What It Does : Laser hair removal is hair reduction Using laser light energy to penetrate the hair shaft, it actually kills the hair root. This doesn’t kill the follicle (the place where hair growth starts). So technically, another hair can grow in its place, but it’s difficult. That means results of laser hair removal last a fairly long time after you have received numerous treatments. Once you have reached the 70% hair reduction point you will only need to shave 3-4 times per year.

Be sure to stop any oral medications that are photosensitive such as antibiotics, accutane, etc. If the face area is being treated, make sure to discontinue all active topical creams such as Retin-A, hydroquinone, etc. If you are not sure about a certain medication or topical you are using, please give us a call prior to your treatment. Avoid direct sun exposure and always wear sunscreen. We want to be able to treat the area on the proper setting based on your skin type to achieve the best result. Commit to your hair removal treatments.

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For years,patients asked for a low impact alternative to tighten  their faces and bodies. After researching dozens of devices, we have found one that I believe lives up to its promises. We are excited to add TriPollar to our practice…I have personally seen how TriPollar can tighten skin and reduce inches. The treatment is generally considered to be an enjoyable experience – comparable to a warm massage.

TriPollar RF  is CE approved (meets EU safety, health and environmental protection requirements) for circumferential reduction and the reduction of cellulite. It is the Rolls Royce of the industry and the treatment of choice in the United States and internationally for non-invasive body contouring procedures.

The safety and effectiveness of TriPollar RF treatments have been proven in many clinical studies. A recent U.S. clinical study showed a 97% improvement (smoother, tightened appearance and texture) following a full series of treatments, and 100% of the patients reported that they were satisfied with their results.

For those of you who have undergone laser treatment fungus infection and are extra concerned about preventing recurrence, SteriShoe manufactures and sells an ultraviolet light shoe tree. When it is placed within your shoes and activated, fungus within the shoes will be killed by the ultraviolet light. Some PinPointe Laser providers can sell this directly to you from their office. Otherwise, you can visit SteriShoe.com to purchase it directly. Type in code CA2719SS for free ground shipping.

 Nail polish use with fungal use

Many female patients have inquired as to the appropriateness of using nail polish following treatment with the pinpointe laser. I do allow use of ‘Dr’s Remedy’ nail polish which has tea tree oil as one of its ingredients. Tea tree oil does have antifungal properties. In some unpublished studies the effectiveness of tea tree oil has approached topical antifungal medications that require prescriptions. Furthermore, never share polish, nail cutting instruments or soaking basins at the pedicurist’s salon….that’s a great way to pick up a fungal infection!

 Nail plate infections

Nail plate infections, also known as onychomycosis, are typically a result of a fungal infection.  The most common fungus is from the Trichophyton group.  These infections may also be mixed, involving both fungus and yeast.  In those cases, Candida may also be involved.  These agents are found in many settings.  They tend to frequent dark, warm, moist environments.

Generally these infections occur as a result of prolonged tinea pedis, which is commonly referred to as athletes foot.  Nail infections may also however also occur as a result of trauma to the nail plate, where the nail is partially lifted off of the nail bed.  In those situations, the fungus may directly infect the nail plate and nail bed region.  Once these structures become infected, nail plate changes typically associated with this infection (discoloration and thickening) tends to rapidly ensue.

Use of various topical over-the-counter and home remedies are successful only a small percentage of the time.  Treatments such as white vinegar/acetic acid or hydrogen peroxide may act to make the nail environment inhospitable to fungus growth.  These treatments, along with topical antifungal agents cannot penetrate the nail or cuticle region where the nail root is located.

Oral antifungal agents such as Lamisil, Sporanox and Nizoral can be quite effective.  These medications however are not innocuous and may be associated with various side effects up to and including liver injury.

The PinPointe Laser acts by heating and therefore killing the fungal cells.  The laser has no effect on normal nail, skin or soft tissue.  The success rate of the laser is similar to that seen with oral medications.  There have been no side effects reported with use of the laser in thousands of patients.

What are lipotropic injections?

