Online Health Chat with Alok Vij, MD
July 12, 2017
Cleveland Clinic Cosmetic & Plastic Surgery Center experts deliver the latest innovations in laser and light treatments for optimal results in your skin’s appearance. From unwanted hair to tattoos to dark spots and wrinkles, cosmetic laser therapies offer a wide range of options for cosmetic and aesthetic purposes.
Laser- and light-based facial treatment, also known as facial laser resurfacing or laser skin treatment, can help reduce fine lines, wrinkles, blemishes and pigmentation, such as freckles and sunspots, through direct, short, concentrated, pulsating beams of light. Also known as lasabrasion, laser peel and laser vaporization, this skin resurfacing technique covers a wide range of skin problems including facial aging, age spots, pigment changes, redness and other conditions. They also range in aggressiveness and downtime, depending on the laser- or light-based device used. Some treatments (non-ablative lasers) require no downtime while others (such as the Fraxel® fractional CO2 laser) require some downtime.
Cleveland Clinic’s Department of Dermatologic and Plastic Surgery provides expertise for both surgical and nonsurgical cosmetic procedures ranging from body contouring to breast procedures to BOTOX® injections. The Center offers patients access to a range of cosmetic specialists including plastic surgeons, dermatologists, oculoplastic surgeons, head and neck surgeons, and aestheticians. Additionally, our surgeons are dedicated to improving patient outcomes through innovative cosmetic surgery advances including minimally invasive facelift techniques, alternatives to face and neck lift surgery, short scar facelifts, and SmartLipo technology.
To see a full listing of our cosmetic services, specialists, locations and before/after patient images, visit clevelandclinic.org/beautifulyou.
Cleveland Clinic dermatologic and plastic surgeons have been pioneers in the field of cosmetic and plastic surgery. Each of our board-certified surgeons performs the full range of cosmetic facial procedures, with extensive expertise in alternatives to face and neck lift surgery, short scar facelifts and minimally invasive facelift techniques. Cosmetic facial procedures can range from nonsurgical facial rejuvenation (such as BOTOX, injectable fillers, Kybella®), to surgical facial procedures (such as eyebrow and forehead lifts, eyelid surgery, cosmetic nose surgery, cosmetic ear surgery, face or lip lifts, facial implants and chin surgery). These procedures can help restore your youthful appearance and re-awaken your natural beauty.
About the Speaker
Alok Vij, MD , is an associate staff physician in the Department of Dermatology and Cosmetic Surgery at Cleveland Clinic. His interests include laser surgery and cosmetic injectable treatments including BOTOX, fillers such as JUVÈDERM®, and Kybella®. Dr. Vij is board certified in dermatology and fellowship trained in micrographic surgery and dermatologic oncology.
Let’s Chat About Cosmetic Rejuvenation Lasers
Help for Hair
boomer46: Can laser be used for gray or white hair?
Alok_Vij,_MD_: Unfortunately, laser hair removal works for dark hair only and not on gray or white hair. The more contrast between your hair color (darker and coarser) and your skin, the better. There are lasers that are safe for darker skinned patients with dark hair, but no lasers work for patients with white or gray hair.
crystalclear: Nineteen years ago, I had laser hair removal done on my upper lip because of the beginnings of a moustache. All looked well until about a year ago. At age 54, dark hairs started to appear on my upper lip. Now at age 55, I have dark hairs that start right below my nose and then go all over my upper lip. The moustache is currently sparse. Any reason why the hair has come back after being gone for so many years? I did not recently go through menopause. Menopause was AT LEAST 10 years ago. About 20 years ago, I had laser done to remove a purple port wine birthmark covering the right side of my face. Now that my facial skin has thinned (I am 55 years old), there are spots on my face where the purple is starting to show through. Most of the spots are very light except for the area between the bridge of my nose and my eyes (both right and left) and under the eyes. Can laser be done so close to the eye?
Alok_Vij,_MD_: Laser hair removal works to reduce the density of the hair, but it is not always permanent, and the dark, coarse, unwanted hair can return. Even if you went through menopause a decade ago, your hormones are still in flux and may be driving the hair to come back. A hormonal evaluation may be a good option to see if there are any medical reasons the hair is coming back. Regardless of the cause, further laser treatments can help the symptom of excess hair itself. Laser treatments can be done for port wine stains around the eye or on the eyelid itself, but we need to insert a metal contact lens to protect your eye from the light of the laser.
