Denver Dermatologists

Redness After 18% Salicylic Acid Peel

I had my first 18% chemical peel done yesterday (22/07/11) for mild/mod acne (I have never had a chem peel prior). And today I am very red/ brown and patchy around my mouth and on the left side of my nose and under my eye. Is this normal? Or have I sustained a burn or hyper-pigmentation? I had it done in my derm's office; however, they are closed for the wknd and just wanted some advice.

Salicylic acid peels up to 30%, in general, are safely used in people of all skin pigmentation types.  From what I can see in your pictures, you have a very normal amount of red/brown color that I would expect to see 24 hours after your peel.  Any dark spots you had to begin with tend to get darker before they peel.  Redness and darkening can last for 4-7 days while the peeling takes place.  Areas around the mouth, eyes, and nose tend to peel first.  I think you will be very pleased with your peel based on your skin's reaction so far, and I would be surprised if you developed any hyperpigmentation.  However, it's very important that you keep they areas moist with a cream or ointment (e.g. CeraVe or Aquaphor), use a gentle cleanser like Cetaphil, avoid picking, avoid rigorous exercise while peeling, and use at least SPF 30 sunblock consistently.

Michael Contreras, MD

Denver Dermatologist

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