Erik Peterson, MD

Hi! Dr Peterson here -
Thank you for sharing these details. Based on what you describe—persistent redness, flushing, swelling with heat, burning, and transient red bumps—it sounds like you may have developed a component of rosacea or post-inflammatory vascular reactivity in the area that was previously lasered. The accompanying hyperpigmentation and mild texture change are also consistent with post-laser sequelae.

For vascular symptoms (redness, flushing, and small red bumps), vascular-targeting lasers such as VBeam (pulsed dye laser) are usually more effective than BBL. VBeam specifically targets blood vessels, reduces background redness, and can improve flushing and post-laser vascular changes.

BBL (broadband light) can help with overall redness and pigment, but in cases where there is burning, flushing, and vascular reactivity, I would lean toward VBeam first, as it is more precise and tends to give more durable vessel reduction.

Both devices can help, but the best approach is often a stepwise plan:
• VBeam for vascular reactivity and redness
• Adjunctive topical regimen (anti-inflammatory rosacea therapies, pigment suppressors if needed)
• Consider BBL or gentle pigment-targeting modalities later once vascular stability is improved

The most important next step would be a consultation with a board-certified cosmetic dermatologist or laser specialist who can evaluate your skin in person, confirm whether rosacea-like changes are present, and tailor the energy settings carefully given your prior sensitivity.

Hi! Dr Peterson here! Thank you for sharing your concerns and photos. Based on your description, the bump or fold that appears only when you smile is likely related to muscle activity of the nasalis or other perinasal muscles, rather than a structural issue with the nose itself. The whiteness you see is likely transient skin compression or minor blanching.

Botulinum toxin (Botox or other neuromodulators) can sometimes help:
• It works by relaxing the overactive muscles that cause the bump or fold.
• Treatment must be precise, targeting only the specific muscle fibers involved, to avoid affecting nasal tip movement or smile dynamics.
• Typically, very small units are injected just lateral to the nasal sidewalls or along the nasalis fibers.

Risks include:
• Mild bruising or swelling at the injection site
• Temporary asymmetry if one side is over- or under-treated
• Rarely, changes in nasal tip movement, flaring, or drooping

Because of the delicate anatomy and functional role of these muscles, it’s important to see a board-certified cosmetic dermatologist or facial plastic surgeon experienced with nasal/upper lip neuromodulator treatments. They can assess exactly which muscle fibers to target and minimize risk while improving the appearance.

Hi! Dr Peterson here - I understand how frustrating hair thinning can be, especially when it’s progressed over a couple of years. With female pattern hair loss (FPHL), especially in women in their 50s–60s, it’s really important to first get a full medical work-up. This can help identify underlying contributors, such as vitamin deficiencies (like vitamin D or folate), thyroid issues, hormonal changes, or medication effects. In some cases, a scalp biopsy may be recommended to confirm the diagnosis and rule out other causes of hair loss.

Oral minoxidil or other medical therapies can be highly effective in slowing or reversing hair thinning.

Laser devices (combs, caps, or helmets) can provide some benefit, particularly in improving hair density and thickness, but they:
• Are not considered primary therapy
• Require long-term, frequent use to see meaningful results
• Usually work best in combination with medical treatments

The most effective approach usually involves a combination of medical therapy, addressing any underlying deficiencies, and adjunctive devices. Consulting a board-certified dermatologist who specializes in hair loss is the best next step—they can tailor a plan specific to your situation, including labs, medications, and device use.

Hi there!
Dr Peterson here. thanks for posting and I’m so glad you reached out. First off, your photo is beautiful and as an aesthetic dermatologist, I can confidently say you have wonderful, proportionate features. So before we embark on any procedures, let’s work on changing your username. Confidence isn’t something we can get from nonsurgical nose jobs, from lasers or Botox. Confidence comes from within. And at age 18, I can tell you I wasn’t the most confident guy. But then a lot of school, and life experiences, and difficult times helped me find myself and gain way more confidence. I know the same will happen for you :)

But I digress! Let’s chat about your question. At 18, your facial features are still developing, and it’s generally best to wait until your face has fully matured before considering any permanent or semi-permanent procedures like a surgical or nonsurgical nose job. Early interventions can sometimes look unnatural later as your bone, cartilage, and soft tissue continue to grow.

