Total Body Surgical Blog

Last week we talked about treatment of facial redness, facial veins, and rosacea as a cause.  Most of these treatments involve some type of light therapy or laser treatments.  The laser is used to close visible veins on the face and at the base of the nose.  It works by damaging the lining of the vein, it ceases to function, and your body eventually gets rid of it.  Of course, some new veins may appear with time and may require further treatment. 

 just a reminder..

For the redness associated with aging and, or rosacea, we use IPL (intense pulsed light).  The intensity of the pulse of light also targets the red pigment in the smaller capillaries of the skin of the face, causing them to close.  After a short time, the redness is much less.  In many cases, we will use the laser and IPL at the same time, closing the larger, visible veins with the laser and the generalized redness with IPL.  The IPL treatments also can target "age" spots on the face, or areas of Melasma (mask of pregnancy or pigmented areas).

 melasma   age spots

These areas are caused by Ultraviolet light (sun) exposure and hormonal changes.  This is why we recommend not tanning your face!!!, or use sun screen on your face and re-apply often.

OK, after this reminder of what we are trying to address with the laser...what is, and why do you need "pre-treatment"?  First of all, we want the treatments to be as effective as possible.  If you pre-treat the skin, the dead layer or stratum corneum is not as thick and the light used penetrates better.  This, of course, gives a better result.  The other problems that can occur with light therapy are:

-hyperpigmentation:  in other words, the skin cells that produce the pigment in the first place can respond by making more....not what we're looking for.

-hypopigmentation:  loss of skin color.  The pigment cell stop working and the skin becomes too light.

-persistant redness:  redness of the skin after treatment that can hang on for months.

Of course the percentage of people that have any one of the three of these happen is very low, however, we want to decrease the risk as much as possible.  How do we do this?....by pre-treating the skin of course.

What we, and most others, use is a combination of a retinol compound, and a fading agent.  Retinol compounds are derivatives of vitamin A.  (retinol, retin-a, tretinoin, etc.)  There are chemical differences between them, but the end result is to compact or thin the outer, dead layer of skin and stimulate the live, basal layer to turn over quicker and thicken.  They also retard the degradation of collagen and slow down the darker pigment cells that create dark spots.  All retinols will also dry the skin to some extent and decrease oil production.  These effects are great for acne and for some forms of rosacea.  The other product we use is a hydroquinone.  Hydroquinone works by inhibiting an enzyme in the melanocyte (the cell in the skin that produces pigment) that is critical in forming the melanin or dark pigment.  By stopping this pigment production before any light treatment, we can decrease the likelihood of hyperpigmentation as a problem.  The continued use, after laser or light therapy, of hydroquinone keeps the age spots and, or melasma from returning.

Of course, pre-treatment does not guarantee that any one, or all, of the problems that can occur will be prevented.  But pre-treatment does greatly lower the chances.  The darker the skin, i.e., ethinic skin, the greater the chance of problems with or without treatment.

At Total Body Surgical, we use the Obagi line of skin care products for pre-treatment and maintenance.  It is medical grade (prescription grade) and works very well even if laser or light therapy is not used.  Our pricing is great and we start people on the travel size products so they don't buy large amounts to start with.  If your skin cannot tolerate it, (very unusual) or if you don't like it, you have not made a huge investment.

So come see us for facial pigment issues, rosacea, or acne.  We have the experience and equipment to help you.  Cosmetic consultations are complimentary so call 918-786-7780 or 1-877-weight-0.

I hope everyone had a great 4th....time to get back at it. 

One of my friends asked me to address those unsightly veins that show up on the face.

  Here is a good example of what I'm talking about.  These are from a condition called rosacea that causes inflammation and eventually the larger veins that appear on the cheeks and around the nose.  The problem is usually made worse with heat (i.e. working in the yard during summer) or consumption of red wine.  It can occur in all ethnic groups but is much more visible in the lighter skinned groups. Rosacea is treated with topical medications, oral medications, and light therapy which will be covered later. 

 Rosacea can also have a deleterious effect on the color and shape of the nose.  Known as "rhinophima", the nose becomes red with acne like lesions that eventually cause the nose to become misshapen.  It can also cause very large veins to become visible.

 The veins that appear at the base of the nose are very common as we age.  Some people have them worse than others of course, but lighter skin tends to allow them to show up more prominently.  They can occur with or without rosacea.

 Here is another example of a facial vein that sometimes bothers people.  This is known as a facial reticular vein.  They can occur around the eye and temporal area.  They are present in young and old alike.