Sharbear1969: How well does the laser treatment work for facial hair?
Alok_Vij,_MD_: As long as there is color in the hair, laser hair removal is a very effective and safe method to reduce the density of hair on a long-term (but not always permanent) basis.
Smithousen: Can this laser treatment be used on nail fungus. I am told by Kaiser there are no clinical studies that show it works. I know it does because I had it done. The only problem is you need repeated treatments, and it becomes too expensive. Are there good, peer-reviewed, double blind studies on this?
Alok_Vij,_MD_: There are no double-blind studies comparing laser treatments for nail fungus against any traditional treatments such as topical or oral anti-fungal medications. The initial study required several treatments of all the nails (both affected and unaffected by the fungus) before the nails cleared. We have had success with the laser treatments, and it seems to work both for nail fungus and nail dystrophy (abnormal texture of the nail). However, this too requires multiple treatments, which are both painful and can be expensive if not covered by insurance.
CGolden17110: Is it safe to have a tattoo removed (with a laser) while pregnant?
Alok_Vij,_MD_: I do not know of any major safety risks with lasers during pregnancy. Many patients choosing to have a tattoo removed by laser will want to use topical numbing medicines, which are usually Category B in pregnancy (meaning, we do not have long-term studies proving a medication is safe. However, there is no evidence suggesting it is harmful). Discussions with your OB and your dermatologist to review the risks and benefits would always be helpful prior to undergoing any treatment.
Fredd: Would you explain the process of tattoo removal, such as the number of treatments, outcomes, pros and cons?
Alok_Vij,_MD_: Lasers work to remove tattoos by pulsing the tattoo ink with very short, very high intensity bursts of energy. Each pulse of the laser breaks apart a little bit of the tattoo pigment, leading to fading of the tattoo. Usually, for a good outcome, anywhere from eight to 12 treatments are required, but it depends upon your tattoo and your skin. The success of tattoo removal depends on several factors: color(s), size, age and depth of the tattoo, in addition to the color of your skin. Tattoos that are black or another single color, smaller and more recently done are generally easier to remove. The biggest downsides are pain that occurs with treatment, the number of treatments required with gradual improvement with each treatment and potential discoloration of your skin due to the laser.
Kittens: Is there any laser that can be used to tighten the skin on the neck?
Alok_Vij,_MD_: For loose skin on the neck, there are several non-surgical treatment options. One common treatment that helps with the texture of the skin is a "resurfacing laser" or a "fractionally ablative laser" that can help build up collagen beneath the skin and reduce the look of fine lines. Additionally, ultrasound-based treatments that heat the deeper layers of skin can help to lift and tighten the skin of the neck. One of the hot new treatments is Kybella, an injectable medication to help reduce the fat that can lead to an unappealing submental angle, the dreaded "double chin!"
Wrestling with Wrinkles
cvinson: What procedures are available to fill in the deep lines around the cheeks and lower mouth? I call them "clown" lines.
Alok_Vij,_MD_: Lasers are better served to work on the texture of your skin and can improve fine lines and wrinkles. For the deeper lines around your cheeks and lower mouth, I recommend filler medications such as JUVÈDERM, VOLUMA®, etc. to help restore volume to the skin and bony structure of the face. These are in-office procedures that can be effective for anywhere from six to 18 months (or longer), depending on the product used. We like to evaluate our patients on a multi-level basis to see what we can do to best address the texture/quality of the skin and any wrinkles that form due to normal movements of the face, as well as any deeper lines that need to be reduced with fillers.
NTN8908: What is a good method to help get rid of forehead wrinkles?
Alok_Vij,_MD_: For lines on the forehead, my go-to procedure is toxin injections (BOTOX, Dysport®, etc.). But depending on the depth of the lines (I don't like the word wrinkle) and quality of the skin, I also offer filler medications or laser treatments.
MsFit123: I have periorytides around my mouth that are rather deep. Also, my eye area is also lined. Would this laser help? If not, what would be the best treatment for deeper wrinkles around the mouth and eyes? Thank you.
