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MixTo Treatment Great, but Unplanned Disaster Happened

I am 54, have taken excellent care of my skin...

I am 54, have taken excellent care of my skin since I was in my mid-20s - but even so, I had developed fine crinkly lines, more noticeable wrinkles, and even puckery skin in the areas around my mouth, under my eyes, the eyelids, and tops of cheeks. My PS had been telling me about MixTo for almost a year, so after doing as much research as I could on this, I got the treatment done on May 14, 2010. From what I'd read, MixTo is excellent on acne scars and age-related skin rejuvenation, and it was the latter that prompted me to have MixTo over Fraxel or even chemical peels.

About an hour before the treatment, my face was slathered in a topical lidocaine gel; that was followed by 3 pills prior to the procedure: one for pain, one for nausea, and a Valium. I also got several nerve block injections around my mouth and eyes to reduce the discomfort further. So I was woodenly numb by the time the procedure began.

My surgeon was awesome at communicating every single step of the way - from the waiting room to the treatment area, throughout the entire treatment and in recovery - what was going to happen and how that would "feel". That really reduced the anxiety and fear factor a HUGE amount.

Overall, on a scale of 1-10, where 10 is unbearable pain, I'd say 80% of this treatment was 1-2; 15% was about a 3-4; the last 5% was definitely HOT, but the sensation lasted 2-3 seconds at most. After the treatment, I was slathered in more topical lidocaine and cool, moist gauzes were placed all over my face and neck to get through about 30-45 min that I was told may be uncomfortably warm - but it was not! I didn't feel a thing at that point. I was driven back to my hotel to begin the recovery, and now I can tell you: THIS is the part where you're going to need to be strong, positive and confident in the results. The swelling doesn't set in till about 24 hours post. Plus, the skin begins to crust over almost immediately - more so in the areas that are treated a bit more aggressively. For me, that's the eyes and mouth. It's tender, but you can actually manage to gently scrape off the Aquaphor and reapply it yourself without a grimace. I have also tried icing the area, but any material will stick like glue on that sensitive face - OUCH when you try to lift it off. Even so, the icing really helped my eyes, and I will continue doing it.

Pain meds? One Extra Strength Tylenol per day (if even) is what I've had. It's not painful, it's MESSY. Aquaphor is on your hands, towels, clothes, hair, anything you get near. If you're a neatnik like me, it'll bug you blind for about a day; then you simply accept it! Since I'm recovering away from home, I packed camisoles to wear under button-up shirts; also a headband to keep the hair off my face; I packed an inflatable, horseshoe-shaped travel pillow that I place under my head at night - with the legs pointing at the headboard, not wrapped around my neck.

Unfortunately, while the MixTo treatment seemed to go well, I had a very severe reaction to the anti-viral drug Valtrex, which is given to prevent an outbreak of Herpes Type I cold sores. After taking the drug for 4 days, I got nauseous, had uncontrollable diarrhea, a rash, hallucinations, and several other side effects. I stopped taking Valtrex, but my immune system was compromised, and I ended up with a staph infection on my treated skin as well as a fever of 103. It was a long and scary week of recovery from that, and the illness derailed my MixTo recovery by at least a week. I am back on track now and making progress to a very fine outcome. I think it's important to evaluate the recovery from these procedures. If there is any unplanned-for occurrence, you need a Plan B to get through it.

Despite my experience with Valtrex, I would not hesitate for a minute to recommend my surgeon who performed the MixTo. I am confident that I'll have an excellent outcome.

Bay Area Facial Plastic Surgeon

While he is extremely good at communicating the process every step of the way and has a very good aesthetic eye, he does not appear to have a "crisis management" plan in place. Sometimes untoward things DO happen, and a patient may need to be admitted to a hospital OR sent to a GP doc asap. I feel that is essential for any plastic surgeon: know what you'll do in case of a crisis.

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smartgirl06 - lotta questions y'got! I'll do my best to answer them all, cuz there are some facts I want to be clear about.

My MixTo treatment was performed by a reconstructive plastic surgeon - a doctor who had done my facial surgery, and to whom I'd gone to for several years for Botox & juvey injections. So I was very familiar with him and confident in his skills.