 In some instances, instead of visible veins, just a "redness" is seen.  This probably is just early rosacea and should be treated as such.

How do we treat these problems?  The treatment depends on what the cause is and how severe the problem has become.  With rosacea, we treat it topically and sometimes with low dose antibiotics when it is early and large venous areas are not present yet.  Once outbreaks are controlled, the redness usually subsides.  If it does not, the next step would be to use Intense Pulsed Light treatments to close the small capillaries that are flushing and causing the skin to turn red.  These treatments (also known as IPL) use bright flashes of light of a certain wave length to damage and close the small vessels that are causing the problem.  Usually several treatments are required, sometimes up to 5.  These treatments will controll the problem for some time after, but usually not permanently, so treatments may be required every few years or so.

For the larger veins, in the cheek, nose, and base of the nasal area, we use the vascular setting of the Cutera 1064 YAG laser.  Using a very small spot size, the veins can be closed and they are no longer visible.  In some cases, we will use both the laser, and the IPL in combination.  This treats the redness that is generalized and the larger veins that are too large.  The treatments are generally pretty quick and the discomfort is tolerable.  We use numbing cream for most as well as the Zimmer chiller that blows cold air over the treated areas.  For larger treatments we will call in Valium if needed.

Reticular veins around the temples or eyes are also treated with the YAG laser.  They may be a little sore after treatment for a few weeks until the body resorbs the vein and some bruising is possible though not very common.

The nasal effects of rosacea can be severe if left untreated.  The laser is used to control the venous problem and it helps with the sebaceous problem as well.  Left alone, the nose can turn into a trunk so treatment is necessary.

All of these treatments are done in the office with little or no sedation.  The treatments alone are fairly quick, taking only a few minutes.  Usually there is only a mild amount of redness after, though there can be some areas of ulceration or skin slough.  These areas usually heal very well.  Ideally, you come in and have the treatment done, leave with a little redness, after that resolves, the veins and redness are gone or greatly diminished.  As I said before, more than one treatment is usually required and are done 4-6 weeks apart to allow for healing.

So, if any of these things are bothering you, give us a call at 918-786-7780 or 877weight0 toll free.  If you have any questions, fill out a contact form and I will try to answer it for you.

I hope this helped some of you understand a very common problem.

Acne can be a terrible affliction or a very minor problem.  It can occur from the teenage years, and also as an adult.  Acne can cause problems that will be present for life, leaving cosmetic issues that may be very hard to deal with.  I want to discuss today the process of the problem and how to handle it.

First of all, what is the process behind the problem???  Acne usually starts in adolesence.  It is a familial problem that manifests during hormonal changes.  It can occur in all skin types and with different degrees of severity.    Acne can lead to social problems that may last a lifetime.  Hormonal increases in adolecense lead to changes in the output of oil in our skin, making it thicker.  This leads to the pores becoming closed, and with bacteria in the skin using this "food" source, they multiply.  The result is the inflamed cystic "comedones" that we call acne. In most instances, the blemishes are limited, resolve in a short period of time, are not severe, and, with the exception of slight embarassment, do no long term harm.  In a minority of cases, the problem is severe, unremitting, and can lead to permanent skin changes.  The changes that can occur are scarring, changes in skin pigmentation, and the resulting self confidence issues that remain. 

What can be done about all of this then?  Most manage by keeping the skin clean and using over the counter products that we see on television.  For minor cases, this is enough.  For more severe cases, these products are no match and the blemishes continue.  At this point, hopefully, parents recognize the severity of the problem and will seek other help.  That is where we can help. 

The first step usually recommend is a change in basic skin care.  We like cleansers that contain salicylic acid.  The salicylic acid in the cleanser helps to liquify and remove the oil that is the root of the problem.  We also recommend benzoyl peroxide solutions that will help reduce the bacterial load.  The third thing I like for patients to do is start a retinol topical cream.  Retinol also helps reduce oil, dry the skin, and compact the stratum corneum, the dead layer of skin cells.  If need be, I will also start an oral antibiotic to decrease the bacteria and decrease the inflammatory response that the bacteria cause.  Antibiotics are generally continued at a low dose as the inflammatory response is less while on them.

For most, these routines are effective in managing the acne.  In others, these steps may not be enough.  The next step I usually add is laser therapy.  We use the Cutera system on a setting that will heat up the skin and kill the actively reproducing bacteria.  There is no recovery time and these treatments can be repeated at 4-6 week intervals with no pain. 

