Archive for the ‘Articles/Q&A’ Category

Discounts on Botox and Dysport in Denver, Colorado

Monday, November 2nd, 2009

Let the marketing wars begin!  Botox throw the first shot at their new competitor Dysport by offering a $50 rebate on any Botox procedure over $200.  Now Dysport has answered with their own rebate of $75 off.  Neither manufacturer seems willing to actually lower the price of their product but this is at least a step in the right direction. 

Now Allergan, the manufacturer of Botox, has fired another shot with the unveiling a new program called Brilliant Distictions.  This new program allows certain offices to give additional rebates to patients.  After every Botox treatment an enrolled patient will receive 200 points into their account.  Every 200 points can be redeemed for a $25 coupon that is good for Botox, Juvederm or even Latisse.  Patient need only enroll in the program on the Brilliant Distinctions home page.

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Posted in Articles/Q&A, Articles/Q&A, Botox, Dysport | No Comments »

Skin Tightening and Wrinkle Removal In Denver, Colorado

Monday, November 2nd, 2009

The most common questions asked in my office are about skin tightening and wrinkle removal.  Patients want to know which laser treatments work the best.  There are so many technologies out there that it is easy to get lost in technical jargon and marketing build up.  The good news is that there are some truly excellent lasers procedures out there for both wrinkle reduction and skin tightening.  The better news is that there are some easy ways to evaluate these technologies.

To truly reduce facial lines is a difficult task, especially wrinkles around the mouth and eyes.  These lines can extend over a millimeter deep into the skin.  It is the depth of the damage that makes them very difficult to treat.  Most procedures for treating wrinkles are very superficial and although they may improve fine lines, they never treat the base of deep wrinkles.  In order to really get improvement one must have a procedure that treated then entire area of damage.  This is why fractionated CO2 procedures like the Deep FX are so effective.  This laser can penetrate up to 2mm into the skin assuring that even deep wrinkles will show significant improvement.  Yes, there will be a few days of downtime but we spent several decades making these wrinkles and a few days is well worth it in order to make the skin look literally years younger. 

What about tightening the skin?  There are two options here depending on the desired amount of improvement and amount of downtime a patient is willing to undergo.  The first option is using an infrared light call the Titan to heat the dermal skin which shrinks the existing collagen (much like a piece of meat shrinks on the grill when heated) and will stimulate new collagen growth.  The dermis of the skin thickens giving modest results of about 10 – 20% tightening after three treatments.  Plan on spending about $600-$1000 per treatment for a face and the results will last about 18-24 months.  The best part about the Titan is that there is absolutely no downtime.  The skin is pink for about 30 minutes after the procedure and that is it. Use this in combination with Laser Genesis which is another no downtime laser treatment that helps decrease pores and fine lines.

The other option is using a combination of Deep FX and Active FX.  A surgical facelift removes approximately 10 to 20 square cm of tissue.  Using fractionated lasers we poke microscopic holes in skin much like aerating a lawn.  After poking these holes, we have removed anywhere from 5  to 10 square cm of tissue.  That means that we can get results that are on par with a facelift without the cost or downtime of a traditional surgery.  This is the reason that many patient are choosing this procedure instead of a facelift (Denver Magazine: Death of the Facelift).  In addition to being the best wrinkle treatment and skin tightening treatment, the combination of Active FX and Deep FX will also treat enlarged pores, sun damage spot and even decrease scars.

There is a ton of confusing marketing when it comes to devices for wrinkle treatment and skin tightening.  With so many products such as Fraxel, Pixel, Matrix, Profractional, Thermage, Lux IR and more being added daily it is hard to know which one is the best.  So how does a consumer rate the different laser procedures?  It is actually very simple, just look at the pictures.  Make sure these are not the generalized pictures from the manufacturer.  Patients should stand firm and request pictures from the provider that will be performing the service.  Ask the provider if these are average results or if they are just showing their “homerun” cases.   If they cannot provide you pictures it is time to find a new provider or look at a different procedure.  Check out examples of before and after photos of Active FX  and Deep FX here.  

It is important that you both trust your provider and the technology they are using.  It takes several hundred cases to optimize clinical outcomes with any devise so make sure to choose someone who can prove that they achieve excellent, safe and consistent results.

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Posted in Active FX, Active FX, Articles/Q&A, Articles/Q&A, Deep FX, Deep FX, Skin Care, Titan, Titan | 1 Comment »

Food Drive with Food Bank of the Rockies

Monday, November 2nd, 2009

This year in order to give back the Colorado Center for Photomedicine has teamed up with Food Bank of the Rockies to help combat hunger in Denver!  From November 1st through December 31st get a dollar off your service for every single item you bring in up to 50 items.  Simply drop the items off at the office between those dates and we will give you a discount on your services that day or even will add a credit to your account for a future service!

