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The newer microdermabrasion technologies of the past few years can give more profound results since instead of an micro-abrasive spray of granules, the device has a fixed-diamond tip head, (similar to standard dermabrasion hand engines). You can combine this with TCA 20% for melasma and post pregnancy pigmentation, and staged-repeat sessions for light scarring of the face. While the device denudes the stratum corneum which can be at at depth averaging 10u or so, I have seen patients coming in to the office with light scarring and pigmentation from this method, where perhaps repeat and deep pressure microabrasion has resulted in deep epidermal erosion down to 100u. While good for all skin types, it comes down to patient selection: geographic ethnic origin,medication usage,skin sensitivity, skin preparation, operator experience, layers of abrasion, and post peel care (including strict avoidance of sun and too early institution of exfoliating skin care products).

TCA peels for spot facial treatments are best used in fair-skinned,sensitive, poor tanning skin types where pigmentation after the procedure is lesss likely. 50% TCA is reported in the literature as a spot agent, but is quite strong. One can use 20-25% TCA in most cases and may need to be repeated. It is common thinking that a full face TCA peel may be better than spot treatments, especially in patients of more light to light olive color and in those who tan easily. Furthermore, 20-30% TCA may be best as a full face peel in those patients. The Obagi peel has been formulated for light and dark skins but takes into visual cues based on a layering of lower percentages of agent, to help the operator offset the tradeoffs of known consequences of deep TCA peeling. The skill and experience of the operator, skin preparation a few weeks before the procedure, and session preparation of the skin are all factors. For pigmentation that follows a TCA peel, usually once can apply 20-25% TCA to improve the post-peel blotches. This also works for post phenol pigmentation splotches and those related to deep laser care. A Wood's UV lamp can be placed against the skin to determine whether the pigment after a peel is superficial or deep. Most post peel pigment problems are superficial. It is best to see a Plastic Surgeon or Dermatologist to determine the course of action.

Consumers often report adverse effects from care on this board, and these things can occur from any well intentioned Cosmetic Procedure. For TCA peel complications, there can be a number of reasons. TCA peels can be formulated in a number of ways to yield a 35% level. It can range from 28% to 42%, thus the operator, must know how his or her pharmacy prepared the agent. It is also critical to know how many layers were used. You may need to see a Plastic Surgeon immediately to determine the best course of action. A Dermatologist well versed in Deep and Medium Peels will also be able to help you. Depending on your skin type, sensitivity factors,general health issues,and peel care, theseissues can determine what may have happened in your case.

We all attempt to suggest a cc amount when we prepare a patient for surgery. The cc or implant size does not equate with cup size. It is the look we simulate with implant sizers at the time of consultation that guides our choice of implant style, cc volume, and projection. When the doctor is within 25 cc of anticipated volume, I believe the surgical decision is noteworthy and proper. Remember, 25 cc is less than 2 tablespoons of volume. The operation is not absolutely perfect but we attempt to come within 15% or so of anticipated volume. To add 25 cc is not appropriate or safe since you will have to manipulate the valve again. It is performed in unusual situations with careful patient to doctor discussion. We try to give a range of sizes with our saline implants so we have some wiggle room. Do not feel underserved if a certain number of cc has not been reached. I am constantly surprised, for example, that one breast may take more or less fill than another, when preoperatively, the breasts looked perfectly symmetric. This is why I prefer saline in many cases. Try to be patient.

Dr Krugman is an excellent surgeon, and I would return to have him exam you. Any mass should be properly evaluated including ultrasound and mammography. If the mass is localized, it may need to be biopsied or removed with special care regarding the saline implants. While the saline implants have lasted a considerable time, it might be good to take a careful look to ensure you are okay. Occasionally a small glob of silicone may be left even with careful washing and inspection.Removal of the entire capsule under the muscle is not advised as it is too traumatic. Removal of the capsule itself is not always necessary except when restricting the breast shape.