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Lasers FAQs
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There are a wide variety of lasers available to treat a number of skin conditions. We have compiled here some lasers frequently asked questions to help with any confusion you may have.

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Q: Can I have Fraxel laser treatment 20 years after CO2 laser treatment?

A: Twenty years is plenty of time between laser treatments! Generally, we recommend a touch-up laser treatment every year or two. If you were comfortable with a CO2 laser, then you might like the Fraxel Dual system best. It uses two lasers to create a dramatic resurfacing and rejuvenation. It only takes one treatment and has minimal downtime. Fraxel Re:Store is gentler, has absolutely no downtime, but may take several sessions to get the improvement you want. Be sure to consult a board-certified dermatologist who can evaluate your skin, explain your options, and help you make the best decision.

Q: My dr. suggests combining IPL with Resurfx, 3 sessions. The Resurfx is quite expensive.

A: Intense pulsed light (IPL) is sometimes described as a “photofacial” as it uses light to remove discolorations such as age marks and redness. If that's your main issue and you would be satisfied with just an improvement in your skin tone, then perhaps IPL is enough for you.If you have issues with skin texture, large pores, and fine lines and wrinkles, then adding in the ResurFX nonablative fractionated laser can substantially rejuvenate your skin. IPL only affects the skin surface. ResurFX not only improves the texture of the surface and tightens pores, it penetrates into the dermis – the 2nd layer of skin – to stimulate collagen production. ResurFX thus actually improves the quality of your skin by causing it to thicken and actually “act” younger because it will have more elasticity, too. If this sounds like it would be beneficial to you, consult your board-certified dermatologist about payment arrangements that can make it easier for you to obtain the optimal treatments for your rejuvenation.

Q: I was wondering, do you think gentle laser or lightsheer duet is better for dark hair on fair skin.

A: Fair skin and dark hair is actually an ideal combination for laser hair removal. I prefer the Lightsheer Duet for removing/reducing hair in areas such as: Back, Chest, Shoulders and Legs. I prefer the gentleMax for: Face, Neck, Bikini and Underarms.The LightSheer uses a vacuum to distract the nerve endings near the hair follicle while the laser light is being pulsed. This actually obviates the need for numbing cream and makes the procedure basically pain free.Darker skin types, such as Hispanic, Asian and Mediterranean complexions also do well with Lightsheer Duet because it uses a higher wave length than most other hair-removing lasers. Its large size allows you to treat a large area – such as the entire back – in less than 15 minutes. As with all lasers, it takes about 4 to 6 treatments spaced 4 to 6 weeks apart to get the best results. Because no laser can completely remove hair, you will need to maintain your results every 4 to 6 months. Consulting a board-certified dermatologist who is an expert with Lightsheer Duet give you the best results.

Q: What is the best way to fix the old looking skin under my eyes? Fraxel laser? Filler in the tear trough, Surgery, cheek filler?

A: Now is the perfect time to begin stimulating your skin to stay young with Fraxel Re:Store. It's a nonablative laser that can remove fine lines and wrinkles, plus stimulate your skin to begin producing more collagen and elastin, which will thicken and strengthen the skin plus make it more elastic. You will probably need at least two to three sessions. There is no downtime. Fraxel requires a yearly maintenance session as well. The Fraxel will also help thicken your eye skin and make it easier to resolve your tear troughs with a dermal filler such as Belotero or Restylane. Be sure to consult a board-certified dermatologist who has experience smoothing tear troughs with dermal fillers.

Q: ResurFX - how long am I supposed to avoid the sun after treatment?

A: ResurFX is a highly effective nonablative skin resurfacing technique that improves fine lines and wrinkles. However, it also makes your skin extra sensitive to UVA and UVB rays. You need to avoid sun for three months. If you must be outside, protect yourself with sun block and protective clothing such as hats – which, by the way, everyone should be doing. Be sure to consult your board-certified dermatologist if you have any questions about how to maintain the benefits of your ResurFX treatment and how to avoid skin damage from the sun.

Q: Is ResurFX a good option for acne scars?

A: As you have experienced, acne scars can be difficult to treat and usually require more than one kind of therapy, plus multiple sessions. ResurFX is one of my favorite lasers for treating acne scars. Maximal results take a few months and between 3-6 monthly treatments are necessary to see a significant improvement. It can definitely help with smaller acne scars and pits. However, you may need other therapies as well, including excision and/or fillers for deeper scars. It sounds like your dermatologist has chosen a good first step, but if you do not get as a dramatic improvement as you want, you may need to talk about adding in other therapies, too. Please consult your board-certified dermatologist about the timeline for improving your scars, what kind of improvement you can expect, and what other therapies you might need.

Q: Which procedure can I do to compliment ultherapy results?

A: Combination treatment is the best way to get the most spectacular results when it comes to nonsurgical cosmetic procedures. Ultherapy will do a wonderful job of tightening and lifting your face, and is the only device FDA cleared for a nonsurgical lift of the brow and neck skin. You can choose from a number of lasers to resurface and smooth out your skin, stimulate more collagen and elastin production, and tighten your skin further. I have published extensively on this and did a retrospective study where we combined IPL with Ultherapy and another one where I combined IPL ultherapy and Fractionated CO2. There are many choices you could have, depending on your needs. We offer more than 50 lasers and light therapies at our center. Consulting a board-certified dermatologist who has a wide variety of effective resurfacing and tightening modalities will give you plenty of options to get a noticeable but natural rejuvenation.

Q: What can I do about large pores, rough skin on my face, and dark spots?

A: Depending on the improvements you need -- which can only be determined with photos or, ideally, in person -- I might recommend a combination of lasers, chemical peels, and medical-grade skin care to shrink your pores, fade your dark spots, improve the texture of your skin and stimulate the production of new, rejuvenating collagen and elastin. When it comes to skin problems, there is no one-fits-all therapy. Often, to get the best results, a number of different therapies must be combined and tailored just for you. Start consulting board-certified dermatologists who can work with you to rejuvenate your skin and then make recommendations so that you can keep the benefits of your treatment going in years to come.

Q: Are these pearly penile papules? They have been around for 8-10 years. I have gone to the doctors before and they either don't notice them or just say it's nothing. Never give me an answer of what they are.

A: Those look like pearly penile papules (PPP), and as the doctors you have consulted have noted, they are nothing to worry about. You should not really feel them or by bothered by them physically. However, if they embarrass you or you would just like to be rid of them, this is easily done in a dermatologists's office with a CO2 laser. Be sure to consult a board-certified dermatologist who has experience treating PPP with lasers.

Q: Trying to remove mole with apple cider vinegar, why is my skin looking like this?

A: While I appreciate your resourcefulness, I don't recommend trying to remove a mole on your own. As you've noted, the skin seems to be getting irritated. And the mole is still there. It's also an unsafe habit as some moles may be cancerous. Save yourself some time and aggravation and ensure your safety by having the mole evaluated by a dermatologist. There are many methods we use to quickly and permanently remove moles so that they do not recur, including laser treatments (Active FX/Deep FX, Sciton, eMatrix, etc.) and/or excision. Be sure to consult a board-certified dermatologist who has expertise in mole removal.

Q: ResurFX is an FDA-approved, nonablative way to improve the texture of skin, including reducing pore size. The handheld laser is passed over the skin once. Its laser energy reaches down into the dermis but does not damage the outer layer of skin. It works by heating up and tightening collagen, plus stimulating the skin to heal and restore itself. A session only takes about 5 to 15 minutes. Be sure to consult a board-certified dermatologist who has experience with restoring the face and tightening pores with ResurFX.

Q: Will lasers tighten loose crepey skin on arms?

A: While we usually think of Fraxel lasers as being used solely on the face, they can treat almost any other area of the body as well. Both Fraxel Re:Store and Dual will heat the underlying collagen layer, forcing it to contract, which will also shrink the skin. The lasers stimulate the production of new collagen and elastin – the building blocks of the skin's supportive matrix. Whether Fraxel is sufficient to alleviate the sagging on your arms, however, will depend on how much sagging there is and the quality of your skin overall. This will be determined when you consult with a board-certified dermatologist who has expertise using lasers to resurface and tighten the skin.

Q: Will Fraxel damage my micro-bladed eyebrows?

A: Your question underlines why it is so important to take your time to find a board-certified dermatologist who has expertise in resurfacing the face with Fraxel. A skilled professional will be able to resurface your entire face without affecting the eyebrows at all. You must alert him or her, however, to the fact that your eyebrows were tattooed. Be sure to find a board-certified dermatologist who can help you improve your skin while maintaining the quality of your microbladed brows.

Q: Which laser is best for dark (sun) spots?

A: Without a photo, I cannot give you a specific answer. Fraxel Re:Pair or Re:Store may be sufficient to resolve your dark spots. You will have a reddened face for two weeks. However, many people who have hyperpigmentation require multiple therapies used in combination to completely resolve their sun spots. Intensed pulse light (IPL), chemical peels, hydroquinone and retinoids can all be helpful. Be sure to consult a board-certified dermatologist who can offer you a number of treatments

Q: With PPP does it also swell the edge where they appear?

A: : If your penis is swollen, that is not a result of pearly penile papules (PPP). PPP are benign growths that affect one in five men. I would suggest that you consult a board-certified dermatologist who has expertise in identifying and treating PPP with CO2 lasers.

Q: I have some pinkish/white dots/pumps on my penis head. What could they be?

A: Without a photo or a face-to-face consultation, I cannot say for sure what the growths on your penis are. Generally, pearly penile papules (PPP) don't appear on the penis head. I'd advise you to consult a board-certified dermatologist to have your bumps evaluated.

Q: Are these red Pearly Penile Papules?

A: Pearly penile papules (PPP) affect one in five men. Your photo does seem to demonstrate their presence. They are benign growths and do not need to be treated. If you are embarrassed by them, they can be removed one at a time with a CO2 laser. The entire procedure only takes about 20 to 30 minutes in the doctor's office. Be sure to consult a board-certified dermatologist who is an expert at treating PPP.

Q: What are these penile papules on the head of my penis?

A: Those look like pearly penile papules (PPP). However, you should have that verified by a dermatologist. PPP can be easily removed with a CO2 laser. Be sure to consult a board-certified dermatologist who has a lot of experience treating PPP with lasers.

Q: How to get rid of pearly penile papules?

A: The most effective way to remove pearly penile papules (PPP) is in a dermatologist's office with a CO2 laser. The treatment takes less than one hour. The PPP will not return. If price is a concern, most dermatologists will be happy to work out a payment plan. Be sure to consult a board-certified dermatologist who has experience with PPP.

Q: PPP on penis. How get rid of white spots on my penis?

A: The best way to get rid of pearly penile papules (PPP) is to go to a dermatologist and have them removed with a CO2 laser. PPP is a benign condition, but some people find it unsightly. If you want the PPP gone, be sure to consult a board-certified dermatologist who has experience treating PPP with lasers.

Q: How to stimulate elastin production? Does tretinoin or any laser treatment work?

A: One of the best ways to stimulate the production of new collagen and elastin is through skin resurfacing with Fraxel lasers. You can either choose Fraxel Re:Pair or Re:Store. Re:Pair is a CO2 ablative laser that will redden your face for a couple of weeks. You only need one treatment to get a dramatic improvement. If you want to eliminate the downtime that comes with a red face, then choose Fraxel Re:Store, which is nonablative and has no downtime. You will need more than one treatment with this laser to get the same results as you would with Re:Pair. Be sure to consult a board-certified dermatologist who has experience resurfacing the face with Fraxel to get the most benefits.

Q: What is this? Pearly penile papules or genital warts?

A: The photos appear to show pearly penile papules (PPP), but this should be verified by a board-certified dermatologist. If it is PPP, they can be easily removed with a CO2 laser. Be sure to consult a board-certified dermatologist who can evaluate your lesions more fully and make the appropriate recommendations.

Q: I have PPP and would like to have them removed.

A: You have read correctly: Pearly penile papules (PPP) can be easily removed with a CO2 laser. It is a painless procedure that can be performed in the dermatologist's office. Be sure to consult a board-certified dermatologist who has experience removing PPP.

