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Sciton® laser: Skin tightening with BBL SkinTyte™

Continuing on with my series of articles about Dr. Macdonald’s Sciton® laser services, available now.

As discussed he will be treating patients soon for:

Sciton® BBL SkinTyte™ laser treatment is an innovative approach to tightening aging skin that is starting to wrinkle and sag.  Of particular concern to many patients is the “turkey gobble” that often develops in the neck region, but common areas successfully treated include:

•    neck
•    lower face/jowls
•    chest
•    hands
•    tummy
•    arms
•    just above the knees

How does SkinTyte™ work?  

BBL (Broadband light) treatment utilizes pulsed light technology to deeply heat your skin while simultaneously cooling and protecting the entire treated surface, setting you on your path to more youthful skin.

Delivered in a sequence of rapid, gentle pulses that heat the dermal layer of your skin’s collagen, use of this technology promotes contraction and denaturation—modification of protein’s natural configuration.  Rebuilding themselves, the skin cells form a new foundation of collagen, leading to increased skin firmness.

How many treatments are needed?  

Although the number of treatments needed will vary based on the level of improvement desired and the starting point of your skin condition, many patients opt for 2-5 treatments to achieve maximum positive benefit.

With no anesthetic needed, this quick and effect “lunch-time” procedure will only last 30 minutes and cause you no disruption to your day.  Not only is there no downtime, there is also no skin care regimen necessary.  The collagen in your skin will, however, continue to rebuild and strengthen up to 4 months after the procedure.

Stay tuned for more details on vein treatments.

© 2012 R.E.L. Copywriting and Michael R. Macdonald. All rights reserved.

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Sciton® laser: Skin pigment reduction with Contour TRL™ or BBL™

Continuing on with my series of articles about Dr. Macdonald’s Sciton® laser services, coming soon…

As discussed he will be treating patients soon for:

Skin Pigment. Unwanted skin pigment is normally referred to as hyperpigmentation. It is unwanted melanin in the skin that creates a spotty look with brown spots and is a result of too much sun exposure and also aging.

I am a candidate for one of these laser procedures, to reduce the pigment on my chest, hands (and maybe fronts of legs too). After my 5-series PCA chemical peel (physician-strength) with Dr. Macdonald, we were not able to make much progress on my chest area. I experienced a lot of itching and irritable rash on chest but no peeling on peels #4 and #5 when Dr. Macdonald used the PCA with resorcinol.

On my face, I was left with a vibrant glow after the PCA peel treatment by peel #5 though. I had wonderful, soothing results with his new private label skin care products, specifically the Power of Three by Replenix and Fortified by Glycolix.

Note: on my face, now that the brown spots have diminished, I have some rosacea that Dr. Macdonald would also like to treat with the Sciton® laser (vein treatment to be discussed later in this series of articles).

A) Contour TRL™ Laser Peel skin pigment reduction treatment. This procedure is not only a treatment for overall skin resurfacing, but specifically reduces hyperpigmentation.

Sciton® Laser Peel – Contour TRL™ safely erases skin hyperpigmentation that appears on the skin from sun damage and age. Although there are several different types of lasers on the market used to perform peels, the Contour TRL™ is widely regarded as the most effective laser available. This treatment targets the effects of sun damage and environmental pollutants which create skin tone irregularities, solar spots, and scars.

How does Contour TRL™ work? This laser safely removes a layer of skin, with computer-guided micron precision. The depth of treatment depends on your skin condition, desired outcome and expectation for down time. Treating your hyperpigmented skin with this laser will stimulate the growth of new collagen to improve the skin as healthy new skin cells regrow.

Common body parts treated:
 face, neck

B) BBL™ Broadband Light skin pigment reduction treatment.

Sciton® BBL™ is an innovative light-based technology that sets new standards for skin conditions associated with aging, active lifestyles, and sun damage. It also treats any unwanted melanin and pigment you were born with (i.e., freckles).

How does BBL™ work? This phototherapy treatment utilizes pulses of light energy to gently penetrate into the skin. The light energy will gently heat the upper layers of your skin, stimulating the skin cells to regenerate new collagen. The natural beauty of your youthful skin will be evident as this process blends the natural skin colors restoring your youthful skin’s glow before the pigment irregularities appeared.

Common body parts treated (body parts exposed to the sun): face, hands, neck, chest, shoulders

Stay tuned for more details on skin tightening treatments.

© 2012 R.E.L. Copywriting and Michael R. Macdonald. All rights reserved.

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Sciton® laser: Skin resurfacing with Contour TRL™, ProFractional™, MicroLaserPeel® or BBL™

Continuing on with my series of articles about Dr. Macdonald’s Sciton® laser services, coming soon…

As discussed he will be treating patients soon for:

  • Hair removal
  • Skin resurfacing
  • Skin pigment
  • Skin tightening
  • Vein treatment

Skin Resurfacing.  In the laser treatment world, what constitutes skin resurfacing? Revamping skin that is damaged from the sun, clearing up acne scars, enhancing skin tone, minimizing or erasing hyperpigmentation in the skin, and reversing the sign of aging.  Laser resurfacing of the entire face also may delay the need for a comprehensive facelift.

A) Contour TRL™ Laser Peel.

Sciton® Laser Peel – Contour TRL™ is a safe and effective deep skin resurfacing laser treatment to promote a younger and rejuvenated appearance.  Although there are several different types of lasers on the market used to perform peels, the Contour TRL™ is widely regarded as the most effective laser available.  This treatment targets the effects of sun damage and environmental pollutants which create skin tone irregularities and create wrinkles, particularly deep wrinkles around the mouth and eyes.

How does Contour TRL™ work?  This laser safely removes a layer of skin, with computer-guided micron precision.  Treating your skin with this laser will stimulate the growth of new collagen to improve the skin’s thickness and resilience as it grows new, health skin cells.

Common body parts treated:  face, neck

B) ProFractional™ and ProFractional-XC™.

Sciton® ProFractional™ and ProFractional-XC™ laser skin resurfacing procedures offer dramatic results with minimal down time.  Enhancing the overall appearance of your skin, this laser therapy targets wrinkles, acne, skin tone and skin pigments.