Nonsurgical nose jobs (using dermal filler) can address minor concerns, such as:
• Small bumps or dips in the nasal bridge
• Slight asymmetry
• Subtle contour adjustments

However, they cannot reduce the size of your nose or correct major structural issues. There are also risks—including bruising, swelling, skin compromise, or rare vascular complications—so it’s essential to see a board-certified physician who specializes in nonsurgical rhinoplasty.

For now, the safest approach is to wait and let your features mature. This way, when you are ready, any treatment—surgical or nonsurgical—can achieve more natural, lasting results.

Hi! Dr Peterson here - Thank you for sharing these details and photos—they are very helpful. Based on your description, your platysmal bands are mild and only visible with neck hyperextension, which is common. In a neutral position, they’re not prominent, but fat removal can sometimes make bands more noticeable if the skin contracts unevenly.

Chin/neck liposuction with skin tightening (such as J-Plasma) can reduce submental fullness and improve jawline definition. In most patients with good skin elasticity, skin tightening smooths the area, and platysmal bands remain subtle.

If platysmal bands are a concern, they can also be relaxed or softened using neuromodulators (Botox), sometimes called a Nefertiti lift, which reduces tension in the platysmal bands and improves neck contour.

The best next step is an in-person consultation with a board-certified cosmetic or dermatologic surgeon. They can evaluate your neck dynamically, discuss how your bands may behave after liposuction, and develop a personalized plan—potentially combining fat removal, skin tightening, and neuromodulator therapy for optimal results.

Hi! Dr Peterson here - thanks for reaching out.

I understand how frustrating malar bags or persistent malar edema can feel. Topical creams alone usually won’t resolve this, because the issue is often related to fat pad position, fluid retention, or skin laxity rather than surface skin changes.

Microneedling with radiofrequency may improve skin texture or mild laxity, but it typically doesn’t fully address malar bags.

Other options that can be more effective include:
• Platelet-rich fibrin (PRF) injections – can improve skin quality, stimulate collagen, and subtly support the area, though they may not fully correct significant bags.
• Lower eyelid surgery (blepharoplasty) – considered when bags are due to fat pad protrusion or persistent edema; this can provide a more definitive result.
• Hyaluronic acid filler or tear trough support – helpful if the bag is partially due to volume loss in the midface.

The best first step is a consultation with a board-certified cosmetic dermatologist or dermatologic surgeon who specializes in lower blepharoplasty. They can:
• Determine the underlying cause of your malar bags (fluid vs fat vs laxity).
• Recommend any nonsurgical approaches that may help first.
• Review your history, including any prior filler or procedures in the area, that could be contributing.

These issues are very common, and a specialist can create a personalized treatment plan to achieve the best outcome while minimizing unnecessary procedures.

Hi there!
Dr Peterson here - thanks for reaching out. I love discussing lasers as they’re a particular focus of mine.

CO₂ lasers can be very effective for improving skin texture, fine lines, and some types of scarring. Different lasers work in different ways:
• Ablative lasers (like CO₂ or Erbium) remove layers of skin to stimulate collagen and new skin growth — great for deeper lines and significant texture issues.
• Non-ablative lasers (like Fraxel 1550) heat the deeper skin without removing the surface, improving tone, mild lines, and pigmentation with less downtime.

Good candidates typically have healthy skin, realistic expectations, and are committed to proper healing and sun protection. Lasers are best at improving texture, fine lines, acne or surgical scars, and uneven pigmentation, but they cannot fully stop aging or replace surgical procedures when needed.

