Smooth unblemished skin is something we all desire but few of us ever have. Cuts and bruises, surgery, accidents, burns and acne all can leave very noticeable scars which can affect our self esteem and bother us. People can’t help staring at scars, which of course makes those of us who have scars very self conscious.

In the past, surgical removal of scars was the treatment of choice. However surgical scar removal leaves another scar and involves surgery. Laser skin resurfacing has been used to remove scars, but the laser resurfacing technique only smoothed the superficial surface of the skin, and did not correct the depression or divot in the skin that occurs with most noticeable scars.

New Starlux 1540 fractional laser skin treatments have produced remarkable scar removal results with no surgery, no peeling and no healing down time. The Starlux 1540 non-ablative fractional Erbium laser works by plumping the scar and smoothing the scar by re-organizing the basic collagen structure of the scar. See before and after pictures of Starlux 1540 laser scar removal treatment below:

Above: Before and after picture of laser scar removal of deep chin scar with the Starlux 1540 non-ablative fractional laser skin resurfacing laser.

What Causes A Scar?

A scar is caused by damage to the dermis, the deep layer of the skin below the surface. A scratch or cut, surgical incision, an acne pustule, a deep burn, or any trauma that goes deep into the skin injures the dermis. If the dermis cannot regenerate itself enough to replace all of the damaged tissue, a depression exists in the skin which appears as a visible scar.

Injuries that affect only the surface of the skin, called the epidermis, usually heal without a scar. When you see a visible scar it means that the injury was deep enough to damage the dermis and the dermis has not been regenerated.

How Can A Scar Be Improved or Removed?

What is needed for improvement in most visible scars is the production of new collagen in the dermis to replace the lost dermis and plump the scar. The main component of the dermis is collagen, and if the dermis can be induced to produce enough new collagen, the scar will be plumped and become less visible.

The basis of the new Starlux scar removal process is the production of new collagen in the dermis.

How Does Starlux 1540 Laser Scar Removal Work?

The Starlux 1540 erbium laser beams actually go deep into the dermis and promote the growth of new collagen in the dermis. This new collagen fills the deficient dermis and plumps the skin beneath the depressed scar. See the diagrams below to understand how the Starlux 1540 builds new collagen in the dermis to plump and improve scars:

Above picture shows how the Starlux fractional laser sends beams deep into the dermis to stimulate new collagen production but leaves the surface of the skin intact.

Above: actual microscopic slides showing new collagen produced in the dermis following Starlux 1540 fractional laser resurfacing of the skin. The pink columns are new collagen. As the laser power is increased, the laser goes deeper and new collagen is produced into deeper portions of the dermis where deep scars need to be plumped.

The best thing is that the Starlux 1540 is a non-ablative fractional erbium laser which means that the surface of the skin is not damaged or removed during the laser treatment. This means that you do not have to go through the prolonged healing required by old time laser resurfacing. Your skin surface is still intact immediately after treatment.

What Is The Starlux 1540 Scar Removal Treatment Like?

We apply a numbing cream to your skin prior to treatment for your comfort. The Starlux 1540 hand piece has a small circle at the end which is pressed against the scar, and the laser is turned on.

You will feel heat as the laser is fired, however patients find it easy to tolerate.

You an see an actual video of the Starlux 1540 laser scar removal treatment below:

Video of Starlux 1540 Laser Scar Removal Treatment

The skin is not broken, thus your skin is only pink or red after treatment. No open wounds, no skin peel, no need for soaks or dressings. The pink may last 24 hours, but you can use makeup to cover the pink because the skin is intact.

How many Treatments Are Needed?

You will need at least 4 treatments spaced 4-5 weeks apart for maximum collagen production and skin and scar plumping. Severe, deep acne scars and surgical scars may require more treatments for optimal results.

When Will I See A Result?

You will see swelling the first two weeks after treatment but this swelling is just the immediate effect of the laser treatment.

New collagen production does not begin for 6 weeks after the treatment, and visible improvement usually is seen by the third month.
Remember, we are stimulating the scarred skin to make new collagen, which takes time. There is no quick fix for immediate scar removal results, even with scar removal surgery.

The collagen production continues for six months to a year after the last treatment.

By 6 months into the program, which is 3 months after your last and fourth treatment you will be seeing visible results. The scar will continue to improve for at least 6 months after your last treatment.

Who Should Do My Starlux 1540 laser Scar Removal?

Board certified plastic surgeons and dermatologists are the experts at laser skin treatments. You should inquire if the doctor specializes or is experienced in laser skin treatments, as many board certified doctors don’t use lasers.

The best scar removal results I have seen have been with the Starlux system made by Palomar Medical a laser company. They have a special interest in scar removal and improvement, unlike other laser companies that have focused mainly on wrinkle removal.

For more information on scar removal with the Starlux 1540 fractional laser call 978-369-4499 or email us. Read our free newsletter to keep up to date on new techniques in face and body rejuvenation. Read Save Your Face to learn how to prevent facial aging.

Dr. Seckel
Concord, Massachusetts
Boston, Massachusetts

Before and after pictures are excellent ways to see how you might look after having a facial filler like Restylane, Juvederm, Radiesse, Perlane, Sculptra, or Evolence or having a Botox injection to remove facial wrinkles. Facial fillers like Restylane, Juvederm, Radiesse, Perlane, Sculptra and Evolence are among the most common non-surgical facial rejuvenation treatments in use today. Botox injection is one of the most common medications used in the world.

Good results after injection of Restylane, Juvederm, Radiesse, Perlane, Sculptra, Evolence and Botox depend entirely on the skill of the doctor who does the injection. Good results require proper injection technique and an understanding of facial aesthetics and facial aging changes. Be sure that you see before and after pictures of the patients that the doctor has actually done. Don’t rely on pictures in the brochures provided by companies that make the fillers and Botox.

Below are before and after pictures of my actual patients who have had Restylane, Juvederm, Radiesse and Botox treatments that I have done.

Before and after pictures of Restylane facial filler injection to plump the lips for lip augmentation, lip wrinkle improvement and lip enhancement:

Above: Before and after Restylane injection for lip augmentation and enhancement.

Before and after pictures of Juvederm facial filler injection for plumping the nasal labial fold:

Above: Before and after picture of juvederm treatment for removal of nasal labial fold or nose to mouth lines.

Before and after pictures of Radiesse facial filler injection and Botox injection of lip wrinkles to rejuvenate the mouth and chin area, a liquid lower face and mouth lift:

Above: Before and after Radiesse and Botox treatment for liquid lower face lift and lip wrinkle removal.

Before and after pictures of Radiesse facial filler cheek lift or liquid face lift:

Above: Before and after Radiesse treatment for liquid cheek lift or face lift.

Before and after pictures of Botox injection to remove eye wrinkles and crow’s feet:

Above: Before and after Botox injection to treat crow’s feet and eye wrinkles.

