A Blog about Minimally Invasive Cosmetic Procedures and Aesthetic Ancillaries.
Saluja Cosmetic and Laser Center (SCLC) is delighted to announce that we will be opening our doors on Feb. 6th for aesthetic laser procedures, injectables and facial cosmetic surgery.
We will be providing an array of aesthetic laser procedures with cutting edge lasers to treat pigmentation, wrinkles, skin tightening, hair, blood vessels and cellulite. All procedures are performed by a board certified ophthalmologist who is fellowship trained in dermatologic cosmetic surgery.
Please schedule your complimentary consultation today!
SCLC
(704) 584-4071
9727 Northcross Center Court
Huntersville, NC 28078.
We look forward to working with you to achieve your most radiant look.
Kind Regards,
Dr. Saluja
GHTime Code(s): nc
43141
Technorati Tags: aesthetic lasers, blood vessels, cellulite, facial surgery, Injectables, pigmentation, saluja cosmetic and laser center, skin tightening, wrinkles
So we have heard in the media and from friends that there are several cellulite treatments on the market, some topical and some laser. Do they work? Have they been studied? Which systems actually produce results. How long do the results last? These are all important questions that are best answered with clinical studies.
There are a couple of landmark studies on the SmoothShapes Laser which answer questions not only on clinical improvements achieved with treatment, but also addressing the duration of time where these results can be appreciated.
Dr. Kulick published a study in Plastic Reconstructive Surgery which was reprinted in Cosmetic Journal. The author performed 8 treatments over 4 weeks and found an 82% improvement in the contour irregularities at one month via Vectra 3-D imaging which was still appreciated at 6 months (76% improvement at 6 months).
Dr. Lach published an article in the Journal of Cosmetic and Laser Therapy which evaluated thighs treated with Smoothshapes (laser and vacuum massage) versus just massage alone. Patients received an average of 14 treatments over 4-6 weeks. What he found was the side treated with the laser AND massage had a 1.19 cm reduction in thigh circumference compared to an actual INCREASE by 3.82 cm in the thigh treated with massage alone.
So there are published benefits to not only improving the appearance of cellulite, but in reducing subcutaneous fat (although it is FDA approved and marketed for cellulite reduction).
This is not a permanent treatment, but there is data showing improvements for up to 18 months post treatment. This may be the stocking stuffer laser treatment that is a gift during the holidays to start in late winter, early spring to be cellulite reduced for the summer!
GHTime Code(s): nc nc
43141
Technorati Tags: cellulite treatment, clinical studies, laser, laser treatment, MD, Raminder Saluja, Saluja, Smoothshapes, subcutaneous fat
Cellulite continues to be a nuisance to the female population. The topographical irregularities which are visually obvious and equally disturbing to the patient occur from fat protrusion through the fibrous septae.
There have been numerous treatment modalities which have been sold to the general public, such as various topical creams and differing endermologie treatments. While some have shown a transient benefit, there has always been room for improvement for the treatment of cellulite.
So what is new in the way of laser technology for cellulite?
One advancement is the new SmoothShapes XV laser. This laser system combines a 915 nm wavelength which is preferentially absorbed by the fat cell (adipocyte), thereby causing a thermal raise in temperate of the fat cell with liquifaction of fat. This wavelength is combined with 650 nm light. The light creates transient pores in the fat cell, thereby allowing the liquified fat to spill into the interstitium which is then mechanically manipulated with vacuum suction and roller massage. The end result is a smoother appearance to the topographic alteration of the skin.
Typical Treatment:
The typical treatment consists of 8-12 treatment sessions delivered over 4-8 week course. There can be some transient redness which lasts for less than 2 hours and possibly some swelling which would be minimal if at all.
The improvements in the appearance of cellulite have been cited at 50-60%. While the treatment is not permanent, studies have shown that improvements are still present 18 months post treatment.
Average treatment costs can range from $2000-$4000 dollars for 8-12 treatments.
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43141
Technorati Tags: cellulite, cost, fat, laser, laser treatment, light based treatments, treatment
If you read the news today, you will find a new surge of interest in coconut oil. Initially touted as a “bad fat” because of the high saturated fat content, researchers are finding out that this is not true but that there are real health benefits from incorporating this oil into the diet.
Coconut oil is comprised of medium chain fatty acids as opposed to long chain fatty acids found in most foods. These unique fatty acids have demonstrated antimicrobrial effects, fat burning effects and cardiovascular benefits.