How do ProFractional™ and ProFractional-XC™ work?  This treatment utilizes a tiny laser to treat thousands of pinpoint areas of your skin, while rapidly healing along side with your body’s existing stem cells, simultaneously.  The healing areas create new collagen and elastin to add firmness and resilience to the new skin.  Two spot size settings with selectable densities are available to enhance collagen remodeling where desired.

Common body parts treated: face, neck, chest, hands

C) MicroLaserPeel® Superficial Skin Resurfacing.

Sciton® MicroLaserPeel®, sometimes known as the “weekend peel”, offers great results with minimal down time.  It’s an outer to mid-epidermal peel that precisely removes a thin layer of skin to a selectable depth. In other words, it does not go too deep into skin, yet is effective for glowing skin and treats mild wrinkles, scars, sun damage, and pigment irregularities.

How does MicroLaserPeel® work?  The laser beam eliminates some of the damaged skin cells that create a noticeably tired, aged look. As the skin heals, fresh cells grow and resurface the treated area, resulting in reduced wrinkles and improved skin color evenness–a healthier, more vibrant look.

Common body parts treated: face, neck, chest, hands

D) BBL™ Broadband Light skin resurfacing treatment.  

Sciton® BBL™ is an innovative light-based technology that sets new standards for skin conditions associated with aging, active lifestyles, and sun damage.

How does BBL™ work?  Delivering photothermal energy, it utilizes pulses of light energy to gently penetrate into the skin.  The light energy will gently heat the upper layers of your skin, stimulating the skin cells to regenerate new collagen. The natural beauty of your youthful skin will be evident as this process blends the natural skin colors while making it smoother, vibrant while restoring a youthful appearance.

Common body parts treated:   face, hands, neck, chest, shoulders

Stay tuned for more details on skin pigment treatments.

© 2012 R.E.L. Copywriting and Michael R. Macdonald. All rights reserved.

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Sciton® laser: Hair removal with BBL™ Broadband Light

Continuing on with my series of articles about Dr. Macdonald’s Sciton® laser services, coming soon…

As discussed he will be treating patients soon for:

  • Hair removal
  • Skin resurfacing
  • Skin pigment
  • Skin tightening
  • Vein treatment

BBL™ Broadband Light hair removal process.  

Sciton® BBL™ is an innovative light-based technology that utilizes pulses of light energy to gently penetrate into the skin, destroying unwanted hair follicles. Say goodbye to shaving, depilatory creams, or even electrolosis–which can be time-consuming and painful.

How does BBL™ work?  Delivering photothermal energy to hair follicles, your treatment can be tailored to your skin type with various selectable wavelengths.  While your hair is in its growth stage (anagen), it is most vulnerable to light therapy. BBL™ selectively heats the full length of the imbedded hair follicle cutting off its supply of nutrients, thus disabling its growth.  (Note: BBL™ treatments are not appropriate for suntanned skin.)

How many treatments are needed?  Because all hair is not always in the growth stage at one time, multiple treatments must be given over time to treat it while it is in the growth stage.  Aimed at permanent hair reduction, and varying per person as well as body part, you will most likely be advised to get a series of treatments, spaced out by 4-8 weeks.

What is the procedure and healing time like?  Although minimally invasive to destroy many hair follicles at once with photothermal light, you will wear safety shields to protect your eyes, and some patients desire anesthetic cream for sensitive skin areas during the procedure–where you may feel a warm “rubber band snap” sensation as the light is absorbed by the targeted areas. With only slight redness and sun-sensitivity after the treatment, there is virtually no down time.

Common body parts treated: face, neck, underarms, bikini line, legs, arms.

Next article:  more details on skin resurfacing.

© 2011 R.E.L. Copywriting and Michael R. Macdonald. All rights reserved.

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Q/A with Dr. Macdonald on rhinoplasty, septoplasty December 2011

Please join me and view this new Questions and Answers page on this blog…  All questions are posed by patients and answered here by Dr. Macdonald.   Check back any time for more additions

Here are some of his responses from December 2011…

Question: How Many Types of Septoplasty Incision Techniques Are Offered?

Are there any benefits of one type of septoplasty procedure versus another type?

Answer by Dr. Macdonald:

The most common septoplasty incisions are known as the “hemi-transfixion” or “complete transfixion” incisions.

The use of a complete transfixion incision, which goes from one side of the septum all the way through to the other side, will most often result in a reduction of the height of the nasal tip by 1-2 millimeters.  If this is desirable, because the projection of the nose away from the face is slightly greater than ideal for your face, then this would likely be the best approach.

Alternatively, a hemi-transfixion incision technique employs an incision on 1 side of the septum only so that there is little change in the nasal tip post-operatively.  The incision may also be made in the immediate area of the deformity in the nasal septum; however, I use this approach less commonly since I have less control of its effect on the other side of the septum, in this case.  I generally prefer to use a hemi-transfixion incision, unless there is a desire to drop the height of the nasal tip.

Question: Do I Need a Septoplasty?

I’ve been to my ENT twice, he’s advised me to get a septoplasty but I am skeptical. I’ve gotten a cat scan, xrays of my sinuses and could see where my septum was deviated. I’m constantly getting weak sinus infections, and those spread to my ears as I can feel congestion there and get dizzy at times. He checked my ears and said they look healthy. I’ve also had trouble sleeping,and have had problems with nasal drip. Dealt with it for months, most days the symptoms aren’t severe but never feel 100%

Answer by Dr. Macdonald:

When teaching surgical residents about how to manage patients with symptoms like yours, I often tell them that we should “treat the patient” rather than treating the x-ray.  What’s more important to me than your x-ray findings is the symptoms that you’re describing and what I would find on physical examination.

I would be looking to determine whether or not your nasal septum is crooked enough to obstruct your nasal airway, and to see if it’s crooked in an important location as it relates to your breathing function (the most important locations related to adequate nasal airway are the “interior” nasal valve area and “posterior” nasal valve area).

In addition to straightening the nasal septum – the structure that is in the midline of the nose, dividing the left nasal airway from the right nasal airway – you may also consider addressing the “nasal turbinates”.  The nasal turbinates are located on the outside walls of the airway.  These can become swollen enough to obstruct the airway due to nasal allergies or simply as a result of your natural anatomy.  They can either be reduced in size – my most common recommendation – or even removed.  Often, reduction of the nasal turbinates can be performed at the same time as a nasal septoplasty, if appropriate.  There is often little downside in adding this to the septoplasty procedure.

