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Dear Dr. Seckel, I have a c section scar which looks horrible. There is a flap of skin hanging over the c section scar which makes my tummy bulge and shows under my bathing suit. I want this bulge removed but don’t want a bigger scar and would like to be able to wear a two piece again. I am otherwise very fit. Thank you, Brenda, Boston, Massachusetts.

May 4th, 2008

 

Dear Brenda, 

Thank you for your email. Your complaint is a very common one today and fortunately you can get back into your two piece with a modern mini or bikini tummy tuck procedure. With modern techniques the tummy tuck or abdominoplasty scar can be hidden under your bikini or swimming suit using the bikini tummy tuck.

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Above-Before and After the Bikini Tummy Tuck to Remove C-section Scar

The bikini tuck works best when there is small to moderate skin excess of the lower abdomen. The bikini tuck works well to remove the C-Section scar and the flap or bulge above the C-section scar.

Many people want to have a tummy tuck but don’t want a visible scar. By placing the incision low and following the lines of your bikini, the scar is hidden by most bikinis and today’s brief underwear.

There is no scar on the “belly button” with the bikini tummy tuck.

To learn more about the tummy tuck procedure visit drseckel.com or contact me.

Be sure to sign up for my free email newsletter.

Thank you,

Dr Seckel

978-369-4499

Boston, Massachusetts

Concord, Massachusetts

Dear Dr. Seckel, I had breast implants several years ago and I have bumps on my implants that I can feel. Sometimes in the right light I can see a bump or fold along the bottom of my breast that feels like the implant. Should I be concerned? Thank you, Mary, Boston, Massachusetts.

April 12th, 2008

Dear Mary,

You should have your doctor examine you to be sure you do not have a breast lump.

It is common especially after breast augmentation with saline breast implants to feel folds or bumps in the breast implants. Sometimes they are visible. The breast implant bump or fold is usually a fold in the saline implant and is not dangerous. Causes of breast implant bumps after breast augmentation can be:

  1. The valve used to fill the saline breast implant
  2. A fold in the shell of the breast implant
  3. A capsule or scar tissue around the implant.
  4. A very loose pocket around the implant so the implant is not held firmly in the breast
  5. Very thin skin with minimal breast tissue-inadequate coverage of the breast implant
  6. Breast implant placed beneath the breast gland instead of beneath the chest muscle-again less tissue covering the implant.

The breast implant bumps or folds are not dangerous but do bother patients very much especially if they are visible.

You can minimize the chance of breast implant bumps or folds during breast augmentation by:

  1. Use silicone gel implants-they are less likely to fold
  2. Place the implant beneath the chest muscle-this provides more coverage for the implant
  3. If the breast implant pocket is too large, an operation can be done to tighten the pocket. If this is done I recommend replacing the saline implant with a silicone gel implant
  4. Massage the breast implants daily

Of course it is important to have your doctor examine your breasts to make certain the bump you are feeling is not a breast lump. If this is the case you will need a medical work up to make certain the breast lump is not dangerous.

Breast implant bumps or folds are almost impossible to avoid when using saline implants in thin women with minimal breast tissue.

Today I most often use the new silicone gel breast implants for breast augmentation which usually, but not always, do not form breast implant folds or breast implant bumps.

The results can be excellent.

Breast Augmentation III

For more information on breast implants contact me. Be sure to sign up for my free email newsletter.

Dr Seckel

978-369-4499

Boston, Massachusetts

Concord, Massachusetts

Dear Dr. Seckel, I had a tummy tuck 6 months ago and the scar on my abdomen is red and itchy. I did not have the bikini tummy tuck you write about but I wish I had. Is there anything I can do about the scar? Thank you, Denise, Boston, Massachusetts

April 12th, 2008

Dear Denise,

Red itchy scars are called hypertrophic scars and are common following abdominoplasty. They are more common when:

  1. The skin is pulled too tight
  2. Too much skin is removed
  3. You are too active and stretch or stress the skin soon after surgery
  4. Your belt buckle or tight clothing irritates the wound
  5. Some people are prone to develop hypertrophic scars.

Ideally a properly done tummy tuck like the bikini tummy tuck will have minimal scars which are well hidden (see below).

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Above-Before and After Bikini Tummy Tuck

There are several ways to improve red scars or hypertrophic scars after tummy tuck or abdominoplasty:

  1. Apply 1% Cortisone cream to the scar
  2. Inject Cortisone into the scar
  3. Apply Cordran Tape to the scar
  4. IPL (Intense Pulsed Light) treatments to the scar
  5. Lux 1540 Laser Treatments to the scar

Cortisone cream and Cordran Tape can only be used for limited time periods because Cortisone a steroid cream can cause skin atrophy.

I use the IPL to remove redness and the Lux1540 Laser to soften and reduce the scar.

The IPL and Lux1540 laser treatments are safe, new and very effective. They are my first line for any red scar or raised scar today.

Results on very difficult scars can be excellent. (See below)

1540-scar-before-and-after.jpg

For more information on the newest laser treatments read Save Your Face or contact me.

Be sure to sign up for my free email newsletter.

Thank you,

Dr Seckel

978-369-4499

Boston, Massachusetts

Concord, Massachusetts

Dear Dr. Seckel, Can you tell me what the bikini tuck is? I have had two kids, I am 38 and very fit. However I cannot get rid of the excess skin on my tummy. I run, work out and do abdominal exercises but that role above my bikini won’t go away. Please help, Cindy, Boston, Massachusetts.

April 11th, 2008

Dear Cindy,

The bikini tuck or bikini tummy tuck is a modified abdominoplasty which places the scar in a position which is hidden when you wear a bikini. The results are excellent and you can still wear a bikini when you go to the beach after your tummy tuck.

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Above-Before and after Bikini Tuck Abdominoplasty.

The bikini tuck works best when there is small to moderate skin excess of the lower abdomen. The bikini tuck also works well when you have a C-Section scar.

Many people want to have a tummy tuck but don’t want a visible scar. By placing the incision low and following the lines of your bikini, the scar is hidden by most bikinis and today’s brief underwear.

