16 of 16 people found the following review helpful:
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I had fine lines and wrinkles on my face, especially around the eyes (Crow's Feet) and forehead (Frown Lines), loose eyelid skin, brown age spots, uneven skin tone and acne scars.
I had the Active FX procedure done in January, with high hopes. Unfortunately, it's now April and I see no improvement whatsoever. I still have the brown spots; in fact, I seem to have more than before the Active FX (like it brought some out that weren't visible before). The wrinkles are exactly the same, the acne scars are exactly the same, my skin tone is still uneven and my eyelid skin is still loose. Also, I experienced some extreme pain when I had my Active FX. My cheeks and forehead were not so painful but I had to be held down so I wouldn't move on the doctor when they did around my eyes and mouth. I try to always be an optomistic person and look at the bright side of things and so I hate to have to report this bad experience. The Doctors and their staff were very nice. But, I spent $2,000 and see no improvement at all.
Active FX reviews by RealSelf.com users
Avg cost $2,369
68% say Active FX was worth it
32% say Active FX was not worth it
5/3/08
Ouch! I'm the laser physician in Chelsea who did the procedure and invite Juladair to please return to the practice to get a free touch up on the areas that did not turn out for her. Higher settings can be used to get rid of fine lines and brown spots and further tighten the skin. Air conditioned cooling is now available for pain control. Hope to see you back.
5/6/08
Wow, my doctor is awesome. She saw this review of my ActiveFX and sent me an e-mail and asked me to come in for a touch-up that will hopefully address some of my issues. I thought I was SOL since the procedure doesn't always effect everybody the same. I figured I was just unlucky. This is great customer service and very much appreciated. Thank you Dr!!
5/20/08
Please follow-up with if the touch-up made a a difference and if the 'air conditioning' made a difference with the pain. Thanks.
5/30/08
Hi Dr. My throat is exactly the same, unfortunately (still the bad white acne scars). The brown spots on my face are healed but are still pink. I'm hopeful the pink will fade. Makeup does cover up the pink spots much better than the brown spots though! As far as the pain ... much, much more tolerable this time. Thanks! ... Julie
5/30/08
Hi Julie,
That's great about the brown spots being gone. The pink will fade. Please be meticulous about sunscreen to avoid hyperpigmentation or repigmentation.
As for the chin acne scars, they take many treatments to go away although they will fade a little each time.
There is a new handpiece to the machine called Deepfx. It targets acne scars better, although I haven't seen outcome data yet. It's been available for about 5 months and I'm waiting to see if it really works before purchasing it.
Active Fx's domain is really texture, tone, tightening and brown spots. It completely misses red lesions and only slightly treats acne scars.
Please stop by and let us see you in another 3 months for after photos. I'll bet you'll be beautiful.
Regards, Dr. H.
6/1/08
i had active fx a 2 months ago in chicago by a well known plastic surgeon. this surgeon is opening his own stores for the skin. i went to this doctor trying to repair acne scars and to smooth out my skin. i was under the impression i was going to receive a deep fx treatment, later finding out this doctor had just trained for deep fx treatments by the distributor a month after my procedure. which is on record. if i had this knowledge in no way would i have allowed this procedure. also the doctor went over my face twice in some area s, from what i researched and spoke to other professionals this is a mistake. the fx lasor is designed to skip natural pigment, using this fx twice would not accomplish this goal. the procedure was horrible !! i would never recommend !!! i was given 3loratab for pain, and doc used paste that was supost to dull the pain, he did not use paste on entire face, slight area on left cheek and slight area on right. i asked if this paste should be spread all over, doc stated this paste was not pliable and it was essentially used to dull needle injections. in my opinion something was done incorrectly. i endured the most horrible pain in my life, mind you i had suffered 3rd degree burns as a child, that was a cake walk. the pain was so horrible i wanted to die, and the doctors assistant had to hold me down from uncontrollable body tremors. even know this was horrible pain i thought of stopping mid procedure, but then wondered what my face would look like then, so i went on.. my face has not improved at all, acne scars seem more apparent ( much worse ) and now suffer from hyperpigmentation because the docs office sent me home with the incorrect spf (15) for my face.. after seeing doc asked what he thought, he found no noticeable improvements but went on to lecture me on sunscreen because i have brown spots all over !! at this point i did not know i was using sunscreen 15 so i put up with lecture, after going back home thinking i applied this sun screen religiously how could i have hyperpigmentation ?? that nite i noticed the 15 spf and was deeply upset. because i found after all treatments a sunblock is required or sunscreen of 60 or higher. during this follow up i asked doc if he would redue procedure he stated no. i am so deeply depressed because of all this then to be treated in such a manner by doctor. i am in the process of building a web site for all to know about the talents of this doctor and to warn others. and have every intention of following up with legal and lic actions ... to anyone considering this procedure research !!! ask for photo s of other procedures which i did not do and remember, just because a doctor has credentials does not make his hand from god.. look foward to hearing from you ............ pete
6/1/08
Dear Pete,
You raise some very important points about this procedure: understanding what is to be done and expectations about outcome. Since the procedure is only one year old, we doctors learn more each month from patients' feedback. You should really tell the doctor in a detailed letter exactly what your experience was. I suspect he'll call you in and offer to help.
