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Dear Dr. Seckel, I am considering laser liposuction. I have a small amount of belly fat and loose skin on my tummy after having 3 children. I also would like a little fat removed from my hips and thighs. I have read a lot about laser liposuction and it sound like it is a better treatment than the older liposuction. I have read that skin tightening is better with laser liposuction and the skin is left smoother. I have read about SmartLipo, Cool lipo, SlimLipo and Lipotherme. I am not sure which ones are available in the Boston area. They all sound great on the internet. Is there a big difference between one laser liposuction machine and another? How does one make the right choice? Thank you, Michelle, Boston, Massachusetts.

March 12th, 2009

Dear Michelle,

Thank you for your question about laser liposuction. There is a great deal of enthusiasm for laser liposuction today. There are some potential advantages to the laser liposuction technique, but the most important thing for you is to find an experienced, expert, board certified plastic surgeon that you are comfortable with and trust.

The doctor who does your liposuction is much more important than the particular technique that is used. I always recommend consulting two board certified plastic surgeons and choose the one who you feel most comfortable with and feel you can trust. Ask this doctor about laser liposuction and the techniques that he or she use.

Having said that, I do use laser liposuction and feel that there are advantages of laser liposuction over the older techniques in my hands. My results so far in my Boston area patients have been very good, see before and after laser liposuction pictures below:

Before and after SlimLipo laser liposuction body sculpting of the upper and lower abdomen and mini tummy tuck

Before and after SlimLipo laser liposuction body sculpting of the upper and lower abdomen and mini tummy tuck

The main advantage that I see so far is smoother skin after laser liposuction, tighter skin, and fewer contour deformities, in my experience. The laser liposuction fiber melts the fat into a liquid, which makes fat removal easier, using smaller cannulas.

There are several laser liposuction machines available and they all work. I use the SlimLipo laser liposuction machine which I believe has the advantage of using a very specific laser wavelength that is uniquely absorbed by fat. The other laser liposuction technologies primary target is water, not fat, so the actual fat melting process is less efficient, in my opinion.

To more specifically answer your question, I am reprinting below an article that I recently wrote which compares some of the various laser liposuction machines that are available.

There are very significant differences between the major laser liposuction machines in use today. Because of patent restrictions, many companies have had to use wavelengths that are not the most effective for fat removal. In the article below I will first try to explain the procedure and then describe the technologies used in the most widely used machines.

How Does Laser Liposuction Work?

Older standard suction assisted lipectomy techniques removed fat by inserting a metal tube called a cannula beneath the skin to remove fat by aspiration with high powered suction. The fat cells are actually ruptured and sucked out from beneath the skin. Other supporting tissues beneath the skin are also removed. This procedure is quite traumatic and can produce bruising and swelling and post operative pain which can lead to a prolonged recovery. Results for fat removal are excellent, however lack of uniformity of skin appearance and loose skin after the procedure have been reported in as many as 20 % of patients.

The new laser liposuction technique first involves the placement of a tiny laser fiber beneath the skin to melt or liquefy the fat before removal. This allows for a much less traumatic fat removal because much smaller aspiration cannulas can be used and there is less tissue trauma and injury to the non fatty tissues.

After the laser fat melting process a small cannula about half the size of the older cannulas is used to remove the liquefied fat. In addition, the heat generated by the laser causes the skin to tighten, and results in my Boston area patients have shown improved skin tightening following laser liposuction.

In addition to liquefaction or melting of fat, many more fat cells are injured by the laser and are reabsorbed by the tissues, so that fat volumes are typically less using this new technology.

SlimLipo Machine

SlimLipo laser liposuction uses a patented 924nm laser wavelength to melt fat. The 924nm laser is the most specifically and highly absorbed laser wavelength by fat tissue. The 924nm laser melts 3-5 times as much volume of fat as the other wavelengths in use today. The SlimLipo uses a 924nm/975nm blended wavelength for skin tightening effect.

SmartLipo MPX Machine

SmartLipo was the first laser liposuction machine on the market. The original SmartLipo used a 1064nm wavelength to melt fat. The target of the 1064nm is water, thus the SmartLipo melted fat by heating the water in the fat and the fat is melted secondarily.

Recently, SmartLipo MPX laser liposuction has been introduced, which uses a combination 1064nm and a 1320nm laser to improve fat melting. Below you can link to a video which shows a comparison of the fat melting power of the SlimLipo vs. the SmartLipo MPX technology:

Video comparing SlimLipo to SmartLipo and Lipotherme.

Cool Lipo Machine

Cool Lipo laser liposuction uses a 1320nm laser wavelength to dissolve fat. Although the 1320nm wavelength has better fat absorption than the 1064nm wavelength, water is still the primary target of the 1320nm. Thus the fat melting mechanism is the same for the 1320nm as with the 1064nm used in SmartLipo.

Lipotherme Machine

Lipotherme is a new entry in the laser liposuction field and uses a 980nm wavelength for fat melting. Again the primary target of the 980nm wavelength is water, so again this new technology melts fat by first heating water rather than by fat absorption of the wavelength.

Why is Laser Wavelength Important in Laser Liposuction?

The importance of using the appropriate wavelength to melt fat is that the greater the absorption by the fat of the laser energy, the easier and more complete the fat melting process. This is graphically demonstrated in the video link above.

Not only is the 924nm wavelength used in SlimLipo capable of liquefying 3-5 times as much fat per unit of energy as the other technologies, but the fat melting mechanism is entirely different. The 924nm is completely absorbed by fat and a much larger area of fat is dissolved. The other lasers which use water targeted wavelengths have to heat water to boiling and the water the heats ad destroys the fat. This water heating process is slower, less efficient and as can be seen in video is essentially chipping away at fat.

The heat generated by the water absorbed lasers is also a concern as the higher temperatures generated by the water heating lasers may be more prone to cause heat injury or burning, in my opinion.

I have had excellent skin tightening using the SlimLipo machine and have been able to actually do laser body sculpting in even thinner patients with small areas of fat to be removed.

I have also been able to remove lumps and smooth the skin of patients who had had a previous old time non-laser liposuction which left skin irregularities after recovery. See before and after pictures below:

Before and after pictures of SlimLipo laser liposuction to smooth skin irregularities caused by previous non-laser liposuction

Before and after pictures of SlimLipo laser liposuction to smooth skin irregularities caused by previous non-laser liposuction

Who Should Do Your Laser Liposuction Procedure?

Laser liposuction is a surgical procedure no matter what the internet marketing campaigns imply. My opinion is that I personally would only want a Board Certified Plastic Surgeon performing this procedure on me or one of my loved ones.

Be very careful and study the credentials of your doctor. There are many doctors today who advertise themselves as Cosmetic Surgeons who have never had one day of surgical training. Check the credentials of your doctor by visiting the website of the American Board of Plastic Surgery.

There are many Board Certified Dermatologists who do this procedure and I am sure some are very good. However when you have surgery of any kind, It is essential that your doctor has had the appropriate surgical training to take care of you if something goes wrong.

Do your homework and protect yourself.

Dr. Seckel

Concord, Massachusetts
Boston, Massachusetts

Dear Dr. Seckel, I have spider veins and broken blood vessels on my legs. I am very self conscious about showing my legs especially at the beach. I have had Sclero for my leg veins but still have many small broken blood vessels and spider veins on my calves and on my thighs that the Sclero did not remove. Which is better for removing spider veins, leg veins and broken blood vessels, IPL or laser? How long is recovery after spider vein removal and how many treatments are needed. Thank you, Monique, Boston, Massachusetts.

March 9th, 2009

Dear Monique,

Thank you for your question about spider veins and broken blood vessels. It is very common to have smaller spider veins and broken blood vessels left behind after Sclerotherapy and that is when IPL or Intense Pulsed Light, and Laser treatment of spider veins and leg veins can be most helpful.

