Kenneth W. Alanen, MD

IPL would not be expected to cause this issue. The wrinkles noted are a result of chronic, low grade sun exposure as well as aging. Zinc oxide based sunscreens help perpetuate the benefits of IPL and also minimize the tendency for the wrinkles to worsen. Be aware the this process is mediated by ultraviolet-A wavelengths (not UV-B). UV-A goes through glass as well as clouds; hence, always be wearing a zinc oxide sunscreen. The sunscreen ingredients are every bit as important as the SPF number.....


* The statements above are not intended as a replacement for authentic medical advice; an in-person medical visit with a formally trained dermatologist is recommended.*


Kenneth W. Alanen MD,
Dermatology FRCPC

This scar should be significantly improved by punch excision - I would use a 2 mm punch biopsy and close with fine 6-0 non dissolving suture; Sutures should be removed in 5 or 6 days and then I would use a silicone scar gel (e.g. Revoderm scar gel). The cosmetic result should be excellent.


* The statements above are not intended as a replacement for authentic medical advice; an in-person medical visit with a formally trained dermatologist is recommended.*


Kenneth W. Alanen MD,
Dermatology FRCPC

Post-IPL hyperpigmentation is a common phenomenon. The risks are greater if you have a recent sun tan or significant recent sun exposure history. Typically, I recommend zinc oxide based sunscreens for several weeks before the procedure as well as 2% hydroquinone. I recommend this routine for you now - ideally, however, there would be a picture to see your skin......

Post-IPL hyperpigmentation should be mostly resolved before you embark on more IPL, in my opinion. 

I would ensure that the physician treating you is well qualified to perform this procedure. Ideally, she / he is a board certified dermatologist and, ideally, a member of the American Society of Dermatologic Surgery.

* The statements above are not intended as a replacement for authentic medical advice; an in-person medical visit with a formally trained dermatologist is recommended.*


Kenneth W. Alanen MD,
Dermatology FRCPC

Typically, I inject Volbella for lips. This hyaluronic acid-based formulation is smooth, pliable, long lasting and gives natural results. 

One should expect transient swelling that subsides over several days. It is prudent to anticipate this and plan your social calendar accordingly. Some patients have a prescription for several days of low dose prednisone (although it is usually not needed).  

Lip injections are technically challenging and should only be done by a formally trained physician.

This scar should be improved with a combination of subscision, fractional laser and possibly filler. 

Post-traumatic scars are treated with an approach that is similar to acne scars, chicken pox scars and post-surgical scars. 

My starting point is typically subscision, performed under local anesthesia, whereby a very thin needle with a scalpel-type end is inserted into the indented scar and this tissue is "loosened" through a gentle back and forth motion. New collagen is laid down in this area, helping to fill the indented area. This process takes about a month or so and I anticipate several sessions. 

If the improvement is incomplete, the sharp edges of the scar can be "blurred" with fractional laser or microneedling. Fillers such as Juvederm are helpful as well. Although they are temporary, they tend to last longer as compared with injections in sites such as lips and melolabial folds (perhaps because scar tissue is densely collagenized).

Finally, there is emerging data to suggest that platelet-rich plasma (PRP) infusion, in combination with fractional laser, can improve acne scars. PRP helps to regenerate collagen and soft tissue though local infusion of platelet derived growth factors.


* The statements above are not intended as a replacement for authentic medical advice; an in-person medical visit with a formally trained dermatologist is recommended.*

Kenneth W. Alanen MD,
Dermatology FRCPC
Fellow, American Society of Dermatologic Surgery, Mohs' Micrographic Surgery
Dermatopathology ABD / ABP, Fellow ASDP