Archive for the ‘Cosmetic Procedures’ Category

Lasers 101: A Guide to Procedure Selection for the patient and a focus on Intense Pulsed Light (IPL): The photofacial/fotofacial revisited

November 5, 2008

When considering ANY cosmetic procedure, the first question one must ask himself or herself, as a patient, is, “What am I trying to improve?”  Rather than jump on catch words for example, like “resurfacing,” and wanting “fraxl,” the key question is again, “what bothers you?”  And what logically follows is, “will a certain procedure benefit that problem?” The next inherently linked and important question to consider is, knowing the benefits, “what are the risks?”

To sum up:

  1. What is my goal as a patient?  What do I want to improve?
  2. Will this procedure help?  What other procedures could do the job?
  3. What are the risks vs. benefits of the proposed procedure vs other procedures that make this one the procedure of choice?

Intense Pulsed Light or IPL, in the right hands, is pretty ideal for treating brown spots, also known as sun spots or liver spots with very little risk or “downtime.”  So, if you are looking at your face and saying to yourself or my receptionist, “I have a few sun spots on my face,” you should not necessarily be asking for a resurfacing procedure or the fraxl.  While ablating or getting rid of a significant percentage of the surface of your facial skin, will likely get rid of the epidermal lesions, it is also most likely not necessary and a more costly, more invasive, riskier procedure.  However, if you suffer more from blotchy pigmentation as opposed to discrete brown spots, then the resurfacing procedure would likely be superior for you.  On the other hand, IPL can selectively target the hyperpigmented lesions/sun spots/solar lentigos….and have them form a VERY superficial crust that flakes off of the face typically in 7 days, with minimal downtime and minimal risk, again, when performed in the right hands.

I did a 2 year cosmetic fellowship that included intensive training on multiple lasers including an IPL machine.  I published a peer-reviewed article in the journal Dermatology Surgery for a study done in conjunction with Estee Lauder.  I recently did another study for Estee Lauder with my newer IPL machine.

What else is IPL good for besides brown spots?  It is also particularly beneficial for treating blood vessels or telangiectasias on the face – again with little downtime or risk.  However, unlike the treatment of brown spots, treating blood vessels can take more than one treatment and difficult cases can take up to 3 to 5 treatments.

This is where the term “photofacial” came from.  The patient would typically get 3 to 5 treatments spaced 3 to 4 weeks apart.  The average patient would have this procedure done for a fair amount of redness/rosacea/broken blood vessels with or without the brown spots discussed above.  Additional benefits include a decrease in pore size, improvement in skin tone, stimulation of collagen production with a concomitant decrease in fine lines and wrinkles; HOWEVER, these latter benefits are usually much more subtle than the improvement in the redness/blood vessels and resolution of the brown spots, and I do not typically encourage patients to have IPL unless they have the aforementioned brown spots and/or blood vessels/redness .  The MIXTO fractional CO2 system is far superior to IPL and in my opinion, to other resurfacing lasers as well, for stimulating collagen production and decreasing fine lines and wrinkles.

To conclude, if you have brown spots and/or blotchiness, “broken” blood vessels, telangiectasias, capillaries, or rosacea, IPL has a very favorable risk/benefit profile and could be the treatment of choice for you!  For more background information including a history and comparison of “resurfacing” or ablative lasers vs. non-resurfacing ones, please see my upcoming blog on the Mixto laser – the state of the art in fractionated CO2 lasers.


Botox Safety Issues

July 29, 2008

Botox is botulinum, BUT botulinum is not Botox!!!


One of the advantages of practicing in Manhattan, the Hamptons, and Aspen, is that whenever an interesting story hits the news, my patient population is bound to know about it.  They are not only savvy, but cover a vast geographic area and often travel to and from my office destinations.  So, if it’s in the news, they are bound to hear about it and sure to inquire about it.


This blog is dedicated to the recent report of botulinum being detected in mice brains after cutaneous injection near the mice’s whiskers.  FIRST, it is important to note that this report is a contradiction to a prior study done by Allergan. SECOND, as the title of this blog suggests, not all botulinum is Botox.  I remember from my high school math classes, that we learned about “logic.”  Basically, if p = q, it does not mean that q = p.  In other words, if Botox is botulinum, it does not mean that botulinum is botox.


To further explain, Botox is a specific version of botulinum toxin, consisting of approximately a 900 kd molecule.  Botox is a specific from of botulinum type A, consisting of light (50kd) and heavy chain (100kd) surrounded by accessory proteins.  These proteins prevent diffusion of the Botox, as does the relatively large size of the Botox.  On the other hand, the recently reported mice story in the news consisted of a botulinum molecule weighing 150 kd, or approximately 1/7th the size AND lacking the aforementioned surrounding proteins; therefore, it is not that surprising that it would be able to diffuse so much more.  In addition, the mice study utilized a mega dose which was approximately 150 times the dose given to patients, when normalized for body weight. 


An example of a differing formulation of botulinum soon to hit the US market is called myobloc, which is a specific form of botulinum-type B.  It can have similar effects as Botox but is completely different in structure and potency.  For example, one vial of Botox consists of 100 units, yet one vial of myobloc will consist of 5000 units.  So, a patient will require a much greater number of units of myobloc than of Botox, to get the same result.


Additional facts about Botox are the following:


  • Botox was first approved for COSMETIC use in the USA in 2002
  • Since then, more than 16 million procedures have been performed for aesthetic/cosmetic purposes
  • Prior to 2002, Botox was already being widely used for off-label cosmetic purposes
  • Botox has also been approved and used for medical purposes/neurological diseases/spasms for approximately 20 years   
  • In one study of 1000 patients, 97% were “definitely satisfied” with their Botox treatment


In conclusion, the study that hit the news was not specifically about Botox!

When is the best time to get cosmetic procedures such as Botox and filler injections done? How long does it take for a procedure to take full effect?

November 28, 2007

Recently, I have been flooded with inquiries on cosmetic procedures such as Botox and Juvederm/Restylane… and the best times to have them done. There are many different aspects to consider when having a cosmetic procedure. Generally speaking, these are considered “lunchtime procedures” – meaning they can not only be performed quickly, but offer an immediate return to a regular lifestyle afterwards.