That said, I think there were a few variables tossed into the mix that resulted in my own horrific outcome: the staph infection. I was not prescribed any antibiotic to take proactively before the procedure was performed. Since I basically got a 2nd degree burn with the MixTo, that seems remiss. In addition, my face was never swabbed down with a sterile solution - I only recall washing it myself in the pre-op room. Strange?

I had to travel to get the procedure done, so I recovered in a hotel room. Is that where I picked up the staph? Or did I get it right at the surgeon's office? Immediately after my procedure, an assistant put cool compresses on my face, Within 24 hours, I had the infection, which began in my left eye. Also, I smelled putrifying skin, but was clueless as to what that was all about. Turns out, it was the staph infection and my infected skin. But staph is a FULL-BODY infection, and it can kill you if not treated pretty quick with antibiotic.

My surgeon continued to treat me during my 10 days of recovery away from home. He never came right out and said, "YOU NEED TO SEE A DOC!" Or, "I suggest you follow up with your GP when you get home." So I felt he didn't know when to hand me off to someone with more expertise in my infection.

When I got home, I took the initiative of seeing both my GP and a dermatologist. Both of them AGREED that I appeared to have had staph infection, should have been hospitalized, but that their diagnosis was made in hindsight after seeing my post-procedure photos and hearing what I went through.

In my post-procedure list of things, I was never told to watch for any sign of fever. So I languished in my hotel room as it climbed from 101 to 103.6 before going back to the surgeon (DUMB! I should've gone to a hospital) for treatment.

His nurse got me started on an antibiotic IV that likely saved my life. No kidding.

Yes, I can now see clearly that my undereye skin is way more tender and delicate than other parts of my face (or neck & chest, which also had the MixTo lasering). I was incredibly lucky to not be left with any disfiguring scars. Now, almost two years post, my skin looks GREAT! Is that because of the MixTo? I simply don't know. I use some excellent skincare products plus strong sunblock daily.

If my current skin is due to MixTo, then it took a good 1.5 years to shine through! That seems too long. I think it's due to healthy diet and good skin care regimen.

Good luck with your procedure! It sounds like both you and your doctor are not only knowledgeable, but also on the same page about results and outcome.

My only advice is: get the Rx for an antibiotic and take it! You may also get an anti-herpes virus med. So be it. But be scrupulous about your sanitation after the burn and MOST important, if you develop a fever in the hours post-procedure, do not walk, RUN to the doctor for a full follow-up.
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Thanks for the positive feedback, Great! I can't believe it's been 1.5 years since my MixTo lasering and staph infection. To my relief and amazement, I can actually go out with no camouflage makeup now. Yes, there is still a permanent, darkened skin color under my right eye, but no one has ever stared at that eye when I'm out with no makeup on.

Whether related to the MixTo or not, I have not needed to get any Botox or Juvey injections since April 2009 either. Botox did not agree with me: it left large, banana-shaped bags under each eye.

I used to have my tear-trough area filled with Juvey - and that is no longer necessary!

But my "marionette" lines on the sides of my mouth are becoming more prominent now, so I am debating finding a doctor to inject Juvey there.

All in all, I am happy, at peace, and MOST of all: back in good health for over a year now.
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Bugjune! Baby! Wow, what a story!!! You know, a few things stand out to me. I have a background in pre-hospital medicine, and I was wondering, if you were instructed to go to your GP for the follow-up with all of the symptoms you experienced vs. going to your dermatologist? Also, I wanted to make sure I understood that you actually got your procedure done by an assistant PA or the actual Surgeon?

Second, just for the record, skin under the eyes is WAY more thin, sensitive, and more easily damages vs. skin around your mouth, i.e., when the discussion was re: the juvaderm injection possibilities with re: to the "melted" look under the eye vs. around the mouth. It makes some sense, BUT was that point ever addressed in particular by your dermatologist as to why this happened?

Did your dermatologist take any responsibility for what happened with you? It sounds like you went to a few doctors, and were told different things, and it sounds at least like your dermatologist should have provided you more answers than you were given, and he should have known right away more than not, as to what was happening with you BECAUSE it was SKIN related! And that is supposed to be their forte`.