For more information on Restylane, Juvederm, Radiesse, Perlane, Sculptra, Evolence and Botox call 978-369-4499 or email me. Read our free newsletter to learn more about face and body rejuvenation. Read Save Your Face to learn how to prevent facial aging.

Dr Seckel
Concord, Massachusetts
Boston, Massachusetts

If you are interested in skin rejuvenation you will be hearing a lot about Starlux, Fraxel Repair and Fractional Skin Rejuvenation in the future. To better understand the significance of these new advances some technical knowledge of cosmetic laser skin treatments for cosmetic laser skin rejuvenation and past laser skin care technology is important.

The photo above shows the result of a full face CO2 Laser Resurfacing for wrinkle removal done 10 years ago using the Ultrapulse CO2 laser, a revolutionary advance in 1995. While the wrinkle removal results were stunning, CO2 laser resurfacing created a “burn wound” that took months of recovery and after a year often left the skin white or hypo pigmented. Because of the prolonged recovery, the need for general anesthesia, and other side effects most people today do not choose to have this effective wrinkle removing procedure.

Over the past three years the concept of Fractional Skin Rejuvenation or fractional laser skin resurfacing has evolved. With Starlux Fractional Skin Rejuvenation the laser beam, an erbium 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 left intact. (See Figure Below.)

The small areas treated by the Starlux and Fraxel fractional micro beams, called micro treatment zones, cause sufficient laser injury to promote new collagen production to replace collagen damaged by aging and sun exposure. The new collagen produced by the laser injury “plumps” skin wrinkles. The intact skin between the micro treatment zones allows for much more rapid healing-3-4 days as opposed to 2-3 weeks for the older CO2, and enough pigment cells are left intact that hypo pigmentation does not occur.

The diagram above shows the progression of laser skin rejuvenation technology from the older CO2 on the left to the newest Starlux fractional ablative lasers which have just been released. The Fraxel laser and the Starlux 1540 are depicted in the 3^rd illustration under Non ablative fractional laser resurfacing.

Starlux Fractional Non Ablative Laser Resurfacing

To ablate means to “surgically remove”. The Fraxel and Starlux1540 are non ablative lasers which mean that when the laser beam strikes the skin the skin is not removed immediately, rather the laser beam heats the skin to cause inflammation and new collagen production. The benefits of the Starlux 1540 non ablative laser skin treatments are dramatically reduced recovery time, but the results in terms of wrinkle removal and skin tightening are less dramatic than with ablative lasers.

However, the new Starlux 1540 fractional lasers are able to penetrate much deeper than traditional non fractional ablative lasers and we are discovering that deeper penetration of the laser produces a much more dramatic stimulation of new collagen formation which translates into a plumping effect on the skin. This is particularly useful in treating depressed acne scars.

Another diagram which helps explain the Starlux 1540 effect is the microscopic section of skin that has been treated with the Starlux fractional laser below.

In summary, the benefits of Starlux fractional non ablative laser skin treatments are:

1. Less down time- only pink skin for 1-2 days and a day or so of bronzing that can be covered with make up
2. Better new collagen production in the deeper skin layers causing skin plumping especially of acne scars
3. Fewer complications like hyper pigmentation (although with Fraxel there is a 15% incidence of hyper pigmentation (darkening of treated areas) especially in dark skinned people, but it is temporary.
4. Improvement in skin texture and possibly enlarged pores
5. Improvement in wrinkles (See Photos below of Lux 1540 Results)

Above-Before and after Starlux 1540 non-ablative fractional laser skin resurfacing, treatment-Photos courtesy of Palomar and Dr Dwight Scarborough

The Future-Starlux Fractional Ablative Laser Resurfacing

Recently several new fractional ablative lasers have been developed which have the benefits of fractional treatments, less down time and complications, as well as the benefits of ablative skin resurfacing, better wrinkle removal and facial rejuvenation. The Starlux fractional ablative lasers are depicted in the last or 4^th picture in the first comparative fractional laser diagram above.

The fractional ablative lasers remove the tissue in the micro treatment zone rather than just heating it as is done with Fraxel and the Starlux 1540.

The benefit of ablation is that more sun damaged, wrinkled skin is removed than with the Starlux 1540 or Fraxel, and better wrinkle removal and skin surface smoothing and textural improvement is achieved. This however comes at the price of some recovery time, redness and pinkness for 4-6 days. The Starlux fractional ablative lasers however require much less recovery time than the traditional non fractional erbium and CO2 ablative lasers which required weeks of recovery. Reliant, the company that makes Fraxel has released a new CO2 fractional laser called the Repair, Lumenis has released a CO2 fractional ablative laser called ActiveFX and DeepFx for Bridge Therapy, and Palomar has released the Starlux 2940, an Erbium fractional ablative skin resurfacing laser.

Impressive wrinkle removal and improvement in skin texture is achieved with the Starlux 2940 fractional ablative laser (see Photos of my patients Below).

Above: Before and after Starlux 2940 fractional laser skin resurfacing.

Above: Before and after Starlux 1540 and 2940 combined fractional laser skin resurfacing.

Above: Before and after Starlux 1540 and 2940 combined fractional laser skin resurfacing.

The first non ablative fractional laser on the market was the Fraxel. The Starlux 1540 and 2940 are newer and improved fractional laser skin resurfacing technology.

The field of laser skin rejuvenation is advancing rapidly and new technological breakthroughs occur frequently. The benefit to you is that better wrinkle removal results are possible with less down time and fewer potential side effects.

The applications of fractional laser technology are expanding to other fields like skin tightening and eventually to fat and cellulite removal.

For further information on the Starlux fractional erbium laser skin resurfacing laser for skin rejuvenation and facial aging read Save Your Face or contact me. In my practice I use the new Starlux 1540 Fractional Non ablative erbium laser and the Starlux 2940 ablative fractional laser for skin rejuvenation.

Be sure to sign up fro my free email newsletter to keep up on new developments.

Dr Seckel
978-369-4499

Concord, Massachusetts

Boston, Massachusetts

New fractional laser skin resurfacing is effective but much safer than traditional CO2 resurfacing. The fractional laser resurfacing beam is broken up into many small beams so that the laser affects only small focused areas of the skin. Fractional laser resurfacing leaves skip areas on the skin that are left normal and undamaged. These untreated skin cells are able to rapidly heal the treated skin with new skin cells. The treated areas, called micro treatment zones are healed in 6 hours with the fractional Lux2940 Erbium laser on the Starlux laser. CO2 fractional lasers like the Fraxel Repair and Lumenis ActiveFX and DeepFX take a little longer, up to 48-72 hours.

Fractional lasers are also able to penetrate the skin into the dermis much deeper than flat beam techniques. Deeper penetration causes more effective new collagen production. This characteristic results in improved skin plumping and better skin texture.

