Aesthetic Lasers Blog

blotchy skin with spots

Treatment of pigmentation is a complex subject. Determining the type of lesion will help to establish which laser or light device to use and what parameters to set.

Hyperpigmentation is a broad descriptive term, offering us little information about etiology or pathophysiology of the lesion. Dividing this expansive category into primary versus secondary helps with treatment decision-making and predicting outcome.

Moreover, hyperpigmentation can stem from epidermal, dermal or a combination of these locations. Discrete lesions, such as lentigines, ephelides (primarily epidermal lesions) and nevus of Ito or Ota and decorative tattoos (primarily dermal lesions), show the most favorable response to laser and light-based therapies.

Postinflammatory hyperpigmentation would be the main component of the secondary hyperpigmentations. Melasma can also be considered in this category, as it generally behaves similarly to postinflammatory hyperpigmentation after laser treatments, showing the most unpredictable response to laser and light-based therapies.

Primary pigmented lesions are generally easier to treat than secondary lesions. For localized lesions on the trunk and face, the Q-switched lasers are very successful at removing pigmentation. These include Q-switched ruby (694 nm), Q-switched alexandrite (755 nm) and Q-switched Nd:YAG (both 1,064 nm and 532 nm). For darker skin types, choose the longer-wavelength Q-switched lasers, as their emissions have less absorption by melanin and hence less competition/absorption from normally pigmented skin.

To learn more about the use of IPLs, long-pulsed dye laser (LPDL) and Q-switched lasers for the treatment of solar lentigines, photoaging and flat seborrheic keratosis read The right tool: Lesion type determines which laser, light device is best choice, opinions of Joely Kaufman, M.D., assistant professor of clinical dermatology at the University of Miami Miller School of Medicine and director of lasers for the University of Miami Cosmetic Group, and Vic Narurkar, M.D., the chair of dermatology at California Pacific Medical Center and director and founder, Bay Area Laser Institute, and associate clinical professor of dermatology at University of California Davis School Of Medicine.

Just like Dr. Kaufman and Dr. Narurkar, I believe that there is a potential of further development of “do it at home” lasers:

“It remains to be seen what type of contribution the at-home devices will play in the treatment of pigmentation. The newer devices coming to the market look very promising as both preventive and adjuvant therapeutic options.”

Laser lasers and light-based devices for home use cannot be considered as a replacement of medical office treatment, but some of the products in the laser industry pipeline can be used as ancillary tools to enhance the effectiveness of a medical treatment plan.

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  • Filed under: LT | pigmented lesions
  • Ablative Non-Ablative Or Both For Acne Scars

    Many methods have been proposed for the treatment of acne scars, with variable cosmetic results. Nonablative skin resurfacing is one method that involves dermis and subcutaneous heating with lasers for the purpose of inducing new connective tissue growth. Because of a need for more noticeable clinical improvements, the ablative fractional laser was recently introduced to resurface acne scars.

    Ablative skin resurfacing typical causes visible trauma to the patient’s skin. Aesthetic physicians who have both modalities can try to reduce complications and improve the results of ablative laser resurfacing (carbon dioxide, erbium or fractional lasers) by combining this treatment of acne scars with nonablative lasers.

    For patients of  skin phototypes III-V with atrophic facial acne scars, the combination of ablative laser resurfacing and nonablative laser resurfacing yields the best results with fewer complications.

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  • Filed under: LT | acne
  • Pulsed dye laser (PDL, 595 nm) is the current treatment of choice for port-wine stains (PWS), but 25–50% of treated lesions do not demonstrate a significant improvement.

    Combination of laser may improve treatment efficacy, especially those using the synergies between PDL and Nd:YAG 1064nm laser. There is a growing body of research and anecdotal evidence that the dual wavelength approach shows efficacy with less discomfort for the patient.

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  • Filed under: LT | combination, LT | pigmented lesions
  • spotlight

    Medical marketing and medical advertising is complicated. Forget general advertising. Billboards, ads in a local paper, radio, TV… It’s expensive and it does not work! Online and media with focus on a story or patient education works!

    Learning how to work with the media systems is a new skill to learn for many physicians. Innovative plastic surgeons have always realized the power of the press and good PR. However, positioning yourself in the media is not an easy task. It can be time-consuming and costly if you don’t know what to do or who to hire.

    First, you need to understand how the media works. You have to have a newsworthy story. Think news. Every patient who comes into your office is a potential news story. They each have a personal reason for wanting your services. Oftentimes, they want to share their stories with others and are willing to be candidates for press interviews.

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    AWeber’s online email marketing system makes it easy to stay in touch with your customers, educate them about new technologies and procedures you have in the office, distribute newsletters and announcements.

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    Keep up with trends. Each year, societies and academies publish results of surveys conducted among their members. Those surveys result in statistics that show the increase in trends and procedures. The media love to see growth statistics, especially those that can be proven by such credible organizations. Whereas most national media outlets report these statistics, many local press outlets are never shown the results and may welcome the chance to interview you as the local resource.

