Daniel Baber, MD - Account Suspended

Thank you for your question which is a very common one. Looking at the pictures and the timing I would suspect some were pulled that would not allow a follicle to regrow a hair shaft in the future. Time will tell how many were lost, and may take up to 18 months to tell. For those having the procedure an antihistamine can help as well as a sedating pill like Ativan to keep from rubbing your head while asleep. Also head position on your pillows, maybe even use a neck pillow, is important to keep the friction from turning your head aggravating the ooze and scab formation. Once your dressings are off, keeping the area moist will decrease the scabs that may end up plucking your hair. Trying to leave the scabs in place as long as possible is best, and maybe two weeks. Generally, most grafts don't ooze that much so there are only a few unsightly problem areas.

Thanks for the interesting question.

Most tattoo removal devices use wavelengths in the visible spectrum, or colors we can see with our eyes. Erbium can be controlled very precisely and loves superficial water. We use the Dynamis that allows for micro adjustments of depth. Also CO2 is much further away from the visual spectrum, and can be safe, but the depth of injury is not as well controlled and may disrupt the color or visibility of the tattoo. NdYAG, diode lasers, and IPL devices will all be attracted to the colors of the tattoo so they can burn you or disrupt the tattoo for sure. If you love your tattoo, and want to have resurfacing, the only laser I would use is a superficial Erbium laser. If you don't care much about it then CO2 is fine as well. I have seen permanent tattoo ink that had faded with time but when hit with a laser change the color of the ink, but those have been NdYAG lasers. Ultimately, it will be up to your provider to discuss the risks with you. I hope this was helpful, and I wish you the best.

We use both CoolSculpting and Vanquish in our practice, and I have not personally used Zerona. I read extensively from Zerona's articles about how it works and most information relates to the direct effects of the red or green light on fat. Currently their device uses 635nm cold laser to stimulate the skin which is suppose to work its way to the cellular level to within the mitochondria to cause the release of fat on the cytochrome C oxidase sub-unit. This does work in the world of liposuction, because the light is so close to the mitochondria, but even hot lasers don't exert their effects that deep across the skin. CoolSculpting is simple, it works by freezing the fat and destroying it. The newer 2nd generation are more perfected and not painful because of the applicator set up. Vanquish works by radio frequency to heat up the tissue to the point that it kills the fat by heat. If a person is not hydrated before the treatment it may not be as effective. BTL provides a scale that also checks the amount of hydration, and we have notice that men typically don't hydrate themselves as well as women and that women tend to respond better. You should not be pregnant while getting this treatment. CoolSculpting is usually a set of two treatments, while Vanquish may be six treatment sessions every 2 weeks. Vanquish is less expensive, while CoolSculpting may be lumpy. The lumps can be smoothed with a laser or radio frequency device if it happens. For large treatment areas liposuction may become cost effective.

The Vanquish works by radio frequency and the high resistance in your fat, it should get hot very quickly, and you may have a sensation like a hair dryer on low settings is heating up the skin. Most patients will sweat during our treatments, and we occasionally use a chiller, a blast of arctic air, to cool and dry the skin surface during the treatment if uncomfortable. The device should sit very close to the skin, and the energy should be set at max to begin with so it should warm very quickly. I would definitely ask your provider about the lack of heat, and even ask if they could measure your temperature by a hand held device to document the change in temperature. You want to hit 40 degree C for 20 plus minutes to get the fat destruction needed. I hope your next session goes better, and that it was just a technician error.

I see the area in the photo, and would assume there was no injection in the eyelid by the provider. We usually won't inject over the eyelid, though sometimes it may feel that way. If the area is painful it may be the beginning of a sty and warm compresses would be good. If it makes a scab and peels off as you describe it should be a self limited blemish that resolves. If it breaks out in clear vesicles or in other adjacent areas it may be the rash from shingles or the Herpes virus. I really don't think it is related to the Botox itself. If not resolving quickly or advancing involvement of the eye I would seek the help of your local ophthalmologist.