There is no scar on the “belly button” with the bikini tummy tuck.

To learn more about the tummy tuck or abdominoplasty procedure visit drseckel.com or contact me.

Be sure to sign up for my free email newsletter.

Thank you,

Dr Seckel

978-369-4499

Boston, Massachusetts

Concord, Massachusetts

Dear Dr. Seckel, I have enlarged pores and oily skin. I have had acne outbreaks in the past and have some scarring. What is the best laser or other treatment to reduce enlarged pores? I live in Boston and can come to see you. Angela, Boston, Massachusetts

March 30th, 2008

Dear Angela,

Thank you for your question about laser treatment to reduce enlarged pores and acne scars. There have been many laser therapies and IPL therapies recommended to reduce enlarged pores but few of them have been satisfactory.

I am happy to say that the new non-ablative fractional laser skin resurfacing machines do work and are by far the best laser treatment for enlarged pores and acne scars.

I use the Lux1540 fractional erbium laser to treat enlarged pores and acne scars. The results are much better than any previous laser in my opinion (see photo below).

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Above-Photo of forehead before and after Lux1540 fractional laser treatments.

The lux1540 fractional laser is a non-ablative laser which means that the Lux1540 does not ablate or remove skin, thus there is no or minimal downtime. Only a topical anesthesia cream is required.

The Lux1540 fractional erbium non-ablative laser works by actually building new columns of collagen in the deep skin layers. These columns of new collagen actually plump the skin and acne scars and the plumping compresses the walls of the enlarged pores. (See photo below)

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Above-Cross section of skin treated with the Lux1540 fractional laser showing new skin plumping columns of collagen (solid pink is new collagen).

The lux1540 fractional non-ablative erbium laser has also been effective for other types of scars and can improve facial skin wrinkles caused by aging.

Be sure to read my other blogs on enlarged pores which cover other very important basic steps you need to take to reduce enlarged pores. It is very important to do deep exfoliation and use drying agents such as Brevoxyl washes to reduce oil content in the skin. Increased oil enlarges pores and can block pore openings.

For more information on skin care and new laser skin technology read Save Your Face or contact me.

Be sure to sign up for my free email newsletter.

Dr. Seckel

Concord, Massachusetts

Boston, Massachusetts

Dear Dr. Seckel, I am 43 years old and have had breast implants for 10 years. My implants are saline implants and they look great but I can feel folds in the implants at the bottom and side of my breasts. I have heard that the new silicone gel breast implants feel more natural and are less likely to develop folds than the saline breast implants. Is that true? Are the new silicone gel breast implants safe? How difficulty is it to replace the old saline implants with the new silicone gel implants. Thank you, Caitlin, Boston, Massachusetts

March 29th, 2008

Dear Caitlin,

Thank you for your email. Breast augmentation or breast enlargement with breast implants is one of the most common plastic surgery procedures. Results are usually excellent and patient satisfaction is very high.

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Above: Before and after breast augmentation

Breast augmentation is also frequently done in combination with a breast lift for patients who have had sagging or breast ptosis after having children:

Breast Lift Before and After

Above: Before and after breast lift and breast augmentation

 

Unfortunately a very high per cent age of Saline breast Implants do develop palpable, and occasionally visible folds after a number of years. The problem is intrinsic to the saline implant and is the most common complaint I receive. The breasts usually look excellent but patients just don’t like the feel of the saline implant especially if they feel the fold. Most commonly the fold occurs, as it has in you, at the bottom of the breast and towards the side.

Most plastic surgeons over fill the saline implants to avoid this problem but folds still do occur.

The new silicone gel breast implants are much less likely to cause folds and generally feel more natural than saline breast implants. Safety data for the new silicone gel breast implants for breast augmentation and breast enlargement is excellent and complication results are very similar for saline implants and the new generation of silicone gel implants.

 

Breast Augmentation III

Breast implant folds are felt to be more common with low profile breast implants. The low profile implants have a wider base and less projection and do have a greater tendency in my experience to cause folds.

Today I more frequently choose a moderate or medium profile implant which projects the breast more forward and has fewer tendencies to fold.

In your case, since you have had folds in your saline breast implants my recommendation would be to replace your saline breast implants with a moderate profile silicone gel breast implant, possibly a bit larger to fill the space and compensate for any stretching of the skin from your previous breast implants.

My experience with the new silicone gel breast implants has been very positive. Patient satisfaction with the silicone gel breast implants has been very high and patients who have replaced their saline breast implants with the new silicone gel moderate profile breast implants have been very happy with the results.

The safety data are very similar for both the saline and new silicone gel breast implants. The one downside is that the FDA recommends follow up MRI scans to check the implant at 2 years. This is a safety feature but can be an inconvenience to you.

Typically the procedure to remove your old saline breast implants and replace them with new silicone gel breast implants is a very simple procedure with less discomfort and recovery than was experienced with the initial breast implantation or breast augmentation surgery.

Thank you for your excellent question.

If you would like to learn more about plastic surgery or breast implants please visit DrSeckel.com or contact me at 978-369-4499.

Be sure to sign up for my newsletter to learn about new developments in breast augmentation and plastic surgery.

Thank you,

Dr Seckel

978-369-4499

Concord, Massachusetts

Boston, Massachusetts

Dear Dr. Seckel, I have broken blood vessels and spider veins on my legs? Is laser treatment the best way to get rid of leg veins? Thank you, Doreen, Boston, Massachusetts

March 27th, 2008

Thank you for your important question. Millions of people men and women alike are bothered by broken blood vessels, leg veins and spider veins on the calves and thighs.

We do have the latest and most effective broken blood vessel, spider vein and leg vein treatments available in our office. We use the Palomar®Lux1064® laser to remove spider veins and leg veins which is different from endovenous laser therapy.

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Before and After Lux Green IPL Treatment of Starburst Spider Veins

There have been many other lasers used to treat broken blood vessels, leg veins and spider veins but most have not been able to effectively remove larger spider veins and leg veins and have not been able to treat the deeper communicating veins and thus the spider veins and leg veins tend to come back.