Q: Severely dehydrated crepey skin! What procedure can be done to take that away and produce new healthy non crepey skin?

A: Fraxel Re:Pair and Re:Store are two of my top modalilties for resurfacing aging skin and stimulating the production of new collagen and elastin. Re:Pair is a CO2, ablative laser that will leave your skin looking reddened for a couple of weeks. You only need one treatment per year. Re:Store is gentler, but will take more than one session. Boosting your skincare regimen with antioxidants and creams like SkinMedica’s HA5 with hyaluronic acid will help you maintain your results. You also need to take extra precautions in the sun and always wear sunscreen. Consulting with a board-certified dermatologist will help you find the best treatments to repair and maintain your skin.

Q: Can Penile Papules Appear on My Glans? PPP Appears on Glans, Corona, Sulcus

A: PPP generally appears on the corona or sulcus portion of the glans. If you do not know whether it is PPP or not, then I'd suggest consulting a dermatologist to rule out other conditions. Be sure to consult a board-certified dermatologist who specializes in PPP. They can be removed in the office with a CO2 laser.

Q: I have developed PPP, mild. How much would it cost to have it eliminated?

A: Pearly penile papules (PPP) will not come back after they've been removed by a CO2 laser. Look for expertise, not price, when searching for someone to remove them in your area. You can find experts on the American Academy of Dermatology website. Be sure to consult a board-certified dermatologist who has experience treating PPP with CO2 lasers.

Q: Do pearly penile papules go away by themselves?

A: We don't know exactly why pearly penile papules (PPP) affect some men and not others. There seems to be a genetic component and they do seem to occur more often in younger men and in those who have not been circumcised. Be assured that PPP is a perfectly normal skin variant and is not a disease or disorder. PPP may represent vestiges of penile “spines” that occur in other animals. They won't disappear by themselves, but you can have them removed with a CO2 laser at a dermatologist's office. Be sure to consult a board-certified dermatologist who has experience using lasers to remove PPP.

Q: I recognized pearly penile papules on the corona of my penis; can I get a non-surgical, but home remedy for this?

A: There is no reason to feel badly about having pearly penile papules (PPP). They are not only harmless, they are a normal variant of penile skin. If you are bothered by their appearance and want them to disappear, the only effective way to make that happen is with a doctor's help; there are no home remedies for PPP, but they can be easily removed in the dermatologist's office with a CO2 laser. Be sure to consult a board-certified dermatologist who has experience removing PPP with lasers.

Q: Cosmetic dermatologist for pearly penile papules?

A: Whenever you are searching for board-certified dermatologist to help you with a problem related to your skin, a good first stop is the website for the American Academy of Dermatology. There you will find experts in your area. You can check out their websites, call for information, find out about payment options, and set up a consultation. When you are ready to have your PPP removed with a CO2 laser, be sure to consult a board-certified dermatologist who has expertise in doing so.

Q: PPP on my penis - can I just live with it?

A: It is fine to leave your pearly penile papules (PPP) alone. They are not harmful and should not cause you any discomfort. If, however, you don't like the way they look or a partner doesn't feel comfortable with them, they can be removed easily in the dermatologist's office using a CO2 laser. Be sure to consult a board-certified dermatologist who has experience removing PPP with lasers.

Q: Best Treatment for Actinic Keratoses, Fine Lines, and Sun Damage?

A: Please start to use sun screen and protective clothing to avoid further damage to your skin. Luckily, the actinic keratoses, fine lines and other evidence of sun damage can be improved and even reversed with photodynamic therapy (PDT). PDT will also stimulate collagen to make your skin thicker and healthier. Depending on your initial evaluation, you may also need combination therapy with other resurfacing modalities, such as Fraxel or microneedling. Please consult a board-certified dermatologist for your Photodynamic Therapy and to receive recommendations for new skin care and sun protection regimens.

Q: Is INFINI the best microneedling tool to improve acne scars?

A: Infini uses fractional radiofrequency microneedling to break up scar tissue, stimulate the production of new collagen, and improve the texture, strength and elasticity of skin. Discomfort during the procedure is minimal and might include some tingling or stinging sensations. At our center, only the doctors perform microneedling and laser therapy. Please consult with a few board-certified dermatologists until you find one who is offering the level of service you desire.

Q: Is Affirm or Accent Skin Tightening Effective for a 70-year-old Woman?

A: Affirm Multiplex is, in my opinion, the most effective and satisfying nonablative laser for resurfacing and tightening older skin. It actually uses two different types of lasers to rejuvenate the skin. First, a fractional laser resurfaces and removes fine lines, scarring, hyperpigmentation and hypopigmentation while also stimulating the production of new collagen to strengthen and rejuvenate the skin. The second laser heats the deep layers of the skin, which shrinks the collagen and other tissue. This not only tightens the skin, but makes it more elastic. That means you will have less sagging and your skin will look significantly younger. How much younger will depend to a large degree on the quality of your skin at baseline as well as your overall health and hydration levels. Affirm Multiplex is easily tolerated and has minimal downtime. You will see results after just one treatment. Please consult a board-certified dermatologist who has expertise in rejuvenating the face with Affirm Multiplex.

Q: Is this PPP? What is going on?

A: Those do look like pearly penile papules (PPP). PPP are a normal variant of sweat glands and are perfectly benign. However, they are not caused by perspiration on your scrotum, masturbation or anything else under your control. They can be easily removed in a doctor's office with a CO2 laser. Please consult a board-certified dermatologist who has expertise in removing PPP with lasers.

Q: About PPP. Is castor oil OK to use?

A: Pearly penile papules are benign dilations of oil glands. Castor oil will have no effect on them, one way or another. If you are troubled by their appearance and would like them removed, this is easy to accomplish with a CO2 laser in a dermatologist's office. The procedure is fast and painless. Please consult a board-certified dermatologist who is an expert at removing PPP with lasers.

Q: Is Fraxel Restore a good idea before a ski trip?

A: While I don't think skiing would actually un-do the benefits of a Fraxel Re:Store treatment, it is not a good idea to expose yourself to intense reflected light (such as that from the snow) so soon after Fraxel. Even though Re:Store is a gentle laser, your skin will be more sensitive than normal and more easily damaged and/or irritated by such elements as sun, wind, and dry air. Enjoy your vacation, wear plenty of sun screen and emollients, and treat yourself to a facial rejuvenation after the ski trip. Be sure to consult a board-certified dermatologist who is an expert at using lasers to resurface skin.

Q: Ive been trying to remove my PPP with tea tree oil for about 2 weeks now, there is no change at all. Why?

A: Tea tree oil is a natural antiseptic, but it will have no effect on pearly penile papules (PPP) other than, perhaps, to irritate the skin. PPP is not caused by an infection. It is a normal enlargement of penile glands on the skin and is perfectly normal. PPP is not a disease or a disorder; it is just a skin variant. Nevertheless, many people are bothered by the way it looks. A dermatologist can easily remove PPP in the office with CO2 lasers. Be sure to consult a board-certified dermatologist who is an expert at treating PPP.

Q: I have PPP at the lower side of glans penis; is there any medicine available to get ride of this?

A: Unfortunately, there are no topical creams or any other medication that I know of that are effective on PPP. Pearly penile papules are normal and benign, but often their appearance causes distress. If you would like to remove them, a dermatologist can do so with a CO2 laser in the office. It is a very quick and pain-free treatment. Be sure to consult a board-certified dermatologist who is an expert at removing PPP with lasers.

Q: 30 seconds of direct sun exposure directly after fraxel treatment on the way to car?

A: I think it's wonderful that your venture into self-care with Fraxel has made you so aware of the dangers of sun exposure and so diligent about avoiding it. This is an additional good outcome to the benefits you'll receive from your rejuvenation.Although the sun can indeed damage the skin in brief periods if it is very intense, between the limited amount of time it took to get to your car and your shading your face, I think you'll be fine. However, please remember that even in the car your skin is exposed to UVA and UVB rays. So please wear sunscreen even when indoors or driving and be sure to pack a hat so that you can walk the parking lot confident that your skin is protected. Please consult your board-certified dermatologist to get more tips on how to protect your skin from sun exposure.

Q: I have got these small white pearly bumps on the back of my penile head after having sex with my gf 4 months ago.

A: Based on your photos and description, the pearly bumps are probably pearly penile papules. These are a normal variant of penile skin, are very common, and are harmless. They are easily removed with a CO2 laser. However, please remember that no diagnosis can be made over the internet. If they continue to concern you, be sure to consult a board-certified dermatologist who has experience removing PPP with lasers to have them evaluated.

Q: I know i have ppp but i dont know who i should go to get treatment or how to find it. Ive searched the internet with no precise results.

A: There are many board-certified dermatologists who will be able to help you. You don't need a surgeon. PPP is removed with a CO2 laser. Call a few board-certified dermatologists and ask about their experience removing PPP with lasers to find someone with the most expertise.

Q: I have PPP; could this compromise my chance of being a soldier?

A: Pearly penile papules (PPP) aren't just harmless, they are a normal variant of penile skin and are very common. There is no reason that they would affect your passing a physical exam for the armed forces. In fact, chances are that one of medics who examines you has them too! If the papules worry you, they can be removed with a CO2 laser. Be sure to consult a board-certified dermatologist who has expertise in removing PPP with lasers.

Q: Do hispanics run the risk of hyperpigmentation when treating acne scars with laser treatments or more sensitive to the sun?

A: Fraxel Re:Store is a very gentle laser that works wonderfully on Hispanic and darker skins. The settings should be adjusted based on your particular skin hue. Depending on the depth and age of your scar, microneedling and even subcision may be necessary. As a caveat, scars can be improved but they don't always resolve completely if they are very deep.As for sun avoidance and sun screen: Whether before Fraxel or after, whether light- or dark-skinned, everybody should be using sunscreen daily, avoiding the sun at peak hours, and using protective clothing such as hats and long sleeves. No ethnicity is immune to skin cancer. Be sure to consult a board-certified dermatologist who has a great deal of expertise treating Hispanic skin with Fraxel and other modalities to remove scars.

Q: I would like to do Fraxel laser on my face but my neck and décolleté area.

A: Fraxel is a terrific way to resurface your skin and stimulate the production of new collagen and elastin – the building blocks of healthy skin. It is appropriate for the face, neck, chest and many other areas of the body; if you have sun-damaged skin anywhere, there is probably a Fraxel option for you.You have a number of choices, including Fraxel Re:Pair (the strongest, CO2 laser; results in about 2 weeks of a reddened face), Fraxel Re:Store (a gentler laser, also known as a “lunchtime” laser because there's no real downtime) and Fraxel Dual, which combines the two other Fraxels. Re:Pair only requires one treatment and gives the most dramatic results. Re:Store and Dual must be administered several times. All lasers will need touch ups after about a year. Cost will vary by practice, area, and expertise. Be sure to consult a board-certified dermatologist who is expert in resurfacing the skin with Fraxel.

Q: From what age is Fraxel dual recommended?

A: Board-certified dermatologists make decisions about what treatment to use on a patient not based on chronological age but on factors such as skin type, skin quality, degree of damage, and desired results. There are people in their 20s whose skin has been damaged by the sun who would benefit from Fraxel Dual. There are others in their 40s who really don't need to do a major resurfacing because they've avoided the sun, still have good skin laxity and volume, and would do just fine with a chemical peel.The only way to know when it's time for resurfacing fine lines, scars and discoloration with Fraxel Dual is that 1) you are ready to do so; 2) you've consulted a board-certified dermatologist who agrees that Fraxel is the best solution. Be sure to consult a board-certified dermatologist who is an expert at resurfacing the skin with Fraxel:Dual to get the best results.

Q: Are these pearly penile papules?

A: Those look like they are probably pearly penile papules, which are enlarged skin glands. They are normal. If you'd like to have them officially diagnosed and evaluated, you need to see a dermatologist. They can be removed with a CO2 laser. Be sure to consult a board-certified dermatologist who has experience treating PPP with lasers.

Q: These bumps been here for awhile and I never had unprotected sex with anyone.

