Todd Minars, MD

To answer your first question - yes, a fractional non-ablative laser is different than a CO2 ablative laser? 

First lets define our terms:

"Fractional" simply means that instead of a solid beam, the laser creates a grid-like pattern (as if you were shining a flashlight through black paper with pinholes in it). 

"Ablative" means that tissue is destroyed.  "Non-ablative" means that the tissue is just heated up.  An ablative laser treatment will leave tiny crusts.  A non-ablative treatment just leaves you red (and maybe swollen).

A CO2 laser is a specific type of laser.  CO2 lasers come in both "fractional" and "non-fractional" varieties, but they are all "ablative".

 

The difference between Restylane and Juvederm is minimal.  I have used both extensively and find that for the most part they are the same.  They are both in fact hyaluronic acid.  Juvederm is a little more concentrated with 24mg/ml of hyaluronic acid, while Restlyane has 20mg/ml of hyaluronic acid.  But Restlyane gives you more in the syringe (1mL vs. 0.8mL). 

Juvederm is a little bit "smoother", but if you put them both in the same syringe with the same needle and did not tell the doctor or the patient which was which, I am not sure most people would be able to tell the diffence (doctor or patient). 

Having said that, we do tend to use more Juvederm under the eyes and more Restlyane in the nasolabial folds (or even thicker products like Perlane).  Neither should be lumpy.   But either can look unnatural if too much filler is injected. As a general rule, always start with less (you can always add more later). And of course pick an experienced doctor.

I get respone rates close to 100% with Accutane.  By that I mean, that almost every patient is clear by the time they finish 6 months of Accutane.  And in most cases, the acne does not come back.  That does not mean you will never get another pimple for your entire life.  But most patients never go back to the severe acne that they had prior to treatment.

Who is at most at risk for their acne to recur after Accutane? 

Younger patients (16 years old and younger) are more likely to need a second course of Accutane. Perhaps because they have more teenage "acne years" ahead of them.

Females have higher recurrence rates than males (but still low).  Perhaps because of hormones.

Patients who do not get the correct total dose are more likely to relapse.  This includes both patients who have not achieved a high enough daily dose and those who ended treatment earlier than advised.

I have had surprisingly few insurance problems with patients on Accutane.  Most insurances seem to cover the treatment.  A few HMO's require a few forms to be filled out.  One HMO limits the course of treatment to 5 months for some reason. 

If you have to pay out of pocket, our local pharmacies charge about $240 for 30 pills of the 20mg or 40mg dose.  Target and Walmart pharmacy where always the cheapest, but even Walgreen's has recently lowered their price.

Laser hair removal is superior to electrolysis in most cases.  A laser can cover large areas that are just not practical to treat with electrolysis because electrolysis is a technique that literally treats one hair at a time.  On the other hand, laser hair removal requires dark brown or black hair to be effective.  Therefore electrolysis is the procedure of choice for white, blonde, or grey hair.

Laser hair removal is also not precise enough to do detail work like shaping eyebrows.  This is another case where I refer to my nearby electrologist.