The 1064 laser is the best laser to treat spider veins and leg veins because it is able to remove veins as large as 4 mm in diameter and is able to penetrate deeper beneath the skin surface where the communicating veins reside.

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Before and After Leg Vein Treatment with the Lux Green IPL

I have tried all of the 1064 lasers on the market and chose the Palomar®Lux1064® laser because in my hands it worked the best. The Lux1064® effectively removes spider veins and leg veins and larger red vessels on the face. More importantly the Palomar®Lux1064® is much les painful than the other 1064 lasers I tried. I believe the unique pulse characteristic of the Palomar®Lux1064® delivers the laser energy in a way that causes much less discomfort than the others I tried.

Laser removal of spider veins and leg veins is effective for veins with a diameter of 4 mm or less. Larger and starburst leg veins may require sclerotherapy which is an injection technique. With sclerotherapy a solution of hypertonic saline is injected into the larger veins to close them. Afterwards the 1064 laser is used to “clean up” the smaller veins left behind.

Larger leg veins that are actually bulging out from the skin are called varicose veins. Varicose veins have traditionally been removed by surgery requiring an incision. However new endovenous laser therapy can remove larger leg veins without surgery by placing a laser catheter inside the vein and closing the varicose vein with endovenous laser energy.Endovenous laser therapy is a revolutionary and very exciting new treatment for varicose veins.

If you would like to learn more about the laser removal of leg veins, spider veins, and starburst veins please contact me. Be sure to sign up for my free email newsletter to keep up with new developments. For more information on prevention of aging and the new laser technology read Save Your Face.

Thank you,

Dr. Seckel

978-369-4499

Concord, Massachusetts

Boston, Massachusetts

Dear Dr. Seckel, I am a 2nd year Nursing Student and am very interested in your field and lasers. There are no formal nursing programs that I can find on cosmetic nursing. I am reading a lot about cosmetic medicine and medical aesthetics but can find no formalized discussion of what these fields entail and where in medical aesthetics a nursing background would be most appropriate. Can you shed some light on what constitutes the fields of medical aesthetics and cosmetic medicine? Thank you, Audrey, Boston, Massachusetts.

March 22nd, 2008

The dictionary definition of aesthetics or esthetics includes “outward appearance-the way something (someone) looks, especially when considered in terms of how pleasing it (he/she) is.” It also includes the phrase “idea of beauty-an idea of what is beautiful or artistic.” Cosmetic is defined as “superficial measures to make something appear better, more attractive, or more impressive”. (Definitions from Dictionary.com)

Medical Aesthetics or Medical Esthetics and Cosmetic Medicine are relatively new terms which describe an emerging field of medicine in which medical science, medical procedures and medical expertise are utilized by physicians to enhance or beautify peoples outward appearance.

The fields of Medical Aesthetics and Cosmetic Medicine are major departures from traditional medicine which has always been directed towards curing disease, relieving human suffering, and improving the quality of human life. Whether we approve or disapprove of the diversion of precious medical talent and research effort away from the traditional, essential, and medically necessary health care field, this radically new cosmetic or aesthetic field of Medical Aesthetics is growing rapidly. These aesthetic or cosmetic medical services are in great demand and demand for these services seems to be here to stay.

With increasing demand for modern skin rejuvenation and other cosmetic treatments, and the trend for these services to be performed in Medical Spas with no doctor present, patient safety has become an increasingly important concern for patients, doctors, and regulatory agencies. The new, more effective laser and injectable Medical Aesthetic or Cosmetic Medical procedures require medical training and expertise and are not safely done in traditional aesthetic or esthetic salons and spas. From a public health and safety standpoint their is increasing concern that a Spa may not be the ideal environment in which to do potentially dangerous and invasive medical procedures.

In the paragraphs below, I will detail what I perceive to be the types of procedures which are currently considered to be within the field of Medical Aesthetics (Esthetics) or Cosmetic or Aesthetic (Esthetic) Medicine. Bear in mind that all of the procedures I discuss below should be done under the supervision of a physician if they are to be considered medical aesthetic procedures.

Medical Aesthetician (Esthetician) Services

Microdermabrasion:

Microdermabrasion is my favorite “no down time” skin care procedure or medical aesthetics procedure and is the most popular aesthetician service in my practice. In this procedure, a medical aesthetican, in my office, provides deep skin exfoliation on your face. The aesthetician uses a technique using micro crystals or various chemicals to exfoliate your skin, removing sebum, unblocking pores and removing dead skin cells and superficial pigment. These treatments also stimulate the production of new collagen in the upper layers of the dermis.

Following microdermabrasion, your skin looks and feels smooth and refreshed. Because dead skin has been removed, topical treatments like Retin A, Retinol, AHAs, and Vitamin C can more easily penetrate the skin. Skin biopsies have shown that, following six microdermabrasion treatments, the epithelium is thicker and healthier-looking and there is an increase in superficial dermal collagen. Both are important goals in any anti-aging treatment. In addition to providing significant microscopic improvement in the skin, microdermabrasion patients report high satisfaction with the treatment in clinical studies.

While these skin care treatments are performed in salons, I believe it is much more valuable if a doctor first examines your face and makes a total skin care recommendation. More importantly, microdermabrasion is most effective if used in an comprehensive, multi-step rejuvenation program involving prescription topical creams and other more sophisticataed procedures, which only can be done in a physician’s office.

Micropeel®

Micropeel is a Medical Aesthetics or Cosmetic Medicine procedure that is to a combination of dermaplaning (scraping dead skin off your face) and applying a dilute AHA (glycolic acid) solution following the dermaplaning. This is referred to as “the lunchtime peel” because pinkness is minimal and you can go back to work after this is done. This skin care procedure was developed by Biomedic® as a useful adjunct to anti-aging therapies and is useful for patients who have sensitive skin who cannot tolerate the microdermabrasion.

 

This procedure is also a very helpful skin care technique for acne patients. MicroPeel Plus is also available with added salicylic acid, which makes the peel go a little bit deeper for more effective skin exfoliation and the stimulation of new collagen growth in the dermis. This Medical Aesthetics or Cosmetic Medicine procedure is an aesthetician service that should be performed by a trained medical aesthetician in a physicians office.

