How can you know which procedure is best for you? (Photo)

Hyperpigmentation and wrinkles caused by sun exposure over the years and weight loss. Each doctor has a different opinion of what I need. One suggested microneedling with HA. Another said IPL would work better.

Doctor Answers 10

Best procedure for skin rejuvenation

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Hi there,

Thank you for sharing your questions and photos.

As you can already tell, there are many treatment options that can help you improve your skin. Deciding which option to choose depends on your expectations for recovery and results. 

Deep laser resurfacing would improve the quality of the skin, smooth wrinkles, and help some with the hyperpigmentation. Laser removes the top layers of the skin to alow deeper layers to regenerate in a more organized fashion. You get a new healthier top layer of skin. It does require 1-2 weeks of recovery were the deeper layers of the skin are exposed and the skin is unprotected. It does have a higher risk of scarring, pigmentation problems, dryness, and prolonged redness. All of these things can be treated and, to a certain extent, preemptively treated. I do think this would give you a more dramatic result, but the recovery is more involved. Deep resurfacing usually involves 50-200 microns of depth. 

IPL or BBL help dramatically with pigment and work best with lighter skin type (like yours). The do not help dramatically with wrinkles, which I think is one of your main goals. The recovery is easier. The barrier of the skin is not broken. You have a period of swelling and when the dark spots turn darker, but this usually lasts 1 week and make up can be used to cover to a certain extent. 

Microneedling can give nice results to improve skin texture and quality. The results for micro needling are moderate and the recovery much shorter. Micro redline makes small holes in the skin through which nutrients and energy can be used. The recovery is usually a few days for the skin to close and a week for the swelling to resolve. The depth of penetration is usually around 5 microns. If you compare 5 microns versus the depth of the deep resurfacing (50-150 or more) you can see how different the depths of treatment of the two options are.

I do think deep laser wound give you the more dramatic result. But if the recovery is too involved for you, you could consider starting skin care with lighter lasers and/or peels or microneedling. 

Hope this helps!

Portland Facial Plastic Surgeon
5.0 out of 5 stars 12 reviews


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Thank you for your question. You may need a combination of treatments. IPL will help with the brown spots. The micro-needling will improve the texture. You should decide what bothers you the most and start with that. Good luck!

Janet Allenby, DO
Delray Beach Dermatologic Surgeon
5.0 out of 5 stars 13 reviews

Multiple options can offer you improvement

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You have skin that has various signs of ageing - fine wrinkling and more course, deeper wrinkles.  You have some volume loss around the cheeks, lips, orbit and temples.  You also have variable pigmentation although this does not show up well on the image posted.

There are many options that can improve these problems and it really depends on how much down time you are willing to take, and how much cost you are willing to incur.  Things like TCA chemical peels may be easily added to a monthly or 6-weekly routine and will help with pigmentation and tighten fine lines.  For greater impact, though more cost and down-time, consider ablative lasers such as CO2, erb-Yag and FRAXEL laser.

Other options that may be of benefit include Hyaluronic acid filler around the nasolabial folds, malar area, lips and temples.  Botulinum toxin can help if carefully utilised around the lips and chin. 

I often prescribe topical therapies such a Retinoic acid/Retin A for the issues you are suggesting, but you would need to see a physician for a prescription for this.  It is an excellent addition to your daily routine.

Richard Zinn, FRACS
Melbourne Plastic Surgeon

How can you know which procedure is best for you?

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The reason behind multiple recommendations is that each treatment works in a different way to address a different issue, and ALL of them would be great for you.

Manjula Jegasothy, MD
Miami Dermatologist

Lasers to Address Wrinkles

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A combination of lasers and photofacial treatments can address your needs. It all depends on what your expectations are and how much recovery time you have. If you really want to soften your wrinkles, an ablative laser needs to be used. However, this treatment requires a downtime of about a week before you can cover up with makeup. If this is not an option for you, then there are other lasers with shorter recovery times but you will need to do it more than once.

