Dr. Shino Bay Aguilera

 The only one that I know that is worth trying is the Zeltiq method of Cryolipolysis.  This system requires at least two sessions per area to achieve the best results.

The Nefertiti neck lift is a new technique achieved by placing multiple injections of Botox along the lower jaw line as well as down the side of the neck along the platysma muscle. This improves the definition of the jaw line and rebalances the underlying muscles to provide ‘lifting’ in the neck and jaw area. You will notice improved tightening and overall reduction of drooping neck skin and often reduced wrinkles on the neck in as few as three to five days.

A well-defined jawline with a long neck has been a sign of beauty since the time of the Egyptians. This new procedure creates a well-toned, smooth neck and lifted jaw line.

There are numerous lasers for hair removal; however, one should know that in order to efficaciously and safely remove hair via laser, one should choose a wavelength that has the most affinity for melanin and also respect the skin tone of the patient.  The 755 nm wavelength is by far the most effective wavelength to destroy hair in all shades of light skin, especially in people with finer and lighter hair.  The 1064 nm wavelength is the best and safest to treat very dark-skinned individuals.  In our practice, we use the Elite and the Elite Multiplex laser (Cynosure Inc.) that uses both 755nm and 1064 nm wavelength.  This laser has won “the best laser for hair removal of its kind” for 7 years in a row.

In my practice, they are best improved by the Affirm Multiplex technology.  Using the Fractional C02 also improves them; however, it tends to cause prolonged redness and hyperpigmentation, which causes concern in patients.  Stretch marks are very difficult to treat and require multiple sessions, but recently acquired stretch marks (such as after pregnancy) will respond better and faster than old stretch marks. 

Acne scars are easily improved with the fractional C02 technology or non-ablative 1440 nm Affirm Multiplex for those that do not want to have too much down time.  If a patient has ice pick scars, I may use a drop of 50% TCA chemical peel into the pit, before I do the lasers.  This will help seal and flatten the ice pick scar, so the laser will later further improve them. 

Until now, with the introduction of the Cellulaze laser, most treatments for Cellulite have been non-invasive with modest to great results, but all have been short lasting.  The Cellulaze laser was just recently approved by the FDA, and has shown in Canada and Europe to be a more permanent solution to treat this multi-dimensional disease.  It works by lysing the fat cells and eliminating the bulging fat that cause the peaks on the topography of the skin, destroying the cords of tissue that are pulling and puckering the skin down, and by increasing the amount of collagen in the skin improving the elasticity and texture.

There are different wavelengths that can target melanin.  In our practice, the most used wavelength is the 755 nm Alexandrite laser, because it has the most affinity for brown pigment.  Sometimes the brown pigment may be a little too light (tan spots), which do not contain enough melanin for the Alexandrite laser to see it.  Those tan spots can be treated with other modalities that tend to peel off the pigment, instead of breaking it down.  For those tan spots, an Erbium-Yag laser can be used, as well as the fractional C02 laser, chemical peels or bleaching agents.

Full ablative technology has been around since the early eighties. Ablative simply means that the top layer of the skin is burned off to reveal smoother, younger-looking skin. The heat generated from the laser stimulated new collagen formation giving a smoother appearance to the skin.  This technology gave great rejuvenating results, but the down time was very long (1 to 2 months and sometimes even longer), and adverse reactions were not uncommon.  The most common adverse reaction was discoloration of the treated area (either too white, too dark or too red) and scarring.  This technology was reserved for light skin types with severe photo damage.

Fractional ablative is a technology where only micro areas of the skin are harmed by the laser and other areas are left unharmed.  The advantage of this technology is that wound healing begins rapidly, so the down time is greatly reduced.  For example, with the Smartskin C02 in my practice, the down time is approximately 5 to 7 days instead of the 1 to 2 months for the full ablative technologies.

Non-ablative technologies like the Fraxel or Affirm Multiplex works by creating micro injuries to the skin without burning off the top layer of skin.  This technology basically helps remodel old sun-damaged collagen and increases the formation of new collagen fibers, giving a more refreshed look to the skin and reducing the appearance of wrinkles.  This technology can be used as a preventative treatment as well as a corrective treatment.  

It all depends.  If the skin itself is feeling loose and crepey, then using a non-ablative or ablative  laser will help to solve this problem; however, if the skin feels lose or basically hanging, then using a device that goes down to the subcutaneous tissue will be more appropriate (like the radio frequency technologies) .  In our practice, we tend to use a combination of these technologies.  The Affirm Multiplex has a wavelength that helps generate new collagen (1440 nm, Nd:Yag) and another one that tightens the skin (1320 nm Nd:Yag).

 The only one that I know that is worth trying is the Zeltiq method of Cryolipolysis.  This system requires at least two sessions per area to achieve the best results.