After this step, if no response is noticed, we have a decision to make.  In some women we will add some other medications as hormone modulators such as birth control pills or spironolactone.  If these do not give us results, we then must consider more powerful oral medications.  The one that is the most effective is Accutane.  Accutane is a medication that works very well.  It is also capable of causing problems for some patients.  Everyone has heard of a horror story related to Accutane but few hear of the great number of successes.  The biggest problem a patient can encounter is conception while on the medication.   I-pledge is a program that was instituted to educate patients taking the drug about how to avoid pregnancy and the birth defects that can occur.  Secondly, headaches, brain swelling, depression to name a few are the other side effects than may be encountered while on  Accutane.  The biggest complaints I see are that of dry skin and cracked lips and these are very tolerable.  In most instances the results far exceed expectations and over shadow the risks.  The usual patient takes the medication for 6 months.

My personal philosopy is that the risks of Accutane, when given correctly, are very much worth it.  I am often asked to try to treat patients with scarring and pigment changes resulting from severe cystic acne....this is VERY hard work and is usually only marginally successful.  For that reason, I start off with the less problematic treatments and give them a fairly short trial...6-8 weeks.  If there is no measurable result and the acne is severe, I usually will then suggest Accutane if the patient is a reliable person and can understand the risks.

Come see us today at Total Body Surgical Cosmetic Surgery if you need help....918-786-7780.

Let's talk about a common problem that we can help with.....acne.  Acne vulgaris is a common problem in adolescence that can continue or leave long lasting changes through adulthood.  It most commonly occurs on the face and back but can cause problems almost anywhere.  It occurs in these places most commonly because of glands that produce a large amount of oily material.  The pores become "plugged" with this thick, oily material and bacteria (germs) get in the mix causing inflammation and pimples.  It occurs when hormonal levels are peaking, thus the high rate during adolescence but adult acne is also a common problem. 
Certainly, acne is not a life threatening condition but it can ruin self esteem and lead to life changing and permanent skin damage.  It can cause scarring and pitting of the skin that will carry through life in severe cases.  Many of us have mild and sporadic breakouts that are only a minor problem, but for some, acne is a curse that can ruin social interactions and make us very self conscious.

At Total Body Surgical we take a systematic approach to the treatment of acne.  I like to evaluate at the initial visit how severe the problem is and what potential for permanent skin damage there is.  If the problem is not severe, we start with a good skin cleanser that contains salicylic acid to remove the oil the skin is producing.  I like the clarifying cleanser made by Skinceuticals.  We also like benzoyle peroxide products for a topical kill of bacteria. Retinol or tretinoin is also used topically to help the skin turn over quicker.  This is usually our first line of treatment for even the worst cases.  For more severe problems I will add a topical antibiotic gel or start treatment with an oral antibiotic at low doses to decrease the inflammation and lower the bacteria count.  These steps will usually make the condition improve a great deal, at least enough to make it tolerable.  If not, the next step we use is the Cutera 1064 laser.  The laser genesis treatment is painless and quick with no down time.  We use the laser to gently warm the skin to a temperature  that eliminates the bacteria causing the problem.  This is usually very effective and allows the other treatments to take hold.  It is also a good way to get ready for special events...treat a week or so before and have a clear face!!  These treatments can be done at 4-6 week intervals and are very affordable.

Now for the severe cases...the dreaded Accutane!!!  I am very careful when I choose patients to use this medication.  They must be reliable and have good supervision from a parent.  The i-pledge program must be followed as well which gives good counseling about pregnancy prevention while on the medicine.  Accutane IS a great drug...it works almost universally.  It can, however, have some severe side effects that are not very common (regardless of what the lawyers on TV portray).  It can cause depression leading to suicidal thoughts, headaches that can be severe, birth defects if you become pregnant or make someone pregnant while on the drug, very dry lips and skin, dry eye....and the list goes on.  Most treatment regimens start at full dose and after clearance of the acne we switch to a lower dose program which seems to be effective.  Any of the above problems that become severe may require a stoppage of the medicine. 

I have found that most individuals will require a minimum of 6 months of Accutane and some may need more than one course of the medicine.

For those with permanent acne scarring we offer the Pearl laser.  You must be off of Accutane for a minimum of 6 months to qualify but these resurfacing treatments help tremendously to soften the scarring.  Down time is around 4-5 days and treatments can be repeated to desired effect.

If you need help with acne...give us a call at 918-786-7780...we'll be glad to give you the help you need.  Don't forget our laser hair removal...$50/treatment/area special too!!

