Skin Rejuvenation FAQs

What is my best treatment option to rejuvenate my skin if I can take a week off from work?

The world of skin rejuvenation has changed rapidly over the past few years. Currently, the state-of-the-art treatment for skin rejuvenation in individuals who can handle a week of downtime is Rhytec Portrait plasma skin resurfacing. Plasma skin resurfacing permits significant improvement in wrinkles, texture, tone, and color of the skin without the risk and recovery time of the older carbon-dioxide (CO2) laser. Plasma works by exciting nitrogen gas using high-energy frequency to affect the desired level of skin changes. Because the procedure can be uncomfortable awake, Dr. Lam performs plasma resurfacing under conscious sedation in which you are made very sleepy with an intravenous (IV) line. As Dr. Lam has an on-site surgery center, he is one of the few physicians that can offer you this level of comfort for your procedure. Plasma provides a deep level of skin rejuvenation with only a short downtime of about a week (see the next question). Although you should look significantly better after the first 1 to 2 weeks, most of the deeper wrinkles require 6 to 12 months for ongoing changes to occur until significant skin rejuvenation appears complete. As plasma resurfacing is a more potent skin rejuvenation technique, you should only require one treatment session, the result of which can be maintained with ongoing smaller skin or spa treatments.

What is my recovery like with plasma resurfacing?

Like a TCA physician-strength chemical peel, your old skin stays intact for 1 to 3 days and then gradually sloughs away at the same time that your new skin forms from below. You do not have the weepy, raw, and crusty problems that were routine with the older carbon-dioxide laser. However, you will not appear socially acceptable that week and should really plan on a week off from work. During that week, Dr. Lam will see you several times in order to make sure that you are comfortable with the details of your cleaning regimen and to walk you through the healing process. Although you will not have discomfort, you will appear red and socially unacceptable for 5 to 7 days. Despite some lingering pinkness that may remain for 2 to 3 weeks more, makeup camouflage can cover almost all of this pinkness and you should be able to return to work after a week off. The light pinkness that may remain is nothing like the prolonged and profound deep redness after CO2 laser resurfacing in the past.

Describe what I need to do to clean my skin for that week off?

Basically, you will clean you skin twice a day after the first day using a vinegar and water solution and then apply Vaseline ointment over the entire face until you new skin forms in 5 to 7 days. Excessive sun avoidance for 6 weeks following the procedure is important to minimize temporary hyperpigmentation (or skin darkening).

What do I need to do to prepare my skin for Rhytec Portrait plasma skin resurfacing?

First, you cannot have taken Accutane (Isotretinoin), a medication used for severe acne, within the past year. At times, Dr. Lam may even defer your treatment for a year and half following cessation of using Accutane. Accutane prevents the skin from healing well and may result in scarring.If you have a history of skin cancer or have areas of your face that you may think are cancerous (change in shape, size, or color of the area or recent unexpected bleeding see Cancer Reconstruction FAQ section for more details), Dr. Lam oftentimes recommends you to consult a board-certified dermatologist before he will elect to treat your skin with plasma resurfacing. For the month that precedes the treatment, you must stop all tanning and excessive sun exposure. In addition, if you are on Retin-A (tretinoin), you must stop using this product a month before the scheduled procedure. For a week prior to the procedure, you must stop all facial scrubs including chemical exfoliators like alpha hydroxy acids and glycolic washes.On the day of the procedure, you should wear a loose fitting shirt that opens in the front and gently wash your face with antibacterial soap without scrubbing your face or using any alcohol or acetone scrubs/washes. You should also plan to have inexpensive sheets for the week after the procedure, as you will most likely soil your bed linens. You should not however line your pillows with towels, which are too coarse for your face and may scrub off the skin inadvertently. Dr. Lam will review all of these instructions with you prior to your treatment. This commentary is only to provide a general overview of your periooperative care instructions.

Does Dr. Lam perform CO2 (carbon dioxide) skin rejuvenation?

Although Dr. Lam trained extensively with CO2 laser therapy, he has never incorporated this type of treatment into his clinical practice for several reasons. The first few days following CO2 laser is uncomfortable with open and weeping skin that stays red for several months. The skin oftentimes takes two weeks to fully heal with the aforementioned redness that lasts several months. Over a period of several years, you can continue to lose skin color, making it very easy to have a sunburn if you go outdoors. In addition, there can arise a white line of dermarcation along the jawline where the CO2 treatment was stopped. Simply put, plasma resurfacing does not have these kind of problems and recovery involved.

Does Dr. Lam perform chemical peels?

Although Dr. Lam has performed numerous chemical peels in the past, Dr. Lam does not believe that a physician-strength chemical peel provides the level of skin rejuvenation that most patients seek today given the improved treatment methods available. With the same week of downtime, plasma resurfacing provides much more substantial results with improvement targeted at the skin texture, tone, wrinkles, and skin color. TCA chemical peels, on the other hand, only yield limited benefit in all these areas, especially providing improvement really only in selected thin-skinned individuals. When Dr. Lam performed chemical peels, he only undertook his peels in the very thinnest-skinned patients in order to attain a satisfactory level of improvement. With plasma resurfacing, he can treat all skin types up to the darkest of a Hispanic, light Middle Eastern, and Asian patient. Fortunately, most darker skin patients who are even darker than the ethnicities mentioned have already a built-in sun protection that reduces or eliminates their need for deeper types of skin rejuvenation.

I can only take limited to no time off from work. What can I do?

