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What is Melasma?

Lori Haney, RN, MEPC, LSO No Comments

While it may have a funny, unique-sounding name, melasma is an all-too-common problem. Maybe you or someone you know has it, but you didn’t know it had a name? It causes dark, brown patches most commonly found at the upper cheek, upper lip and forehead. These brown spots come on quickly (during pregnancy, starting birth control, over the summer or after a vacation) can be large and are often symmetrical. Worse, they are almost impossible to cover up with make-up!

Many women are confused about what causes melasma. In truth, we aren’t 100% sure either! But, we know that there are a variety of triggers and that hormonal changes play a major role. Pregnancy (pregnancy mask/chloasma), the use of birth control pills and menopause are common in the onset of the condition.  Many patients believe that sun exposure, heat and humidity cause Melasma, but in reality they can make it worse, but not cause it.

* Melasma before and after photos

Because the exact cause remains unknown, Melasma can be treated but in many cases remains chronic.  Often, people who have it struggle over their lifetime with it.  Even so, your condition is not hopeless and we can effectively manage this difficult condition!

We understand the frustration and difficulty you’re going through when you have melasma. Chances are you’ve tried many different things to look and feel better, but many aren’t successful. We are here to help you! We can help you understand your condition better, provide an excellent treatment option and explain how to modify your lifestyle to avoid Melasma triggers.

With a good treatment partner, you can have clearer skin and win over melasma! Celibre Medical has helped many women (and a few men) gain control over it and keep it in check. We are confident that we can do the same for you.

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Difference Between Melasma And Sun Damage

Lori Haney, RN, MEPC, LSO No Comments

It is not uncommon for men and women to confuse sun damage with melasma as both conditions involve pigmentation on the face. Despite the similarities in pigmentation, melasma and sun damage are actually quite different. The source of the discoloration is the major difference between the two melasma and sun damage. For example, melasma is caused by pigmentation (melanocytes) that is generated in response to hormonal fluctuations. Because it is related to hormonal changes (pregnancy, menopause, oral contraceptives, etc.) it is considered chronic and has no cure. The idea behind melasma treatment is to control and suppress the formation of new pigmented cells thereby minimizing the appearance of melasma. One of the challenges in treating melasma is that is can occur in the dermis (deep skin layer). Because the condition can be rooted deep in the skin, the condition can be sometimes be resistant to treatment.

Sun spots


sun spots and melasma before and after photos los angeles sun spots and melasma before and after photos los angeles
Sun spots and Sun damage laser treatments before and after pictures

In contrast, the pigment associated with sun damage (solar lentigines, seborrheic keratosis, freckles, sun spots, liver spots) lies closer to the surface of the skin and is much less challenging to treat. Existing sun damage is effectively treated with class IV medical lasers whereas melasma may be better addressed with topical preparations. Q-switched (very short pulsed and high powered) laser technology is very effective at breaking down the pigment associated with sun damage in several treatments. This technology also has the benefit of completely destroying the cells associated with the pigment. This means that new cells replace the old ones and do not contain the same pigment that was present previously. With q-switched laser technology, we are able to completely remove most age spots and sun damage.

The following descriptions highlight the differences between melasma and sun damage.


Light to dark brown patches usually seen on the forehead, cheeks, chin, upper lip.

Very symmetrical in appearance on both sides of the face.

Discoloration may be dense pigment and may lie on the epidermis (upper layer of skin), dermis (lower layer of skin), or combination of both.

Linked to hormonal changes and considered a chronic, recurring condition.

Sun exposure, heat and humidity may exacerbate condition.

Sun Damage (Sun Spots, Age Spots, Freckles, etc.):

Appears randomly on all areas of the face.

Usually not symmetrical, may be patchy or scattered.

May be associated with textural changes to the skin also known as photo-damaged skin (lines, wrinkles, etc.)

Not related to hormonal changes but directly linked to sun exposure.

Responds well to lasers.

Not considered a chronic condition.

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What Does Brow Shaping Mean?

Kevin DiCerbo, RN, BSN, LSO No Comments

You’re browsing Realself and you keep coming across the term “brow shaping”. If you’re thinking this term relates to plucking, tweezing or waxing the eyebrows, think again! In the aesthetic world, brow shaping refers to techniques and treatments that change the position, lift/arch and or volume of the eyebrow and the area around it.

Why is this important? Because no other area reveals more information about your age than your eyes. Signs of sun damage, volume loss and skin laxity show up here first before anywhere else on your face. A skilled aesthetic practitioner knows this, and understands the value of using minimally invasive treatments such as Botox Cosmetic and dermal filler injections to correct and reverse these changes.