A: Those look like they are pearly penile papules (PPP). They are a very common and completely normal skin variant that probably has a genetic basis. It usually affects younger men and uncircumcised men. PPP is not an STD. However, you should still continue to have protected sex. If they bother you, they are easy to remove with a CO2 laser. Be sure to consult a board-certified dermatologist who specializes in removing PPP with CO2 lasers to have your condition resolved.

Q: When can I go for tattoo removal?

A: You can't begin to remove a tattoo until it has totally healed. This usually takes between two weeks to two months. However, catching the tattoo as early as is safely possible sometimes allows for easier removal as the pigment has not had as much time to integrate into the skin. The picosecond lasers are the most advanced and effective tattoo removal lasers currently available and I often use a combination of both PicoWay and PicoSure lasers to get optimal results for all colors of tattoos. However, it will still take a number of sessions to fade your tattoo, probably at least three to five. Please consult a board-certified dermatologist to have your tattoo expertly removed.

Q: Will it be possible to lighten my sleeve tattoo for a cover up?

A: The picsecond lasers (PicoWay and PicoSure) are my lasers of choice for removing complex tattoos with many colors. These use intense and very short bursts of energy to shatter the pigment, which your body will then eliminate. This is not a quick process. It will probably take at least five or six sessions to fade your tattoo sufficiently for you to do a cover up. Please consult a board-certified dermatologist to handle your tattoo removal.

Q: Can a Fraxel laser or some sort of scar revision be done on the nose for a scar due to acne?

A: Fraxel is perfectly safe and effective on the nose and can be used to treat scars in that area. Scars are usually quite difficult to resolve and often require combinations of lasers, microneedling, and chemical peels. Which combination would be the best treatment for your scar must be determined in a face-to-face consultation with a board-certified dermatologist.

Q: Is Fraxel Repair for me? 40 year old Asian with brown spots and freckles.

A: Fraxel Re:Pair is an ablative laser that would not be appropriate on your skin as it is too harsh. Darker skin must be treated more gently to avoid possible hypo- or hyperpigmentation. Fraxel Re:Store or Dual, however, might be an excellent choice for you. They do take more than one session to give you optimal results, but there is significantly less downtime. You may also need combination treatment to fade your freckles sufficiently. Please consult a board-certified dermatologist who has expertise in resurfacing Asian skin for best results.

Q: Are these PPP?

A: Those look like they are probably pearly penile papules. You should have this confirmed in person by a dermatologist. They can be removed with a CO2 laser in the office. It is a fast and virtually pain-free experience. Please consult a board-certified dermatologist to have your PPP treated.

Q: Can Fraxel Restore/Repair improve the texture of hypertrophic surgical scar?

A: Scars can be very difficult to treat and usually need combination therapy. I've gotten some very good results using Fraxel Re:Pair combined with microneedling to break up the fibrous tissue. To find out if your scar will improve significantly with Fraxel Re:Pair and/or other therapies, please consult a board-certified dermatologist who has expertise in treating scars.

Q: After photodynamic therapy, how long does the skin's purging process last?

A: PhotoDynamic Therapy (PDT) uses four different wavelengths of lasers (PDL, IPL, red light and blue light) to target lesions and irregularities on the skin. It can be used to improve or resolve issues such as: Aged or irregular skin Acne Actinic keratosis (precancerous lesions) Hyperactive oil glands Hyper and hypo-pigmentationDepending on your metabolism, it will take approximately 4 to 8 weeks before the old skin is completely eliminated and the new layers of improved skin can be seen. Please wait about two months before deciding if you need another treatment. Finding a board-certified dermatologist who is expert at resurfacing the skin with PDT will help answer any questions you have and determine if you are a candidate for PDT.

Q: Can I use Pepsodent for pearly penile papules treatment?

A: Please do not use any kind of toothpaste or home remedy on your pearly penile papules (PPP). These substances may irritate your skin and even cause damage. PPP is a benign condition that does not need to be treated at all. However, if you find the papules embarrassing or if they bother you, they are easily and painlessly removed in the doctor's office. Please find a board-certified dermatologist who is expert at removing PPP with a CO2 laser to help you.

Q: Will PPP go away by itself?

A: Pearly penile papules (PPP) are nothing to worry about, as they are merely a benign penile skin variation that may be genetic in nature. They tend to appear in younger men and in uncircumcised men. You will get fewer as you age, but they will not disappear on their own. If you are bothered by them, they are easily removed in a doctor's office with a CO2 laser. Please consult a board-certified dermatologist who is expert at removing PPP with lasers.

Q: The best stretch mark removal? I have black stretch marks on my bum & breast since I was pregnant.

A: Stretch marks are difficult to treat, as the damage reaches into the deepest layers of the dermis. They can be improved with a combination of lasers or light therapy plus microneedling. They will not fade completely, but combination therapy should fade them. Please consult a board-certified dermatologist to find out if you are a candidate for improving your stretchmarks with combination therapy.

Q: How long do Fraxel Repair Results last?

A: Once you have resurfaced your skin with Fraxel, the results are immediate and permanent. Your skin will continue to improve over the next six months as it begins to repair itself from the microwounds caused by treatment. The repair process stimulates the production of new collagen, which will further rejuvenate your skin. Although the results from your treatment are permanent, you will continue to age as normal. The rejuvenated look should last anywhere from five to 10 years. Please consult a board-certified dermatologist about repairing your skin with Fraxel.

Q: I have been using Tretinoin (Retrieve Cream) for a couple of years. It has been beneficial but I feel that my skin is very thin now. My questions is how long should I wait (or should I not have it) before doing Fraxel Restore? I am concerned that my thin skin will cause the Fraxel Restore laser to penetrate too deeply. Will the skin go back to its original thickness eventually? Any advice would be appreciated.

A: To avoid irritation, discontinue your tretinoin at least two weeks before you have Fraxel Re:Store. The laser will not only resurface your skin, but stimulate the production of collagen. This should add some volume to your skin, making it look more youthful. Please consult with a board-certified dermatologist to have your skin evaluated for Fraxel.

Q: Is it safe to use Fraxel on african american skin?

A: Fraxel Re:Store is a non-ablative laser, which means it does not create wounds on the surface of the skin. In most cases, it can be used on darker complexions without risk of hyper- or hypo-pigmentation. Please see a board-certified board dermatologist to see if you are a good candidate for Fraxel.

Q: I got hit by a car and I have alot of scars but the most noticeable ones are on my face. I have train track stitches scars from the guys windshield. I ended up with over 300 stitches and the scars look like it. I don't want anything crazy and I have seen 15 doctors and none could help. Has anyone had surgical scars removed and can tell me about it? Thanks

A: Fraxel Re:Store breaks up scar tissue and stimulates the production of collagen, which will improve the appearance of scars – including ones that are years or even decades old. You will probably need multiple treatments spaced from a month to a month and a half apart, depending on your healing process. The scar will not be totally removed, but will blend much better into the surrounding skin. Depending on how deep and discolored the scars are, you may need additional therapies, such as micro-needling and chemical peels. Please consult a board-certified dermatologist to have your scars evaluated and find out which treatment options will give you the best results.

Q: I have a mole on my cheek about 3.3 mm in diameter and maybe raised 1-2mm. I want to get it surgically removed and have spoken to a plastic surgeon about it and know there will be some scarring. I plan to have Fraxel and would like to know how long after the removal would I have to wait to have it, and if it will actually do anything for the scarring. Thanks!

A: Provided that the mole was benign, Fraxel Re:store can help remove the scar once it heals. I would wait at least two to three weeks before using Fraxel on the scar. Please see a board-certified dermatologist.

Q: I am hispanic with olive skin can I get Fraxel treatments? I have some acne scaring from when I was younger and I also have a very small amount of brown spots from tanning. Am I a candidate for fraxel treatments and if I am, would it be Fraxel re:fine, re-store or re-pair?Thank you very much!

A: Fraxel Re:Store is a non-ablative laser that does not create the wounds that might create hyperpigmentaton in ethnic skin, provided it is performed at the correct setting. Please see a board-certified dermatologist to resurface your skin with Fraxel.

Q: The skin on my arms is getting saggy and I have some sun spots. Will Fraxel Laser work for this and which one, Restore or Repair? Also, which one is better for the decolletage area? I am in my late 40's, fair-skinned. Thanks

A: Fraxel Re:Store should work well on your decolletage area, where the skin is quite delicate and thin. Depending on the degree of sagging, it is possible your arms would respond better to Re:Pair. Re:Pair can both fade the sun spots plus tighten your skin. However, pale skin tends to be more sensitive, so I would advise a patch test. If you can't tolerate Re:Pair, Re:Store could work for the arms as well, although it may take more sessions. Please consult a board-certified dermatologist.

Q: Are there benefits for having more than 6 Fraxel treatments?

A: Generally, patients improve significantly sufficiently after four to six treatments that they see no need to continue. And, as with all cosmetic dermatology procedures, sometimes less is more. You want your skin to look natural and healthy, so I would avoid over-treating. It is a good idea to have yearly maintenance treatments to continue the benefits of collagen production and rejuvenation. Please see a board-certified dermatologist about how to repair and rejuvenate your skin with Fraxel.

Q: What do you feel would be most helpful for making my skin look better? Should I consider the Fraxel Repair or Fraxel Restore?

A: Using a combination of Fraxel Re:Pair and Fraxel Re:Store should improve the scarring and the texture of skin on your face. Consulting with a board-certified dermatologist will help you come up with an appropriate treatment plan.

Q: Is the fraxel laser good for under eye wrinkles? I have fine lines directly under my eyes. My doctor applied Botox to the outer eye area (where the lines were very minimal); but I still have fine lines. I've tried Fraxel under my eyes about 6 times last year, and saw a vast improvement. They still bother me though. Should I go back for more Fraxel to build more collagen? Thanks.

A: Depending on the depth of your wrinkles, either Fraxel Re:pair or Fraxel Re:store would be appropriate. Both technologies will also stimulate collagen production, which improves the quality of your skin. You may also need some fillers, such as Restylane, and possibly some Botox to prevent further wrinkling. Because Fraxel Re:store is less aggressive than traditional Fraxel, it may take multiple sessions to obtain your desired results. However, there is no downtime after treatment, allowing you to return to daily activities immediately. Please schedule an appointment with a board-certified dermatologist to find out how Fraxel can rejuvenate your under-eye area.

Q: Do I need to modify my workout after laser treatment?

A: You do not have to modify your lifestyle in any significant way after receiving Fraxel Restore or Fraxel Dual treatments, as they are nonablative and do not wound the skin. However, if you have a Fraxel Repair treatment, you will have some downtime that may last a few days to a week. Because you may be slightly uncomfortable after your treatment and experience such minor side effects such as tingling, burning, slight swelling or bruising, I do recommend holding off of exercise for at least a day, and perhaps up to three or four days, depending on how you feel. Call a board-certified dermatologist for a consult and learn how to use Fraxel to restore youth to your skin.

Q: What is best for a 77 year old woman Fraxel or halo?

A: Fraxel lasers are a wonderful choice to begin repairing skin damage caused by sun exposure and aging, and can be safe at any age. Fraxel removes the damaged outer layers of the skin. With repeated treatment, Fraxel can resolve age-related hyperpigmentation as well as crepey or finely wrinkled skin. Please consult a board-certified dermatologist to have the quality of your skin evaluated and an appropriate treatment plan developed to restore youth to your face.

Q: I'm a 45 year old woman who is a past sun fanatic. In the past year or so I've noticed my skin severely breaking down, no surprise given the abuse from the years of sun tanning. Is there any procedure that will help reverse or diminish the crepey/wrinkley skin on my chest, legs, arms, hands and even feet? Would Fraxel or Ultherapy be of any help? It's depressing to know I can no longer comfortably wear shorts, t'shirts or even a bathing suit in public again.

A: Fraxel lasers can indeed help repair some of the sun damage on your body and also stimulate the skin to produce new collagen, which will help it maintain elasticity. Consult with a board-certified dermatologist to discuss Fraxel and also a skin-care regimen that will let you take control of your aging process so that you feel comfortable in summer clothes again.

Q: i saw a brochure for fraxel laser at my dermatologist. it seems like it works on lots of skin problems. is fraxel better for some skin problems than others?

