Monthly Archives: December 2012

Longer Lashes in a Bottle?

Today I’m going to talk about Latisse– I think most of us have seen the commercials with Claire Danes, where she develops the most amazing eyelashes, just by putting a drop of Latisse on each eye every night.  And unlike most mascara adds, the Latisse before and after pics are not digitally altered, nor do the models have any eye makeup on.  So here are some of the questions I’m commonly asked about Latisse:

courtesy of

courtesy of

1. Does it work?  To this, I can emphatically say YES!  It does work as advertised.  I have personally used Latisse for nearly two years, and my eyelashes are looong.  When I have mascara on, they actually touch my eyebrows.

2.  How long does it take to see results?  Here is where you have to be patient- it really does take the 2-4 months advertised to see the results.  And yes, it gets difficult remember to use a medication every night when you don’t see results for several weeks.  Using Latisse more than once a day does not make your lashes grow longer or faster- it just wastes the medication.

3.  Do you have to keep using it?  Again, yes.  If you stop using Latisse, your eyelashes will  gradually return to the length and thickness they were prior to treatment.

4.  Is it hard to get the medication on that little brush?  Surprisingly, no.  Water has high surface tension, which is what holds it in a drop.  This surface tension also pulls that little drop right onto the brush.  From there, you brush it onto your upper lash line just as if you were applying eyeliner.  And if a little drips into your eye, remember; Latisse was originally developed as a medication for glaucoma, so it’s perfectly safe to get into your eye.  But you should remove your contacts prior to use, as the medication can absorb into your contact lenses.

5.  Does Latisse change your eye color?  The most common side effect of Latisse is minor eye irritation and itching, which occurs in about 4% of people.  But the eye color change is what I find people really worry about.  So can it change your eye color?  Yes.  Does it?  What happens most often is that you will see a slight darkening of the skin on your upper eyelid along the lash line.  This skin pigmentation fades if you stop using Latisse.  The eye coloration changes in the iris are far less common, and were largely reported in patients who used bimatoprost ophthalmic solution for glaucoma- these patients were applying drops of medication directly into the eye, which is not at all how Latisse is applied.  The color changes that can occur in the iris are permanent, however.  So even though having your eyes change color is extremely unlikely, if this is something you absolutely cannot deal with, don’t use Latisse.

Overall, Latisse is a great product, that works as advertised. It is a prescription medication, but many physicians carry in their offices, meaning you don’t have to make a separate trip to a pharmacy.

Do you have any questions about Latisse?  Or any experiences of your own you’d like to share?

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

laser resurfacing

Laser Resurfacing – The Complete Guide

guide to laser peels

Laser resurfacing is a phenomenal tool to smooth fine lines and prevent the signs of aging. In previous posts, I’ve touted the benefits of the microlaser peel.  But if you’ve spent any time reading up on laser peels, you’ve likely heard of either Fraxel or profractional laser peels as well.  They’re essentially the same thing, but Fraxel uses a CO2 laser, and Pro-Fractional uses an Erbium laser.  The lasers themselves behave similarly.  What sets the Pro-Fractional apart from a traditional microlaser peel is the way the skin is removed.

Types of laser resurfacing

A microlaser peel removes a thin layer of skin (the epidermis).  This smooths fine lines and helps skin look smoother and more even. The diagram below shows the skin in cross-section. The portion in blue shows what part of the skin a microlaser peel affects.

laser resurfacing












The profractional peel  works a bit differently.  Instead of removing 100% of the outer layer of skin as a Micropeel does, a Profractional removes only portions of the skin in a pixellated pattern. The diagram below shows you what each type of peel looks like over the skin surface.

laser resurfacing



Microlaser peels heal quickly because only a superficial layer of skin is removed.  Profractional peels remove a deeper layer of skin (check out the last image, below), but because there is healthy skin in between the areas hit by the laser, the recovery time is about the same as a micropeel.

laser resurfacing

When you look at the diagram, you’ll see that the profractional peel reaches all the way down into the dermis, which is the deep layer of the skin.  Those squiggly gray lines you see are collagen, the protein that gives skin elasticity.  When the laser damages the collagen, the skin responds by growing more collagen to heal the wound. This results in a tightening, smoothing effect that you don’t get with a regular micropeel.  What patients actually see is an improvement in wrinkles (deeper wrinkles than those treated with a traditional micropeel).  The profractional peel can smooth out scars as well.  And when we combine a micropeel with a profractional peel, the results are even better! If you would like to see some before and after pics, check out the Sciton website.