In fact, we often use sclerotherapy on the larger spider veins and leg veins before we use IPL for spider veins or Laser to “clean up” the smaller spider veins and leg veins and broken blood vessels that are left behind. Results of IPL treatment of spider veins can be excellent and provide beautiful vein removal results as seen in the before and after picture of IPL spider vein removal below:

Before and after picture of IPL spider vein leg vein removal

Before and after picture of IPL spider vein leg vein removal

(Palomar Medical-Vasiliy)

IPL is a newer treatment for spider veins, leg veins and broken blood vessels and has many advantages over laser therapy. The IPL is a less intense form of light therapy and IPL leg vein treatments tend to cause less discomfort than many laser treatments. IPL treatment of spider veins and leg veins does not cause bruising as does the Pulsed Dye Laser, thus there is less visible down time after IPL treatment. In my experience there is also less risk of skin injury that can result is white marks where the vein has been removed after healing.

IPL works best on spider veins and leg veins that are 4 millimeters or less. Larger veins often require treatment with the 1064 laser. Veins that are even larger require Sclerotherapy first before IPL and or laser treatment.

How Long Does IPL Removal of Spider Veins and Leg Veins Take?

The average IPL spider vein removal takes about 30 minutes. However it depends on how many veins need to be removed. You will need three treatments scheduled 4-6 weeks apart. You will see gradual improvement as the IPL causes the spider veins and leg veins to close down and disappear slowly over 5 weeks. We encourage you to wear compression stockings right after treatment.

How Long is Recovery or Down Time after Removal of Spider Veins?

Using IPL there is no bruising or noticeable marks. The only down time would be the time you wear support hose after treatment. Smaller spider veins high on the leg frequently do not require wearing the support hose.

What Does IPL Spider Vein Removal Cost?

Average IPL spider vein and leg vein treatments cost between $350-$500 per treatment. The cost is based on the time required for your treatment. Larger areas can be more expensive.

Where Should I Go For IPL or Laser Spider Vein Removal?

The most experienced and best trained providers of IPL and laser therapies are board certified plastic surgeons and dermatologists. Not all of these physicians offer IPL and laser treatments so you will have to search the internet and find board certified doctors who do these treatments.

For more information on spider vein, leg vein and broken blood vessel removal with IPL call 978-369-4499 or email me. Read our free newsletter to keep up on the latest non-surgical and laser face and body rejuvenation techniques. Read Save Your Face to learn how to prevent facial aging.

Dr. Seckel
Boston, Massachusetts
Concord, Massachusetts

Dear Dr. Seckel, I have spider veins and broken blood vessels on my legs. I am very self conscious about showing my legs especially at the beach. I have had Sclero for my leg veins but still have many small broken blood vessels and spider veins on my calves and on my thighs that the Sclero did not remove. Which is better for removing spider veins, leg veins and broken blood vessels, IPL or laser? How long is recovery after spider vein removal and how many treatments are needed. Thank you, Monique, Boston, Massachusetts.

March 9th, 2009

Dear Monique,

Thank you for your question about spider veins and broken blood vessels. It is very common to have smaller spider veins and broken blood vessels left behind after Sclerotherapy and that is when IPL or Intense Pulsed Light, and Laser treatment of spider veins and leg veins can be most helpful.

In fact, we often use sclerotherapy on the larger spider veins and leg veins before we use IPL for spider veins or Laser to “clean up” the smaller spider veins and leg veins and broken blood vessels that are left behind. Results of IPL treatment of spider veins can be excellent and provide beautiful vein removal results as seen in the before and after picture of IPL spider vein removal below:

Before and after picture of IPL spider vein leg vein removal

Before and after picture of IPL spider vein leg vein removal

(Palomar Medical-Vasiliy)

IPL is a newer treatment for spider veins, leg veins and broken blood vessels and has many advantages over laser therapy. The IPL is a less intense form of light therapy and IPL leg vein treatments tend to cause less discomfort than many laser treatments. IPL treatment of spider veins and leg veins does not cause bruising as does the Pulsed Dye Laser, thus there is less visible down time after IPL treatment. In my experience there is also less risk of skin injury that can result is white marks where the vein has been removed after healing.

IPL works best on spider veins and leg veins that are 4 millimeters or less. Larger veins often require treatment with the 1064 laser. Veins that are even larger require Sclerotherapy first before IPL and or laser treatment.

How Long Does IPL Removal of Spider Veins and Leg Veins Take?

The average IPL spider vein removal takes about 30 minutes. However it depends on how many veins need to be removed. You will need three treatments scheduled 4-6 weeks apart. You will see gradual improvement as the IPL causes the spider veins and leg veins to close down and disappear slowly over 5 weeks. We encourage you to wear compression stockings right after treatment.

How Long is Recovery or Down Time after Removal of Spider Veins?

Using IPL there is no bruising or noticeable marks. The only down time would be the time you wear support hose after treatment. Smaller spider veins high on the leg frequently do not require wearing the support hose.

What Does IPL Spider Vein Removal Cost?

Average IPL spider vein and leg vein treatments cost between $350-$500 per treatment. The cost is based on the time required for your treatment. Larger areas can be more expensive.

Where Should I Go For IPL or Laser Spider Vein Removal?

The most experienced and best trained providers of IPL and laser therapies are board certified plastic surgeons and dermatologists. Not all of these physicians offer IPL and laser treatments so you will have to search the internet and find board certified doctors who do these treatments.

For more information on spider vein, leg vein and broken blood vessel removal with IPL call 978-369-4499 or email me. Read our free newsletter to keep up on the latest non-surgical and laser face and body rejuvenation techniques. Read Save Your Face to learn how to prevent facial aging.

Dr. Seckel
Boston, Massachusetts
Concord, Massachusetts

Dear Dr. Seckel, I am 25 and am still having acne outbreaks. I use Brevoxyl washes and try very hard to exfoliate my skin. I don’t want to take Accutane as I hear it is dangerous. What are the best new methods for acne control and avoiding acne scars? I had hoped that my acne would stop after my teen age years but I am still having acne outbreaks at 25. Thanks, Rose, Boston, Massachusetts.

March 1st, 2009

Dear Rose,

Thank you for your email about acne. Acne is one of the most common and frustrating skin conditions in the world. Good acne control is very important to prevent acne scars. Many people continue to have acne outbreaks into their 30’s so you are not unique. I am going to reprint below an article about modern effective skin care methods to prevent acne outbreaks and acne scars. You have to follow a good skin care routine completely to gain control over acne, but it is possible.

All of us who have ever had an acne sore or Comedone have found it very distressing. It is even more distressing for people who have many acne lesions which keep coming back. People who go on to develop acne scars are troubled by them for many years as scars left by acne are very difficult to conceal.

The good news is that modern medical methods of acne control are very good and can reduce outbreaks and lessen the chance of acne scarring. See improvement in acne control using modern skin care methods below:

before and after acne treatment with microdermabrasion to remove acne and improve acne scars Above: Before and after acne control treatment with microdermabrasion, topical Clindamycin and Retin A.

However, you will need to follow the skin care program fastidiously. You will also need to consult an expert dermatologist or plastic surgeon that is up to date and knows how to treat acne. You will need prescription medications. You will also need to have monthly exfoliation treatments by a medical aesthetician who is experienced in acne control treatments.

You also need to start early, at the first sign of an acne outbreak. Delaying treatment only gives the comedones the chance to worsen and possibly cause an acne scar.

What Causes Acne

Acne is caused by obstruction and infection of the oil glands in our skin. Our skin contains oil glands called Sebaceous Glands which secrete normal oil called Sebum which helps moisturize and protect our skin.

If Sebum production is too high, for example during adolescence, or skin debris like dead skin blocks the pore that drains the Sebaceous Gland, the Sebaceous Gland can become distended and obstructed so that oil builds up and distends the gland.

An obstructed, distended Sebaceous Gland provides an ideal place for bacteria to grow and create an infection. Once the Sebaceous Gland becomes infected, the skin overlying the gland becomes red, swollen, and painful, an acne lesion. A whitehead can form on the skin, which is essentially a small skin abscess, called an acne pustule.

Acne tends to occur most commonly in areas where oil glands or Sebaceous Glands are most plentiful, the area around the nose, forehead and chin, called the T zone, and the back.


