Don Mehrabi, MD

Thank you for your question.

Microdermabrasion is not a standard treatment for melasma. Rather, it would be better to try different bleaching creams, specifically Triluma, to try to lighten the area. Sometimes laser will work, but studies have shown that melasma will recur after laser in most cases, so at most, it is temporary relief. Contant use of a bleaching cream + laser (if desired) may be a great starting point.

Also, Cosmelan is an excellent treatment. It is meant to be a once a year treatment, but you can repeat it in 4-6 months if the results are good, but not perfect. Other options for melasma include repeated glycolic peels. Theoretically, deeper peels would work, but I would worry about it coming back worse.

The standard rules apply: birth control and pregnancy will worsen melasma. Those two and sun exposure will prevent any treatment from working.

Hope this helps!

Thank you for your question.

IPL is safe in both of these situations. Intense Pulsed Light (IPL) is simply visible light (like sunlight), but given at a high energy. There is no carcinogenic radiation, no ultraviolet light, and no cancer potential or potential harm to internal organs / baby. The light does not penetrate farther than the skin. You should be fine doing this procedure while pregnant and while breastfeeding.

Good luck!

Thank you for your question.

It does sound like you either had a deeper peel effect or a slight glycolic acid burn; both are normal with glycolic peels and can happen with anyone at any time (yours was the 4th time). Dry skin is usually the cause, and although this happened to you, don't worry. The darkness will take time to resolve and you can do two other things: 1. Wear sunscreen and avoid the sun, and 2. Get a hydroquinone or Triluma prescription to bleach the dark areas.

With time, no matter what it looks like now, it will heal. They always do.

Hope this helps!

Thank you for your question.

Yes, you shouldn't have problems getting Botox while on microcurrent therapy, or while getting any other cosmetic procedure. The only time I tell patients to wait is if they are going to undergo any procedure that causes a great deal of heat in the dermis right after getting the Botox injections, namely laser resurfacing or IPL.

You should do just fine with your treatment.

Good luck!

It sounds like you have the standard goggle eye protection. It is important to make sure that the goggles are tight and that you continue to have your eyes closed. It is normal to see some flash of light, but there is no true risk of eye damage unless the flashes are close to the eye or are more direct.

Hope this helps!

Radiesse lip injections are strongly discouraged by doctors and the company. Radiesse will appear clumpy and uneven in lips, and should be avoided. You have other options such as Restylane and Juvederm for your lips should you wish to have them injected.

If you already had the Radiesse injected, you can try to massage out some of the lumpiness, but you might not be successful. Your best treatment is time - it should wear itself out in about a year. The only other option is to cut it out, and I wouldn't advise this.

Hope this helps!

Thank you for your question.

Botox is very safe, and as of now, does not carry a malignancy risk, so there should be no problem with your MGUS, multiple myeloma risk, and concurrent Botox treatments. The largest risk of you getting multiple myeloma is your MGUS, and Botox will not increase this risk.

Hope this helps!

Thank you for your question.

If you already have darker skin, it is more likely that you will turn dark after chemical peels or laser procedures. Since this has happened to you, as long as it is simply darkness and not scarring relating to blistering or severe skin damage, you should resolve with time and a good bleaching cream. Avoid the sun and avoid any other cometic procedures, including other peels. Sometimes it takes months for darkness to resolve, but it will resolve.

Hope this helps!

Thank you for your question.

As a blanket statement, I would not do TCA peels at home and would advise anyone thinking of getting a TCA peel over 25% to definitely go to a medical professional.

For your tight red skin after your home peel, keep in mind that this is normal. Keep applying aquaphor or vaseline liberally and simply wait to see if the skin will shed. Signs of infection include pain, swelling, or yellow crusting. If you start seeing this, visit your dermatologist immediately to get antibiotics.

Hope this helps!