Fractional laser skin resurfacing is better than old time flat beam laser resurfacing because skin healing is much quicker, and the risk of white skin, hypo pigmentation is much less. Below are before and after pictures of results of fractional laser skin resurfacing done for skin rejuvenation. I am showing before and after pictures of the Starlux, Fraxel Repair, ActiveFX, and DeepFX fractional laser skin resurfacing results below.

Above-Before and after Starlux Lux2940 fractional laser resurfacing laser peel. Note freshening of facial skin.

Above-Before and after Combined Starlux1540 and 2940 fractional laser skin resurfacing. Note pigment removal and rejuvenated skin texture.

Above-Before and after pictures of Starlux1540 and 2940 Combined fractional laser skin resurfacing. Note improvement in skin texture and wrinkles.

Above-Before and after pictures of Starlux 2940 ablative fractional laser skin resurfacing for wrinkle removal around the eyes and mouth.

Above: Before and after Fraxel Repair ablative fractional laser resurfacing.

Above: Before and after ActiveFX ablative fractional laser skin resurfacing.

Above: Before and after DeepFX fractional ablative laser skin resurfacing.

For more information on fractional laser resurfacing call 978-369-4499 or email me. Read my free newsletter for the latest information on new non-surgical skin rejuvenation methods.

Dr. Seckel
Concord, Massachusetts
Boston, Massachusetts

All of us have a little trouble buttoning our jeans during winter and after the holidays. Many of us have often thought that it would be nice to have liposuction to remove the excess fat and start over again by watching our diet and exercising. However traditional old time liposuction is a traumatic surgical procedure which is painful and with a prolonged recovery. Worse, a large percentage of people who have old time liposuction end up with lumps bumps, divots and irregularities on the skin after liposuction.

I have been using tumescent laser liposuction with the new SlimLipo laser lipo technique for fat removal, laser body sculpting and laser liposculpture for almost a year now and I am amazed at how much better the tumescent laser liposuction technique is than the old time non-laser liposuction method. My patients have smooth tight skin after laser liposuction, and their recovery after laser lipo is much easier and less painful.

The benefit of the new tumescent laser liposuction technique is that the laser melts the fat before it is removed, making fat removal much easier with laser lipo. The tumescent technique minimizes bleeding and discomfort. The laser also tightens the skin as the fat is melted. The result is more uniform fat removal, smooth skin, less bleeding and less pain after tumescent laser liposuction. See before and after pictures of tumescent laser liposuction and mini tummy tuck below:

What Is Tumescent Laser Liposuction?

Tumescent laser liposuction is a new liposuction method that combines the use of tumescent solution with laser melting of fat before fat removal.

Tumescent solution is a liquid that contains an anesthetic or numbing solution and a vasoconstrictor, a medication that helps control bleeding. The tumescent solution is injected beneath the skin, into the fat to be removed, before the laser liposuction or laser lipo is started.

The tumescent solution numbs the skin area for pain control which can last up to 24 hours. The solution also prevents bleeding which reduces post laser liposuction bruising and swelling, which speeds recovery.
The tumescent solution is injected under pressure, which swells or distends the fat and makes removal easier. The distention and hydration (adding water to) of the fat also improves the effectiveness and safety of the laser treatment to dissolve the fat.
The benefits of the tumescent laser liposuction technique are:

• Excellent pain control
• Less bleeding and bruising
• More effective fat removal
• Less risk of skin irregularities after liposuction

Before and after tumescent laser liposuction of neck and chin implant to correct double chin

How Is the Tumescent Laser Liposuction Treatment Done?

Tumescent laser liposuction may be done with you awake or asleep. Many areas can be treated with you awake using only the local anesthesia provided by the tumescent solution. However, the benefits of tumescence are so important that tumescent solution is also used when laser liposuction is done under general anesthesia, for control of bleeding, improved fat removal and for post operative pain management.

After your skin has been cleansed with a sterile anti-bacterial soap, the skin area to be liposuctioned is sterilely draped to prevent contamination.

Tiny punctures are made in hidden areas of the skin, and a small needle inserted beneath the skin into the fat to be removed. The tumescent solution is then injected into the fat under pressure to swell the fat and deliver the anesthetic and vasoconstrictor (prevents bleeding) solution.

After a brief waiting period until your skin is numb and the tumescent fluid has taken effect, the laser fiber is inserted through the same puncture sites and the fat is melted with the laser. The fat is liquefied into a thin liquid which is much easier to remove than fat that is removed with traditional old time liposuction.

After the fat has been liquefied, a small tube called a cannula is inserted and the liquid fat removed by suction. Because the fat has been liquefied, much smaller cannulas can be used than with traditional non-laser liposuction. This fact results in a less traumatic procedure with tiny hidden scars, very different from old time liposuction.

The laser also tightens the skin as the fat is lased. The laser heats the fibers that attach your skin to your body, and causes these fibers to shorten which pulls the skin closer to the body. Microscopic studies have shown that many more fibers, called connective tissue, are left after laser liposuction than after non-laser liposuction. I believe that this fact helps explain the improved skin tightening and smooth skin after laser liposuction.

Before and after SlimLipo tumescent laser liposuction to smooth skin deformities caused by prior old time non-laser liposuction

How Will I Feel After Tumescent Laser Liposuction?

Because the tumescent laser liposuction technique places numbing solution in the liposuction area, you will have very little discomfort immediately after and up to 12 hours after your laser liposuction procedure. In addition you will be given strong pain killers to manage any discomfort.

The second day you will feel discomfort in the treated areas, however in my experience, the level of discomfort is certainly much less than that experienced with traditional non-laser liposuction. By day 3 most patients are very comfortable.

You will be wearing a supportive compression garment on the treated areas which adds additional support and comfort.
You will be up and around, able to eat, walk, use the bathroom and do normal daily activities the day after your tumescent laser liposuction. I recommend that you not go to the gym or do vigorous physical activity for the first week to ten days because I want the healing process to be undisturbed during this time.

How Long Is the Recovery after Tumescent Laser Liposuction?

You will be active and walking from day one. However I will limit your vigorous exercise and weight lifting or aerobics for ten days.
Your garment will be changed to a light Spanks type garment after three to five days. If small sutures are used to close the small puncture sites they will be removed at day five.

When small areas like the chin or a minor tummy liposuction are done, some people return to work the next day. I do not recommend returning to work the same day-I want you to be quiet and rest the first day.

Recovery to a more normal skin appearance can take ten days to two weeks for swelling and bruising, if any, to resolve.

Your skin appearance, skin tightening and laser liposuction result will continue to improve for three to six months as the skin gradually tightens over the areas where fat has been removed. The remarkable thing about the tumescent laser liposuction technique is that the skin is much smoother after laser liposuction than after traditional old time, non-laser liposuction. I believe that the laser dissolving of the fat prior to removal results in a more uniform fat removal.