What Causes Acne Scars

Visible scars are caused by destruction of the Dermis, the deep layer of the skin. When the Dermis is damaged and tissue is lost, a visible depression or scar appears.

Because the Sebaceous Glands extend deep into the Dermis, the infection in the Sebaceous Gland or Comedone causes infection and destruction of the surrounding Dermis. After healing a deep depression or scar forms because the supporting Dermis tissue has been lost.

How to Control Acne Outbreaks

The basic requirements for control of acne involve:

• Reduce oil production of the Sebaceous Glands
• Remove skin debris to prevent obstruction of the Sebaceous Glands
• Treat and prevent infection of the Sebaceous Glands

Topical Benzoyl Peroxide is an anti-bacterial agent and a skin drying agent. It is marketed as Brevoxyl Cream or Brevoxyl wash. It is the most commonly used product to control acne and is very effective. Benzoyl Peroxide reduces oil and helps prevent infection.

Vitamin A (retinoic Acid) derivatives reduce skin oil production by inhibiting the Sebaceous Gland cells. Products that are commonly used are Differin (adapalene), Retin A, Tazorac, and Accutane (isotretinoin). These prescription drugs are very effective but do have side effects like skin irritation dryness and other potential problems, thus they must be used under the direction of a physician.

Topical Clindamycin is the most effective antibacterial agent for controlling skin infection in my experience. It comes as a gel or cream or small wipes called Clindets, which I use most frequently.

Microdermabrasion is the most effective minimally invasive, no down time deep exfoliation method. Microdermabrasion treatments are essential to remove debris, open pores and prevent obstruction of the Sebaceous Glands and the development of a Comedone.

Oral Antibiotics like Minocyclene and other Tetracycline derivatives are widely prescribed for acne control. They can be effective, but my own prejudice is that it is very hard, if not impossible, for an oral antibiotic to reach a skin abscess like a Comedone. The skin abscess forms a thick wall of inflammation that is almost impossible for the oral antibiotic in the bloodstream to penetrate.

That is why I place so much emphasis on topical care to reduce oil production, deep exfoliation to remove debris and allow the oil out of the gland, and topical Clindamycin applied directly to the infected oil gland or Comedone.


IPL, Diode Laser and Blue Light Treatments
can kill the bacteria Propionibacterium acnes (P. acnes) which cause the infection or Comedone and some can reduce oil or Sebum production. These therapies are effective when used properly.

Acne Control Program

The control program depends on the severity of the acne.

Mild Occasional Outbreaks

• Monthly professional medical grade microdermabrasion treatments
• Topical Benzoyl Peroxide-(Obagi Clenziderm MD penetrates the best)
• Clindamycin- Clindets for acute lesions

Moderate to Severe Acne

• Monthly to bi-weekly microdermabrasion
• Obagi ClenzidermMD Benzoyl Peroxide
• Topical Clindamycin-Clindets
• Retin A Derivative-in increasing order of strength-Differin, Retin A, Tazorac, Accutane
• Consider IPL, Blue Light or Diode Laser Therapy

Severe Cystic Acne

• Microdermabrasion
• Obagi Clenzidrm
• Topical Clindamycin Clindets
• Accutane
• IPL, Diode Laser or Blue Light treatments

How to Remove Acne Scars

Traditionally dermabrasion or surgical excision was used to remove scars. However, with the advent of laser resurfacing in the mid 90”s, laser resurfacing with the CO2 laser became the most common method. However, CO2 laser resurfacing required prolonged recovery, often caused the skin to lose color, and CO2 laser resurfacing only smoothed the surface of the skin and did little to improve deep acne scars caused by destruction of the Dermis by the acne infection process.

Deep ice pick scars still require a special surgical procedure called floating grafts followed by CO2 laser resurfacing for effective removal. During this procedure, under local anesthesia, a small circular punch or trephine is used to cut around, but not remove the ice pick scar. The punched area floats up above the surface of the surrounding skin. After 2 weeks, the protruding graft has taken, which means it has new blood supply and will survive. At this point, the CO2 laser is used to plane down the protruding grafts flush with the surrounding skin. The new graft closes the ice pick scar. This is the only method I have seen that effectively corrects ice pick acne scars.

New fractional non-ablative laser skin resurfacing lasers are able to significantly improve deep acne scars by building new collagen to replace the collagen lost in the Dermis by the Comedone infection.

These new fractional non-ablative skin resurfacing lasers do not break the skin thus no healing time is required. You will need at least 4 treatments scheduled 4-6 weeks apart. The laser energy is fractionated, that is broken up into many small beams that pass through the skin without injuring it, and heats the deep dermis to build new collagen to actually plump up the acne scar.

The fractional non-ablative resurfacing laser is a revolutionary advance in scar removal treatment.

before and after picture of acne scar removal nwith fractional laser skin resurfacing with Starlux 1540 Above: Before and after acne scar removal with Starlux 1540 fractional laser skin resurfacing scar removal (Palomar.)

Where Do You Find a Good Acne Care Program?

First, re-read this article and be armed with the facts about acne skin care. Many physicians just prescribe Minocyclene and do not understand the importance of a comprehensive approach to acne skin care.

I recommend that you consult two board certified dermatologists or plastic surgeons that have an interest in acne skin care. Check their websites, do they offer all acne related services.

It is important to find a doctor who offers microdermabrasion treatments and laser therapy in their office. That means they are up to date on current technology.

I also believe that it is essential that the physician have an excellent experienced medical aesthetician in their office. Most of your contact and the most important person in your program will be the medical aesthetician, and she needs to know what she is doing.

You are very unlikely to find the expertise you need in a walk in Medical Spa without a board certified doctor present to examine you and recommend a course of therapy. Physician supervised in the Medical Spa world usually means the doctor is actually at an office some distance from the Medical Spa and provides his/her supervision in the form of a phone call when something goes wrong.

Do your homework.

For more information on acne control or acne scar removal call 978-369-44999 or email us. Read our free newsletter to keep up on the latest information on laser and non-surgical skin care. Read Save Your Face to learn how to prevent facial aging.

Dr. Seckel
Concord, Massachusetts
Boston, Massachusetts

Dear Dr. Seckel, I am 25 and have struggled with oily skin, large pores and acne outbreaks all my life. My acne outbreaks are less now but my enlarged pores are very noticeable. Even with makeup the large pores show and sometimes the large pores are more noticeable with makeup than without. Can laser skin treatments really help shrink enlarged pores? How does that work. I use Brevoxyl washes and have microdermabrasion every six weeks. These make my skin less oily but the enlarged pores do not seem to get better. Please tell me if laser treatments can shrink my large pores. Thank you, Stella, Boston, Massachusetts.

February 27th, 2009

Dear Stella,

Thank you for your email about large pores and laser treatment of enlarged pores. Happily, the new non-ablative fractional laser skin resurfacing using the Starlux 1540 laser can be very effective at shrinking large pores. The Starlux 1540 builds new collagen in the dermis of the skin which actually compresses the neck of the Sebaceous glands which cause the large pores when they become distended with excess skin oil. I also recommend continuing the Brevoxyl washes and microdermabrasion. If you have significant acne outbreaks then Retin A, or Tazorac can also be used to reduce oil production. Below I will reproduce an article I recently wrote about reducing and shrinking large pores.

Are you bothered by large pores or enlarged pores around your nose, forehead and cheeks? Large pores or enlarged pores on the face are a very frustrating problem for many people. Large pores are prone to forming blackheads and acne. Large pores also often stand out and are more noticeable when makeup is applied. Treatment of large pores in the past has been primarily directed towards drying agents to reduce oil production in the skin. These treatments do help, but they are temporary measures and do not change the skin structure in a way to reduce enlarged pores and pore size permanently. New combined fractional laser skin treatments using the Starlux 1540 and 2940 lasers is a revolutionary new method to shrink large pores caused by oily skin and by collagen loss associated with skin aging.

What Causes Large Pores or Enlarged Pores?

