Laser and Cosmetic Surgery

Laser resurfacing is a procedure used to reduce the prominence of wrinkles, photodamage, and age related changes on your skin. The ablative laser removes thin outer layers of skin and causes the underlying structural collagen of the skin to tighten. This technique can give dramatic improvement in the appearance of winkles, skin discoloration and sun damage that are unrivaled compared to other techniques.

Laser resurfacing is performed in an outpatient clinic setting without the need for any sedation or general anesthesia. The treated area will be numbed with local anesthesia which makes undergoing the procedure extremely comfortable. The laser will remove the outer layer of skin (epidermis) as well as heat the layers of skin underneath it (dermis). The collagen in the dermis remodels when heated, resulting in skin tightening when the treated area heals.  The improvement in collagen gives a more youthful and consistent skin appearance.

There is downtime with ablative resurfacing as the skin heals from the procedure. For the first 1-2 weeks, a mask and/or ointment is applied to skin as it heals form the laser. Patients take medication to help with any discomfort and to prevent infection. As the skin heals, patients can use make up to cover the temporary redness that develops during the healing process. Over the next months the skin gradually improves, resulting in a dramatic and sustained result.

Much like full ablative resurfacing, fractional laser treatments are done to improve the appearance of wrinkles, photodamage, and age related skin changes. Unlike full field resurfacing which removes the entire surface area of a treatment site, fractional laser ablates narrow-diameter columns into the skin, covering only a fraction of the total treatment area. By doing this, the laser causes collagen tightening and overall skin quality improvement.

However, because most of the surrounding skin is unaffected by the laser (only 10-30% of the entire skin surface is treated at a time), the skin heals much more rapidly. Therefore while not providing the same dramatic improvement as traditional full face resurfacing, fractional laser has shorter healing time, less downtime, and far easier to recover from. The fractional laser can be tuned with varying expected results and recovery time.

Botulinum toxin is an FDA approved medication packaged under various brand names (i.e., Botox®, Dysport®, and Xeomin®) that is used to treat wrinkles, frown lines and crow’s feet causes by movement of the underlying muscles in these areas. The medication is injected directly into the muscle which results in the relaxation and smoothing of the overlying skin. In some patients with long standing, deep wrinkles, it may take several addition sessions to achieve maximum results. Botulinum toxin starts having an effect after several days and can take up to a full week to kick in. Results typically last for about 3 months, but can be longer or shorter in individual patient.

In addition, botulinum toxin is used for the treatment of severe excessive sweating known as hyperhidrosis. For many patients this condition causes severe impact in their quality of life and with professional/social interactions. For many patients who have failed other options, this is a life changing treatment for their severe sweating.

The treatment is relatively painless, and most patients do not require any anesthesia.  Anesthetic cream or ice can be applied to the skin prior to treatment, if the desired. Patients can typically resume their regular routines and activities after the treatment.

UCSF Dermatologic Surgery and Laser Center offers patients a consultation appointment before opting to have any cosmetic or medical procedure. At the appointment you will discuss the condition you have and what outcome you would like to achieve. The doctor will take a complete medical history to understand what concerns you have and what your goals of treatment are.  He/she will then perform a physical exam to evaluate your skin and make a diagnosis.  Your doctor will explain your treatment options, how each procedure works, the expected result of each procedure and any potential risks.  This allows you to have a personalized treatment plan that is specifically tailored for your skin and concerns. Your consultation will allow your physician to fully answer all of your questions, address all your concerns, and give you a personalized recommendation and treatment plan.  In some cases, this can be done in just a few minutes, and in other instances may take longer. Every patient is unique and your doctor can help determine the best treatment options for you.

A chemical peel is a resurfacing procedure that helps rejuvenate the skin. This procedure is useful for treating fine lines, wrinkles, and photodamage and discoloration. A chemical solution is applied to the skin which peels away the top layers. Typically chemical peels are performed on the face and neck, but can be used in other locations as well. There are a variety of intensities of chemical peels, which is based on the specific solution used. A light, medium or deep peel can be performed depending on the desired results. Light peels have an easier recovery and shorter downtime as compared to deeper peels, but don’t produce the same results. Your doctor can advise you on the different chemical peel options and what is the right treatment for you.

Before the peel your doctor will clean your face, and your eyes and hair will be protected. Your doctor will apply a solution to your face, neck or other target area using a gauze or cotton tipped applicator. The solution may cause a light stinging on the treated area for approximately several minutes. A cold compresses can be placed on the treated area after applying the solution. A fan is used to cool the skin during the procedure.

The recovery process varies depending on the type and depth of chemical peel performed.  Patients generally have mild irritation, peeling, and redness for several days after the procedure.  A good moisturizer can be used to help promote healing and maximize the final result. The treated skin should have a rejuvenated appearance. Your skin should be tighter, smoother and have an improved appearance.

Subcision is a technique that helps improve the appearance of depressed scars from acne, surgery or trauma. In many cases, fibrous tissue connects upper layers of skin to subcutaneous tissue and contributes to the depressed appearance of some scars. Subcision helps to release these scars, which results in an improved appearance. The scars are numbed with local anesthesia. A special blade is used to sever the fibrous tissue connecting the upper layers of the skin with subcutaneous tissue. Multiple incisions can be performed in one session.

During the healing process, the new tissue elevates the superfical aspect of the skin, resulting in a reduction in the scar’s appearance. The procedure is quickly and easily performed in the office and there is often very little downtime or recovery. Patients often need multiple treatments to achieve maximum results. 

