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If you have a brown birthmark, you’ve probably heard of q-switched lasers. But you may not realize that this is not a specific type of laser or the name of a single laser. Rather, q-switching refers to the way a laser delivers light energy to the skin. Q-switched lasers achieve very high peak powers by using very short bursts of light, making them a group of lasers designed for this purpose. This is possible because the q-switch is an amplification system that shortens the length of time of a single burst of light (the pulse width). For q-switched lasers, the pulse width is measured in billionths or trillions of a second!
Think about the strength of a pulse of laser light in this way. It’s kind of like swinging a baseball bat. If you swing slowly, a longer pulse width, the baseball doesn’t go very far when hit. But if you swing very fast, a short pulse width, and hit the ball, you can generate more power to send the ball much farther and at a faster speed.
So, why do we need a laser with this much “pop” for birthmarks? It comes back to our intended target, excess melanin in the birthmark. The Q-switched laser perfectly absorbs the wavelength of melanin, and we generate power with a short burst of light to break up excess pigment-containing cells. This combination of short bursts of high powered light is what makes (permanent) removal of brown birthmarks—or any darkly pigmented spot—with q-switched lasers the gold standard.
Not all brown birthmarks can be completely removed with these devices and not every q-switched laser is safe to use on any skin type (color). Although we’d love to see your brown birthmark completely disappear after treatment, this result isn’t always possible. Sometimes, we are only able to fade it significantly. At Celibre Medical, we only use specific q-switched lasers that are safe for every skin color. Not every practice does this, however. You need to be aware of this specifically if you have a darker skin type (Hispanic, Asian, African), and make sure that you ask about which q-switched laser would be safe to use on your skin type.
While they may not be a perfect answer for all pigmented birthmarks, q-switched lasers offer you the best chance at getting rid of your brown birthmark. Or at the very least, fading it significantly.
Poikiloderma is a term that is used to describe sun damage (photo-aging) on the face, neck, and chest. This skin condition is represented by red and brown discoloration and also a slightly rough texture in the sun exposed areas of the neck and chest. The redness is a result of superficial vascularity as a result of sun exposure. The brown discoloration is also a form of sun damage and may give a mottled appearance to the skin.
Because class IV medical lasers are very specific and effective in what they treat – both colors are treated with two different lasers. Pulsed dye lasers treat the red pigment whereas Q-Switched YAG lasers treat the brown discoloration. Besides fading or resolving the discoloration, these lasers also stimulate collagen which leads to improved skin texture. There is no downtime with these types of laser treatments.
Poikiloderma photo (courtesy of eMedicine)
On the practitioner’s side, various factors affect the delivery of laser treatment care, including communication style, training, experience, time constraints, empathy, and teaching skills. Similarly, on the patient’s side, basic health habits, existing health conditions, the ability to follow instructions, motivation to improve, and psychological health all play a role in determining the effectiveness of treatment. It takes a good mix of both sides for healthcare to go right. It takes a good practitioner and a good patient. All too often, patients expect this relationship to be too lopsided and forget they’re responsible for how successful their treatments are.
Cosmetic medicine is no different. A crucial part of having a successful procedure is understanding what a procedure can and cannot do for you and having the correct expectation for your treatment. This process begins with an excellent practitioner who will take the time to discuss a treatment thoroughly and answer all your questions, as well as provide you with all appropriate treatment options. However, it is then your responsibility to understand and process that information and form realistic goals and expectations for your procedure.
Sometimes, this isn’t easy. We live in a society with a quick-fix mentality. We want what we want when we want it. But medicine doesn’t always work like that. Many problems, even cosmetic ones like acne and melasma, are chronic and incurable. And if you don’t understand this before you start treatment, then you’re setting yourself up to be very frustrated and unhappy.
At Celibre Medical, we put an emphasis on patient education. To us, this is the key to helping you establish reasonable, realistic expectations. This means that we make it a priority to spend more time with you up front to prevent unpleasant or unhappy conversations down the road. We will take the time to explain your condition, your treatment options along with the risks and benefits of each, in addition to your expected costs and time for recovery. We want to be your partner in your treatment process not a bystander.