Dr. Bruce Fife with the Coconut Research Center has done extensive research on the benefits of coconut oil and the effects of coconut oil systemically. He even incorporated a section in his new book on Coconut Oil to skin care.
A paper by KG Nevin published in Skin Pharmacology and Physiology in June 2010, evaluated topical virgen coconut oil on wound healing.
Before we discuss this, let’s first define the differences between refined coconut oil and virgen coconut oil.
1. Refined Coconut Oil
Most coconut oils are made from COPRA which is basically the dried kernal (meat) of the coconut. Most copra that is dried is not sanitary therefore it must be refined through heat to deodarize the oil and then filtered through bleaching clays to remove impurities. The end product is RBD coconut oil which stands for refined, bleached and deodarized coconut oil.
2. Virgen Coconut Oil
This oil comes from using fresh coconut meat and chemicals and high heating are not used in refining since this natural type of oil is stable.
For the purposes of the discussing the article on wound healing and coconut oil, it is important to note that virgen coconut oil was studied.
What was found was that the wound healing properties of the virgen coconut oil were superior to non treated skin. This could be do to the minor biologically active components and antimicrobrial fatty acids.
Coconut oil is rich in medium chain fatty acid (lauric acid), and has been shown to minimize bacterial infection and stimulate the immune response. There are also high levels of polyphenols, Vitamin A, Vitamin E and significant antioxidant properties. All of this is important for skin health.
So this is my thought, why not use coconut oil post fractional CO2 laser treatment instead of aquaphor which can lead to acne eruptions? That is exactly what I am doing now for patients.
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Technorati Tags: coconut oil, Coconut Research Center, Dr. Bruce Fife, fatty acid, Fractional CO2, lauric acid, medium chain fatty acid, virgen coconut oil
The idea of a “skin peel” is not only visually, but also verbally appealing in that it could simply “peel” away all the years of sun worshipping that are apparent on our photodamaged skin.
And actually, there is a lot of science associated with the peel. Here are the important issues to think of when you are considering a skin peel.
1. Chemical Peels
With a chemical peel, acids are utilized to denature the protein in the skin which essentially “wounds” the upper layers of the skin. If the papillary or upper dermis of the skin is wounded, then it is considered a medium depth peel. If the deeper, reticular layer of the dermis is wounded, then it is considered a deep peel.
The acids utilized help to exfoliate the upper layers of skin.
The most common acids that you will find in chemical peels are:
a. Alpha Hydroxy Acids: these penetrate the outermost layer of the skin
b. Trichloroacetic Acid (TCA): typically used in concentrations of 30-50%
c. Phenol: This is utilized for a deep peel.
You can classify the peels as either light, medium or deep peels.
1. Light to Medium Peels
These peels are typically performed by first cleansing the skin with a surfactant which removes skin oils and allows for greater penetration of the acid. Then acetone is usually utilized to further remove oil from the skin. Finally, Jessner’s solution is applied to again aid the penetration of the acid.
After the skin has been prepped and cleaned in this fashion, TCA is applied, usually at 35%. Whitening of the skin can occur in 30 seconds to 2 minutes.
If there is erythema and minimal whiteness, then it is a light peel. A medium depth peel will occur when the skin shows a white frosting with surrounding erythema and finally skin appearance with a deep peel will appear white with no erythema.
2. Deep Chemical Peel
These are typically 50% TCA or Baker Gordon phenol peels.
The Phenol peel was introduced in 1981 and became popular. But, present day, the popularity has waned.
In order to have this peel, IV sedation is necessary as well as cardiac monitoring. The goal is to increase the penetration of the phenol at the skin level, but not in the blood, because phenol can be toxic to the heart and lead to ectopic beats or life threatening cardiac issues.
A study published by Landau in 2007 reviewed 181 patients receiving phenol peels and out of these patients, 6.6% suffered cardiac arrhythmia from the full face peel.
Another reason why deep phenol peels are falling out of favor, is the advent of laser technology which can go deep, but in a more controlled fashion. Fractional CO2 laser is more popular in this day and age compared to deep phenol peels.
Until next time…
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Technorati Tags: AHA peel, chemical peel, Fractional CO2, Jessner's solution, phenol peel, skin peel, TCA peel
The gold standard for treating photodamaged skin, photoinduced facial rhytids, precancerous lesions, dyschromias and atrophic scars has been the carbon dioxide laser. This laser basically vaporizes or ablates the top layer of the skin (epithelium), down to the middle aspect of the dermis.
