IPL

Introduction: Come Towards The Light

For those of you who have not the time to recover from nor the epidermal capacity to withstand lasers -- High Intensity Pulsed Light Therapy may be for you. This promising new procedure is also known as Intense Pulsed Light Therapy, computer controlled light therapy, Light Laser, MultiLight, Photo Laser or by various trade and service marks, FotoFacial ™, PhotoFacial ™, PhotoDerm ™, EpiLight ™, MultiLight ™, PlasmaLight, and I am sure, soon-to-be others.

It is phenomenal new mini-procedure capable of diminishing or fully ridding one of age/liver spots, fine wrinkles (rhytids), facial flushing, redness, broken capillaries, telangiectasia (Teel-ann-ject-AZE-yah) which are purple or blue veins on the face, hemangiomas (sacs of red, purple or blue blood vessels resembling a blister, aka strawberry hemangiomas), freckles, minor sun damage, port wine stains, tattoos, varicose veins, spider veins, flat birth marks, hypo-pigmentation and even hair removal! And the best part? NO downtime! Intense Pulsed Light Therapy gives you the benefits of a medium depth laser or chemical peel or other type of resurfacing/rejuvenation procedure without the blisters, burns and long recovery time. Not only that, it is the only proven therapy to help with redness (rosacea, flushing, etc)! And to boot, many patients report a reduction in pore size, smoother skin, and less wrinkles!

What Is High Intensity Pulsed Light Therapy or IPL?This incredible new therapy was pioneered by Dr. Patrick Bitter Jr. and is based on emitting high intensity pulses of light (not lasers) to penetrate the skin and rid you of various complaints. There are different machines for different levels or types of penetration. It is also knows as IPL Photorejuvenation. For instance, PhotoDerm as the PhotoDerm VL (vascular lesions) {VascuLight/MultiLight}, PhotoDerm PL (pigmented lesions) or PhotoDerm HR (hair removal). PhotoDerm and PhotoFacial™ intense pulsed light systems are expensive! ESC Medical Systems in Needham, Massachusetts, costs around $130,000. ESC is an innovator in all kinds of high-end medical equipment and is a trusted leader in the medical profession.

PhotoDerm VL (vascular lesions): With this machine, the light pulses are directed at the spider and varicose veins as well as vascular birth marks. The tissue targeted is the hemoglobin in the blood.

Hemoglobin <he*mo*glo*bin>(noun) : an iron-containing respiratory pigment of red blood cells that functions primarily in the transport of oxygen from the lungs to the tissues of the body.

A highly advanced computer regulates the light pulse to a specific wavelength range, which in turn heats the visible, targeted blood vessel(s). Thereby damaging or otherwise destroying the targeted lesion while sparing the surrounding healthy or normal tissue. The penetration depth and degree of heat is highly controlled so that most complications contributed to these specific factors are not an issue with Pulsed Light Therapy.

PhotoDerm PL (pigmented lesions): With this machine, the light pulses are directed at the age spots, freckles, flat pigmented birthmarks and other types of discolorations. The tissue targeted is the melanin in the epidermis.

Melanin <mel*a*nin>(noun) 1 : any of various dark brown or black pigments of animal or plant structures (as skin or hair) .

The melanin is then heated and damaged or destroyed - thereby ridding you of the unwanted hyper-pigmentations.

PhotoDerm HR and EpiLight (hair removal): This machine makes it possible to rid one of unwanted hair, supposedly permanently. The pulsed light is controlled via the computer and with the use of special filters the theory of Selective Photo Thermolysis is what damages the follicle and causes it to fall out. Sort of like the PhotoDerm PL above, the pulses of light target the melanin in the hair shaft and travel to the follicle, heating and destroying it. The hair production cells themselves are damaged or destroyed making permanent hair removal, well, possibly permanent.

Now, hair grows in cycles and some follicles lie dormant and begin to grow again after a time. So, it may seem when you try any type of hair removal system or even shaving that some hair grows back faster than the others. Unfortunately as I said, this is a cycle and a vicious one at that. The Light therapy must affect the hair follicle during its growing phase to work properly. When you notice these hairs when they fall out and then see a few weeks or days later, hair emerging, don't automatically think that it didn't work. The follicles must be caught during this growing phase for them to be destroyed.

According to a lecture I listened to by Dr. Robert A. Weiss, the assistant professor of dermatology at the University of John Hopkins School of Medicine in Baltimore, Maryland by on intense pulsed light treatments:

It is quite possible to actually shrink sebaceous glands (oil glands), pore size, with repeated treatments. Although at this time it is unknown just how many treatments this result would require. Also hyper and hypopigmentation is possible. Other than that the lecture covered the same info of which I already knew and covered.

Are You a Candidate For HI Pulsed Light Therapy?If you are prone to keloids, hyper or hypo pigmentation, are dark-skinned, darkly tanned or do not react well to burns you may not be an ideal candidate for High Pulsed Light Therapy. Also, if you have ethnicity (like Greek, Italian or African American, etc.) in your biological family, you may be prone to hyper or hypo pigmentation resulting from the procedure. An ideal patient would be of white European descent with elastic, non-oily skin. Although many other types of skin are treated successfully. Only a qualified doctor or dermatologist can determine if you are eligible for treatment.

If you have lesions such as age/liver spots, broken capillaries, telangiectasia (purple or blue veins on the face), hemangiomas (sacs of red, purple or blue blood vessels resembling a blister, aka strawberry hemangiomas), freckles, port wine stains, tattoos, varicose veins, spider veins, flat birth marks or hypo-pigmentation you may be a candidate for HI Light Pulsed Light Therapy. HI Pulsed Light Therapy can even remove fine wrinkles, facial flushing, rosacea, redness, minor sun damage, and even hair removal!

If you are a insulin-dependent diabetic, you can not be treated. Insulin-dependent diabetics run the risk of wound-healing and infection problems. Although diabetics who take prescription oral-medication, to be treated, you must provide a letter from your primary care physician, written on his medical office stationary stating that you are, indeed, approved for HI Pulsed Light Therapy.

Also, you should discontinue the use of any blood thinners such as Coumadin®, Heparin®, aspirin or other types of anti-platelet or anti-coagulant herbal remedies including and not limited to...

Garlic, Ginger, Cayenne, Papaya and Bilberry Tablets/Supplements, have anti-platelet properties and may inhibit vital clot formation. These medications are normally taken to remedy edema (fluid retention).

Gingko, Gingko biloba, & Selenium are powerful anti-coagulants. It is considered to be 3 times stronger than Vitamin E, which should also be avoided.

...for 10 days prior to your patch test and treatment. You are also not a candidate if you have a blood clot-forming disorder (i.e. excessive bleeding). Although you may have seen information on some websites stating that HI Pulsed Light Treatment does not emit radiation of any kind and is safe for treatment during pregnancy -- it is mentioned by the company that treatment should not be undergone while pregnant and to wait until after delivery to even have a patch test or spot treatment.

What To Expect At Your ConsultationOnce you find a respectable clinic or practice in your area and decide to make a consultation appointment, you will meet with the doctor or dermatologist and he or she will determine if you are a candidate to receive treatment. He or she will discuss your health, examine your skin and prior scars, ask you a million questions regarding your

family history (answer them honestly and disclose all!) and explain to you what can and essentially what cannot be successfully treated. Prepare to pay for a spot test or test patch if it is decided you are eligible. The hefty price of about $75 bucks will cover several areas that represent what will be treated. A wrinkle here, a capillary there, you get the picture. He or she will also advise you on approximately how many treatments and pulses per treatment that will be needed to achieve your desired goal.

After your test patch/spot treatment you will wait and watch the test area for any negative reactions such as blistering, hyper- or hypo-pigmentations, rashes, persistent redness, etc. and report them to your technician/doctor. If all is well you may schedule an appointment and you will be instructed on what and what not to do for the next two weeks before your first full treatment. For instance if you are taking any of the above supplements or medications you will have to discontinue them until a few days after treatment or until instructed otherwise. You will also be instructed not to tan as hypo-pigmentation (patches of skin lighter in pigment than your normal tone).

How HI Pulsed Light Therapy Is PerformedYour technician or doctor will ascertain your comfort and if desired a topical anesthetic may be applied. After the treatment area is numb a cold, soothing gel will be applied and a glass prism (pyramid) will then be placed over the gel and treatment area. An intense flash of light, or pulse, is flashed through the prism where it is directed at the treatment area to rid you of your complaints. This initial treatment may not be as aggressive as your following treatments so as not to possibly damage the skin and to determine your skin's tolerance for further intensive treatment. Treatments are usually performed every 3 to 4 weeks.

The Road To RecoverySince there is no real downtime you may resume your normal activities after a Pulsed Light treatment. However you must protect your treatment area from UV light, be it natural sunlight or tanning beds. You may be slightly pink or red directly after your treatment as well as have mild swelling. This should subside in a few days and if not you should inform your doctor/technician.

Risks & Complications of HI Pulsed Light TherapyAlthough rare, blistering or slight bleeding is possible as is hypo- or hyper-pigmentation (lightened or darkened areas of skin). If pigmentation problems occur, it may be anywhere from 3 to 12 months before normal skin tome returns. This is especially so with hypo-pigmentation (lack of color). Be aware that some patients may experience permanent skin pigmentation changes. Scarring is possible although it too is a rare occurrence.

Frequently Asked Questions About HI Pulsed Light TherapyComing soon! Please check back!

The Least You Need To Know

This incredible new therapy was pioneered by Dr. Patrick Bitter Jr. and is based on emitting high intensity pulses of light (not lasers) to penetrate the skin and rid you of various complaints.

Not everyone is a candidate for HI Pulsed Light Therapy. Only a qualified doctor or dermatologist can determine if you are eligible for treatment.

An ideal patient would be of white European descent with elastic, non-oily skin. Although many other types of skin are treated successfully.

HI Pulsed Light Therapy is capable of diminishing or fully ridding one of age/liver spots, fine wrinkles, facial flushing, rosacea, redness, broken capillaries, telangiectasia (purple or blue veins on the face), hemangiomas (sacs of red, purple or blue blood vessels resembling a blister, aka strawberry hemangiomas), freckles, minor sun damage, port wine stains, tattoos, varicose veins, spider veins, flat birth marks, hypo-pigmentation and even hair removal!

