As reported in the February 2008 issue of Dermatologic Surgery, a study involving 60 patients compared the effects of calcium hydroxylapatite (Radiesse) versus stabilized hyaluronic acid (Juvederm, Restylane) for the treatement of nasolabial folds. The study was randomized and split-face, that is, one side received the hylauronic acid and the other side the radiesse. Patients were re-evaluated and 6, 9, and 12 months by an observer that did not know which side had received which treatment. The results were strongly in favor of Radiesse. At 12 months, 79% of treated folds were still improved vs. only 43% of hyaluronic acid folds. Both evaluators and patients preferred the Radiesse side two to one over the hyaluronic acid side.

Another study in the February 2007 issue of the Journal of Academic Dermatology also reported long-lasting correction of nasolabial folds with Radiesse. Among patients that had previously received hyaluronic acid injections, such as Restylane, Radiesse was preferred due to long-lasting effects and more cosmetically pleasing correction. Radiesse was well-tolerated and had no significant adverse effects in the study.

Of note, hyaluronic acids, such as Juvederm, are still the preferred injection material for lip augmentation. Calcium hydroxylapatite is know to sometimes cause small nodules under the skin that could be more easily visible under thin lip skin. This is not a significant issue when injecting in the thicker skin of the rest of the face.

Well-known methods of permanent hair reduction include the use of lasers and electrolysis. This article focuses on the former. The mechanism for how lasers work is called “selective photothermolysis.” This concept means that there are different-colored pigments in the skin, including the hair. If certain of these skin elements absorb more of a particular wavelength of laser light than another element, then they will be more likely to be damaged by the laser. A classic example of this is using laser on black hair growing on light skin. In this scenario, the dark hair absorbs the laser light at a much higher rate than the surrounding skin. At a particular energy, the hair and its follicle will be damaged, but not the surrounding skin. The energy used has to be just right for the best effect that is still safe. A contrary example is someone who is tanned or dark skinned but has blond hair that they want lasered. It is quite likely that the surrounding skin would absorb more of the laser light than the hair itself. This would lead to a burn and such patients are generally turned away from getting laser hair removal.A remarkable technology that is used in the Comet laser is called ELOS. This adds bipolar radiofrequency energy to the diode laser. Although how this works is difficult to explain in a brief blog entry, the radiofrequency works on a current that runs at the level of the laser head. The current generates a magnetic field through the skin. This field becomes most concentrated around hair shafts. As the field rapidly reverses polarity back and forth, it generates heat that augments what the laser is already doing. By itself, radiofrequency is not sufficient for hair removal, but it certainly boosts the ability of the laser. Another benefit is that it is color-blind. It therefore extends the range of the laser into darker skin types without compromising safety.

With each treatment, additional hair follicles are completely killed or reduced in size. With sufficient treatments, most dark hairs will be eliminated, to be replaced with fine, barely-visible hairs or with nothing at all. It takes a number of treatments to cycle through the currently visible follicles, as well as the ones that are dormant within the skin.

In the proper hands with appropriate patients, laser hair removal has reached a state of technology that provides fast, affordable and satisfying permanent hair reduction results. Come to Tattoo MD Medispa for a free consultation!

Pseudofolliculitis barbae or razor bumps, is a common skin condition that affects the bearded area of the face. It causes redness, pain, itching and sometimes scarring in the affected hair follicles. At least 50 percent of black men and 3 percent of white men who shave are prone to this condition.1 Any area that is shaved can be affected, but it most commonly occurs in the face and neck. A good history often elicits very close shaving, shaving against the lay of the hair and using a double-edged razor. This leads to red, painful and pustular follicular inflammation.Pseudofolliculitis barbae occurs when the sharply cut hair curls back and reenters the skin. The reentered hair is treated as foreign material within the skin and elicits a foreign body reaction. More tightly curling hair, such as in African Americans, is prone to doing this when shaved. When shaved, these hairs are sharper and prone to pierce the skin. The hairs may penetrate to a depth of 2-3 millimeters. The process resolved when the head of the pustule drains and the hair pulls out again. Over time, the skin can become hyper-pigmented and, in people prone to keloid or hypertrophic scarring, can lead to disfiguring scarring in a cosmetically sensitive area.

