Denver Dermatologic Surgeons

3 Days Post IPL: Freckles Are More and Darker - Is This Normal?

This type of info is probably in your consent or other paperwork, and it is totally expected.  Freckling is darker for a several days after IPL (often 3-7 days). Sometimes new freckles even become more apparent during this timeframe. This is all because the target for the IPL device is pigment. With continued treatments (often 3 or +), this darkening is less prominent each time, and there is less target pigment each session. Sunprotection is essential, and also ask your doc about Rx products that can help with pigment correction--as studies show that these can be synergistic with IPL for lentigines.

Joel L. Cohen, MD

Denver Dermatologic Surgeon

Can Juvederm Ultra 3 Be Injected into the Glabella Lines?

In the US, we don't have JuveDerm 3 but rather similar products of JuveDerm Ultra and JuveDerm Ultra Plus.  The data shows that the combination of Botox plus filler works better and longer than filler alone (study by Carruthers in Dermtologic Surgery with 18 weeks of Restylane durability in the glabella vs. 32 weeks of durability if Botox was used to pre-treat the area).  So, Botox or Dysport can be very helpful if used first to reduced the movement of the area, and then filler placed about a week later. The filler than doesn;t have the muscles working across it, so work better. The important caveat is that the glabella has blood vessels (supratrochlear artery and dorsal nasal artery) that could be compromised with filler injections, so it is imperative that fillers be used very carefully. Use of a hyaluronic filler is recommended, as the enzyme hyaluronidase is then available to potentially be of assistance in the case of vascular compromise.  For safety purposes, use of low filler volumes and considering a few treatment sessions with a hyaluronic filler is commonly recommended.

Joel L. Cohen, MD

Denver Dermatologic Surgeon

Is Chemical Treatment or Laser Peel the Only Treatment Available for Acne Scars After Accutane ?

Acne scars can be classified on several levels, but most common is to differentiate rolling vs. ice pick vs. box car scars (Dermatologic Surgery by C. Jacob and J. Dover).  For very focal scars that are characterized as rolling, subcision can be very helpful (Dermatologic Surgery by M. Alam) and fillers such as Restylane as well as JuveDerm can show dramatic results as well. For focal more ice-pick type scars, there is a study out of Asia that shows great results from using very high concentration 100% TCA not as an overall peel, but focally at the scar. For focal boxcar type scars, sometimes a punch elevation or punch graft is done.  For more widespread scars of various kinds, we often perform non-ablative fractional lasers over several treatment sessions (sometimes 5-8)--and these have very little downtime, usually patients are just pink for 2-3 days. For patients with more widespread scars that want to see results more quickly, ablative fractional lasers work great but do require 4-10 days of downtime for each treatment (usually less treatments than ablative fractional lasers).

Joel L. Cohen, MD

Denver Dermatologic Surgeon