If you are prone to keloids, hyper or hypo pigmentation, are dark-skinned, darkly tanned or do not react well to burns you may not be an ideal candidate for High Pulsed Light Therapy. Also, if you have ethnicity (like Greek, Italian or African American, etc.) in your biological family, you may be prone to hyper or hypo pigmentation resulting from the procedure.

Prepare to pay for a spot test or test patch if it is decided you are eligible. The hefty price of about $75.US will cover several areas that represent what will be treated. Thereafter treatments are approximately $10. per pulse with a minimum of $100.US per visit.

Since there is no real downtime you may resume your normal activities after a Pulsed Light treatment. However you must protect your treatment area from UV light, be it natural sunlight or tanning beds.

Although rare, scabbing, blistering or slight bleeding is possible as is hypo- or hyper-pigmentation (lightened or darkened areas of skin).

Intense Pulse Light

Intense Pulse Light (IPL) is a non-invasive procedure that uses pulse of visible light to improve the appearance of the aging skin. It is most often performed on the face, neck, chest, and hands to erase the signs of aging.

(before & after)

Among these signs of aging are fine lines, red blemishes, mottled coloration, broken blood vessels, pigment discoloration such as freckles and age spots, enlarged pores, coarse or rough skin, loss of skin tone and elasticity, and general sun damage. A series of Intense Pulse Light (IPL) treatment brings a more youthful, smooth and revitalized skin appearance, with no downtime.

Intense Pulse Light (IPL) is clinically shown to reduce wrinkles and improve the tone of the skin by non-invasively stimulating new collagen production.

The type of response heard from patients after having Intense Pulse Light (IPL) is that they feel like their skin is lifted. There is a decrease in pore size, their skin feels tighter, and there is a reduction in fine lines and wrinkles.

What are the benefits?Intense Pulse Light (IPL) Treatments are beneficial for the following:

-Improve appearance of aging or sun damage skin (fine wrinkles, freckles, pigmentation)-Smoothen skin and reduce pore size -Improve skin tone or tightness -Reduce redness, flushing or Rosacea-No recovery time

Am I a candidate for Intense Pulse Light?The Best Candidates for Intense Pulse Light (IPL) are:• People with early skin aging changes and sun damage who desire healthier more youthful skin • People who suffer from Rosacea and experience flushing and redness of their skin• People who don't want to take time off to heal from laser resurfacing or chemical peels • Active people who want to improve their skin, but do not want to interfere with social or outdoor activities.

How does Intense Pulse Light (IPL) work?A specialized medical device delivers a series of pulses of light to the skin using settings that are customized to skin type and skin color. A series of five or more IPL treatments are performed at three-week intervals. The benefits of Intense Pulse Light (IPL) are consistent, visible changes from the first session, with little discomfort and minimal risk.

The light is changed to heat energy as it reaches to the level of the collagen beneath the skin surface. Red blemishes from broken blood vessels and brown spots of pigment from sun damage respond to the gentle, yet, Intense Pulsed Light.

What areas can be treated with Intense Pulse Light?Intense Pulse Light can be used on any part of the skin. IPL is especially effective for improving the appearance of the face, neck, and chest and hands.

What results can I expect from IPL? The effects of Intense Pulse Light (IPL) are cumulative. People with visible aging skin from the sun can expect to see smoother skin with a decrease in fine wrinkles, reduction in pore size and fading of sun spots. Others can expect to see a gradual decrease in overall redness, flushing and dilated capillaries. Many people with Rosacea can see improvement in the number of breakouts and are able to decrease or discontinue their medications.

Why are multiple treatments of IPL necessary? Depending on the number of conditions you are treating, and the severity of the individual problems, a series of five or more treatments of IPL, spaced three weeks apart, is our standard recommendation. You can return to work the same day and resume all regular activities. By dividing the full program into several treatments, the procedure provides gradual improvement with very low risk - and, it preserves the wonderful "no downtime" feature people appreciate so much.

Are there any side effects from Intense Pulse Light (IPL)?Immediately following the procedure you may experience some redness and/or a slight darkening of pigmented areas. The redness usually dissipates within 24 hours; however, darkened pigmentation may persist and peel lightly for up to two week. Makeup can be applied to the treated area immediately, if necessary. Additionally, tattoos may be lightened and hair growth may be impaired in the treated area, although it is not the intended purpose of this particular treatment. It is extremely important to wear sun block and avoid sun exposure on a daily basis to reduce any potential side effects.

What are the IPL treatments like? Each Intense Pulse Light treatment takes approximately 15 to 30 minutes. People with more sensitive skin may prefer to use a topical anesthetic cream applied 30-60 minutes before the treatment. After treatment, there is no discomfort - you can return to your normal routines and activities immediately. Occasionally, there may be signs of treatment such as redness or blotchiness that last for a few hours. You will see gradual improvement from each session, resulting in a dramatic improvement by the end of your treatment program. Results are long-lasting, usually a year or longer.

I'm interested - What do I do next?

WHEN LIGHT IS DEDICATED TO BEAUTY

For over a few years now, technological progress in the field of light ray use has opened up new scopes of application for medicine in general and aesthetic treatment in particular.

Enhanced control and safety has made light an indispensable vector for certain treatments such as laser, Pulsed Light, ultra-violet, chromotherapy etc...

In the specific field of aesthetics, unwanted hair, blemishes or signs of skin aging and skin or vascular stains can be attenuated or eliminated simply by repeated exposure to a flash of natural light that is filtered and made safe.

You too can benefit from state-of-the-art Pulsed Light (SPL™) technology for perfect customer satisfaction

Intense pulsed light therapy

Intense pulsed light (IPL) or flashlamp therapy is a non-invasive and non-ablative treatment that uses high intensity pulses of visible light to improve the appearance of vascular lesions including spider naevi, port wine stains, broken facial veins, rosy cheeks, thread veins of the legs, mild acne spots, freckles and age marks, and facial lines and wrinkles. The procedure of rejuvenating aged skin is referred to as photorejuvenation and may consist of a series of IPL treatments. Treatment of unwanted hair works best when the hair is deeply pigmented.

How does it work?

IPL systems work on the same principles as lasers in that light energy is absorbed into particular target cells with colour (chromophores) in the skin. The light energy is converted to heat energy, which causes damage to the specific target area. IPL systems are different to lasers in that they deliver many wavelengths (or colours) in each pulse of light instead of just one wavelength. Most IPL systems use filters to refine the energy output for the treatment of certain areas. This enhances penetration without using excessive energy levels and enables targetting of specific chromophores (these are skin components that absorb light).

IPL therapy is considered a non-ablative resurfacing technique, which means that it targets the lower layers of skin (dermis) without affecting the top layers of skin (epidermis). The results are not as dramatic as ablative resurfacing where both the dermis and epidermis are injured to produce a much more noticeable overall outcome. The advantage of IPL therapy is its minimal downtime – a patient can often have the procedure done in their lunch break and return to work immediately afterwards.

What IPL machines are available and what do they do?

There is a range of IPL machines including LumenisI® Quantum IPL® (the successor to PhotoDerm®), EpiLight® and Ellipse®. Individual machines may be specially designed to focus on certain problems but may not be equally effective.

Vascular lesions

For the treatment of spider and thread veins, and some vascular birthmarks.

Light pulses targeted at the red-pigment (haemoglobin) in the blood which heats and destroys the pigment without affecting the skin or other tissues.

Pigmented For the treatment of age spots, freckles, flat pigmented birthmarks and other skin

lesions discolouration problems such as melasma / chloasma and erythromelanosis of the neck (poikiloderma of Civatte).

Light pulses targeted at the melanin in the skin’s surface which heats and destroys melanin to remove the discolouration.

Hair removal For the treatment of unwanted hair.

Light pulses targeted at the hair follicle causing the hair to fall out and prevent further growth. Generally ineffective for light coloured hair.

Effect of IPL on a freckle

Close-up Dermoscopy

What does the procedure involve?

Prior to the procedure your specialist practitioner should explain the process to you and clearly define your expectations of the treatment. They should be able to tell you whether or not the results you are looking for will be achievable using this method. It is important that the correct diagnosis has been made by your doctor prior to treatment.

IPL treatments are normally straightforward. Make sure the technician has been properly trained and is experienced in IPL therapy.

Avoid sun exposure in the days and weeks before and after treatment.

A topical anaesthetic may be applied to the area but is not usually necessary. Cold gel is applied to the area being treated. IPL devices often have integrated cooling systems. The smooth, glass surface of the IPL treatment head is applied to the skin, delivering precise pulses of

light to the area being treated. Treatment sessions usually last about 20 minutes. A course of 4-6 sessions every 3-6 weeks may be

needed to achieve desired results. Most patients can return to work immediately after treatment.

Throughout the treatment session the patient must wear protective eyewear. IPL treatments are relatively painless compared to other facial rejuvenation techniques. The sensation has been likened to a light pinch or the snap of a rubber band, but some people find it distressing.

Are there any side effects?

Side effects are minor and include:

Pain druing treatment (reduced by contact cooling and if necessary, topical anaesthetic)

Skin turning pink and a little sore immediately after the procedure. Sensation of a mild sunburn (redness, peeling, swelling) that may last a few days after treatment. Rarely, skin pigment may absorb too much light energy and blistering can occur.

Sometimes the pigment cells (melanocytes) can be damaged leaving darker or paler patches of skin. White patches or scars are rarely permanent.

Hair loss may occur. Bruising affects up to 10% of patients

Facial lines and wrinkles

Ageing skin droops and develops wrinkles, lines and furrows. The severity of these changes in an individual depends on genetic tendency, skin phototype and exposure to environmental factors.

Dermatologists and cosmetic surgeons often use Glogau's classification when describing these ageing changes.

Mild – Few wrinkles, requires little or no make-up for coverage Moderate – Early wrinkling, sallow complexion, requires little makeup Advanced – Persistent wrinkling, skin discolouration with broken blood vessels and solar keratoses, often wears make-up Severe – Severe wrinkling and furrows, solar keratoses, often wears make-up but it may not hide the ageing changes

The Fitzpatrick classification of facial lines refers to the degree of wrinkling around the mouth and eyes:

Class I: Fine wrinkles Class II: Fine-to-moderately deep wrinkles and moderate number of lines Class III: Fine-to-deep wrinkles, numerous lines, and possibly redundant folds

How do facial lines and wrinkles form?