Superficial Chemical Peels

Superficial peels with either AHAs (Alpha Hydroxy Acids) like Glycolic and Lactic Acid 20-30% or salicylic acid are a Medical Aesthetics or Cosmetic Medicine procedure that can be applied by medical aestheticians in a doctor’s office under the supervision of a physician and are an excellent skin care treatment. These peels provide skin exfoliation, removal of superficial pigment, and can also stimulate new collagen production.

The deeper skin care peels, with high percentage AHAs (50-70%), TCA peels and phenol peels should only be performed by a physician. These are not minimally invasive. Deeper peels, such as these, can be very effective, but there is significant down time.


I do not use deep peels because the risks of scarring and hypo-pigmentation (whitening of the treated skin) are too great. Most physicians today prefer laser resurfacing if a deeper peel is needed. This is a much more controllable, less risky form of facial resurfacing. Some doctors get beautiful results with the deeper peels and are more experienced than I am in their use. However I have simply seen too many patients who suffered complications after another doctor has done their peel, and at that point, unfortunately, there is nothing I can do to help them.

Dermasound

Dermasound is a new Medical Aesthetics osmetic Medicine skin care treatment that uses ultrasound for skin exfoliation and deep cleaning. Following Dermasound skin care treatment, a great deal of oil, sebum, and skin debris is removed from the surface of the skin.

It is postulated that Dermasound treatments can also improve the penetration of topical skin care creams. Patients with oily skin and acne prone patients benefit from a combination of Dermasound and microdermabrasion treatments done at the same session. Dermasound is becoming one of the more popular aesthetician services.

Permanent Eyeliner and Lip Liner-Micro Pigmentation

Many patients today desire to have permanent eye liner and lip liner applied. When done correctly micro pigmentation is a medical aesthetics procedure which can produce a beautiful result. The benefits are time saving and a permanent appearance.

Micro pigmentation for permanent eyeliner and lip liner is an aesthetician service performed in our office by a very talented and experience nurse-medical aesthetician.

Importantly we protect the eye with eye shields and use topical numbing cream on the eyelids and nerve blocks on the lips. These techniques significantly improve the safety and your comfort during these procedures.

IPL - Photofacial Skin Rejuvenation

The Medical Aesthetics or Cosmetic Medicine procedure called IPL stands for Intense Pulsed Light. IPL is not a laser procedure. IPL is a bright flash of visible light, like a flash bulb, but very powerful. IPL is produced by a machine that has different filters or lenses that can be used to control the color of the light or IPL beam that comes out of the handpiece.

The IPL can be tuned to target specific problems in the skin. When the IPL is tuned red, the IPL light is absorbed by blood in skin blood vessels, the light heats the blood, injures the blood vessel and the blood vessel is removed from your skin. The same tuning is possible to remove pigment. The technical term for this is photothermolysis. Photo means light, thermo means heat, and lysis means dissolve; thus the light energy heats the target and dissolves it.

IPL is unique because it is target specific. This means the IPL only removes the specific target, pigment or blood vessel and does not injure the surrounding skin. This makes IPL, or Photofacial, a “no down time” procedure with minimal or no recovery time required.

IPL is used to:

Remove pigment

Remove red spots, small blood vessels, and Rosacea

Improve skin texture

Reduce pore size

Rejuvenate the skin

Improve fine lines

IPL is a powerful therapy. Although performed often by a nurse or aethetician, IPL, in my opinion, requires medical supervision and should be performed under the supervison of a doctor, preferably in a doctor’s office. Three to four treatments are usually required for the best result.

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Above before and after IPL (Photo courtesy of Palomar Medical)

 

IPL is a very safe, no down time procedure for the conditions listed above.

Eye protection is required for you and all personnel in the treatment room.

Skin Tightening- The “Non surgical Face Lift?”

 

Everyone over 40, and many in their 30’s, see facial and eyelid aging changes in their skin. No one wants to see these changes and many people consider some type of facial rejuvenation therapy. But no one wants a face lift, which is the only way to get the result pictured below: (Contact Dr Seckel)

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Whether it is fear of surgery or the stigma of having surgery, almost everyone who comes in to my plastic surgery office tells me they want to look younger but they do not want a face lift.

Recent technological advances in Medical Aesthetics and Cosmetic Medicine have resulted in new light-based skin tightening devices which are being marketed as the non-surgical face lift. While skin tightening technology is impressive, and does work, the results of skin tightening to date hardly qualify as a face lift, non-surgical or otherwise. Skin is tightened, but at best results are about 20% to 30 % of what a traditional surgical face lift can achieve.

The new skin tightening is called non-ablative to distinguish the new skin tightening technology from the old CO2 laser resurfacing, the Gold Standard for Wrinkle Removal.

laser-resurfacing-before-and-after3.jpg

 

 

Above, Before and After CO2 Laser Skin Resurfacing

To ablate means to surgically remove, and the CO2 laser resurfacing ablated or removed old damaged skin and new skin grew to replace the old. In the process of CO2 Laser Resurfacing, heat generated by the laser injures the deeper skin layers and when they heal with new collagen, the skin is contracted or tightened.

The newer skin tightening technology uses radiofrequency energy or infrared energy to heat the deep layers of the skin to cause contraction and tightening, but first cools the skin before the energy is applied to prevent injury and ablation of the superficial skin by the heat energy. The skin is tightened but the surface is not ablated, thus non-ablative skin tightening. There is no down-time following non-ablative skin tightening making it a more appealing option than the older CO2 laser resurfacing skin tightening.

Several new skin tightening machines are available. The LuxIR® by Palomar®, and the Titan® by Cutera utilize infrared energy for skin tightening. The Aluma® by Lumenis and Thermage® utilize infrared energy for skin tightening. Refirme® by Syneron® uses a combination of light energies with radiofrequency for skin tightening.

All of the machines achieve about similar results when used properly. Generally there is less discomfort with the infrared skin tightening machines. Complications have been minimal although some serious complications occurred with Thermage® skin tightening early on.