Question: How Are Bulbous Tip and Upturned Nose Corrected?

I am wanting to have a Rhinoplasty to reduce my bulbous tip and to de-rotate my naturally upturned nose. How exactly does the surgeon fix my nose?

Answer by Dr. Macdonald:

Because these two problems are quite distinct, I will try to answer them for you separately.  Although I am often happy to perform rhinoplasty surgery through a “closed” or endonasal technique, the two problems that you are concerned about generally are easier to address using an “opened” technique so that the cartilage can be directly and clearly visualized.

A bulbous tip is the more easily corrected of the two problems.  This is done by removing some cartilage and either suturing together or weakening the remaining cartilage.  The most critical element to correcting a bulbous tip, however, is to not overcorrect the tip.  In other words, it is important to not create a single narrow tip; instead, two distinct “tip defining points” should be left intact so that the nose looks as natural as possible.  In addition to narrowing the cartilage, there is often excessive soft tissue between the skin and the cartilage.  If this can be sculpted and or removed, the tip will appear even less bulbous.

There are two ways to approach correction of a nose that is naturally upturned:  the first, to increase the apparent length of the dorsum of the nose, thereby making the tip less unturned; the second, to shorten the base of the nose by shortening the septal cartilage or removing soft tissue at the base of the nose, thereby eliminating the upturned appearance without actually lengthening the nose.  The decision about which approach to take would involve a very detailed analysis and individualized plan to address your concerns.

© 2011 Michael R. Macdonald. All rights reserved.

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Sciton® laser: Skin resurfacing, skin tightening, skin pigment reduction, hair removal, vein treatment

The Sciton® laser sounds amazing. Dr. Macdonald has one now for his office, and is starting the treatment procedures soon to enhance his skin rejuvenation service offerings. [These details will be documented fully on his new website under laser services..coming very soon.]

From treating wrinkles, scars and sun-damaged skin to hair removal, the Sciton® innovative technology supports procedures which range from light and quick, to deeper and more inclusive… all depending on your skin’s needs.

I’ll be writing a series of articles on this laser, but first to introduce the specific areas it treats:

Hair removal.

BBL™ Broadband Light offers high speed laser hair removal and phototherapy, safe for all skin types and colors, for various body parts. The procedure is virtually pain-free with a little numbing cream. The side-effects (temporary pigment changes, redness, slight swelling) only last for 48 hours.

Skin resurfacing.

MicroLaserPeel® (the “weekend peel”), Laser Peel – Coutour TRL™, ProFractional™ and BBL™ Broadband Light are all offered for resurfacing the skin and restoring your natural youthful look. Whether it be sun damage, age or acne scars, these procedures will enhance your overall appearance.

Skin pigment.

Hyperpigmentation from sun damage and aging can make you look years older than you actually are. Laser Peel Contour TRL™ and BBL™ Broadband Light can help you clean up any areas that are exposed to the harmful rays of the sun by reducing unwanted melanin. In the process, the collagen in your skin gets regenerated.

Skin tightening.

Make a difference toward sagging, aged skin with SkinTyte™ or BBL™ Broadband Light procedures. As the infrared energy heats dermal collagen, it also cools it to protect the surface. Comfortably and with no downtime, this procedure promotes the tightening of the skin.

Vein treatment.

Veins that pop out of your legs or your face can be diminished with BBL™ Broadband Light phototherapy. Tiny and larger blood vessels are activated by heat on the upper layers of your skin, allowing the heat to absorb the targeted areas as they stimulate the skin and regenerate new collagen. Smoother, more youthful looking skin is your result.

Next article: details behind laser hair removal.

By the way, appointments are booking already for mid-January. I know I’m going to try to get on the list…

© 2011 R.E.L. Copywriting and Michael R. Macdonald. All rights reserved.

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Did you know that there are 43 muscles in the face?: Some causes of wrinkles

Did you know that there are 43 muscles in the face? This results in approximately 7,000 different facial expressions. Each of these when done repetitively contributes to wrinkles.

Of course, it is not advised to never make a facial reaction in order to lower your chance of getting wrinkles though. We should all live our happy lives as they are meant to be lived, which includes moving these 43 muscles!

But, you might want to protect against extra wrinkles where possible.

Here are some of the solutions to help you, if you are interested in minimizing wrinkles in your face.  The results last many months.

Wrinkle minimizers:

BOTOX® and Dysport™

Used interchangeably by Dr. Macdonald, they are neurotoxins which relax the muscles that produce wrinkles.  They are primarily used on the upper face, but can also be used to recontour the lower face.

Tissue fillers:

Injections of small amounts of tissue filler, such as JUVEDERM®, Restylane® or RADIESSE®, can produce wonderful results in improving the skin’s texture, and in restoring facial contour in areas of tissue volume loss.  Depressions in the skin surface (e.g. post-acne scarring) can be raised to the level of the surrounding skin.  Lines and scars can be minimized.  Textures can be improved to soften the skin’s appearance and give a more even contour.

Most common areas of treatment include:

  • Lips (for fullness)
  • Nasolabial folds (creases between nose and corners of the mouth)
  • Marionette lines (creases at corners of the mouth)
  • Glabella lines (wrinkles between the eyebrows)
  • Lower eyelids (for adding volume to sunken, tired eyes)
  • Midface/cheeck area (for lifting the drooping effect)
  • Prejowel area (creases along jawline)
  • Hands (for correcting hallowed, aged hands)
  • Acne scarring (for filling in scars)
  • Brow lift
  • Ear lobes

Restylane®.  Tissue filler for depressions, scars and wrinkles.

Perlane™.  Like Restylane® but is thicker and lasts longer.

RADIESSE®.  Good for volume augmentation in the cheeks.  Often called a “liquid facelift”.  Also great for backs of the hands.  Doesn’t work so well around the lips and mouth area.

JUVEDERM® Ultra is similar to Restylane®

JUVEDERM® Ultra Plus is similar to Perlane™

PREVELLE® Silk is newer and like Restylane® and JUVEDERM® Ultra but thinner.  Good for fine lines around the mouth.