The pores on your face are small holes in the skin which are the openings of the oil glands on the face. These glands, called the sebaceous glands, form a small sack beneath the skin which produces normal skin oils called sebum. There are two basic causes of large pores, which is enlargement of the opening of the oil gland onto the skin:

• Excess Skin Oil Production- People with oily skin have more oil producing cells in their sebaceous glands, the oil producing glands beneath the skin. As more sebum or skin oil is produced, the oil gland enlarges and becomes distended. As the gland and oil sack become enlarged the opening of the oil gland onto the skin, the pore, becomes stretched and appears on the skin as a large or enlarged pore. Large pores in young facial skin are most common in the areas of the face where the greatest number of oil glands occurs-the nose, forehead and chin. This is often called the T zone, and if you check you will find these areas have more skin oils that the cheeks and eyelids.

• Aging of the Skin- As our face skin ages many very significant changes occur. The most striking aging change is loss of collagen. Collagen is a very important supporting structure in the skin. The oil glands and pores are surrounded and supported by collagen. When collagen is lost with aging, the oil glands and pores loose support and become lax and the pores become enlarged. Interestingly, enlarged pores in aged facial skin also occur on the cheeks, an area which has fewer enlarged oil glands in younger people with oily skin. The pores are there in younger people but oil production is less and the pores are not large. However when the supporting collagen is lost with aging, the large pores can show up in all face areas.

New Laser Treatment for Enlarged Pores

The new laser treatment for enlarged pores works because new collagen is produced which supports the oil glands and actually squeezes or constricts the large pore itself by compressing the opening of the pore onto the skin. This laser treatment is called combined therapy and is a two step process:

• Non-ablative 1540 or 1440 Laser Treatments-We use a 1540 or 1440 Fractional Erbium Laser to treat the facial skin. There is no down time-your face will have some added color immediately after the treatment for about a day or two. These lasers go deep into the skin and stimulate your skin to make new collagen to compress the pores. You will need 3 treatments scheduled about 3-4 weeks apart. Treatments take about 30 minutes and are done by our medical aesthetician. See before and after pictures of shrinkage of large pores and acne scar removal with lux 1540 fractional laser treatments alone below:

Before and after pictures of shrinkage of large pores and removal of acne scars with Starlux 1540 fractional laser treatment

Before and after pictures of shrinkage of large pores and removal of acne scars with Starlux 1540 fractional laser treatment

2940 Ablative Fractional Laser Resurfacing-At your last non-ablative treatment we do an additional treatment called a Fractional Ablative Laser Resurfacing with the Strarlux 2940 laser. This treatment is an actual laser skin peel. However the new fractional laser is much gentler than the old fashioned CO2 laser resurfacing. Your skin will peel and your skin will be red for 5-7 days. We do use a topical anesthetic for your comfort.

Our results with this new combined laser approach have been very impressive. Older CO2 laser resurfacing actually made pores larger.

The new approach using fractional laser technology is much better at building new collagen to compress the pores. We have seen surprisingly good results in even older aged skin.

Before and after pictures of shrinkage of large pores and skin plumping of aged skin with Starlux 1540 and 2940 combined fractional laser treatemnt. Notice improvement in cheek above old scar

Before and after pictures of shrinkage of large pores and skin plumping of aged skin with Starlux 1540 and 2940 combined fractional laser treatemnt. Notice improvement of pebbling in cheek above old scar

Other Supportive Measures

Traditional methods for shrinking large pores include skin oil reduction with Brevoxyl skin washes, microdermabrasion, and oil reducing medications such as Retin A, Differin, and Acccutane. These treatments must be discontinued during the combined laser therapy. However after your skin has recovered, you will be re-evaluated for the need for these traditional supportive therapies.

This new combined fractional laser treatment is a remarkable and truly revolutionary new therapy. The results, especially in aging skin are truly excellent. If you are troubled by enlarged pores on your face learn more about this exciting new treatment which may be what you have been looking for.

For more information on how to shrink large pores and improve your skin texture call 978-369-4499 or email me. Read our free newsletter to learn about new non-surgical skin care methods for facial and body rejuvenation. Read Save Your Face to learn how to prevent facial aging.

Dr. Seckel
Concord, Massachusetts
Boston, Massachusetts

Dear Dr. Seckel, I am writing about Photofacial skin rejuvenation. I have a lot of brown age spots on my face, neck and chest and a few broken blood vessels around my cheeks, nose and chin. I have used the Obagi skin care system for 6 months but still have the brown spots. I think the broken blood vessels are worse on the Obagi. Is Photofacial the best course for me? Can Photofacial also be done on the neck and chest? The spa I go to offers Photofacial skin rejuvenation treatments, is there any difference between their machine and the one in your office? Is a Photofacial treatment as effective as the laser for removal of age spots and sun damage? Does the Photofacial treatment also help wrinkles? Sorry for all the questions but I want to get started with Photofacial as soon as I can. Thanks, Sandy, Boston, Massachusetts

January 26th, 2009

Dear Sandy,
Thank you for your question about Photofacial skin rejuvenation. The Photofacial or Intense Pulsed Light (IPL) is an excellent option for removing the brown spots and broken blood vessels on your face, neck and chest area. The IPL is gentler than the laser but works very well. I would have you stop the Obagi two weeks before your Photofacial treatment. The Photofacial machines that are used in a physician’s office are, by law, stronger than those allowed to be used in a Spa. You also will get medical advice about skin care, Photofacial, and other non-surgical skin rejuvenation options in a doctor’s office. To better answer your questions about Photofacial anti-aging skin care treatments please read further below.

before and after pictures of photofacial ipl anti-aging skin care treatments of neck and decolletageBefore and after picture of Photofacial anti-aging skin rejuvenation treatments for the neck and decolletage or chest area (Palomar.)

Photofacial or IPL is not a laser and is a new non-surgical anti-aging skin care treatment method. Photofacial uses a flash of visible light to remove aging changes from the facial, neck, hand and décolletage skin. Anti-aging Photofacial skin care treatments do not require a topical anesthetic, are quick, and effective. Photofacial skin care treatments do not require the down time or recovery time associated with laser skin resurfacing or surgical anti-aging skin care methods such as the aggressive laser skin resurfacing skin rejuvenation method.

Photofacial anti-aging skin care treatments or IPL treatments can freshen aging and sun damaged skin to a clear uniform appearance without age spots, brown spots and broken blood vessels. See the before and after pictures of photofacial skin care treatment of the face below:

before and after pictures of photofacial anti-aging skin care treatment of face to remove brown spots and broken blood vessels for non-surgical skin rejuvenationBefore and after pictures of photofacial anti-aging skin rejuvenation treatments of the face (Palomar.)

What Causes Age Spots, Sun Spots, Red Blotches and Broken Blood Vessels on the Face Neck and Décolletage?

Browns spots and broken blood vessels around the nose, chin, cheeks, neck, hands and Décolletage are classic signs of sun damage and aging of the skin. Brown spots, often called age spots are caused by pigment that is produced by the skin to protect the skin from the harmful ultraviolet (UV) rays of the sun. New blood vessels grow into the skin in response to skin injury by the sun. This process of new blood vessel growth is called inflammation.

The new blood vessels bring blood into the facial skin first to wash out damaged skin cell debris and later to bring in skin healing factors.

As our skin ages, the brown spots and broken blood vessels are left behind on the skin after the inflammation or skin injury has passed. These pigmented and red vascular spots create an aged variegated appearance to the facial skin which is called dyschromia, which is a sign of facial aging.

Photofacial skin care treatments or IPL treatments are the non-surgical anti-aging skin care treatment of choice for benign facial skin pigmentation, age spots, brown spots and broken blood vessels, the small red spots called telangiectasia, on the face, hands, neck and Décolletage. Photofacial treatments are now preferred over laser treatments for these specific pigment and vascular lesions.

How Do Photofacial or Intense Pulsed Light Non-surgical anti-aging Skin Care Treatments Work?

Photofacial or IPL anti-aging skin care treatments use a bright flash of visible light, like the light of a camera flash to remove pigment and blood vessels non-surgically from the skin. This pulsed or flashed light is very different from a laser and in most instances, less powerful and less dangerous that laser light.