A: When administered by a board-certified dermatologist, Fraxel can be used to treat a variety of troubling skin issues. In addition to helping rejuvenate scar tissue, and virtually erasing lesions such as acne scars and stretch marks, Fraxel can fade age spots, smooth out wrinkles, and even resurface large-pored and uneven skin. Please consult with a board-certified dermatologist to find out how Fraxel can help your skin look its best.

Q: I'm looking to get this laser done on my belly. b/c i have stretch marks everywhere on my tummy. its very unwanted scars i cant ware a two piece b/c its so ugly. please somebody let me know if this is a good thing to do.

A: Fraxel can indeed help to minimize stretch marks on the abdomen, allowing you to feel comfortable in a bikini again. Laser treatment with Fraxel can help to soften and smooth the scar, helping it to fade into the surrounding skin. Although many patients find that one treatment is sufficient, depending on the depth of the scar and the quality of the skin, multiple sessions may be advised. Please consult with a board-certified dermatologist to discuss how Fraxel can restore your skin's smoothness and elasticity.

Q: Heard a lot about Fraxel laser. Acne is a problem for many people, as well as scarring — can Fraxel treat acne scarring on the face?

A: If you no longer have active acne, resurfacing and rejuvenating the skin with the Fraxel fractionated CO2 device can be an excellent choice. It is particularly helpful for patients with darker skin tones, who might experience hyperpigmentation with other resurfacing treatments. Fraxel penetrates the skin deeply and helps even out color, texture and tone. Multiple treatments may be necessary, depending on the severity of scarring. Please consult with a board-certified dermatologist to find out how Fraxel can help resolve your skin issues.

Q: Is it okay to take a 2 hour flight immediately after a Fraxel treatment?

A: It should be fine to fly right after a Fraxel treatment. You may be a little uncomfortable, however. If you are having a stronger Fraxel treatment such as the CO2 Fraxel Repair, it might not be a good idea to fly, as the downtime is a little more severe than with the non-ablative Fraxel lasers. I would discuss your concerns with your doctor and follow their advice.

Q: Why do the pores enlarge as years go by after having a Fraxel Dual treatment? Is it always the case that this will happen?

A: Fraxel Dual should not cause the pores to enlarge. However, pores will often appear larger as a function of age. The size of your pores is genetically determined, so if your parents had large pores, most likely you will too. There are various ways that you can help to minimize the appearance of pores, though, among which is laser resurfacing.

Q: Is Deep FX or Fraxel Repair better for treating deep acne scars?

A: Acne scars can be tricky to treat, and often require a combination of treatments, including a vascular laser for redness and sometimes even subsicion for maximum results. Which laser is used is less important than the skill of the dermatologist using the laser. I suggest finding a board-certified dermatologist in your area who has experience treating acne scars and going in for a consultation to come up with a custom treatment plan.

Q: How do I find an expert to do Fraxel or a different laser treatment for crow’s feet on an African American?

A: I would research board-certified dermatologists in your area, making sure to look through their before and after photos to see if there are African American patients there. Laser treatments have gotten much more advanced in recent years and can be done safely on people with darker skin tones, but it still requires an expert with years of experience. For the crow’s feet, however, a better solution than a laser is Botox, which can be done safely on any skin type.

Q: Is it okay to use Fraxel Restore on African-American skin under the eyes for tightening and wrinkles?

A: Fraxel Restore can be used safely on African-American skin when performed by an expert, board-certified dermatologist with experience treating a wide range of skin colors. Ultherapy is my treat of choice in this area as it is a good option for tightening skin and smoothing wrinkles around the eye area that and is safe for all skin types.

Q: Does IPL work to clear reddish pink port wine stains or is PDL preferable?

A: For port wine stains, a PDL (pulsed dye laser) will usually be your best bet. IPL is not generally used to clear this type of birthmark, but is instead better for brown spots or overall redness from rosacea or flushing. PDL works well to clear even deeply colored port wine stains, though.

Q: I had two IPL sessions at the dermatologist for blue veins in my face, but they were not eliminated. What treatment is best to get rid of these veins?

A: IPL is not the best treatment for blue veins in the face. At my practice, I’ve had great success using the CoolTouch Varia laser to eliminate unwanted blue facial veins; see a before and after picture in the link below. I would suggest finding a new board-certified dermatologist with experience eliminating unwanted facial veins to come up with a better custom treatment plan.

Q: Does IPL increase photosensitivity? I received IPL on my shoulders for brown spots and noticed some improvement, but then I went on vacation 4 months later and now have more brown spots than I did before the IPL. There’s no increase in brown spots on my face, where I didn’t have IPL. I used SPF 60 sunscreen but I was sun exposed.

A: IPL can increase photosensitivity immediately after treatment, but not four months later. We always advise avoiding the sun and being diligent about applying broad-spectrum sunscreen and protective clothing following treatment. Perhaps your sunscreen only provided UVB protection, as the SFP number only refers to UVB protection. For best coverage, the sunscreen label should state both UVA and UVB coverage. I doubt the IPL had much to do with your increase in brown spots, though. Brown spots can appear after sun exposure whether you’ve had an IPL treatment or not. Perhaps there is another reason, for example, certain medications can cause photosensitivity like tetracycline or sulfur antibiotics. While it may be unrealistic to avoid the sun entirely, being very diligent about reapplying sunscreen every few hours, making sure your sunscreen blocks both UVA and UVB rays, making sure not to stay in the sun for too long, and wearing hats and protective clothing when you know you’ll be in the sun for a while will all help to reduce the occurrences of brown spots. With good protection, those spots may fade completely. If not, I suggest you visit your dermatologist for evaluation.

Q: Is this PPP? I’ve seen photos but mine seems to have too many bumps.

A: It’s difficult to tell from your photo whether you have PPP or something else. I suggest visiting a doctor to find out if you have PPP. If it turns out that you do, they can be safely removed with a CO2 laser treatment done by an experienced, board-certified dermatologist. Good luck.

Q: I’m 52 and have bags under my eyes. I want to get rid of them but I don’t want surgery. Is there a way to do this that’s not too expensive?

A: There are a variety of non-surgical ways to treat eye bags but it depends on what is causing them. Dark circles under the eyes are typically caused by a combination of 4 different factors: volume loss, excessive pigmentation, excessive vasculature, and fat herniation. Each of these can be addressed in a variety of ways but the good news is that there is a non-surgical option for almost every situation. These options include injectable agents and lasers. Consult with a board certified dermatologist or cosmetic physician for a full assessment and discussion of what may be the best for you. Good luck!

Q: I’ve always had bags under my eyes. Will a laser treatment help to reduce them?

A: There are a variety of non-surgical ways to treat eye bags but it depends on what is causing them. Dark circles under the eyes are typically caused by a combination of 4 different factors: volume loss, excessive pigmentation, excessive vasculature, and fat herniation. Only the excessive pigment and vasculature can be targeted with laser treatment. Consult with a board certified dermatologist or cosmetic physician for a full assessment and discussion of what may be the best for you. Good luck!

Q: Do I need to stop Retin-A before having laser resurfacing for acne scars?

A: There is no peer-reviewed evidence to suggest that topical Retin-A has any negative effect on laser resurfacing for acne scars. I do not counsel my patients to discontinue prior to the procedure.

Q: What can I do about broken veins and pigmentation on upper cheeks and under my eyes?

A: Broken blood vessels and excess pigmentation are two of the most common concerns that present to my practice. There are a large variety of options for the effective treatment of these issues. These options include intense pulsed light (IPL), vascular lasers, pigment lasers, and resurfacing lasers. I typically use a custom combination of all these options to address each patient’s individual needs. Tailored individual treatments that use a combination of different therapies are essential to achieve the best results. However, these combinations should only be undertaken by experienced and specialty trained physicians. Hope that helps and good luck!

Q: What laser is best for freckle removal? I tried IPL but it didn’t work for me.

A: There are several options for pigment removal using laser devices. These options in IPL, alexandrite, ruby, pulsed-dye, KTP, Nd:YAG, and picosecond lasers. I’m sorry to hear that IPL did not work for you, but often it’s the settings and treatment technique that determine the outcome not necessarily just failure of the device. The best device depends on many factors such as your skin type, the type of freckle you have, your previous treatment record, and how your skin reacts to laser energy. For assessment of these factors and design of an appropriate treatment plan tailored to your needs, it’s best to see a specialist trained laser surgeon. Good luck!

Q: I’m considering laser resurfacing for wrinkles around my mouth and eyes. Would CO2 or Total FX be a better procedure?

A: The areas around the mouth and eyes are excellent areas to treat with ablative laser resurfacing (of which the two main types are CO2 and Erbium). Total FX is a type of CO2 laser that can be used to great effect to reduce wrinkling around the mouth and eyes. I typically combine a variety of different lasers to achieve the best effects in these areas (both ablative and non-ablative as well as both CO2 and Erbium). In particular, the eye area tends to be very responsive to ablative laser resurfacing but the treatment settings and treatment technique of the laser surgeon are the most important factor in ensuring optimal results. You can see typical examples of CO2 laser resurfacing around the eyes and mouth on my profile pics. Hope that helps!

Q: Does laser resurfacing work for dark circles under the eyes? What are my options for lightening and tightening this area?

A: Dark circles under the eyes are usually caused by a combination of several factors: volume loss, increased pigmentation, increased vascularity, and fine lines and wrinkling. If fine lines and wrinkling is the main contributing factor, then laser resurfacing can be an excellent treatment option. However, volume loss is better addressed with fillers and pigment and vasculature is best addressed with pigment and vessel-specific lasers. Usually, combination treatment will result in the best outcome. As this can be a tricky area to treat, it’s best to see an expert laser surgeon who has a solid understanding of the various causes of dark undereye circles to tailor your best treatment.

Q: When can I go back to work after a laser resurfacing procedure? Are there any tips to recover faster?

A: Non-ablative laser resurfacing procedures typically have between 0-3 days of downtime, during which time you may look a bit bizarre but you are able to function without any real impairment. Ablative laser resurfacing can sometimes entail 7-10 days of downtime with the earliest you can return to work around 5-7 days. The most important thing to do to speed recovery is to follow the post-operative care instructions provided by your laser surgeon and to follow up regularly during the first few days to make sure everything is on track.

Q: What are the pros and cons of laser resurfacing for acne scars?

A: Acne scarring can be a tricky problem that is resistant to treatment. The pros of laser resurfacing are that it is one of the single most effective treatments and that it undeniably improves the structure and function of your skin via inducing new collagen formation. The cons are that there is a variable amount of downtime after the procedure depending on what type of laser treatment is selected and that the results tend to take months to fully come in. The optimal way to treat acne scarring is using multiple different modalities – including ablative and non-ablative lasers, minor surgical procedures such as subcision, radiofrequency and ultrasound devices, and injectable fillers – to achieve the best result. Patience is the key as the treatments are sometimes best done in stages and improvements come in gradually over time.

Q: It seems like laser resurfacing will be tough on my skin. What can I do to take care of my skin afterwards?

A: Laser resurfacing is broadly categorized into “ablative” and “non-ablative” procedures. The amount of damage and aftercare required after each is quite different. For the ablative procedures, a careful regimen of healing ointments and cleansing protocols must be followed with regular and frequent follow up appointments with your laser surgeon to make sure everything is on track. These aftercare regimens vary from clinic to clinic and so it’s important to find one with certified operating facilities, experienced nurses, and specialty trained laser surgeons who will walk you through every step of the way. The non-ablative laser resurfacing procedures typically require less aftercare with a thin ointment or cream sometimes all that is required for a few days to a week. Hope that helps!

Q: Is it okay to have Fraxel treatments spaced 3 months apart? I’ll be out of the country for 3 months and am wondering if I should have my first treatment now or wait until I get back to start.

A: It’s up to you whether you want to get started right away or wait until you get back to start. While typically Fraxel sessions are done spaced one to two months apart, there is no real harm in waiting 3 months between treatments; the only downside could be that it may take longer to see full results from your full course of sessions. You may also want to take into consideration that your skin will be more sensitive following a Fraxel treatment, especially to the sun, so depending on what your trip abroad entails you may want to wait until you get back to start treatments.