Sculptra™ is newer but expensive.  Good for larger volumes.

It’s a good idea to go an expert such as Dr. Macdonald for wrinkle minimization and tissue filler injections so that you get the most expertise.

This is why it is so important to get BOTOX® injections from an expert such as Dr. Macdonald who believes in a natural approach to wrinkle reduction. He has an individualized approach to his facial procedural artistry, and is familiar with many products and their unique results.  He takes pride in his patients’ glowing appearance, and youthfulness that is natural to the expressions of who you are.

© 2011 R.E.L. Copywriting. All rights reserved.

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PCA chemical peel for face, neck and chest

Last month I began a physician-strength PCA chemical peel with Dr. Macdonald for my face, neck and chest (a.k.a. decolletage area) to attempt to repair some –if not all–of my sun-damaged skin.   Now I am on peel #3 of 5 and seeing a positive effect.  Dr. Macdonald, whom I only see every 2 weeks, sees a noticeable difference as well.

On peel #2, the concentration was increased on both the neck and chest to PCA resorcinol which contains hydroquinone to lighten the hyperpigmentation. On peel #3, resorcinol was used on my face too, and yet a stronger dose on chest and neck since I had very little reaction on previous attempts.

The resorcinol peel does produce a hot, burning sensation during the peel, making it soothing to use the fan to cool my skin for 10 minutes.

Rosacea. An issue Dr. Macdonald wanted to bring to my attention is some rosacea on my cheeks and nose (i.e., little red blood vessels on the skin).  After lightening my hyperpigmentation, the red vessels will be more visible.  His solution would be to treat the rosacea with laser treatment after the peels are completed with VariLite laser at 512 nm strength.

Like clockwork, it seems that after 48 hours, my skin begins to peel and lasts until around day 6 for the face, with a longer delay on the neck.

My neck has been the itchiest.  I treated this with hydrocortisone creams.  PCA SKIN® Après Peel Soothing Balm (with 0.5% hydrocortisone) was especially supportive.  I also fell in love with a new lotion with a soothing effect called “Yes to™ Cucumbers”  It is formulated for sensitive skin and gently hydrates with organic cucumbers, aloe vera and green tea.

During one of my peely-ist moments, an acquaintance asked me:  Is that good for you? Answer:  Here is exactly what happens to the skin–and underneath the skin–during the 2 weeks between peels.

The carefully selected solutions in a chemical peel sink into the skin and cause the skin layers below the surface to react on the cellular level.

  • The skin cells are repaired
  • Melanin is reduced (darkness)
  • Cells produce more collagen and elastin
  • Dead cells are eaten away

Even though it looks like a sunburn, there is a science behind chemical peels vs. the sun.  Melanin protects the skin from the sun’s harmful rays or from any skin injury.

  • Suntan. The skin of a person with enough melanin in their skin to handle the sun’s rays turns a little darker as a result.
  • Brown spots. However, the skin of a person with less melanin in their skin reacts; it goes into protection-mode and releases melanin (that naturally lays beneath the skin’s surface).  This melanin rises to the surface… but not uniformly, resulting in a spotty look.

The tender skin on my neck and chest are starting to react for the first time on peel #3.  Of course, I have the itchiness but also some significant skin shedding….

Throughout the peel process, I need to pay extra attention to sunscreen.  During the days where I’m wearing lots of lotions to sooth or cover up peeling and itching, it sure is nice to have the powdered sunscreen by Colorscience®.  [Dr. Macdonald is now carrying this product in his office.]

5-minute sauna and steamroom steam sessions sure do help to break down and soften harder, thicker, dryer skin on days 4-5, while continually dousing with cool water while in the steam.

I’ve experienced the most advanced stage of peeling today (counting my PCA peel last year, 1st and 2nd PCA peels this past month and Vi PEEL™ this year) on day 5 of peel #3.  I’m scared to post this one, but here is a lovely photo of my peeling-look as I woke up this morning.  Today is the day I discovered the “Yes to™ Cucumbers Soothing Cooling Body Butter“.  In a few days I will be all better…

Dr. Macdonald has a full-fledged skin rejuvenation and skincare treatment center in his office, including laser treatments for full fractional resurfacing, skin tightening, sun damage repair to hair removal, dark spots and rosacea.

Pam DePianto is his new Medical Esthetician in the office as of August.  Pam is focusing exclusively on the beauty of your skin…  She brings you 15+ years of experience as a small skin spa owner, a Kaiser skin health educator and, most recently, the lead esthetician for an East Bay dermatology & plastic surgery practice. With Pam, you’ll be in good hands!

Pam is offering a special Pumpkin Enzyme Peel Facial now (on special now through next Friday):

This luxurious facial is loaded with antioxidants, beta-carotene and vitamin C to replenish the skin with much needed nutrients.  Exfoliating the skin’s surface, this facial will soften the appearance of fine lines and wrinkles as it improves the skin’s texture.  Price includes: deep cleansing, steam, pumpkin enzyme exfoliation, extractions, massage, treatment mask, treatment serums, day cream and SPF. 

© 2011 R.E.L. Copywriting. All rights reserved.

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Are you having a war with snoring?

image by simeon schatz

Snoring expert, Dr. Macdonald, has been treating snoring for his patients for over 10 years. He was one of the first in the Bay Area.

Trained in the U.S., Canada and Australia, and Chief of Head and Neck Surgery at the Alameda County Medical Center for over 10 years, he is uniquely qualified in the management of snoring and obstructive sleep apnea (OSA) because of his depth of understanding of the contributors to sleep-disoriented breathing.

Primary contributors to snoring and their treatment options:

  • Soft palate.  Obstruction to the airway allows for a vibration of the tissues in the back of the throat.  Most often treated with the Pillar® Procedure.
  • Nasal.  Obstruction of the nasal airway.  Most often treated with septoplasty surgery, turbinate reduction, or nasal valve.
  • Oral.  Tongue related. Most often treated with tongue reduction, maxomandibular advancement, hyoid suspension, or genioglossus advancement.
  • Lifestyle.  Obesity, alcohol consumption and smoking increase the chances and intensity of snoring. Treated by a change in lifestyle.
  • Aging.  Tissue elasticity decreases with age, which gives less protection for the airwaves.

