Charleston Dermatologists

Erbrium Laser on Lower Eyelids

I have a little sag and crepey skin in the lower eyelids and around the eye skin looks a little thin and wrinkly. The dermatologist recommended the Erbium laser resurfacing for this area to see the results that I am concerned about (downtime apprx 10 days. My concern is that I have been told by a few other skin care specialists that the lower eyelid is extremely hard to treat. If my skin is already thin in this area, is is safe to do? Help I hate my eyes..I am treating crows feet with botox.

The Erbium:YAG laser can be very effective for the rejuvenation of the lower eyelid.  Performed properly, the laser can safely improve the appearance of fine lines and wrinkles.  Because of the high water absorption of the erbium light, some heat is generated and thus tightening of the skin occurs.  There are different kinds of erbium lasers. The non-ablative type has a wavelength of about 1540-1550nm and is done as a series of 3-5 treatments with mild downtime of 2-4 days.  The ablative erbium at 2940nm has a 7 day downtime period, however results are seen with one treatment. 

The other cause of lower eyelid problems is volume loss.  Your physician may discuss the option of adding some filler along the bony rim below the eye to restore lost volume.  This treatment blends the cheek to the eyelid better and can improve the apperance of this area. 

Be sure your physician is experienced in either technique.  When using lasers on the eyelids, the eyes should ideally be protected with intraocular eye shields that fit under the lids and completely shield the eye from light. 

These treatments in combination with the best professional skin care for the eyelids can be very helpful in improving the appearance of the eyelids you describe.

Todd Schlesinger, MD

Charleston Dermatologist

Non Surgical Options Facial Rejuvenation in my 30s?

Hi. I am in my mid 30s and looking to have some non surgical facial rejuvenation done. My main issues are (slightly) uneven skin, uneven skin tone (mostly brown spots but nothing that can't be covered with light makeup).... I am looking for something with only 3-5(max) day down time... Any advice would be greatly appreciated. Thanks

A photofacial series using intense pulsed light (IPL) or a pulsed-dye laser (PDL) would be the most helpful here.  In 4-6 sessions with essentially no downtime.  IPL may be the best option as it works on three main targets:

1) Pigment (brown spots) - lifts them to the surface = less brown spots!

2) Opened blood vessels that make the skin look red - evens skin color and removes unsightly visible vessels

3) Water - the heat from the filtered light stimulates new collagen formation resulting in smoother, healthier appearing skin.  The skin is also more resilient due to additional collagen.  

This combined with a solid professional skin care regimen with the four main components (retinoid, growth factor, topical antioxidant such as vitamin C, and a good sunscreen) should produce very nice results.

Avoid excess sun exposure! 

Todd Schlesinger, MD

Charleston Dermatologist

What's the Best Way to Treat Melasma?

is there any surgery that can lighten the dark spots? what surgeries do you recommend? are skin lightening creams affective, which skin lightening cream brands do you recommend?

Melasma, or increased color deposits to areas of the face, responds best to a combination of:

1) Fractional laser resurfacing - non-ablative, where the energy is focused under the skin to break up the pigment color.  A series of 5 or more treatments is usually required because the process takes time.  The newer lasers, like the Lux1540 by Palomar have demonstrated good results and are tolerable.  For those who mention that fractional resurfacing can make the melasma worse, I would like to mention that proper patient selection is important.  Selecting patients that have a tan or darker skin, or who will not follow sun protection measures may see a worsening of the condition.  Also, pre and post treatment with hydroquinone combination topicals helps.

2) Sun avoidance, sun protection and sunscreen.  Melasma is triggered by visible light.  Sunscreens block ultraviolet light.  Even with good sunscreen and a window, sunlight can darken melasma, even if it has been treated.

3) Hydroquinone topicals, in combination with others like a glycolic acid and a retinoid (Retin-A or similar).  Hydroquinone in concentrations up to 4% block the transfer of the pigment color from the cells that produce it to the cells that store it.  By blocking this transfer, treatment results are better and the benefits are extended.  Concentrations higher than 4% hydroquinone, especially when compounded can increase the risk of oochronosis, an untoward bluish discoloration of the skin and a known side effect of hydroquinone.

4) Maintenance therapies like various peels, microdermabrasion, topical antioxidants like Vitamin C and alternative non-hydroquinone pigment reduction products may also help, but they are likely to be less effective or best for maintenance.

These are the most effective treatments.  There are many others being marketed and these may help in combination with the above.

Todd Schlesinger, MD

Charleston Dermatologist