Despite this, there are still no absolute guarantees for your treatment plan. We don’t hide this fact or sugarcoat it for you. And we are more than happy to tell you no. We won’t do something that isn’t in your best interest or wouldn’t benefit you. We believe that this is delivering the highest quality of care, and this is something that we absolutely will guarantee!
If you’re confused about the terminology of leg veins, you’re not alone. Many people use the terms spider veins and varicose veins interchangeably, but the truth is that they mean very different things.
If you think of the veins in your legs like a tree, you have very large vessels deep inside your leg that carry blood back up to your heart. Medium-sized veins enter into those large veins, resembling branches branching off from a trunk. These are closer to the skin’s surface of your leg. Next, coming off those are the very small branches and twigs which are the small veins in the skin itself.
Varicose Vein (Pacific Vein Center) Spider Veins
Understanding how blood is supposed to flow in the legs is key to comprehending why varicose and spider veins occur. It flows inward and upward from the smaller veins to the larger ones. Now, remember that most of the time, this process must occur against the pull of gravity. To fight the constant “down and out” pull, each vein contains a series of one-way valves that keep the blood moving in the right direction.
Varicose veins occur when the valves fail in the medium and larger sized veins. This causes them to fill with blood, swell and enlarge and bulge out on the surface of the skin. Varicose veins look swollen, blue and spongy. They are usually several millimeters to a centimeter (or more) in diameter. They can also be painful. Most people with varicose veins will tell you that they can become inflamed, tender to the touch and ache. This usually happens after a long day of standing or prolonged activity.
In contrast, spider veins (also called telangectasias) are very small, only 1-2 millimeters in diameter. They manifest as red, blue, or purple clusters, often forming mats resembling spider webs within the skin. They are flat and generally don’t hurt. Lastly, spider veins do not have “feeder” veins like varicose veins do.
Most people who have varicose or spider veins generally don’t like them. Luckily, there are effective treatments for both these problems, but they are different. Knowing which type of vein issue you have is important.
Vascular surgeons are generally responsible for evaluating and treating varicose veins. Surgical vein stripping is an effective procedure, but may leave scarring. Lasers can be used for varicose veins, but the procedure is very different from laser treatment of spider veins. Healthcare providers can effectively use internal, endoscopic lasers to heat and seal off larger internal veins that are not functioning well.
Treating larger varicose veins is crucial for the successful treatment of smaller spider veins because they are the constant blood supply that keeps the surface open and visible. Spider veins respond very nicely to both sclerotherapy (injections) and external laser treatment. Sometimes, a combination of both treatments is necessary to completely get rid of them. Deeper, larger, blue veins tend to do better with sclerotherapy and smaller, more superficial red veins respond well to laser.
Understanding the differences between the types of veins you have will help you choose a treatment plan. Finding the right provider with the right knowledge, skills, and equipment is essential for safely, effectively, and completely eliminating varicose veins and spider veins.
Are you living with unwanted, embarrassing stretch marks? This difficult condition is all too common and unfortunately, can affect anyone. Both men and women suffer with stretch marks; often they appear at vulnerable times in our lives like during puberty or pregnancy. But if you’re suffering with stretch marks, there is help.
Typically, stretch marks are red, brown or silver/white in appearance. Darker colored stretch marks are usually newer, whereas older stretch marks are silver or white in appearance. If your stretch marks are brown or hyperpigmented, you likely have a darker skin type (color). Brown stretch marks are difficult to hide because they stand out so much from your natural skin tone. Unlike red stretch marks, which usually fade to the white/silver color with time, brown stretch marks often don’t.
One of the most frequently recommended treatments for dark stretch marks is bleaching creams with hydroquinone or exfoliants. While these sound like they might work for dark stretch marks, they usually don’t. Hydroquinone is a bleaching or “fading” agent that when applied to the skin slows down the excess production of melanin or pigment. Sounds like exactly what is needed, right? Well, not really. It takes a very, very long time for hydroquinone to work; and when combined with Retin A, can be extremely irritating to the skin. Many patients have trouble using it long enough to see the full benefit. It also shouldn’t be used for extended periods of time.
An alternative, and we believe better treatment option for brown stretch marks, is class IV medical lasers. Specifically, q-switched YAG lasers work well by targeting and breaking down excess pigment in your skin. Remember, brown stretch marks become hyperpigmented because the excess pigment in the cells caused by the trauma to the skin when stretch mark is formed. Q-switched YAG lasers can be used to gently and effectively break down excess pigment so your body can remove it on its own.