If you feel like your brows are flat, there’s an easy way to both lift and arch them with Botox. When precisely and carefully placed into the right facial muscles, Botox can completely change the shape and position of your eyebrows. Lifting them, opening-up your eyes and smoothing out the skin around the eyes can take years off your appearance.

If your brow bone (or bony eye socket) has flattened, then injections with dermal filler products such as Juvederm and Restylane can softly and naturally reshape your brow. This in turn also lifts and shapes the eyebrow.  Are your eyes looking hollow?  Temples sunken in? Do these changes make your eyes look sharp or angular?  If so, hyaluronic fillers such as Restylane can safely be used under your eyes and in your temples add volume and “round out” your upper face.

Restoring the balance and natural contour of your eyes can help you look refreshed, younger and relaxed. Remember, your eyes are the focal point of your face—your most important facial feature!

Read About All Celibre’s Facial Shaping Techniques

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Is There a Cure for Melasma?

Kevin DiCerbo, RN, BSN, LSO No Comments

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We know that having melasma can be frustrating, embarrassing and hard to deal with day after day. It’s an extremely common condition yet despite that, we still don’t yet have an effective cure for it. But don’t give up! There are treatments that can control melasma and make it much more manageable! Finding a good practitioner who is experienced and educated about melasma treatment can make all the difference in helping you beat this difficult skin problem.

melasma treatment los angeles before and after photoslos angeles melasma treatment before and after photosMelasma is a problem with excess pigment. The cells in your skin that make pigment are called melanocytes. In melasma, the melanocytes are overly stimulated to make pigment and this results in the dark patches that pop up on the forehead, cheeks and upper lip. Hormonal stimulation is the culprit that triggers the melanocytes to work overtime. This is what makes melasma so different from and much harder to treat than other conditions that include brown spots like freckles, sun spots, brown acne scars and moles.

Treatment for melasma is designed to fade the brown patches and then maintain your clear skin; so, it’s very important to realize that it is an ongoing process. Once you’re better, you need to continue with prescription medication or you will end right back up at square one. The cornerstone of melasma treatment is usually hydroquinone, a bleaching medication that works to suppress excess pigmentation. There is no one mix that works for everyone, so it’s important to be patient, use your product as directed and follow up with your practitioner frequently to assess your response to treatment.

The bottom line to remember with treatment of melasma is that there is hope—and many options for treatment. With patience and diligence, you can and will get better. Hang in there!

Here at Celibre Medical, we offer two, different treatment plans for melasma. We encourage our patients to ask questions and we work hard to make sure that our patients understand their condition. There’s no way to predict which of these two will work for each person, so we let you know this up front and we never make you promises that we can’t keep. We know that successful treatment of melasma depends on an ongoing relationship with you and we’re your partner for the long haul!

Melasma before and after photos

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Tired of Shaving Bumps in your Bikini Area?

Kevin DiCerbo, RN, BSN, LSO No Comments

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If you’re tired of being on the endless “merry-go-round” of grooming unwanted hair in your bikini area, then it is time to consider laser hair removal. Do you find yourself shaving daily (or every other day) wishing and hoping for smooth, hair-free skin only to end up with razor burn and shaving bumps in place of your unwanted hair? Maybe you’ve tried waxing, haven’t found it looks much better after (and hurts a lot more!)?

Laser hair removal is the answer! Here’s why we get shaving bumps and ingrown hairs with these other methods. First, the hair in the bikini are is coarse and curly. The follicles are actually slanted in the skin, which causes the hair to curl as it grows out. These thick, curly, freshly shaved hairs (or newly growing ones) immediately grow into the surrounding skin at this angle. So, no matter what you do to get rid of the hair, if there’s new hair growing in, you’re likely to get the bumps.

How does the laser help? It uses heat to permanently remove the hair. If there’s no hair, then there are no bumps. And remember, it’s permanent hair removal! So, while you do need a series of treatments performed every six to eight weeks, when you’re done—you’re done with bikini hair for good!

Here at Celibre Medical, laser hair removal in the bikini area is one of the most common procedures we perform. We have a device that works on every skin type (color), so we make sure that your treatments not only give you great results, but are safe for you too. Imagine having smooth, clear skin and not having to mess with razors or waxing ever again! If you think the price tag is too high, consider what you’re really getting in return. Our patients love their results and tell us that it’s worth every penny.