I use a Photofacial IPL machine called the LuxGreen IPL made by Palomar Medical Laser Company in Burlington, Massachusetts. Palomar Medical is the premier manufacturer of Aesthetic Laser and Light therapy machines in the world. The LuxGreen Photofacial is the best Photofacial technology I have ever used. The LuxGreen Photofacial IPL machine is very effective and is the most comfortable for you the patient of any IPL device available.

Photofacial skin rejuvenation works by passing a flash of bright light through a filter that only allows a specific color of light in the flash to pass through the filter and hit the skin. In the case of the LuxGreen Photofacial, only light with a wavelength of 550nm (nm=nanometers or one millionth of a meter and is the measure of the green light wavelength in the visible light spectrum) to pass through the IPL filter and hit the skin.

The LuxGreen Photofacial 550nm light is selectively absorbed or taken up by the brown pigment in an age spot or the dark reddish brown color of blood in a blood vessel. When the Photofacial light energy is absorbed by the pigment or blood vessel, the heat from the Photofacial or IPL light destroys the pigment or blood vessel by heating it.

This process is called Target Specific Photothermolysis. A specific target, that is a color, is heated (thermo) with a light (photo) beam and dissolved or destroyed (lysis).

Using color filters placed in front of the Photofacial light beam, a wide variety of colors can be allowed through to treat many different skin conditions including hair removal (LuxRed), acne (LuxViolet), and others.

What Will My Skin Look Like Immediately After a Photofacial Skin Care Treatment?

Unlike lasers, which can cause the skin to peel and possibly leave scars, the Lux Green Photofacial treatments are very gentle on the skin. The pigment in the brown spot or age spot will darken very slightly, and the treated blood vessel will also darken a bit. However the skin will be intact. The treated areas may also be slightly pink for a few hours.

We place ice or a cool pack on the treated area immediately and this also may make the skin pink. However, the pinkness may be covered with makeup immediately. You may return to work. And your skin will be nearly normal the next day.

Does A Photofacial Skin Care Treatment Hurt?

There is minimal discomfort during a Photofacial skin care treatment. Anesthesia or numbing medicine is not required. When the Photofacial or IPL flash hits the skin you will feel a small snap or sting, but this is easily tolerated by all of my patients.

How Many Photofacial Skin care treatments will I Need?

Usually 3 Photofacial skin care treatments are required spaced 4-5 weeks apart for the best results. Multiple treatments are the price for gentle treatments that are not painful and do not injure the skin.

Technically enough power can be used to remove the brown spot or blood vessel in one treatment, but this energy level would be painful, blister the skin and possibly leave a scar. This is what happened with old time laser treatments, and the new Photofacial is designed to remove pigment and blood vessels painlessly and with no trace or scar left behind. To accomplish this we need to stage the removal in 2-3 treatments 4-5 weeks apart. The results are well worth the wait.

How Soon after My Photofacial Skin Care Treatment Will I See a Result?

Generally you will see the results of your Photofacial skin care treatment at 4-5 weeks. The brown spot will be lighter or gone and the red spot or blood vessel will be much smaller. Some patients with thin skin and very light pigment or small broken blood vessels will see complete removal after one treatment.

However most people see definite improvement 5 weeks after the Photofacial IPL treatment and require 2 more treatments for complete removal.


Who Should I Consult For My Photofacial or Intense Pulsed Light (IPL) Skin Care Treatment?

The best Photofacial or IPL machines are found in a physician’s office. Less powerful Photofacial machines are allowed to be used in Spas, but results are not as effective with these downgraded machines. In my experience patients do not get the results that they want in a spa, and often come to my practice for repeat treatments with the LuxGreen Photofacial after having already spent money for IPL in a spa.

The other benefit of having your Photofacial treatment in a physician’s office is that you will be examined by a doctor who can properly diagnose your skin condition. Some brown lesions are dangerous and require medical evaluation and should not be treated with IPL. If you have Rosacea or larger blood vessels on your face, a different therapy is required. These are medical treatments and should be done in a doctor’s office. Your skin will be evaluated for more serious skin conditions, and you will receive more effective Photofacial skin care treatments.

How Do I Find a Good Doctor to Do My Photofacial Skin Care Treatment?

Light based and laser non-surgical skin rejuvenation treatments are best done by a doctor who is well trained and specializes in anti-aging skin care. Your safest bet is to seek consultation with a board certified plastic surgeon or dermatologist who has experience in laser and light based therapies such as Photofacial or Intense Pulsed Light.

I am of course prejudiced because I am a board certified plastic surgeon. However, a plastic surgeon is trained and capable of providing the full range of non-surgical and surgical skin anti-aging procedures and can customize your skin care treatments to your unique face. Doctors who cannot provide all treatments are tempted to “fit your unique face” into the particular skin care treatment they offer, and that is not the best situation for you.

Good sources of honest objective information about choosing a physician are available at the following links:

American Society of Plastic surgeons

American Society of Aesthetic Plastic Surgeons

American Board of Plastic Surgery

American Society of lasers in Medicine and Surgery

Read our free newsletter to learn more about non-surgical facial rejuvenation. read Save Your Face to learn how to prevent skin aging.

Dr. Seckel
Concord, Massachusetts
Boston, Massachusetts

Cosmetic Laser Surgery–How Aesthetic Lasers Are Used To Improve Your Appearance

January 25th, 2009

Cosmetic is defined as “serving to beautify” or “used or done superficially to make something look better, more attractive, or more impressive.” Cosmetic plastic surgery is used to change the form appearance of the normal face and body to make these structures look good or more beautiful. Cosmetic plastic surgery is different from reconstructive plastic surgery which is used to change the form and improve function of damaged or deformed facial and body structures.

Cosmetic laser surgery involves the use of medical lasers to beautify and improve the form and appearance of normal face and body structures. Although the term cosmetic laser surgery is applied to a wide variety of laser procedures, many of the laser procedures are not truly invasive surgery. While some cosmetic laser procedures involve an incision with the laser, most do not break the skin, and achieve their cosmetic result with minimal skin injury.
Cosmetic laser surgery has revolutionized cosmetic and aesthetic plastic surgery during the past 10 years. The perception that cosmetic laser surgery can be done with the press of a button has led many people to believe that lasers are miracle machines that anyone, trained surgeon or otherwise can use and get good results. This is far from the truth, lasers are very complex, potentially harmful medical devices that require medical and surgical education in laser safety, laser tissue interactions, and safe medical and surgical techniques.

In this article I will try to explain for you, the potential patient, what cosmetic laser surgery can do for you, how the cosmetic or aesthetic lasers work, what the risks of cosmetic laser surgery are, and how you can find the appropriate doctor to have a safe and effective cosmetic laser treatment.

How is cosmetic laser surgery used to improve or beautify your appearance?

• Cosmetic laser eyelid surgery-
• Laser Liposuction-
• Cosmetic laser skin wrinkle removal-laser skin resurfacing-
• Laser skin tightening
• Laser removal of brown spots and sun damage on skin-
• Laser stimulation of new skin collagen or skin plumping laser treatments-
• Laser acne scar removal
• Laser skin scar removal
• Laser removal of excess skin blood vessels spider veins, and Rosacea
• Laser hair removal-
• Laser tattoo removal

How do cosmetic lasers work?

Cosmetic lasers and medical lasers work by heating tissue. Heat can be used to remove unwanted skin tissue like a skin wrinkle. Heat can also be used to stimulate the new growth of tissue for example new collagen in the skin. What is so special about lasers is that the heat produced by the laser can be very specifically and accurately directed to heat only very specific tissue that is to be removed or effected, and not heat the normal surrounding tissues that are to be left in place. Lasers have the ability to remove tissue, similar to what surgery does, without scarring the normal tissue surrounding the removed tissue.

This specificity or accuracy of laser tissue heating is based on the fact that laser light is monochromatic, that is of one color, depending on the particular laser used. Laser light is also coherent, which means it is focused, and this coherence or focusing of laser light makes the laser beam very powerful.