Laser days at Total Body Surgical!!!!  We know have the Cutera laser full time in Grove...VERY exciting.  The Cutera laser is one of the most comprehensive lasers, IPL combinations on the market.  The system can nearly do it all, and do it well.  I have many years of experience using this system and it is great at treating a large number of problems.  Let's itemize them:

1.  Laser hair removal.  With the Cutera system we use the ProWave 770.  It is an IPL (intense pulsed light) that can treat large areas and do it very effectively.  In a pinch for smaller areas that are difficult, we have the 1064 YAG which most of the older systems are based on.  Laser hair removal is very popular and has, in the past, been cost prohibitive.  For a limited time, we are offering an exceptional deal...$50.00 per area per treatment.  This will be good through the summer so don't miss it.  Usually facial hair takes about 9 treatments and body hair 6.  This means you can get your underarms done for $300.00.  Take advantage of a great value!

2.  Facial or body dyschromias.  Age spots and redness become a problem as our skin ages.  The IPL Limelight system is great for treating a variety of discolorations on the face, arms, and hands.  This usually requires a series of 3-5 treatments and we usually like to have you on the Obagi skin care system to prevent further damage or recurrence.

3.  Facial veins.  We use the 1064 YAG to treat small viens that occur at the base of the nose, on the cheeks and chin.  The laser targets the pigment and closes the vein, removing it on a permanent basis. 

4.  Leg veins.  We use the 1064 YAG to treat small areas of leg spider veins as well.  For larger areas we usually inject with a sclerosant.

5.  Laser skin resurfacing.  We have the Pearl laser for resurfacing.  This helps with reducing pore size, improving skin color, fine lines, and wrinkles.  The great thing about the pearl is the short recovery time and similar results to the CO2 laser.  Recovery times are about 4 days with great results.  Some may require a series of 2-3 treatments about 2 months apart.

6.  Laser treatment of Hemangiomas or cherry spots on the body or face.  These require only one treatment in most cases and they are eradicated.

7.  Laser Genesis for treatment of acne, to reduce pore size and improve skin tone and texture.  This works exceptionally well with no down time.

8.  Titan treatments for skin laxity in the neck and face using Radio Frequency with no down time.

We are very proud to have such great technology in Grove.  Our pricing is unbeatable and results are outstanding.  Our nurses, Janet and Trish are very skilled at suggestions and advice and are very good at treatments.  We also have the Zimmer system that provides comfort during treatment sessions.  

Come see us soon to arrange YOUR treatment plan and schedule.  Call 918-786-7780 to arrange today.

New blogs starting after the new year.

Let's hope 2012 will be a great one and that things actually do "change".

Look for some of the same offers this year AND some new ones.

Thank you all for making our year a very good start here in Grove.

Today, for the final installment on lasers, we are going to discuss the use of lasers to treat veins on the face, legs and elsewhere. 

First, leg veins.  Superficial or spider veins occur very frequently on the legs.  As I have discussed before, when the areas are large, I prefer injections to the laser because I can cover much more ground and cause less dicomfort.  For small areas, however, the laser is very convenient and in most cases works very well.  The veins in this picture are perfect....why??  Remember that laser light is attracted to pigment.  The darker the pigment, when the laser light hits it, heat is generated, the small vein is injured, the flow stops and the vein is gone.  After lasering the vein it turns red and forms a clot that slowly dissolves.  I use the Cutera 1064 laser for the darker veins.  For veins that have a lighter and more red pigment we use the KTP or 536 wavelength laser.

The second area that is most commonly complained about is the face.  Adults of European descent commonly develope visible veins around the base of the nose that are unsightly.  Those with Rosacea get veins that are visible on nose, at the base of the nose, and nearly anywhere else on the face.

The nasal areas we treat with the laser to close the veins.  For Rosacea, it may require several different methods, even systemic medications on some cases. 

The results we get are very good.  In most cases, new areas will arise and will require repeat treatments from time to time we call maintenance.

A third condition that is vascular and can be treated with laser are hemangiomas.  These areas occur in the young and old and anywhere on the body.  They can be very small.  They can also be very large.  Most of these can be closed with the laser.  Larger ones may require several treatments.  They turn dark, dry up, and are usually gone.

There are other uses for lasers but that about covers the more common things and I'm worn out with it.  We have covered how lasers work, hair removal, skin rejeuvenation, abnormal coloration, and vascular lesions....we treat them all.  Something new next week.

Don't forget our specials at Total Body Surgical.  We have a few surgical spots left before the first of the year then the summer countdown begins....believe it or not.

In the past few weeks we have discussed how lasers work, removing tattoos, removing unwanted hair, and renewing the skin.  These are important uses for laser technology and as it gets better, we will see more uses pop up.  Today I want to discuss pigment issues on the face, arms, and chest. 