Q: How long after having Fraxel is it safe to have sun exposure? I’ll be visiting Hawaii 2 months after my treatment and am worried about keeping my skin protected.

A: The amount of time required to stay out of the sun after a Fraxel treatment varies depending on which treatment was performed and what area of the body was treated. There are a number of different laser wavelengths available under the Fraxel name, with varying levels of aggressiveness. I recommend talking to your doctor who performed the treatment about your concerns, and following their advice about sun exposure. Keep in mind also that sun protection is important at all times, not just after a laser treatment! You definitely want to make sure you are protecting your investment if you are embarking on having laser procedures.

Q: I had Fraxel Dual a week ago and now I have red streaks on my face. Will these streaks dissipate in time?

A: It is common after a Fraxel treatment to have areas of redness. While typically this redness occurs all over, it may also be concentrated in “streaks” where the laser was focused. This redness may last for a few weeks, after which it should completely dissipate. If you are still experiencing significant redness after 1 week, I would recommend visiting your provider for a follow-up to see what can be done.

Q: Can PicoSure fully remove tattoos? I have a large, colorful half sleeve tattoo that I’m looking at trying to get removed.

A: PicoSure is a great laser for removing certain colors, but if your tattoo is very colorful you will most likely require a combination of lasers to try to fully remove it. Different ink colors respond better to different laser wavelengths, so if your tattoo has many colors it would be impossible to treat with just one laser. I recommend visiting a board-certified dermatologist for an in-person consultation to come up with a custom treatment plan.

Q: Is PicoSure a good option for skin rejuvenation?

A: While PicoSure can be a good option for skin rejuvenation in the right candidate, an in-person consultation is necessary to properly evaluate your skin and come up with the best treatment plan for you. “Skin rejuvenation” is a vague term, and more information about your skin issues and desired goals is needed in order to determine which laser is right for you. I recommend visiting a board-certified dermatologist with an array of different lasers (not just one which is applied to multiple conditions) for an evaluation and custom treatment plan. Good luck!

Q: Can PicoSure remove a tattoo with dense black outlines and shading?

A: PicoSure works well to remove blue, green, and some black tattoos. Different colored inks respond better to different lasers, and an in-person consultation is necessary to evaluate your tattoo and make sure your skin color Is right for the picosure or would be better served with the pico way laser. We offer a variety of lasers that can help treat a wide range of tattoos at my practice, and have a high success rate for tattoo removal.

Q: Is Fraxel good for removing sun spots? I’ve heard some people get hyperpigmentation afterwards.

A: Fraxel Dual can be great for reducing sun spots in the right candidate. Hyperpigmentation can often be avoided by making sure to visit a Fraxel expert who will be honest about whether you are a good candidate for the treatment and who is skilled at performing the treatment. At my practice, we have performed thousands of Fraxel treatments with very good results. I recommend visiting a board-certified dermatologist for an in-person consultation to see if Fraxel is right for you.

Q: What benefits can you get from Fraxel? What kind of skin problems does it best treat?

A: There are different types of Fraxel laser, and each one will treat a different skin concern. Fraxel Re:pair is the most aggressive type; it is an ablative CO2 laser that is great for overall skin rejuvenation. Fraxel Re:pair can soften deep wrinkles, reduce dark spots, and smooth and even skin tone and texure. Fraxel Re:store Dual has two lasers in one: the original Re:store, which is an erbium laser good for treating fine lines and wrinkles as well as overall skin texture and certain types of acne scars, and a thulium laser that is great for reducing brown spots. An in-person consultation with a board-certified dermatologist is needed to determine which laser is best for your individual skin concerns.

Q: Can laser resurfacing help with crepey, wrinkled skin on sun damaged hands?

A: Both non-ablative and ablative laser resurfacing can be applied to the hand in the correct situations. There are also a variety of other ways to rejuvenate the hands and combining multiple different treatment modalities into a single session usually yields the best results. Good luck!

Q: Would laser resurfacing help with mild acne scarring and hyperpigmentation? I’ve had mild acne scarring since I was young and got deep cystic pimples.

A: Laser resurfacing can be very beneficial for acne scarring. To get the best advice on exactly which type of resurfacing procedure would benefit you the most, it would be best to see a board certified specialist in cosmetic procedures for their live consultation. There are many different options for treatment and acne scarring can sometimes be slow to respond. Thanks for sharing your pics and good luck!

Q: What can I do to reduce redness in the temples and cheeks? I had Sciton profractional laser resurfacing 3 months ago, and my face has healed but my cheeks and temples still look red. What’s the best way to treat this? Topical creams, hydroquinone or hydrocortisone, other types of lasers?

A: There are four ways to actively reduce post-laser resurfacing redness. Firstly, you can applied a vascular pulsed dye laser such as the V beam to target enlarged blood vessels that are contributing to the red discoloration. Similarly, an intense pulsed light (IPL) treatment can also be very efficacious and can also help to alleviate any hyperpigmentation that may be residual from the laser resurfacing. Thirdly, LED photomodulation may have some benefit in reducing redness although this technology is not as tried and true as the pulsed dye laser and the IPL. Lastly, anti-redness creams can be beneficial. I would recommend against using hydroquinone or hydrocortisone for this purpose as either compound may even make things worse. Hope this helps!

Q: What’s the best aftercare following a laser procedure? Is there anything I should or shouldn’t do after a treatment to help my skin recover or increase the effectiveness of the treatment?

A: The aftercare regimen following a laser procedure is dependent on the type of laser procedure performed. For example, after a simple procedure such as IPL, minimal to no specific aftercare is required. After a non-ablative fractionated resurfacing procedure such as Fraxel Restore or Dual, a bland ointment such as Aquaphor or Vaniply are sufficient and usually only need to be applied for several days to a week. After a non-fractionated fully ablative resurfacing procedure, a more complicated regimen consisting of ointment, vinegar soaks, prophylactic antibiotics and antivirals may be indicated. There are two major things that need to be avoided during the post-operative period. Firstly, it is very important to refrain from picking at your skin. Secondly, excessive sun exposure during this time can result in unsightly hyperpigmentation that may take a while to fade. The above are general guidelines. Any laser specialist at a reputable and professional establishment will give you a thorough pre-operative assessment and will then follow up with you very regularly during the immediate post-op period in order to ensure that your healing is on track and to implement any changes to the standard care routine that may be necessary based on your own individual and unique healing patterns. Hope that helps!

Q: What’s the best laser for skin resurfacing? My dermatologist offers a laser treatment for skin “resurfacing” that is different from the laser at my favorite medspa. Are all lasers the same? How do I make sure they use the right one?

A: The most important factors to consider are not the specific laser to be used, but rather who is using the laser and why is it being used. There are a variety of resurfacing lasers available today and they are broadly categorized into ablative vs non-ablative. A further subdivision is into fractionated and non-fractionated lasers. Generally speaking, non-ablative and fractionated lasers have less healing time associated with them but also produce less prominent results. However, ablative lasers are not appropriate in many situations. Therefore, it is very important to have a face to face consultation with an experienced expert who can assess your exact needs and make the appropriate recommendations.

Q: What should I do between laser hair removal treatments?

A: You can shave as often as you would like between laser hair removal sessions. It is important that you avoid waxing, plucking and/or any depilatories throughout your treatment process and for 3-4 weeks prior to initiating laser hair removal, in order for your treatment to be effective. To avoid unnecessary complications it is also important to keep the treatment area out of the sun. This includes tanning beds, tanning lotions or anything that can change the natural skin color.

Q: How close to a laser hair removal treatment should I shave?

A: It’s best to shave the night before or the morning of your scheduled laser hair removal treatment. This will allow the laser to target the pigment in the hair follicle to effectively heat and destroy the follicle.

Q: Is IPL or Fraxel better for reducing fine lines and wrinkles around the eyes?

A: IPL is a great treatment for reducing brown and red spots and evening skin tone, but it is not generally used to treat wrinkles. Fraxel can work well for deep wrinkles around the eyes, although depending on your individual condition, Botox may be a better option. I suggest visiting a board-certified dermatologist with experience treating wrinkles for an in-person consultation to determine the best treatment plan for you.

Q: What is IPL laser therapy? What do the letters stand for, and what can it do for skin improvement?

A: IPL stands for intense pulsed light. It is not technically a laser, but rather a light-based energy technology. IPL is great for reducing brown and red spots, broken blood vessels, and overall redness in the skin, including from rosacea. It can also help to correct uneven skin tone. IPL is a very popular treatment due to its effectiveness and relative lack of downtime, and we have had great success with it at my practice.

Q: I want to get CO2 laser under my eyes, as I want to tighten that area to lessen the dark circles which are getting worse daily. Would this dissolve the fat under the skin? I’m afraid of a hollow eye look is fat is removed. I had a surgical procedure to remove under eye fat about 20 years ago.

A: In expert hands, CO2 laser under the eyes can yield very satisfying results. When used appropriately, there should not be any risk of dissolving fat under the skin since the laser does not reach that deep. The fact that you had lower lid surgery before should be factored into your consultation because that may affect the degree of laxity that can currently be safely treated in that area. The periocular region can be tricky to treat so best to see an experienced laser dermatologist for optimal results.

Q: Are breakouts normal after a CO2 laser treatment?

A: It is very common to get breakouts after CO2 laser resurfacing. The reasons for this are the occlusive ointments used in the post-op recovery period, and the major changes and fluctuations in the skin micro-environment during this time. Additionally, the healing skin may be more sensitive to contact with environmental irritants, resulting in acne-like eruptions. The good news is that these reactions are always temporary and can be successfully treated in the meantime. Best to see your dermatologist to discuss appropriate treatment options. Good luck!

Q: When can I start using acne medications after having CO2 laser surgery? I had the laser treatment one month ago. My face is healed but still red, and is now breaking out with acne. I’ve been using Retin-A Micro 0.08% for a couple years to keep my acne under control, but now that I’m not using it the acne is back. When is it safe to use the Retin-A again?

A: This is a common question after CO2 laser resurfacing. There is no black and white answer. After the surface of the skin re-epithelializes or heals completely, then there is the possibility to start re-introducing previous topical products. The general rule is to re-introduce one product at a time and to use very sparingly for the first few days to a week in order to test the waters. Extra caution should be used with Retin-A products which themselves are skin irritants even on normal, non-resurfaced skin. If you still have significant redness to your skin, I would avoid Retin-A until further resolution occurs. Good luck!

Q: Does IPL for sun damaged skin cause problems with uneven hair regrowth on the face/neck after treatment? I’m a male with mild sun damage on my face, neck, and chest, and am considering IPL, but I’m worried that it will change how my beard grows back. Should I ask the dermatologist to avoid treating the areas where my beard grows?

A: Generally speaking, IPL should be avoided in hair bearing areas due to risk of hair loss. In select cases, if hair loss is not an issue (for example, the area is always clean shaven) then IPL may be considered. This is a conversation best had with your dermatologist. Good luck!

Q: How do I treat this pigmentation on my face? I’ve had it for a year. I had a series of IPL, but it didn’t help at all.

A: Thank you very much for your question. Based on what can be seen in your photograph, you appear to have a condition known as melasma. This is one of the trickiest pigmentary conditions to treat as it often requires a variety of different treatment approaches as well as a strict maintenance regimen. In select cases, very cautious use of IPL can be beneficial for melasma but it can also worsen the condition so it is important to go to an absolute expert for further consultation. The other treatment options include peels, Clear and Brilliant, Fraxel, and fractionated picosecond lasers. Importantly, protecting your skin from sun exposure plays a major role. Finally, topical lightening agents are often required for maintenance. The bottom line is that your condition would be best treated by a variety of different methods and it would be best to see an experienced Board Certified cosmetic dermatologist for further consultation. Good luck!

Q: I have dark scars on the tops of both of my feet. Is Fraxel Dual an option?

A: An in-person consultation with a board-certified dermatologist experienced in both scar reduction and laser therapy is needed to see if you are a good candidate for Fraxel for your feet. That being said, Fraxel Dual is often used successfully for reduction of certain types of scars. Good luck!