In my practice I find that non-ablative skin tightening is most helpful for younger patients who do not have severe aging changes and significant sun damage, people in their 30’s and 40’s who want to correct or tighten early skin sagging along the jaw line or jowl area, neck and cheeks. I use the LuxIR® on these larger areas. For skin tightening around the eyelids I use the Aluma® which has a smaller treatment head and a suction device that will pull the delicate peri-ocular skin into the treatment chamber for skin tightening.

The Medical Aesthetics or Cosmetic Medicine field of non-ablative skin tightening is in its infancy and will definitely become more effective in the years ahead. The companies are improving their products frequently. For now, however, the people who benefit most from the skin tightening machines are younger people who still have thick healthy skin with early aging changes.

The use of the term non-surgical facelift to describe the Medical Aesthetics or Cosmetic Medicine procedure of non-ablative skin tightening is an overstatement with technology available for skin tightening today. At best, a 30% result is possible when compared to a traditional face lift.

In my practice skin tightening is performed as an aesthetician service by a trained, very experienced Medical Aesthetician using the new Lux IRDeep skin tightening machine. The LuIR Deep® is one of the most effective skin tightening machines available. Most importantly for you it is the least painful of all of the available machines.

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Above: before and after LuxIR skin tightening (Photo courtesy of Palomar Medical)

Fraxel and Lux1540-The new minimal down time “skin plumping” lasers for Fractional Skin Resurfacing

Perhaps you saw the piece about Fraxel on The Today Show (2/1/08). What is so exciting is that the new fractional laser skin resurfacing is a great improvement over older CO2 laser resurfacing. In the past, the Medical Aesthetics or Cosmetic Medicine procedure CO2 ablative laser resurfacing was the “Gold Standard” for wrinkle removal and skin tightening. However prolonged and difficult recovery time with peeling skin made this procedure unacceptable for most people.

During the past three years a new Medical Aesthetics or Cosmetic Medicine technology called fractional laser skin resurfacing has been developed which does not require significant recovery or anesthesia.

With Fractional laser skin resurfacing the laser beam is broken up, or fractionated, into many small micro-beams which are separated so that when they strike the skin surface, small areas of the skin between the beams are not hit by the laser and are left intact. These small areas of untreated skin promote a much more rapid recovery and healing with less risk of complications. The small areas of the skin treated by the fractional micro beams cause sufficient laser effect to promote new collagen production which plumps the skin improving wrinkles, pigment and acne scars.

The first fractional laser Fraxel and a newer technology called the Lux1540 have produced excellent results treating acne scarss and facial pigmentation and have improved skin texture.

To ablate means to “surgically remove.” The Fraxel® and Lux1540® are non-ablative fractional lasers which mean that when the laser beam strikes the skin the skin is not removed as it was with the traditional CO2 ablative lasers. Rather, the laser beam heats the skin to cause inflammation and new collagen production. The benefits of non-ablative Fraxel® and Lux1540® laser skin resurfacing treatments are dramatically reduced recovery time. After the treatment, your skin is pink the first day and the second day the skin may have “bronzing” which is easily covered by make up.

The new fractional laser skin resurfacing lasers safely go deep into the skin (see diagram below) where they can produce more effective new collagen production than more superficial laser treatments. This new collagen production replaces collagen that has been damaged by sun, aging, and acne. The new collagen produced can actually plump the skin wrinkles and acne scars and improve skin texture.

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This skin plumping effect can significantly improve wrinkles and acne scars, reduce enlarged pores, remove pigment and actually improve surgical scars.

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Above: Before and after Lux1540® treatment-Photos courtesy of Palomar and Dr. Dwight Scarborough

 

 

 

 

 

We have the new Palomar Lux1540® fractional non-ablative resurfacing laser in our practice and I am very impressed with the results. The Lux1540 treatment takes about 30 minutes and we use a topical numbing cream for your comfort. Your face will be pink the first day but your skin is intact- no oozing or open areas. The second day you may have a “bronze” cast to your facial skin but make up can be applied to mask this. In some patients who have more significant scars or wrinkles, we use higher settings. In these patients there may be peeling and redness for 3-4 days after treatment. Patients with thin skin from prior use of Accutane or previous dermabrasion or laser resurfacing can benefit from the skin plumping effects, but may also have more days of redness

The new fractional skin rejuvenation lasers are very exciting and a very significant development in Medical Aesthetics, Cosmetic Medicine and non surgical facial rejuvenation. For further information on facial rejuvenation and lasers read Save Your Face or contact me.


Topical Skin Creams-The Importance of Prescription Topical Skin Creams For Skin Rejuvenation

 

An effective daily topical skin cream regimen is one of the most important Medical Aesthetics or Cosmetic Medicine routines you can do to keep your skin looking healthy and to prevent facial aging. More importantly, prescription topical Retinoids like Retin A not only exfoliate the skin, stimulate the production of new collagen to replace collagen lost due to sun and environmental damage, but Retin A can actually reverse precancerous changes in your skin cells.

The effective skin health promoting effects of the retinoids has been known for over 20 years. Retin A is the only topical cream approved by the FDA for reversing aging skin changes, yet few doctors prescribe Retin A for its anti aging effects. Retin A is one of the first medical aesthetics treatments ever and my feeling is that if your skin cream does not require a prescription then it is unlikely that it is scientifically proven to work. You would not take a non prescription drug for an infection, high blood pressure, or other medical condition. Why is your skin health any less important?

I encourage all of my patients to use Retin A because I have seen dramatic and wonderful results in my patients. Patients who have very sensitive skin and cannot tolerate Retin A can usually use Vitamin C Serum instead of Retin A.

Over 20 billion dollars are spent each year on face creams to prevent facial aging yet most of them are not scientifically proven to work. As Dr. Klingman, the pioneer who developed Retin A, put it, “we have a marketplace that is absolutely crazy and the consumer is left to do her own personal clinical trial to see what works.” The most important thing I want you to remember is that there are only two treatments that have been approved by the FDA as effective for reversing facial aging changes– Retin A and laser resurfacing. The latter, of course, is a surgical procedure.