When I saw my patient's note on the blog, I was mortified and contacted her immediately. We worked together on correcting the problem areas at no charge to her and with better pain control that we had established one month after her procedure, and, I believe, parted on good terms.
About 30% of patients get hyperpigmentation from the procedure and summer is definitely more pronounced. Get a good hydroquinone cream (hopefully from the doctor and medical grade) and bleach it out. It works very well and truly goes away between 6 and 12 months. We give our patients a factor 30 sunscreen with 17% zinc oxide at the time of the procedure.
One final point: the collagen building continues over 6 months, so you'll get more results (and filling in of acne scars) over the next several months. Keep an open mind and watch as the months go by, being certain to use the sunscreen, hydroquinone and hopefully a retinol to help the skin.
Good luck!
6/3/08
Dear Lasordoc,
Thanks for you're correspondence, and have a few more questions about ACTIVE FX if I may ?
In you're opinion, since I was given an SPF15 sunscreen after my FX treatment, instead of the appropriate 60SPF or sunblock. Could this have caused my hyperpigmentation ? And now must I be worried about CANCER ?
Also, is it typical to use the FX Laser twice in one area ? I have olive skin and was told this treatment would be most beneficial because it persicely skips over the pigment, leaving a percentage of you're pigment untouched. Could this is anyway, may have contributed to my hyperpigmentation ?
I noticed having a stinging sensation, along with bloodshot eye,( for 6 days) along with blurred vision in right eye, and still have slightly blurred vision in right eye. IS THIS TYPICAL ? should I been given eye protection ? I had upper eye area s done along with lower eye region ( entire face & neck treated )
Also, when you perform a procedure, what are you're methods of blocking pain ? After taking 3 LORATABS, having the so called TOPICAL paste applied, and sensory numbing. Why was the procedure so horribly painful ? How much of a role does the TOPICAL creams play in numbing the face ? And should the topical paste been spread evenly all over my face ?
Thanks for taking the time to answer my questions, and I must give you the respect you deserve. Because you stand behind you're work !! And obviously have compassion, and the acknowledgement that every human face has its own importance & value
Sincerely
Pete B.
6/3/08
I am 47 years old and an x heavy smoker. I quit the nasty habit 7 years ago. I was also raised in south Florida and my face skin has taken the toll along with the aging process. I have loose skin around my jaw and neck, fine laugh wrinkles (one side more than the other), laugh wrinkles around eyes and my forehead has deep wrinkles. I also have the lovely wrinkles between my brows but not as bad as I've seen in others. My question is why should I waste money on many, many treatments of laser skin resurfacing, etc. etc instead of a one time face lift that would take off 10 years of age and THEN go in for some laser treatments. After the face lift, I would need wayyy less laser. Something to consider out there people. :-) I have a consultation with my plastic surgeon who offers all these things. I'll let you know what he says. By the way, I've already had my eyes done by him 7 years ago and he did an excellent job.