Facial lines and wrinkles (rhytides) form because of the following factors:

Ageing processes

Sun damage Muscle movement Gravity Injury Surgery Acne Other skin diseases with a tendency to scar (e.g. discoid lupus) Smoking

There is often a degree of asymmetry to the lines, as people tend to smile or frown more on one side than the other, or consistently sleep on the right or the left cheek.

Fine lines Fine lines and wrinkles arise because of irregular thickening of the dermis and because of a decrease in the

amount of water held by the epidermis. This is mainly caused by sun damage and exposure to environmental toxins such as tobacco smoke. Furrows Deeper lines or furrows are classified as dynamic or static. Dynamic lines appear with movement i.e. the activity of facial muscles. Static lines are unchanged with muscle movement. Eventually dynamic lines become static.

Crow's feet around the eyes are due to smiling and activity of the eyelid muscles (orbicularis oculi).

Worry lines on the forehead are due to contraction of the frontalis muscle when raising the eyebrows Frown lines between the eyebrows are due to contraction of corrugator

supercilii muscles and procerus muscle when concentrating or angry

Facial lines and wrinkles

Dynamic lines in smiling teenager Static lines (crow's feet) in 40's Worry lines

Extensive perioral lines Deep furrows Hollow-looking eyes

Sags and bags

Skin laxity or drooping is caused by several factors:

A reduction of the fat cells under the skin (subcutaneous tissue)

Loss of collagen and elastin fibres in the dermis reducing cutaneous strength and elasticity Gravity, which allows the lax tissue to sag

The result is:

Brow ptosis (the forehead sags so the eyebrows drop over the eyelids, which then feel heavy)

Eyelid ptosis (the upper eyelid drops, sometimes obscuring the pupil) Baggy upper and lower eyelids Sagging lower eyelids, revealing the reddened mucosal surface (ectropion) Hollow look to the eyes Tired-looking eyes with a prominent groove beside the nose (tear-trough deformity) Jowls (loss of jaw line) Loss of neckline

Elongated earlobes Dropping of the tip of the nose Thinning of the upper lip

What treatment is available?

Remarkable changes in facial appearance can be obtained, giving a younger appearance and improving complexion. Often combinations of different cosmetic procedures are required for the best results.

It is most important to protect the skin from the sun life-long using sunscreens on exposed areas daily, and to avoid smoking and exposure to second-hand smoke or other pollutants.

Moisturisers Ageing skin feels and looks better when moisturisers are applied regularly. These improve the water-holding capacity of the skin. Choose one that feels nice to apply, doesn't sting or burn or provoke acne.

Use tepid or warm tap water and a non-soap cleanser to wash your face twice daily.

If you will be outdoors even briefly, include UV-protection as part of your morning regime.

Anti-ageing formulas Many face creams may include so-called anti-ageing ingredients. These may include anti-oxidants and/or exfoliants including:

Topical retinoids

Vitamin c Alpha hydroxy acids Polypeptides Various plant extracts

With the exception of the topical retinoids, the effectiveness of many of these anti-ageing ingedients is unproven.

Resurfacing Resurfacing refers to various techniques in which the top layers of the epidermis are peeled off using chemical or mechanical means. Peels may even out pigmentation and improve skin texture. They can improve fine lines and static furrows but have no effect on dynamic lines.

Superficial and medium-depth chemical peels

Dermabrasion and microdermabrasion Neodynium:YAG or carbon dioxide laser resurfacing Non-ablative laser, intense pulsed light or thermal resurfacing including thermage

Implantation Individual lines and furrows can be lifted up with implants, i.e. temporary or permanent fillers or grafts. They can also be used to improve the appearance of a thinning lip.Botulinum toxin Botulinum toxin is most useful for dynamic lines. It can be used to paralyse the muscles that are responsible for frown lines, crow's feet and forehead lines. It can also be used to change the shape of the eyebrows and to soften so-called smoker's lines around the lips, among other uses. Cosmetic surgery Cosmetic facial surgery involves repositioning facial tissues (rhytidectomy) and altering the structure of the sagging tissues.

A facelift or mid-face lift remove excessive skin and tighten underlying muscles of the lower two thirds of the face (cheek and neck).

A forehead or brow lift, and mid-temporal lift reduce static lines and lift up drooping eyebrows. Rhinoplasty may lift up the tip of the nose, reshape it or thin out excessive tissue due to rhinophyma Upper and/or lower blepharoplasty removes redundant skin and fat pads from the eyelids. Correction of platysmal bands in the neck by an open plication technique improve the appearance of a

sagging neck.

Brown spots and freckles

Freckles

Freckles are small flat brown marks arising on the face and other sun exposed areas. They are most often seen in fair skinned people, especially those with red hair, but they are an inherited characteristic that sometimes affects darker skin types as well.

The medical term for this type of freckle is ephilis (plural ephilides). The colour is due to pigment accumulating in the skin cells (keratinocytes).

Skin pigment (melanin) is made by cells called melanocytes. They don't produce much melanin during the winter months, but produce more when exposed to the sun. The melanin is diffused into the surrounding skin cells, called keratinocytes. The colour of ephilides is due to localised accumulation of melanin in keratinocytes.

Ephilides are more prominent in summer but fade considerably or disappear in winter as the keratinocytes are replaced by new cells.

As the person ages this type of freckle generally become less noticeable. Apart from sun protection, no particular treatment is necessary.

Freckles

Lentigines

Larger flat brown spots on the face and hands arising in middle age also result from sun damage exposure. Unlike freckles they tend to persist for long periods and don't disappear in the winter (though they may fade). Commonly known as age spots or liver spots, the correct term for a single lesion is solar lentigo (plural lentigines).

Lentigines are common in those with fair skin but are also frequently seen in those who tan easily or have naturally dark skin. Lentigines are due to localised proliferation of melanocytes.

It is important to distinguish the harmless solar lentigo from an early malignant melanoma, the lentigo maligna. If the freckle has arisen recently, is made up of more than one colour or has irregular borders or if you have any doubts, see your dermatologist for advice.

Lentigines

Other brown marks

If the brown marks are scaly, they may be solar keratoses (sun damage) or seborrhoeic keratoses (senile warts). In this case there is a proliferation of keratinocytes.

Other brown marks

Solar keratosis Solar keratosis Seborrhoeic keratosis

Treatment of brown marks

Brown marks may fade with careful sun protection, broad spectrum sunscreen applied daily for 9 months of the year. Regular applications of anti-aging or fading creams may also help. These may contain hydroquinone, or antioxidants such as:

alpha hydroxy acids

vitamin-C retinoids azelaic acid .

However, brown marks may be removed more rapidly and effectively by chemical peels, cryotherapy or certain pigment lasers that target melanin in the skin.

Suitable green-light devices include:

Flashlamp-pulsed tunable dye laser

Frequency doubled Q-switched Nd:YAG laser (neodynium:yttrium-aluminium-garnet) KTP laser Krypton laser Copper bromide laser

Suitable red light devices include:

Q-switched Alexandrite

Q-switched Ruby

Intense pulsed light has a similar effect. Carbon dioxide and Erbium:YAG lasers vaporise the surface skin thus removing the pigmented lesions.

Results are variable but sometimes very impressive with minimal risk of scarring.

With superficial resurfacing techniques, there is minimal discomfort and no down-time but several treatments are often necessary. Unfortunately the treatment occasionally makes the pigmentation worse. Continued careful sun protection is essential, because the pigmentation is likely to recur next summer.

Effect of treatment

Before (left) and after (right) green

laser light

Before cryuotherapy After cryotherapy

Beyond Lasers: Pulse-Light Therapy for That Fantasy Face

July 27, 2000 -- It's not as if Tina Huoso needed a face-lift. At age 31, she was essentially wrinkle-free. A handful of superficial acne scars, reminders of her teen-age years, were just about her only blemishes.

But the brown sun blotches that began appearing on her forehead, and especially one above her lip, made Tina self-conscious. "I put a lot of concealer to blend it in, but I really don't like wearing a lot of makeup," she tells WebMD. "It looked like I was covering something up."

Huoso is an assistant to Atlanta facial plastic surgeon Seth Yellin, MD. She took advantage of the newest technology -- intense pulse-light therapy -- to smooth her imperfections. "People commented," she tells WebMD. "They said I looked great, that I glowed." As for the blotches, "They're gone."

It's the new way to keep aging at bay.

Growing numbers of dermatologists are now using intense pulse-light therapy -- instead of lasers -- to smooth and soothe facial woes. With this new magic wand, they can delete fine-to-moderate lines and wrinkles, remove unwanted facial hair, and erase a whole array of pigment problems, including sunspots. Doctors say it actually tightens up those unsightly pores -- perhaps permanently.

And for many people with an embarrassing condition called rosacea -- a facial redness caused by spider veins and acne-like outbreaks -- this may be the first true treatment, doctors say.

Best of all, there's no "downtime" as there is with laser treatments. "It's truly a lunchtime therapy," says Yellin, who is assistant professor of facial plastic surgery at Emory University School of Medicine.

Intense pulse-light skin therapy won FDA approval for hair removal five years ago. In the past few years, dermatologists have discovered many more uses for this technology, which involves pulsed multiple lengths of light rays, explains Yellin.

While it may sound like a laser treatment, "it's not a laser," Yellin tells WebMD. "We can select from multiple wavelengths of light [whereas lasers use one continuous light wavelength.] We can enter into the computer the skin color, body area, skin type to generate specific settings. During treatment, multiple wavelengths of light are entering the skin, concentrating their energy at different levels. That allows us to treat many, many different problems."

"In terms of superficial problems, it works great," says Ronald Moy, MD, editor-in-chief of the journal Dermatology Surgery. "I've treated famous movie stars, a pretty particular crowd. For those in their 40s and 50s who don't have deep lines, there's really no down side." Moy is also an associate clinical professor at UCLA.

Two years ago, dermatologist Patrick Bitter Sr., MD, of Los Gatos, Calif., developed the first treatment for rosacea. In over 20 years of practice, he had seen no good solutions for this common but complex disorder. "People have tried various laser treatments, but they never were very successful," Bitter tells WebMD.