Healthy sleep habits.  Although snoring effects others around you, it is ultimately about you and your health.  There are many health consequences to sleep-disoriented breathing depending on the severity.

The health consequences of snoring include:  daytime sleepiness, poor mental and emotional health, decreased productivity, slower reaction time, to name a few.

If your breathing is obstructed enough while you sleep, your snoring will be accompanied by a collapse of the airways either in the nasal airway, soft palate, tongue base or pharyngeal walls.   This would indicate obstructive sleep apnea (OSA) where the consequences are more severe such as: hypertension, heart attack, stroke, type II diabetes, depression, cognitive dysfunction, impotence, sexual dysfunction, reduced libido, morning headaches.

There are some holistic approaches to better sleep that could help alleviate some of your systems such as relaxation, yoga, calming herbs and essential oils, massage and soft music before sleeping, allowing your inherent natural sleepiness to have its best chance for slumber.

Don’t let snoring ruin the quality of your life.

© 2011 R.E.L. Copywriting. All rights reserved.

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Q/A by Dr. Macdonald on facelift, mid-face/cheek lift, rhinoplasty November 2011

Please join me and view this new Questions and Answers page on this blog…  All questions are posed by patients and answered here by Dr. Macdonald.   Check back any time for more additions

Here are some of his responses from November 2011…

Question: What is the risk of a facelift, revision rhinoplasty, and laser resurfacing at the same time?

I just turned 50 and am showing my age. Thinking of brow & neck lift (or full face lift), laser resurfacing, & revision rhinoplasty at the same time. Is this too much for one day? Too much risk to be under anesthesia for so long? Possible to do with local?

Answer by Dr. Macdonald:

I would always recommend addressing all of the areas that you are concerned about at the same time, if at all possible.  I think it yields the best results and the best possible overall outcome, the shortest overall recovery time, and it is often the most cost-effective.

Having a brow and face/neck lift, revision rhinoplasty, and laser resurfacing as one combined procedure is commonly done and is certainly would not be considered too much to do at one time.  In fact, it makes good sense to combine all these procedures to achieve the best overall outcome.

With regard to the laser, I prefer to avoid using full ablative laser resurfacing in the areas where a flap has been elevated–in this case, the lateral cheek and the forehead areas.  Instead, I would advise confining the laser portion of this procedure to the area around the mouth and the eyelids–areas that would not be involved in the surgery under consideration.  Laser resurfacing is often not required in the surgically treated areas referenced here.  If laser resurfacing is indicated in the cheeks and forehead areas, this can be delayed for at least 6 months following surgery.   You may be so pleased with the surgical results that you can delay much longer than this before contemplating any further laser resurfacing treatment.

(November 2011)

Question: What happens when brow lift and facelift start to sag again?

I’m considering a brow and facelift. How long will the results last. Do people look a little strange as the face starts to fall again as the years go by…I’m mean, do things fall in a weird way because of the previous surgeries?

Answer by Dr. Macdonald:

The easy answer to this question is that a brow and face lift last forever.  What this means is that you will always look better than you would have had you not had these procedures done at all.

The aging of the face and the sagging of the skin does not progress and accelerate after you’ve had surgery; however, you will continue to age and gradually you’ll notice flattening of the mid-face/cheek area, deepening of the nasolabial folds, recurrence of the jowling and recurrence of the loose skin in the neck and lower position of the eyebrows which inspired you to consider a face and/or brow lift originally.  These effects occur gradually over time–usually 10-15 years–before you will be interested in considering further surgery.

The ongoing aging of the face after surgery definitely does not occur in a “wierd” or “unnatural-appearing” way.

(November 2011)

Question: Will a temporal lift for brows and excess eyelid skin alter the hairline?

I am considering a temporal lift to elevate the side of my eyebrows and correct excess skin on upper lids. Will the placing of the incisions alter the hairline in the temple earea?

Answer by Dr. Macdonald:

 A limited incision, temporal or lateral brow lift generally involves using very small incisions above the hairline in the temporal region to elevate the lateral aspect of the eyebrows and improve the contour of the upper eyelids in this region.  I will generally place the incisions involved in this procedure above the hairline and remove some skin in addition to elevating the muscle and soft tissue beneath the skin.  Removing a  small amount of skin in this area further guarantees a long-lasting and more effective lift.

Whether or not any skin is removed, placement of the incision above the hairline will necessarily alter the hairline slightly by elevating it along with the elevation of the eyebrows.  Alternatively, if the hairline position is very important to you, the incision could be placed right at the edge of the hairline, angled in such a way that the hair follicles will grow right through the incision post-operatively in order to camouflage the incision.  In this way, the hairline location would not be altered.

However, there is a small risk that careful inspection of the hairline (i.e. when hair is pulled back) might reveal a small scar.  If the hairline position is elevated slightly, along with the elevation of the brows, this is balanced off by the benefit of a well-hidden scar, so that the choice of placing the scar above the hairline is selected by most patients.

Personally, I usually prefer to hide the scar as completely as possible, even at the expense of a slight change in position of the hairline.

(November 2011)

Question: Is it necessary for the surgeon to put in drains when completing a full facelift?

I’ve had several consultations. One doctor puts in drains, one doesn’t, and one uses glue.

Answer by Dr. Macdonald:

When performing a facelift, I will place drains at the end of the case, but only on selected patients.  However, I would much rather err on the side of caution by placing the drains, if in doubt, since the disadvantage of drains is minimal and the potential benefit often outweighs any small disadvantage.

The drains serve to provide safety and security in patients that have any significant amount of bleeding during the case and to prevent the small risk of post-operative hematoma.  The drains are well-tolerated and easily removed on the first post-operative day.  In healthy patients with minimal bleeding during the case, drains are often not required.

Tissue glue, used at the end of the case, may minimize the risk of post-operative bleeding; however, I personally do not believe that the minimal benefit gained by placing this foreign material inside the face warrants doing so unless there is a special reason to do so.

(November 2011)

Question: I’m 36 but would a mid-facelift improve my long face and nasolabial folds?