Laser Hair Removal Before and After Pictures

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Can Threading for Hair Removal Have an Effect on My Skin?

Kevin DiCerbo, RN, BSN, LSO No Comments

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You’ve read about threading for hair removal and have talked to your friends who absolutely love it. You’ve decided to try it and you’ve booked your first appointment. But before you head over to the salon, we’d like to caution you about a few things that may make you think twice about using threading as your go-to method to get rid of hair.

Many people don’t realize that there can be potential unwanted side effects with threading such as acne-like breakouts, infections and darkening of the skin. While threading has been around since ancient times, it may just not the best modern-day solution for you to get rid of your unwanted hair!

picture of side effects of threading

Threading is a technique in which unwanted hair (usually facial hair) is epilated (pulled out) by an intricate rolling and twisting of fine threads over the affected area. No doubt, threading leaves your skin completely smooth, but it also is extremely irritating! Often touted as “exfoliation”, the threads can damage the very top layer of skin, the epidermis, as they pull out the hair. This basically creates thousands of tiny pathways for infection-causing organisms to gain entry to your skin. Don’t think it can happen? A recent study reported multiple cases where patients developed warts after threading due to infection from HPV (human papilloma virus) transmitted this way.

Many practitioners who provide threading use their mouths to steady the threads during the procedure. That’s because they still practice threading today like practitioners in ancient times. And while that may have seemed like a good idea back then, we know now that the human mouth is dirtier than the average toilet seat!

If you are prone to acne (or even if you aren’t), the traumatic nature of threading can leave your hair follicles irritated, stimulating a breakout that looks like tiny, puss-filled pimples. Known as folliculitis, you can see an example in the picture of the woman on this page. The last thing you want to do is to trade your unwanted hair for a bigger problem—unwanted breakouts.

If you take a second look at this picture, you’ll also see an example of the unintended problem of hyperpigmentation or skin darkening that can occur after threading. This doesn’t happen to everyone after, but if you have darker skin, your pigment cells may respond to the irritation threading triggers by making more pigment, leaving you with unwanted dark patches on your skin. Again, it’s a safe bet to say this young lady would have kept her hair or chose another hair removal method if she knew this is how she’d look after threading!

By now, you’re probably wondering if you should just skip your threading appointment. Here at Celibre, we won’t tell you what you should do, but we do want you to be informed of the potential risks and unwanted side effects that are possible with any type of popular treatment. Sometimes, a procedure gets a lot of hype and the truth gets lost in the all noise. A procedure such as threading for unwanted hair removal may not be the “panacea” that the media and your friends make it out to be!

Our practice doesn’t offer threading. We offer class IV medical laser treatment for unwanted hair. We do realize there are potential risks with laser hair removal as well, and we will always make it our priority to discuss these with you prior to starting treatment. Each device that we use is FDA-approved for laser hair removal and we have multiple, different devices that have been consistently shown to be both safe and effective to permanently remove your unwanted hair, no matter what your skin type (color).

Unlike threading, which hasn’t evolved much, Celibre offers only the latest and most up-to-date laser treatment. Our practitioners stay at the forefront of this growing field by maintaining the highest levels of continuing education and hands-on experience.

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Will Using Mineral Makeup Help my Acne?

Kevin DiCerbo, RN, BSN, LSO No Comments

At Celibre Medical, we approach acne from a different perspective. We truly understand how your acne can impact your entire life…not just your skin. We are committed to providing you with the safest, most innovative, and personally tailored acne treatment plans.

Part of this relationship involves straightforward advice and recommendations for ways to manage your acne. Our practitioners have spent years learning and observing what works for the treatment of acne and what doesn’t. Many acne patients come to us extremely confused about what products are “good for” or “safe” to use on their skin. One of the most frequent of these products is mineral makeup.

Infomercials and other forms of direct-to-consumer marketing would have you believe that mineral makeup is an answer (almost a treatment) for acne and acne-prone skin. We believe the opposite. There are many terms that get thrown out there in these marketing ploys: oil-free, safe for sensitive skin, mineral-based, natural, etc. While all these tend to lead you to believe that they are good for acne, they actually aren’t. For a product not to be acne-stimulating, it needs to be labeled non-comedogenic.

Non-comedogenic means that a product doesn’t block or clog pores – which is the first step in the formation of acne. While the mineral makeup manufacturers typically don’t use this term, they use almost everything else to lead you to believe that their products are good for acne. It’s no surprise that most of our acne patients are hesitant to give up mineral makeup. They’ve been falsely led to believe that it’s helping when more than likely, it’s only been adding to their acne problem.