In his study of 57 patients with an assortment of problems -- photo aging, scars, wrinkles, and rosacea -- Bitter found 89% patient satisfaction with the level of clearing. "Patients were thrilled with it, especially when it came to the redness of rosacea," he tells WebMD. "People suffer from that for years ... it makes a huge difference to them." As for pore problems, Bitter says, genetics rule. "It will not decrease pores beyond the genetic limitations," he says. "But they will be substantially smaller."

During treatments, Yellin explains, "light energy is sent through the outer skin -- the epidermis -- and energy is concentrated on the dermis, the deeper part of the skin. Because the light generates heat, it stimulates cells in the body that go on to form more collagen, as much as 20% more."

Because it "plumps the skin, it's like giving yourself a collagen injection but using your own collagen," says Yellin.

There's no down time because no healing is involved, he says. "Unlike laser therapy, it attacks the problem from the inside. It leaves the outer skin completely intact, so there is no visible damage to skin. Because skin is left completely intact -- because it is not damaged -- it doesn't need to heal."

"The vast number of patients cannot tolerate any down time, don't want the stigma of the red face that comes with lasers," Yellin tells WebMD. "When you laser someone, they may be red for six weeks to six months. There's a week of real peeling, where you have to cover your face with Vaseline and hide. It's a significant disruption in someone's lifestyle."

"You don't want a shotgun to kill a fly," he adds. For relatively small problems, "pulse-light therapy is fabulous."

Facial therapy procedures take about 45 minutes, whereas hair removal times will vary depending on the area being treated. Afterward, there is "just a flush, not really redness," Huoso says. "It goes away in an hour or two. You can apply makeup right afterwards. I had it done on my lunch hour and went right back to work."

Typically, six treatments are necessary for most problems with a pricetag of a little more than $2,000 for a the series.

While Huoso says she doesn't think the treatments hurt, some might find them a bit painful, she says. She had her procedures done without anesthetic but says some patients may opt to have some anesthetic applied to the skin. "You'd be surprised," she says. "Your face is less sensitive than you would think ... You just feel a bit of heat."

Intense pulse-light therapy won't work with deep wrinkles. "It's not a panacea for everything. But we've replaced almost all other laser treatments with [this technology]."

Light Therapy is a treatment method which uses lasers, leds, fluorescent lamps for a limited time to the spot.

The method has a proven efficiency on Acne vulgaris and SAD.

Which Acne Alternative Treatment Is Right For Your Acne?

If you suffer from acne then you already know that there are hundreds of acne alternative treatments being sold in stores and online. In fact if you do a search for acne alternative treatments using the Internet you will find a myriad of websites that are stuffed full of testimonies from former acne sufferers who have used the latest zit and pimple treatments in order to eliminate their irritating skin blemishes. Unfortunately what these testimonies can't do for you is guarantee the elimination of your acne because every individual that has acne could very well need a different type of acne fighting solution. The actual proof is in the pudding so to speak. You won't know 100% for sure if an acne alternative treatment will cure your blackheads until you actually try it out on your acne.

For many consumers that have successfully eliminated their acne it only came after they had gone through a lineup consisting of acne topical treatments, a dose of pimple fighting antibiotics and in the most serious acne cases a prescribed treatment using Accutane. If these are considered the traditional methods of treating your acne then what about the alternative or nontraditional acne fighting solutions? Can they effectively prevent an acne outbreak from happening on your skin? Just like the routine ways of fighting zits, you won't know if an alternative method will work until you actually try it for yourself.

Before trying any alternative acne treatment it is highly recommended that you become an educated consumer. You can accomplish this task by asking around with your family and friends, chances are one of them is suffering from acne or has recently cured their acne outbreak. Check to see if they used any type of alternative means or methods to clear their skin up. If they did, then use that combination of prescribed treatment on your own acne to see if you can duplicate the same results. I'm sure you already know this, but traditional acne remedies are rather expensive. Fortunately many of the active acne fighting ingredients are the same in the cheaper alternative solutions. It may be worth it to experiment with the lesser priced creams and zit cleansing solutions in order to cure your acne at a reasonable price.

One aspiring method of alternative acne treatment involves the use of a naturopath. This professional specializes in the use of gentle cleaners made from herbs and vitamins to treat you acne. In fact, they have been known to clear up acne by prescribing a simple treatment plan consisting of regular dosages of Vitamin A, which is what the more expensive Accutane is derived from.

Another very promising method of alternate acne treatment focuses on the use of red and blue ultraviolet rays of light. This regiment of light therapy treatment can be done in the comfort of your own home with a laser that safely emits the required light rays. For a more powerful application you can seek outside help from a trained esthetician who specializes in using a more power light emitter too cure your acne.

The reality is even if traditional means of curing acne don't truly work on your eliminating your unsightly skin blemishes you don't have to despair. There are many different acne fighting alternative treatments that you can easily and safely try out to see which one is right for curing your zits and pimples.

Introduction to PhototherapyLight therapy has been used by ancient cultures (Greeks, Egyptians, Chinese) for thousands of years. It is only recently that science has been able to explain these healing principals and apply them in a manner that is safe and efficient for healing and anti-aging purposes.

Phototherapy is the scientific application of light, to specific points of the body to activate or produce particular physiological results. There is often some confusion, when discussing the behavior or light in tissue. When light is generated, and travels through air, it can be described as being comprised of electro-magnetic waves, measured in nanometers (nm). However, it is the "energy" that we are most interested in. It is the proper combination of

energy output, type of light wavelength and absorption of energy in the cell that assists in skin rejuvenation and anti-aging.

The activities caused by phototherapy increase vascularity in the formation of new capilaries as well as help to replace damaged ones. Certain wavelengths of light also stimulate the production of collagen. The chemical comound ATP (adenosine triphosphate) is a major carrier of energy in cells and its release allows for a faster acceptance of nutrients in cells and the removal of toxins when stimulated by phototherapy. Increases in lymphatic funciton also occur with the application of phototherapy.

The Benefits Increases collagen production by

50% thus reducing wrinkles. Creates more skin moisture to help

fill out the skin. Increases circulation, providing a

healthier skin tone. Restores the skin’s natural cellular

(collagen) activity. Reduces melanin production, which

causes brown ages spots.

Promotes nutritional elements existing within the skin. Because it plumps up the skin, its like giving yourself a collagen injection…but using your own collagen.

The Procedure

The LightWave Skin Rejuvenation System allows therapeutic light waves to penetrate the epidermal layers of the skin enabling

increased circulation by escalating the formation of new capilaries. New capilaries speed up anti-aging processes by supplying additional oxygen and nutrients needed for cellular healing.

The photothearpy application of the LightWave Skin Rejuvenation System increases RNA and DNE synthesis helping damaged cell

components to be replaced more rapidly. It stimulated the production of collagen which allows the skin to maintain elasticity

and a wrinkle free appearance

“Beyond Laser” Pulsed-Light Facial A Breakthrough TreatmentSuccessful Treatment of Redness & Flushing

Rosacea is a common complexion disorder, which causes facial redness, flushing of the nose, cheeks,

forehead, chin & neck, dilated capillaries and acne. As many as 13 million Americans, usually over the age of 30,

are affected by this condition. Up until now, lasers have been used to treat the capillaries, but there has been no

treatment to control the embarrassing & uncomfortable flushing & redness.

Now, a new treatment has been developed, based on research by a dermatologist in California. It uses pulses

of light to eliminate the redness & flushing of rosacea. In a study of 16 patients with rosacea, facial redness was

treated using intense pulses of light from a PhotoDerm™ (ESC Medical). This laser-like medical device allows the

doctor to precisely set the characteristics of light energy for each patient’s skin, permitting exact treatment of the

dilated blood vessels and redness without injuring the remainder of the skin. With this treatment, the entire face (or

the affected part) is treated in 8-10 minutes using repetitive flashes of light from the PhotoDerm™. Then, after

healing, microdermabrasion will be considered. No anesthesia is necessary. Patients experience only mild

redness immediately after the treatments. All patients are able to return to their full activities immediately.

Every patient saw improvement in eliminating redness, flushing & capillaries immediately. Maximum benefit occurred after 3 treatments. Flushing was reduced at least 80%. 100 percent of patients achieved much smoother skin, and smaller pores. It has been observed that the pimple-like breakouts disappeared or even stopped entirely when the flushing was eliminated. Some patients were even able to

discontinue dermatological medications they had taken for years. Redness of the neck & chest is also

treatable by this method. No adverse reactions or scarring was observed. With pulse light treatment, people no

longer need to suffer the embarrassment of red faces, red necks, red chests, or the discomfort of flushing. The

PhotoDerm not only treats the redness of rosacea but also shows promise as a possible cure for rosacea. Few

things are as dramatic as the elimination of a red face that a person has suffered from for years.

WRINKLES BE GONE!

• Intense Pulsed Light Treatments for Aging Skin

• Pulsed Light: An Alternative to Laser Resurfacing

Over the past six years, laser skin resurfacing has gained great popularity in the treatment of facial lines and

wrinkles. The disadvantage with laser skin resurfacing is the lengthy “downtime” and persistent redness following

the procedure, lasting from 3 weeks to 3 months. Now there is a nonsurgical alternative to laser skin resurfacing

using intense pulses of light. A series of three to five 15 minute treatments requires no anesthesia a results in

dramatically smoother, softer skin that has few wrinkles, smaller pores and less redness. Patients are able to

return to work immediately following treatments.

The treatments are effective for the aging of non-facial skin where laser resurfacing of these areas poses a

much greater risk of scarring. PhotoFacials™ are especially beneficial for younger patients with fine lines and

early signs of aging who are not candidates for laser resurfacing. PhotoFacials™ involves less expense,

discomfort and downtime. They are the ideal treatment for individuals with early aging changes and for redness

and flushing.

Answers About the Pulsed-Light Facial Using Intense Pulse Light

The treatment involves a unique pulsed light rather than the intense hot laser beam, which improves the

appearance of sun damaged and aged skin, as well as reducing facial & neck redness and flushing. PhotoFacial

treatments result in a more youthful-appearing skin

The Ideal and 1st Long-Lasting Treatment

Seventy million Americans have an undesirable redness and/or sun damage of the face. The causes are:

Rosacea, sun exposure, alcohol, medications, stress, emotional causes, time and aging of the skin. It occurs most

commonly in fair-skinned individuals of northern European descent. Some of these individuals have a condition

called Erythrophobia - a morbid fear of having a red face. In severe cases, emotional & social problems occur.