Which Laser is best for Tumescent Laser Liposuction?

There are several lasers in use for laser liposuction. I use the SlimLipo Aspire laser liposuction system made by Palomar Medical. I have chosen this laser because the SlimLipo uses the only laser wavelength which is specifically absorbed by fat. The SlimLipo uses a 924nm (nm=nanometers, one millionth of a meter and describes the wavelength of the laser color in the visible light spectrum, which for 924nm is yellow, the color of fat) laser wavelength.

The 924nm laser wavelength used in SlimLipo dissolves or releases three to five times as much fat during lasing as do the other commonly used wavelengths. The other wavelengths used by different laser liposuction machines target water, not fat, and are less efficient and less specific at fat dissolving.

The 924nm SlimLipo also works very well in hydrated fat, meaning that fat dissolving with the laser works very well after the tumescent fluid has been injected.

How Do I Find a Surgeon for My Tumescent Laser liposuction?

I am a board certified plastic surgeon, thus I am very prejudiced that you should have your tumescent laser liposuction performed by a board certified plastic surgeon. My view is that if you are going to have surgery of any kind, you want a board certified surgeon who has been fully trained and is expert at taking care of a surgical patient. You want the safety of knowing that if something goes wrong, your doctor will have the skill, experience and training to take care of you.

Some dermatologists do liposuction and are trained in liposuction and lasers. If you wish to have a dermatologist do your laser liposuction, I recommend that you make certain that your dermatologist is board certified and has had a fellowship in dermatologic surgery.

I recommend that you visit the following links to learn more about liposuction surgery and how to check out your doctors training, experience and board certification status:

American Board of Plastic Surgery
American Society of Plastic Surgeons
American Society of Aesthetic Plastic Surgeons

What Questions Should I Ask the Doctor About Tumescent Laser Liposuction?

Do not be intimidated by the white coat and afraid to ask the doctor important questions. You are an educated consumer, and a good doctor will welcome the fact that you are prepared and have done your reading. I prefer to have informed patients, they always do better after surgery. Plastic surgery is no place for snap decisions or impulse buying.

In my book Save Your Face, in Chapter ten, I give details on how to choose your doctor and what questions to ask. A brief summary of important questions are:

• Are you certified by the American Board of Plastic Surgery?
• How often do you do tumescent laser liposuction?
• Do you think I am a good candidate for tumescent laser liposuction?
• Are you comfortable operating on me with my particular goals?
• Do you anticipate a good result-why?
• Can you show me before and after picture of patients that you have operated on?
• Can I speak to a patient who has had this surgery by you?
• What are the arrangements for an emergency during nights and weekends-are you available?
• Will my tumescent laser liposuction be done in an approved operating room or outpatient facility under standard sterile and safety precautions? Are emergency services and monitoring available if needed?

Most importantly, trust your gut feelings during your visit with the doctor. Is the office clean and professional? Do the doctor and staff treat you in a respectful manner? Ask yourself will I be comfortable calling these people and depending on them if I have an emergency at night or on weekends? Will I be comfortable expressing my concerns or disappointment if I feel that way? If you detect any discomfort or uncertainty, you should consult another doctor.

Tumescent laser liposuction is a remarkable, revolutionary advance in liposuction and fat removal techniques. The benefits can be very significant. However, the results of liposuction, like any surgical procedure are very dependent upon the skill and expertise of your surgeon. Choose wisely and I expect that you will have a very happy result.

For more information on tumescent laser liposuction call 978-369-4499 or email me. Read our free newsletter to learn about the latest non-surgical and plastic surgical face and body rejuvenation techniques.

Dr. Seckel
Concord, Masachusetts
Boston, Massachusetts

Have you noticed brown spots or age spots and broken blood vessels on your face, neck and décolletage? These skin changes are signs of sun damage and facial aging. New non-surgical Photofacial anti-aging skin care treatments using intense pulsed light, called IPL, can remove age spots, broken blood vessels and skin aging changes with minimal or no down time. Results for non-surgical rejuvenation of the skin can be fabulous, see before and after pictures of Photofacial IPL anti-aging skin care treatments of the décolletage below:

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:

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 leaarn more about non-surgical facial rejuvenation. read Save Your Face to learn how to prevent skin aging.

Dr. Seckel
Concord, Massachusetts
Boston, Massachusetts

Many people come to my plastic surgery practice wanting treatment for removal of dark circles under the eyes. Most often they tell me they look tired and that people often ask them if they have gotten enough sleep. In my experience lack of sleep, watching too much TV or spending a lot of time on the computer has nothing to do with dark circles under the eyes.

There are specific medical or structural eyelid causes of dark circles under the eyes that many physicians just do not understand. There are very effective modern laser and light treatments that can permanently remove the dark circles under your eyes.

However, these dark circle treatments must be directed at the underlying medical cause of the dark circles for removal to be effective. Therefore I am going to discuss the medical and structural causes of dark circles under the eyes first. Once you understand the cause, you will be able to seek the right treatment for removal of your dark eye circles.

Medical Causes of Dark Circles under Eyes

• Thin Eyelid Skin- Eyelid skin is so thin that you actually see through the skin and see the color of the eyelid muscle, which is purple. Look at every face you see and you will see that the lower eyelid is the darkest colored skin on the face. People with very thin skin have darker lower eyelids which appear as dark circles under eyes.

• Visible Small Blood Vessels- Many people have hundreds of small blue veins visible on the lower eyelid. These blood vessels cast a blue dark appearance to the lower eyelid. Broken blood vessels are a common cause of dark circles under the eyes.

• Pigment-People who have excess sun exposure and do not wear sun block often develop brown pigment on the lower eyelid. People of dark skin types such as African American, Hispanic, Asian, Arab, and Central Asian people are very susceptible to pigmentation of the lower eyelid. Dark pigmentation such as this is a very common cause of dark circles under the eyes.

• Hollow Eye-Many people have a hollow eye appearance. This is caused by a lack of fat surrounding the eyeball. The hollow eye is most often inherited, and is very common in people of Central Asian origin, in my experience. Hollow eyes can cause very pronounced dark circles under the eyes.

• Arcus Marginalis Deformity- Many people have a deep depression beneath the lower eyelid which they have noticed since childhood. It is an anatomic or structural condition which is usually inherited. It is caused by a small structure called the arcus marginalis which tethers the lower eyelid skin to the bone of the eye socket. The skin of the eyelid above the arcus falls over and downward creating a deep shadow which is referred to as a dark circle under the eye. I view the arcus deformity as the true dark circle under the eye.