Alok_Vij,_MD_: Lasers like a fractionally ablative CO2 laser can work for lines around the eye area, and we do procedures to help the eyelid skin on a regular basis. While lasers can work for fine lines and wrinkles, we often use a combination of neurotoxin injections (such as BOTOX or XEOMIN®) and filler medications to restore volume to the face. This helps reduce the look of the deeper lines around your mouth (and, sometimes, around the eyes).
nmaclarren1: I was curious if this was an option for moles as well, as I have a large one on my neck and didn't know if this would be an option. Thank you.
Alok_Vij,_MD_: Most dermatologists do not treat moles with lasers because we cannot monitor the mole for the rare possibility that a skin cancer develops within the mole.
Lastuka: Can laser treatment be used for precancerous moles?
Alok_Vij,_MD_: Unfortunately, no. Careful monitoring of the mole is important to make sure nothing bad develops over time.
Singling Out Spots
barbl708: I am an olive skinned, 54-year-old female, and I have melasma on my face, both cheeks. Is there anything out there that lightens these dark spots? They are very hard to cover with makeup.
Alok_Vij,_MD_: Melasma is a challenging problem for dermatologists and patients alike. I recommend a combination of several things to optimize treatment of melasma: strict sun protection, skin lighteners/brighteners and gentle procedures to help lift away the pigment. I recommend a daily facial sunscreen that has both UV and IR protection, with frequent re-application through the day with additional sun exposure. There are a few skin brighteners available over-the-counter, but one I really like is LYTERA 2.0, which you can purchase at the Cleveland Clinic Aesthetician's office. Finally, I recommend a combination of peels and laser treatments to lift off the pigment that has developed. To properly treat melasma, I believe you have to do all of these things to protect the melanocytes, slow down the production of pigment and remove the excess pigment instead of just covering it up.
Peppy: How well do lasers work on "liver spots"? I have many and they are now developing on the sides of my face despite using sunscreen and avoiding too much sun.
Alok_Vij,_MD_: "Liver spots," or seborrheic keratoses, are thickened, rough spots that develop on the outer layer of the skin. If they are darker than the background skin color, there are some lasers that can be effective. Often, I resort to the traditional method of "cryotherapy," or freezing them with liquid nitrogen to encourage them to peel off.
GRAMMYRUTH: Does laser surgery remove wrinkles or age spots on the face?
Alok_Vij,_MD_: Laser surgery with a fractionally ablative laser can help to reduce the look of fine lines as well as age spots on the face. Done by itself, it can help to improve the quality of your skin. However, it is often a technique we use in concert with other techniques such as sun protection, night creams and other minimally invasive procedures to help optimize your skin.
zoozoo: I have rosacea on my face, which has caused little broken veins on my cheek. I was told laser was the only way to remove these. Is this a safe procedure? What are the side effects? Are the results permanent?
Alok_Vij,_MD_: Rosacea is one of the most common reasons we use lasers in dermatology. The procedures are safe and provide long-lasting (but not permanent) results. The laser works by heating the blood in the small blood vessels of your skin, causing swelling and eventually encouraging your body to resorb the vessels. The laser feels like a rubber band snapping against your skin. Then, you notice a hive-like area of swelling and redness for about 24 hours after the treatment before your skin returns to normal. Very rarely is there any bruising, and there is an almost zero risk of scarring. Typically, I recommend three to four treatments spaced about two months apart to get started. With any treatment in dermatology, we are always fighting against nature, so likely in the future more treatments will be needed.
Nama4: Do resurfacing lasers strip pigment?
Alok_Vij,_MD_: Resurfacing lasers can reduce the look of "sun spots," "liver spots" or "age spots," in addition to tightening the skin and reducing fine lines and wrinkles. In patients with darker skin color, they can lead to unwanted changes in the natural pigment, too. So, I always recommend strict sun protection before and after resurfacing lasers and almost any other laser treatment.
vintagemirror: Have you had much success with treating stretch marks?
Alok_Vij,_MD_: Stretch marks can be challenging, but good results can be obtained by using a combination of treatments. For stretch marks that are red or purple, we use a "pulsed dye laser" to remove the color just as I would treat broken blood vessels for my rosacea patients. For skin colored or lighter stretch marks, I use other lasers or do microneedling to help improve the texture and build up the skin's collagen. And I always offer to combine or alternate treatments for patients with both texture and color changes in the skin.
YOGIDOG: Can laser help diminish a scar from a dog bite on the cheek that happened years ago?