    Get more than CMEs at industry events. Though many of you attend meetings and events to learn new techniques and fulfill CME requirements, don’t overlook the gold mine of information in the exhibit hall. This is where all the new future possibilities lie, and things are discussed there before they are discussed from the podium.

    Be charitable. Charitable work or philanthropic contributions are of interest to the media. In these instances, aesthetic surgery is considered “surgery of the soul,” especially when it is reconstructive surgery. Such a media campaign promotes a positive community image.

    Get involved in your community events. Sports, kids, local gatherings are excellent opportunities to get your name out and create the buzz.

    Planning a grand opening, a patient education seminar, adding new services? Invite the press. Many community newspapers have a “society” or “locals only” section. If you are opening your practice, get involved with the local Chamber of Commerce and have a ribbon-cutting ceremony.

    Getting yourself in the spotlight does not always happen overnight. Public relations campaigns can take weeks, months, or even years to become successful, depending on your goal. Start now.

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  • Filed under: Marketing Ideas
  • liposculpture-swimsuit

    Final Inches Medical Body Shaping Center in California just announced a new marketing idea. That is in addition to picking a cool name. This practice has two locations specializing solely in Laser Liposculpture, a minimally-invasive procedure that permanently eliminates frustrating fat. This lipo sculpture practice recently announced that they are helping their patients get ready for summer with their custom swimsuit giveaway.

    “Certain areas of the body are genetically predisposed to store fat, including the waist, stomach, hips, thighs, and arms. This fat can be very difficult to reduce or eliminate through diet and exercise but at FINAL INCHES we remove this stubborn fat permanently, in about an hour,” states Anh Ngo, MD, Board Certified Surgeon and Medical Director of FINAL INCHES. “With our Laser Liposculpture procedure, we permanently remove stubborn fat, reshaping our patients’ bodies to create a slimmer, sleeker swimsuit-ready body.” This lipo practice performs more Laser Liposculpture procedures than any other Southern California practice.

    “We couldn’t be happier designing custom swimsuits for the lipo sculpture patients,” states Jessica Neeper, National Sales Manager of Ginger’s Island, one of the swimsuit companies partnered with the practice in this promotion. “Lipo sculpture patients are some of our most enthusiastic customers because they come to us ready to show off their slimmer bodies. It’s a real thrill working with them to design custom swimsuits that accentuate their curves and get them ready for the beach.”

    Qualifying for the free custom swimsuit is simple; patients only need to come in for a consult and have their slimming Laser Liposculpture procedure done before August 31, 2009. After the procedure, patients are then fitted for their free custom swimsuit to show off their new beach-ready body.

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  • Filed under: Laser Clinics, LT | lipolysis
  • Cellulite is very common. It appears in teenagers and may bother a lot of women throughout their life time. Due to the complexity of the problem, there is no permanent cure for cellulite as the lumpy and dimpling skin over the thighs, hips and buttocks still challenge the best of the cosmetic dermatologists, plastic surgeons and aesthetic physicians.

    A new study posted in Longevity and Age Management, Aging, Skin-Hair, Women’s Health, Aesthetic Medicine on Wed May 13, 2009 shows that combination laser treatment and fat transplantation may help combat cellulite.

    Robert Gotkin, M.D., F.A.C.S., from the Cosmetique Dermatology, Laser & Plastic Surgery, LLP, in New York, N.Y., co-authored a study to determine the effects of laser energy used in combination with an autologous fat transplant to improve the signs of cellulite.

    The study included 52 women with grades 3 and 4 cellulite. Participants were treated with a 1064 nm Nd:YAG laser, after which they underwent an autologous fat transplantation in fat-depleted target areas. The laser was used to break down fat stored in fat cells, then to superficially break up the fibrous bands that connect the muscle to the skin and cause the skin to dimple and have an orange peel-like effect. Autologous fat was then transplanted to the areas with the most severe concave contour deformities. The goal was to fill out those areas in order to provide a smoother, more even contour to the target skin’s surface.

    At the conclusion of the study, the participants completed a patient self-assessment questionnaire. Almost 85 percent rated their improvements as either “good” or “excellent.”

    Although Dr. Gotkin believes that the results of this combination treatment are lasting, he notes that the effects will lessen over time as the women age. “As a woman gets older and continues to develop skin laxity, cellulite will likely return,” Dr. Gotkin says. “However, in the 12- to 30-month follow-up that we had in our study patients, we could significantly improve the cellulite long-term. Most of the approaches currently used in aesthetic surgery are noninvasive and therefore also achieve minimal results. Our goal was to give some permanent improvement in the appearance of cellulite and we were able to achieve that using this surgical technique.”

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  • Filed under: LT | cellulite
  • podcastActinic Keratoses and Treating Skin Color

    This coverage includes: treatment for actinic keratoses, safe tanning and treating skin color.

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  • Filed under: Podcasts
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