Laser Surgery

Port Wine Stains

Port-wine stains (nevus flammeus) are malformations of tiny blood vessels located in the upper levels of the skin. These irregularly shaped patches range in color from light pink to red to dark red-violet. Port-wine stains are present at birth, are usually located on the neck, face, and scalp, and occur in 0.5% of newborns. They thicken and darken with age, making treatment more difficult.

Port Wine Stain Removal - Pulsed Dye Laser Cynosure Photogenica V

Treatment

Hughes Dermatology's 585nm pulsed-dye laser (Cynosure Photogenica V) is the gold standard for safe and effective treatment of port-wine stains. It is FDA-approved for newborns. Treatment success depends on the age at which it is begun and the location of the lesion. Ideally, this FDA-approved treatment can be started shortly after birth. With multiple treatments, most port-wine stains can be significantly lightened. Effective topical (LMX 5 cream) and cold air anesthesia (Zimmer Cryo 5) are administered before and during the procedure to minimize discomfort. Oral Valium and pain meds may be used. The treatment is done in our office. New: Thicker (nodular) older dark port wine stains can now be successfully treated with our new long-pulsed Lyra-i Nd:YAG laser! This is usually done on conjunction with the 585nm pulsed dye laser.

Hemangiomas

These are benign tumors of the vascular endothelium. Hemangiomas of infancy are the most common and are characterized by growth in early infancy, followed by slow involution over the next decade in 2/3rd's of hemangiomas (1/3rd do not disappear). They may threaten vision or the respiratory system and then treatment is an emergency. Most lesions appear after birth, within the second to fourth weeks of life. Hemangiomas may be treated with our pulsed dye laser (if thin), or (if thicker) with our new long-pulsed Nd:YAG laser (Lyra-i). Intralesional corticosteroids, sometimes systemic steroids (if the respiratory system or vision are threatened), or, more recently, imiquimod, a topical immune response modifier, are additional options.

The latest breakthrough: propanolol orally triggers resolution of serious infantile hemangiomas (New England Journal of Medicine, June 2008)!

Hughes Dermatology advocates treatment as soon as the hemangioma appears since they are most responsive to treatment then. Since only 2/3rd's will resolve in late childhood, delaying treatment will result in 1/3rd of them becoming permanent. Also, the presence of a disfiguring hemangioma is psychologically damaging to a young child when they start school.

Pulsed Dye laser (Cynosure Photogenica V)

Short pulses of yellow colored light are produced by our 585nm pulsed dye laser (Cynosure Photogenica V). Because yellow light is more precisely absorbed by hemoglobin than other colors, these lasers are the "gold standard" for safe effective treatment of blood vessel disorders, such as port wine stains, red birthmarks, enlarged blood vessels, rosacea, hemangiomas and red-nose syndrome. The pulsed dye laser may also be used to treat stretch marks and is safe and effective for infants and children. Topical (LMX 5 cream) and cold air analgesia (Zimmer Cryo 5) make the procedure safe and comfortable.

Hughes Dermatology has over a decade of experience with the pulsed dye laser (Cynosure Photogenica V)

Stretch Marks

New red stretch marks (striae rubra) can be successfuly reduced or nearly eradicated with early 585nm pulsed dye laser treatment in conjunction with topical retinoid applications. Older white stretch marks (striae alba) are more difficult, but they can be improved as well.

Stretch Mark Removal Pulsed Dye Laser

Acne Scars

Acne scars can be improved with medical or surgical methods. Topical Retin A products and chemical peels slowly produce some scar remodeling.

Box car scars can be resurfaced with the Er:YAG laser. Recently scar improvement has been documented with laser rejuvenation using Hughes Dermatology's long-pulsed Nd:YAG laser. This is a no-downtime procedure requiring several sessions to achieve moderate "filling-in" with collagen and ground substance. With the right type of scar, our patients have been pleased with this safe and affordable new treatment. (See the before and after photos under "laser rejuvenation" below.)

Depressed scars can be filled with autologous fat (fat transfer) or dermal fillers such as Restylane.

Deep ice-pick scars are best excised and then resurfaced with the Er:YAG laser.

A new approach, developed in Korea but now practiced in the USA, is focal TCA application to depressed scars. A series of multiple treatments, 1 month apart, causes an improvement by triggering new collagen production. This is a relatively inexpensive treatment. Hughes Dermatology has experience with this method.

Hughes Dermatology is experienced with all these modalities. Please schedule a consultation appointment for evaluation of your scarring so appropriate treatment can be instituted.

The picture on the left demonstrates acne scarring treatment using Erbium: YAG laser resurfacing. The picture on the right was taken 10 weeks later.

Laser Rejuvenation

Laser rejuvenation (or nonablative laser resurfacing) is a relatively new and promising minimally-invasive procedure using a laser to reverse dermal signs of aging. The long-pulsed Nd:YAG laser (Laserscope's Lyra-i) stimulates collagen and ground substance production in the skin and improves facial and neck fine wrinkling, produces modest tightening and modest acne scar improvement. A series of treatments (usually 6) over the course of a year constitutes the typical treatment. Then, improvement is maintained with laser treatments every 3 to 12 months, based on new studies. This is a no-downtime treatment, producing minimal redness for less than an hour. The treatment is relative inexpensive. We are pleased that our acne scarring patients have seen nice improvement of their shallow facial scars with this method, as it "plumps them up" with collagen and ground substance. Laser rejuvenation manages only deeper wrinkling issues and it should be combined with a surface rejuvenation regimen (topical retinoids, alpha hydroxyacids and chemical peels) for maximum benefit. The improvement is slow, with patients and physicians usually noticing the improvement after the 3rd treatment. Improvement in collagen and ground substance can be seen under the microscope, as reported in numerous studies. The clinical improvement can be more subtle. The majority of our patients are happy with their improvement.