There is some initial tissue tightening which occurs from the removal of tissue and heat effects, but the predominant tightening and results will start to be appreciated at about 6-8 weeks after the laser treatment.
Last decade, we had standard CO2 resurfacing. This do a great job, but there was a significant “downtime” associated with the laser which could be from 4-6 weeks up to 3 months! Who has the time to heal from this?
Not to mention, the side effect profile was a lot greater with standard ablation. Issues such as infection and pigmentary alterations were too common to embrace this laser.
So for awhile, it was either standard ablation or no laser at all.
Then an exciting thing happened in the aesthetic arena. Fractional technology was created. This meant that pulses of CO2 laser were delivered almost like a pin cushion where small areas were treated and equally small zones that were left untouched etc. Although the results looked like confluent treatment, the small skip areas allowed for much quicker healing while still maintaining nice results.
I have received several comments on the blog and from patients, if I could post photos of what a patient would look like each day following a procedure.
After each photo, I will add comments, so you know what is expected for patient care at each stage of the healing process. I hope this clarifies questions.
What is important to know is that while fractional CO2 has a much decreased “downtime” compared to standard CO2, there is still a “downtime”. This downtime is typically about 4 days and usually by the end of the 4rth day or the beginning of day #5, sunscreen and make-up can be worn again.
This is what the face looks like immediately post fractional CO2 laser. This was done with the Performa Laser (Cynosure, Westford, MA), with good depth of penetration. So what you see is some pinpoint bleeding and the gray, stippled fractional photothermolysis appearance.
Initially after the treatment, we recommend cool compresses and I have the patient take a pan and place ice in it. Then I have them add water that has been mixed with vinegar (1 cap of vinegar per cup of water) and have them place two small towels in the pan and rotate the cold cloths to their face. The more patients can do this the first day, the less the swelling.
Also, patient should not excercise on the first day and their face should constantly have a sheen of Aquaphor. So typically patients will place a thin layer of aquaphor every 2 hours or four times per day on the skin. There will be heat that the patient will feel for about 2 hours post procedure and then there is no more discomfort.
To the right is day number 1 and 2 after the laser. You can
see that the face is swollen (edema is usually prominant around the eyes). There is a fine layer of aquaphor on the face.
Day 3 and 4 (below) show the skin getting a touch darkeer. Itching can be experienced on day 2-3 as the skin is almost ready to peel. There will be underlying erythema (redness) when the skin begins to peel on day 3 or 4. Now sunscreen and make-up can be worn. 
Baseline and Day number 7.
Here you can see the difference between baseline and day 7. But know that there is still a little bit of swelling so this actually makes the face look as if collagen is already stimulated. But it is important to remember that you will look fantastic at day 7-10 and then the swelling will totally be gone, and you will think your wrinkles are returning! But by 6-8 weeks the skin again begins to go through a process where collagen can now be appreciated clinically and you will start to notice the tightening.
Here is a photo comparing baseline to 10 weeks.
Baseline and 10 weeks post laser.
Now you can appreciate the tightening. Again, it is important to remember that all the wrinkles will not be gone (wrinkles around the mouth are stubborn), but the laser will help to minimize the wrinkling.
Hope that helps.
Until next time…..
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Technorati Tags: 1 week after fractional CO2, aquaphor, day, day four, day one, day three, day two, each day, face, fractional CO2 laser, healing, patient, Performa laser, photos, skin, swelling, vinegar, wrinkles
Our ability to address volume depletion has improved significantly since the launch of FDA approved fillers several years ago.
Restylane (Medicis) was one of the first hyaluronic fillers to be FDA approved in the US followed by Juvederm (Allergan) and now several others on the market. The ease of use of fillers has made it a widely acceptable, very minimally invasive procedure in restoring youthfulness.
However, complications can occur. The common issues of bruising and minimal swelling and erythema will be there. Bruising is the most significant around the ocular area as well as around the mouth. Patients can also have issues of overfill, again the culprit area is typically under the eyes. Even a small amount of filler here can in some patients, cause prolonged swelling. Or simply, there is just too much filler placed in a certain location.
If this occurs, what can be done?
We discussed hyaluronidase in a previous post. I have received a lot of questions regarding hyaluronidase, especially under the eyes, but in other areas as well, so I thought I would discuss it in greater detail.