I have noticed nasolabial folds since I was 32 and it is worse on the left side of my face. Since then, I had 2 vials of juvederm ultra injected into my cheekbones and the left nasolabial fold and now, 6 months later, it is already bothering me again. Even right after the procedure, it did not see to do that much. I would like something more permanent and something that would show more improvement, but have been told to wait till I’m older by 2 surgeons. Would a cheek lift solve my problem?

Answer by Dr. Macdonald:

You are an excellent candidate for a mid-face/cheek lift.  This procedure, with its small, well-hidden incisions, is specifically designed to reposition the mid-face/cheek soft tissue to a higher position–often back to the position where it originally was before the early effects of gravity.

Not only does this recreate the youthful appearance of volumization in the cheek area, but it also corrects the deep nasolabial folds that you are concerned about.  Not only is this procedure more permanent than facial volumization through injected tissue fillers, it also is more easily tailored to your specific needs and can create a more significant and long-lasting improvement.

The incisions are completely hidden above the hairline and inside the mouth.  It is a much less extensive procedure than a facelift and designed perfectly for someone your age and to address the concerns that you have expressed here.

(November 2011)

© 2011 Michael R. Macdonald. All rights reserved.

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New spacious office space for a Dr. Macdonald chemical peel and more

For over a year now, I’ve been on the path to clearing out the hyperpigmentation on my skin. My light, sun-damaged and aged skin has been stubborn. Since my skin is also sensitive, we have had to take the slow path.

Last summer I did 5-series PCA peel through Dr. Macdonald’s office. My results were a better complexion, smoother skin, fine wrinkle line reduction, and less hyperpigmentation.

I wasn’t convinced at that point that I was not capable of going to the next level in hyperpigmentation reduction. To that end, I did the following:

  • Sunscreen and hat all year round (even on cloudy days)
  • Recognition of my sensitive skin and genetics as seen in my father
  • HQRA (Hydroquinone to lighten pimentation & Retinol A to reduce wrinkles)
  • Research on PhotoFacial
  • Research on 2 Sciton laser applications: skin resurfacing, IPL for sun-damage (available in January 2012 through Dr. Macdonald’s office)
  • Vi PEEL™ (12 days) last month

My goal is to make a visible difference in my brown age spots on my face and upper chest area (i.e. decolletage area) and hands so that I a) look younger and b) feel that there is a solution to most of the sun damage from my many years in the sun.

Dr. Macdonald’s new office space at 500 Sutter St, Suite 430 in San Francisco. The new office space is beautiful and is a lot more spacious than the previous office. He has stunning artwork from local artist and photographer, Simeon Schatz on order–a must see…

Dr. Macdonald and his staff are ready to take on more patients and a new Sciton laser, among other perks. [It's only a block away so the parking situation is similar.]

PCA Chemical Peel. Since Dr. Macdonald has been working with me on this for over a year, during my recent skin check-up he decided that he wanted to do another PCA peel on me himself (and go a little deeper to make some more progress on the darker pigmented areas, yet pay close attention to my sensitivies).

I had my 1st of 5 PCA peels to my face, neck and chest area (i.e., decolletage). Similar to my previous experiences, I had no irritation in the first 2 days. I am starting to peel today, 48 hours later.

What I like the best this time around is the PCA SKIN® post-procedure solutionwhich includes:

  1. PCA SKIN® Facial Wash (very light and absorbant)
  2. PCA SKIN® Apres Peel Soothing Balm (with 0.5% hydrocortisone)
  3. PCA SKIN® ReBalance (to help inhibit redness and inflammation)
  4. PCA SKIN® Silkcoat Balm (for nighttime moisturizing)
  5. PCA SKIN® Perfecting Protection SPF 30 (for UV protection)

The products are soothing and restorative to the skin (and have a great scent and light non-greasy after effect).

I will return in 2 weeks for PCA Peel #2 of 5.

Day 2

The skin on my face was a bit tight but I kept the PCA SKIN® products on all day. I had a healthy glow.

Day 3

The skin on my face was tighter and noticeably wrinkly. I continued with the PCA SKIN® products.

In the afternoon, which is 48 hours since the peel, my skin started to peel. It started around my mouth and continued through the day.

Day 4

My neck was itchy but the PCA SKIN® products soothed it tremendously. I had to use the products more often than previous days.

By afternoon my face was peeling in big flakes, and the skin on my chest started to peel partially in flakes, previously splotchy looking skin (as if it had peeled). There was no itching or irritation though.

Day 5

The skin on my face and chest was peeling all day. It was a little itchy. I wore a hat and long sleeves all day (even on hot sunny day).

Day 6

My face was still peeling along hairline. I noticed that the peeling on my chest had stopped yet was still splotchy (i.e., half-peeled). I made a note to have double PCA solution applied next time (hopefully) so that it will all peel off.

Day 7

I was still peeling on my face, neck and chest. I started to use an exfoliant cleanser at this point to continue the peeling (possibly). Next peel in a week.

Amazing new sunscreen by Colorscience®

Pam turned me on to this powder sunscreen by Colorscience®. It’s SPF 50 plus comes in a convenient brush applicator. It contains some skin color, so is much like powdered foundation makeup. I love the easy application and light formula. Thank you, Pam!

© 2011 R.E.L. Copywriting. All rights reserved.

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Active skincare regimen for teenage acne

Taryn is being treated for teenage acne through Dr. Macdonad’s Clinical Esthetician, Pamela DePianto.  She began her treatment 8 months ago.

After visiting Pam, Dr. Macdonald’s Clinical Esthetician, for a skin assessment and facial, Taryn has begun a new acne treatment regimen.  She has a new set of products to try out, but in general this is a continuation of all of her skincare knowledge through Dr. Macdonald‘s office in the last 8 months.

Prior to the facial, Pam assessed Taryn’s skin and interviewed her.  She emphasized the need for sunscreen every day.  They discussed how good it is for your face to use warm water, followed by cold water on your face.

During the facial, Pam cleansed her face, steamed it, and then applied an enzyme mask to open her skin pores and remove dead skin cells.  A hot towel was soothing to her face.  She extracted the existing pimples manually without any tools, in a gentle manner.

Pam advised Taryn that in the next 1-2 days following the facial, her pimples could reactivate (but that this is normal).  This did occur.

