    Are varicose and spider veins painful or dangerous?

  • Medical treatment usually is not required for varicose or spider veins. However, varicose veins can become quite uncomfortable as well as look unattractive. Varicose veins usually enlarge and worsen over time. They can cause the legs and feet to swell. Although severe leg pain is not common, leg muscles may feel fatigued or heavy, or throb and cramp at night. The skin on the legs and around the ankles also can itch or burn.

    In some cases, varicose veins and spider veins can cause more serious problems, and medical treatment will provide benefits. If the veins become severe, they can cause a condition called venous insufficiency, a severe clogging of the blood in the veins that prevents it from returning to the heart. This condition can cause problems like a deep-vein thrombosis (blood clot), or a severe bleeding infection. These usually are caused by injury to the varicose vein. A blood clot can be very dangerous because of the possibility of it traveling from the leg veins to the lungs, where it may block the heart and lungs from functioning. Lastly, because the skin tissue around the varicose vein may not receive enough nourishment, sores or skin ulcers may develop.
Unwanted Tattoo Treatments
  • Q1 :

    How do I remove my unwanted tattoo?

  • In order to remove a tattoo without a scar, a Q-Switched laser must be used. The term Q-Switched indicates that the laser is pulsed so quickly (billionths of a second) that it is able to dissolve the ink without destroying the live tissue in the process. Similar to running your hand over a candle very quickly, there's not enough time to burn the skin. There are only three types of Q-Switched lasers used for tattoo removal: Q-Switched Ruby (red light), Q-Switched Yag (infrared & green light) and Q-Switched Alexandrite (purple/red light). The reason for the three types of lasers is because they respond differently to different colors of ink.
  • Q2 :

    How does the laser work?

  • The lasers deliver very short pulses of high intensity light into the treated area. The tattoo inks and pigments then selectively absorb the light without destroying the normal surrounding skin tissue in the process. The tattoo is dissolved into smaller ink particles that are harmlessly removed by the body's immune system in the weeks following treatment.
  • Q3 :

    How many treatments will it require?

  • Removing a professionally applied tattoo is usually a fading process that requires a series of treatments spaced approximately 5-6 weeks apart. Professional tattoos usually require 5-10 treatments for complete clearing. The black-colored inks usually respond quicker then the bright-colored inks because they absorb the light better. The depth, color and amount of ink, as well as the location of the tattoo on your body are all determining factors in how long and how quick we will be able to remove your tattoo. Most amateur or otherwise known as "street tattoos" are removed in only 2-5 treatments scheduled about 4-5 weeks apart.
  • Q4 :

    Does this process cause scarring?

  • Very rarely have any scars been seen while utilizing this process. Providing state of the art technology helps ensure patients that the risk of scarring is dramatically reduced. There have been occasions where some lighter or darker colored pigment persists from the tattoo site, but normally after the course of treatments is complete, the treated area is usually indistinguishable from normal surrounding skin.
  • Q5 :

    Will my tattoo be removed completely?

  • Yes, in most cases tattoos can be completely removed. Though there are many factors involved in completely removing unwanted tattoos. The depth, density and types of colors are probably the biggest determining factors. After each treatment we fragment a little bit more ink and a little deeper into your skin, blistering and scabbing often follows for a week or two. We see some tattoos disappear within 2-3 treatments, as well as in some cases seeing tattoos requiring 8-10 or more treatments for complete removal. Taking care of the treated area is the most important factor in removing a tattoo without a scar. It can be said that the better you take care of the area treated the better the results.
  • Q6 :

    Is the process painful?

  • Most or our patients say that the laser treatment feels like being snapped by a rubber band and that the discomfort is roughly equivalent to having a tattoo put on. Almost all of our patients are able to resume their normal activities immediately following treatment.
  • Q7 :

    What about lightening an existing tattoo?

  • Many tattoo artists encourage customers to receive a minimum number of laser treatments to lighten an existing tattoo before covering it with a new one. This will dramatically reduce any chance of the old tattoo appearing through the new one. In most cases, a minimum of 2-4 treatments is all that's required in lightening an existing tattoo.
Vascular Lesion Treatments
  • Q1 :

    What is a port wine stain?