What is Hyaluronidase?
Hyaluronidase is a naturally occurring substance that degrades hyaluronic acid (such as juvederm and restylane). There are 5 different commercially made hyaluronidases:
1. Amphodase (Amphastar Pharmaceuticals, Rancho Cucamonga, CA)
2. Hydase (Prima Pharm, San Diego, CA and distributed by Akorn, Lake Forest, IL), has not been available since 2009.
3. Vitrase (ISTA Pharmaceutical, Irvine, CA): This is the one we use.
4. Wydase (Wyeth-Ayerst, Madison, NJ), has not been available since 2001.
5. Hylenex (developed by Halozyme Theurapeutics, San Diego, CA and distributed by Baxter, Deerfield, IL)
Out of these 5, only 3 are available: Amphodase, Vitrase and Hylenex.
Amphodase is derived from testicular bovine hyaluronidase and does have mercury derivative thimerosol as the preservative.
Vitrase is made from purified ovine (sheep) testicular hyaluronidase and is preservative free. This is the one we utilize at our office.
Hylenex is made from purified recombinant human DNA and is the most expensive out of all three hyaluronidases. This one is rarely used.
Hyaluronidase is FDA approved to be used as an adjunct to increase the absorption and dispersion of other drugs. So for example, in ophthalmology, it is used with a retrobulbar block to help increase the dispersion of the injected drug.
It is used off label to help decrease excess hyaluronic acid fillers or the Tyndall effect which can occur if HA fillers are injected too superficially.
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Technorati Tags: Amphodase, filler, hyaluronic acid filler, hyaluronidase, Hylenex, Juvederm, Restylane, Tyndall effect, Vitrase
Lipomas are the most common soft-tissue tumor, occurring in 1% of the population. They are benign fatty tumors which form soft masses that can be felt under the skin. .
Lipomas in the subcutaneous location are typically asymptomatic but may be removed for cosmetic purposes.
There is no rhyme or reason why the occur, but there has been speculation regarding a link between trauma and subsequent lipoma formation. One theory suggests that fat may herniate after trauma through tissue planes to create a “pseudolipoma.” Another thought is that trauma releases cytokines which may trigger various chemical factors which allows for fatty cells to differentiate and mature.
But many patients have the presence of multiple lipomas with no antecedent trauma history.
When lipomas appear in areas that are cosmetically unacceptable, patients often desire excision. Depending on the location, the excision itself may leave a visually unacceptable scars.
Liposuction has been documented as a treatment option for lipomas, however, complete removal may still not be possible with aspiration alone.
With the advent of laser lipolysis, SmartLipo has emerged as a treatment option. Pretreating the lipoma with laser lipolysis prior to extraction minimizes complications such as post-operative scarring from excision site, hematoma formation and dimpling seen with liposuction alone.
Mild bruising can occur after extraction of the lipoma, primarily from the digital massage. The addition of the Nd:Yag laser in the multiplex setting of laser lipolysis helps with coagulation thus minimizing bruising. The 1320 nm wavelength helps with emulsification therefore assisting the ease of extraction of the lipomatous material.
This also allows for quick healing and no obvious scarring.
If lipomas are very little, then simple excision may be the quickest option. However, for the medium sized or larger lipomas, know that there are options out there which won’t leave you worse off then your starting point.
Here is a patient that was bothered by his lipomas on his arms. They were mid sized lipomas that gave his arm silhouette a cosmetically notable area. He had some lipomas removed from the trunk of his body by excision, but because of the scarring, he was reluctant to have them excised.
He came to us for consultation on options for lipoma removal with minimal scarring.
We tumesced the lipomas and then did SmartLipo MPX to the lipoma. Finally, the lipomatous material was expressed out with pressure.
Here are photos of his arm before and 5 days after SmartLipo with expression of the fat.
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Technorati Tags: excision, laser, laser lipolysis, lipoma, minimally invasive, option, scarring, SmartLipo
Solar Lentigo
Solar lentigenes are often referred to as “liver spots” and tend to occur primarily on the hands and the face. They are flat areas of pigmentation which occur secondary to prolonged sun exposure on certain skin types. These areas of pigmentation are benign but it is important to distinguish them from pre cancerous lesions.
Pigmentation on the hands and face can be cosmetically unappealing. So what can be done for these liver spots?
