Dear Dr. Charry and Dr. Hansen.

Just did my first MLP 2 days ago, I did a full face 10 micron MLP she was a skin type 5-6. She came in today with mild- mod hyperpigmented areas and foot prints. She has a big photoshoot in two weeks. What do I do? Help needed urgently.

How soon should I start HQ.

Jakie,

When I treat Fitz 4 to 6 I always pretreat with HQ for a minimum of 2 weeks but prefer 6 weeks. I would start the HQ about day 7. You may just be seeing some dead skin that is sloughing off. The dead skin always darkens and can give the appearance of hyperpigmentation. If that is the case you can try to do a couple of microderms prior to the photo shoot.

Lornell E. Hansen II, M.D.
LazaDerm Skincare Centre
www.LazaDerm.com

Jakie

" I would start the HQ about day 7. You may just be seeing some dead skin that is sloughing off. The dead skin always darkens and can give the appearance of hyperpigmentation. If that is the case you can try to do a couple of microderms prior to the photo shoot.'

I agree with that LH said.Give her a HQ cream for 1 month with a high SPF sunsblock and then do it a couple of microderms on these areas of her face.

Dear Dr. Charry and Dr. Hansen,
Thank you both so much for your help. I had pre-treated her with HQ for two weeks. It was dead skin. fortunately the last time I had seen her most of it was gone.
Which is the best way to get rid of post acne pigmentation ?

Jakie, It depends on the color of the post acne pigmentation, if red, I use the 560-590 filter with the spot adaptor. However you have to remember that people prone to post acne pigmentation are prone to hyperpigmentation, thus treating with the laser may make the condition worse. Depending on their Fitz will also lead the course of treatment. I usually try a combo of agressive peel/microderm with take home combo of Retinol in pm/ lightening product as/pm and glycolic cream in am. It is also important to prevent further breakouts.

Jakie,

The best treatment option for treating post-inflammatory pigmentation following acne is time. Most of this will go away over about 3 months. The best treatment is prevention by getting control of the patients acne.

We carry a little hydroquinone stick that they can spot treat the pigmentation with. If they are Fitz 4 to 6 then the more likely you are to cause worsening pigmentation issues.

Lornell E. Hansen II, M.D.
LazaDerm Skincare Centre
www.LazaDerm.com

I've been doing 2 passes of skin Tyte at around 50j- 8ms-12 degrees and two passes of 420nm at 4j- 120ms-12degrees for Acne Vulgaris with not much benefit-
Any suggestions

rad2011

Try different settings such as ST 50-55J ,6 sec , 14 degrees and 2 passes of 420nm at 6j , 200msec ,15 degrees.What is the skin type of your patient?These settings are for type III.If you have also a MLP you can do a light MLP (8-10 μm) before the 420nm.

Thanks Charry,

My patients are type vi-v . I do have the MLP- do you use the MLP on all areas or just affected areas?

rad2011

For these skin type of patients use the same settings but with a little lower fluence for the ST and the 420nm.Yes i am using the MLP on the affected areas only.

I have a patient with acne scars. She did 6 months ago silicon filling of biggest scars, but she is the great candidate for Profractional res.
How do you think is it possible to do fractional resurfacing of skin which contain sillicone? Or it is better to do just MLP 50 microns and don't go deeper?

My personal feeling is that a MLP of 50 microns is useless with acne scarring. At 50 microns, you are still in the epidermis and it will just replace itself. You will get some short term benefits but not the long term results you ad the pt are looking for.

There was a study done in 2001 with a CO2 lase that they got a flash with the silicone. The flash caused extended trauma to the skin surrounding it and they have said silicone injection is a contraindication to the CO2 resurfacing. Now remember this was full resurfacing with a CO2 and not the fractional resurfacing with an erbium. I have not found a study with the erbium over silicone. Most of the time the silicone should be placed deep so I would try to do some test spots on an inconspicuous area that has silicone in it. Start with 750 to 800 microns at 11% if you are using the XC. I would then give it a couple of weeks to make sure there are no late appearing complications.

If things look good after a couple of treatments go ahead and treat the areas but be very careful and watch for any flash or charring. I could not find long term studies of laser resurfacing over silicone as another concern with silicone is that you can get a inflammatory response years after the injection and could you cause that to occur with the laser.

Lornell E. Hansen II, M.D.
LazaDerm Skincare Centre
www.LazaDerm.com

I have used the 515 nm filter for melasma in type 5 skin and am getting complete resolution if the pigment in the treated areas in rectangles with surrounding areas of pigment this is because I don't overlap. How do I avoid this- do I overlap more?

I would tell you to overlap about 10%. Be very cautious on those Fitz 5 with the 515. You could very easily blister, scar or depigment the area.

LH

cxymd

The ST and also the Er YAG and CO2 wavelengths are being absorbed by water so with the ablation or coagulation that they induse ,they reduce the total skin water.If a skin is dried out and the patient doesn't use a moisturizing cream there is a possibility for the skin to become more dried out after the procedure.

chinh le

I think that you are not as hard as you think.Don't worry!!You could go deeper because it is type II skin with less coagulation.

Hi Charry

Thanks for your comment. Her crow's feet has not improved much, however her erythema seems persisted after nearly 2 weeks.

Is any one using any thing immediately after 10 micron MLPs like Hyaluronic Acid, etc? If so how useful is it.

Dr. Charry,
Just to be sure. your order for acne therapy is
ST first
MLP 2nd
BBL 420nm 3rd

rad2011

Yes first ST to splach the sebaceous glands ,then a MLP to remove the stratum corneum of the skin and then a BBL (420nm) to destroy the P.Acnes (2 passes).

Any review about the Lycogel products (Lycogel Camouflage and concealer) that can be used immediately after a MLP or a resurfacing session or after a chemical peel or dermabration?

thanks Dr. Charry

Charry, you mean 420 nm immediately after MLP?