Do you have any questions regarding ProFractional?

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

5 Facts About Laser Hair Removal

I hear an advertisement for laser hair removal several times a day on the radio.  And for as widely as hair removal is advertised, I feel like it is rather poorly understood.  So today, let’s clear up some of the misconceptions.

1.  Laser treatments don’t remove hair – Yep, that’s right.  Laser hair removal is a misnomer.  It should actually be called laser hair reduction.  The treatments don’t make fewer hairs grow; they just make the hairs that are there much finer and thinner.  So why does it look like the hair is gone?  Go ahead and reach up and run your hand over your cheek for me.  Feel any fuzz?  Not much, right?  Your cheeks actually have the highest density of hair on your body, but the hair is so fine you can barely see it (unless you’re Liam Hemsworth, maybe, in which case that scruff is just part of your natural charm).  This is what laser hair removal does- it makes the hair so fine you no longer notice it.

2. Not all hair is created equal – laser hair treatments target the pigment in hair.  The energy is absorbed by the hair follicle, damaging it so that it grows in more finely next time.  If hair has little (blonde) or no pigment (gray hair) then the laser doesn’t have anything to target.  So laser hair treatments work best on darker hair.

3. Hormones can reverse the effects –  if you had laser hair removal as a teenager and then finished puberty, you might notice some of the hair has come back.  This is because your hormones were still adjusting.  Laser hair removal doesn’t work on pregnant women for the same reason- their hormones are causing hair growth that makes laser hair removal fighting an uphill battle.  It’s much easier to wait until after pregnancy, when hormones (and hair growth) return to normal.

4. Some areas can’t be lasered – and no, I know what you’re thinking.  The Brazilian laser hair removal does exist.  Surprisingly, laser hair removal doesn’t work on the eyebrows.  Most body areas require anywhere from 6-8 treatments to achieve hair reduction, because the hair is in different phases of the growth cycle (if hair were all in the same phase, you would be bald or have no eyebrows for several weeks at a time- now there’s a thought!).  Usually 6-8 treatments will cover all the different phases… except in the eyebrows.  They are in so many different phases that it’s pretty much impossible to treat this area effectively with laser.

5. But we can still get rid of the hair! Electrolysis uses an electrical current applied directly to the hair follicle using a very tiny needle to accomplish what the laser can do over a much broader area.  But it works on hair in more phases of the growth cycle because the current is directly applied to the hair follicle (laser energy is absorbed best by hairs in the anagen phase of the growth cycle- see below), so electrolysis works well on the eyebrows.  It also works well on any stray hairs that laser hair removal may miss.

image from Cleveland Clinic Foundation

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Is There Really a Non-Surgical Facelift?

I often tell my friends that I need to start watching daytime tv, because at least once a week we have someone call the office asking about a procedure they saw on Dr. Oz, or Oprah, or another show.  Often I end up googling (yes, doctors do use google- you’re not really surprised, right?) the terms I haven’t heard to see what is actually being described in medical terms, so that I know whether or not it is a procedure we offer.  Many of these procedures focus on non-invasive “face-lifts”.  Terms like the liquid face-lift and Vampire face-lift have actually been trademarked, but are actually only a slightly different way to use an already existing treatment.  Today I’m going to talk about non-invasive ways to make the face appear younger, and give you my two cents.

Courtesy of

The Aging Face – To understand how to fix an aging face, you need to first understand what makes it look older in the first place.  Skin becomes lax, wrinkled, and dyspigmented.  I’ve talked about wrinkles and dyspigmentation in other posts, so I’ll let you refer to those.  The other big change is volume loss.  The fat we have in faces during youth, especially along the cheeks, atrophies as we age.  So here I’m going to talk about ways to fix the skin laxity and volume loss that come with age.