• Bags under Eyes, Puffy Eyes and Eyelid Aging- As we age our skin loses elasticity and becomes lax. As the lower eyelid becomes lax it fails to support normal fat which lies below the eyeball. This fat pushes the lower eyelid forward and forms a puffy eye or eye bag. The eye bag or puffy eye creates a dark shadow beneath the bulge where the arcus marginalis is tethering the skin to the underlying bone. This is the most common form of dark circles under the eyes I see in my plastic surgery practice. See before and after treatment of my patient below:

Dark Eye Circles Treatment–How to Remove Dark Circles under the Eyes

• Intense Pulsed Light-IPL -Photo Facial Treatment For Removal of Dark Eye Circles- These therapies are not lasers. They use a flash of light which specifically targets the color of a pigment or blood vessel in the skin. The light is adjusted to be absorbed by the color red or brown.IPL can help lighten dark eyelid skin caused by blood vessels or pigment and remove dark circles under the eyes.

• Fractional laser Skin Resurfacing Treatment of Dark Circles- Ablative fractional laser skin resurfacing can remove wrinkles and stimulate new collagen production in the skin. In some cases fractional laser resurfacing can be used to plump or thicken thin eyelid skin. These treatments can remove pigment and wrinkles and remove dark circles under the eyes.

• Transconjunctival Laser Blepharoplasty with Arcus marginalis Release and Fat Grafting for Removal of Dark Circles- This is a plastic surgery operation that is done to remove dark circles caused by the arcus marginalis and in patients with puffy eyes or eye bags. A laser beam is used to make a small incision on the inside pink part of the lower eyelid called the conjunctiva. The arcus marginalis which is tethering the lower eyelid skin and causing the dark circle is released, and the removed fat is then placed back inside beneath the arcus marginalis to plump the depression which was causing the dark circle. This is the most effective laser method for removal of dark circles under the eyes. See before and after photos of my patient’s arcus marginalis release in the lower eyelid below:

• Fat Grafting for the Hollow Eye Dark Circle Syndrome- For people who have a hollow eye appearance because they lack enough fat around the eyeball, I harvest fat from around the umbilicus or belly button. I then make a laser transconjunctival incision inside the lower eyelid and place the fat in a position to plump the hollow appearance. The fat grafting technique is the most important component for removal of dark circles under the eyes.

Words of Warning and Advice About Dark circles under Eyes

• Do Not Have Soft Tissue Filler Injections Near Your Eyes to Treat Dark Circles under the Eyes- Many doctors are injecting soft tissue fillers to plump depressions beneath the eyelid. This is an off label use which means the companies that make the fillers do not recommend it. There has been a reported case of blindness in England caused by injecting soft tissue filler around the eye.

• Do Not Have Fat Injections to Correct Dark Circles under the Eyes-Fat injection is a blind procedure in which your own fat is injected beneath the eyelid skin. The eye can be injured and frequently the fat is placed in the wrong position and the depression beneath the eyelid looks worse. I have had to surgically remove fat placed by other physicians. Some, very few, surgeons can do it well, but I will not risk the potential complications.

• Choose an Experienced Board Certified Plastic Surgeon- Eyelid surgery and laser surgery are very sophisticated fields which require training, board certification, and most important-experience, in my opinion. Always seek two opinions and do your homework on the doctor you choose. Good resources for reliable information are:

American Board of Plastic Surgery

American Society of Plastic Surgeons

American Society of Aesthetic Plastic Surgery

For more information on the medical causes and laser and surgical treatment of dark circles under your eyes call 978-369-4499 or email us. Read our free newsletter to keep up to date on new discoveries in aesthetics, non-surgical facial and eyelid rejuvenation and plastic surgery. Read Save Your Face to learn how to prevent facial aging.

Dr. Seckel
Concord, Massachusetts
Boston Massachusetts

No matter how hard I work out and watch my diet, I always have fat around my waist that I don’t like. Every year it gets worse, especially after the holidays. I also don’t like my double chin, and most women I know feel the same way about their hips, thighs and buttocks.

Like many of you I have thought that liposuction would be a great way to get rid of the belly fat or spare tire, but old time liposuction is a very traumatic operation. Many people who have had liposuction complain of a painful recovery, have bruising for many weeks, and are often left with loose skin and lumps, bumps, and skin irregularities after liposuction.

I have been using the new laser liposuction technique called SlimLipo for almost a year and have been very impressed with the results. The new laser lipo technique leaves the skin looking smooth after liposuction. Laser lipo also tightens the skin as the fat is melted by the laser fiber which is placed under the skin. Thus the fat is much easier to remove after laser lipo than with the old time liposuction techniques.

Before and after pictures of laser lipo of abdomen. Notice the smooth tight skin without lumps and bumps in the after picture on the right.

How Does Laser Lipo or Laser Liposuction Work?

Laser lipo is a laser liposuction technique for removing excess or unwanted fat from beneath the skin in certain areas of the body. Most commonly laser lipo or laser liposuction is done to remove belly fat from the tummy, chin or neck fat in a double chin, and fat from the inside of the thighs, outside of the hips, and the buttocks, knees and arms.

The laser lipo liposuction procedure involves placing a tiny laser lipo fiber beneath the skin into the fat pockets under the skin, and melting the fat with laser energy. Laser lipo melts the fat into a liquid which is much easier for the plastic surgeon to remove than with traditional liposuction methods. Because the fat is a liquid it can be removed with a very tiny tube called a cannula. The cannulas used after laser lipo are 2-3 millimeters in diameter, less than half the size of the cannulas often used in old time liposuction.

The heat from the laser lipo laser fiber not only melts or liquefies the fat, but laser lipo also tightens the skin as the laser lipo procedure is done. This prevents the loose skin that is so common after traditional liposuction techniques.

Why is Laser Lipo Better than Old Time Liposuction?

While traditional non-laser liposuction has been very successful for removing fat and improving body contour, many patients are disappointed by loose or irregular skin after liposuction. As many as 20% of patients who have traditional liposuction complain of lumps, bumps, swellings, wavy lines or skin irregularities after recovering from liposuction. Plastic surgeons call these problems contour deformities. If you check your surgical consent given you before non-laser liposuction, you will read that these deformities are expected in a certain percentage of cases.

In my experience to date I have been truly amazed at how smooth the skin of my patients is after laser lipo liposuction. My opinion, based on my anecdotal experience, is that because the fat is liquefied by the laser lipo fiber before removal, the fat removal process is more uniform. Non-laser liposuction cannulas actually use strong suction pressure to pull, avulse or rip fat from beneath the skin. This technique not only causes trauma to the skin, but also leaves skipped or missed areas of fat which appear as lumps and bumps on the skin afterwards. See before and after picture below of laser lipo correction of skin deformities (circled in purple) that had been caused by old time liposuction done two years before.

Before and after pictures of laser lipo skin smoothing of abdomen. The patient had an old time liposuction 1 year before and was left with lumps and bumps which are outlined in purple on the left. On the right after laser lipo the skin is significantly smoother.