  • A port wine stain (naevus flammeus) is a red or purple birthmark which affects about 3 out of every 1000 babies. It is a type of blood vessel birthmark which presents at birth as a uniform flat red, purple or pink mark on the skin, often on one side of the body, usually the face. They are congenital overgrowths of small blood vessels in the skin. Port wine stains are twice as common in girls as boys, and they may darken with age, thicken with raised bumps (papules) or ridges and increase in size proportionally to the child's growth. They grow with the individual and do not improve over time. They can occur on any part of the skin surface but cause most concern when they affect the face.
  • Q2 :

    What are the causes of port wine stains?


  • Port wine stains are caused by an abnormal development of blood vessels in the area of the skin where they are present. They are not inherited and are not related to anything that the parents may have done during pregnancy.
  • Q3 :

    What causes the splotches of skin pigmentation that are commonly known as birthmarks? Why do they persist on one area of the skin?

  • Birthmarks fall into two major categories: vascular lesions, which are spongy and consist of blood vessels, and non-vascular pigmented lesions.

    Vascular lesions are caused by abnormal development of blood vessels in the skin. Although they are usually present at birth, they may also develop later in life. They may also appear suddenly, persist for a while, and then disappear again. This can happen when the body is going through a big physiological change, such as puberty or pregnancy.

    As with pigmented birthmarks, there are various different ways in which vascular malformations are presented. The two most common forms are port wine stains and venous plexi  intricate networks of veins. Port wine stains are pinkish-red and flat, and may darken in colour to a purple colour several years after birth. They are usually found on the face, but may occur anywhere on the body, and they persist for life, although they can be treated by surgery or laser therapy. They may even grow larger and more conspicuous later in life, darkening, thickening or forming vascular bumps. Those that occur on the face may be associated with eye or brain problems. Venous plexi are thin and light blue, and may be flat or raised.

    Haemangiomas are a third type of vascular lesion. They may develop after birth and consist of many tiny blood vessels bunched together. Haemangiomas occur in up to 2 per cent of newborns, but as many as 12 per cent of babies develop them by age one. Interestingly, they are more common in girls. Haemangiomas may change in size, and most disappear completely by age 10.
Vascular Specific Laser Treatment
  • Q1 :

    What kind of vascular lesions are treated with a laser?

  • The vascular laser can treat vascular lesions such as telangiectasias or spider veins, port-wine stain birthmarks, and strawberry hemangiomas. Leg veins up to 2 mm. in width can also be eliminated. All of these conditions made up of abnormal blood vessels in the skin. They all vary in severity for example, telangiectasias, or broken blood vessels, usually involve single vessels and are often harmless.


    Port-wine stains, on the other hand, tend to grow with the patient, usually infants, darken in color and will never go away if left untreated. Hemangiomas grow very rapidly after birth but often go away with time. Some, however may impair vision or breathing and should be treated before they are allowed to advance to this stage. In addition, warts, red and raised scars and inflammatory lesions such as psoriasis can be treated by targeting their rich vascular supply.
  • Q2 :

    Why is treatment with a laser safe and effective?

  • The laser is safe and effective because of its unique ability to selectively treat the blood vessels of a vascular lesion without adversely affecting the surrounding tissue. Thus, it will eliminate many lesions while leaving the surrounding skin intact. In fact, the laser is so safe that it is recommended for the treatment of infants as young as a few weeks old.
  • Q3 :

    What does the treatment involve?

  • Treatment with the laser varies from patient to patient depending on the type of lesion, and the size of the affected area. Some lesions, like small broken vessels, will require only a few pulses, while others, like port wine stains, will require many more. Leg veins will sometimes require more than one treatment.
  • Q4 :

    Should certain precautions be taken after the treatment?

  • Immediately following treatment, some patients find the application of an ice pack to be soothing to the treated area. Some patients may require the application of a topical antibiotic cream or ointment. In addition, care should be taken in the first few days following treatment to avoid abrasive skin cleansers and not scrubbing in the area should take place. A bandage or patch may be helpful in preventing abrasion of the treated area.
  • Q5 :

    Are there any side effects?