Q: Why do you have to wait weeks in between IPL sessions for hair removal? Is it dangerous to do it every week or just not effective? If I have the chance to do it every week why shouldn’t I?

A: Hair grows in three stages, and laser hair removal is most effective when the hair is in the anagen phase, when melanin in the hair follicle is darkest. If the hair follicle is treated in the wrong growth phase, it will not be effective. This is why laser hair removal sessions are always spaced 4 to 6 weeks apart, depending on the individual and the location of the hair. Doing IPL for hair reduction every week, while not dangerous, would not get you results any faster and you would be paying for an ineffective treatment.

Q: I have a port wine stain birthmark. Can I still have a non-surgical facelift?

A: This is a very interesting question. Generally speaking, a port wine stain (which is basically a malformation of small capillaries) will not have any impact on non-surgical facelift procedures. However, some port wine stains can become quite bumpy, thickened, and nodular over time and this may affect the contours of the face thus having an indirect impact on non-surgical facelifting. Port wine stains can be treated with a variety of laser technologies and this can be done at the same time as most non-surgical facelift options. Hope that helps and good luck!

Q: I purchased an IPL hair removal device and have used it twice now to try to remove my tattoo. It scabbed up the first time and when the scabs fell off there was less ink. Is this going to work in the long run or can I damage my skin trying it? What should I do?

A: Thank you for your question. IPL is not the appropriate device to remove your tattoo and it definitely has the potential to burn and scar you. There are excellent tattoo lasers available these days and one like the Picosure or Picoway would be ideal for your situation. Best of luck!

Q: I’m 18 years old and have pretty bad acne scars from when I had severe acne a couple years ago. I’m considering laser resurfacing but have heard that it doesn’t work all that well. What’s the best way to get rid of acne scars?

A: Acne scars are unfortunately difficult to remove completely, but there are a variety of procedures available that can help to significantly reduce them. There are different types of acne scars, and each type will respond better to different treatments, so it is important to visit a board-certified dermatologist with experience treating acne scars in order to have an evaluation and come up with a custom treatment plan. Laser resurfacing, non-abvlative lasers, dermal fillers, and some surgical procedures are all options to help improve the appearance of acne scars.

Q: Can black lines be treated with PicoSure?

A: The PicoSure laser can treat a variety of colors effectively, including black. An in-person consultation would be best in order to examine your tattoo and come up with a custom removal plan. Different laser wavelengths can be used depending on color and density, and a custom treatment plan can be created so that you get the best results.

Q: I had a CO2 laser treatment on my face a month ago. How long until I can do another procedure, such as TCA peel or dermapen?

A: The effects of the CO2 laser treatment can continue to improve even at 6 months post-treatment. Therefore, if you are not in any rush, it would be very reasonable to wait for the 6 month mark before doing further treatments. That being said, the minimum amount of time that you should wait is at least 1-2 months as the skin can still be undergoing some element of healing during that time period depending on the aggressiveness of your CO2 treatment.

Q: Is fractional CO2 laser safe for me? I’m part Asian and want to tighten the area around my eyes and other parts of my face.

A: Thank you for your question. You are right to have concerns given your Asian heritage. However, under the correct settings and in experienced hands, fractional CO2 laser can absolutely be safe and effective for treating the area around the eyes in even full Asian patients. The most important thing is to see an experienced Board Certified cosmetic dermatologist who specializes in skin of color for a full consultation and an explanation of your options and risks.

Q: Can I use tea tree oil for PPP? Are there any side effects?

A: Unfortunately, there are no effective topical treatments for PPP. Tea tree oil should not have side effects, but it also will not help to eliminate the papules. The best treatment for eliminating PPP is CO2 laser performed by an expert dermatologist. I have been performing CO2 treatments for PPP for years, and have had very high success rates. I recommend visiting a board-certified dermatologist with experience treating PPP for a consultation.

Q: I’m 16 and have had pearly penile papules for a while. I want to know how to remove them; are there any topical treatments that work?

A: Pearly penile papules are a relatively common condition and often show up in adolescence. They are benign, and do not cause symptoms other than being unsightly. That being said, many people do choose to remove them. The best way to remove PPP is with a CO2 laser; that is the only proven safe and effective method. Unfortunately, there are no topical treatments that will work effectively.

Q: Does IPL cause facial hair loss?

A: IPL has the ability to remove hair. Therefore, it’s best to avoid hair-bearing areas of the face if facial hair loss is unwanted.

Q: Why am I still red 6 days after my IPL/PDT laser treatment?

A: The degree of your reaction typically depends on a variety of factors including how much baseline sun damage exists on the skin, the incubation period with the ALA or MAL, and the light sources used to activate the medication. Therefore, redness lasting 6 days or so after a PDT is not uncommon. However, if you have any concerns, best to see your treating physician who can give you a more accurate assessment in person.

Q: IPL laser recovery?

A: One may have some transient pinkness after the IPL procedure (depending on the settings used), for up to 1 day. If one has a lot of brown spots, they will get darker and fall off gradually over the course of 1 week. The amount of downtime required depends on how aggressive the IPL treatment was; less aggressive treatments may require no downtime while more aggressive treatments may require up to a week of recovery time. It is also important to stay out of the sun and wear a strong sunscreen following any laser procedure, as the skin will be extremely sensitive to UV rays for a few weeks after.

Q: Is there a way to remove pearly penile papules with an at home treatment?

A: Currently, there is no effective at home treatment for pearly penile papules. The best way to remove them is through a CO2 laser, which is highly effective and provides visible, permanent results. Pearly penile papules are asymptomatic, but they can be unsightly and many men want to remove them - however, some men are embarrassed to visit a doctor. At-home remedies at best do not work well and at worst are actively harmful. I recommend visiting a board-certified dermatologist with experience treating PPP for a consultation about removing them.

Q: Is it safe to pluck facial hair before IPL?

A: a. IPL to the beard area should be avoided for two reasons. Firstly, is the potential for unwanted hair removal (regardless of plucking or shaving) which is typically uneven and results in a moth-eaten appearance. Secondly, due to the absorption of energy by the hair follicles, it can be quite a bit more painful.b. If redness is your main concern, then I would recommend a pulsed dye laser such as V Beam to treat hair-bearing areas since they are excellent at reducing redness and carry no hair loss risk.

Q: Which would you recommend Fraxel or IPL?

A: While Fraxel and IPL are both laser treatments that can help reduce signs of aging, they are very different procedures and a recommendation would be based on each patient's specific needs. There are several types of Fraxel lasers ( and several types of fractionated lasers—not just Fraxel) that we use to resurface the skin and reduce the appearance of wrinkles, fine lines, acne scars, and pigmentation. Fraxel treatments are an effective way to stimulate new collagen and provide a younger, texture to damaged skin. The downtime will vary from 1 day to 1 week depending on the type of fractionated laser and how strong you need the laser to be for your problem. IPL is a more gentle treatment that is ideal for patients with a lot of color problems like sun damage spots, broken capillaries, and age spots. It also improves the texture of the skin and pores, but really isn’t used for wrinkles or acne scars. Using intensed pulsed light technology, this treatment reduces uneven pigmentation without causing damage to the surrounding skin. IPL treatments are gentle, yet effective and there is no downtime required. Visit a board-certified dermatologist to discuss your skin concerns and determine whether Fraxel or IPL would be best for you.

Q: Can I have an Active FX treatment for the 3rd time?

A: Depending on your specific needs and unique situation it is not uncommon to have multiple treatments.

Q: Is it normal to have extreme pain in neck area with Active FX?

A: There should be little to no pain following the procedure itself. Pain over the treated area usually indicates an infection which must be treated immediately or improper post-treatment care. Some warmth, swelling and mild irritation is expected following the procedure due to the healing process. However, I tell all my patients to call me immediately if they are experiencing any significant pain or discomfort.

Q: How often can you get an Active FX treatment?

A: While it does depend on your exact case as well as the “strength” of the treatment, most people will want to get additional treatments every 3-5 years to see ideal results. We often use different laser and light based technologies between treatments to enhance results even further. As long as you take care of your skin with optimal antioxidant and growth factor creams and protect it from sun exposure, you should be happy with your results for quite some time.

Q: Pico wave and Picosure? What is the difference?

A: They are both highly effective picosecond technology lasers from different companies. Picosure has a 755nm wavelength. Picoway has a 532 and 1064nm wavelength. There may be advantages of each laser and that is why our practice is one of the only laser centers in the world with BOTH of these technologies as well as q-switched ruby, Nd:YAG and Alexandrite lasers and fractionated CO2 ;lasers which are all used separately or sequentially to ensure optimal treatment results that are best for your specific skin type and tattoo.

Q: I really hate this tattoo. Should I remove with Picosure or not? Will be better or not?

A: Certain colors respond quicker to elimination. For example, black, red, dark orange, and dark blue are the easiest and fastest to remove. Green, purple, brown, light orange and light blue may require more visits. The depth of the tattoo will also determine how many treatments are needed, as well as the type of ink used. Lastly, your skin tone will play a part in how fast the laser works. Lighter skin tones typically have a higher success rate. Picosure and Picoway are currently the best two available options for laser tattoo removal.

Q: Can I have an Active FX treatment for the 3rd time?

A: Actually, each time you have a laser treatment, your fibroblasts are stimulated to make more collagen and the skin gets thicker. This is why wrinkles improve. Therefore, if you need to, you can have many laser treatments in your lifetime. The fear of thinning the skin is from the look of patients who have a laser treatment that is too strong. That can give an unnatural appearance of the skin. However, appropriate laser treatments can be repeated many time as needed for healthy skin throughout your lifetime.

Q: Is it normal to have extreme pain in neck area with Active FX?

A: In my patients, there is little to no pain following the procedure itself. Some warmth, swelling and mild irritation is expected following the procedure due to the healing process. However, I tell all my patients to call me immediately if they are experiencing any significant pain or discomfort so I recommend that you call your doctor immediately.

Q: How often can you get an Active FX treatment?

A: While it does depend on your exact case, most people will want to get 3-5 treatments to see ideal results. Your skin type, skin condition, and other factors will help your doctor determine the right number of treatments for you. As long as you take care of your skin and protect it from sun exposure, you should be happy with your results for quite some time. We often combine the Active Fx with the Deep Fx for one stronger single treatment, lasting 3 -5 years. This will require about one week of downtime, but some patients prefer this because excellent results are seen with only one treatment.

Q: How long between sessions should I go back? (Picosure) Looking for advice on how long after your session should you go back. I hear 4-6 weeks. Then I hear the longer the better. What are people's thoughts on this? And did it make a difference?

A: During your consultation, one of our board-certified dermatologists will estimate the number of treatments you will need. As every person is unique, every tattoo is unique, but most take between 5-10 treatments to remove, each a minimum of 4 weeks apart. We have published clinical studies that demonstrate that treating any sooner than 4 weeks does NOT improve results and may actually be wasteful as it takes at least 4 weeks for your body to clear the pigment that the tattoo laser treated.

Q: Is this a normal reaction after Picosure? two days ago I did a treatment laser tattoo removal with picosure , today my tattoo is very red and blisters. it's normal? blisters must be broke?

A: Blisters and scabs can be a normal response to tattoo removal. Our office actually published a clinical study and demonstrated that the use of an accupulse laser immediately after the Picosure enhanced treatment results and prevented blistering. It is important to not pop or pick at them. If the blister pops on its own, keep the skin over it covered with a healing ointment and gauze to promote healing and prevent scarring. If this continues I suggest a visit to the doctor who treated you.

Q: Will Fraxel repair help with scars from acne and bad peel results?

A: Fraxel will improve acne scars but not 100% and may need multiple treatments for optimal results. At Cosmetic Laser Dermatology in San Diego, our team of world-renowned dermatologists are pleased to offer patients the largest selection of lasers in the country, many of which are ideal for diminishing body and facial scarring.

Q: How long will the post-bruising take to heal from using a Fraxel Laser?

A: Brusing is not usually seen with Fraxel laser but redness and swelling can but usually for just a few days. It would really depend on the depth of the fraxel laser.

Q: Would the Picosure laser work to flatten a raised scar?