The Food Bank will take any non-perishable food item.  Products such as tuna, ham, beef stew, chili, baked beans, soup, vegetables, fruit, peanut butter, jelly and pasta tend to be the most in demand.  Please take the time to give back this season and we will make it worth your while!

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Posted in Articles/Q&A, Articles/Q&A, Uncategorized | No Comments »

Zerona versus SmartLipo versus Liposuction Do They Work?

Monday, November 2nd, 2009

I have had many question about the Zerona body contouring system and if it works.  The premise of this device is to use low level light therapy to get your body to dissolve fat.  This means using power level equivalent to a laser pointer on the skin and expecting that this will remove fat.  I have to agree that a no downtime, completely non invasive liposuction procedure does sounds great, but unfortunately it just does not work. 

I recent returned from a Laser Therapy meeting a Harvard and had a discussion with several of my colleagues about the subject.  These are guys from Harvard, MIT and UC Davis who are much smarter than myself when it comes to understand the engineering behind these devices.  The simple fact is that this device will not penetrate much deeper than 1cm into the tissue.  It defies the laws of light based physics with the energy and type of power source they are using. 

After reviewing the data on their site there are a few things to keep in mind.  First is that circumferential body measurements (literally taking a measuring tape around the body part in question) are notoriously inaccurate.  Simply adding a little more force on the measuring tape can decrease the measurement several inches.   If Zerona really wanted to measure fat loss in an area they needed to do an MRI.  The second is that their own data show the device does not penetrate more that about 1 cm.  The total girth loss in their study was a little over an inch (or about 1cm from both sides).  The slides they show with the fat breaking up are realistic but remember that this is very superficial.  Most fat pads in the body are from 6 to 10 cm thick for people who are not overweight.  For those that are overweight or obese the Zerona device is truly useless.   

So then how does this compare to SmartLipo and traditional Liposuction?  It truth is that it does not compare.  The pictures I have seen on Zerona’s e websites are less than impressive.  They have large lighting and positioning changes.  Even with those camera tricks, they do not show much improvement at all.  My patient would be asking for their money back if I provided them with those type of results.  I have seen other Zerona before and after pictures floating around the web that show amazing results. Those are either altered with Photoshop or they are the results of a different procedure. 

SmartLipo and traditional liposuction are still the standard of care.  We have now performed well over 100 SmartLipo cases and the SmartLipo procedure really does have much shorter downtime than traditional liposuction.  There is much less bleeding which leads to less bruising and swelling.  The lower cost and safety of the SmartLipo procedure also make it very attractive.  A study presented at the American Society for Laser Medicine and Surgery last year showed that SmartLipo produced about twice as much tightening when compared to traditional liposuction. The SmartLipo procedure will take slightly longer to do and is best for those with body masses indexes below about 30.   Overall, given two good surgeons that perform the procedures well, the final results of SmartLipo and traditional lipo are about equal but the SmartLipo will cost a bit less and achieve faster results.

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Posted in Articles/Q&A, Articles/Q&A, SmartLipo, SmartLipo | No Comments »

What's the best way to tighten loose skin?

Tuesday, February 17th, 2009

There are several “Skin Tightening” devices, and none are created equally.  The two main categories are:

  1. Ablative (vaporized some elements of the skin)
  2. Non-ablative.  

The non ablative procedures have little to no downtime and tend to cost a little less per procedure while the ablative procedure tend to provide better results but can have significant down time.

Ablative: higher cost, better results, more downtime, usually single treatment

CO2
The ”gold standard” of tissue tightening is full CO2 resurfacing.  This procedure ablates 100% of skin over the treated area.  It can range in cost from $5000-$15000 dollars and usually requires at least two weeks of downtime but usually more.  Results are normally significant and last several years.  Redness after the procedure can last months and other side effects can include permanent lightening of the skin and or scaring.

Fractionated CO2
Fractionated procedures, such as Active/DeepFX and CO2 Fraxel, normally ablate anywhere from 20-80% of the skin by punching holes about twice the diameter of a human hair into the skin.  These procedures offer many of the tightening benefits of full CO2 with less downtime, cost and risk of long term side effects.  

Although I am not aware of any head to head studies that specifically address skin tightening between full CO2 and fractioned CO2, I can say that during an Active/Deep FX procedure a provider can actually watch the skin tighten as the laser passes over the treatment area. 

Cost is about $2500-$4000.  Expect anywhere from 5 day to 2 weeks of downtime with fractionated CO2 depending on how aggressively your provider performs the treatment. The procedure provides excellent results that last several years.

Non-Ablative: Lower cost, little or no downtime, less results, usually a series of treatments

Titan
Infrared light used to heat collagen so it shrinks and simulated new collagen growth over a 3-6 month period.  I have used this machine since 2004 and works well for laxity around the eyes, cheeks and neck, so-so for jowls. 

Procedure cost about $800-$1000 for a full face. There is no downtime but plan on at least three procedures.  Results usually last about 18 months, and about 80-85% of patients are happy with results. This is a very tolerable procedure, and the side effects are limited to a very rare blister.  

