LAM FACIAL PLASTICS

Good evening Dr. Lam. I have an appt. next month for more Botox. I am interested in also addressing a couple small, red spots. One is on the bridge of my nose (looks like a tiny hemangioma to me) and the other is on my neck. I guess I need to call back and make arrangements w/Luminaire?? I wish to accomplish both w/the same visit. Please advise.

Oh-also! How do you feel about my using Retin-A Micro and hydroquinone after plasma/FG--I'm presently three mos. post. Thank you!

hi,
1. as far as the red spots, i have the best laser on the market to take care of that problem. even though i have multiple lasers in Luminaire to manage redness, if you have a broken capillary, a spider/cherry angioma (which you are describing), or any red vascular area my KTP laser is tremendously well suited to manage the problem. The KTP is very focused on the color red. It literally eliminates the redness on the spot without bruising or discoloration. A comparable laser, the pulsed dye, works by instead of evaporating the vessel, it explodes it so you have a similarly great result but with a week of a bruised look. A recent article in [i]Dermatologic Surgery[/i] journal compared the KTP and the pulsed dye and found that the KTP was superior as far as clinical efficacy. Obviously, traditional cautery techniques are a poor substitute both in terms of risk of scarring and very early recollateralization of the vessels. That brings me to another important point. Despite excellent laser treatment of your problem, you WILL have these either come back or you will develop new areas. I always try to explain whenever I treat the skin for almost any condition, it is a PROCESS in other words you should expect recurrence. How soon? from weeks, months, to years. In general, most often about 6 months to 2 years as an interval but everyone varies to a certain degree.
2. yes, you may start your hydroquinone/retin-a now. it is safe. although retin-a is good for the long run, what is your reson for using hydroquinone? i assume prescription strength 4%? if it is to manage hormonal pigmentation, that is reasonable. in general, i don't like to use hydroquinone for the long run. i use it in 4 to 6 month intervals at the most to treat problem conditions then try to give a vacation from it and maintain color issues with glycolic acids as much as possible. Although hydroquinone should be perfectly safe, I am always wary about its long-term safety on the liver. I hope I am not scaring you. Also, make sure that you are using only on a small area like your face. It is unsafe over wider areas of the body. Extreme examples are Africans trying to bleach their entire body with 20% (which you thankfully cannot buy here) and literally dying from it. Two more words of caution: 1) remember to avoid the sun as much as possible and use a sunscreen of SPF 30 or more not only every day but especially if you are on hydroquinone and/or retin-a as they are photosensitizing and can engender a sun burn. 2) BEFORE YOUR LASER TREATMENT I WOULD BE OFF OF BOTH PRODUCTS FOR AT LEAST A WEEK IF NOT 10 DAYS PLUS. Like a sunburn, laser treatments are not recommended for people on retin a and/or hydroquinone.

see you next month,
sml

Thank you for the comprehensive and most helpful answer.

I visited a derm. for general screening (MM history) and she suggested the hydroquinone (it IS 4%-brand name Lustra) for one very small brown spot (yes-hormonal) above my eyebrow.

Maybe you did scare me a little with info re: hydroquinone--only because I know you professionally and am inclined to believe you over other sources. (I had read pos. negatives but dismissed them as over- prudent.) If [i]you[/i] say be conservative, I'll pay attention.

Thanks again and btw, my skin hasn't looked this good since..I don't know when.

I actually have no hard-core science to back up what I am saying but then again neither do the people that say long-term, uninterrupted treatments with hydroquinone are safe. In general, I think it should be fine. I just try to minimize the time when you don't need it. Say it takes you 6 weeks to 3 months to get rid of the brown spots. And you can maintain the brown spot off with glycolic acids for 3 months. Then I would do 3 months on and 3 months off as a regimen if that makes sense. Just titrate its use to a minimum, but I think it is still a very important treatment for skin discolorations. I also want to emphasize that I do think it is safe. I just try to minimize my patient's unnecessary exposure to prolonged use of any chemical.
best,
sml

Good Evening, Dr. Lam,

Just returned from my road-trip to visit your office. (appr. 5 hr. round trip and you're worth every mile)

It appears that the laser you used for that dreaded spot was successful. Thank you! I understand it may return.

Also, glad to have fresh Botox. To anyone else reading this--he's not aggrandizing when he claims you'll experience NO PAIN..... Dr. Lam has amazing technique.

Great to see everyone at LFP and wow! You're busy!! Please remember all your old faithfuls (and keep room for us) when you get super-famous, as I believe you're destined.

Lisa

Hi Lisa,
It is my honor and pleasure as always to take care of you. Thanks for making the drive.
Best,
SML