The New Treatment for Redness, Wrinkles & Dilated Facial Blood Vessels

An intense light is emitted in a series of gentle pulses at intervals of approximately three weeks for a series of

five treatments. This is different than laser treatments, which emit light over many wavelengths, allowing the light

to penetrate To all the levels of the skin where abnormal easily dilated vessels can be destroyed. Lasers do not

work because they use only a single wavelength of light, which is limited in depth of penetration.

It Works Well if There is General Skin Redness

The intense light, because of its unique nature of emission, attacks the tiniest of vessels, which can only be

seen by a microscope.

Most Patients Have 75-95% Improvement - On Average, a 90% Improvement is Seen

It will also help patients who suffer prematurely from excess sun exposure, pigmentation (Age Spots),

irregularities of skin texture, and it can improve mild acne scars, reduce large pores and dark circles around the

eyes and helps reduce fine lines, especially around the eyes and mouth.

Most people require 3-5 treatments, and, if necessary, a follow-up treatment in 2 or more years to maintain the “fresh” look, and to avoid the likelihood of future treatments.

This treatment won’t help frown lines, especially the forehead and between the brows and eyes, or next to the

nose. This requires Botox cosmetic injection therapy, or a surgical face lift. It is not a substitute for a face-lift and

will not help baggy or sagging skin, or puffiness around the eyes. This requires Kool Touch laser therapy or

blepharoplasty. It is not a treatment for skin cancer. It won’t remove bumpy moles, but can remove their pigment. It

will remove, however, acquired freckling. genetic freckles usually return after treatment. It won’t remove those

strands of deep parallel blood vessels occasionally seen on lower cheeks, which can be removed in other ways. It

will not remove seborrheic keratosis including the tiny genetic ones on the upper cheeks and around the eyes

sometimes called dermatosis papulosa nigra. It also won’t remove sebaceous hyperplasias, a benign growth of

some oil glands in mid-life.

The Contraindications for This Procedure

• Connective tissue damage or auto-immune disorders

• Pregnancy

• Recently sun-tanned skin (or in those who will receive excessive sun exposure for a few weeks following

treatment

• Usage of Accutane, or for 6 months after stopping Accutane

• Active acne cysts and large pustules

• Severe active rosacea

Most medications such as antibiotics, anti-anxiety, sulfa drugs, birth control pills and anti-hypertensive

medications are not a contraindication. Care must be taken in patients who get fever blister attacks on the face.

An anti-herpes medication can be taken, thus avoiding the problem.

The most common side effects are mild and of short duration, which can consist of short-term discomfort.

There is redness immediately following treatment, lasting less than 24 hours. (Rarely, it may last up to three days.)

Mild blistering and bruising is possible but in our experience occur in less than 1% and usually clear very quickly.

Post treatment pigmentation, or hypo-pigmentation, has been noted on occasion, but is highly treatable and

fortunately very rare. Scars or infections of the skin after treatment have not been reported in the research, but

they can occur. Swelling of the face for 3-5 days occasionally occurs and is most common in severely sun-

damaged skin due to reduced quality of connective tissue around the blood vessels.

To receive this treatment it is necessary for the patient to complete a general medical questionnaire on the

nature of the skin to properly evaluate the correct settings for their skin condition and skin type. Pre-treatment,

mid-treatment and post-treatment photos will be taken. An informed consent sheet and photographic permit form

must be signed. All questions must be asked and answered by the patient prior to treatment.

If you have a low pain threshold or sensitive skin ....

A topical cream can be applied 30-60 minutes prior to the treatment, eliminating most discomfort. This is only

required in 50% of patients who have sensitive skin.

Each treatment takes approximately 15 minutes. It is important to remove all make-up or creams. Men will be

asked to shave on the day of treatment. Eye shields/goggles will be applied to protect the eyes. A soothing gel will

be placed on the skin prior to treatment, which will help reduce discomfort. After the procedure, ice may be applied

to the area, and any additional post-treatment instructions will be given.

This is superior to laser resurfacing because laser resurfacing does not affect or remove blood vessels or

flushing. In fact, it can worsen this condition, and is unsightly and requires time away from work and your usual

everyday activities for two week up to a few months.

With space age intense pulsed light, you can have glowing, smooth, blush-free skin with NO DOWN TIME

from work or play. You can usually go to work the same day or the following day without the stares of friends and

strangers. No procedure has ever been developed that can accomplish so much with such low risk and no down

time. The treatment is based on research and development by dermatology and varicose vein treatment

specialists.

The same results cannot be achieved with chemical peels, microdermabrasion (Power Peel™, Parisian

Peels™, DermaPeel™) alone. It must be used combined with intense pulsed light, not laser.

Contrary to what some doctors say, there is no laser that can duplicate the efforts of intense light therapy. The

laser cannot reach all the levels of the skin in a manner similar to intense light. There is no alternative to this

exclusive mode of treatment. Acne scars will be improved with pulsed light therapy

Especially the shallow scars including fine lines will be improved, but ice pick type acne scarring and deep

scars will not be helped. Laser resurfacing or dermabrasion may be indicated here. If the scars are milder and do

not respond to PhotoFacial alone then we often add another procedure called microdermabrasion to the treatment

schedule.

Other parts of the body can also be treated successfully, much like the face. It is especially noticeable in

getting rid of the “V-neck” effect of sun damage that has accumulated in these areas from years of sun exposure.

Scientists who treat rosacea believe that there is hope to control the embarrassing blushing that gets worse with

age and time. Breakouts from rosacea can be diminished in frequency. Some rosacea patients are able to stop

taking antibiotics they have been taking for years, and the need is reduced for topical cortisone creams.

1. What is Intense Pulsed Light?

This incredible new therapy was pioneered by Dr. Patrick Bitter Jr. and is based on emitting high intensity pulses of light (not lasers) to penetrate the skin and rid you of various complaints. There are different machines for different levels or types of penetration. It is also knows as IPL Photorejuvenation. For instance, PhotoDerm™ as the PhotoDerm VL (vascular lesions) {VascuLight/MultiLight}, PhotoDerm PL (pigmented lesions) or PhotoDerm HR (hair removal).

2. When can Intense Pulsed Light be performed?

There is no decisive age regarding this therapy.

3. What does a typical Intense Pulsed Light consultation entail?

Once you find a respectable clinic or practice in your area and decide to make a consultation appointment, you will meet with the doctor or dermatologist and he or she will determine if you are a candidate to receive treatment. He or she will discuss your health, examine your skin and prior scars, ask you a million questions regarding your family history (answer them honestly and disclose all information) and explain to you what can and essentially what cannot be successfully treated. Prepare to pay for a spot test or test patch if it is decided you are eligible. He or she will also advise you on approximately how many treatments and pulses per treatment that will be needed to achieve your desired goal.

After your test patch/spot treatment you will wait and watch the test area for any negative reactions such as blistering, hyper- or hypo-pigmentations, rashes, persistent redness, etc. and report them to your technician/doctor. If all is well you may schedule an appointment and you will be instructed on what and what not to do for the next two weeks before your first treatment. For instance if you are taking any of the above supplements or medications you will have to discontinue them until a few days after treatment or until instructed otherwise. You will also be instructed not to tan as hypo-pigmentation (patches of skin lighter in pigment than your normal tone).

4. How is Intense Pulsed Light performed?

Your technician or doctor will ascertain your comfort and if desired a topical anesthetic may be applied. After the treatment area is numb, a cold, soothing gel will be applied and a glass prism (pyramid) will then be placed over the gel and treatment area. An intense flash of light, or pulse, is flashed through the prism where it is directed at the treatment area to rid you of your complaints. This initial treatment may not be as aggressive as your following treatments so as not to possibly damage the skin and to determine your skin's tolerance for further intensive treatment. Treatments are usually performed every 3-4 weeks.

5. What should I expect after my Intense Pulsed Light treatment?

Since there is no real downtime you may resume your normal activities after a Pulsed Light treatment. However you must protect your treatment area from UV light, be it natural sunlight or tanning beds. You may be slightly pink or red directly after your treatment as well as have mild swelling. This should subside in a few days and if not you should inform your doctor/technician.

6. Does Intense Pulsed Light hurt?

Although all pain thresholds are different -- you may feel anything from a sensation of warmth to a sting as if a rubberband has been snapped against your skin. Some patients may wish to use an EMLA cream beforehand.

7. When will I be able to see the results?

After one or two treatments you should see results depending upon the complaint -- However, some problems may take several to see any results. Only a consultation with a qualified physician can determine this factor.

8. What are the risks of Intense Pulsed Light?

Although rare, blistering or slight bleeding is possible as is hypo- or hyper-pigmentation (lightened or darkened areas of skin). If pigmentation problems occur, it may be anywhere from 3 to 12 months before normal skin tome returns. This is especially so with hypo-pigmentation (lack of color). Be aware that some patients may experience permanent skin pigmentation changes. Scarring is possible although it too is a rare occurrence.