In my practice, Cheryl, my medical aesthetician, and I perform a careful medical evaluation of your facial skin as the first step in any medical aesthetics program and recommend the products that are most effective and safe for you.

My current Medical Aesthetics or Cosmetic Medicine recommendations for various skin conditions are:

1. Fine wrinkle removal, exfoliation, new collagen production and improved skin texture: Retin A or Vitamin C serum for those who cannot tolerate Retin A. Obagi Nu Derm System is an excellent Retin A based skin care program which includes 6 products-3 at night, 3 in the morning. The results of the Obagi System are dramatic and reverse many of the superficial aging changes in the skin. There is pinkness and mild peeling for the first two weeks, but after that you will see incredible improvement in your skin

2. Pigment Control-removal of sun damage: Retin A combined with 4 % Hydroquinone. The Obagi System works very well for pigment control.

3. Acne and break outs: Retin A and Pro Heal Serum® by Innovative Skin Care are excellent products for controlling the occasional break out. Patients with more severe flare ups and chronic recurring breakouts need the addition of Brevoxyl Washes and occasionally Differin® and Clindamycin® topical antibiotics. Severe cystic acne usually requires Accutane® which I prefer to be prescribed by your dermatologist. The Obagi System, a combination of 6 products including Retin A, produces phenomenal results for acne control once acute episodes are under control and is dispensed in our office.

4. Rosacea and facial red spots, blood vessels and telangiectasia- blood vessels on the face are a sign of inflammation most commonly secondary to years of sun exposure. Pro Heal Serum

4. Rosacea and facial red spots, blood vessels and telangiectasia- blood vessels on the face are a sign of inflammation most commonly secondary to years of sun exposure. Pro Heal Serum® is an excellent product for patients with sensitive blotchy skin and Rosacea. is an excellent product for patients with sensitive blotchy skin and Rosacea.

Topical creams are a very important part of your Medical Aesthetics or Cosmetic Medicine program for optimal skin health. However, good diet, hydration, exercise, and stress management will also contribute to your skin health.

One major benefit of having your skin care supervised by a physician in a medical office is that there are many additional treatments that will improve or enhance the results of your skin care program that can only be safely and effectively done in the office of a physician experienced in these new techniques.

For many of you, topical creams alone are not enough, and if that is the case we can provide you with the safe, effective leading-edge non-surgical medical aesthetics technologies necessary to help you.

If you would like to come in for a professional skin evaluation please call the office at 978-369-4499. Cheryl and I will give you our recommendations based on sound scientific principles and 25 years of experience. I will also give you a complimentary copy of my book, Save Your Face, so you can learn the basics of modern medical skin care and anti aging.

 

Injectables

Fillers- Radiesse®, Restylane®, and Juvederm®

Soft tissue fillers are an excellent Medical Aesthetics or Cosmetic Medicine method to rejuvenate and plump the aging lip and correct lip lines:

Lips Restylane Before and After

Above: before and after a filler injection in the lips

Soft tissue fillers like Radiesse®, Restylane® and Juvederm® are also used to camouflage Nasal Labial Fold lines and fill Marionette lines. (Contact Dr Seckel)

Younger women today want full voluptuous lips and fillers are an excellent way to create a beautiful full lip appearance.

Fillers can also be used to plump or fill acne scars and other skin depressions.

Soft Tissue Fillers-Characteristics

Modern fillers in use today are inert biological compounds that do not cause allergic reactions. Restylane® and Juvaderm® are made of Hyaluronic Acid a compound that is found in all human tissues. The fillers are synthesized and specially prepared for injection into human tissue. Restylane® lasts about 4-6 months. Juvederm® is also Hyaluronic Acid but has been modified to last longer, up to a year after injection.

Radiesse® is a long lasting soft tissue filler which is composed of Calcium Hydroxy Apatite, an inert material which actually stimulates your own tissue to grow into the filler and help plump the skin. Radiesse® is a long lasting filler which lasts up to a year in most people.

There are many other fillers on the market and they are all good. I use Restylane®, Juvaderm® and Radiesse® and will not discuss the others here.

Your Soft Tissue Filler Treatment

The soft tissue filler injection takes only a few minutes in my practice. I apply a topical numbing cream on everyone. I also recommend that my patients allow me to do a nerve block so that you do not experience pain with the soft tissue filler injection. I inject a small amount of local anesthetic underneath the upper lip much the same way the dentist numbs the front teeth-the same nerves go to the upper lip.

When I numb your lip you will have no pain when I inject the filler into the lip or the nasal labial fold.

Soft tissue filler injection is an art and a good looking result requires experience and careful technique. I numb your lip so I can do the injection properly. With you comfortable I can take the time and do the number of injections necessary to give you a good result.

I also have you take an herbal supplement called Arnica Montana which helps prevent bruising after the injection. I also apply ice packs to the treated area immediately after injection to prevent swelling.

Bruising does occur in some people, but the bruising is easily covered with make up.

Swelling does occur, especially in the lip, but it usually resolves in 24 hours. I recommend that you do not have a lip injection if you plan a social event that evening.

Overall patient satisfaction is very high. Your appointment will last about 20-30 minutes if a nerve block is done but the actual soft tissue filler injection takes only a few minutes.

Restylane Filler Nasal Labial Fold Before and After

Call me for an appointment or email me if you have questions. If you would like to learn more about soft tissue fillers read Save Your Face.

Laser Skin Care and Light Therapy

Laser Skin Care-What Lasers Do, How They Work On Your Skin

 

Laser skin treatments are Medical Aesthetics or Cosmetic Medicine procedures used for a wide variety of skin conditions. (Contact Dr Seckel)

laser-resurfacing-before-and-after.jpg

Above: before and after laser skin resurfacing for wrinkle removal.

The most common medical aesthetics laser skin treatment or laser skin care procedure available today is laser hair removal but there are many other types of laser skin treatments available today. Laser skin resurfacing is rapidly becoming the most common laser skin treatments in use today. With regard to the issue of concern to you, wrinkles, fine lines, crow’s feet and facial pigment, I group the laser skin care procedures under the broad category of laser skin rejuvenation.

