Treatment for chest and neck redness, wrinkles and overall mottled appearance? (photos)

Hi H.  We use several options for our Orange County patients that want chest rejuvenation.  We do offer fractional resurfacing, but that's not where we usually start.  First we use q-switched lasers and pulsed dye lasers to get rid of brown spots and improve the redness.For the skin laxity (crepey skin) between the breasts, we would use Sculptra and/or fractional laser resurfacing.  

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture. Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.

Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best,
Dr. Karamanoukian
Realself100 Surgeon

The chest and neck are two of the trickier areas to treat as abnormal healing is much more common due to the fact that the skin is thinner and more delicate.  Redness is often best treated by a high grade IPl system although some lasers such as excel-v can be used for persistent reds.  Improving texture of the decollete area often involves several modalities to provide the maximal benefit:
Ablative laser resurfacing- Fractionated C02 resurfacing or erbium at a lighter setting can help build up collagen
Fractora- RF needling can help improve the texture and collagen creation in the skin here
IPL- can help improve the brown spots and discoloration of the area
Melanage or Cosmelan- Peels can help improve the appearance of the discoloration
Sculptra- Dilute Sculptra can help improve the texture of the skin and crepy appearance of the skin.

Fraxel is a laser skin rejuvenation treatment that resurfaces your outer skin, erasing imperfections. It also encourages the production of collagen, a protein found in connective tissue.The result is clearly visible lines, folds and wrinkles. Fraxel laser skin rejuvenation is a non-invasive technique that affects only about 20 percent of the facial skin exposed to it. The most common side effects of Fraxel laser treatment are swelling and skin redness, which should subside within a couple of days. Other temporary side effects may include minor itching, dry skin, peeling or flaking, and a bronzed skin appearance. The risk of infection or scarring is very limited.

There are many options for this.  However, given both red/brown/wrinkles I would suggest a combination approach such as IPL for color, Clear+Brilliant and Micropen for wrinkling.  I get amazing results in my practice with this, and have very little downtime.  More agressive approaches include co2 laser resurfacing as well as pulsed dye laser in combination with others.  Best, Dr. Emer.

As
mentioned there are several great treatment options. I would echo my peers and recommend a
combination of laser treatments, I think IPL is a great choice, and
Ulthera. The take home message is that
the best results will be had by combining a few different treatment modalities.
See an experienced and well trained cosmetic dermatologist or plastic surgeon
for a tailored treatment plan.

There are 3 methods I would recommend for this chest. My first choice would be Fraxel Thulium. Fraxel Dual has 2 wavelengths; one is called the Restore and one is called the Thulium. The Restore is for deeper lines and wrinkles and scars; the Thulium is for brown spots and superficial wrinkles. The chest has very thin skin and is fragile when it comes to healing. Fraxel Thulium matches the thin skin and the brown spots well. Even recommending this, the treatments themselves should be less aggressive than those on the face because the chest doesn’t heal as well or as quickly as the face. Fraxel Restore will not take away the brown spots and may or may not get rid of the deep wrinkles. Ideally for this chest I would perform 2 treatments of Fraxel Thulium and combine with Ulthera (ultrasound based tightening) for decolette. This will give the optimal result for the surface texture and tone and the deep wrinkling.Another choice if you cannot tolerate the approximately 5 days of peeling from the Thulium would be to perform photo rejuvenation treatments. These involve IPL or ELOS treatments usually once per month for 5 months. A way to get a faster and better result would be to add Levulan to each treatment (Photodynamic Therapy or Photodynamic Photorejuvenation). This makes the skin smoother and tighter but also has peeling associated with it. It is hard to say if this were performed whether there would be enough wrinkle reduction in the center chest to not need an additional treatment. However, this last choice is the most ideal for you as it is a proven treatment for actinic keratoses and has shown it may prevent skin cancer from occurring.

If concerned about precancerous lesions, Fraxel is a great treatment for that and is FDA approved for it.  For the darker pigmented lesions, I hit first on the same day with my Spectra Laser.  The wrinkles could be improved with Sculptra placed in the skin.  I use cannulas for this.  If red is a problem, the Excel V laser is helpful.  A package deal might be obtained if you commit to everything I would guess.  Infini can also help with wrinkles in the chest.

I am using the new InMode Lumecca for IPL treatments which I have found to be far superior to any other IPL on the market (and I've pretty much had them all over the years). This, combined with cryotherapy to several spots on your chest, would do wonders. I'd start with IPL to get the color correction done, and then see if additional resurfacing would be helpful. P.S. Daily sunscreen is a MUST! "This
answer has been solicited without seeing this patient and cannot be
held as true medical advice, but only opinion. Seek in-person treatment
with a trained medical professional for appropriate care."