In addition, the laser lipo fiber produces heat beneath the skin which not only melts fat but also tightens the skin. This skin tightening achieved by the laser lipo method helps prevent the problem of loose skin after non-laser liposuction. This is a major advance in liposuction technique in my opinion.

While skin tightening has been possible with invasive ultrasound non-laser liposuction technology, the size of the ultrasound probe and the risk of skin burn, has limited the use of this technique to the abdomen. The laser lipo fiber is so small that it can be used in any body area that can be treated with liposuction.

How is laser Lipo Done?

Laser lipo can be done under local or general anesthesia. The most important thing is that your laser lipo liposuction be done in an approved, licensed, operating room where strict sterile and surgical precautions are used. Resist the temptation to bargain shop for a low priced laser liposuction in an office. You may save money but you could lose your life to an infection.

Prior to your laser lipo liposuction procedure, a small needle will be inserted beneath your skin and a special liposuction fluid called tumescent fluid is instilled beneath the skin. The purpose of this tumescent fluid is to minimize bleeding, provide pain control for up to 24 hours, and to loosen or prepare the fat beneath the skin for later removal. The fluid causes the skin to bulge or tumesce, which makes the movement of the laser lipo fiber easier through the fat layer.

Next, very tiny holes are placed in hidden locations on your skin, for example inside the belly button, to allow the laser lipo fiber to be placed into the fat beneath the skin. The laser is turned on and the fiber is moved back and forth in the fat to dissolve the fat and tighten the skin.

After the laser lipo fiber has dissolved the fat beneath the skin, a small tube, the cannula is inserted beneath the skin and the fat removed by suction. Because the fat is now liquid, I use a small syringe to remove the fat and do not usually use the more powerful liposuction machine, unless I am treating a large area.

When finished, the tiny entrance holes are closed with one suture or a stere-strip. The area that has been treated will be placed in a tight compressive garment to support the skin.

After a brief stay in the recovery room to make sure you feel well and are stable, you will be discharged home. Usually you will return to the office in 4-5 days for an exam and suture removal if any were placed. I will ask you to bring your own garment such as a “Spanks” or other tight garment to wear home after your first office visit.

How Long Is the Recovery from Laser Lipo?

You will be up and and around, able to walk, eat, use the bathroom and perform other normal activities right after your procedure. I do ask you not to do strenuous physical exercise or heavy lifting for about a week.

In my experience, there is less bruising with laser lipo or laser liposuction than with traditional liposuction. If you do have bruising, it will likely be gone in 10 days to two weeks. I have not seen the prolonged bruising and swelling that I have seen in the past with regular liposuction.

Which Laser Lipo Machine Is Best?

I use the SlimLipo laser lipo machine made by Palomar medical. The SlimLipo laser lipo or liposuction technique uses a patented 924nm (nm stands for nanometer which is one millionth of a meter and is used to describe laser wavelength) laser wavelength. The 924nm laser wavelength is absorbed specifically by fat, and 3-5 times as much fat is released or liquefied with the 924nm laser wavelength as with other laser wavelengths used in laser lipo, the 1064nm and 1308nm laser wavelengths.

How Do I Find the Right Doctor to Do Laser Lipo?

I recommend that you consult 2 plastic surgeons that are certified by the American Board of Plastic Surgery. There are many different doctors who advertise and do laser lipo. However, any procedure which involves treatment beneath the skin is considered surgery, and if you are having surgery of any kind, you want a board certified surgeon taking care of you. Board certified plastic surgeons spend 5-7 years of training and 2-3 years of experience before they are allowed to take the certifying examinations.

Plastic surgeons spend years learning how to provide safe surgical care and have the expertise and ability to achieve good aesthetic results. Most importantly, if anything goes wrong, they have the experience to take care of you, unlike some physicians who have never had surgical training.

Laser lipo is an exciting, remarkable, revolutionary new technique in liposuction, body contouring and body sculpting. In my personal experience it has many advantages over old time liposuction techniques.

If you are considering liposuction, please do your homework and choose an expert. The links below are excellent resources for finding the best doctor for your laser lipo procedure:

American Board of Plastic Surgery

American Society of Plastic Surgeons

American Society of Aesthetic Plastic Surgery

For more information on laser lipo please call 978-369-4499 or email us. Read our free newsletter to learn about the newest laser and non-surgical treatments for face and body rejuvenation. Read Save Your Face to learn how to prevent facial aging.

Dr. Seckel
Concord, Massachusetts
Boston, Massachusetts

The word 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 or appearance of the normal face and body to make these structures look good or more beautiful. An example of cosmetic plastic surgery would be a face lift or breast augmentation. 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. Skin grafting for burns, correcting a cleft lip or palate or breast reconstruction after mastectomy would be examples of reconstructive plastic surgery.

Cosmetic laser surgery involves the use of laser light waves or photo therapy 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 aesthetic or cosmetic laser procedures, most of the procedures are not truly invasive surgery. While some cosmetic laser procedures involve an incision, most do not break the skin, and achieve their cosmetic result with minimal skin injury. The ability of cosmetic laser surgery to alter or improve the appearance of the face or body without a surgical scalpel and without creating scars is the revolutionary aspect of cosmetic laser surgery.

Cosmetic laser surgery has dramatically changed 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, as lasers are very complex, potentially harmful medical devices.

The use of a laser on the human body requires 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 or interested reader, what cosmetic laser surgery can do for you and how the cosmetic or aesthetic lasers work. I will cover the most common situations in which these techniques are the best choice for aesthetic treatments. I will give you general information on how you can find the appropriate doctor to have a safe and effective treatment.

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

• Cosmetic laser eyelid surgery-Eyelid rejuvenation is the most common incisional surgical application of the laser in plastic surgery. The CO2 laser blepharoplasty is used to remove excess skin or hoods from the upper eyelid. The technique is also used to remove bags under eyes, puffy eyes and dark circles under the eyes. A new technique called the transconjunctival laser blepharoplasty performs lower eyelid rejuvenation through a tiny incision on the inside pink part of the eyelid. This technique avoids a visible scar on the eyelid. It also avoids changing the natural shape of the eyelid, a complication which often happens with traditional scalpel blepharoplasty done through an external incision.

Before and after picture of transconjunctival laser blepharoplasty to remove bags under eyes.

• Laser Liposuction-Liposuction is the newest application of the laser to a common plastic surgery operation. In this technique a small laser fiber is inserted beneath the skin to melt the fat and tighten the skin before fat is removed by suction. Because the fat is liquefied, it is easier to remove and tiny tubes called cannulas are used to remove the liquefied fat by suction. The result is much smaller, hidden incisions, less trauma, and quicker recovery, in my experience. Laser liposuction results so far have shown smoother skin after laser liposuction without the lumps, bumps and skin irregularities often see with the traditional liposuction procedure.