Laser rejuvenation: after (left) and before (right) using Hughes Dermatology's long-pulsed Nd:YAG laser.

A well-done new study, published in the August 2005 Dermatologic Surgery journal, demonstrated 28% objective acne scar improvement with this nonablative laser rejuvenation (using our same Lyra-i laser), a nice result! The patients themselves evaluated the improvement at 37%.

A recent presentation at the 2006 American Society of Laser Medicine and Surgery meeting showed Nd:YAG laser rejuvenation skin lifting and tightening superior over Thermage RF treatment.

Acne scarring before (left) and after (right) laser rejuvenation with the long-pulsed Nd:YAG laser.

For deep wrinkles or rhytids around the mouth, Erbium:YAG laser resurfacing which is usually combined with chemical peels is better, but this does require a 5-7 day healing time. New: We are now combining laser resurfacing and laser rejuvenation (Er:YAG resurfacing followed 6 weeks later with a series of non-invasive laser rejuvenation treatments to help "fill-in" undulated depressions of the skin). Hughes Dermatology is experienced with all these methods and can recommend approaches on an individual basis.

Laser Hair Removal

Laser hair removal uses a laser to gently remove unwanted hair. The laser energy passes through the skin and is absorbed by the pigment in the hair follicle. In a fraction of a second, many of the treated hair follicles are injured by the heat generated by the laser and hair production ceases in thse follicles.

With the exception of the region close to the eye, almost any area of the body with excess hair can be treated with lasers. The most common areas requested by patients are the face, upper lip, neck, chest, periareolar (breast region), underarms, back, abdomen, bikini line and legs.

In the past, patients with light skin and dark hair were the only ideal candidates for laser hair removal. However, the use of longer wavelength lasers and contact saphire skin cooling devices (Hughes Dermatology's Laserscope Lyra-i laser) have increased the safety of lasers used to treat patients with darker skin types that, until now, have not been candidates for laser hair removal. These skin cooling devices and the Nd:YAG's longer wave length and longer pulse duration protect the skin (even darker skin) and allow safe dark hair removal in all skin types.

Multiple treatments (typically 6) are necessary to achieve satisfactory hair reduction. A consultation visit is necessary to determine if a patient is a good candidate for laser hair removal.

Lyra-i Laser Hair Removal

Shaving bumps (pseudofolliculitis barbae) are caused by ingrown hairs which produce a foreign body reaction in the skin. Previously, the only effective treatment was to "grow a beard." Now, Hughes Dermatology's new long-pulse Nd:YAG laser successfully treats this troublesome malady and is safe for all skin colors. Contact us for evaluation and treatment.

Nd:YAG Laser Treatment of Shaving Bumps

New: A pilonidal sinus is a congenital sinus track (usually in the buttock fold, but occasionally in the underarm) aggravated by a foreign body reaction to ingrown hairs. It has recently been discovered that these can be treated with the long-pulsed Nd:YAG laser to remove the hairs and thus improve the problem with this non-surgical method. Hughes Dermatology has had success with this new treatment.

Laser Resurfacing

Laser resurfacing is an ablative procedure, done with the erbium:YAG laser, most often for deep wrinkles (rhytids) around the mouth. The surgery is done in our office surgical suite and has a 5 day healing time post-op. Using effective topical anesthesia and oral medications, it is safe and comfortable. This procedure significantly improves these peri-oral lines and wrinkles and tightens the skin. Laser resurfacing improves certain types of acne scars (box car scars). Laser resurfacing is used to erase traumatic or surgical scars of the face, but this must be done within 4 to 6 weeks after the scar-producing injury. The Er:YAG laser produces a plume that is viral-free and safe, as discovered by Hughes Dermatology.

Hughes Dermatology has a decade of experience with laser resurfacing, has published original papers in the Journal of the American Academy of Dermatology and Dermatologic Surgery, has been a speaker at the annual national meeting of the American Society of Dermatologic Surgery, and has taught laser resurfacing nationally.

Rhytids, full face - Erbium: YAG Laser Resurfacing 2 months after treatment

Rhytids, Wrinkles Around the mouth - Erbium: YAG Laser Resurfacing 7 months after treatment

Leg Veins

The long-pulsed Nd:YAG laser will eliminate blue spider veins of the leg (and face). It may be used alone or in combination with sclerotherapy to achieve the best results.

Spider veins: before and after

Facial Redness

This is caused by a multitude of tiny red vessels (telangiectasia) and is generally inherited or sun-induced. It often coexists with acne rosacea. Other than prevention with early use of sunscreens (or picking different relatives!), treatment of small red vessels consists of laser eradication with our 585nm pulsed dye laser (Cynosure Photogenica V). This is done after 30 minutes of topical anesthesia (LMX5) and our new Zimmer Cry 5 cold air machine is used during the procedure. The procedure leaves a superficial bruise that lasts 7 to 10 days and can be covered with Dermablend make-up. About half the time a second touch-up session is done a month or so later. Hughes Dermatology has over a decade of experience successfully treating this problem.

Pulsed Dye Laser Surgery - Facial Redness Cynosure Photogenica V

Blue vessels of the face are safely ablated with the long-pulsed Nd:YAG laser (Laserscope Lyra-i), or sclerotherapy. The blue nasal blood vessels shown here are best treated with Hughes Dermatology's long-pulsed Nd:YAG laser; sclerotherapy would be an alternate option.