Nd:Yg (Yag) lasers are safe to use on any skin type (color). They gently heat the skin during treatment, and we’ve found that this provides improvement in the texture of stretch marks by stimulating collagen production. Treatments are generally quick, but require a series of at least three to five spaced four weeks apart to see maximum improvement. Most of our patients tell us that they see positive changes after several treatments!
It’s important to know that laser treatments like these cannot completely erase stretch marks. There’s no perfect treatment that can make your skin look as if you’ve never had stretch marks, however, significant improvement is the goal. Call us today to learn more about treating dark stretch marks.
Stretch Marks Before and After Pictures
We have many patients like you seeking help for their acne scars. They want to see scars gone and gone fast. We understand. Living with the emotional pain of acne scarring is difficult and we are truly passionate about providing treatments for our patients that are highly effective and tailored for their lifestyles and budgets. Having said all that, it’s difficult for us to give hard and fast numbers on laser treatment of acne scarring, because each case is different. If you’re reading this article, it should be used as a ballpark reference for the number of treatments, not the definitive rule.
The first factor to consider is what type of acne scarring you have. Acne scars typically fall into one of two categories: pigmented or textured. Some people have only one or the other and some have both.
Pigmented acne scars are different shades of brown, red or both. Brown and red scars can both be treated with lasers, but they each require a different type of laser since they stem from different sources. Both brown and red acne scarring is dramatically better after four to six laser treatments (respectively).
Textured acne scars affect the smoothness of your skin. This type can be a bit tricky to treat depending on your skin type (color or your skin) and the severity of your scarring. The type of laser procedure that is used to treat textured acne scars is laser resurfacing. Laser resurfacing can be one of two different types: ablative or non-ablative resurfacing.
Non-ablative laser resurfacing can be done on any color of skin, so it is safe for anyone. This procedure works by delivering heat energy beneath the skin’s surface without damaging or removing any skin. There is no downtime (recovery) associated with non-ablative resurfacing, and it works best for someone with mild to moderate textured acne scarring. Most patients will need a minimum of six non-ablative laser resurfacing procedures to see improvement of their textured acne scarring.
Ablative fractional laser resurfacing is a more aggressive treatment that works better for severe scarring. Patients who have ablative laser resurfacing will need to recover at home for a few days after their treatment. Most patients requiring this type of treatment will need an average of two – three procedures see dramatic improvement. If you have severe textured acne scarring, you many need more than three treatments.
If you’re asking when is the best time to address your acne scarring, we will tell you that there is no time like the present. We have found (and research has shown) that the earlier you deal with acne scarring, the better it tends to respond to treatment and the happier you are with your results.
Does your skin tell the story of recent injuries? If every bump, bite, nick, burn or scrape leaves behind discoloration that lasts weeks, months or years, then you’re likely revealing more about yourself to others than you’d like. Traumatic hyper-pigmentation is the medical term that’s used for scars that get darker as they heal. It’s a temporary or permanent skin discoloration related to a past injury, and can be red, brown or a mixture of both colors.
Many patients like you suffer with this problem. Any injury—from acne to bug bites to surgical scars – leaves behind a telltale sign of injury. However, it doesn’t have to be something you just “live with”. If you want a solution, lasers offer an excellent treatment option for all types of traumatic hyper-pigmentation.
The key to successful laser treatment is to choose a device that has the appropriate wavelength of light for the color of scarring you have. When we use the right laser, we can correct the pigmentation using gentle settings to slowly break up the red or brown discoloration. The marks slowly fade away and eventually disappear giving you back a more even skin tone. Best of all, these devices are safe and appropriate for all skin types (colors) including African Americans.
When you choose to invest in clearer, more even skin, we suggest you protect it after treatment by using sunscreen every day. This is especially important while you are undergoing laser treatments, but it’s also wise to continue afterward. Sunscreen use keeps your skin looking healthy and young and more importantly, keeps you out of the dermatologist’s office as you get older!
Scars before and after pictures
If you’ve been researching fractional laser resurfacing, no doubt you’ve come across a variety of new terms. It can be confusing to understand the options available to you and what they do, let alone choose which one may be best. We’ll talk a bit about fractional erbium resurfacing here to help shed some light on this highly effective type of fractional resurfacing procedure.