We understand this may be an unpopular opinion. We also can’t prove our position with any formal research or outside verification. This is simply our professional opinion based on years of clinical observation.

  • Mineral makeup is extremely difficult to remove (fully) from the skin. We have had negative skin reactions occur during laser treatments due to mineral makeup. This leads us to believe that there is a “residue” of mineral-containing particles lodged within the pores even after several washings.
  • Celibre Medical has repeatedly contacted the manufacturers of several prominent mineral makeups asking for research or documentation supporting their claim of being “safe” for acne patients. We continue to receive no response.
  • Every acne patient who we have persuaded to discontinue the use of mineral makeups has seen improvements in their skin–every single one!

We are not against these companies or products at all. But we are against what we believe to be false advertising claims of being “safe” or “helpful” for acne-prone skin. Our years of real-world experience and clinical observations tell us this just isn’t true! We don’t promote one product over another, but we do want our patients to get better. And this means we discuss the use of appropriate skin care products that help us reach this goal, not sabotage it.

orange county california acne laser treatment before and after picturesorange county california acne laser treatment before and after pictures

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Hydroquinone and Melasma

Kevin DiCerbo, RN, BSN, LSO No Comments

Over the years of treating this common and frustrating condition, we’ve met many women who are dissatisfied with using hydroquinone to treat melasma. Not only have they spent much time and money, they’ve not seen much improvement and feel that it’s only irritated their skin.

We often spend a large amount of time during the consultation discussing this issue. We educate our patients that hydroquinone is a valuable tool in treating melasma, but that it’s only part of a bigger picture.

los angeles melasma before pictures los angeles melasma after pictures
Melasma before and after pictures

That being said, hydroquinone is very useful for melasma, but again, only as one of many treatments that are used in combination. We’ve found that products containing bearberry and kojic acid often augment and enhance the effect of hydroquinone. These are just a couple of complimentary products that we incorporate into a complete, individualized melasma treatment plan.

Finally, we can’t “cure” melasma. However, with the help of our expert nurses, we can tailor a regimen that not only works for you, but that helps your skin look clearer, healthier and more like it did before you developed Melasma.

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What are the Potential Side Effects of Photodynamic Therapy?

Kevin DiCerbo, RN, BSN, LSO No Comments

Have you heard of photodynamic therapy (PDT) for the treatment of acne? Chances are that if you have severe acne or you have failed multiple other conventional acne therapies that you have. ALA stands for aminolevulinic acid, the light sensitizing medication that is used in the treatment. PDT stands for photodynamic therapy, which is the more descriptive of the procedure since it involves both the use of medication and light together to improve your acne.

acne laser treatment photodynamic therapy los angelesacne laser treatment photodynamic therapy los angeles

PDT with ALA can be an extremely effective treatment for many skin problems including acne. Many acne patients choose PDT not only because they failed traditional acne treatments, but because they could not tolerate the side effects of powerful acne medications such as Accutane. And while the results for photodynamic therapy can be impressive and many patients do very well after treatment, it’s important to share with you that it is not a treatment without potential side effects.

Post Inflammatory Hyperpigmentation or PIH as it is commonly referred to is the main potential side effect of PDT.  We see this side effect in about 20% of our patients, mostly in those with medium or darker skin types (colors). PIH with PDT can happen as a normal response to the intense inflammation triggered by treatment. It can be a persistent red color in lighter skin types, or brown discoloration with medium and dark skin types.

The good news is that it doesn’t last for long. Usually within a few weeks, it resolves on its own. On occasion, we’ve had to use other treatment options to help speed resolution.

Closed comedones or whiteheads can also flare up in response to PDT treatment. We see this commonly in clusters around the mouth and jawline. Although we aren’t totally sure why this happens, it is believed it may be the skin’s response to the healing hair follicles. Hair follicles are joined to an oil/sweat duct which takes up and stores the ALA during the treatment.

Unlike PIH, which is rare, small comedones around the mouth and jaw happens in most of our patients. In fact, we tell them to expect it during their consultation. While it worries most to see an “acne-like” breakout just after an intense treatment for acne, it doesn’t last long. One to two weeks in most cases is the norm and it typically disappears without any special treatments or products.

At Celibre Medical, we routinely use PDT with ALA therapy for the treatment of severe and/or resistant acne and we believe it’s an invaluable procedure. We’ve seen it help hundreds of patients over the years. But it is a procedure that has the potential for some side effects, and we do our best to always discuss this in-detail and up front with anyone considering it.

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