A laser beam can be directed to heat and destroy a very specifically colored skin target such as a red blood vessel. A red laser beam, a laser with a wavelength of 532nm (nm is the abbreviation for nanometer which is one billionth of a meter and is a term used to describe the wavelength of light in the visible light spectrum) which is in the red portion of the visible light spectrum, will be absorbed by anything that is red.

When the 532nm laser beam is applied to a blood vessel which contains red blood, the blood is heated by the laser, the blood “boils” and injures the blood vessel wall, and the blood vessel closes. This is how the laser is used to remove spider veins on the leg, small blood vessels on the face, and the small blood vessels that cause Rosacea.

This process is called target specific photothermolysis. What this means is that the laser can heat and destroy or change a very specific target based on its color. Photothermolysis means light (photo) heat (thermo) disintegrate or dissolve (lysis).

For you techies, the word laser stands for Light wave Amplification by Stimulated Emission of Radiation. A laser beam is a light wave that is stimulated by an electrical charge which amplifies the light to make it stronger, and the stronger light wave is emiited from the laser tube as radiation. Cosmetic or aesthetic lasers emit very specific colors which are highly and specifically absorbed by different tissues of the human body.

Laser Wavelengths used in cosmetic or aesthetic laser surgery.
Laser wavelengths are chosen based on the color of the tissue in the body that needs to be removed or altered. Some lasers target water inside the cells of the skin and simply vaporize or remove tissue. Below I will list some of the common laser wavelengths used in cosmetic laser surgery.

• 532nm-Absorbed by red-purple-used to vaporize blood vessels and spider veins

• 755nm-Absorbed by brown-black and used for hair removal and tattoo removal

• 924nm- The 924nm is absorbed by the color yellow and is used to dissolve fat during liposuction

• 1064nm-Absorbed by purple-black and used for hair removal and closure of large veins


• 1308nm
-Absorbed by fat and used in liposuction


• 1440nm and 1540nm
-Erbium absorbed by water and used to coagulate deep collagen in the skin to stimulate new collagen and plump skin wrinkles and acne scars

• 2940nm-Erbium absorbed by water, vaporizes cells, used to resurface the skin and remove wrinkles

• 10,000nm-CO2 absorbed by water inside the skin cells, ruptures the skin cell, used for incisions and to vaporize skin growths

Cosmetic laser surgery was introduced to plastic surgeons in 1995 yet many have been very slow to adapt to the new technology. The new technology is very expensive and requires a significant investment in lasers.

More importantly, I believe is that these new techniques require a totally different approach to surgery. In traditional plastic surgery the surgical scalpel, and thus the surgeons hand is always in contact with the patient’s skin. With cosmetic laser surgery, all cutting is done with the laser beam and thus direct physical contact with the patient’s skin by the surgeon does not occur.

In my personal view, a different part of the surgeon’s brain is used with this new technique. Older scalpel procedures are manual and the left side of the brain is used. The laser procedure is more of a spatial, visual task that uses the right side of the brain. This requires that the plastic surgeon re-learn basic surgical techniques. After many years of training in a left brain task, re-learning and adapting to a right brain technique is a difficult and challenging task.

You will have to ask your plastic surgeon if he/she performs laser eyelid surgery. The following are good places to start your search:

• Check the American Board of Plastic Surgery to find a board certified plastic surgeon in your area
• Check the American Society of Plastic Surgeons to find a plastic surgeon in good standing in your community
• Check the American Society of Aesthetic Plastic Surgeons to see if your plastic surgeon is experienced in and specializes in aesthetic or cosmetic plastic surgery.
• Check American Society of Lasers in Medicine and Surgery to see if your plastic surgeon has experience and interest in laser surgery
• Do a web search under “laser blepharoplasty”.

Be careful to choose a plastic surgeon certified by the American Board of Plastic Surgery. There are many non-surgeons who offer laser blepharoplasty. Don’t be fooled, you want a trained board certified plastic surgeon if you are considering laser eyelid surgery.

If you are interested in reading my published scientific article on laser blepharoplasty in The Plastic and Reconstructive Surgery journal you can read a summary online.

If you want to learn more about cosmetic or aesthetic laser surgery you can read the first medical book published on aesthetic laser surgery, which I wrote in 1995.

Laser eyelid surgery is a very significant advance in eyelid rejuvenation. Do your homework and find an expert. Let the laser help you look as good as you feel.

For more information on cosmetic laser surgery call 978-369-4499 or email me. Read my free newsletter to keep up with new developments in cosmetic laser surgery and non-surgical face and body rejuvenation. Read Save Your Face to learn how to prevent facial and eyelid aging.

Dr Seckel

Concord, Massachusetts
Boston, Massachusetts

Dear Dr. Seckel, I am interested in Botox. My first question is if Botox is safe? I have crow’s feet and lip wrinkles. I don’t want plastic surgery and I don’t want to be red form a laser treatment. Some people say your face looks like a figure in a Wax Museum and has no expression. Is that true? My doctor lets his nurse do the Botox injections but I think he should be doing it. How much does Botox cost. Thanks, Priscilla, Boston, Massachusetts

January 11th, 2009

Dear Priscilla,

Thank you for your question about Botox(TM). Botox(TM) is safe when the treatment is done by an experienced board certified physician who is an expert in facial rejuvenation. I do my own injections and do not have my nurse do the treatments. You will not have an expressionless face like that in a wax museum-especially if your treatments are done properly. Below I am reprinting an article of mine which gives a lot of information about Botox(TM).

Is Botox(TM) safe?

Yes when FDA approved Botox(TM) made by Allergan™ is used according to approved dosage by licensed physicians who are experienced in Botox(TM) use, in my opinion.

What Is Botox(TM)?

Botox(TM) is an injectable medication that relaxes facial muscles that cause lines or wrinkles. Technically called Botulinum Toxin A, Botox(TM) is synthesized in the laboratory by Allergan™, a major pharmaceutical company.

botox-before-and-after11.jpg Before and after picture of Botox(TM) treatment for crow’s feet.

Contrary to stories in the media Botox(TM) is not food poisoning bacteria and you cannot get food poisoning from a Botox(TM) injection. Botulinum Toxin A was discovered as a toxin created by the Clostridium Botulinum bacterium which is a cause of food poisoning which caused muscle weakness.

The synthesized, medical grade Botox(TM) used today has been safely used in medical practice for 30 years and is FDA approved. The first use of Botox(TM) was in children with spastic legs-the spasms were relaxed by this medication. Botox(TM) has also been used in Toticollis-painful spasms of the neck, and in Oculogyric spasms-tics or involuntary movements or twitches of the eyes.

How Does Botox(TM) Work on Wrinkles?

The wrinkles caused by the pull of your muscles of facial expression are called “dynamic lines” because they are dynamic or move. That is these wrinkles and lines are caused by repeated motion of muscles of facial expression-each time the muscle moves it pulls the skin into a wrinkle. After years of repeated motion, these wrinkles or lines become permanent.

Botox(TM) relaxes or quiets the muscles of facial expression. When the muscle is relaxed, the line or wrinkle caused by the muscle disappears.

Which Wrinkles Are Removed with Botox(TM)?

The lines of facial expression which are:

• Crow’s Fee
t-lines on the cheek around the eyes

• Frown Lines-the deep creases between your eyes at the base of your nose

• Worry Lines-the creases running across your forehead

• Bunny lines-the wrinkles at the base of your nose that wrinkle when you smile hard

• Lip Lines-the wrinkles around your mouth when you purse your lips

• Marionette Lines-the lines running from the corner of your mouth down to the jaw lie that pull the mouth down when you are angry or sad

liquid-facelift-_final.jpg Before and after Botox(TM) treatment for lip wrinkles as part of a liquid face lift which also uses the facial filler Radiess(TM).

How is Botox(TM) Given?

Tiny amounts of Botox(TM) are injected directly into the muscle that is causing the wrinkle or dynamic line. These injections are dosed in International Units (IU). Very small amounts of the solution are used.

Generally a treatment of 25 IUs 0f Botox(TM) is used to treat the crow’s feet and frown lines-5-6 IU in each side of the crow’s feet and 13-15 IUs in the frown lines. If the worry lines are also treated and additional 6.25 IU is placed into each side of the forehead for an additional 12.5 IUs.