Who is it for?
This special formula for individuals who are “stuck” in their weight loss attempts and need that extra boost to achieve their goal weight. It can be effective in enhancing an additional 1-3 pounds per week to your current regimen.
This injection has also been gratefully used for individuals who want to maintain their weight, or prevent re-gain of their lost weight.
Special considerations
The different ingredients of this mixture are known to have the following attributes:
• Co-enzymes that are required for proper metabolism of fats, and have the ability to remove fat from the liver
• Energy boost
• Speed up thought process and improve mood
• Helps with focus and concentration
• Essential components for normal cell and brain function
• Help flush the liver and gallstones
• Helps emulsify cholesterol and detoxify amines
• Helps keep healthy skin tone and strong nails
• Promote healthy hair growth, and controlling estrogen levels
• Help with transforming carbohydrates into energy
• Help minimize unwanted water gain

The most recent and the most intense fat burning solution. He uses two different fat burning ingredients in this solution, which is a step-up from the Metabo-lipotropic. This is definitely the favorite among patients, as most are reporting a decrease in their sugar cravings and appetite.

This powerful Injection contains a total of 5 different ingredients that work in your system to directly burn your body Fat.  The additional benefits of this Solution is that it helps Optimize Insulin function, Curb appetite, eliminate sugar cravings, and furthermore favor and help preserve muscle mass during your weight loss.. Especially recommended this solution to all individuals with Diabetes, pre-diabetes or Metabolic Syndrome. However, he does encourage any individual to take advantage of its benefits.

Many people are deficient because vitamin B12 has a very unique requirement for absorption.  All vitamins are either water soluble, meaning they absorb along with water when taken orally, or fat soluble meaning that they absorb along with the digestion of dietary fat.  Vitamin B12 is the exception.  This vitamin is unique in that it will not be absorbed unless it is bound to intrinsic factor, a molecule secreted in the stomach from the same cells that produce hydrochloric acid.  Hydrochloric acid production often diminishes with age, and this decline aggravated by overconsumption of acid blockers make B12 deficiency a widespread health concern that typically goes undetected.

Many think that B12 deficiency is a concern of the elderly, however the  Framingham Offspring Study revealed that people over the age of 26 show just as much likelihood for B12 deficiency as those 65 and older.  Vitamin B12 is the largest and most structurally complicated of all vitamins.  Humans and animals cannot make their own B12; it has to come from a carnivorous meal.  There are three forms of B12: cyanocobalamin, hydroxycobalamin and methylcobalamin.  Hydroxycobalamin, produced from bacteria, is what we get from our diet.  Once ingested, hydroxycobalamin can be converted into the other two forms.  Rich food sources of vitamin B12 include: fish, shellfish, meat (especially liver), chicken, cooked eggs, milk products and termites if you are so inclined. There is a pseudo-B12 that can be found in certain food such as algae, seaweed, Spirulina and barley but is not a form usable by the body.

Gut bacteria can synthesize some B12, but it is not enough for the whole body. This is why vegans need to supplement in order to get enough B12. Standard blood tests for serum B12 are unreliable because serum B12 does not accurately reflect intracellular concentrations.  Elevated serum Methyl Malonic Acid (MMA) levels are a better indicator of B12 status because this occurs only if there is a B12 deficiency.  I don’t usually do this type of test because improvement of symptoms with B12 supplementation is the best test.   If adequate intrinsic factor is produced, then oral and sublingual B12 supplements work well.  The RDA for adults is 2.4 mcg daily; an amount I believe to be insufficient for today’s stressed out population.  I would suggest an adult oral dose of 50-200mcg daily for prevention of symptoms and 500 – 1,000 mcg daily for a therapeutic effect.  For autistic children I prescribe a methylcobalamin nasal spray because it works more effectively than oral supplementation.

B12 injections are essentially painless and provide nearly 100 percent delivery by by-passing the digestive system. If there is insufficient intrinsic factor, as with pernicious anemia, or other digestive absorption issues then injections are indicated.  The frequency will depend on the individual’s health history.   Cyanocobalamin injections are the least expensive and cover most of the deficiency concerns I’ve listed.  Hydroxycobalamin provides the same benefits and will last longer.  Methylcobalamin also lasts longer, and more effectively addresses neurologic concerns.  I offer all three forms because some people respond better to one than another and some respond best when I add a little folic acid to the B12. When supplementing with a therapeutic dose of B12 on a regular basis it is important to also get extra folic acid or folate either in a multiple vitamin, B complex, injection or by itself.

