Your Questions

Q: Dr. Eppley, I am interested in fractional laser resurfacing. I had acne scars on my cheeks and decided to get revision surgery. A plastic surgeon suggested dermabrasion only on my cheeks. This left the area hypopigmented, uneven texture, and raised in the form of hypertrophic scars. I’m under the impression I can’t repigment the area. I’m using retinA to even out the texture and have received kenalog injections to reduce the hypertrophic scarring. However, since the injections are localized, and the scarring is over a broad area, I’m not getting the results I am seeking. I read a post by you where you suggested CO2 laser followed by topical corticosteroids which I believe could flatten the entire area. I’ve attached pictures for your review. I’m not sure if you can get an accurate understanding of my situation from the pictures. Note: the indented area on the left side of my cheek is due to a kenalog injection. I’m hoping this will fill in with time. 

A: Fractional laser resurfacing would be my treatment of choice for broad-based hypertrophic scarring from a prior dermabrasion. To prevent any recurrence, topical sterioids should be used as soon as the area is healed after about 5 to 7 days. Their penetration is aided by the channels cut into the skin by the fractional laser ttreatment. Whether the indented areas from the kenalog injection will fill in over time depends upon how long ago they were done and how many injections were done. If more than three months after the injections you should consider spot fat injections into the indented areas.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr Eppley,I was interested in getting a chemical peel or something for my skin type to help reduce/get rid of acne scars, melasma, freckles on my face.  I am half asian/white and I am concerned about scarring and hyperpigmentation from doing such a procedure.  I wanted to know your experience has been with asian patients and the success you have had with them.

A: I am not very enthusiastic about treating patients with intermediate skin pigments for discoloration issues because, as you know, those skin types are very problematic and often as many problems are created as are solved. Acne scars are problematic in any skin type in terms of the degree of improvement and the concept of completely getting rid of them is not usually possible. The fractional laser can help but, again, in intermediate skin types one has to balance the depth of treatment with the risks of hyperpigmentation. Scarring is not a concern in my experience.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, the areas around my eyes is starting to look really bad over the past five years or so. My eyes used to be one of my best features but now they are just getting old looking. I am 47 years old and have wrinkles around my eyes and some extra skin on the eyelids. My brows now seem a little low too. I don’t want to go through surgery such as an eyelid tuck or a browlift so what can I do? Do I need some special cream or some type of laser treatment?

 A: There is no non-surgical equivalent to what eyelid and browlift surgery can do, but there are some laser treatments that offer some mild to moderate improvement… certainly far better than what any type of topical cream can do. These are the newer fractional laser treatments and they offer some really good improvement around the eye area. Fractional lasers are different than traditional ones because they treat only a fraction of the skin surface but each tiny laser point or dot penetrates deeper. This allows for actual skin rejuvenation through collagen remodeling and less down time and recovery. Because eyelid skin is so thin ( the epidermis is only 0.04mm thick), it requires a series of light laser treatments ( one to four) to prevent a burn injury and get some really visible improvement. Studies have shown patients get a 25% to 50% improvement with half of the patients maintaining a 1 to 2mms eyebrow lift one year later. Recovery is usally anout 3 to 4 days after each treatment.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,  I am interested in laser resurfacing to help reduce the growing number of wrinkles on my face. I don’t know much about laser surgery and how it works. I have seen some very good results and then read some bad stories about it. I know to get a really good result it is not s one day recovery. Do you think the results will be noticeable or rather worth the ordeal?

A: In laser resurfacing the historic rule is…the deeper you go, the better the results. Simplistically, the more bad skin you remove the new skin that heals over it will look better. But laser skin resurfacing is not all one tool and there are different ways to do it. By far today’s use of fractional laser resurfacing is superior to what has been done in the past. What makes fractional laser different is that it only treats a fraction of the skin’s surface. (as the name implies) But each penetration of the beam goes deeper, creating a better effect but with less recovery. These laser treatments can be done at all levels from light to deep and is based on the severity of the problem and how much time one has fofr recovery. Even a lighter fractional laser resurfacing treatment does really produce a noticeable result with very tolerable recovery. It can look pretty bad the first day or two (by your standards) but by five to seven days be completely healed.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  Dr. Eppley, I have alot of scarring on my face. Mostly small scarring from acne and also some from adult acne which includes one very large pocket where a cyst once was, also another very large scar where I had to have a surgeon remove another cyst .There are also a few smaller scars where more cysts were removed and one ice pick also. I’d like to know if you can help to remove some of these in your office or at least help to minimize some of the issues. I am embarrassed to go out into any type setting outside my home wether it be work or any other. I use to be what most would consider a pretty attractive woman. I would like it so much to not feel so awkward about myself because of my complexion. I have been dealing with the the withdrawing from others for about 17 years or so where as I use to be an outgoing and confident person. If you can help me I would greatly appreciate it. Thanks so much.

A: One of the most challenging facial skin conditions to really improve is that of acne scarring. There is no magic solution to this devastating problem and it is compounded by the fact that there are many different types of acne scars by depth and shapes. Surgical methods of improvement can include excision, dermabrasion and fractional laser resurfacing. There is even an occasional role for fillers placed underneath certain types of acne scars. Usually some combination of several of these approaches are needed. Almost always some improvement in acne scarring can be obtained. It is just a question of how much and is it worth the effort involved to do so.

Dr. Barry Eppley

Indianapolis, Indiana