Cautions: Ablative lasers have more downtime, risk of redness, scarring, and pigment changes, especially in darker skin types. Proper post-care and experienced administration are essential.

I recommend consulting a board-certified dermatologist to determine the safest and most effective laser for your skin and goals.

Hi there!
Dr Peterson here. Thanks for sharing your experience. You’re not alone in the frustration that comes from experiencing hypopigmentation after a procedure.
Post-procedure hypopigmentation and texture changes, especially after aggressive treatments like a CO₂ laser, can be very challenging to treat, and results often take patience and careful management.

Here’s what can help:

1. Sun protection: Daily broad-spectrum sunscreen is essential to prevent worsening pigmentation and help any treatments work optimally.

2. Microneedling with adjuncts: Microneedling combined with bimatoprost can sometimes help repigment areas by stimulating melanocytes in hypopigmented skin.

3. Topical treatments:
• Calcineurin inhibitors or mild retinoids in select cases may support repigmentation.
• Growth factor serums can support texture improvement, though pigmentation results are limited.

4. Lasers and light-based therapy: Non-ablative fractional lasers or low-fluence Q-switched lasers may improve texture but need to be approached cautiously to avoid worsening hypopigmentation.

5. Camouflage and cosmetic strategies: While working on repigmentation, tinted sunscreens are a great tool to help manage visual impact. Dermablend makes a really great, very high coverage makeup that I often recommend for patients with vitiligo or other pigmentation disorders. It’s pigmented enough to cover tattoos, so it can be a great option while you’re working on other strategies to bring the pigment back.

Hang in there! It’s a long journey but there’s light at the end :)

Because this is a highly nuanced and delicate area, it’s best managed by a board-certified dermatologist experienced in post-laser complications. With a carefully tailored plan, improvement is possible, though it may require multiple modalities over time.

Hi there!

Dr Peterson here. Thanks for sharing! The neck is a tricky area because even at a healthy weight, the combination of skin laxity, subcutaneous fat, and muscle tone can contribute to fullness and lines. There are several approaches to improve both texture and contour:

1. Skin tightening: Radiofrequency microneedling can stimulate collagen and help firm the skin over time, improving texture and reducing the appearance of lines. You may have heard of Morpheus8, which is one of the more common microneedlingRF devices, but there are many different options.

2. Biostimulatory fillers: Hyperdilute Sculptra or Radiesse can be used to encourage your body’s own collagen production, which improves skin thickness, firmness, and overall neck contour.

3. Neuromodulators: Botox in the neck (a technique sometimes called the Nefertiti lift) can relax platysma bands to create a smoother, more defined jawline.

4. Skincare & preventive measures:
• Daily retinol helps thicken the skin and improve elasticity.
• Consistent sunscreen protects against further photoaging.
• Laser treatments can also improve skin texture and tone.

Since this is a nuanced area with multiple contributing factors, I recommend seeing a board-certified dermatologist or facial specialist to create a personalized plan. From what you’ve described, you’re a great candidate for a combination approach that can significantly improve the neck without surgery.

Hi there!

Dr Peterson here. Thank you for sharing your concerns. I completely understand why it feels frustrating. What you’re describing is actually more common than it seems. The dimples under the corners of your mouth are often related to muscle attachments like the depressor anguli oris (DAO), and combined with fuller cheeks, can create the appearance you’re noticing. The lines pointing downward from the corners of the mouth are also related to both muscle activity and volume changes in the mid-face.

The good news is that there are safe, subtle options to soften these lines and lift the corners of the mouth — including neuromodulators like Botox, sometimes combined with strategic filler in the cheeks or chin to balance the proportions. It is a somewhat nuanced area, so I always recommend a board-certified dermatologist or facial specialist for the best, natural-looking results.

From what you’ve described, you’re a great candidate, and with careful planning, this can make a noticeable improvement without looking “overdone.”