You were wanting to know if Exilis and SculpSure could be used at the same time. SculpSure is a 1064 wavelength diode laser that is applied to the skin to target fat deeper. It generates heat and so there is collagen stimulation from the heat as well. Exilis uses radio frequency, part of the electromagnetic spectrum, and is not a laser. Both devices work by elevating the temperature of fat to 42 C to destroy fat. The newest Exilis uses cooling to either go deeper to get fat or no cooling to stimulate collagen superficially. The more fat destroyed the more triglycerides need to be converted to energy, so there really is a limit in a session to the amount of fat the liver can handle. I would recommend one at a time, and feel both could give tightening. I currently only use Exilis and also a different 1064 laser to reduce fat. I have not used SculpSure, but have read about it, and think either modality should give similar results. 

I am sorry for the burn you obviously had, and yes it can be from the heat of the machine. BTL lists that as one of the possibilities with treatments. Fortunately, we have not experienced that, as drying the skin is helpful as well as using a Zimmer chiller to spot treat hot spots allows higher energy levels and better elevation of temperature at the level of the fat cells. Time will make the scar better, and various lightening creams like hydroquinone,  vitamin C, Kojac Acid, many Tyrosinase inhibitors (Tyrosine is a precursor to melanin) like mulberry, blueberry, liquorice lighten the skin. Hydroquinone can have paradoxical darkening of the skin so vigilance is necessary. Fractional CO2 or Erbium can be helpful if the scar is not resolving adequately. Also regular massage of the scar can help to reorganize the fibroblasts as well. Marked pigmentary changes can be handled well by a Q switched laser, like the StarWalker by Fotona, has given us very good results in our office. I hope this was helpful, and that you get a great result.

Thank you for your question. I assume you have not lost much in abdominal girth. It may be partially because you are not dieting to help from the liberated fat being deposited elsewhere. It may be the machine is not tunning in enough to reduce your fat because of lack of hydration or application error. For fat to die it is very important to get the temperature of the fat up to 42 degrees and hold it for several minutes.

If you are asking, after some results and six treatments, can you still loose more girth even though not treated? The answer is yes, as there may be 2 months of further fat necrosis, as well as tightening from the heat stimulation of collagen growth. It is important for these treatments to be done in every two weeks or so, to get a continued effect. I hope it was beneficial for you, as we have had good results when the patient does as instructed. Vanquish is not intended for weight loss, but those who benefit most restrict the calories, and once they measure the waist line drop they are more rigorous with their exercise and diet.

Thank you for the pictures as it always helps to give a better answer. And looking at a few of the other contributors, they  have already given very good information. You will definitely want to use a laser that can attack the colors using four different wavelengths. We use the StarWalker by Fontona and it includes four different wavelengths and a proprietary FracTAT™ procedure, that pretreats the tattoo with an ablative Nd:YAG that creates  little holes or chimneys in the dermis that allow the escape of gases from the photoacoustic explosions from the pigment destabilization. Ink spray can actually come out these holes so there is less ink for your body to break down, and you can do several passes in a session.  Alternatively, pretreatment with a fractional beam like Erbium can create a similar result, though the Nd:YAG is more pigment specific. Both methods also minimize risk of scar formation.

The StarWalker is capable of delivering  an unprecedented 10 J of Q-switched energy in one giant structured MaQX pulse for treating epidermal and dermal pigmented lesions. The StarWalker thus combines the high energy capabilities of nanosecond lasers with the ultrashort pulse peak powers of traditional picosecond lasers, the best of both technologies. Whatever laser you use needs to be Q-Switched and preferably have picosecond pulses. 

The treatments can be done with a chiller, but as large of area as you have, needs to have lidocaine and probably should be done in two different area treatments, like one day the leg and another the thigh. The pretreatment, as above, allows several passes in one session so you get more pigment reduction without too much heat or tissue injury. I hope this is helpful in try to get the quickest and safest result for your tattoo removal.

CoolSculpting is beneficial to get rid of fat, however in the face most do not have excess fat to get rid of or you wouldn’t be complaining about the wrinkles and lines. Other modalities such as Exilis, radio frequency, treat wrinkles superficially and Fotona’s Dynamis using Erbium and YAG 1064 stimulated the collagen inside and out for tightening. We use these in our practice. Depending on the nature of the marionette lines fillers are good options as well as Sculpture. We also use threads that can be placed in the grooves or can be used to give a lift that is minimally invasive. There are surgical options as well, but these are certainly best addressed with your local cosmetic surgeon. I hope this gives you some ideas.