Robert T. Anolik, MD

One of the best options for the improvement of uneven tones, texture, and scars is laser resurfacing.  There are several resurfacing options, including those with little to no downtime all the way up to aggressive options with weeks of downtime.  Most often, I will choose a non-wounding (aka non-ablative) laser such as the Fraxel Restore Dual.  Over a few treatments, my patients will see improvements.  The treatment is not painful, but the downside is a few days of pink, dry flaky skin with each treatment.

New and old tattoos can be removed successfully.  Usually this is performed to restore the skin's normal appearance, but sometimes removal is performed so that a patient can replace the existing tattoo with another.  The types of lasers available and the physician experience with laser surgery play important roles in clearance rates and success.  Often Q-switched Ruby, Q-switched Nd:Yag, and Q-switched Alexandrite lasers are used to remove pigment.  Sometimes fractional resurfacing lasers are incorporated to remove less common tattoo pigments.  I encourage you to have a consultation with a physician who specializes in laser surgery to discuss your options.

The popularity of tattoos is on the rise, as is the desire for laser tattoo removal.  Removal has become easier and more efficient with the development of so many laser options.  As one would expect, a particular physician's training and research plays an important role in tattoo removal.  What also plays a very important role is which lasers the physician has available and what settings are used.

Most tattoo pigments can be eliminated using a variety of what are called "Q-switched" lasers.  "Q-switched" is just a technical term that indicates when a laser is designed to deliver high powers and very short pulses.  Commonly used Q-switched lasers for tattoo removal include the Q-switched ruby and Q-switched Nd:Yag lasers.  One type of Q-switched laser offers advantages over others.  Often two different Q-switched lasers are needed for the treatment of different colors in the same tattoo.

There are some tattoo pigments that should not be lasered with a Q-switched laser, such as white and beige, since this type of laser can make these pigments very dark.  Obviously this is undesireable when trying to remove evidence of a tattoo.  In these cases, it is very possible to treat a tattoo using an ablative fractional laser.  Ablative fractional lasers superficially wound the skin while reducing pigment after each treatment.  It's very tolerable if the skin area is numbed and should heal rapidly after treatment.

When tattoos are located on the eyebrow or even the eyelid, it is possible to remove tattoos using combinations of Q-switched lasers and ablative fractional lasers.  It is critical that the eyes be protected.  If the eyelids are being treated, protective shields must be placed under the eyelid to protect the patient's eyes.  It is important to note that white and beige pigments are often used in tattoo makeup.  In these cases, the ablative fractional laser is the best bet.  Lastly, there is some risk of damaging hair follicles.  That is why it is valuable to choose lasers that allow for small areas to be treated (such as the Q-switched Nd:Yag) so that hair follicles can more precisely be avoided.

I have written about the topic of tattoo removal around the eyes in detail in a book titled Smith’s Ophthalmic Plastic & Reconstructive Surgery, 3rd edition, that is due out early next year.  The good news for the person who posted the question on this webpage is that the tattoo is about 15 years old.  We recently performed a study at our center on tattoo removal that was presented at the 2011 American Society for Laser Medicine and Surgery Annual Meeting titled: Age of Tattoo is an Indicator for the Rate of Success of Laser-Assisted Tattoo Removal.  We showed that older tattoos (i.e. tattoos older than 10 years) were eliminated at a more rapid rate than fresh tattoos (i.e. tattoos newer than 5 years).

Good luck in your pursuit of tattoo removal.  Please look into all of your options and I strongly recommend that you have an experienced physician treat you when pursuing tattoo removal.

Sincerely,

Robert Anolik, MD, FAAD - New York Dermatologic Surgeon

The variety of Fraxel lasers (such as the Re:Store, Dual, and Re:Pair) along with the other fractional resurfacing lasers (such as the Palomar Artisan, ActiveFX and others) are wonderful tools in the strategy to minimize scarring, whether these scars are old or new.

Although there are treatments for scars of all ages, I believe getting to scars earlier than later can be of benefit in many cases, as I feel we can affect the way new collagen and scars form in a positive way.  In fact, when I perform Mohs micrographic surgery for the treatment of skin cancer, I will often employ a variety of lasers to reduce any scar appearance during the initial routine follow-up visits.  Of course, each situation is different and must be individually evaluated.  However, if scars begin to show evidence of uneven textures (either thickening or thinning), the use of ablative (i.e. superficially wounding) fractional lasers (such as the Fraxel Re:Pair) in the near term (i.e. first 1-2 months) can be very valuable.  When the developing scars show evidence of just slight uneven texture, the non-ablative (non-wounding) fractional resurfacing lasers are often valuable.  If scar redness is prominent, the pulsed dye laser (such as the Candela VBeam laser) can also be integrated at the same time.  When broken blood vessels become evident, other vascular lasers can be employed to augment the pulsed dye laser therapy, such as the Gemini laser.  These lasers, in combination with injecting a variety of medications can also help minimize the appearance of scars.  I will often consider injecting steroids (such as Kenalog) and 5 fluorouracil depending on the situation.

I realize there is a lot of information out there, but the good news is that scars can be markedly improved and its valuable to consider the entire arsenal of tools out there and even a combination approach.  To summarize the question that prompted this discussion: yes, Fraxel lasers are a very valuable component in the treatment of new scars, but consider all the options and combination therapies that are available.

Sincerely,

Robert Anolik, MD

There are several lasers available to reduce your beard hair.  What's more important is choosing a physician and a center with extensive experience rather than a specific laser, since nuances and setting variations make a big difference in lowering complication rates and increasing rates of success. 

Lasers for hair removal target the hair pigment.  This is why laser hair removal is not effective on blonde or white hair.  It is also why treating darker skin types is more challenging.  Pigment on the skin competes with the pigment in the hair.  As a result, different settings must be selected to protect the skin.

In general, I favor the Gentlemax laser, which allows me to select between an alexandrite or an Nd:Yag laser.  For darker skin I favor the Nd:Yag wavelength and for the fairer skin types I favor the alexandrite.  Other lasers, such as diodes and others out there may also be effective.  You have indicated in your question that you are skin type 3 or 4.  This gives your physician several options.  If you are truly type 3 skin (always tan, sometimes burn in the sun), then I would select the Gentlemax using the alexandrite component.  If you are type 4, I would want to evaluate your hair and skin contrast to choose the proper settings and laser.  Either way, you should have success.

The white heads are simply the result of inflammation in the hair follicle following the treatment.  It can actually be somewhat of a good sign that the laser is targeting the proper areas (i.e. the follicle), although I do understand the white head aftermath is a nuisance.  As a result, talk to the physician performing the procedure.  You might be a good candidate for a benzoyl peroxide wash.

I wish you luck.  Stick with it, because the beard  hair should respond very well.  I strongly recommend having physicians involved in your care rather than a spa environment, as it will markedly diminish risk to your skin and increase the chances for success.

Warmly, Robert Anolik, MD