9. What is Arnica montana or Bromelain, I have heard that these homeopathics reduce swelling and bruising? Which is the best kind to take?

also known as: Mountain Tobacco, Mountain Arnica, Common Arnica, Leopard's Bane and Sneezewortplant family: Asteraceae type: Herbaceous perennialparts used: Roots and flowersdescription: Arnica montana or Leopard's Bane is a perennial herb, growing close to the ground. The leaves form a flat rosette, from the center of which rises a flower stalk, 1 to 2 feet high, bearing orange-yellow flowers. The rhizome is dark brown, cylindrical, usually curved, and bears brittle wiry rootlets on the under surface.habitat: Indigenous to Central Europe, in woods and mountain pastures, although it has been found in England and Southern Scotland. warning: This herb should NEVER be taken in raw form. This plant, like many medicinal plants if ingested, can cause intestinal bleeding, abdominal cramping and sickness. Homeopathy is the medicinal use of tinctures and suspensions using herbs and other plants and should never be consumed without proper preparation. Only respectable homeopathic remedies and tinctures should be consumed.

from the plant of the: Pineapplealso known as: Ananas, Nanas, Pinaplant family: Bromeliaceae

type: herbaceous perennialparts used: mostly in the stems of pineapples, but some fruit is used as well.description: 2 1/2 to 5 ft. high with a spread of 3 to 4 ft. The plant is like a thick stem with a rosette of wide, waxy leaves. These pointed green, red, and white/off white striped leaves are approximately 18 - 70 inches long and graced with a spiny needle-like tip. The plant produces a sweet to tangy and sometimes sour fruit that is yellow to white in color. The unpeeled fruit is brownish with a hard, spiky covering and a large green sprout from it crown. The fruit is shaped like a coffee can with rounded ends and is about 10-12 inches long usually when considered prime and may even weigh up to 10 lbs.

habitat: Indigenous to southern Brazil and Paraguay, The fruit is now grown all over in green houses and in the fields of Spain, Guatemala, Hawaii and more. The pineapple is a tropical plant and thrives in hot, humid places. Although it can survive cold snaps, it is not recommended for the more northern areas if intended to be grown outdoors.

Bromelain is an anti-inflammatory formula containing the proteolytic enzyme from the stems of pineapples. Proteolytic enzymes are capable of dissolving proteins. It is most often used after sports injuries, to relive edema and after surgical procedures to help with swelling.

ALWAYS ASK YOUR SURGEON FIRST BEFORE TAKING ANY MEDICATION.

*Enhancement Media has NO financial ties to Alpine Pharmaceuticals, SinEcch, and merely suggests it for your convenience and post-operative ease.*

10. Are the results permanent?

Depending upon your habits (sun exposure, skin care, use of sublock, medication use, etc), hyperpigmentations may be fully eradicated. Collagen replacement due to the thermal wound response is subject to natural aging as the rest of your collagen. The longevity is complaint-specific and only a qualified physician can determine this factor.

What is Intense Pulsed Light?

Intense Pulsed Light (IPL) also known as photo-facial, fotofacials, and photo rejuvenation is a state-of-the-art system and the latest technique in photofacial therapy. The IPL system delivers high intensity, smooth and powerful pulses of light (not lasers) that greatly enhances the results of your skin rejuvenation. For skin therapy, IPL stimulates new collagen growth resulting in smoother, more even, healthier skin.

How Does it Work?

A highly advanced computer regulates the light pulse to a specific wavelength range, which in turn heats a portion of the skin. This removes the unwanted tissue while it spares or avoids the surrounding healthy or "normal" tissue. The penetration depth and degree of heat is highly controlled to minimize complications. With IPL fotofacial rejuvenation, the light pulses are directed at the blood vessels, age spots, freckles, flat pigmented birthmarks and other types of discolorations.

An additional bonus is that the treatment causes inflammation of tiny blood vessels in the skin which stimulates the production of new collagen.

It is possible to shrink sebaceous glands (oil glands), and pore size, with repeated treatments. The number of treatments necessary to achieve this result varies from patient to patient.

How is the IPL Photo rejuvenation different from CO2 or Erbium Laser Resurfacing?

IPL photo rejuvenation is a noninvasive, safe method to improve the look and feel of the skin without undergoing the pain and downtime associated with deep laser resurfacing. Deep laser resurfacing removes the entire epidermis leaving the skin vulnerable to infection and requires 3-4 weeks of patient downtime and an even longer time to complete healing.

We also combine Fotofacials with Levulan in a procedure called Photodynamic Skin Rejuvenation. This is the ideal treatment for moderate to severely sun-damaged skin. If you have pre-cancerous skin lesions (Actinic Keratoses), this is an excellent way to improve your skin.

Who is a Good Candidate?

IPL is an excellent choice for women and men of all ages considering treatment for various skin problems including:

Brown or age spots. Facial spider veins. Rosacea. Abnormal Skin pigmentation. Large Pores. Enlarged oil glands (sebaceous hyperplasia)

You should NOT have IPL Fotofacial treatments if you have:

Lupus. A tendency for form thick scars after you heal (keloids). A tendency to develop increased or decreased skin pigmentation when healing. A dark skin colour (South Asian, African). A dark tan. Porphyria (A blood disorder that makes you sensitive to light). Extreme sensitivity or allergy to light

What are the advantages of IPL treatments?

The treatment is gentle. There is no interruption of routine activities. There is often no recovery time required or time needed to be taken off work. There are no stitches, cuts or bleeding to worry about. Improvement is subtle. In this way, your friends, family and spouse don't have to know that you're having

treatments, unless you want them to.

What are the risks?

Some mild swelling or bruising may occur. Swelling is more common in patients with very red or pink toned skin that are having treatments to reduce redness.

Bruising may occur if many large facial blood vessels are being treated.

Although rare, blistering or slight bleeding is possible as is hypo- or hyper-pigmentation (lightened or darkened areas of skin). If pigmentation problems occur, it may be anywhere from 3 to 12 months before normal skin tone returns. This is especially so with hypo-pigmentation (lack of colour). Some patients may experience permanent skin pigmentation changes.

Scarring has never been reported after an IPL treatment. It is impossible to get permanent results. Even though the skin may be “rejuvenated” for long periods,

the aging process continues. The skin will usually improve with further treatment. It might be impossible to remove a lesion forever or get permanent results. Even though a lesion may be

diminished or “disappear” for long periods of 3-6 months, it might return in the future. The fact that the lesion responded to treatment but recurred usually means that it will improve with further treatment

Does it Hurt?

There is discomfort associated with the treatment. Each pulse of the IPL feels like an elastic band snapping against the skin. Numbing creams such as EMLA and Maxilene can be used prior to treatment, but are generally not required.

To make the treatment more comfortable the laser is equipped with a chilling tip that cools the skin prior to treatment.

Furthermore, we have recently acquired a unique Zimmer Cryo Chiller for added patient comfort. This machine blows cool air onto the treatment area which helps to reduce discomfort. This makes the procedure significantly more pleasant. Many offices do not offer this added feature.

How should you select where you should go for Fotofacials (IPL) treatment?

Unfortunately there are no government regulations as to who can own or operate an IPL (Intense Pulsed Light) machine. There is no minimal training required by regulatory agencies and virtually anyone who has the capital can purchase a machine and start doing treatments. For those reasons, you have to be very careful where you go.

There are several questions you should ask.

1. Is the clinic a doctor's office or a spa? IPL can be potentially dangerous if not used by well trained technicians.

2. How long have they been doing treatments? 3. Is there a doctor? Is the doctor someone who is specialized in skin care and IPL therapy such as a

dermatologist? Or is the doctor a family doctor? Dentist? Chiropractor?

What are the qualifications of the technician who is treating4. you?. 5. What type of IPL machine are they using? 6. Who will manage any complications is they should happen to arise? 7. Does the technician do a full and in depth consultation with you to ensure that you understand the pros

and cons of treatment, the risks and benefits? 8. Do they take photographs to help monitor improvement? 9. Does a dermatologist check you first to make sure that you are a good candidate for therapy?

When will you notice improvement?

You will start to see results after one or two treatments, depending on the nature of the problem. Some skin problems will require several treatments before you see any difference.

What areas can be treated?

Any area can be treated. This includes the face, neck, chest, back, hands, arms, legs and feet.

How many treatments should you have?

A series of 5 treatments is usually recommended for most skin types and body areas. Treatments are usually done 1 month apart. Dr. Vignjevic will determine the number of treatments that your specific skin type and condition will require at the time of your consultation or treatment.

How should you prepare your skin prior to an IPL treatment?

Absolutely No tan coming into treatment . Treating skin with a tan can produce white “striping” which can take several months to fade. Your skin MUST NOT BE TANNED.

Stop the use of all Retin-A, Reversa, Glycolic acid products and toners a week before your treatment. If possible, come to your appointment without make-up.

Dr. Vignjevic recommends that even though most people do not have a significant down time after IPL, that you not plan any major events for 2 to 3 days after your fist IPL treatment. This will give you a chance to see how your skin reacts and how easily you can incorporate IPL treatments into your scheduleWhat is the procedure for IPL-Intense Pulsed Light-Fotofacial therapy?

1. At your first visit an IPL technician will provide a free consultation. During the consultation, she will discuss the benefits of IPL therapy, explain the procedure to you and answer any questions that you may have. Furthermore, she will explain how the procedure works and how many treatments you will need, and provide you with a price quote. She will also ask you a series of questions to determine if you are a good candidate for the procedure and to determine your skin type and sensitivity.

2. After your FREE consultation, the technician will call in Dr. Vignjevic. He will assess your skin type and whether IPL would be suitable for you. In addition, he will answer any further questions that you may have. You cannot be treated by the technician unless you are assessed by Dr. Vignjevic first. Dr. Vignjevic will select the treatment protocol that best suits your skin type.

3. If you decide to go ahead with a treatment, photographs will be taken of the treatment area. These photographs are strictly for your chart and will not be released or used without your permission. Your privacy is of the utmost importance to us.

4. You will be asked to wash your face and to remove any makeup. It is not necessary to remove mascara, lip stick or lip liner.

5. Your skin will be cleansed and any remaining make-up will be removed. 6. You may purchase an anesthetic topical cream to be applied prior to the light exposure. This is usually

not necessary. 7. Your eyes are covered with special goggles during the treatment. 8. A cold, soothing gel will be applied and a glass prism (pyramid) will then be placed over the gel and

treatment area. The portion of the IPL machine that is in contact with your skin is about the size of a quarter. An intense flash of light, or pulse, is flashed through the prism where it is directed at the area to be treated. This initial treatment may not be as aggressive as your following treatments so as not to possibly damage the skin and to determine your skin's tolerance for further fotofacial treatments.

9. You may need a spot or test patch to make sure there are no negative reactions. 10. During the treatment you may feel stinging, tingling, prickling, or burning of the lesions, but this should

go away after the treatment. A Zimmer Cryo-chiller is used to blow cool air over the skin to make the treatment more comfortable.

After treatment with Intense Pulsed Light, the gel will be11. washed off the skin using soap and water. Cicaplast, a healing cream is applied to the skin, and then a

layer of Anthelios 60 sunscreen is applied last prior to leaving the office. 12. You will be provided with a booklet of after-care instructions and the technician will recommend specific

products to take care of your skin after the treatment. 13. You will be provided with Doctor V's personal cell phone number should you have any questions or

concerns that arise after office hours.