A: Classically when we use any laser for scar revision, a combination of lasers are utilized, including the use of either 5-FU or kenalog.

Q: How effective is the PicoSure laser on wrinkles?

A: I personally do not use the PicoSure laser for wrinkles, as there are other lasers that have shown superior results in wrinkle reduction after a single treatment that have a longer track record of safety and efficacy for this indication.

Q: What are the best after care products to use after Picosure laser removal?

A: After a picosure treatment, I classically have my patients keep the area moist with a fragrance-free, bland ointment and covered with an nonadherent gauze.

Q: What is the best laser for acne scars?

A: Rather than trying to figure out what is the best laser for acne scars, it would be better to think about do you want a treatment that requires downtime for wound care and healing or would you rather have a series of treatments that don’t require significant healing time. We have 7 or more lasers that can be used for treating acne scars and we use all of them. It is important to be able to offer options and to understand the pros and cons of different approaches. My personal favorites are the Fraxel Re:Pair and the Fraxel Re:Store lasers. However I also use the Actve Fx ,Deep Fx, V-Beam, pulsed erbium, pulsed CO2, Alexandrite and Ruby lasers as well as various fillers and punch excisions. Speak with an expert San Diego dermatologist about your options.

Q: What is the time to recover from an IPL laser treatment?

A: One may have some transient pinkness after the IPL procedure (depending on the settings used), for up to 1 day. If one has a lot of brown spots, they will get darker and fall off gradually over 1 week.

Q: I had a photofacial/IPL procedure done 4 days ago. I expected that my hyperpigmented blotches would be peeling off by now, but they still haven’t. How long does it normally take?

A: It typically takes 7-10 days for hyperpigmentation to peel off on the face, and can take up to 2 weeks off the face.

Q: Active FX or Fraxel Laser—Which is Better?

A: Fraxel is a brand name like “Audi.” There are many types of Audi cars each with a different look and speed just as there are 3-4 types of “Fraxel” lasers. The ablative CO2 Fraxel is similar to the Active/Deep FX made by Lumenis. Head-to-head evaluations of both show that after 3 months, the results using comparable settings are similar. The Fraxel is a bit more painful and has higher erythema/redness for the first month than the Lumenis Active/Deep FX.

Q: Is Active FX a good treatment for smokers lines?

A: The Active FX laser is an excellent treatment for the treatment of smokers lines. Depending on the severity of their appearance, multiple treatments may be required, and as a rule of thumb, I generally advise my patients to undergo the procedure at least twice to receive the best results possible. I also combine the Active FX with the Deep FX to get even better results. Keep in mind that the Active FX is a very strong treatment that yields great results, however there will be 7-10 days of downtime necessary following the treatment. As a dermatologist and Diplomate of the American Board of Cosmetic Surgery, I would advise you to visit a board certified dermatologist to learn more about your options and the best treatments available.

Q: Can Active FX get rid of freckles?

A: Freckles can be significantly lightened with treatment from an Active FX laser. Depending on how many freckles appear on the treatment area, multiple procedures may be required. As a board certified dermatologist in San Diego and Diplomate of the American Board of Cosmetic Surgery, I would advise that you visit a laser expert for your treatment as results can vary greatly depending on your practitioner’s experience. I also advise using skin lightening creams like Lytera™ from SkinMedica before and after treatment to prevent freckles from recurring. Sunscreen is also very important since freckles are produced from sun exposure.

Q: What Does the Active FX Treat?

A: The Active FX CO2 laser is an excellent device for the treatment of several different skin conditions, including sun damage, fine lines, wrinkles, pigmentation problems, texture, improving saggy skin, and surgical or acne scars. Because this treatment can be painful, I most often perform the procedure under anesthesia to reduce pain and discomfort for my patients. Following a treatment, a period of 7-10 days of recovery should take place, where it is normal for skin to swell, peel, and feel slight discomfort.

Q: Is one week enough time to recover from Active FX?

A: Each person who undergoes treatment with this laser will heal differently, though as a general rule of thumb, it is advised that patients recover from the treatment for 7-10 days. That means that you usually cannot apply makeup until 7 days. However, this depends on the strength of the treatment given. During this time, it’s normal to experience facial pain, discomfort, swelling, and skin peeling. If you’re planning to return to work or social activities before one week, be advised that you will most likely still appear to be in the recovery stage and your face will most likely still be red and peeling.

Q: What is the difference between a PhotoFacial and CO2 laser treatment?

A: Photofacial is usually for brown spots, blood vessels, and large pores. There is no down time and it is non-invasive, but you may need multiple treatments. Co2 is for skin tightening, wrinkles, tone, and texture. It usually has 1week down time and is mild to moderately invasive. Usually 1 treatment is all that is needed.

Q: Can a Photofacial cause dark spots? I got a photofacial 8 months ago and it seems to have caused dark spots on my skin where I had none before.

A: Usually not. I would suggest that you follow up with your treating physician.

Q: Can Fraxel cause volume loss?

A: Fraxel will not cause volume loss. If anything Fraxel will stimulate your skin’s natural recovery process and the production of fresh, healthy skin. With the penetration of the deeper layers of the skin it incites the production of collagen, which will give your skin a more youthful look.

Q: Is it safe/ good idea for a 14 year old to get laser hair removal?

A: If a board-certified dermatologist performs the laser hair removal and the teenager has parental consent it would be okay and safe to perform the non-invasive procedure.

Q: Whats effects does an IPL treatment present after receiving cheek fillers?

A: A study done by Goldman et al found that IPL fired immediately over a hyaluronic acid based filler had no effect on the filler both histologically and clinically. Classically fillers are deposited much deeper than the 1mm depth that IPLs penetrate to.

Q: Is excessive sun exposure really the main cause of age spots?

A: Excessive sun exposure is probably the greatest culprit behind freckles or "age spots" but environmental pollutants, as well chronic infrared exposure as well as visible light exposure may also be to blame for aging skin changes such as wrinkles.

Q: Is Pulse Dye Laser good for Scars? How many treatments are normally required? Are there other treatments to reduce redness of scars?

A: Scars can be tricky. Scars that are treated within the first year are usually always easier to treat. So it depends on how old the scar is. But in general any scar that is treated with laser (PDL) will do better than no treatment at all. PDL (pulse dye laser) is an appropriate laser to use for red scars.

Q: What is the Best Treatment for Big Actinic Keratosis with Minimal Scarring?

A: Actinic keratosis is a pre-cancerous lesion that represents extensive sun damage. While there are many topical treatments as well as spot liquid nitrogen treatment for an individual lesion, I recommend Photodynamic Therapy. PDT works well at destroying the actinic keratosis with little to no scarring or harm to the surrounding tissue as well as treating the surrounding sun-damaged skin. Recent studies also demonstrate the rejuvenating benefits of PDT. I recommend that you visit a board-certified dermatologist for treatment of actinic keratosis and discuss the possibility of PDT treatment.

Q: Will a Co2 laser treatment help acne marks and scars?

A: We commonly use a C02 laser to help with acne scars and marks. Sometimes our doctors will combine the procedure with a pulsed dye laser to address the redness more thoroughly and a q-switched alexandrite laser to address the pigment more thoroughly, on the same day.

Q: How young can a patient go for laser hair removal of the arms and legs?

A: Generally, laser hair removal is performed on patients 18 and older. Patients under 18 should at least wait until after puberty and will need the permission of a parent/guardian.

Q: Laser tattoo removal with keloid? I have a tattoo that was done poorly and developed a keloid scar. Is there any way I can remove the entire tattoo/scar?

A: It would be hard to remove the entire tattoo without the possibility of creating more keloid scarring, so I would keep this in mind and be very cautious. The keloid can be improved with 5-FU/Kenalog injections.

Q: Does Fraxel work for white stretch marks?

A: Fraxel restore has been found to work well for improving the appearance of white stretch marks.

Q: Does the Pulse Dye Laser work for scars? I recently had surgery and have long scars on my legs, how long should I wait to have pulse dye laser or other laser treatments to improve scarring?

A: You should be able to begin Pulsed Dye Laser treatment on the scars once the sutures are removed, or shortly thereafter. So, we recommend treatment sooner than later. Other lasers or Intense Pulsed light may also be useful depending on the appearance of the scar. Visit an experienced dermatologist for laser treatments.

Q: What is the best treatment for red capillaries on face?

A: As a laser specialist, I treat capillaries on the face with a variety of lasers depending on their appearance and type. There are several laser treatments, including PDL, Nd:YAG combination, IPL, and the CoolTouch Varia Laser that are effective in minimizing the appearance of red capillaries on the face.

Q: How can I clear up horrible rosacea?

A: The redness associated with Rosacea is caused by a network of small dilated capillaries just under the surface of the skin. These capillaries can be targeted with IPL or with a vascular laser , such as the Candela V-Beam. This requires expertise, so you should be seeing a Dermatologist who specializes in Lasers. I prefer the V-Beam, as I think it targets these fine capillaries more precisely. Typically 3 treatments will give greater than 75 % improvement, but this is a chronic condition and therefore tends to regress gradually . Maintenance treatments at 6 – 12 month intervals will usually keep it controlled. The acne component responds to general acne treatments (both topical and oral).

Q: I’m Not Really Seeing Any Noticeable Results Yet from IPL laser hair removal After 8 Sessions. Will I Need Many More Sessions?

A: Although the IPL is generally an excellent choice for hair removal, there are certain conditions that may limit its effectiveness. To get rid of unwanted hair with lasers or IPL requires a high enough energy to kill the hair follicle. If you are not seeing a response after 8 treatments it is time to change. You may need a different device or a different operator. I would advise you to see a dermatologist who specializes in lasers.

Q: Face Looks Worse After Photofacial, Will the Brown Spots it Caused Eventually Go Away?

A: It is common for dark spots on the skin to become darker soon after Photofacial treatment. They will heal and fade within 1-2 weeks, but be sure to avoid sun exposure and treat your skin gently during the healing process.

Q: How Many Treatments with PicoSure Laser Would I Need to Remove My Tattoo?

A: Without seeing you in person, it is hard to say exactly how many treatments you will need to remove your tattoo, but most patients do require at least a few treatment sessions. Darker tattoos and those placed more deeply require more treatments. The PicoSure is highly effective and make sure you visit a laser treatment expert for best results.

Q: What Should I Expect From Laser Tattoo Removal? I got a colorful sleeve tattoo that was professionally done a few months ago. Is it better for me to wait a couple years before beginning laser removal treatment, or is earlier better? Is it possible to surgically remove whatever is left of the residual tattoo?

A: The most important factor in a successful laser tattoo removal is going to be choosing an experienced dermatologist to perform the procedure. With large, colorful tattoos it may take many treatments for your desired result. Our board-certified dermatologists use the newest PicoSure laser for tattoo removal and have experienced great success. If you do surgically remove the remaining tattoo, you will likely have very large scars. I recommend seeking laser treatments from an expert. The sooner you remove the tattoo the easier it is.

Q: Does Laser Treatment on Facial Age Spots Leave Scars?

A: When performed by an experienced, board-certified dermatologist, laser treatment for age spots should effectively minimize the appearance of age spots and leave no scars. Be sure to seek treatment from a laser expert to ensure the best result.

Q: When Can I Remove Tattoo? I got a tattoo 2 days ago. How soon can I start the laser removal process?

A: I would start the laser tattoo removal process as soon as you can, as the ink hasn’t been taken up by macrophages yet (the cells that make it more permanently reside in your skin). It will be easier to break up and hopefully you will not need as many sessions.

Q: Can Photodynamic Therapy be used over large area of body for actinic keratosis?

A: I commonly perform PDT to the entire body. I may break it up into different sessions, but studies have shown that the combination of one of the immunomodulators (like Efudex, Aldara, or Carac) with PDT, works better than either treatment alone in providing AK clearance.

Q: Does Photodynamic Therapy really work for acne and how long does it last? I’ve tried everything else and I’m really looking for a permanent solution.

A: PDT has worked very nicely in my practice for acne patients, but I use 2 different lasers and light sources to activate the medicine, making it more effective in my hands than with a single light or laser source. Unfortunately, there is no true “cure” for acne. Even after accutane one may continue to break out. The PDT shrinks the sebaceous glands, so in some of my patients the results from a single session have worked as long as 2 years in controlling their acne, and then they do a repeat treatment.