Why do we get them and what are they??  is picture shows melasma, aka "pregnancy mask".  It is caused by sun in combination with hormonal changes.  It is quite common and cases can vary a great deal in severity.  These changes can occur on anyone but seem to be worse in ethnic skin.  It can occur over the entire face but is the most common on the cheek area.

The second area is on the chest.  Brown spots and red spots occur with age and again.....the sun.  Sun worshipers get this and the more you worship the worse it gets.

The third area is on the hands.  Age spots, liver spots, whatever you want to call them are caused by sun damage and can be present over the entire arm.

Even if you don't worship the sun, we all get exposure during normal daily activites of walking out doors, driving, etc.  So they can occur on any of us.

How do we treat them??  First, I suggest a good skin care regimen.  This is key to getting the skin to heal and to slow down the pigmentation process.  It also prepares the skin for more aggressive treatments.  At Total Body Surgical we like to use the Obagi system for treating damaged skin.  Obagi contains tretinoin and hydroquinone.  These stimulate the skin to grow faster and shed the dead portion of the skin.  It also turns off the melanocyte or pigment cell.  Lastly, it contains a good sun screen to prevent further damage.  Once used for a short period of time, we treat these areas in a couple of ways.  First is the IPL (flashlamp or Intense Pulsed Light).  This is a machine that shoots short bursts of intense light.  The wavelength is set to target the darker colors in the skin and some red pigments.  These areas then peel off and since the pigment cells are turned off, their recurrence is much less severe.  Continued protection from the sun makes them "stay away".  Treatments are usually done in a series of 3-5 treatments and the areas gradually disappear.  We can also use laser to resurface the skin and remove pigment.  The Pearl laser is perfect for this killing "two birds with one stone".  This gives you rejuvenated skin texture, helps with fine lines and wrinkles, and rids the pigment too.  Recovery time for this treatment is only about 4-5 days.  The IPL recovery time is minor redness for about 24 hours then crusting of dark areas that will peel off.  The Obagi system causes the sensation of dryness and may cause some minor shedding of dead skin for a few weeks.

Come see us at Total Body Surgical where our staff is trained and experienced with Obagi and Skinceutical products.  We also have a full product line in the office and can get you started.

Remember our specials that are still going on too!!

Call 918-786-7780 for a complimentary cosmetic consult or fill out a contact form and we will contact you!!

More laser stuff next week!

We also have special Christmas pricing on products and gift certificates available for all laser services and skin care, Latisse and more!!

What can lasers do for your skin??  ALOT!!!!  As time goes on and the natural aging process of the skin occurs there are many changes that occur.  Ultraviolet light from the sun, pollutants in the air, pollutants in what we eat, the loss of collagen as we age, genetics, loss of fat,....and the list goes on and on.  All of these things lead to the aging of our skin causing spots, wrinkles, enlarged pores, and even skin cancers.

Here is a comparison of young and old skin...here you see how the age spots form, the outer layer thins, and fat is diminished.  On a smaller scale we would see collagen loss as well.

    What we see on the outside is this....

  How can laser treatment alter these changes??  There are a number of effects that a good laser treatment can cause making the skin look and feel younger.  Laser can tighten the skin by causing new collagen to form as the damage caused by the laser is healed.  The outer layer of skin (stratum corneum) is also thinned and made more organized by laser treatment making the skin look and feel smoother and softer.  Dark spots (age spots) or dark patches (melasma) are not only caused by sun damage but also are aggravated by hormonal changes.  When lasers are used carefully and these treatments are combined with targeted skin care and sun protection, these spots can usually be treated and removed.

Laser skin resurfacing today is safer, cheaper, and recovery times are significantly less than ever before.  At Total Body Surgical we use the Cutera Pearl laser.  This laser is unique for a number of reasons.  It is a wavelength that penetrates well into the skin but shortens recovery time.  We have the only pearl in the area.  It gives the same results as a CO2 laser but the recovery time is only around 4 days.  This means that you can wear makeup after about 4 days but will have some redness for a week or two. 

Laser resurfacing can make a huge difference in acne scarring too.  Smoothing them and helping pigment changes they can cause. 

So if you want to get rid of age spots, melasma, acne scarring, or just tighten the skin up to look younger, come see us at Total Body Surgical.  We can get you started on the new you in 2012.  Now laser treatments are as cheap as $800....much cheaper than the big city.....schedule today!!   918-786-7780...cosmetic consultations always complimentary...

Don't forget our specials too!!