For makeup, Pam advised mineral makeup such as the Bare Essentials and Color Science lines.  She also advised her about a powder sunscreen which is moisture resistant, also by Color Science.

Here are the new products Pam is having Taryn try out:

  • Glycolix Gly-Sal 2-2 cleanser (with 2% glycolic acid, 2% salicylic acid)
  • Derma Topix Benzaderm Gel (with 5% benzoyl peroxide)
  • Derma Topix Ultra Lite Moisture Dew Cream
  • Derma Topix Oil free Moisturizing Sunscreen SPF 30
  • Glycolix Gly-Sal 2-2 Acne Medicated Pads (with 2% glycolic acid, 2% salicylic acid)
  • Derma Topix Clay Mint Mask

New morning routine:

  1. Cleanse face with cleanser
  2. Spot treat pimples only with Benzaderm Gel
  3. Apply moisture cream
  4. Apply sunscreen

New evening routine:

  1. Cleanse face with cleanser
  2. Spot treat pimples and overall broken out areas with medicated pads
  3. Apply moisture cream if skin is dry

Once per week:

  1. Apply clay mask, leaving on for 20 minutes

Taryn is loving her new acne routine and feels empowered–something all teenagers crave–to combat her teenage acne like never before.  She’s been using these new products for a couple weeks now after her latest facial.  Stay tuned for new photos and comments from Taryn.

morning routine

 

evening routine

© 2011 R.E.L. Copywriting. All rights reserved.

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Vi PEEL™ daily results, first 12 days: Final results at 4 weeks

I ended up going for it and got a Vi PEEL™ to  reduce the hyper pigmentation (i.e., brown skin spots), visibly improve my complexion, firm up my skin and produce smoother, more youthful skin.

It has worked beautifully so far.  But 2 weeks later, I have learned that I won’t see the final results most likely until week 4.  As stated already, I had been nervous about getting the stronger peel with my sensitive skin. Here are my daily results.

Day 1

Vi PEEL™ performed by Pamela DePianto, Dr. Macdonald’s Clinical Esthetician.

Preparation. For the week proceeding this day, I had not used any cleansers or creams which would have exfoliated the skin on my face.  I needed to let my skin rest.

The procedure. To prepare my skin, Pam started with an acetone cleanser. She then applied 2 layers of Vi PEEL™ solution while I was cooling off by the fan.

I felt a little tingly and warm sensation but no real burning. In fact, the burning sensation was less than my PCA peel series I did last year.

The scent was more like a “perm” (for permanent hair curling).

Two hours post-procedure. As expected, my skin was yellow-orangish, similar to the look after coming back home from a day at the beach, or after having applied tanning lotion. It’s was not red or hot though. It felt a little tight though.

I was instructed to leave the solution on until I go to sleep at night.  My skin was a little itchy but not too uncomfortable. What bothered me the most was the scent.

Pam sent me home with a small home kit containing:

  • Vi PEEL™ post-peel towelettes (two) containing Retin A and Vitamin C — to use each night before going to sleep
  • Vi DERM™ moisturizer — to use as often as needed when my skin feels tight, irritated or dry
  • Vi DERM™ sunscreen SPF 55, containing aloe and green tea, for daytimes

I was also instructed to avoid exercise and heat such as a sauna or the sun.

Sunscreen is important. Pam reminded me how important sunscreen is on a daily basis. She has a great way to remember the two important breakdowns of ultraviolet radiation that we get from the sun.

  • UVA — think of A as standing for aging. We get UVA rays from the sun through clouds and on days when we don’t know it. This is when most people forget to wear sunscreen, or do not think it’s important.
  • UVB — think of B as standing for burns. We get UVB rays from the sun through direct, hot sunlight. This is when most people think to apply sunscreen.

*** Sunscreen is necessary to protect against harmful UVA and UVB rays.

Nighttime routine. I cleansed my face with a mild cleanser containing tea tree oil and awapuhi. I then followed the Vi PEEL™ instructions by swiping my entire face and neck with the Vi PEEL™ post-peel towelette.  I could feel the stinging sensation of the Retin A / Vitamin C. That sensation didn’t last too long though. I was instructed to apply it one hour before bed and to leave it on overnight.

After a few hours, I found myself still awake working on my computer.

The skin on my neck started itching too much….

I tried many cooling remedies and finally washed off the Retin A / Vitamin C from my neck around midnight and applied the Vi DERM™ moisturizer which contains 1% hydrocortisone, vitamin E and organic aloe vera gel.  [2 hours later my face was unbearably itchy so it too was washed of the Retin A / Vitamin C .  I tried to last as long as I could, but I felt like sleeping..]

Then I went to sleep more comfortably, ceiling fan on.

Day 2

First morning after procedure. I woke to a red face as expected. After cleansing, I applied the Vi DERM™ moisturizer to my entire face and neck. It had a soothing effect.  My skin was comfortably warm.

I noticed that I needed to keep the activity level to a minimum, as even walking fast would make my face feel extra hot, which then turned to an itchiness. Drinking cool water and staying cool in general helped.

Mid morning. Drove in car on a sunny day.  I had to turned on the air conditioning to max to cool down. I wore a big floppy hat for extra sun protection.

My neck still felt itchy, so I applied Vi DERM™ moisturizer repeatedly.

Afternoon. I tried out the Vi DERM™ SPF 55 and it was soothing and comfortable for my face. So, with the A/C blasting and my sun hat, I was comfortable even as the day got hotter.

Nighttime. Cleansed and reapplied the 2nd and last Retin A / Vitamin C towelette provided by Vi PEEL™ for day 2.

  • To my neck: Since Retin A / Vitamin C was too strong for my neck the evening before, and I feel like sleeping, I did not put it on my neck. I used Vi DERM™ moisturizer instead.
  • To my face: Applied Retin A / Vitamin C as directed. It did not burn as much as previous night. I went straight to sleep, so was able to leave it on the entire night. My lips felt especially dry so I used Alba Un-petroleum jelly. [I was not putting the Retin A / Vitamin C on my lips, nor was the Vi PEEL™ applied to my lips--only to the skin above my upper and lower lip.]

Day 3

Upon waking.  Face felt a little dry, a little hot, a little itchy before I did the morning cleanse.

No peeling yet. I noticed the most dryness around my lips.