6/4/08
Beverly,
You raise some good points. But I would actually do the treatments in the opposite order. Get a C02 fractional resurfacing before the facelift. That way, you are lifting nice healthy skin rather than making damaged skin taught. Be sure to work on your skin with excellent medical grade products including a retinol, cleanser that exfoliates, sunscreen with zinc or titanium and some peptides or tissue growth factor. Do this after your facelift too to keep the skin healing from your prior smoking. You're going to look great.
6/4/08
Pete,
I don't think the spf 15 sunscreen contributed to the hyperpigmentation as 29% of patients get it anyway. The fact your skin is olive makes you a more susceptible than lighter skin types. Thankfully, it does not cause cancer. Be sure to get a bleaching hydroquinone cream from you doctor to undo it. It will take about 3-6 months to get rid of the hyperpigmentation. Don't worry, I've always seen it go away. Keep the sunscreen going daily.
Some doctors will use the laser twice in specific areas. I do it for patients with a brown spot or scar they want treated more aggressively or if they want more skin tightening in an area. It gives a better result and shouldn't make you pigment more.
Your eye concerns me. It should be looked at. There should be eye protection for the procedure, usually goggles or intraocular metal shields (if the lids are being treated). The numbing cream can cause a chemical burn if it gets into the eye, which happened to one of my patients. A metal eyeshield or goggle could scratch the cornea. Do get it checked to be sure it's fine. My patient with the chemical burn took about 1 month to heal and I had ophthalmology follow her to be certain. Then we changed suppliers to get a cream that could not run into the eye.
To block pain, there are several methods. We do give 2 lortabs, 2 ativans to sedate the person 1 hour before the procedure. Then we either apply numbing cream to the entire face for an hour or use injectable nerve blocks instead. (Plastic surgeons tend to use nerve blocks as that is how the profession practices and they find the pain relief superior). I also use an air conditioned hose to blow onto the face while I'm treating. That has helped immensely for pain control. We always ask our patients their pain level on a scale of 1-10. Before we got the air conditioned hose, they typically said 8. Now it's 2-3. I can't believe the difference and only sought it out after a patient told me how terribly it hurt. Patient feedback is so important so that we can improve.
(I had the procedure done myself before the air cooling and had level 8 pain. It felt like I was being branded. But I loved the outcome so much that it was worth it).
Thanks for your kind comments on my work. It's a passion and nice to know that patients appreciate the communication.
Good luck!
6/13/08
I had ActiveFX a month ago, and there has not been one single improvement--or change of any type--as of today. I had my face and neck "done" for $3,000.
That was minus a $500. discount for booking the appointment within a given time.
The doctor is a very intelligent, well-informed physician, and a beautiful person. Plus, many years in the realm of skin-care and lazer resurfacing. This MD suggested that I consider the ActiveFX to improve my concerns of hyper pigmentation and to have a more even skin tone. This MD added that it would also improve--some skin toning, which I wasn't concerned about, but was happy that it would "do" more than I had known.
I am taking pictures of my treated areas, week-by-week and I am patiently waiting for some degree of improvment. I am a realist and not looking for a miracle.
I didn't mind the pain, I didn't begrudge the cost, and I didn't expect fantastic improvement! But, here I am with a very lonely feeling, confused thinking, and looking exactly the same. This is a wonderful web-site to share our experiences---than you so very much.
6/14/08
Dear Lazerlee,
Hold tight. At one month, I'd say most people are disappointed. When I saw the very disappointed comment above and that it was my patient, I had my staff call every single patient who had the procedure over the past year to ask their satisfaction. It was overwhelmingly positive. Only the writer on the blog and one other patient were disappointed. All others were delighted. I redid the two disappointed people to try to achieve the best results possible for them and remain optimistic that it will do so.
By 4 months, one really sees the improvement in texture, tone, brown spots and fine line reduction which then maxes out at 6 months. Be meticulous about sunscreen and take photos only monthly. I suspect you'll be as pleased about the procedure as the others eventually were.
Regards,
Dr. H.
6/14/08
Thank you for reading my post, responding to it, and offering your encouragement !
This is a great way to share everything we experience-- and that makes it positive.
RealSelf.com offers an education about a procedure (s) that can be "unknown" to many of us. Thank you, again.