  • Unlike other methods of treatment, the laser greatly reduces the potential for scarring or changes in the skin texture. You will, however, experience some temporary discoloration of the skin around the treatment site. This blue-grey discoloration is called purpura and usually resolves in 5-7 days.


    When treating leg veins, however, the purpura may last from 7-14 days. Also, depending on your skin type, and the site and size of the lesion treated, some patients may experience a temporary brown discoloration of the skin for a few weeks following treatment. It is always transient, however. These side effects can often be minimized with proper preoperative and postoperative care. The laser can be used with much less purpura but additional treatments might be necessary.
  • Q6 :

    Are there any other precautions that I should know about?

  • Optimal results will be achieved with the laser if you are not suntanned. It is also recommended that you avoid exposing the treated area to the sun or cover the area with sun block that has been approved by your physician. Because pigment is often closer to the surface of the skin than the blood vessels of a lesion, a lot of pigment, such as in "tanned" or deeply pigmented skin, may act as a barrier to prevent the laser light from reaching the lesion. Therefore, the laser is most effective in lighter skin types.
Wrinkle Treatments
  • Q1 :

    How Do Wrinkle Treatments Work?

  • Chemical peels, laser, dermabrasion, and skin care are all guided by the same principles. But to understand them, you first must know a little something about your skin.

    Your skin is made up of damaged superficial cells and healthier deep cells. Every day, your old superficial cells die, shed, and are replaced by younger cells. When you are born, the process of shedding a new skin cell takes about 30 days. By the time you are 60, the process takes about 60 days. Thus, as you get older, your complexion becomes dull and lifeless because the cells on your skin's surface are, in fact, older.

    Each treatment mentioned above causes uniform destruction and shedding of your old damaged superficial skin cells. This allows healthier deep cells to surface while they are still young and fresh. Each of these treatments organizes and expedites the process of skin turnover and helps you reclaim the skin of your youth. As a result, you will see improvement in some or all of the following skin problems: large pore size, loss of skin vitality, roughness, discoloration, fine wrinkles, acne scars, dynamic wrinkles, and loss of skin tone. (Fillers and Botox are guided by other principles).

    Despite their similarities, each treatment works slightly differently and therefore yields a different degree of improvement. No one treatment solves all problems. In general, deeper treatments yield greater improvement but impose longer recovery. To optimize their results, many people employ two treatment options that complement one another, such as laser resurfacing and Botox injections.
  • Q2 :

    What are Dynamic Wrinkles?

  • Doctors call them dynamic wrinkles. Everyone else simply calls them smile lines and frown lines. No matter what you call them, they are the most troublesome of all wrinkles and often are the most difficult to treat. They are our crow's feet, scowl lines, forehead creases, and lip wrinkles. They develop because each time we smile, laugh, or frown, our skin creases or folds in the same way. After making the same expressions time after time, our skin "remembers" these creases even when they are not there. These wrinkles can be improved through laser resurfacing, dermabrasion, deep peels, Botox, and fillers. However, even if these treatments could vanish your dynamic wrinkles will return, because you will continue to make the same facial expressions that caused them in the first place. Interestingly, if you have ever seen anyone who has had one half of their face paralyzed, you may have noticed that the paralyzed side appears younger. This is because they do not move that side of the face, so there are no dynamic wrinkles.
  • Q3 :

    What are Fine Wrinkles?

  • Fine wrinkles are seen on dry crepe paper skin (usually on the cheeks). These wrinkles are superficial and their removal is relatively easy through skin care, micropeels, and other simple treatments. (See table).
  • Q4 :

    What are Skin Fold Wrinkles?

  • Skin fold wrinkles are the wrinkles that go from the corner of our noses, around our mouths, and down to our chins. They look like big parentheses around our mouths. They develop within the skin fold (called nasolabial fold by doctors) which is due to sagging cheeks. Because these wrinkles are due to sagging skin, the only way to treat them is by tightening the skin...through a facelift. Just look in the mirror while you are pulling your cheek skin back toward your ears. You will see a dramatic improvement in your nasolabial folds, as well as the skin fold wrinkles.