You are a very sweet and brave girl to post everything you did. And I am planning to get the mixto on my face, fraxel on my neck and chest in about 14 days! So to read your scenario was disturbing, but I do agree that you have something that should have been brought out in the history and physical, or at least attempted, as with having a problem with staph, although people may not know something like that UNTIL something like this happens because their system isn't put under "just the right set of stressors/circumstances," you know? In any case, do let me know the answers to these as you are able.

My doctor, who I have known for 17 years, and who is an adjunct professor to a local teaching college at UCI, is someone I trust completely. He says he does not want to "over-promise and under-deliver," so he is very realistic about what things feel like and what they will look like. He said he has never had anyone have a bad reaction, and that it "usually feels like a bad sunburn for about 3-5 days, or longer if skin is very sensitive, which mine is, but I have had a chemical peel under my eyes about 10 years ago with him and the worst of it was the "burn!" JESUS!

Then it was gone and the new baby skin was so damn soft! :)

Anyhoo, get back to me when you can and you have my deepest regards and hope you are doing well.
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Just to clarify, it was my plastic surgeon (whom I'd known for several years) who performed the MixTo lasering - not a derm doc.

I was never told to follow up with my GP after I got the staph infection, but I took the initiative to see him plus a dermatologist. Both of them agreed on the diagnosis: toxic shock staph infection, for which I should have been hospitalized.

In my post-procedure list of things, I was never told to watch for any sign of fever. So I languished in my hotel room as it climbed from 101 to 103.6 before going back to the surgeon (DUMB! I should've gone to a hospital) for treatment.

His nurse got me started on an antibiotic IV that likely saved my life. No kidding.

Good luck on your procedure. It sounds like both you and your doctor are on the same page regarding results and outcome.

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BugJune, thanks for sharing your horrifying experience with us. Your pic at 9 weeks post op is actually not bad at all, the light red spots do not take anything off your face. Hope things are getting better for you. BRAVO for your review! You seem like a strong individual who despite taking so much since your operation, is cheerful and helpful. Keep up the attitude! Thanks.
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Dotcom, despite all I've been through with my MixTo experience, I want to emphasize that this could be unique to ME. I've read about others who've had the procedure done with results they were pleased with.

Your best bet is to check around, but keep the caveat in mind: this is MAJOR, skin-burning treatment! It's essential to eliminate ANY chance of getting an infection such as I had.

I consider myself beyond lucky to have survived the staph infection and be left with a couple stubborn patches of burned skin - where the texture of it is actually bumpy and red. I continue to use camouflage makeup on these areas, and find myself wishing I'd never had my skin burned so bad. Good luck to you in any future treatment.
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I just talked with this same doctor today (at his San Mateo locaiton) about Mixto.
Thank God for the internet age! I will NEVER have this procedure, by him or anyone else.
Thank you for your review!!!
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Thank you! You, too! I am on day 10 and the stye is still here. I have one more day of antibiotics. Sadly, the brown spots are still on my face.
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That is puzzling about the stye not responding to antibiotic - hope your doc has a solution in mind for you. Perhaps a combination of meds and topical stuff.

As for the brown spots, I found that Gemini Iridex laser zapped my darker brown freckles right away. But if these are the larger, paler age spots, that will take multiple treatments from just about any laser type. You have to be patient and contemplate as many as 4-6 treatments - combined with bleaching cream - to see good results. I would only go to an outstanding derm doc for that kind of a program. And do NOT settle for trained assistants to do this on your face. Period. It's the doc, no no one.
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My eye seems to be going down a little. There is a huge stye under the upper eyelid. Today is day seven and I am down to about 26 zits. The only brown spots that I had on my face are still there. I never really considered laser treatment, because I only had this one area. The doctors office told me that I was getting a four thousand dollar treatment for half price and that I had a three to five day recovery period. I hopefully will heal soon and not have to go through what you have. I have learned a valuable lesson from this. Thank you for sharing your story.
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San Clemente, stick with your GP doc until that stye clears up! Since these are often caused by bacteria, you'll want to be extra clean - no makeup! - till it's gone. I'd recommend you visit your GP doc just to get a 2nd opinion and possible medication or topical ointment to treat it. With luck, it'll go away on its own, but you don't want to risk any vision problems as a result.

