Claire Wolinsky, MD

The brand of laser is not the only factor in determining the success of laser hair removal.  

Laser hair removal is something that requires an experienced technician most importantly.  I have seen consistent results with Alex, Diode and Yag lasers (755, 810and 1064 nm respectively).  Selecting the correct wavelength and energy (or fluence) depends on several factors.  The quality (ie coarse or thin), color of hair, skin color of the patient and bronzing/tanning of the skin are all considerations.  If a response is not seen with a particular wavelength, it may be because the energy is not high enough.  That being said, caution and experience is required when increasing the energy of the laser.

Combination therapy many times leads to improved results.  In regards to combining Hydrafacial and microneedling at the same session, this could be true if the indication is collagen induction plus clarity of skin (for example acne and acne scarring together).  However, if you are doing Hydrafacial and microneedling to better control acne and/or for clearer skin, I would suggest alternating and doing them separately to enjoy longer lasting results.  Microneedling can reduce sebum production (ie make the skin less oily) and enhance delivery of topical treatments to the skin.  Hydrafacial can extract clogged pores and remove the most superficial layer of the skin while infusing a clarifying solution.  Either treatment should lead to clearer skin independently for about 4-6 weeks at which point another session would be warranted.  If used in combination, results may be enhanced but the longevity of clearer skin would likely remain at 4-6 weeks.  

Post-inflammatory hyperpigmentation is defined as brown or dark spots, however if your scars are purple and red, you likely have post-inflammatory erythema.  This is an important distinction a cosmetic dermatologist would need to make in order to select the appropriate laser therapy.  Fraxel Dual can be a very successful treatment for pigmentation and brown spots.  Other lasers are better suited for red or purple discoloration.  

As far as hyperpigmentation after non-ablative Fraxel, settings must be selected carefully and extra caution must be used in patients with darker complexions in order to prevent this undesirable side effect.  As with all cosmetic procedures, the experience of the medical provider with the device is invaluable.

Vollure is the latest of the Juvederm family of fillers and is lovely for improvement of the marionette area of the face.  The filler is supportive yet soft in order to allow for natural facial expressions.  It lasts 18 months which is more than the other standard hyaluronic products used in this region.  An experienced injector would address your concerns and guide you as to how to achieve your goals which likely would include more than one type of filler.

Good luck!

My preferred technique is also injections of a soft hyaluronic filler such as Belotero directly onto the orbital bone.  The skin under the eyes is thin and unforgiving.  Lumps and bumps can be visible if the product is not placed deeply in this region.  I also educate my patients that tear troughs deformities sometimes can not properly be fully addressed without injecting the mid face and cheeks with filler as well.  Patients may come in pointing to their under eye area, however a small amount of product in the cheeks will allow for a more natural enhancement.