Volume Loss – Replacing lost volume can be done essentially two different ways.  Fat grafting takes some of your own fat and moves it to where the volume has been lost.  The fat develops new blood supply, so this is essentially a permanent solution.  But up to 50% of the fat transplanted may not live, so you may require a touch-up procedure.  Fillers such as Radiesse and Sculptra are another way to restore lost volume, and this is essentially what a “liquid facelift” does.  Different fillers last different amounts of time, so discuss with your doctor which solution is right for you.  The Vampire facelift is essentially fillers combined with platelet-rich plasma- it takes your blood and processes it to get out the serum which supposedly has growth factors and stem cells that will improve the appearance of your skin above and beyond just regular fillers.  But to my knowledge, there aren’t any good studies on whether the extra effort and money result in any actual difference compared to simply using a filler.

Skin Laxity – The traditional way to improve skin laxity is to remove the excess skin, which is what is done in a face-lift.  But heating up the skin and underlying tissue will also cause the collagen to remodel, resulting in tightening of the overlying skin.  Heating up the skin can be done a number of ways: Thermage uses radiofrequency, Ulthera uses ultrasound, and SkinTyte uses broad-band light.  But the principle is the same.  They do result in an improvement in skin tightness, although not as significant as you would get with surgery.  The specifics of each treatment are more than I can go into here, so ask your physician which therapy he or she has experience with.

Do you have any experience with fillers or skin tightening procedures that you would like to share?


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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

What is Having a Breast Augmentation Really Like?

First, let me give you a disclaimer- I have not personally had a breast augmentation.  But until I find a patient who will guest-author on my blog and tell it from her point of view, I can at least give you details on what the steps you would go through are like.  If you’re thinking about breast implants, my hope is that this will help you have an idea of what questions to ask your surgeon.

photo courtesy of

Step 1- the Consultation

When I first meet patients, I need to know what their specific goals are.  Have they always had small breasts, or did things change after having children?  Do they want just a bigger size, or a lift as well?  Do they have a significant other involved in the decision-making process?  These are some of the questions I ask, along with taking a detailed medical history.  The examination itself consists of a basic breast exam, along with taking several measurements which guide me toward what style of implant I will use.  Below are some of the questions I’ll have for you during our consultation:

  1. Silicone or Saline?  Both are safe, and both have similar risks of implant rupture.  Silicone is only FDA-approved for women over 22, so if you’re younger than that, it’s an easy decision.  If we need different size implants from one side to another, saline is also more adjustable.  After that, it largely comes down to cost, and feel.  You’ll get to see each type of implant during your visit.
  2. What size?  I can’t guarantee a cup size, simply because different bra manufacturers size differently.  But we spend time deciding on what size implant to use by trying out several different gel sizers, which are placed in the bra to give you an idea of what different sized implants would achieve.

Step 2- the Surgery

Breast augmentation is done as an outpatient surgery.  It takes anywhere from 1-2 hours, depending on the surgeon.  If you’re having a lift as well, it may take longer.  After your surgery you weill have a postoperative bra on, and you may have an ACE wrap on as well.  These dressings generally stay on for at least 3 days, and possibly up to a week.  You will be given pain medications.  You may also have the option of having a pain pump, which is a device that slowly drips numbing medication into the surgical site.  These pain pumps come out after three days, which means that most of your recovery has very little discomfort.  You unfortunately will not be able to shower until after your first dressing change, so plan on sitting in the bathtub and washing your hair in the sink for the first few days.

Step 3- the Recovery

Patients that have a breast augmentation generally only need a few days off of work.  This means if you can schedule your surgery before a long weekend, you may not miss much work at all.  If your job requires heavy lifting, however, be aware that you will not be able to lift more than 10 lbs for up to 6 weeks.

Working out will also be restricted for several weeks.  After two weeks you will likely be able to start light workouts like walking, but heavy aerobic activity (spinning classes, running) will have to wait at least a month.  And lifting weights will have to wait at least 6 weeks.

After you have a breast augmentation, it is very important that you wear a bra with good support.   Your surgeon can give you specific recommendations.  But if you don’t provide support for your new implants, they will eventually stretch out the skin and tissue holding them in place, meaning they won’t look the same after several years.

Read more about breast augmentation at the American Society of Plastic Surgey website.

Do you have any questions about breast augmentation?

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.