If you haven’t already noticed, almost any laser resurfacing procedure out there is compared to CO2 (carbon dioxide) laser resurfacing. Why? Because this laser was the very first that was used to resurface the skin, and despite many other types of resurfacing technologies that have come out since, it’s still considered the “gold standard” by most laser practitioners. Why bother with other resurfacing procedures, then? Because while CO2 may be the best (and most aggressive) treatment for lighter skin types, it also has the highest potential for unwanted side effects such as permanent changes in skin color and prolonged recovery times. For these reasons, many new and different types of laser resurfacing have come onto the scene in since 2007.
One of these is the erbium laser. Both erbium and CO2 are “ablative” fractional laser resurfacing procedures. This means that during treatment, skin is physically vaporized or “ablated”, an intended effect of the treatment. Ablative fractional resurfacing treatments require more healing time then non-ablative lasers, but they can also mean that you’ll see better results. Both lasers treat many of the same skin problems such as acne scarring, wrinkles, sun damage and skin laxity (looseness).
At Celibre Medical, we offer the Sciton Profractional laser skin resurfacing. Out of all the erbium systems, we believe this one delivers the most impressive results consistently for our patients. While there is recovery time, it’s much less than you would have after traditional, full field CO2 laser resurfacing.
In terms of safety, the Sciton Profractional is a fantastic option for all patients considering laser resurfacing. We even use it on our African American patients with no hypopigmentation (skin lightening) concerns. If you’ve been considering fractional laser resurfacing the Sciton Profractional Erbium laser is an excellent choice. Over many years and hundreds of treatments, we’ve found that it delivers results with a fast recovery and low risk of side effects.
We know birthmarks can be embarrassing. When you have one that grows hair, it can be even worse. We understand the emotional and psychological difficulty of living with this type of birthmark. And we have a laser treatment program for brown birthmarks that is safe and effective.
However, some brown birthmarks (those with hair) fall into a category that requires us to refer you out to a dermatologist for full evaluation and biopsy. Congenital nevi (a specific type of brown birthmark) may be susceptible to an increased risk of skin cancer. It is very important for you to understand that not every congenital nevus turns into skin cancer, but we wouldn’t be taking the very best care of you if we just treated your birthmark with a laser before having it full evaluated.
Many types of brown birthmarks (café au lait, Mongolian spots, etc.) do not require full evaluation before treatment and are appropriate for lasers. But some congenital nevi with hair do and these are usually not appropriate for laser procedures.
Accidents happen. We see several patients weekly who come to us asking for help reducing the appearance of traumatic scars from caused by injuries or accidents. Surprisingly, there is little expertise out there for treatment of these types of scars. Until 2010, we had limited options to help people improve their scars!
We started performing fractional laser resurfacing in 2013 for cosmetic resurfacing, and we quickly became intrigued by the concept of using this laser for the improvement of traumatic scarring. Since then, we’ve treated hundreds of patients each year with this device and our results have been amazing! The patient in the pictures below had a car accident in which she suffered forehead lacerations. She received proper medical attention and had stitches for her wounds, but she developed several scars as a result. We treated her with a series of three separate treatments and she was thrilled with her results—and so were we!
You might be wondering how treating a scar with a laser helps it look better. The answer is that the laser creates a controlled injury and when your body heals, new collagen is created, but this collagen is deposited in a more organized fashion because of the control we have with lasers. The “abnormal” scar tissue is replaced with skin that is more “normal” looking. This helps it look and feel better.
Not all fractional lasers can be used on everyone though. The Sciton Profractional is an exception. It is safe for all skin types (colors) because it is an Erbium rather than CO2 laser. This gives us the ability to help all patients who want fractional laser resurfacing treatment of scars including Hispanics, African Americans and Asians.
Do you know your skin type? It’s okay if not as most of us don’t, but if you’re considering laser treatments, it’s a very important question. Let’s ask it another way: do you burn when you’re in the sun? If you answered yes, then you most likely have type I or type II skin. If you’re answer was no, then you may be a type III, IV, V, or VI. Skin type refers to the color of a person’s skin, how dark or light it is. This generally reflects their ethnic background. There are six different skin types from type I to type VI. The lower the number, the lighter the skin and the higher, the darker.