Very small amounts of Botox(TM) are used around the mouth to avoid any interference with mouth function. Generally only 1 or 2 IUs are used on the upper lip for lip wrinkles-after treatment you may not be able to whistle or drink through a straw-but those lip wrinkles will be gone. Only 1 IU is used on each marionette line-this treatment can reduce the mouth line and help reduce the jowl.

Small amounts of Botox(TM) can also be used on the bands on the neck below the chin. 1 or 2 IUs in each band will reduce the folds or bands on the neck.

Does Botox(TM) Injection Hurt?

I use a topical numbing cream which is very effective. I also use a cold Titanium Roller to cool the skin which is very effective at numbing the skin and which also helps prevent bruising. My patients often do not even feel the injection. If the patient has had a previous Botox(TM) injection without these measures in a different office they are amazed at the difference.

What Does Botox(TM) Injection Cost?

Nationally Botox(TM) injections cost $20.00 per unit injected. If you are offered a discount or deal be sure to ask how many units you are getting. Some low priced offers are using diluted Botox(TM) which will not be as effective for removing wrinkles.

What Can Go Wrong with Botox(TM)?

Botox(TM) injections are safe when done properly by an experienced and licensed physician who is an expert in facial anti-aging therapy. However there are potential side effects which can occur-some are unavoidable-some are related to injection technique.

Generally there is about a 2% incidence of side effects in my current experience although initial studies years ago were higher. The more common potential side effects of Botox(TM) are:
• Headache
• Flu like illness
• Nausea
• Temporary eyelid droop

Eyelid droop is caused if the agent is injected too low in the forehead near the eyelid, and does not occur with the typical forehead injection.

Where Should I Go to Learn about Botox(TM)?

See an expert in facial rejuvenation and anti-aging skin care therapy. In my opinion experts are board certified dermatologists and plastic surgeons that specialize in facial rejuvenation procedures.

Study your doctors website and ask questions-especially ask how many Botox(TM) injections they have done and how many they do each week. Experience is very important in getting the best result and avoiding complications.

Don’t go to Botox(TM) parties-I have seen some unhappy results on patients who have had Botulinum Toxin A injections in a non medical setting.

My opinion is that you want an expert who is board certified in dermatology or plastic surgery who is an expert at what causes facial aging and wrinkles, knows all of the various techniques for correcting facial aging, and knows which treatment is best for your unique face. Some doctors are now handing Botox(TM) injections over to nurses or PA’s because they dont want to be bothered by doing an injection. I am a board certified plastic surgeon with 26 years of experience. I do every Botox(TM) injection in my praqctice. I believe I can do the injection better, my patients prefer that I do the injection and I believe patients deserve my expertise. attention and care when they are paying for this service.

Botox(TM) is one of the most revolutionary advances in anti-aging skin care in the past 10 years. Regular use can actually prevent permanent wrinkles from occurring on your face. In terms of facial aging, prevention is the best cure.

To leaqrn more about Botox(TM) call 978-369-4499 or email me. Read our free newsletter for updates on non-surgical facial rejuvenation. Read Save Your Face to learn how to prevent facial aging.

Dr. Seckel
Concord, Massachusetts
Boston, Massachusetts

Dear Dr. Seckel, I am scheduled to have Smartlipo laser liposuction on my tummy. The doctor said I could return to work the same day. I have read your blog about Slimlipo which you seem to prefer. What are the risks of laser liposuction? My doctor assured me that laser liposuction was safe. I have searched the net and found nothing about laser liposuction risks and complications. I have a pre op appointment next week and assume I will be told the risks then. I know all surgeries have risks and I am surprised I can find nothing on the net about the risks of laser liposuction. I have read about the risks of regular liposuction but no information seems to be available about laser liposuction. Thanks for your help, Lindsay, Boston, Massachusetts.

December 27th, 2008

Dear Lindsay,

Thank you for your email about the risks of laser liposuction. Laser liposuction is a new procedure so there is not much information about problems, risks, and complications published yet.

Much of the marketing for laser liposuction, laser liposculpture and laser body sculpting give the impression that the new procedure is a safe, risk free, painless and quick procedure. I have read and heard claims that you can have your procedure done under local anesthesia, lose your fat, tighten your skin, and go on with your life, even back to work, the same day. If it sounds too good to be true it usually is-we all know that.

The perception that laser liposuction is easy to do has also encouraged some professionals without surgical training or no formal training in aesthetic surgery to offer this this new procedure to patients in their practice or Spa.

While I enthusiastically support laser liposuction as a revolutionary new advance in plastic surgery, it is still a surgical procedure. All surgical procedures have risks and the potential for complications.

Many of the risks of laser liposuction are those associated with any traditional suction procedure. However, the introduction of heat by the laser during liposuction poses some newer potential complications. If the fiber is placed too close to the skin for too long, or one area is treated to aggressively, there is risk of thermal injury, a burn can occur.

Risks of Laser Liposuction


• Skin Burns
-Laser liposuction utilizes laser energy to heat fat and liquefy fat. This makes fat removal easier. In my experience with laser liposuction skin burns are very rare and are easily avoided by proper technique.

• Skin Loss-Too aggressive use of the laser too near the skin can create a burn and the overlying skin can be damaged and lost. Again, technique and experience are key to avoiding this complication.

• Bleeding-In my experience bleeding is less with new laser liposuction procedure than with standard liposuction. But bleeding can occur as with any surgical procedure.

• Infection
-Infection can occur with any invasive procedure. Since the laser fiber is inserted underneath the skin, sterile operating room precautions and antibiotic coverage are necessary.

• Anesthetic Risks-Several well publicized deaths after liposculpture and suction body contouring were caused by overdose of lidocaine, the anesthetic used to control pain during the procedure. Training and experience are keys to avoiding this.

• Contour Deformities
-Wavy lines, depressions and lumps or bumps in the skin occur in 20% of standard liposuction patients. These contour deformities are caused by irregular fat removal and fat removal too close to the surface of the skin. In my experience contour deformities are much less common with new laser assisted procedure. I believe this is because fat is dissolved by the laser and fat removal is less traumatic.

• Loose Skin-Loose skin after liposculpture or laser body sculpting and fat removal has always been the major drawback to high volume fat removal in older patients with poor skin elasticity. The major advance with the new laser assisted procedure is that the heat from the laser tightens the skin. In my experience loose skin is very uncommon with the new procedure. However, technique and experience are important to avoid loose skin after fat removal.

• Inexperienced or untrained Doctor
-Specialized surgical training, technical skill, aesthetic knowledge and judgment, and experience are necessary to achieve a good result in any type of surgery. This is especially true in an aesthetic procedure like laser body sculpting where results are visible and the surgery is purely elective. Only a medical license is required to perform cosmetic surgery in this country. If you are considering liposculpture or body contouring surgery, do your homework and check out the credentials of your surgeon.

Major Benefits

I do enthusiastically endorse the new laser assisted technique as a revolutionary advance in technology. The laser technique is the only one I now use in my practice. Results of laser liposuction for double chin removal and laser tummy tuck are remarkable, see before and after pictures below.

before_and_after_4_days_post_edited-1.jpg

amanda-best-size.jpg

The advantages are very clear in my anecdotal experience and are:

• Skin Tightening
• Smoother skin
• Less bleeding
• Less trauma
• Quicker recovery

I predict that this new technique will set the standard for liposculpture and body contouring results in the future.

How to Choose a Surgeon

I admit up front that I am prejudiced in my opinion because I am a board certified plastic surgeon. Liposculpture with or without the laser is a surgical procedure and as with heart surgery, brain surgery or any other type of surgery, if I am having surgery I am going to do my homework and find the best board certified surgeon I can find to perform my operation.

Board certified plastic surgeons spend many years in training and have to have several years of experience and have to demonstrate their knowledge, experience and skill to pass their board examinations. Surgery is a technical, manual as well as intellectual task, and most doctors that possess these fine motor qualities are drawn to surgical training and specialty.