6/15/08
Lazerlee,
You're very welcome. I have learned so much from this blog as a doctor and what patients need to have this procedure work for them. It really makes us better at what we do by getting pain under control, results improved and expectations realistic.
Best regards,
Dr. H.
6/15/08
So glad you are having more success with the #2 lasering ! And, very good of your MD. to ask you to come back in for more treatment !
I have good skin, some fine wrinkling, some light brown age spots, two AKs and one or two SKs. Also, I have large pores with some blackheads.
Not my main concern, but pointed-out to me by the MD: some loose skin--I had a face lift 7 yrs. ago--and fine lines starting to appear around eyes, mouth, and on cheeks.
I have taken good care of my skin since pre-teen. I am now somewhere between the ages of Madonna and death, and I am in excellent health
Alittle more of my results from my #1 ActiveFX:
I think the setting on the laser was at 159; some areas were swept over twice.
Not one place, spot, area on my face looks any different; my skin problems were surfaced, and none were deep; why do I still have all my areas of defect ?
How can Seborrheic Keratoses and Actinic Keratoses and Light Brown Spots start to drop-off/disappear ? The peeling has stopped; I don't think it will happen now.
6/18/08
Can anyone tell me from their experiences if CO2 laser resurfacing, Fraxil, or Active FX was better for getting rid of major age spots. My mother has extremely sensitive skin, and pretty profound rosacea, especially around her nose and cheeks. I know there's not much to be done about her rosacea, other than the creams, etc., that she uses from her dermatologist, but I'm seeing her get more and more depressed by her age spots. She went to a dermatologist and he told her there was nothing she could do about them, which I just have a hard time believing. Have any of you gotten that same response? I'm getting married in October and I would love to be able to give my mother the procedure as a thank-you for all she's done, but I don't even want to broach it with her if, in the end, there really isn't a procedure that would help. I'm afraid that would just dishearten her more.
Thank you all so much for any insights you may be able to offer.
6/19/08
Dear Gesuip,
Age spots are best gotten rid of with Active FX. Fraxel is better at acne scars (with several treatments). But if your mom has profound rosacea, IPL is best for her. It also treats age spots at the same time. Google "IPL and rosacea" and read all about it. It's also in the low $300's, quite a bargain. I'd have her do monthly treatments for 4-6 times for best results.
Then she'll need a good skin care program with medical grade sunscreen, peptides and cleanser.
Good luck,
Dr. H.
6/23/08
Pete, what is your latest comments/opinions on your experience ?
Please write more of what is current on your ActiveFX procedure.
Thank you !
6/26/08
Hi laserdoc,
I think it's so fantastic that you're answering questions here. I'm having full-face DeepFX next week. I have scars and some fine lines and have been treating rosacea with IPL. IPL has worked fairly well, but I'm wondering if it will set me back (rosacea-wise) to have DeepFX done... is there any risk that my rosacea will get worse? I'd like to do something for the scars & fine lines & my doctor seems to think that this is the best procedure for me.
Thanks so much!
6/27/08
Hi Karal,
The Deepfx will be great on fine lines and scars but it won't touch the rosacea. I have not seen it worsen rosacea either. It just doesn't target the blood vessels because it's too superficial. My experience is that many patients get a few months of mild acne as a response to the treatment, but no rosacea flares. Good luck!
6/28/08
I am a 47 year old man . I would like to ask laserdoc what procedure she would recommend for upper and lower eye lids . Also how would I find a doctor with your dedication in my state [ NJ ]? Thank you ..John .
6/28/08
Dear John,
For upper and lower eyelids, there are two good choices: surgery (if they are very saggy) or Active FX if they are mild to moderate. The laser physician will put metal eyeshields into the eyes (like a contact lense) and laser right to the lashline. It gives a considerable amount of tightening, but not as much as surgery.
In New Jersey, the one laser physician I know to be excellent is Dr. David Goldberg. He teaches many of the laser courses I've attended. His field is dermatology.
Good luck,
Dr. H.