Yeah, we have definitely learned our lesson - this time around! Good luck in your continued healing.
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The doctor has put me on antibiotics. What kind were you prescribed for your infection? Great attitude Begiune. I had no idea that any of these complications were possible. I only had a day to decide to do this. The doctor needed a "model" as he was training four other dermatologists. I should have sensed trouble when one of the derm's parting words to me were, "good luck".
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OY San Clemente! One day to decide? OMG, that sounds outrageous! I was at least counseled over a year about MixTo, and made the decision myself without any pressure.

You've probably read above that I was given no antibiotic PRIOR to the procedure, no do I recall my face being sterilized, but after my staph infection was diagnosed (a WEEK late!) I was put on a mega dose of Keflex antibiotic. I was also given an IV of antibiotic right in the doc's office, and that knocked my fever of 104 down overnight. The Keflex kept the staph infection from recurring.

In hindsight, we'd both probably have done things differently. But what's happened has happened, and now the only thing that matters is our general health. Did you get the infection under control yet? What about your swelling?
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Without meaning to beat a long-dead horse even MORE, I simply have to add that in the first week of September, I started to lose my hair. It just broke right off at the scalp - luckily leaving the root intact! But each day, I was losing about 400-500 hairs. I have very thin hair and little of it to begin with. So. This seemed to fit with the pattern of staph-related oddities to befall my beleaguered body.

I simply refused to obsess over it, stress about it, or even see a doctor. Because I'd been forewarned back in July that I *could* lose my hair right about that same time frame, at least I was mentally prepared for it.

My hair continued to break off at such an alarming rate that I actually clogged my home shower drain with it. A wig's worth of hair was dredged up from that drain at the end of September. UGH.

It has been about six weeks since the episode began, and things are getting better - finally! I only lose about 150 hairs upon combing it out after my daily shower. I am extra gentle with my hair, and even skip washing it unless I've had a slathering workout.

I hope I am the anomaly odd-ball case here, post-MixTo. Cuz if a significant proportion of patients went through half of what I've been through, there would be a hue and cry raised PDQ.

My face now looks tolerable when I have makeup on. Without makeup, I still have bright red areas under each eye and on my left eyelid. Having gone through so much with this procedure, I am now completely sanguine about my future. I refuse to stress about it. It is what it is, and I will try to avoid any future elective cosmetic procedure like the plague.
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Day three after the Mixto Laser, I broke out in white bumps. There are about 30 of them. My doctor put me on antibiotics and then the next morning I woke up with my eye swollen shut. I am on day 6 and my eye is really scaring me. The swelling is not only on the eyelid, but going down the side of my nose. I am a nervous wreck :(
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San Clemente,

The white bumps you have sound like they may be milia - a kind of whitehead. I also have a sprinkling of these under my left eye and one on my left eyelid. I don't know exactly why they appear, but mine only sprouted after I started to wear makeup again, so I'm thinking it could be due to clogged pores.

As for your swelling - THAT'S definitely a big concern. So get to your GP doc asap and see if you can get to the bottom of what's happening. Don't rely on the doc who did the MixTo. S/he may not be a specialist in what's causing the swelling. If you have developed an infection, you NEED to get medical help A S A P. That's exactly how my own staph infection manifested early on: swollen left eye.

Treat this problem NOW. Because if you do have any kind of infection, it can spread systemically in the form of "scalded skin syndrome" within 24-36 hours, and you will be recovering from that either in a hospital or weeks and weeks at home. GO NOW.
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Bugjune, I am still thinking about you and wishing a complete recovery for you. When you are back to normal, would you post a picture? I'd post pics of my face during the healing process, but I don't know how. Seeing your pictures helped me because I knew what my face could look like, and since even under the best circumstances the face looks bad during healing, it's good to get an idea of it beforehand. I went to my dr's office a couple of days ago to set up my next treatment. The PA's who work with my doctor do these treatments on each other, and they go to work with their faces in the ugly healing stages. I guess it shows the patients that they trust it for themselves, and they're not embarrassed about how their faces look while they're healing.
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Summer66,
Sorry for the delay in getting back to you. I've had a crazy-busy couple of months, but I also don't recall getting the email notification that you'd posted a reply here! I could've overlooked it tho.

Yes, I WILL post a follow-up photo. Right now, I'm on the road, but when I get home and get some time, I'll take another shot of me without my makeup on.