I also notice that the hyperpigmentation I had on my cheeks had turned darker.

20110924-011636.jpg

Afternoon. Just when I was thinking this “peel” should be renamed, I started peeling in big flakes. It began on my chin. Then around my mouth. No discomfort.

Dr. Macdonald called to check up on me about the state of my skin. He mentioned,

I would not apply the Retin A / Vitamin C this early on in a peel. I would not have advised it until day 4 or 5 instead.  [A change in the Vi PEEL™ company instructions].

Since my Vi PEEL™ packet only included 2 of these towelettes, I was already finished with them.

Dr. Macdonald also let me know that although there is trichloric acid in this peel, he does not consider it a typical TCA peel because the amount is so minimal. This peel is a step between typical PCA and TCA peels.

Evening. Skin started to tighten and peel more continuously all day.

Before bed. I cleansed my face with the Trader’s Joe’s tea tree oil cleanser, applied the Vi PEEL™ moisturizer and went to sleep with some active peeling. No itching or pain.

Day 4

Morning. I woke to tight skin and skin shedding like a lizard. It felt the tightest on my forehead and around my lips. No pain, no itching.

I smiled at all that is getting peeled away here. All of my skin’s impurities.

Afternoon and evening. Continued to peel. I was in public most of the day just smiling as if I had a Hawaii suntan peel. I applied more Vi PEEL™ lotion than previous days.

By bedtime it started to feel like the lotion was irritating my skin, especially on my chin area which had stopped peeling (also where peeling began) so I didn’t put on as much as before. I used another moisturizer which contained more inert ingredients  – Alba’s Un-petroleum Jelly.

Day 5

Morning.  I woke to extra tight skin and very strange looking tight crepey wrinkles when I smiled. 

Forehead and upper cheeks were still peeling.  Using the Vi PEEL™ moisturizer and SPF 55 sunscreen, which both soothed the raw skin.

Afternoon.  Skin peeled off in sheets. By early evening, it was close to done (little remnants along hairline). What remained on my forehead and upper face was a smoothness, yet red and splotchy.  What remained on the lower half of my face was an irritation (slight raw skin pain) and dry, hard skin like a callous or leather.  I continued with the Alba Un-Petroleum Jelly  since at this point the Vi PEEL™ moisturizer  was too irritating.  The Alba product contains:

  • Castor seed oil
  • Coconut oil
  • Beeswax
  • Vitamin E

Early evening. Since the peeling had subsided and I knew my skin craved some serious moisture, I went into the steam but had cold water with me to keep pouring on my face too. I did this routine for about 10 minutes. While I was in the steam, the hardened skin seemed to be completely better!

Hours later, it was a little raw again but the hardened skin was not as bad.

Later in the evening I switched to 100% pure jojoba oil for my dry and scaly chin and lips.

Day 6

Morning. My skin was still dry. The area around my mouth was dry and scabby, beginning to flake off in tiny sections (very unlike the initial layer which came off in light sheets of skin).

My overall face was reddish and all previous hyper pigmentation now darker (reddish) and more pronounced.

I kept up with the moisturizers, caked on at this point.

A quote from my daughter:

“My mom looks like a snake failing to shed its skin. It feels hard like scabs on her chin.”

Afternoon. Check up with Pamela DePianto and Dr. Macdonald’s.

Pam said that I was definitely was not done peeling and healing. The darker skin would lighten up to 4 weeks post-peel.

Day 9 and Day 10

Second layer of peeling on forehead and cheeks.

20110930-093559.jpg

20110930-093630.jpgI was happy to find that the darkest hyper pigmentation areas had extra dryness and scabbing, preparing to peel off.

Before bed I used a Vitamin C Exfoliant cleanser (by L’Oreal). Very mild but has a little kick to the exfoliating. Since my skin is not irritated at all, I wanted to get that extra boost so these dark spots definitely come off…

Day 12

Skin color evened out.  Peeling stopped.  Skin felt smooth….   Planning on next update at 4 week mark.

Week 4

My face is smooth and noticeably healthy, similar to day 12.  It is recommended to do 3 peels with the Vi PEEL™ series.

© 2011 R.E.L. Copywriting. All rights reserved.

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Teen acne update: Active teen with great results on acne treatment

Taryn is being treated for teenage acne through Dr. Macdonad’s Clinical Esthetician, Pamela DePianto.  Her home treatment started 6 months ago.

Last time we heard from Taryn was in May.  She had been using her teen acne products for 8 weeks, and was seeing great results, especially after an office visit facial through Dr. Macdonald’s office.

Taryn is due back for another facial soon.  This time she will meet with Pam who is an expect in teen acne.  We are excited to interview Pam and to see the assessment of Taryn’s skin.

To recap, throughout the summer Taryn washed her face every morning and evening with a mild Neutrogena cleanser, along with the teen acne Mandelic and Clear Cream regimen she was taught by Dr. Macdonald’s office.

Staying true to the advice she was given on what makes acne worse, she made sure she:

  • stayed away from M.A.C makeup and liquid foundation.
  • had a new view on the balance between too much oil on the skin and healthy oils, which if overtreated can backfire and make your skin even more oily.
  • steered clear of fast food.
  • eased up on caffeine (not so easy being a new high school student with a rigorous curriculum).
  • drank plenty of water.
  • wore the right amount of sunscreen, but not too much so that it clogs the pores.

Taryn did test the waters though to some extent.  This summer she had plenty of sleepovers with her friends (where she forgot her acne products), she lost her Mandelic potion for awhile which allowed her to see what happened to her skin without it.  The answer is:  some of the acne came back.

After she returned to her regimen, she had it under control again though with her 10% Mandelic acid in the mornings, and 5% benzoil peroxide in the evenings to wear overnight.   Also, she has to admit that she did see some positive result from the sun this summer!

In addition, last spring she began taking a multi-vitamin specifically for teens which, along with probiotics and other vitamins specially formulated for teen hormones, has a potent skin-clearing action.

She has also been exercising at a health club all summer with her mom, focusing on all over health :)

Stay tuned for details after her facial and consultation for potential teen chemical peel in Dr. Macdonald’s office this week.

© 2011 R.E.L. Copywriting. All rights reserved.