Laser skin treatments for laser skin rejuvenation are used in several different ways to rejuvenate the face and facial skin. Broadly, these laser skin care treatments can be classified as follows:

1. Laser Skin Exfoliation or Laser Skin Peel, Laser Skin Resurfacing – Lasers can be used to peel or exfoliate the skin to remove dead skin and smooth wrinkles and fine lines. Once the dead skin and surface of the wrinkles are removed by the laser peel, you see new shiny skin on the surface of your face. The skin can form new cells daily and deep laser exfoliation or laser skin peel is a very effective way to stimulate the production of new facial skin cells. Laser skin care for exfoliation or laser peel usually requires some down time for redness and healing because laser skin peel is an ablative laser procedure which means the dead skin cells and wrinkles are ablated or removed so that new skin cells can grow over the facial skin, The first exfoliative laser skin care procedure was laser resurfacing, a very deep laser skin peel, but the recovery time was very long and the skin was lightened, so laser resurfacing is only done today for very deep wrinkles and acne scars. More modern laser skin care for wrinkles and fine lines involves the use of fractional laser resurfacing with de-powered lasers that do not cause as deep a laser peel. Modern laser skin care for wrinkles uses superficial laser skin peels with minimal down time for recovery, usually 4-6 days of redness. Examples of the new laser skin care systems are the ActiveFX® laser skin peel with the Lumenis Ultrapulse Encore® laser, the Microlaserpeel® with the Sciton® Erbium laser, and the newest Lux2940® fractional ablative erbium laser made by Palomar. Exfoliative laser skin care is used for treating acne scars as well as facial aging, fine lines and wrinkles and to remove pigment.

2. Laser Stimulation of New Collagen in The Deep Skin Layer, The Dermis – A major cause of wrinkles and acne scars is loss of collagen in the deep layer of the facial skin called the dermis. Sun damage kills the collagen in the dermis of the skin. When the collagen dies, the skin loses volume and shrinks, and the overlying outer surface of the skin reveals wrinkles. This is similar to what happens to a nice plump plum which is dried in the sun. After the plum loses its inner water volume, the skin wrinkles and you have a prune. Laser skin care also describes laser skin procedures which can stimulate the production of new collagen to replace the damaged collagen and plump up the wrinkles and even acne scars in the skin. The laser skin peels do this by irritating the skin as the laser peel is done. The irritation causes inflammation of the skin and when the skin is inflamed the skin responds by forming new collagen. The newer laser skin care techniques are very effective at stimulation of new collagen formation even in the deeper portions of the dermis and are very effective at plumping acne scars and can improve wrinkles. Examples of non-ablative laser skin resurfacing techniques for new collagen production for treatment of facial skin aging and acne scars are the non-ablative fractional lasers the Lux1540® by Palomar® and the Fraxel® by Reliant® Technology.

3. Laser Skin Treatment of Pigment and Facial Skin Photo-Damage – The aging effects of the sun, called photo damage, are not only dry skin and wrinkles but also pigment, called brown spots, sun spots, age spots, and “liver spots.” Laser skin care procedures are very effective at removing pigment and photo-damage. The ablative laser skin care procedures, such as the laser peel and laser resurfacing, strip away the pigment, but only the superficial pigment. Newer Fractional laser skin care treatments go deeper and can remove deep pigment with even less recovery time than the laser resurfacing laser skin rejuvenation treatments. Microlaserpeel, and ActiveFX are the laser skin peel treatments, and the Lux1540 and Fraxel are the non-ablative fractional laser skin care treatments for pigment. Today laser skin care for pigment removal is more often done with newer IPL or photo facial treatments. IPL, or photo facial, uses light energy, not laser energy, to remove pigment, and is a more gentle treatment with no down time.

4. Laser and Light Skin Tightening – Laser skin care can tighten sagging facial skin but only minimally. All of the lasers mentioned above do tighten skin a bit because when they stimulate new collagen production in the skin, the new collagen is tighter and the tighter collagen tightens the skin. This effect takes months after the laser skin care treatment and is not nearly as noticeable as a face lift. Newer and more effective skin tightening treatments are possible but not with laser skin care. The more effective skin tightening treatments are done with Infrared or Radiofrequency energy with machines called LuxIR®, Titan®, Aluma with Faces®, Refirme®, and Thermage®.

5. Laser skin treatment for Broken Blood Vessels, Red Spots and Rosacea on the Face – Photo-aging and sun damage also cause broken blood vessels to appear on the face. Laser skin care can remove broken blood vessels on the face and legs. Both the 532 and 1064 Yag lasers are useful for removal of broken blood vessels. However the newer IPL and Photo-facial treatments are very effective, produce less down-time and are used more frequently today. The 1064 Yag laser is the choice for larger broken blood vessels and leg veins.

6. Laser Hair Removal – Laser hair removal is the most commonly performed laser skin care procedure done today. There are many different laserand IPL skin care treatments for laser hair removal. The diode laser Light Shear Diode® was the gold standard for many years but more recently IPL has gained in popularity.

7. Laser Tattoo Removal – Laser skin care for tattoo removal was one of the first applications of laser skin care. There are many different lasers for tattoo removal and different laser wavelengths are chosen for the specific color of the tattoo to be removed. Laser tattoo removal takes many treatments over a long period of time, but is preferable to surgery which can leave scars.

I am sure there are other Medical Aesthetics or Cosmetic Medicine laser treatments that can be classified as laser skin care, but the above are the most widely available and useful laser skin care treatments available today. As you can see, the applications in the field of Medical Aesthetics or Cosmetic Medicine are very different for each type of laser so it is very important that the type of laser skin care be customized to fit the facial skin problem that you are trying to correct.

A board certified Dermatologist or Plastic Surgeon , who is knowledgeable and specializes in laser skin care, are traditionally the most experienced doctors with lasers. Laser skin care, if not done correctly by board certified medical specialists, can damage your skin. The State Medical Boards and legislatures are trying to establish guidelines and licensing regulations in many states.