Fortunately, not everyone can or needs to take a week off from work for skin rejuvenation. Dr. Lam’s new skin care and laser center in the Spa at Willow Bend (across the hall from his office) offers numerous alternatives that provide incredible options for rejuvenation that can be titrated to your needs, expectations, budget, and expected recovery time. The flagship of skin rejuvenation for individuals who do not desire a week off from work is the PIXEL erbium laser rejuvenation that works on a micro-fractionated technology. In the old days, we had two major types of skin rejuvenation: the kind that removed the old skin (ablative) and the kind that did not (non-ablative). Today, we have a hybrid treatment in which a computer delivers micro laser punctures to the skin that is barely perceptible to the naked eye. With this technology, you can titrate your recovery time between 1 to 5 days depending on what you desire. With only 1 to 2 days off from work (or a weekend off), you will oftentimes require 5 to 7 treatments spread out at 3 to 4 week intervals. With 3 to 5 days of having some visible striping on the skin, you will typically only require 2 to 3 treatments spread out at 3 to 4 week intervals. Unlike plasma resurfacing, your skin stays intact meaning that you can resume makeup camouflage the day following the procedure. However, if you have significant sun damage already, the skin striping that appears may be visible up to 5 days following treatment, especially after your first treatment. For more information about PIXEL technology, please visit

What about the Fraxel laser?

When Dr. Lam was investigating which microfractionated technology would best suit his patients, he considered both the PIXEL and the Fraxel devices. After careful research and investigation, he felt that the PIXEL delivered a more precise computer-controlled result without the need for blue-dye indicators and discomfort levels associated with the older Fraxel technology. However, both the PIXEL and the Fraxel do provide wonderful skin rejuvenation.

What do you think about fotofacials? Do they work?

Fotofacials are an important part of what Dr. Lam has to offer for skin rejuvenation. However, the real problem with fotofacial technology is twofold. First, fotofacials do not truly manage wrinkles, texture, or tone of the skin. They have really been oversold to the prospective patient, making many dissatisfied with the outcome. Instead, fotofacials are specifically designed to target skin color problems, e.g., brown and red – and Dr. Lam has a specific fotofacial device for each skin color problem. At times, he combines two fotofacial devices to accomplish the intended task better. The second problem with fotofacial machines has been with overall safety. The older machines (even a few years ago) delivered energies that were uncontrolled and could inflict a burn injury. Dr. Lam uses only the latest technology (and replaces that technology) in order to provide the safest results possible. The new Advanced Fluorescence Technology? (AFT) of the Harmony system truly limits the peak fluences (energy levels) to deliver maximal result without the risk profile of older machines. A consultation at the Spa at Willow Bend will help guide you in the best treatment protocol for you. As Dr. Lam simply has so many different laser, plasma, and light devices, he can tailor your needs by combining machines to suit your skin type and aesthetic needs.

I have tiny broken blood vessels on my face. What can I do?

Although fotofacials can certainly do wonders for tiny broken blood vessels, there is nothing better than the KTP laser that Dr. Lam uses. This laser is specifically designed to knock out unwanted blood vessels and capillaries on the face and neck WITHOUT the bruising that may arise after similar pulsed-dye therapy. The KTP laser is a workhorse in delivering wonderful elimination of blood vessels and rosacea on the face. However, you should always recall that you would most likely need further treatments since the skin that constantly renews itself will inevitably produce these blood vessels again over time, from several months to several years depending on your good fortune.

I have had microdermabrasion at a spa and don’t see much difference.

Microdermabrasion is wonderful for lighter levels of skin rejuvenation. It should not be thought of as a replacement for laser, light, and plasma treatments. Dr. Lam uses microdermabrasion at times in preparation for laser treatments. In addition, he works hand in hand with spas to use microdermabrasion really as a way to maintain a result that Dr. Lam may deliver for you. In addition, if you are looking for lighter levels of rejuvenation, then microdermabrasion and facials may be your answer until you are ready or need a deeper treatment. In any case, spa facials are a great way to maintain Dr. Lam’s results, and he believes that these treatments may keep you from needing another treatment from Dr. Lam in the future.

Do I need daily skin care if I do a laser treatment?

Absolutely. Dr. Lam offers wonderful products for skin rejuvenation, and a daily regimen of skin care is very important as part of your daily skin health. If you have enjoyed the rejuvenation that your aesthetician has offered you through his or her products, you may elect not to use the skin-care products offered at the Spa at Willow Bend. However, after a consultation at the Spa at Willow Bend, our expert team of staff can help you in your endeavors for healthy skin should you so desire. Beyond good skin care therapy, sun avoidance, sun blocks, hydration with plenty of water, sleep, diet, exercise, etc. are important parts of an overall regimen toward healthy and glowing skin.

I have acne scarring. How can Dr. Lam help me?

In the past, Dr. Lam used mechanical dermabrasion to manage acne scarring. However, he believes today that dermabrasion (not to be confused with microdermabrasion) does not offer sufficient improvement to be warranted in most cases. The major pathology in acne scarring is a depressed scar. Traditional dermabrasion tries to level the field by lowering normal skin down to the level of the abnormal skin. Instead, Dr. Lam believes it is important to elevate the depressed scar to the level of the normal surrounding skin. The way in which Dr. Lam accomplishes this task depends on the problem at hand. For small pits and depressions, he uses what he calls the CROSS technique which elevates the microscars up toward normal skin tissue levels using a series of very concentrated micro-acid treatments. He has used this technique safely in skin types, including Hispanic, Middle Eastern, and East Asians without loss of skin color or scarring, having performed hundreds of procedures to date. In wider areas of depression, Dr. Lam uses microdroplets of silicone to elevate these depressed scars and to bring the atrophied (depressed) tissues up toward the level of normal skin. Finally, if wider scars are tethered down to the lower skin, he undercuts this attachment using an advanced technique known as the Surgiwire to release this attachment before using silicone or acid treatments. In rare cases, he still uses mechanical wire-brush dermabrasion as needed.

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