Alok_Vij,_MD_: It depends on the scar itself, but we use lasers very frequently to revise or optimize the way a scar looks. I tell my patients, "once a scar, always a scar," but there are several ways to improve the scar's appearance.
ccuser1000: I have acne scars, large pours and oily skin. I'd like a smooth texture. What are some options?
Alok_Vij,_MD_: There are several treatment options for acne scars and large pores, but the go-to is a fractionally ablative laser to help build up the collagen below the scars, making them smoother, and tighten your pore structure. For the oily skin, there are other lasers that we can use, but this is a harder problem to manage with lasers. Using a gentle cleanser and a toner can help manage this symptom.
Nuts and Bolts
ccuser1000: How do we find out more about the price and insurance coverage for these options discussed?
Moderator: As a rule, cosmetic plastic surgery is considered “elective surgery” and is not covered by most insurance plans. If the service is not covered by insurance, Cleveland Clinic may provide some financing options. Please call 216.444.4004 and ask to speak to one of our financial representatives who can explain payment options, including CareCredit financing.
PamD: With all of the information now available regarding the very bad chemical additives and ingredients in many topical creams, lotions, ointments and other things we put on out skin, is there concern in the world of dermatology about these ingredients? Do you have products or know of a prescription product line that leans toward safer ingredients? Are there any that you could/would recommend? I'm very interested in safe products but I also want them to work.
Alok_Vij,_MD_: If you look online, you can find a lot of information about the potentially harmful effects of various ingredients in creams and sunscreens. I was recently interviewed by WebMD about a sunscreen ingredient that caused allergic reactions in children that looked like second-degree burns! Scary! But remember that not everything you read on the Internet is true, and some of the reports are overblown.
I recommend sun avoidance (not going out in peak hours, wearing sun protective clothing/hats), just as much as I recommend sunscreen. When choosing a sunscreen, I recommend mineral-based sunscreens (zinc oxide, titanium dioxide) over the chemical options. I also recommend looking for "sensitive skin" products that do not have fragrances, preservatives or dyes. There are several brands available over-the-counter at pharmacies or grocery stores. Skin care companies are paying attention and are coming out with sensitive skin anti-aging creams, and Eucerin® seems to have one available now that is safe and effective.
That is all the time we have for questions today. Thank you, Dr. Vij, for taking time to educate us about Cosmetic Rejuvenation Lasers.
On behalf of Cleveland Clinic, we want to thank you for attending our online health chat. We hope you found it to be helpful and informative. If you would like to learn more about the benefits of choosing Cleveland Clinic for your health concerns, please visit us online at http://my.clevelandclinic.org.
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About Cleveland Clinic
The Dermatology & Plastic Surgery Institute offers patients a full range of dermatologic, reconstructive and aesthetic services. Our specialists focus far beneath the skin. Dermatologists and plastic surgeons at Cleveland Clinic are as concerned with function as with appearance. They collaborate in a multidisciplinary setting with ear, nose and throat specialists, ophthalmologists and dentists to provide the highest level of care and ensure that patients’ varying aesthetic needs and functional requirements are met.
The Department of Dermatology includes more than 30 dermatologists who offer a full array of subspecialized care for adult and pediatric patients. Our physicians provide expert diagnosis and treatment of all disorders of the skin, hair and nails, whether primary or related to an underlying systemic illness, including industrial-related conditions. The department also offers a full range of procedures in the area of dermatologic surgery, including laser surgery, soft tissue augmentation and Mohs micrographic surgery. Additionally, our Cutaneous Care Center provides outpatient treatment, utilizing phototherapy and excimer laser treatment, for patients with psoriasis and other chronic skin diseases.
The Department of Plastic Surgery includes more than 15 board-certified plastic surgeons, making it one of the largest plastic surgery departments in the country. Our specialists have significant experience and expertise in all areas of aesthetic and reconstructive plastic surgery, especially in the areas of facial cosmetic surgery, cosmetic and reconstructive breast surgery, pediatric craniofacial surgery, upper extremity surgery, reconstructive microsurgery and plastic surgery research. For the past several years, the department has focused on minimally-invasive techniques in facial cosmetic surgery. This includes alternatives to face and neck lift surgery, short scar facelifts, and minimally-invasive facelift techniques.
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