Q: Is it safe to have laser done when I have metal braces on my teeth?

A: Yes, the laser beam does not penetrate deep enough to go through your lip fat and muscle to get to the metal. Some people may feel some heat, and we use soaked gauze to make it more comfortable for them.

Q: What is the best laser for eye elasticity/fine lines around the eyes?

A: Radio Frequency (Ultherapy) is a nice option and doesn’t have any downtime, but may take a few months to notice a difference in wrinkles and tightening. Also Laser Resurfacing like Active/Deep FX would provide another excellent result (immediate, after a few days of healing).

Q: Does Total FX Laser treatment weaken skin and make it more prone to wrinkles in the future?

A: Total Fx laser treatment would actually help thicken the skin and it stimulates collagen production so the skin will strengthen as one ages.

Q: I had an upper and lower blepharoplasty 6 months ago. I have scaring complications on one eye. My doctor has recommended Fraxel laser to improve the scarring. Is this a recommended option? If so which Fraxel laser is better to treat this scar?

A: If I were treating your scars, I would use the Fraxel Repair or the Restore. The Fraxel lasers have been studied and published in scientific journals more than any other fractional device on the market. There are many of these publications on scars specifically. The Fraxel lasers can penetrate up to depths of over 1.5mm or 1500 microns, although this is not necessary for all scars. I would also consider using the Vbeam Perfecta and injections to treat your scarring as well.

Q: Best Procedure for Skin Damage? I am 28 year old black female with skin damage from tretinoin and ahas. I am left with very itchy orange peel textured skin, prominent enlarged pores and lots of fine lines on my face, forehead, and particularly on mouth and chin areas where I was more aggressive. My marionette lines, which were very faint, have deepened and now extend arch-like round my lower lip to my chin. What is the best treatment to address this?

A: A low-fluence QS-Nd YAG laser can induce some mild collagen remodeling, improving your skin texture and reducing pore size to a degree. As far as more etched in lines, a filler like Belotero would be appropriate in helping improve the appearance of this area.

Q: How Do I Correct Scarring Caused by Deep and Active FX? I had Deep and Active FX done nearly 3 years ago and have had nothing but trouble ever since. I have stripes on both sides of my face, additional indentations and dark pigmentation.

A: I have treated patients with similar problems and published on it. The Fraxel Restore has worked very well in improving any scars and pigmentation issues.

Q: Fillers After Re:pair? How quickly after re:pair can I get fillers for the remaining scars, and what kind of filler would be recommended?

A: I like to combine the Fraxel Repair and fillers for acne scars, and typically wait at least 2 weeks, sometimes 4 weeks after the treatment to use a filler like Belotero (which can be injected superficially) or an injectable like Laviv (which stimulates one’s own collagen).

Q: Laser Resurfacing and Facial Hair Growth? If I remember correctly, acne scars affect facial hair growth due to the presence of damaged follicles and scar tissue, correct? Will laser resurfacing that improves acne scars help with the eventual regeneration of facial hair in areas once prone to cystic acne and scarring?

A: Laser resurfacing, whether ablative or nonablative, will definitely improve the texture of the skin and improve acne scars. How much improvement will occur in the acne scars varies because of the uniqueness of each scar and each individual, but our goal is 50 % improvement with one treatment of ablative resurfacing (Fraxel Re:Pair) or 3-4 treatments with nonablative resurfacing (Fraxel Re:Store). The reason for hair loss in conjunction with scarring is that the hair follicles have been killed by the inflammatory response that caused the scarring. They are no longer present. The laser procedures stimulate new normal collagen fibers replacing the scar tissue, but stimulating growth of new hair follicles is a different story. Although it has been reported with improvement of laser treated scars, it is not something that happens with any predictability. The only predictable method to restore hair growth is hair transplantation – surgically inserting new healthy hair follicles in the area of hair loss.

Q: What is the Best Method to PREVENT the Worsening of Perioral Lines (I.e. Vertical Lip Lines, Smokers Lines)? Is laser resurfacing every several months a good course of action for me?

A: You are very smart to initiate some corrective measures before the problem worsens. The reason for the appearance of the lines is because of loss of normal collagen and elastic fibers secondary to ultraviolet light (tanning) and oxidant (smoking) damage in an area where muscle activity results in repetitive folding/creasing of the the skin with speech and expression. There are a number of nonablative lasers such as Fraxel Re:Store that stimulate new collagen formation without peeling the skin and these lasers are intended for a course of multiple treatment sessions and give gradual improvement over a period of 6 – 12 months. Ablative lasers such as Fraxel Re:Pair or Profractional actually vaporize tiny bits of damaged tissue with each treatment so result in more rapid improvement but require some downtime for healing. By keeping the density of treatment low (that’s the percentage of the surface area actually covered by the tiny dots of the laser) the visible healing can be minimized but the number of treatments needed increases. The response to treatment can be significantly boosted by using topical agents that stimulate new collagen: Growth factors (TNS by SkinMedica), Retin-A or Retinol, and properly formulated VitC (SkinMedica or Skinceuticals). Botox can help by putting those muscles at rest that cause the lines, but that is a tricky thing to do , as low dosages that wear off fast must be used in order to avoid problems with speech, expression and eating/drinking

Q: Can a Tattoo Be Too Big and Dark for Effective Laser Removal? How effective would laser, specifically Picosure, be for removing a new, large, and dark design? Can the whole tattoo be treated at once or do I have to do it in sections? And does the body take much longer to remove the ink of a large piece vs smaller piece?

A: As an expert in tattoo removal, I regularly remove tattoos using a variety of lasers including the PicoSure. The larger and darker the tattoo, the longer the process can take, but the PicoSure laser system is the best available. I recommend finding a board-certified dermatologist who is a laser tattoo removal expert, and who utilizes a variety of lasers including the PicoSure, to get the best possible result.

Q: What is the best way to smooth out very noticeable acne scars for my olive/tan skin?

A: Acne scars are tough! Aggressive laser resurfacing can help (most skin types do well, even olive skin type but you must see a VERY experienced dermatologist). Sometimes a filler like Restylane/juvederm or belotero can improve them dramatically without much down time.

Q: Can Active FX Help Tighten Skin on Legs, Arms and Abdomen?

A: The Active FX is mostly used for the face/neck/chest. Ultherapy is a great option for tightening the legs/arms and abdomen and doesn’t usually have any down time.

Q: How Long Do I Have to Wait to Exercise After an IPL Photofacial?

A: I typically have my patients resume their daily activity right after IPL treatments as long as they are strict with sun protection.

Q: Is Pulsed Dye Laser Effective for Red Acne Marks?

A: PDL is effective to improve the appearance of red acne marks. I typically combine it with a Fraxel Restore treatment which helps stimulate new collagen production, improving the appearance of both the color of the acne scar and the texture.

Q: Sun Exposure After Fraxel? I had Fraxel restore on my nose two days ago. How long am I supposed to stay out of the sun?

A: After a non-ablative fractionated laser procedure I typically want my patients out of direct sunlight for a month following the procedure to avoid any post-inflammatory hyperpigmentation.

Q: I am a 50 yo female with freckles, age spots and beginning sagging skin and wrinkles? Would CO2 full face laser resurfacing be recommended as the best method to rebuild collagen and reduce/eliminate freckles and age spots?

A: An in-person evaluation would be necessary to assess your skin and determine the best course of action for the age spots and wrinkles you describe; however, CO2 resurfacing may be a good option. Depending on the amount of skin laxity you are experiencing, Ulthera skin tightening may also be beneficial as part of your treatment plan. I suggest visiting an experienced board-certified dermatologist.

Q: Would Like to Know if Erbium Yag Laser Resurfacing Can Result in Loss of Facial Volume? I have been recommended a series and I am in my sixties. A friend of mine had a single, very effective laser treatment, and although she is wrinkle free, she appears to have lost facial volume. That would be a very bad trade for me. Is this a common side effect?

A: As a laser expert, facial volume loss should not be caused by laser resurfacing. In fact, almost all lasers actually build up collagen and restore the skin’s natural thickness. We all naturally lose facial volume as part of the aging process, and the smoothing effect of the laser treatment your friend had may make her volume loss more apparent. We often incorporate fillers or biostimulating treatments like Sculptra™ with laser resurfacing to achieve more dramatic results.

Q: What is the best tattoo removal method for my tattoo? Picosure vs MedLite vs R20, etc? Due to an upcoming event in about 7 months, I need to get my tattoo removed. It is currently on my back and I got it about 3.5 years ago. It is about the size of a quarter. How many treatments and with which type of laser would be best for my case?

A: The PicoSure laser is the best tattoo removal system available and can decrease the number of treatments necessary for complete removal in half. In addition, the Picosure may also improve skin texture. We also have all three different Q-switched lasers as well as fractionated CO2 lasers (DeepFX). Sometimes a variety of lasers are necessary to get the best results. Laser tattoo removal generally takes between 5 and 10 treatment sessions depending on the size and color of the tattoo. I suggest you visit a laser expert who has all of the lasers including the PicoSure for a consultation soon to ensure the tattoo is removed before your event.

Q: I have acne scars on my face. What procedure would you recommend?

A: For acne scar treatment, I use various different lasers as well as sometimes subcision and fillers to get to the optimal result.

Q: Will IPL Photofacial Cause Dermal Fillers to Absorb More Quickly? If I get IPL treatments to remove sun spots will it cause dermal fillers in the same areas to absorb and be removed from my skin more quickly?

A: I published a paper on the use of IPL over Sculptra, and we found no difference clinical duration or side effects from the combination. There have also been other studies with IPL immediately over Restylane, that showed no difference in clinical outcome. The thought is that IPL does not penetrate as deep as the plane were most fillers are injected. Hope this helps.

Q: Can PicoSure remove yellow and orange ink?

A: Yellow and orange ink are some of the most difficult colors to remove, however, it is not impossible. Depending on your skin tone and the exact shades of yellow and orange in the tattoo, different lasers may be needed for a complete removal. I would recommend an in-person consultation to assess the tattoo and formulate a treatment plan. Be aware that it may take several months of laser sessions to fully remove a tattoo with difficult ink colors.

Q: Can PicoSure remove a blue tattoo? What precautions do I need to take if I get this treatment? Can I do it in the summer?

A: The PicoSure laser works extremely well on dark blue and green inks; however, you will need to be careful about sun exposure following a treatment. While it’s fine to have a PicoSure treatment in summer, you do need to take extra precautions in keeping your treated skin away from UV rays. The number of treatments needed will depend on a number of factors, including how large and dense the tattoo is, and how fair your skin is. Generally, the laser works best on darker tattoos on lighter skin. Your dermatologist will be able to assess your situation and recommend the best treatment plan for you.

Q: I’m 23 with acne scars and large pores. I’m thinking of having a laser skin resurfacing treatment, but I’m worried that the results won’t be permanent.

A: Laser resurfacing is a great way to smooth certain types of acne scars. There are many types of lasers available that can provide noticeable results; however, no cosmetic treatment of the face is permanent. Your skin is constantly changing as you age, and many different factors play a part in how your skin will look in the future. The best way to prolong the effects of a laser treatment is to take good care of your skin. Habits such as sun exposure or smoking will age the skin more rapidly, and genetics play a part as well, especially when it comes to pore size. Laser resurfacing can diminish acne scars, but it can’t prevent future outbreaks. That being said, laser resurfacing is one of the best and longest-lasting means of dealing with acne scars. I would recommend an in-person consultation with a qualified dermatologist to assess your skin and determine the best kind of laser to use and how long the effects are likely to last given your skin care habits.

Q: How long must one wait after an injury has healed to have fractional laser surgery to reduce the scar? Hello! I recently (1 week ago) had a mole removed that looks like it might leave a small indentation in my skin. I am extremely worried as this is on my face and would like to know any suggestions that you have to help with this sooner.

A: Laser treatment may be effective, but the outcome depends on how the mole was removed. Please consult with a board-certified dermatologist to help determine a treatment option that’s right for you.
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