While you may not care much about what your skin type is, we care a lot. In fact, a person’s skin type might just be the most important piece of information for us to know when they’re seeking laser treatments.
From a laser dermatology perspective, it’s not enough just to look at the color of a person’s skin. We need to know how their skin behaves in the sun. Believe it or not, there are people with darker, olive skin who will burn badly on their first day of sun exposure!
Lasers use specific wavelengths of light to target very specific components of the skin (melanin, hemoglobin or water). And some wavelengths are not appropriate for every skin type. Generally, shorter wavelengths are less safe for darker/higher skin types. Longer wavelength ones tend to produce the desired, intended effect without risk of unwanted side effects. Why? People with darker skin who tan very easily have more melanin, and this tends to compete for the laser light with the intended target (hair, spots, etc).
Recent advances in laser technology have given us more laser than ever to choose from. It’s our job to understand both the condition we are treating and your skin type to pick the safest, most effective device to get the job done.
This is just one more reason why it is so important to research your laser practice/practitioner before you have your first treatment. If the practice doesn’t clearly understand the specifics of laser physics and skin type, then they can’t choose the safest laser for your skin. And a practice that only has one or two different lasers but claims to be able to treat all skin types should worry you.
There are many safe and effective laser treatment options if you have a dark skin. Just make sure whomever you choose has the proper laser knowledge and technology to treat your skin.
Don’t get us wrong. We use IPL and think that it definitely has a place at our laser practice. However, we wanted to address the issue (or confusion) around whether an IPL is the same as a laser. It’s not. So, if you want laser treatment, then you shouldn’t have an IPL. They are apples and oranges.
Now, with that out of the way let’s talk about how lasers and IPL are different. First, they both use light as an energy source. But lasers use one, single wavelength of light. IPLs use multiple wavelengths (usually a range). If that doesn’t sound like a major difference to you, let us explain a bit more why it should.
The main “targets” for lasers are hemoglobin (blood vessels, redness, vascular growths), melanin (pigmented spots, freckles, birthmarks, dark hair and tattoos) and water (useful in skin resurfacing procedures). Because lasers use a single wavelength directed at one of these parts of the skin tissue, a laser is more powerful, targeted and effective when treating one of these particular issues.
An IPL on the other hand is a “jack-of-all-trades.” The wavelength of light used in an IPL is based upon a filter that is placed in the device. When an IPL is fired, an intense pulse of visible light is created, but the filter only lets a certain range of that light through the hand-piece. Most of the time, the range includes wavelengths that target both redness and pigmentation. Because IPL is less targeted, energy must be lower, which limits the type of treatments we can use it for.
Lasers amplify the single wavelength of light that they use to make it powerful enough to destroy the tissue it is targeting. IPLs may provide some result, but their design doesn’t allow for high peak power, so the results may not be quite as dramatic or permanent.
Class IV medical lasers are the most effective and efficient way to tackle many cosmetic skin conditions. That is why at Celibre Medical we prefer to use these devices to address our patients’ skin concerns. While many other practices use IPLs for many of the same types of skin conditions, our experience shows that doing so leads to more adverse outcomes, increased risk of side effects and higher overall costs to patients.
For example, the photos above show a person with a café-au-lait spot, a type of pigmented birthmark. This patient should only have treatment with a q-switched laser, not an IPL. With our Medlite C6 q-switched laser, we were able to significantly reduce the appearance of this lesion. Had this person had an IPL, it most likely would have only made this type of pigmented birthmark worse.
Scarring is a difficult problem to both have as a patient and to treat as a practitioner. If you’re suffering with one or more unwanted scars, we feel for you. Much like any other health condition, yours is unique. The look of your scar(s) is different from everyone else’s; so is your treatment plan and response to treatment. Here at Celibre Medical, we’ve helped many people improve the look of their scars—even dense, thick keloid scars. Lasers, along with other treatment options, can be one very effective tool to get the job done.
To show you just how effective laser treatment can be for keloids, we wanted to share the story and photos of a patient that we successfully treated. This gentleman came to us after seeing a plastic surgeon for surgical removal of his keloid scar. His keloid originally developed after a severe acne cyst to his cheek about nine years prior to him seeking treatment.