6/28/08
I am very appreciative of the Doctor's advice and explanation of the Active Fx Laser procedure. I would like to ask her, as I am considering having it done prior to my son's wedding in August. Should I wait, as the time is running short, and just have some fillers done? My skin concerns are some short vertical lines over my lips, for which I have had many different laser treatments over the course of 18 months, and moderate sagging of the eyes and jowls. Also, I would like to know if you are familiar with the Fraxel Re-pair laser and please explain the differences if you know them. To my knowledge, both are fractional Co2 laser treatments, but does one go deeper into the skin or are there more drill's or burns into the skin with more density from one treatment to another. Thank you for your excellent answers!
BL
6/28/08
Thank you Dr. H . I appreciate your time and advice . Wish you were here but I will try Dr. Goldberg ...Thanks again John ....
6/28/08
To lazerlee,
It should take approximately 30 minutes of treatment time to do an Active FX on the face and neck.
Regards,
Dr. H
6/28/08
Dr. H
Thank you for the quick, honest, and insightful information on so many issues with ActiveFX/DeepFX. This learning curve keeps expanding !
6/29/08
My pleasure. It is very beneficial to get real information to make decisions with. I've learned a lot from the feedback too.
Regards,
Dr. H.
6/29/08
Dear Barb Leone,
That's a tricky question on whether you should have the C02 resurfacing done right away before the wedding in August. That would depend on your skin type. If you are a bit darker, I'd wait because you could get hyperpigmentation and not have time to bleach it out before the wedding. However, if you are a lighter skin type, I'd go for it because the fine lip lines will be lots better and you'll love the texture and tone. If you've had numerous laser procedures in the past, how did you heal afterward? If it was in a expedient way, that would be favorable to go ahead with the procedure.
The new Fraxel Re pair is also a C02 fractional resurfacing laser with the same wavelength. Both the Fraxel and the Active FX (Encore is the laser's name) can be made more or less dense, leaving behind more or less of the old tissue. I'm finding the 4-5 day recovery time the same, whether we're aggressive or not. So I generally turn it higher to get a better result. The Active FX laser has an additional handpiece called Deepfx that goes deeper and is good for acne scarring. Since this doesn't appear to be your issue, either brand would work well for you. You'll get tightening around the eyes and jowl area, approximately 30%. But it takes 6 months for the full effect. I find the lip lines go away somewhat sooner which you'll like for the wedding. Also your skin's texture and tone will be nice and new, giving you a fresh look. Then if you really want the jowl line shaped up, you could add filler to that area. Allow at least a week after the filler before the wedding so that there isn't any bruising.
If the practice you go to has a line of mineral makeup, get fresh minerals for an excellent new look. The difference is quite remarkable.
Good luck.
Dr. H.
6/30/08
Dr. H,
Is there a way to tell the difference between hyperpigmentation and residual red/brown discoloration on the face, and if it is hyperpigmentation will it fade, or do you recommend the hydroquinine? Can you use hydroquinine with Retin A, and will all of this be drying to the skin? How long would you estimate discoloration should fade from the Active FX treatment? Will IPL get rid of hyperpigmentation, and about how many treatments would it take?
Thanks
6/30/08
BL and laserdr, it reads that you both have much experience with lasers !
What does the #159 on the Active FX setting represent ?
What is the highest number setting for that laser ?
6/30/08
Dear Maxine,
Hyperpigmentation is a diffuse darker pigment of the skin over the entire face. You can usually see a line of demarkation between the treated face and untreated neck.
Residual red/brown discoloration will be red/brown in the exact areas that were present before treatment. I can usually spot them on the before and after pictures. Remember that the Active FX does not treat red discoloration. For that you'd need an IPL. You can use hydroquinone with retin a. Retin a can be drying but not hydroquinone. There is the commercial product "Triluma" that has hydroquinone, retin a and hydrocortisone in it. You could get your doctor to prescribe this. With daily hydroquinone and sunscreen application, usually the hyperpigmentation resolves in 3-6 months. IPL will make it go away sooner, but I'd still use the hydroquinone.
Good luck.
6/30/08
Hi Lazerlee,
I'm not sure what #159 means. The settings on the screen are first the pulse energy in mJ(millijoules). That goes up to 225 mJ. I usually use between 100-150 mJ.