The LuxIR also uses infrared light to treat skin laxity, but there seems to be slightly less consistency in the literature with this devise.

Thermage
Uses Radiofrequency to heat tissue.  Although I have seen this machine be effective the reports in the literature say that it only works well about 29% of the time. 

The treatments can be very painful and in rare cases radiofrequency can cause damage to the fat layer under the skin resulting in loss of volume over that area.  Cost range from $1000-$3500 and plan on 1-3 procedures with little to no downtime.

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Posted in Active FX, Articles/Q&A, Deep FX, Titan | No Comments »

Active FX vs. Fraxel vs. Pixel vs. Profractional What's the Difference

Thursday, December 18th, 2008

There are quite a few fractionated resurfacing lasers out there.  So exactly what is resurfacing and what are fractionated lasers.  What makes one fractionated laser different from other? 

Resurfacing is a procedure where layers of damaged skin are removed usually by vaporization from a laser.  It can be used to get rid of brown pigment caused by sun damage, decrease wrinkles, shrink pores and tighten skin.  Vaporization is the process of using heat to instantly evaporate water out of the exposed tissue.  Resurfacing not only removes the tissue on top but also heats the tissue below the level of vaporization causing collagen contraction and stimulation.

So then what is fractional resurfacing?  If resurfacing is like mowing a lawn where every blade of grass is cut to a somewhat shallow depth then fractional resurfacing is more like aerating a lawn.  Fractional resurfacing pokes small but deep holes in the skin, but leaves a certain amount of the skin completely untouched.  Because these patch of undamaged skin patient heal much faster with minimal side effects. Fractional resurfacing was developed at The Wellman Center of Photomedicine at Harvard around 2001.  The original fractional laser did not destroy any tissue (non-ablative), it simply applied heat in order to stimulate new collagen formation.  This non-ablative (non-vaporizing) procedure required multiple treatments and has some significant limitations on efficacy.  Around 2005 we started testing fractionated ablative (tissue vaporization) CO2 lasers (Active FX, Deep FX, Fraxel Re:pair) and found that in a single treatment we could achieve results that were not attainable after 5 or 6 treatments with the non ablative fractionated lasers. The downtime of about 5-7 day was a huge improvement over traditional CO2 resurfacing (think mowing the law) that can take several months to heel. 

Now the market is saturated with fractionated products and it is hard for the patients to figure out which one is the best for them.  The first thing that separates these devices is the actual type of laser.  There are two main lasers used for resurfacing CO2 and erbium.  The Active FX, Deep FX and Fraxel Re:pair are CO2 lasers.  The Pixel and Profractional are erbium lasers.  The CO2 lasers heat tissue much better causing more skin contraction and more collagen stimulation.  They also cause much less bleeding than erbium lasers.  The clinical results speak for themselves as much more skin damage can be removed with by a CO2.

Between the CO2 platforms FX (made by Lumenis) and the Fraxel (made by Reliant), the FX is much preferred by patients.  In 2007 Dr. Robert Weiss performed a split face study at Johns Hopkins using the Active FX on one side and the Fraxel Re:pair on the other.  Nine out of ten patients preferred both the comfort of the procedure and the results of the Active FX.

Ok so the Lumenis FX gives the best results and the most patient preferred procedure. So then what is the difference between Active FX, Deep FX and Total FX?  The Active and Deep FX are different heads that can be attached to the laser.  The Active FX is more shallow (about 1/3 mm) and wide which is better for skin tightening, decreasing pore size and removing pigmented sun damage.  The Deep FX is a narrow beam that goes deep (up to about 2mm) into the skin in order to treat wrinkles and scars.  The Total FX is more a marketing term that describes using both heads during the same treatment (which is how the procedure is normal done).

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Posted in Active FX, Articles/Q&A, Deep FX | No Comments »

What's New at the Office!

Friday, October 3rd, 2008

Cryo 6: We just received our new Cryo 6 cooler.  This is a small unit that blows extremely cold air over the skin to make treatments so much more comfortable.  It can be used during hair removal, IPL, FX, Pearl or just about any other heat related procedure.  Make sure to ask for the new Cryo cooler when you book your appointment!

Deep FX: A single treatment of the new fractionated CO2 can give better results than 5 Fraxel treatments, this is simply one of the best new treatment for acne scars and wrinkles.  Patient who have had the procedure report that it makes their skin look younger than their friends who have had surgery such as a face lift.

Active FX: This is the second hand piece for the fractionated CO2 can tighten skin as much as 30 percent in a single treatment. kin tightening, melasma, moles and just about any other superficial skin issue.

SmartLipo MPX: Liposuction with little to no downtime and 40% less than traditional liposuction with better results

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Posted in Active FX, Articles/Q&A, Deep FX, Hair Removal, SmartLipo | No Comments »