He thought that surgery would be a cure for his keloid (as many people do), but his surgeon (to his credit) was honest and open with him that this is often not the case. Keloids removed surgically often reoccur…and that is exactly what happened in his case. The really unfortunate thing for him was that it reoccurred almost immediately after surgery and grew even bigger than it had been prior.
After discussing all of this with him and examining his keloid, we chose to incorporate the use of Kenalog (steroid injections) our Cynosure V-star (Candela V-Beam) laser into his treatment program. This laser is a pulsed-dye laser, so it targets the blood vessels or vascularity of a scar, which is often significant. If there’s less blood in the tissue, then there will be less growth, and over time, the keloid will shrink. We combined these laser treatments with steroid injections in between laser visits. This is another way that we can decrease or “atrophy” a large-sized scar. In his case, it worked! He was thrilled that we could help him and so were we.
It is important for you to know that while lasers and other treatments can help improve the appearance of scars, they don’t always. Just like the plastic surgeon, we also had a discussion with him up front, before we started treatment, that he may not see any change in the size of his keloid. Again, everyone will respond differently to these treatments. Maybe the biggest difference between laser removal and surgical removal of keloids is that with the laser, there is virtually zero chance that it will increase in size after treatment. This fact is critical to consider if you are weighing out the risks and benefits of laser or surgery for your keloid scar.
Many patients view lasers as a “cure all” for their skin condition. While laser technology has certainly come a long way in the past several years, this idea is simply not true. Unless you know what to look for, your expected results could fall short. At Celibre, we are committed to helping you match the right laser with your particular skin condition.
In the case of age spots (sun or liver spots), lasers that target pigment are used to permanently remove these spots. At Celibre, we use q-switched lasers to effectively remove spots caused by sun exposure and we use BBL (IPL) to remove or improve diffuse pigment (general discoloration).
Q-switched lasers are designed to remove pigment such as tattoos and birthmarks, so sun spots are typically very straightforward. These lasers are extremely powerful so we often use them only on the area of the skin where the actual sun spot is seen. IPL is very different. Often IPL cannot remove round age spots, but does a good job of getting rid of accumulated sun damage that causes unevenness in the color of the forehead, neck and chest. Together these devices offer a powerful tandem to help patients like you with sun damage to get rid of most or all of the discoloration.
But remember, no matter which laser we use to treat your age spots, we always let you know that the best treatment is prevention! Always practice sun-smart behavior and use a broad-spectrum sunscreen that protects your skin from UVA and UVB rays.
If you’ve been reading online about laser treatments for a particular skin problem that you’d like to improve, you may have come across the term “gold standard.” It refers to the idea that a device or technology is the “best around” and the “bar” we use to measure other devices against it.
You may also wonder if the term “FDA-approved” relates at all to this concept? Surprisingly, it doesn’t! It simply means that the FDA has deemed the device safe to use on people and has little to do with how effectively it does what it claims to do.
Unlike “FDA-approved”, “gold standard” is more of a subjective term. People in laser medicine tend to use it as a consensus term, meaning that they believe it to be the best option. Sure, there are clinical trials and data showing that a device can be effective, but many people get too caught up in the hype that often surrounds a new device and will often tout it as the new “gold standard” before they treat enough real-world patients to really know for sure.
At Celibre Medical, we want the laser devices and technologies that we offer our patients to be BOTH safe and effective. We understand there is a group of patients that just want the “latest and greatest” laser dermatology treatments out there. We know we might miss out on taking care of this group of people because of this, but we’d rather offer proven options, true gold standard treatments, and have happy patients than offer sub-par services that are the fad of the moment.
We believe that safety and efficacy can go hand-in-hand. We only offer laser treatments that are FDA-approved for the conditions they treat and know from personal experience give us superior results. This means we often don’t have the latest, hottest devices that may be “trending” at any given time. We’re okay with that! We’ve built our practice with over 20 different devices that have stood the test of time and we know how to consistently deliver results patients are looking for.
If a laser practice the term “gold standard”, carefully consider if this is a self-imposed term. This is especially true if a practice only has a handful of lasers that it claims can treat almost any skin condition. This kind of “jack-of-all-trades but master-of-none” mentality is very common in our field. Ask questions and make sure you feel comfortable that your laser provider has your best interest in mind.