The next line on the screen is the frequency, measured in Hz, which is cycles per second. The range is 1-1000 pulses per second. I tend to use settings aroun 75 Hz. By turning up the Hz, it can get around painful areas like the forehead without having to turn down the pulse energy.
The highest power setting is 60W.
So if I have to guess what the #159 is, I'd say it was the setting in mJ.
Regards.
6/30/08
Hi Dr. H,
Thanks for the prompt reply. I think I didn't make myself clear on my situation. What I have now after the procedure are red/brown splotchy patches and some horizontal lines that I did not have before the procedure. These appeared after the "brown mask" peeled off around day 5. It appears that some of the redness has gone away, but it also appears that it's more brownish in color now. I mainly have it on one side and you can also see my regular skin color in some areas. The other side has a very small area of the patches. I read somewhere that hyperpigmentation can be brought on by the procedure and that's what my concern is. I didn't have any of this except a few sunspots before the laser treatmemt. At the one month period should all of this have cleared up by now if it isn't hyperpigmentation? Also, your comment about using the hydroquinine was that meant to state that you would use that instead of IPL or along with the IPL? What are the side effects of the hydroq?
I appreciate your time and efforts to help all of us out here.
7/1/08
Hi Maxine,
Your splotchy patches do sound like hyperpigmentation. Don't worry, they will go away. I assume the horizontal lines are also brown which means they also are hyperpigmentation. I would bleach them with 4% hydroquinone for 3 months, twice daily. Then if any remain, IPL if necessary. Active FX has a hyperpigmentation rate of 29%, which is quite high. I didn't realize how frequent it was until my staff and I experienced it on our own faces!
In dark skinned individuals, I'll often start them bleaching with hydroquinone for 1 week pre procedure to down-regulate the melanocytes.
Summer is worse for this because we do get more sun, despite our best sunscreen efforts.
The bottom line: rest assured, they will go away. For stubborn ones, we even custom mix stronger hydroquinone of 8%.
Good luck.
7/1/08
WOW...Dr. H. you are the greatest. I have an appointment with the doctor tomorrow and I will see what he thinks the blotchiness is. You had mentioned TriLuma. Do you think the hydorq 4% or the TriLuma would be best? I've used Retin A for several years until the procedure, and my skin had gotten used to it and done quite well with it, but now I'm wondering if using something so strong would stop the healing process if it hasn't already stopped. Do you think one month after the Active FX treatment is enough time to start putting this type medication on? I've never been obsessed with my skin, and I'm really just wanting to move on and forget about the whole Active FX procedure. At this point I just want my old face back again.
Thanks again,
7/1/08
Hi Maxine,
I usually use the 4% hydroquinone because most of my patients already are on a retinol. Also, it's a lot cheaper. A tube of Triluma is approx $150 and it's approx $20 for the hydroquinone. Also, Triluma is designed for melasma, which is a different animal than post procedure hyperpigmentation.
Now that you're one month post procedure, I would be putting on the retinol and the hydroquinone. In fact, I start my patients who are at risk for hyperpigmentation on the hydroquinone after one week post op. Usually they wait until 1 month on the retinols as they are harder to tolerate.
Just be the queen of sunscreen with your hydroquinone and by the end of September, you will be pleased with your skin.
Regards
7/1/08
Hi Doc H.
I can guarantee you that I will be the queen and the rest of the royal family with the sunscreen. I'm using the Neutrogena 55 with Helio. I went to the doc today and he gave me an rx for the hydroq 4% and advised me start using the Retin A on a daily basis again at night, and the hydrq twice a day. He said I could also add in some of the Desoximetasone 0.05% if I wanted to. He's not sure the one side is hyperpigment because it still has slight redness to it and that is the side the infection was on, and it's taking longer to heal, but he says it's worth trying the hydroq. So, I'm going to do all of that and stop looking in the mirror for a few months. I've learned a lot about skin care through all of this mess. I was never very worried about moisturizing and skin products other than trying to avoid the sun and using sunscreen when I couldn't avoid it, but I'm sure I didn't use nearly enough to do any good, and washing my face everynight. So, hopefully the outcome will be good and I now have an appreciation for keeping my skin "young" for the rest of my life. I enjoy reading your responses to everyone knowing how time consuming it must be for you. It's too bad most doctors are not really interested in patient feedback other than at appointment time. I will continue to read your posts and be a fan of yours, and I will occasionally post about my progress.
