Question: Is Erbium laser resurfacing a good treatment for acne scars?

Answer: Erbium laser resurfacing, I think, is an excellent treatment for acne scars since it is an ablative treatment, which means that it vaporizes tissue and causes a significant amount of new collagen deposition.  My personal opinion on acne scarring is that you need to treat this problem extremely aggressively to even get an improvement in the quality of the acne scarring.  So, minor or mild treatments really are completely ineffective.  At this time, I actually prefer the fractionated Erbium laser or ProFractional Laser treatments for acne scarring where tunnels are vaporized into the skin and heat is laid down into these tunnels in the deep dermis creating a healing response where a large amount of collagen is deposited into the skin.  This creates a significant improvement in the surface characteristics of acne scarring, but I do recommend that patients get three treatments spaced at least one month apart for maximum results.  Overall downtime when you combine the three treatments is actually longer than a single deep Erbium laser resurfacing, but the risks are virtually eliminated.  The effectiveness is improved in my opinion, and these can be performed in a spa setting.  

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Question: Someone recently told me how great the fraxel laser is for resurfacing the skin. Are there different types of fraxel lasers?

Answer: Fraxel is a trademarked name, but there are many different types of fractionated lasers, which use different types of lasers that are broken up into a matrix of dots or tunnels that treat the skin.  This allows for moderately aggressive treatment of the skin while maintaining the integrity of the surrounding tissue so that healing is maximized and risks are minimized.  There certainly are significant limitations as to what a nonablative fractionated treatment can provide and, therefore, we prefer the ablative treatment of a fractionated Erbium laser, which will literally vaporize small tunnels into the skin and during the healing phase we get a very significant amount of collagen deposition which in turn creates significant skin tightening and wrinkle reduction in combination with treatment of the discolorations and overall texture of the skin.    

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Question: Now at 60 years old, I need a booster for the facelift I had 11 years ago. Can laser skin resurfacing rejuvenate a previous facelift?

Answer: Yes, laser skin resurfacing can certainly help rejuvenate a previous facelift as can consideration of an Ultherapy treatment since Ultherapy actually creates a lift in the deeper tissues whereas laser skin resurfacing simply tightens the overlying skin and creates a significant amount of wrinkle reduction.  I would have to evaluate you personally to decide which technique would be most beneficial, but frequently patients realize that they can combine treatments and treat various levels of facial aging by performing the laser skin resurfacing and the Ultherapy together.

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Question: When does one need a neck lift alone without a full facelift?

Answer: If you have early signs of aging in the lower third of the face such as early jowling and laxity under the chin, then a neck lift alone may be all that you need for rejuvenation.  If a patient has significant signs of aging in virtually all areas of the face, including the brows, upper and lower eyelids, lower face and skin then I would recommend a more comprehensive approach that would include brow lifts, eye lifts, and facelifts as well as a laser skin resurfacing.

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Question: Is microdermabrasion able to remove freckles, or are there any other procedures that would be more effective?

Answer: Microdermabrasion can certainly help people with the reduction or removal of their freckles, but additional treatments, including a good skin care with hydroquinone and excellent sun protection, would also be necessary and even then more than likely these procedures alone would not completely rid someone of their freckles.  In order to rid them of the freckles themselves, they would need to undergo a more aggressive treatment such as a laser resurfacing, though simply for freckle reduction they would not necessarily have to go horribly deep with the laser resurfacing, but in the future they would have to provide excellent sun protection for their skin or the freckles will definitely return.

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