I am now 5+ months post. The red skin under each eye and on one of my eyelids has faded - which is great! But under my right eye, I seem to be stuck with a long crescent-shape of dark red skin. It looks like a permanent pigment change, but only time will tell.

I also have a scattering of white milia that I hope to have a derm doc address when I get home. So yes, I am getting BETTER, but not 100% back to normal yet. I'm glad my photos helped out, cuz it really is critical to go into this kind of procedure with BOTH eyes open as to the possible outcome. Good luck to you, too.
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Skywalker - I'm no doc, and can't comment as to the MixTo being done right or not - and no one for 250 miles or more does that treatment near me. So that is water under the bridge now. I will continue to heal AND apply the camouflage makeup. The good news is that the bright red skin is slooooooooowly diminishing by not even a percent per week, but IS getting smaller. I had asked my MixTo doc specifically about the Juvey having been done just 3 weeks before, and he assured me the MixTo laser does not penetrate that deep. I also had Juvey injections on either side of my mouth, and they were Mixto'd with NO red skin at all there! So I'm convinced IF the Juvey/filler is placed deep enough it should not interfere with the laser. The heat from the laser may not have impacted my Juvey, but IT SURE AS HELL did impact my surface skin - it was a 2nd degree burn, plain and simple. Now if that's what it takes for youthful rejuvenation, I am not interested in EVER having this again.
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bugjune: it sounds like your mixto tm was not correctly done then if you have a burned scarred look underneath your eyes. Very sorry to hear that. Did you get a second opinion on whether the Mixto was in/correctly done? Your doc might owe you at least the money for the procedure back. I am also wondering if it was appropriate to do Mixto only weeks after Juvederm; I remember reading somwhere that that is not appropriate and that one needs to wait at least 6 months. Sounds like the other way around: 1st mixto, then after proper healing Juved. would have been appropriate. The heat from the mixto would make the juved. melt? cause other reactions?
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My face was entirely healed in 10 days, as my doctor said. I'm sure the antibiotics helped. I'm planning on taking them up on the free second treatment because of the uneven converage. My doctor doesn't do injections to numb the pain, so it will be painful for me, which is a small trauma compared to your saga. I think you were one of small percentage of unfortunate people for whom this treatment goes wrong. On the 10th day, I went on my two-week trip to England, came home for 2 days, and went on another 3-week trip. No complications whatsoever at that time (the acne I got from the Aquaphor healed up quickly with my daughter's acne meds-- I should have known something so thick and greasy would cause me to break out).
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That is excellent Summer66! You are proof that these procedures CAN work out A-OK! And kudos for taking the pain that comes with it, too. You can enjoy your outcome and it looks like you are even going to go for the free second treatment! Hope it is as good as the first and that you have another smooth recovery. I am just getting back to my summer activities about 3 full months after my MixTo. Ah well, next year, things will be better.
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bugjune: Thank you so much for posting your rather traumatic experience; that is very brave and generous of you. I am so sorry you suffered as much as you did and only hope that with time your health will be restored, your skin will be healthy, and you can forget about this ordeal (well, at least leave it behind you). I was offered yesterday by my plastic surgeon the mixto laser with the 10-day glowing skin promise, that's why I went online to gather some info. Now I know what to do: Say "No Thank you". I can't fathom taking such a risk (after all there are no guarantees that things go well for anyone) and jeopardizing my looks, health, sanity, precious time and money, for the hope of somewhat nicer looking skin. Perhaps my somewhat aging but very healthy skin is good enough. THANK YOU for sharing!!!
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Skywalker, Every individual is different - and so are the surgeons! While I would say that my MixTo disaster was unique (and THANK GOD FOR THAT), it simply *could* happen to anyone. Even so, if you have confidence in the doctor, are comfortable with their surgical protocols, are perhaps a previous patient, have seen photos of their work, maybe even talked to a patient, then you can go with your gut. I am a bit jaded now, and would definitely think twice or more about getting any elective procedure where there is the trade-off of looks for health. You are so right there! I guess, what I'd say is don't give up entirely on this, but DO feel comfortable having done the research with your final decision.
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bugjune: It is amazing that you can still have such a balanced view of the procedure despite your disaster. Kudos to you. That raises the questions in my mind: Do you see any benefit to your skin?
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