Before and after picture of laser liposuction of abdomen for laser body sculpting.

• Cosmetic laser skin wrinkle removal-laser skin resurfacing-Skin resurfacing to remove wrinkles and tighten facial skin was the first major cosmetic or aesthetic plastic surgery application of cosmetic laser surgery. In the beginning CO2 lasers were used, but prolonged healing and hypo pigmentation (whitening) of the treated skin were major disadvantages. In recent years fractional Erbium laser skin resurfacing has drastically reduced recovery and complications. The new fractional skin resurfacing breaks the laser beam into many small beams which leave intact areas of skin behind which promote healing and lessen recovery time and complications.

Before and after picture of fractional laser skin resurfacing to improve skin texture and smooth fine skin wrinkles.

• Laser skin tightening-CO2 skin resurfacing produced dramatic skin tightening but fell from favor because of the prolonged healing and loss of skin pigment mentioned above. Several different skin tightening methods have been developed using radiofrequency and infrared energy. These include Thermage, Titan, LuxIR Deep, Refirme and others. However these newer techniques achieve only about 20% tightening of the skin and in my experience results have been disappointing. The newest skin tightening technique uses the laser liposuction fiber placed beneath the skin, and results so far have been excellent in my experience.

• Laser removal of brown spots and sun damage on skin- A different type of laser is used to remove brown spots from the skin. These techniques are non-ablative, which means that only the brown pigment is removed and the normal skin is not ablated or removed. In recent years Intense Pulsed Light (IPL) is more commonly used to remove brown spots, because the IPL technique is gentler and there is less risk of skin injury.

• Laser stimulation of new skin collagen or skin plumping laser treatments-Sun damage and aging destroy the collagen in the deep layer of our skin called the dermis. The dermis is that pink or red tissue that you see when you scrape your knee. When the dermis of the skin loses collagen, the skin becomes lax and wrinkles. This is similar to what happens when you dry a full juicy plumb in the California sun. In time the plumb loses its water and shrivels into a wrinkled prune. When the dermis is irritated or inflamed it responds by producing new collagen to plump the skin and fill wrinkles. New, non-ablative fractional erbium resurfacing lasers can go through the surface of the skin and inflame the dermis and cause the production of new collagen. Examples are the Fraxel and the Lux1440 and Lux1540 Erbium machines. Becuase the skin is not ablated there is minimal redness and recovery time.

• Laser acne scar removal-Acne scars are caused by the destruction of the dermis caused by the acne skin papule. This acne lesion is an infection of the skin, and the infection destroys the dermis and creates a “sink hole” in the skin, the acne scar. The new non-ablative fractional resurfacing techniques mentioned above can build new collagen in the dermis to plump acne scars. If skin irregularities are left after non-ablative fractional erbium skin resurfacing, ablative fractional laser skin resurfacing with a 2940 Erbium laser can be used to smooth the skin.

• Laser skin scar removal-Scars from any cut or trauma, or surgery, are caused by a disruption and damage to the dermis beneath the skin. The non-ablative fractional Erbium laser skin resurfacing technique can also be used to improve these other types of scars. In my experience, the results can be dramatic. If scars are red, the IPL can be used to lessen the redness of scars.

• Laser removal of excess skin blood vessels spider veins, and Rosacea-The 532 and Argon lasers were the first ones used to remove blood vessels and spider veins from the skin. These wavelengths are absorbed by the color red, thus when they are radiated on blood vessels that contain blood, the light energy heated the blood and damaged and closed the blood vessel. More recently, IPL is used more frequently to treat blood vessels because the IPL is a gentler procedure with less risk of skin injury. On larger spider veins on the legs, a 1064nm wavelength is most frequently used today.

• Laser hair removal-Hair removal is the most common application of cosmetic laser surgery in use today. The laser beam is absorbed by the pigment in the hair follicle, heats the follicle and damages the tissue. The hair follicle is scarred and shrinks but is not permanently killed. After these treatments, the follicle produces a small blond (velum) hair.

• Laser tattoo removal-Tattoos can be successfully removed with these techniques. The benefit is that a surgical scar caused by surgical removal of the tattoo is avoided. However laser tattoo removal requires many repeated treatments over a year or more. In addition, a ghost or white area can be left behind where the tattoo was originally located.

How do cosmetic lasers work?

Cosmetic laser surgery works by heating tissue. Laser generated heat can be used to vaporize or 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 this technique is that the heat produced can be very specifically and accurately directed to heat only the tissue that is to be removed or affected, and not heat the normal surrounding tissues that are to be left in place.

The specificity or accuracy of this tissue heating is based on the fact that laser light is monochromatic, that is of one color, depending on the particular wavelength used. This light is also coherent, which means it is uniform, and this coherence or focusing of this light makes the 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 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 laser 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 beam is applied to a blood vessel which contains red blood, the blood is heated, the blood “boils” and injures the blood vessel wall, and the blood vessel closes. This is how cosmetic laser surgery 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 light beam 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. These amplified light beams are very powerful (amplified) light beams (radiation) that is emitted (emission) from a tube which is designed to create one specific color or wavelength of light. A complex electrical method is used to stimulate (stimulated) the light into a powerful amplified state. Cosmetic surgical lasers are designed to emit or produce specific colors which are highly and specifically absorbed by different tissues of the human body.

What wavelengths are used in cosmetic laser surgery?

There are hundreds of different laser wavelengths that can be tuned to vaporize very specifically colored biologic targets on the human body. The color of hair, blood vessels, tattoos, veins, arteries, pigment in brown spots and other colors can each be specifically targeted best by one particular laser wavelength. The trick is to produce the specific wavelength that is needed for the application you desire. Some common wavelengths used in cosmetic laser surgery are:

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

• 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 water and used for hair removal, closure of large veins, and in laser liposuction

• 1308-Absorbed by fat and used in Laser 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

Which doctors are experts at cosmetic laser surgery?

Lasers were first used in dermatology and otolaryngology as non specific heating devices to destroy cancerous lesions in a manner similar to traditional electrocautery. Only after lasers were refined to selectively heat specific tissues were cosmetic laser surgery applications possible.

The first of these new cosmetic laser surgery techniques was formally 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 new equipment.

More importantly, I believe is that these new cosmetic laser 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 a light 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. This new type of surgery 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 uses these new light based cosmetic photo therapy techniques. 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 for more information on the use of lasers in medicine and surgery.

Be careful to choose a plastic surgeon certified by the American Board of Plastic Surgery. There are many non-surgeons who offer these advanced techniques. Don’t be fooled, you want a trained board certified plastic surgeon if you are considering having surgery with these new techniques. There are many board certified dermatologists who are expert at the non-surgical treatments using these new techniques.