What should you expect after your treatment?

There will be redness, and occasionally, mild blistering or bruising of the treated areas lasting from several hours to 3-14 days. The treated area might “crust”, “flake”, or look like a “cat scratch.” This will depend on the sensitivity of your skin and the severity of the problem being treated. Most people are completely healed within 7 days.

There may be some mild swelling, crusting or bruising which will go away after a few days, and if not, you should inform your doctor.

The dark areas or freckles may crust, turn black and “peel off’. This is normal and should resolve within 7 to 10 days.

Your skin will be more sensitive for a few days up to a couple weeks after your treatment. There should be some discomfort, but no significant pain. You can return to your normal activities.

What should a person do if they get significant redness, swelling, or pain after a treatment?

1. Apply very cool or cold compresses to the face every 15 minute. 2. Take Tylenol for the discomfort. 3. Spray La Roche Posay Eau Thermale on the skin after you have completed the compresses. 4. Apply Cicaplast regularly to the skin. 5. Avoid the sun or bright lights as much as possible. 6. Call the office where you had your treatment. They should be happy to help you and to answer your

questions. 7. If you are concerned that you have had an abnormal reaction, have a cold sore, or an infection - call

your doctor's office immediately.

Precautions for the first seven days after your IPL treatment:

Avoid contact between hot water and the treated area. Keep the area moist and protected with Anthelios 60 sunscreen. You should stay out of the sun, ultraviolet light and tanning beds, especially for the next 48 hours to

minimize the risk of getting increased pigmentation in the skin. If sun is unavoidable, use Anthelios 60 sunscreen for at least 4 weeks following treatment. For the first 2 days wear a wide-brimmed had or similar covering of light-opaque material. Sun exposure may lead to the production of blotchy dark pigmentation which may take several months to fade.

Avoid any aggressive skin care products such as scrubs, exfoliants, alpha or beta hydroxy acid products.

Avoid excessive heat exposure such as saunas, steam rooms, hot showers or baths, and strenuous exercising for 24 hours. This prevents the risk of blistering.

Keep clothing from rubbing the treated area and avoid other irritation to the area. Do not get hairspray on the treated area. Notify the office should you have any prolonged redness, excessive puffiness, or other unusual side

effects.

How should you take care of your skin after an IPL Treatment

Morning

1. To cleanse your skin, use a small amount of Toleriane Dermo Milk Cleanser and a soft cloth to remove it. You may use lukewarm water with it. If your hands or body has been treated, use Lipikar Syndet as a cleanser.

2. Gently mist La Roche Posay Eau Thermale (Thermal Water) on the treated area. The antioxidant and anti-irritant properties of the water will help calm the redness and promote healing.

3. For the first 2 weeks apply Rosaliac to area treated to reduce redness from treatment. After the first two weeks use:

o Reversa 8% anti-wrinkle cream if your treatment is for sun damage o Rosaliac if your treatment if for redness or rosacea o Toleriane moisturizer if your treatment if for precancerous sun spots o Your prescription cream if your treatment is for excess pigmentationo 4o *Important* Apply Anthelios 60 sunscreen to the treated areaso

4. 20 minutes before going outside, every day for 4 weeks. Use it even if there is little or no sunshine out. 5. Apply foundation/make-up.

Evening

1. Repeat steps 1 through 3. 2. for the first two weeks apply Toleriane moisturizer. After 2 weeks apply:

o Active C cream if your treatments are for sun damage o Your prescription if your treatments are for rosacea o Toleriane moisturizer if your treatment if for precancerous sun spots o Your prescription if your treatments are for excess pigmentation

Anthelios 60, Toleriane moisturizer Active C anti-wrinkle cream, Eau Thermale, Toleriane Dermo Cleanser and Rosaliac are available in my office for your convenience.

Laser and intense pulsed light (IPL) therapies for acne scars, injury scars and skin blemishes

Many people have facial scars and blemishes that they would like to reduce. Laser and intense pulsed light (IPL) therapy can provide an effective acne scar treatment, as well as being a solution to scarring due to injuries.

Laser and IPL therapies work by targeting intense light onto the skin. Your specialist will focus the light onto the area around the scar or blemish. The IPL or laser light then penetrates through the upper layer of your skin, effectively 'burning' it off. The treatment stimulates new skin to grow, and when the treated area heals, the scar or blemish is usually much less noticeable than before.

Following scar treatment by laser or IPL, your skin will be red and weepy, and redness will probably persist for several weeks. You'll need to use sunblock on the area for at least six months after treatment. The full results of your laser or IPL treatment will not usually be seen until ten to twelve months afterwards. Your specialist may also recommend further therapy six to twelve months after your first treatment.

The effectiveness of laser or IPL therapies for acne scar treatment and skin blemishes depends both on your skin type and on the extent and type of your scars. Often laser and IPL are used in conjunction with other cosmetic procedures to achieve the best results. Your specialist will advise if laser treatment is suitable for you. Lasers can cause an uneven colour in brown and black skins so the treatment may not be suitable for people with these skin types.

All procedures carry risks as well as benefits. The chance of complications following scar treatment by laser or IPL depends on the type of treatment and other factors such as your general health. Your specialist will explain how the risks apply to you.

LASERS, INTENSE PULSE LIGHT THERAPY,AND RADIO FREQUENCY RESURFACINGIssues involving cosmetic corrective surgical procedures are complicated enough, but when the topic turns to lasers, intense pulse light (IPL), or radio frequency resurfacing, what you will find is a clutter of complex, technical information that is hard to decipher. All this is further complicated by enthusiastic physicians making unrealistic claims and promises. An article in the Archives of Facial Plastic Surgery (January-March 2002, pages 6-7), summed up the problem beautifully: "In facial plastic surgery, many articles written by physicians may read more like advertisements than science, overestimating the advantages of laser surgery, while underestimating the disadvantages and complications. Currently, it is unclear who is benefiting from laser madness in medicine. Is it the patient, the physician, or the laser company?"

Perhaps the best way to start making sense of cosmetic resurfacing procedures is to describe the kind of resurfacing methods being used, how they work, and then explain what machines are employed to perform those tasks.

When it comes to lasers, IPL, or radio frequency resurfacing machines, they function as either ablative or non-ablative modalities. Non-ablative treatments target the lower layers of skin (dermis), while leaving the skin's surface (epidermis) unharmed and intact. Ablative laser resurfacing targets both the surface and the lower layers of skin by injuring or "ablating" the surface of skin. Lasers can perform either ablative or non-ablative resurfacing, while IPL and radio frequency resurfacing are considered non-ablative methods. Which system you choose depends on the results you are looking for and how much risk you are willing to take.

Ablative resurfacing can make a significant difference in the appearance of deep wrinkles, surface wrinkles, and skin discolorations. But there are serious risks and complications that can occur with ablative resurfacing. These include swelling, scabbing, oozing, bleeding, flaking, redness, and irritation, and there is also a risk of longer-term skin discoloration and scarring.

Non-ablative resurfacing has none of the side effects associated with ablative resurfacing. However, non-ablative resurfacing doesn't produce the same dramatic or impressive results as ablative resurfacing does. Not only are the results subtle, but multiple treatments are required for any kind of noticeable outcome. The advantage for non-ablative resurfacing is its minimal downtime; women can reapply makeup before leaving the doctor's office and return to work the same day.

Laser is an acronym for Light Amplification by Stimulated Emission of Radiation. In essence, lasers work by generating a concentrated and penetrating stream of pulsed bright light that can be controlled and strategically directed over the skin. Resurfacing the skin with lasers can work as ablative or non-ablative procedures depending on the type of laser utilized. An ablative laser literally vaporizes and removes deep wrinkling and scars from the surface of skin and penetrates deeper into skin tissue, reorganizing and stimulating production of collagen and elastin fibers in the process.

Non-ablative lasers can remove some skin discolorations, improve some wrinkling, and, with repeated treatments, help generate collagen and elastin. (Sources: American Academy of Dermatology, www.aad.org; and Cosmetic Dermatology, December 2002, pages 39-43.) For ablative resurfacing with a laser peel, the quality of the postoperative techniques is as important as the skill of the physician during the procedure. After ablative laser treatment, the skin oozes, crusts, and needs to be cleaned and dressed for about two weeks before you look even vaguely normal. Because the top layer of skin has been stripped away, the raw, exposed skin needs to be cleaned and treated very carefully. Patients need to make sure they follow post-op care instructions precisely, because inconsistency or incomplete care can cause infection, delay healing, and increase irritation.

The following is a list of the more popular lasers and light-emitting machines in use for cosmetic resurfacing: (Note: The cost of the various procedures can vary so dramatically from doctor to doctor that there is no way for me to provide a cost estimate for these treatments.)

CO2 Pulse Laser (trade names Feather Touch or Ultra Pulse): This is one of the oldest types of ablative machines around. Although it can create more lasting and noticeable results than any other laser, it is also

associated with the most risk and potential skin damage. The skin can take one to two weeks to heal and can be red for one to two months afterward. Risks of scarring, skin discoloration, and uneven texture must be weighed against the intended outcome, although these side effects are rare when the doctor is experienced with this kind of procedure (Sources: Dermatologic Surgery, April 2004, pages 483-487; Lasers in Surgery and Medicine, May 2003, pages 405-412; and International Journal of Dermatology, June 2003, pages 480-487).

Erbium:YAG Laser: This ablative laser is far less invasive than the CO2 Pulse laser and is considered effective for minor or superficial wrinkling. However, if the intensity of the machine is increased, deeper wrinkling can also be treated. Another option is the Variable Pulse YAG Laser which alternates frequency with pulses that heat the skin and cause ablation that resurfaces the skin almost as effectively as CO2, but with fewer side effects (Sources: Dermatologic Surgery, August 2004, pages 1073-1076; Archives of Dermatology, October 2003, pages 1295-1299; and Archives of Facial Plastic Surgery, October-December 2002, pages 262-266).