The reason is that B12 supplementation may mask a folic acid deficiency anemia on blood tests.  By supplementing with folic acid this is not a concern.  As folic acid is water soluble like all the other B vitamins except B12, an oral supplement works very well, from 100-1,000mcg daily. People with allergy to cobalamin should not take B12, and people with Leber’s optic disease need to consult their physician before taking supplemental B12.  B12 supplementation beyond what you’d get in a typical multiple vitamin formula for infants, toddlers, pregnant and lactating women should also be accompanied by a physician’s guidance.  For all others, at even high doses, oral B12 has no side effects and B12 injections have minimal side effects beyond occasional bruising and or a little temporary discomfort at the injection site. In summary, B12 deficiency is a widespread health concern for most adults.  Low level deficiency in healthy people can be addressed with a multiple vitamin formula (see website newsletter: Supplements – Complete Life), while people with overt symptoms will best be served by taking a B12 supplement or the occasional injection.

The Asclera Polidocanol Injection was recently approved in the United States primarily as a spider vein treatment. However, the injection also works on varicose veins with diameters less than 4mm. WhenAsclera is introduced to the thickened vein, the polidocanol it contains causes the deterioration of the vessel’s inner walls. The destroyed lining makes the walls adhere to each other, which in turn contracts the space inside the vein. Eventually, the entire vessel would be closed off and consequently lose function. The dead vein becomes connective tissue between the other blood vessels.

This spider vein treatment usually takes around half an hour, but the veins only disappear completely between a period of two to twelve weeks. Often, a patient would have to return for more sessions, because varicose and spider veins usually cover big areas in the lower extremities.  There is a possibility that new veins would thicken again, so maintenance injections are needed after a few years have passed since the initial polidocanol injection.

Since the cosmetic enhancement procedure is non-invasive, the recovery from the spider vein treatment doesn’t take a lot of time. Patients are able to go about their regular activities almost immediately after the process. The use of compression stockings during recuperation might be suggested by the physician in order to speed up the recovery period.

As with any procedure, the Asclera polidocanol injection also carries certain risks. Potential side effects include swelling, irritation and bruising in the target area. There is a possibility that particular tissues would be damaged and contract infections as well. Patients can also experience pain and discomfort during and after the spider vein treatment, although the Asclera polidocanol injection is said to be less painful than its counterparts.

Before deciding whether to go for the Asclera spider vein treatment, it is advisable to consult with a doctor first. Apart from receiving a primer on the treatment, it is also important to determine whether a patient has allergies to polidocanol or to other ingredients contained in the injection. Moreover, pregnant women and those suffering from certain medical conditions are not ideal candidates for the polidocanol injection.

The Asclera injection has enjoyed a high rate of success, most especially in Europe where it has been used in the last four decades. It is expected to gain popularity in the United States now that it has been approved for public use.

IPL, or intense pulsed light, is one of my favorite treatments.

Why? I have 2 big problems: lots of sun damage and lots of redness in my skin.

I was always freckly. Cute freckles when you’re young turn into age spots in your 30s and 40s (and beyond). That’s sun damage. And even if you have protected your skin faithfully for 10 years the damage will work its way to the surface of your skin and give you a mottled complexion.

The redness comes from 2 sources. Some of it is environmental damage in the form of broken capillaries. I remember when I was a 25-year old intern working in a dermatology clinic and the dermatologist pointed out (loudly!) to someone that I already had broken capillaries (except he used the term telangiectasia) in my cheeks.

The other source of the redness is rosacea, a chronic inflammatory condition of the skin that can include excessive flushing, acne-like blemishes, rhinophyma (think of W.C. Fields’ nose) and eye involvement.

IPL is the perfect treatment for me because it specifically targets pigments, the melanin in the brown sun spots and the hemoglobin in the redness of flushing and broken capillaries.

I don’t know if you’ve noticed in the media lately how everyone seems to have a perfect pale complexion. Of course, makeup plays a role but a large part of it is IPL treatments.