Thanks again
7/2/08
Hi Maxine,
You're on the right path. I'm glad your doctor took a look at you to correctly diagnose the problem. Good luck with the hydroquinone. You'll be pleased after a few months.
7/6/08
Dr. Howlin,
If you could be so kind, I wondered if you could give me some advice on something. I am currently a 4th year medical student and have been discussing my issue with our Dermatologist on staff at our school. Since about my early teenage years, I started developing many many freckles especially on my face and arms. There are line dermarcations where they stop on my face around my eyes making for an uneven skin tone. He said he is pretty confident that the Fraxel will work well for me. I was just wondering what your thoughts are on other treatments, namely, IPL and Active FX. Also, I realize that I have the genetic propensity for pigmentation but which one/how long would be the most permanent and longest lasting of these three? I am a fair skinned individual. Thanks so much for your time!!!
7/6/08
Dear Medstudent,
First, congratulations on your medical school achievements. It's always nice to welcome the next generation of physicians. I wrote you a long note yesterday and somehow it did not get posted. So I'll paraphrase it.
Regarding your freckles: there are several ways to treat. Your physicians don't want to get rid of freckles as we're so sternly warned about the one that could be malignant. You'd probably have to sign off on them (and get a good derm checkup prior).
First, I'd try IPL for your freckles. This works well and is inexpensive and has no down time. You'd need several monthly treatments, depending on how dense and deep the freckles are located. Active FX could do the trick, depending on how deep they are located. The newer Deep Fx handpiece could go deeper to get them. Another viable option is Fraxel's erbium laser. It goes deeper than the Active FX and has the FDA's allowance for melasma, which is also a pigmentation condition. It takes many treatments like the IPL and costs more.
Once the freckles are gone, the only way to keep them away is sunscreen. I wouldn't use hydroquinone on a longterm basis as the Europeans and Asian countries have banned it for potential malignancy. In the US, we use it short term without any problems though. Neither treatment is more durable in results if your skin responds.
One final comment: many of us find type I fair freckly skin with red hair very beautiful! It just needs TLC with sun protection.
Good luck.
7/7/08
Dr. Howlin,
Thanks so much for your advice and input. I sincerely appreciate it.
7/15/08
Hi Doc H.,
It's been 6 weeks now since the Active FX. I do have major hyperpigmentation, but overall my skin has healed. Even though I'm having to wear a lot more makeup to cover the hyperpigmentation than I wore before, many people have complimented me on my skin. I'm using the hydroq., Retin A, and occasionally the Desoximetasone .05% on some spots. I haven't really seen that much lightening from the hydroquinine yet, but my face feels healthier and almost back to the condition that it was before the procedure. When I use the hydroq. I'm trying to just hit the spots where the hyperpigmentation is, but since it is so pervasive, I'm wondering if I will also be bleaching out the skin that isn't hyperpigmented?
7/15/08
Hi Maxine,
Glad to hear of your skin turning healthy and nice. It's been 6 months for me and I still get compliments. So wait it out. What state are you in? If summer really goes away in September like it does for us in Michigan, so does the hyperpigmentation. Californians seem to get it year round though...
Use the hydroquinone over all the skin rather than spot treating. The white won't get whiter and the skin will blend nicely.
Good luck.
7/15/08
Thanks Doctor H. Unfortunately I'm in Texas, so it's hot and sunny 7 months out of the year, but I avoid the sun as much as possible always using sunscreen and a hat. Once it goes away will does it come back? I never had this problem except when I was on birth control many, many years ago, and that resolved itself.
9/25/08
Dr. Howlin;
Your comments regarding the pain level you experienced personally during Active FX surprised me. I was given one Ativan and had the numbing gel placed on my face about an hour and one half prior to my treatment. I used a relaxation program on my IPod prior to and during the treatment. (Laser Lamaze LOL) I made it through both Deep and Active FX without any Novocaine and had only minor discomfort until the last minute or two when, I assume, the gel had "timed out."