There are also doctors who are not board certified plastic surgeons that are skilled and experienced at this technique, most commonly board certified dermatologists trained in dermatologic surgery. Just do your homework and make certain your doctor is trained and experienced.

I always recommend that patients do the following when considering plastic surgery:

• Consult 2 board certified surgeons
• Ask the doctor how experienced he/she is at the procedure you are considering
• Ask to see photos of their surgical results
• Ask to speak to one of their patients who have had the surgery
• Go online and check the doctors credentials
• Ask your family doctor about the reputation and skill of the doctor you are considering
• Ask your friends about the reputation of the doctor
• Read about the procedure you are considering-an excellent resource is The American Society of Plastic Surgeons.

Plastic surgery can create very beautiful results when the proper procedure is done on a properly selected appropriate patient. If you are considering any type of plastic surgery do your homework. Read more about the procedure you are interested in. Study the bio and credentials of the board certified plastic surgeons in your area. Be an informed consumer.

An educated patient has the best chance of obtaining a happy and satisfying result. The websites of the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) have excellent, honest information. By visiting these websites you can learn about the various procedures and find board certified plastic surgeons in your area.

Dr. Seckel

Concord, Massachusetts
Boston, Massachusetts

Dear Dr. Seckel, I have purple or blue dark circles under my eyes. I also have a lot of blood vessels under my eyes. I have used a concealer eye cream but the dark circles show through. I have read about laser eye surgery for dark circles but I don’t have eye bags, just dark circles under eyes. Can the laser remove blood vessels from the skin under the eyes? I think if I had fewer blood vessels showing the dark circles under my eyes would be lighter. Do you recommend the laser? Thanx, Donna, Boston, Massachusetts.

December 26th, 2008

Dear Donna,

Thank you for your email about dark circles under eyes. You are very perceptive, as most people do not recognize how often small blood vessels can cause dark circles under eyes.

If you see small red and purple blood vessels on the lower eyelid and the skin has a blue or purple color then blood vessels may be the cause of your dark circles under eyes. Dark circles under the eyes effects millions of people. Many people have the arcus deformity which is a hollow depression under the eye. The arcus deformity requires laser surgery for removal. Many have eye bags or puffy eyes which create a deep dark circle under the eyes. Some people have brown pigment or sun damage on the lower eyelids which causes a dark circle look. In my experience, most patients who complain of dark circles under the eyes have broken blood vessels and a dark blue or purple color on the skin under the eyes.

The different causes of dark circles under eyes are each unique and each requires a very different treatment method. Broken blood vessels and small veins that cause dark circles under the eyes are best treated with intense pulsed light treatments. Dark circles caused by the arcus deformity require surgical release of the arcus marginalis. Excess pigment causing dark circles requires laser treatment.

dark-circles-before-after2.jpg

We inherit the color and characteristics of ourr lower eyelid skin from our parents. Dark circles often appear during childhood, many people tell me they first noticed dark circles when they were 9 or 10 years old. Since you apparently have broken blood vessels causing your dark circles I am going to add some information from an Ezine Article that I wrote about broken blood vessels as a cause of dark circles under the eyes. Broken blood vessels are the easiest cause of dark circles under eyes to treat and correct.

How Broken Blood Vessels Cause Dark Circles under Eyes?

Actually what most people call broken blood vessels are not really broken blood vessels. What most people see are visible blood vessels on the skin in areas that they do not expect to see blood vessels. These small vessels are arterioles, venules, and capillaries. Arterioles carry fresh blood to the skin and venules take old blood away from the skin, back to the heart and lungs to be refreshed with oxygen. Capillaries connect the arterioles and venules. Normally blood vessels are deeper in the skin and not visible. Visible or broken blood vessels become noticeable in the following situations:

• Thin Skin- The eyelid skin is the thinnest skin in the body. The eyelid skin is only 1/6 the thickness of the skin on the rest of the face. The skin is so thin that you can see through it. You can actually see the small blood vessels in the skin of the eyelid. These same vessels are present in all skin but are not visible in thicker skin elsewhere in the body. The lower eyelid muscle is purple, and this color is visible through the eyelid skin. That is why all lower eyelids have a darker color. This color is what most people refer to as dark circles under the eyes.

• Telangiectasias or Spider Veins
- The small bood vessels seen in dark circles under the eyes can be dilated or enlarged a condition called telangiectasia or often referred to as spider veins. The dilated or enlarged vessels can be arterioles or venules. Telangiectasias are most often caused by heredity. However, aging, pregnancy, use of topical steroid cream, excessive exertion such as weight lifting, and Rosacea also can cause telangiectasia

• Aging and Inflammation- Ultraviolet radiation and other skin aging factors produce inflammation or irritation to the skin, especially the thin skin around the eyes. When eyelid skin is inflamed, new blood vessels grow into the skin to repair the damage. These new blood vessels stay in the skin and are visible. The presence of these blood vessels darkens the color of the lower eyelid skin and can appear as dark circles under the eyes.

How To Remove Dark Circles under Eyes Caused by Broken blood Vessels

Lasers can remove broken blood vessels under the eyes, but newer light based treatments are safer and better. The newer technique called Intense Pulsed Light (IPL) or photo facial is a much gentler procedure that is very effective and does not leave marks or white areas under the eye, a major problem with older laser techniques.

• IPL- Photo Facial
-Intense pulsed light (IPL) is not a laser. IPL uses a bright flash of visible light which is tuned to be absorbed by the specific color of blood. The light passes through the skin without injuring the skin and is preferentially absorbed by the blood in the small broken blood vessels-venules and arterioles. The light energy causes the blood to boil and the heat causes the blood vessel to shrink and close. The process takes about 6 weeks. Usually 3 IPL treatments scheduled 6 weeks apart are required to remove all of the vessels causing the dark circle under the eye. Eye shields must be placed on the eye to protect the eye from the light. IPL is the best treatment for Rosacea.

• Laser- Two laser wavelengths are specifically absorbed by blood vessels-the 532nm and 1064nm laser wavelengths. The 1064nm laser is usually too strong to be used on the eyelids. The 532nm laser is the one more commonly used to correct dark circles under eyes caused by blood vessels. However, because the laser is so strong, the eyelid skin is often damaged and a scar or white area on the eyelid skin can occur. Since IPL has been developed, the laser is no longer the choice for treating dark circles under eyes. Eye shields must be [placed on the eye to protect the eye from the laser.

• Vein Injections- Very large and noticeable veins on the lower eyelid can be closed by injecting a sclerosing solution that is most commonly used on the lower legs to treat spider veins. This is a very tricky procedure and should only be done by an expert experienced in this technique.

• Fractional laser resurfacing to thicken skin
- New fractional laser resurfacing techniques are safe to use on the eyelids with eye protective shield in place. These new fractional laser techniques plump or thicken the lower eyelid skin and can improve dark circles under eyes. Thicker lower eyelid skin helps camouflage the broken blood vessels and Telangiectasias.

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Prevention of Dark Circles under Eyes caused by Broken Blood Vessels

Inherited dark circles under eyes cannot be prevented. However there are things we can do to prevent new blood vessels from forming and making the dark circles worse. Since Ultraviolet radiation from the sun causes inflammation and new blood vessel growth, sun protection is the most important.

• Sun block- Always make sure that you apply sun block to the eyelids when you apply sun block to your face.

• Eye protection
-Always wear protective sunglasses that cover the crow’s feet areas as well as the eyes.

• Anti-inflammatory-Medical grade topical Vitamin C Serum is a powerful anti-inflammatory medication. Its use on the face and eyelids can help reduce inflammation which leads to new growth of blood vessels and Telangiectasias on the facial and eyelid skin.

If you are bothered by dark circles under eyes and can see many small blood vessels on the lower eyelid skin, IPL may be the answer you are looking for.

For more information on dark circles under eyes call 978-369-4499 or email us. Read our free newsletter to learn about new non-surgical rejuvenation techniques. Read Save Your Face to learn how to prevent facial aging.

Dr. Seckel
Concord, Massachusetts
Boston, Massachusetts