Dr. Alison Tam

Microdermabrasion primarily uses crystals to exfoliate that superficial layer of the epidermis and a chemical peel uses some sort of chemical. Whether it's a TCA peel, Jessner peel or alphahydroxy, there are many peels that can chemically exfoliate the top layer of skin.

Microdermabrasion uses very fine crystals to essentially exfoliate the superficial layer of skin, leaving smoother skin. The texture just feels a lot nicer and a lot of other problems such as pigmentation and large pores can actually improve with microdermabrasion.

There are different things you can do for that. Certain laser procedures such as IPL, chemical peels, microdermabrasion, even deeper chemical peels as well, such as TCA peels, can really help stimulate and minimize the pores.

I don't think you could prevent the need for a facelift but you can actually prolong the need for a facelift more than anything else.

Fractional resurfacing does help stimulate collagen production. It's never going to replace fillers or facelifts because they work at all different layers of your skin. So where the fillers are injected the lasers don't go that deep, they are a little more superficial so we always tell people that generally a combination of therapies actually make you look more natural than if you just did one or the other. Because the fillers and fat transfer go much deeper than what a laser can do, they build the framework from that level within the skin. When you're doing a laser procedure you're looking at tightness of the superficial portion of the skin and sun damage and fine lines.

Definitely a combination. In order for you to look natural and refreshed I do not recommend completely removing your wrinkles because that looks unnatural. So when you smile you're supposed to have some crow's-feet. You're supposed to have laugh lines. You're supposed to be able to move some muscle when you have Botox, you're not supposed to look frozen and wrinkle-less. It really is a combination of softening the face, the wrinkles, stimulating the collagen with topical antioxidants, topical retinoids and overall improving the health of your skin.

Generally we do not do deep chemical peels on the neck and chest because you scar badly from them on the neck and chest. But what we do tend to do nowadays is the newer fractional laser technology which can go down to the neck and chest. So if it's an issue of sun damage and brown spots then we use IPL but if it's from the wrinkling and in the cleavage area we use fractional laser treatment. It won't take it away completely but it will improve it.

For brown spots and sun damage there are a lot of options available. You can do something conservative such as topical lightening cream, as well as a topical retinol. If you want to be a little bit more aggressive you can do an IPL series or a photo facial series. IPL works very well for people who don't have any downtime or have to go back to work, and there are rarely any complications. If you want to get a little bit more aggressive and there are other problems such as large pores or fine lines, thinner skin, you can also do an ablative resurfacing procedure which tends to be geared more toward people with many other problems including large pores and fine lines. Chemical peels are also a very good option. If you don't have down time you can do some of the milder peels or a glycolic one. If you want to be more aggressive and you do have down time you can do the stronger TCA peel.

There are different things you can do for that. Certain laser procedures such as IPL, chemical peels, microdermabrasion, even deeper chemical peels as well, such as TCA peels, can really help stimulate and minimize the pores.

The ablative laser is even better than a TCA peel. For TCA you're taking the top layer of the skin off. Essentially you're making the skin peel with essentially a fresh new layer which then subsequently makes it look very smooth and refreshed and the texture is great, you also get a little bit of tightening from it. The fractional resurfacing procedures these days are laser procedures and those are great as well because the downtime is about seven days of redness with crusty scabbing and for seven days you also have a pink color. And then over the course of six months the texture, the tone and the pores improve significantly.

Generally we do not do deep chemical peels on the neck and chest because you scar badly from them on the neck and chest. But what we do tend to do nowadays is the newer fractional laser technology which can go down to the neck and chest. So if it's an issue of sun damage and brown spots then we use IPL but if it's from the wrinkling and in the cleavage area we use fractional laser treatment. It won't take it away completely but it will improve it.

For brown spots and sun damage there are a lot of options available. You can do something conservative such as topical lightening cream, as well as a topical retinol. If you want to be a little bit more aggressive you can do an IPL series or a photo facial series. IPL works very well for people who don't have any downtime or have to go back to work, and there are rarely any complications. If you want to get a little bit more aggressive and there are other problems such as large pores or fine lines, thinner skin, you can also do an ablative resurfacing procedure which tends to be geared more toward people with many other problems including large pores and fine lines. Chemical peels are also a very good option. If you don't have down time you can do some of the milder peels or a glycolic one. If you want to be more aggressive and you do have down time you can do the stronger TCA peel.

If you have a lot of redness and sun damage on the neck you can do laser treatments like IPL, if it's just a little bit more of the texture. Sometimes as we get older our necks have that texture of chicken skin that's very rough and so a laser resurfacing procedure can help with that also.

You will probably need multiple appointments and there are actually many different lasers that can help with that. IPL can be a very useful laser. It actually picks up a couple of different things, redness on the face, as well as brown age spots. A yag laser is very helpful for individual veins and there's a pulse dye laser that is very helpful for overall redness and broken capillaries.

On the back of hands there are many laser procedures you can do to remove brown spots. You can do IPL. Nowadays I'm doing fractional resurfacing on arms and hands and it takes about three treatments and helps to lighten the brown spots. It doesn't take them away completely but they aren't as dark. There are health and cosmetic reasons to remove the spots. It's important to clear up the skin on the hands because a lot of times if you work on the face and the hands don't match it looks horrible because your hands also show your age, as do the neck and chest. So a lot of times when I do a consultation for the face, especially a laser consult, I'll also check the neck and chest to make sure it's not something I have to treat as well. Otherwise, if you take a photo in a v-cut shirt, your chest and neck will show.

There are different things you can do for that. Certain laser procedures such as IPL, chemical peels, microdermabrasion, even deeper chemical peels as well, such as TCA peels, can really help stimulate and minimize the pores.

With a procedure like Thermage you can get some tightening of the underlying tissue. With the laser resurfacing you can also get some tightening of the tissue but if there's enough in laxity then you probably truly need a facelift. Lasers like Thermage never replace a facelift in the event that you actually need a facelift. They can be used preventatively though.

Definitely a combination. In order for you to look natural and refreshed I do not recommend completely removing your wrinkles because that looks unnatural. So when you smile you're supposed to have some crow's-feet. You're supposed to have laugh lines. You're supposed to be able to move some muscle when you have Botox, you're not supposed to look frozen and wrinkle-less. It really is a combination of softening the face, the wrinkles, stimulating the collagen with topical antioxidants, topical retinoids and overall improving the health of your skin.

With a procedure like Thermage you can get some tightening of the underlying tissue. With the laser resurfacing you can also get some tightening of the tissue but if there's enough in laxity then you probably truly need a facelift. Lasers like Thermage never replace a facelift in the event that you actually need a facelift. They can be used preventatively though.