For more information on laser skin care, laser skin treatments, laser peel, laser skin rejuvenation, and non-surgical facial rejuvenation read Save Your Face or contact me,

 

IPL-Intense Pulsed Light-photo facial treatments

IPL is a very important Medical Aesthetics or Cosmetic Medicine procedure. I have covered IPL or Photo-Facial above under aesthetician services.

Future Developments in Medical Aesthetics and Cosmetic Medicine

The demand for Medical Aesthetics or Cosmetic Medicine services is high and will continue to grow as our population ages and with our cultural interest in looking and feeling your best. We are working on new laser technologies to dissolve fat and I predict that in a few years liposuction, as we know it today, will be replaced by new non invasive laser liposuction and lipodissolve technology. Skin tightening technology will continue to improve and eventually the face lift will be done much less invasively than it is today. Age management techniques in the form of molecular biological modifications and DNA and Gene therapies will definitely advance and are, at this point, more likely to be embraced by doctors involved in Medical Aesthetics and Cosmetic Medicine than by those in traditional medicine.

I am sure I cannot fully imagine what the field of Medical Aesthetics and Cosmetic Medicine will be like in another 20 years, but at the pace of technological breakthroughs of the past 10 years it is going to be very different than it is today.

For more information on the field of Medical Aesthetics, Cosmetic Medicine and non surgical facial rejuvenation read Save Your Face or contact me.

Be sure to sign up for my free email newsletter to keep informed of new developments in the field of medical aesthetics.

Dr. Seckel

978-369-4499

Concord, Massachusetts

Boston, Massachusetts

Dear Dr. Seckel, Do you remove leg veins? I have spider veins on my calves and thighs ever since I had my children and I am embarrassed to wear my bathing suit at the beach. I have heard they can be injected but I have also heard of the laser for removal of leg veins and spider veins. Is this the same as endovenous laser therapy I hear about on the radio? How effective is the laser and how painful is it? Thanks, Betty, Boston, MA.

March 15th, 2008

Dear Betty,

Thank you for your important question. Millions of people men and women alike are bothered by leg veins and spider veins on the calves and thighs.

We do have the latest and most effective spider vein and leg vein treatments available in our office. We use the Palomar®Lux1064® laser to remove spider veins and leg veins which is different from endovenous laser therapy.

spider-veins.JPG
Before and After Lux Green IPL Treatment of Starburst Spider Veins

There have been many other lasers used to treat leg veins and spider veins but most have not been able to effectively remove larger spider veins and leg veins and have not been able top treat the deeper communicating veins and thus the spider veins and leg veins tend to come back.

The 1064 laser is the best laser to treat spider veins and leg veins because it is able to remove veins as large as 4 mm in diameter and is able to penetrate deeper beneath the skin surface where the communicating veins reside.

spider-veins-2.jpg

Before and After Leg Vein Treatment with the Lux Green IPL

I have tried all of the 1064 lasers on the market and chose the Palomar®Lux1064® laser because in my hands it worked the best. The Lux1064® effectively removes spider veins and leg veins and larger red vessels on the face. More importantly the Palomar®Lux1064® is much les painful than the other 1064 lasers I tried. I believe the unique pulse characteristic of the Palomar®Lux1064® delivers the laser energy in a way that causes much less discomfort than the others I tried.

Laser removal of spider veins and leg veins is effective for veins with a diameter of 4 mm or less. Larger and starburst leg veins may require sclerotherapy which is an injection technique. With sclerotherapy a solution of hypertonic saline is injected into the larger veins to close them. Afterwards the 1064 laser is used to “clean up” the smaller veins left behind.

Larger leg veins that are actually bulging out from the skin are called varicose veins. Varicose veins have traditionally been removed by surgery requiring an incision. However new endovenous laser therapy can remove larger leg veins without surgery by placing a laser catheter inside the vein and closing the varicose vein with endovenous laser energy.Endovenous laser therapy is a revolutionary and very exciting new treatment for varicose veins.

If you would like to learn more about the laser removal of leg veins, spider veins, and starburst veins please contact me. Be sure to sign up for my free email newsletter to keep up with new developments. For more information on prevention of aging and the new laser technology read Save Your Face.

Thank you,

Dr. Seckel

978-369-4499

Concord, Massachusetts

Boston, Massachusetts

Dear Dr. Seckel, Do you perform the mommy tuck tummy tuck procedure that Dyla Devons had done? It looks fairly simple on http://extratv.warnerbros.com/2007/11/dayna_devons_lifechanging_deci.php. I have had three children, am in great shape but just have some lax skin on my lower tummy that I cannot get rid of. Thank you, Lori, Boston, Massachusetts.

March 13th, 2008

Dear Lori,

Thank you for your email. I do a minor tummy tuck similar to the mommy tuck you refer to. I use a very small incision that can be concealed by a bikini so you can still go to the beach and not have a visible scar showing. I also call this the bikini tummy tuck. The popularity of the mommy makeover which includes a tummy tuck and a breast lift or breast augment probably explains the name mommy tuck, although some women have objected to the use of that name.

The key element in the mommy tummy tuck or bikini tummy tuck is a short scar which is well hidden by your bikini. This is possible when only the lower abdominal skin is lax, and this is the most common situation in younger women who have had children but have stayed fit and do not have a large amount of loose abdominal skin. If there is a great deal of loose skin above the belly button (umbilicus) then a more extensive procedure with a larger scar is required.

Recovery time varies but patients usually are up and around after 4-5 days although I recommend waiting for vigorous physical activity for 3 weeks. I currently use a “pain pump” after surgery which is a small catheter which infuses numbing solution into the surgical area for 2-3 days and minimizes any post operative discomfort.

Generally the mommy tuck or bikini tuck tummy tuck or abdominoplasty is a very successful operation and patient satisfaction is very high.

If you would like to learn more about tummy tuck and abdominoplasty see my website or contact me.

Thank you,

Dr Seckel

978-369-4499

Concord, Massachusetts

Boston, Massachusetts