Cosmetic laser eyelid surgery in particular is a very significant advance in eyelid rejuvenation. Do your homework and find an expert. Let these exciting new aesthetic techniques help you look as good as you feel.

For more information on cosmetic laser surgery call 978-369-4499 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

Before and after picture of laser removal of dark circles under the eyes.

Are you tired of looking tired? Do people look at your eyes and say did you get enough sleep, are you sick, do you feel well? Eye bags, puffy eyes and dark circles under eyes make our eyes and faces look tired and old. The eyes are our most recognizable and important facial feature and when the appearance of your eyes change, people’s perception of our face changes.

People read our eyes to see how we are feeling and to gain social clues about how to interact with us. You know when someone is happy, sad or angry just by looking at their face and eyes. As we age many of us develop bags under eyes, puffy eyes and dark circles under eyes that distort our look and how we really feel. This is very distressing when we are feeling great and have had a good night’s sleep. Many people who notice aging changes in their eyes consider plastic surgery to regain young fresh looking eyes.

Traditionally a plastic surgery operation called a blepharoplasty was used to remove eye bags, puffy eyes and dark circles under eyes. While these procedures are effective, the surgery often left the lower eyelid sagging at the corner with a sad eyed look often called the hound dog look. In addition traditional scalpel blepharoplasty surgery can cause significant bleeding which often leads to prolonged bruising and a painful recovery.

New cosmetic laser eyelid surgery to remove eye bags, puffy eyes and dark circles under eyes has revolutionized the treatment of these conditions. New IPL (intense pulsed light) treatments can lighten the dark blue, purple or black circles under the eyes. These new techniques have revolutionized the way cosmetic eyelid surgery is done.

Before and after picture of laser surgery fro removal of bags under eyes.

What causes eye bags, puffy eyes, and dark circles under eyes?

The eyeball rests on a small pad of fat which is between the eyeball and the bone of the eye socket. This fat is held in tightly by our eyelid muscles and eyelid skin. As we age, our eyelid skin and muscle become loose or lax. The fat pad pushes forward or herniates against the loosened lower eyelid skin and creates a bulge or bag under the eye or a puffy eye.

The bottom of your lower eyelid skin is attached to your cheek bone by a structure called the arcus marginalis. This structure holds the bottom of your lower eyelid tight to the bone so the eyelid does not fall down into the cheek. As the eye bag or puffy eye bulges over the arcus marginalis attachment, a shadow is created beneath the eye bag, and this dark depressed shadow creates the dark circle under the eye. I also call this the arcus deformity, because it is caused by the attachment of the arcus marginalis.

The eyelid skin is also very thin, so thin that you can actually see through the skin and see the color of the eyelid muscle beneath the skin. Since the muscle is purple, the skin overlying the muscle looks purple or blue. If there is sun damage to the skin, brown pigment appears on the lid and the lower lid can appear brown or even black. These factors also create dark colored blue, purple, brown or black circles under the eyes.

In summary eye bags, puffy eyes and dark circles under the eyes can be caused by:

• Loose eyelid skin
• Protrusion or herniation of lower eyelid fat
• Tethering of the lower eyelid to the cheek bone by the arcus
• Thin eyelid skin
• Purple color of eyelid muscle beneath the skin
• Brown pigment on the eyelid skin caused by sun damage

How does laser eyelid surgery to remove eye bags, puffy eyes and dark circles under eyes work?

The laser beam is actually used to make the incision for eyelid surgery. The laser beam seals blood vessels and nerves as the incision is made thus there is less bleeding during the procedure, the most important factor in any eyelid surgery. Because the nerves are sealed, there is less pain.

I use a newer cosmetic laser surgery technique called the transconjunctival laser blepharoplasty which involves making a very tiny laser incision on the inside of the lower eyelid to remove bags under eyes, puffy eyes and dark circles under the eyes. By doing this procedure inside the eyelid, and not cutting through the skin and muscle on the outside, I do not damage the support of the lower eyelid. Thus the natural beautiful shape of the eyelid is preserved.

This transconjunctival laser surgical technique avoids the sad eyed look or hound dog eye that often occurs when an external scalpel is used to make the lower eyelid incision on the outside of the skin.

If my patient has a deep depressed shadow beneath the eye bag, the arcus marginalis deformity, I also release the arcus marginalis through my tiny inside incision or transconjunctival incision. This releases the dark circle shadow under the eye.

I also place small pieces of fat, called fat grafts, on the cheek bone beneath the dark circle to plump the area and prevent re-attachment of the arcus marginalis. This technique plumps the dark circle, corrects a hollow eye appearance, and plumps the cheek for a more youthful look. The entire mid face and cheek area is rejuvenated and looks younger after the arcus marginalis release and fat grafting.

If wrinkles and pigment are present on the eyelid skin I often use a different cosmetic laser surgery application called fractional laser skin resurfacing to remove the wrinkles and pigment. This is a different laser which does not make an incision, but rather vaporizes sun damaged skin, wrinkles, and pigment.

In summary, the laser surgery technique for treatment or removal of bags under eyes, puffy eyes and dark circles under eyes involves:

• Laser incision
• Incision inside on pink part of eyelid-the transconjunctival laser blepharoplasty
• Removal of bulging fat causing eye bag and puffiness
• Release of the arcus marginalis which causes the dark circle shadow
• Grafting or placing fat on the cheek bone to plump the dark circle and make the cheek look younger
• Fractional laser skin resurfacing to remove wrinkles and pigment if necessary
• No sutures

Before and after pictures of laser surgery to rejuvenate upper and lower eyelids.

Benefits of this laser surgery technique are:

• Less bleeding
• Less bruising
• Less pain
• Quicker recovery
• No change in shape of eye
• No visible scar

How does IPL-Intense Pulsed Light- remove dark blue, purple or black circles under the eyes?

If you do not have eye bags or puffy eyes but still see dark circles under your eyes, IPL or Intense Pulsed Light, also called photo-facial can remove the dark color from your eyelid skin. Younger people with blue circles, purple circles or brown or black circles under the eyes have thin skin with many small blood vessels called veins, arteries and capillaries which cause the lower eye skin to look blue or purple. Other people have brown pigment which can make the skin look brown or black.

IPl is a light flash treatment that closes the excess small vessels and removes pigment to lighten the color of the lower eye skin. It is very safe, relatively painless and takes only a few minutes. There is no down time. The skin may be pink for a day but no incisions, no surgery, no healing is required.

An eye shield is placed to protect the eye from the light flash. No anesthesia is required and you can go back to work after the IPL treatment. IPL is used to:

• Remove blue and purple circles under eyes
• Remove brown and black circles under eyes
• Requires no anesthesia
• No down time
• Takes only a few minutes
• Requires eye shields to protect the eyes

How do I find a plastic surgeon that performs cosmetic laser surgical procedures?

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.

Before and after total laser eyelid rejuvenation.

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