A combination of CO2 and Er:YAG laser treatments is now gaining popularity. In this treatment, the Er:YAG laser is first used to remove the epidermis, followed by use of the CO2 laser to achieve contraction of underlying collagen. This produces the collagen-tightening benefits of CO2 therapy but with minimal damage to surrounding tissues (Source: Department of Otolaryngology/Head and Neck Surgery at Columbia University and New York Presbyterian Hospital, http://www.entcolumbia.org/laserskinresurf.htm; and Dermatologic Surgery, February 2000, pages 102-104).

Long-Pulsed YAG Laser (tradenames CoolTouch and Lyra): This non-ablative laser is often used for wrinkles and reducing the appearance of acne scars. As is true with any non-ablative laser resurfacing, it takes several treatments to achieve very subtle results. The CoolTouch has a built-in cooling device that protects the top layer of skin but it can still feel like a rubber band snapping against the face as it is used. Types of the Long-Pulsed YAG Laser can be used for hair removal and removing surfaced capillaries (Sources: Lasers in Medicine and Science, April 2004, pages 219-222, Seminars in Cutaneous Medicine and Surgery, December 2002, pages 288-300; and Laser Abstracts from the 14th Annual Congress of the American College of Phlebology).

Several lasers are used for other cosmetic considerations aside from wrinkling. These include:

Q-Switched Ruby Laser: This laser is minimally ablative and is primarily used to selectively remove skin pigment, such as freckling, sun-damage spots, and actinic keratosis without damaging the surrounding tissue. It is also useful for removing birthmarks. It usually takes several treatments to see the desired results. One of the popular uses for the Q-Switched Ruby laser is cosmetic tattoo removal. Many physicians have noted that impulsive tattoo designs or the poor work from inexperienced or poorly trained aestheticians who tattoo lip liner, eyeliner, and eyebrows on women is so rampant that eliminating these constitutes a large portion of their laser work (Source: American Journal of Clinical Dermatology, February 2001, pages 21-25).

Pulsed Dye Laser, Short- and Long-Pulsed: This non-ablative laser gives impressive results in removing surfaced capillaries on the face, port wine marks, hypertrophic scarring (thick or raised scars), and hemangiomas (red dots on the surface of skin). It doesn't cause skin damage, but it almost always causes temporary bruising. Several treatments may be required (Source: Dermatologic Surgery, January 2004, pages 37-40).

Long-Pulsed Alexandrite Laser (trade names GentleLASE and Cool Pulse): This non-ablative laser is another option for hair removal and removing surfaced capillaries and leg veins. This machine quickly covers large areas of skin. (Sources: Lasers in Surgery and Medicine, May 2002, pages 359-362 and Dermatologic Surgery July 2001, pages 622-626.)

The following is a summary covering a range of laser machines and the skin conditions they address. Which one to use depends mostly on the physician you see, which laser machines they own (or lease), and their skill with those particular machines.

Skin Condition Laser or Light Emitting System

Wrinkles and lines CO2 (carbon dioxide)Erbium:YAGCoolTouch Long-Pulsed YAG

Brown spots CO2 (carbon dioxide)Nd:YAGQ-Switched Ruby

Deep pigmented lesions Q-Switched Ruby

Nd:YAGPulsed Dye

Scars and stretch marks CO2 (carbon dioxide)Pulsed DyeCoolTouch Long-Pulsed YAG

Tattoos CO2 (carbon dioxide)Nd:YAGQ-Switched Ruby

Hair removal Nd:YAGLong-Pulsed AlexandriteIntense Pulsed LightLong-Pulsed YAG

Intense Pulse Light (IPL): A "light" modality that uses high intensity pulses of light that are not lasers and are considered to be exclusively non-ablative. Though similar to lasers in many ways, the IPL's beam of light is limited to the depth of resurfacing it can produce. This technique is not meant for those with extensive sun damage and skin discolorations but it can reduce surfaced capillaries or veins, port wine marks, hemangiomas, brown spots, as well as tighten the skin to some degree. The number of side effects is minor, but it can take several treatments (typically 4-6) to see desired results. There are a range of IPL machines including PhotoDerm VL, PhotoDerm PL, PhotoDerm HR, EpiLight, and Quantum (Sources: Plastic and Reconstructive Surgery, May 2004, pages 1789-1795; Lasers in Surgery and Medicine, February 2003, pages 78-87); and www.emedicine.com, "Non-ablative

Resurfacing," June 30, 2003 .(

Several IPLs are used for other cosmetic considerations aside from wrinkling. These include :

PhotoDerm VL (for vascular lesions): Light pulses are directed at the spider and varicose veins as well as vascular birth marks. The tissue targeted is the red-pigment (hemoglobin) in the blood which is heated by the light

pulses destroying it without affecting the skin or other tissue .

PhotoDerm PL (for pigmented lesions): Light pulses are directed at the "age spots," freckles, flat pigmented birthmarks and other types of discolorations. The tissue targeted is the melanin in the skin's surface. The melanin

is then heated and the resulting damage or destruction removes skin discolorations .

PhotoDerm HR and EpiLight (hair removal): Light pulses are directed at the hair follicle causing the hair to fall out and prevent further growth, but this method is not permanent .

Radio frequency (RF) resurfacing is neither a laser nor IPL. Rather, it is a form of electromagnetic energy very similar to microwaves. It is considered a non-ablative resurfacing treatment. The RF treatment passes radio frequency electricity through the skin to heat up tissue. This is supposed to make the tissue contract and, as is true with any injury to skin, it begins making collagen. The most popular RF machine is known as Thermage. Another device, called the Aurora, uses IPL and RF together for a unified procedure, supposedly to give the patients the best of both modalities (Sources: Journal of Cosmetic Dermatology, January 2002, page 142; and Cosmetic Surgery Times, “New Trends Spur Doctor, Patient Education,” July 1, 2004,

www.cosmeticsurgerytimes.com/cosmeticsurgerytimes/article/articleDetail.jsp?id=106139) .

You may have heard claims that RF treatments are painless, have no adverse effects, or complications, yet the research, though extremely limited, demonstrates otherwise. First, RF is considered by some as one of the most painful non-ablative procedures, requiring localized anesthesia because it intensely heats up the skin (Source:

Cosmetic Dermatology, December 2003, pages 28-34) .

A study published in Lasers in Surgery and Medicine (November 2003, pages 232–242) reported that "fifty percent (41/82) of subjects reported being satisfied or very satisfied." Keep in mind that means 50% of the subjects were less than satisfied or were unhappy with their results. Further, 2nd degree burns did occur and "Three patients had small areas of residual scarring at 6 months." Scabbing and edema (skin swelling) occurs in some patients and though it does resolve it can take six months to do so. Technically the improvement measured in this study saw an average lift of 0.5mm. Half of one-millimeter is 0.019 inch long. That may not be exciting for what can be a costly

procedure .

Intense Pulsed Light (IPL)- Photofacials

For skin rejuvenation and Rosacea

Photo rejuvenation (photofacial or fotofacial) is a non-invasive skin health and restoration treatment that erases the damage inflicted on your skin from sun, aging and biological factors as well as Rosacea. The technology supplies a broad spectrum of light which reaches deep down within the skin, targeting pigment and vascular imperfections. The goals of therapy are a more even skin color and texture.

The IPL corrects a variety of skin conditions such as brown spots and redness of the face, while offering a safe, non-invasive solution that can be tailored to your individual condition and skin type. The IPL can treat the imperfections on the face as well as the neck, chest and hands.

The IPL is one of the most common technologies used to treat Rosacea. After a series of treatments this technology can significantly reduce the redness and visible blood vessels on the face. Intense Pulsed Light (IPL) treatments are comfortable and performed without downtime. We sometimes alternate between IPL and Pulsed Dye Laser treatments (Vbeam laser) when treating Rosacea.

After a series of IPL treatments, patients also report improvement in the texture of their skin and reduced pore size. With a series of treatments, IPL Photo rejuvenation can help restore your skin to a more youthful appearance without the prolonged recovery.

Examples of Intense Pulsed Light Systems used at Reflections include the Starlux, Ellipse and Medilux.

What can Intense Pulsed Light Therapy treat?

IPL treats a variety of conditions on the face, neck, chest and hands, including:

Rosacea sun damage flushing skin texture redness broken capillaries brown spots age spots sun-induced freckles on the hands, chest, and face broken capillaries around the nose fine lines and increased pore size ruddy skin

Who performs the IPL treatment and what is the treatment like?

In contrast to many facilities, at Reflections only physicians perform the IPL treatments. The procedure takes 20-30 minutes and is well tolerated. Occasionally we will use a topical numbing agent before the treatment. During the treatment, light energy is delivered to the skin through a series of gentle pulses and is accompanied by methods utilized to cool the skin during the process.

How many treatments are required and at what interval? Is follow up necessary?The number of treatments required depends on several factors including skin tone and the extent of pigmented and vascular lesions and the degree of sun damage that exists. Typically a minimum of three treatments (range 3-5) are performed at monthly intervals for optimal results.

After your initial series of treatments, it is possible to require a follow-up treatment in two or more years. Patients with rosacea may require regular maintenance treatments, frequency depends on the severity of the condition. We will educate you in ways of caring for your skin to help diminish the need for future treatments.

What can I expect to see after treatment and is there downtime?Recovery with the IPL Photo rejuvenation is minimal. Your face may be mildly red for several hours after the procedure but this will subside. Pigmented areas on your skin will become darker initially, and then flake off over the following week.

You should be able to resume all of your regular activities immediately. By dividing the full program into several treatments, the procedure provides progressive improvement with very low risk.

You will need to avoid the sun as much as possible before and after the treatment, and no treatment should be provided if you are tan. Sunscreen with a minimum of SPF 40 should be utilized daily, at all times of the year.

How does an IPL differ from a laser?The IPL emits light over many wavelengths and can therefore have many targets whereas lasers produce only a single wavelength of light therefore it has only one specific target. One of the more popular lasers used in combination with the IPL for the treatment of Rosacea is the Vbeam Pulsed Dye Laser.

What treatments can be combined with IPL?

The following procedures combined with IPL produces excellent results: Fillers - to fill out folds & wrinkles, including the area next to the nose and mouth, to enhance the lips,

and to soften the hollows under the eyes.

Lasers - to tighten the skin & reduce wrinkles and acne scars

Botox - to soften and erase lines in the upper face including forehead, frown and crow’s feet