IPL works on redness from many different causes such as acne blemishes, hemangiomas (little round red spots), dilated capillaries and diffuse flushing. The principle is the same for all: the red pigment, hemoglobin, absorbs the flashes of intense light and becomes heated up. The heat will either shut down the vessel, in the case of dilated capillaries, or alter the hemoglobin molecule. The body recognizes that the hemoglobin molecule is no longer normal and cleans it up.

OK, so IPL is a great treatment but I have to tell you that people who are prone tomelasma, a familial predisposition to developing brown pigmentation on the cheeks, upper lip, forehead and nose, can actually become darker with an IPL treatment. These people need to be on good skincare, usually including retinoids and skin lighteners. IPL can be done only after the tendency to darken the pigment has been suppressed with skin lighteners.

Ink color: Typically green, blue, and black inks are easier to remove, while red, orange, yellow, and white inks are progressively more challenging. New devices, such as the PicoSure laser, have improved the efficacy and efficiency in treating these tattoo colors. A recent study demonstrated that 1-2 treatment sessions led to at least 75% clearance of blue and green pigments with the PicoSure device, with more than two-thirds of tattoos approaching 100% clearance. Another2012 study also showed 75% clearance in black pigment as early as 2-4 treatment sessions.

Tattoo Age: Older tattoos are prone to pigment fading and may be more easily removed compared to newer tattoos.

Tattoo Size: One variable that is undisputed is that larger tattoos require more treatments than smaller tattoos. A 2010 study published by the Journal of the American Medical Association noted that tattoos over 12 inches in diameter were least successfully removed after 10 treatments.

Smoking: The study mentioned above also directly linked the negative effects of smoking on tattoo removal. Subjects who smoked regularly had a 70% lower rate of removal after 10 sessions compared to their non-smoking counterparts. This lower success rate is most likely related to smoking’s direct effects on wound healing.

Skin Color: Tattoo removal is more effective for individuals with lighter skin (specifically Fitzpatrick type 1 or 2 skin types). Because lighter skin does not significantly absorb laser light, most of the laser energy is focused on the tattoo pigment. In contrast, dark skin siphons a portion of laser light from the tattoo. Also, most laser operators use lower energy settings on patients with darker skin types, as they are more susceptible to unwanted side effects.

Location: Tattoo removal is harder in areas that have a limited vascular supply and slower healing. Thus, tattoos on the feet, lower legs, or hands require more treatments than tattoos in areas like the chest or back.

Amount of Ink: The amount of ink used is another parameter that affects laser tattoo removal. Professional tattoos have a greater density/volume of pigment that resides deeper in the skin. On the other hand, amateur tattooing is usually uneven, superficial, and done with dramatically less ink.

Scarring or tissue damage: Some people, especially those with dark skin types, are at risk for developing scars or other tissue damage during the tattooing process. Ink pigment that resides under scar tissue is much more difficult to remove and requires more treatments.

Layered Tattoos: Layered tattoos (which often occur when a patient tries to cover up their initial tattoo with another one) are difficult to remove and require significantly more treatments than singular tattoos. Most tattoo ink is translucent, meaning it is necessary to use darker ink tones to cover previous tattoos. Since the new layer is larger and darker (and layering increases the overall volume and density of ink), full removal can be very difficult.

First and foremost, What does “LASER” mean?

Did you know the word “LASER” is an acronym which means…
Light
Amplification by
Stimulated
Emission of
Radiation

The term “radiation” is often misinterpreted because the term is also used to describe radioactive materials or ionizing radiation. The use of the word in this context, however, refers to an energy transfer. Energy moves from one location to another by conduction, convection, and radiation and cannot alter DNA structure.

How does it work?

Basically, lasers cause localized damage to the hair by selectively heating dark target matter, melanin, in the area that causes hair growth, the follicle, while not heating the rest of the skin.

Is every laser created equal?

No.  Different companies have different names for their lasers, but the two main lasers out there today are: Alexandrite (755) or the “Alex” & YAG (1064).  This one in particular is what I was trained on and is the latest.    It actually has both Alex and Yag in one machine!  Don’t quote me on this, but I don’t think there’s another two-in-one out there right now.  Very convenient since both are significantly different from each other.  Why?…

Alex vs YAG… What’s the difference?