There is no complete cure for this disorder of ingrown hairs. Conservative measures include improving shaving techniques, such as not shaving as often or as closely, shaving with the lay of the hair, and using electric clippers. When such measures fail, a good solution may be laser hair removal. Laser hair removal works by damaging the hair follicle so that it grows ever smaller, finer hairs that are barely visible or none at all. One may not need to shave again. It also reduces the risk of pseudofolliculitis barbae or razor bumps by reducing the number and thickness of the beard hairs. Contact Tattoo MD Medispa for a free consultation!

Placing a new tattoo on untouched skin is like creating a new painting on blank canvas. The artist has complete freedom of expression, constrained by the customer’s wishes and skin color. When one wants to get an unwanted tattoo covered up, however, the difficulty is much greater. The problem with covering up tattoos is in taking two different designs that may be completely unrelated and trying to superimpose one over the other in such a way that the older tattoo becomes “invisible.” This is rarely able to be accomplished well. The problem arises due to a number of factors:1) large area of the original tattoo
This requires that the covering tattoo be very large, usually 2-3 times larger than the original.
2) dark colors used in the original tattoo
Light color cannot be used over dark ones. Usually a cover-up tattoo has to be dark to work.
3) very dense original tattoo
If the artist is creating a cover-up tattoo with an intricate design then a large “blob-like” original tattoo under-it is very design-limiting, probably forcing him or her to create a larger blob.

There is no easy solution to this problem. The best available solution is laser tattoo fading followed by cover-up tattooing. Especially when working with easy to fade tattoos, such as names, even if the tattoo is not perfectly removed after 2 or 3 treatments, which it rarely will be, it will still probably be light enough that a satisfactory cover-up can be performed. This will broaden the artist’s choice of colors that can be used for th cover-up and greatly improve the design options.

Since not every tattoo is removable, not every tattoo will fade with treatment. Some inks, like iron-based inks turn or stay black with laser treatment and are very difficult to fade. Others, such as charcoal-based inks, fade very easily. It’s usually impossible to know what you have in a very old tattoo, but you can only find out by trying. It’s best to find a tattoo removal clinic that performs a lot of tattoo removal procedures and has an ongoing relationship with local tattoo artists.

Tattoos used for cosmetic rather than artistic purposes are a special class of tattoos. The ink colors tend to be pink, white, light brown or rust-colored. The tattoo pigments used to make the inks may or may not contain iron ores. Through an unknown chemical reaction, iron-containing inks may darken irreversibly to black or dark grey when treated with a q-switched laser normally used for laser tattoo removal, such as a YAG or Ruby laser. Attempts to further remove the tattoo may succeed after multiple treatments or may fail altogether, requiring surgical excision. The mechanism is thought to be the reduction of the ferric oxide (Fe2O3, “rust”) to ferrous oxide (FeO, black) but it is unknown exactly why it occurs with q-switched laser exposure.

There is a great degree of variability in inks used for cosmetic tattooing. Some artists also do tattooing and cosmetic tattooers may use artistic ink or ink that doesn’t contain any ferric oxide. In that case, the tattoo should respond to tattoo removal similarly to another artistic tattoo anywhere on the body. For this reason, when approaching the treatment of cosmetic tattoos, especially on the face, extreme caution is used. At Tattoo MD Laser Clinic, patients are warned about the risk of irreversible conversion of their cosmetic tattoo from flesh or rust-colored to black. With that in mind, a test spot is then performed in the least exposed part of the tattoo (about 3 millimeters wide). The patient is then brought back in 1-2 weeks for a re-examination. If there is no darkening and/or if the patient wants to continue treatment for the rest of the tattoo then the rest of the tattoo may be treated.

The process of laser tattoo fading can be painstaking.� Research has therefore also focused on the use of adjuvants, or chemicals that can make the process go faster and more effective.� One of these that has gotten a lot of attention is topical imiquimod cream.� Imiquimod’s mechanism of action is not fully known, but it is throught to stimulate the immune system, by causing the production of molecules such as interferon alpha.� Thus, it was thought, applying imiquimod to the skin over a tattoo that is getting removed by laser might speed up the rate of clearance.

A recent animal study from March, 2007 in Dermatologic Surgery held promise.� Imiquimod used in pigs getting laser tattoo removal showed improved ink removal compared to laser alone.� However there was significantly more scarring noted in the imiquimod sites.� A more recent human study from September, 2007 in Dermatologic Surgery was less encouraging.� This study in 20 patients found no difference between imiquimod and placebo in the rate of tattoo removal by laser.

At this time, there is no known adjuvant or chemical that will speed the process of laser tattoo removal.� However, future research is bound to find alternatives to imiquimod that will be safer and more effective.