I am very pleased with my results. I'm ten days post, age 54, have no redness or swelling and can already see some dramatic results, especially around my eyes. I adhered strictly to the post care treatment plan recommended by my doc who is at the "U" just east of Chelsea. As I live in Kazoo, he and I have done post care via photos, email and phone discussions. After viewing my pre/post photos, he sent me feedback stating he was also impressed with my results. He mentioned that a patient's diligence in following the post care plan, which I did, may have an impact on the patient's final outcome.
Reading through the numerous comments, I have to wonder how many of the people who've expressed dissatisfaction with Active FX have actually been diligent in following the post care plan. That may be a great topic of discussion for the medical providers, such as yourself, who so graciously contribute to this site.
Thank you for your participation.
9/26/08
Dear Kenai,
Thanks for your informative comments. Everyone's pain threshhold is different. We definitely find the healing rate to be directly related to the condition of a person's skin and their general health as well as adherance to the post op instructions.
When patients don't like something, it often is put on the doctor when sometimes the patient hasn't been diligent in post op instructions. And since they have spent considerable money on the procedure, a comment like "I don't notice a thing" is hard to take. We feel bad. So, managing expectations is crucial in cosmetic medicine and pre op education is paramount to a satisfied patient. Yours is going to turn out great.
All the best,
Dr. Howlin
9/27/08
Hi Doctor H.,
I'm almost at the 3 month mark of using the hydroq. and unfortunately I still have too much hyperpigmentation to not do something about it. I will be having the IPL treatment soon. Is there anything I should do before that such as stopping the Retin or hydroq. or is it okay to be using these up until the IPL?
Thanks
9/27/08
Hi Maxine,
We have people stop the retinol 2 days before IPL and continue the hydroquinone straight through. If you use the retinol straight through, you get a more robust (redder) response to the IPL.
Good luck!
Dr. Howlin
10/3/08
Thanks Doctor H. How many IPL treatments does it usually take to correct the hyperpigmentation from the Active FX?
10/4/08
That's very individual, depending on the person's skin type and how deeply pigmented it became. 3-5 treatments would be typical though I've seen more and less. I'm a type 2 and hyperpigmented from Active FX. But now I look even and tanned with healthy skin. So I figure I'm just not needing any foundation or artificial color.
Regards. Dr. Howlin
10/5/08
Hi Doctor H.,
Once again I'd like to thank you for your prompt and helpful responses. According to my doctor I am a type 2. It's been four months and although the hyperpigmentation has lessened I'm still not at the point where I can go without any makeup, which is why I did the Active FX to begin with. I'm still using the hydroquinine and I'm starting to get cold feet as far as the IPL treatments. The thought that something could go wrong and something worse than the hyperpigmentation show up on my face, is giving me second thoughts about doing IPL. Do you think the hyperpigmentation will go away on its own or improve at the stage I am at, or will it take IPL to get rid of it all? You mentioned your face has gotten to the point of not needing makeup. Is this from IPL or did your problems just resolve on their own?
10/6/08
It will improve on its own over 1 year. The IPL can hasten it. I'm not aware of any disasters with IPL causing hyperpigmentation and have been doing them for 5 years. My face resolved from the hydroquinone and I haven't gotten around to an IPL for that yet. If you can get the practice to get you some 8% hydroquinone for 1-2 months, that can speed it up.
Good luck!
Diane Howlin
10/24/08
Hi Doctor H.,
A quick update. I had a "test" IPL about 10 days ago. They just did one small part where the hyperpig. was dark on one side of my face. I think the setting was 2.8 or something with a 2 and an 8. She did it one time and then thought it was ok to go over the area again. It turned dark almost immediately, and flaked off about 6 days later. No bad side effects, pain or anything similiar to Active FX. 95% of the hyperpig. is gone. It's barely noticeable, so I'll probably have my whole face done soon.
It's a very promising treatment for those suffering from the hyperpigmentation issues of Active FX.
10/25/08
Excellent results. Thanks for the update. Regards,
Dr. Howlin