Alex (755)-

• Attracted to melanin (treats hair and pigmented lesions)
• Great on fair skin (skin types I – III).
• Not recommended for skin types IV – VI.
• No sun exposure for at least 4 weeks prior to treatment.
• Better on thin hair.
• Most report less discomfort than “YAG”.
• More effective laser (usually less treatments are needed).

YAG (1064) – 

• Attracted to melanin and hemoglobin (treats hair, pigmented lesions, loose skin, veins, wrinkles, enlarged pores, tattoos, pseudofolliculitis barbae commonly called “ingrown hairs” or “shaving bumps”, and toe nail fungus… Yes. Fungus!)
• Safe for every skin type (I – VI).
• Can be used on sun exposed skin (3-4 days post).
• Effective on thick, coarse hair.
• Not ideal for thin textured hair.
• Many report more discomfort during treatment than “Alex”

How many treatments are needed? 

Hair grows in several phases (anagen, telogen, catagen) and a laser can only affect the currently active growing hair follicles (anagen). This is why several sessions are needed to kill hair in all phases of growth.

The actual number of sessions depends on various parameters, including the area of the body being treated, skin color, coarseness of hair, reason for hirsutism, and gender.

Average number of treatments:
Face: 6-10 treatments every 4-6 weeks.
Body: 4-6 treatments every 8-12 weeks.

Can all hair colors be treated?

No.  Laser does not work well on light-colored hair, red hair (sorry Carrot Top), grey hair, white hair, as well as fine hair of any color, such as vellus.
Coarse dark hair on light skin is easiest to treat (ideal candidate: Snow White… or the guy below will do).

What are the most common side-effects and risks?

During treatment: discomfort.

Post treatment (most common): itching, redness, and swelling (perifollicular edema) around the treatment area. These side effects rarely last more than three days.

Unwanted side effects and risks:  hypo- or hyper-pigmentation, blistering, scarring, skin texture changes, flare of acne, swelling around the hair follicle, scab formation, purpura, infection and burning of the skin.

What areas can be treated?
If it grows hair.. Then, yes it can be treated (as long as there isn’t any underlying contraindications).

What are the contraindications?

In other words, if you have any of these conditions or are taking any of the meds listed, you CANNOT be treated?

• Pregnant
• Gold Therapy (If you don’t know what this is, then you have never had it)
• Light induced seizures
• Anyone taking photo-sensitive meds (if you are, then you need to wait 3 weeks)
• Accutane (need to be off for 6 months)
• Anticoagulants
• History of skin cancer
• Suspicious pigmented lesions
• Lupus
• Herpes (pre-treat with an antiviral drug such as Valtrex… But, if active, cannot be treated until dormant again)

How do I prepare for laser hair removal?

• No waxing, tweezing, or electrolysis for 4 weeks prior.
• If you have fair skin (skin types I -III), no sun exposure for at least 4 weeks.
• If you have darker skin (types IV – VI), no sun for 3-5 days.
• No threading for 10 days
• No self-tanner for 14 days
• Shave the area being treated the same day or the night before
• No make-up, lotion or deodorant should be worn on the day of your treatment
• No topical Retin-A for 3-5 days
• No oral Retin-A for 3 weeks
• No Accutane for 6 months

How much does it cost?

Clearly, prices are going to vary from country to state to city to town…
Prices can range anywhere from $100 per area per treatment to $900 per area per treatment (all depends on the size of the area and amount of hair).  Yes, it can be costly, but let’s take into consideration the amount of money we all spend on razors, waxing, threading, plucking.

Are there any post-treatment instructions?

Yes!.. And please follow strictly.

• No sun exposure for 1 week (if blistered or burned, then stay out of the sun until healed… unless you want to scar)
• Apply cool compresses to red or swollen area.
• No Retin A for 24 hours
• No direct heat for 24 hours (ie: hot showers.. )
• It will look and feel like a sunburn… treat it like one!
• Lastly, enjoy being HAIR-FREE!