Robert G. Aycock, MD, FACS
Bay Area Plastic Surgeon
4.7 out of 5 stars 16 reviews

Skin dermasurfacing for hyperpigmentation and wrinkles

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Although microneedling with HA and IPL are good recommendations, you may need multiple modalities to address multiple skin issues, i.e. hyperpigmentation and wrinkles.

One good option to optimize multiple skin issues is the Erbium YAG Dermasurfacing.  This laser procedure works effectively by removing the outer layer of skin in order to make it smooth, while also creating a thermal response in the dermis to induce collagen enhancement.  The treatment can be used to improve wrinkles and remove superficial pigments.

In addition you may want to consider collagen facial fillers to address deeper wrinkles.

Also Platelet Rich Plasma (PRP) treatments have scientifically shown to be very effective in long-term for facial collagen enhancement since PRP also contain growth factors.

David P. Melamed, MD
Los Angeles Dermatologist

Texture, tone, volume... it is the balance that gives the best results.

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Each doctor will have their own method of treating your concerns, depending on your goals and expectations. Your Specialists  training and their  access to lasers, energy devices, surgical and filling skills will also play a part in the final outcome.
The best outcome is a natural and realistic one. Balance skin texture (pigmentation, wrinkles), tone ( how tight your skin is, how much lift your skin can get) and volume ( Mid cheeks, around the eyes, temples, mouth area) and you will get a good outcome. There is no one treatment.

A good non-surgical step is laser resurfacing, I know IPL will not treat your wrinkles. I personally would use a fully ablative laser like CO2 or erbium. The flip side is that downtime will be 8-10 days. 

4-8  weeks later I would consider fillers to strategic areas to address volume loss. This displacement in volume can also improve skin tone, and decrease your wrinkles. 

If micro needling was to be done, I would use one with an energy delivery system like Infini, or combine micro needling and PRP for growth factors. 

Just my opinion. 

Best regards

Dr Davin Lim
Laser and aesthetic dermatologist
Brisbane, Australia. 

Best option for photo damage.

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The reason you got different opinions is that there is NOT a single solution to this issue.  Another words, most patients are looking for a  magic bullet and there is not one.  There are multiple options because sometimes it takes different treatments to achieve a goal.  Each patient response is different and sensitivities are different so that increases the options available.  Your best bet is to find a doctor that you trust and is board certified for a treatment plan, which may include fillers, IPL or even some sort of an ablative treatment option like laser or chemical peel or even micro needling.
Good luck
Dr Vasisht
South Shore Plastic Surgery

Bhupesh Vasisht, MD
Voorhees Plastic Surgeon
5.0 out of 5 stars 94 reviews

How can you know which procedure is best for you? = it depends on your goals and recovery time #fb #skincare #drmesa

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Patients with hyper pigmentation and wrinkles in the face caused by sun exposure over the years would be managed with multiple treatment modalities. To decide what treatment option is best for you it depends of multiple factors like length of downtime, extend of results, cost, etc,.

Treatments like chemical peels or ablative laser resurfacing could have an "Fast" great result but requires a downtime of at least 1 week (7 days), while treatments based on creams like Obagi Nu-Derm could achieve similar results with minimal downtime, but requires a 3 month long treatment. Also the cost of certain procedures could be significantly different compared with other ones.

Therefore the "best" treatment option depends on the patient ultimate goals ( e.g. for a house wife a chemical peel could be the best treatment because she can have fast results while recovering for a week at home, while Obagi Nu-Derm is the best option for a company CEO or TV personality since they can't afford any down time).

Patients interested in hyper pigmentation and wrinkles management should make a consultation with a Board Certified Plastic Surgeon specialized in skin care.

John Mesa MD
Board Certified Plastic Surgeon
New York City (#NYC) & New Jersey (#NJ)

John Mesa, MD
New York Plastic Surgeon
4.9 out of 5 stars 141 reviews

Which Treatment is Best For Age Spots?

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I think you have to trust the people you are seeing, especially if they are board certified experts.  There are many treatment options for your skin and often a combination is needed.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.