1. Topical cream with hydroquinone 4% (bleaching cream) and tretinoin (which is generic retin A). There are several great prescription products, namely Triluma which contains hydroquinone, tretinoin and a mild steroid. The only negative is that it is quite costly.
You can use hydroquinone (generic) and tretinoin and mix them together and utilize on the face or hands at night.
2. Chemical peels
There are many different types of chemical peels and based on the skin type, you may not be able to get overly aggressive. Trichloroacetic acid works quite well on solar lengtigenes, however, make sure you go to someone who does a lot of them.
3. Broad Band Light Source
My practice is in the southeast, so many patients consult us regarding their areas of pigmentation. IPL (Intense pulsed light) is one of the most popular treatments that patients have done. Basically the broad band of light targets several chromophores (targets) from the photodamage. It targets melanin, therefore these “liver spots” can be treated and it targets hemoglobin, so small vessels and skin ruddiness can be treated. My IPL of choice is the Lum One (Lumenis) Depending on the severity of the pigmentation, it may take several treatments (typically about 3).
4. Lasers
There are several lasers which can be utilized.
If the area of pigmentation is discrete, an Alexandrite laser can be used with a small spot size and short pulse duration.
Also Q switched Alexandrite laser (Accolade, Cynosure) Q switched Nd:YAG (Affinity, Cynosure) work brilliantly for discrete areas of pigmentation.
If pigmentation is not superficial, but tends to be deeper, then the Q switched Yag or fractional CO2 laser (SmartSkin, Cynosure) can be employed.
But with all that said, make sure you wear sunblock to protect yourself from sun exposure while undergoing the treatments (and afterwards, to maintain the cleared skin).
Until next time….
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Technorati Tags: Accolade Laser, Affinity Laser, Cynosure, fractional CO2 laser, IPL, liver spots, Lumenis One, pigmentation, q-switched laser, SmartSkin, solar lentigo, triluma
More options are present today for minimizing photodamage to the skin which occurs after long term sun exposure. Although caucasian skin has a tendency to show more photodamage, ethnic skin too can exhibit changes in vascularity, pigmentation, dyschromia and elastin and collagen changes from years of sun exposure.
In the recent several years, laser technology has advanced where lasers now have the capability of treating ethnic skin while protecting the epidermis from injury during the treatment.
Why is this important?
Ethnic skin represents the majority of the world’s population. This includes East Asians (Chinese, Japanese, Koreans), SouthEast Asians (Indonesians, Malaysians, Singaporeans, Thais, Cambodians, Vietnamese) and South Asians from Bagladesh, India, Pakistan and Sri Lanka.
Standard CO2 laser was not an option for ethnic skin because the risk of pigmentary complications. With the advent of fractional CO2 laser, darker skin types may be treated at lower settings, however, when skin is darker then Fitzpatrick skin type V, fractional CO2 or ablative lasers are not recommended.
What laser would be recommended for ethnic skin tightening?
Fractional nonablative lasers have provided a nice alternative to darker skin types. The objective of the laser is to improve aesthetic concerns of photoaged skin including the appearance of pigmentation, static fine wrinkles, course texture and prominant pores along with recontouring of mild surface irregularities via dermal collagen remodeling.
What are the different nonablative fractional lasers available?
There are several different fractional nonablative lasers on the market today. The lasers use light in the mid infrared spectrum for deep heating of the tissue. Microscopic areas of thermal injury are created on the skin, without ablation, meaning that the epidermis is intact. Because melanin is not a target, patients with darker skin types can be treated.
What to expect during and post treatment?
The laser that we employ in our clinic is an Affirm laser (Cynosure, Westford, MA). This laser has two different wavelengths (1320 nm and 1440 nm) which can be used in a multiplex fashion for additional heating of the skin.
Sometimes, I will numb a patient for 10 to 20 minutes with topical EMLA, but the majority of patients will not need numbing. There is cold air which circulates over the skin as the laser is being performed, adding to patient comfort and protecting the epidermis even further.
After the treatment, the face will be erythematous (red) for about 24-36 hours. The redness has the circular configuration reflecting the circular laser tip. Make-up can be applied, because the epidermis is intact (unlike fractional CO2 laser where the skin surface has been ablated).
We typically do treatments every 4 weeks and patients will need 3-6 treatments depending on the baseline evaluation of their skin. After hours, this is the laser that I use on my skin.
Until next time….
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Technorati Tags: Affirm laser, collagen, Cynosure, ethnic skin, fractional nonablative, skin tightening