Sclerotherapy is a treatment to lessen the appearance of spider and varicose veins. For many patients, the increasing number of veins on the legs can be both an unsightly as well as uncomfortable condition. Sclerotherapy is performed using an injection of a chemical solution into the vein.

The injected chemical solution irritates the walls of the vein which results in the vein swelling. The walls of the varicose or spider veins thus weaken and collapse. The collapsed vein is broken down by your body and reabsorbed by the surrounding tissue. Sclerotherapy does not have any impact on the normal blood flow in the legs and is extremely safe. A slight burning is sometimes felt while the solution is being injected, but no anesthesia or sedation is required. Depending on how large or numerous the veins are, patients often need additional treatment to achieve the desired results.

Soft tissue fillers are gel solutions that reduce wrinkles and restore the fullness lost in aging. There are a variety of fillers offered at UCSF which are designed to target specific imperfections e.g., Restylane®, Juvederm®, Voluma®, and others. Fillers can be used to plump lips, smooth fine or deep wrinkles, fill hollow cheeks, or elevate depressed scars. Many fillers contain anesthesia within them, making the injections very well tolerated. During your consultation, your doctor will determine which filler best suits your case.

As you age, collagen and hyaluronic acid, two molecules that create a youthful appearance in your skin, are depleted. Two types of fillers restore these molecules: fillers that activate collagen production and fillers that contain hyaluronic acid. Hyaluronic acid is a complex sugar molecule that acts as a sponge in your skin. Its main function is to absorb water molecules. The water-hyaluronic acid network creates volume in the skin.  Collagen is the supportive and structural molecule of the skin. When it is injected into the skin, the structural support that was diminished is restored. The increase in collagen allows the skin to create a stronger support network which leads to a rejuvenated and younger appearance.

Some blemishes require multiple visits to be completely resolved. In addition, fillers are not permanent – they can last from 6 months to up to two years. Occasionally your doctor will advise “touch-up” appointments to maintain the effect of the filler. Minor swelling, redness, and bruising are typical after the procedure. Most patients can return to their regular routines immediately after the procedure. If bruising occurs, it often subsides after several days. Makeup can be used directly to cover any discoloration and patients can return for a laser treatment to help speed up the resolution of the bruising.

Laser treatment can be performed to remove undesired tattoos. The energy from a high intensity laser beam breaks up the pigment in the tattoo ink. Each laser and intensity of the beam targets different colors of pigment, and we have multiple lasers that we canuse to target specific colors. We select lasers that are the most effective in destroying the tattoo ink and the least likely to hurt the surrounding tissue. The shattered pigment gets absorbed by the surrounding tissue.

Patients will often have the area numbed prior to laser treatment in order to make the procedure more comfortable. Patients may have temporary blistering, bleeding or inflammation after the procedure. Different color tattoo inks respond differently to the laser and some colors are easier to remove than others.  Following each laser treatment session, the tattoo will gradually lighten/fade. Most tattoos require multiple treatments to achieve the desired results.

Many different skin conditions can be treated with laser including broken blood vessels, rosacea, angiomas, port wine stains, and vascular birthmarks. The doctors at the UCSF Dermatologic Surgery and Laser Center have extensive experience treating a wide range of conditions with lasers. The clinic has a variety of different lasers that can be used to treat vascular lesions. During the consultation, the doctor can choose the best one for your specific condition. The lasers work by specifically targeting the blood vessels in the vascular lesions and birthmarks.

Most procedures are performed in an outpatient clinic setting. Typically, laser treatment is well tolerated by patients. In some instances, patients use a topical anesthetic cream to minimize any discomfort during the procedure. Pediatric patients can be treated in the children's hospital under general anesthesia. Following treatment, the number of visible lesions can decrease and the overall color can fade. Depending on what condition is being treated, more than one treatment is often required for maximum improvement. Most patients are able to resume normal activity immediately after the treatment.

The UCSF Dermatologic Surgery and Laser Center is one of the largest laser centers in the Bay Area. We have a variety of different lasers that are used to treat a number of different skin conditions and concerns. Some lasers are used to target redness and broken blood vessels, others are useful for treating brown spots and irregular pigmentation, and some are able to tighten the skin and reduce lines and wrinkles. The advantage of having so many different lasers is it allows us to specifically select the best option for your specific needs. UCSF is on the forefront of laser technology and we have access to the newest, best, and most effective devices to treat our patients.

The field of dermatologic surgery has been leading the way with highly effective treatments that can fit into any busy lifestyle. UCSF Dermatologic Surgery and Laser Center offers numerous treatments and procedures that are able to improve the appearance of your skin with minimal/no downtime. Our physicians can see you in consultation, review your skin concerns and goals, and come up with a personalized treatment plan that fits best for your needs.

At the UCSF Dermatologic Surgery and Laser Center, we offer a variety of laser and cosmetic procedures. The vast majority of treatments are easy for patients to go through without much discomfort. However, for more invasive procedures that are more uncomfortable, we are able to use topical and local anesthesia to make them pain free. Our patients routinely tell us that their treatment didn’t hurt at all!

Dermatologic surgery is the use of surgical, reconstructive, injectable, and laser procedures for the treatment of various medical and cosmetic conditions of the skin. Dermatologic surgeons are experts in the use of minimally invasive procedures requiring local anesthesia. There are a variety of procedures that are used to improve overall appearance, reduce signs of aging, and reverse photo damage. Through the use of laser, fillers, botulinum toxin, and other techniques, dermatologic surgery offers excellent clinical and cosmetic results, with an excellent safety profile, often with minimal to no downtime.

All the procedures are performed by doctors at the UCSF Dermatologic Surgery and Laser Center. Your physician will be involved in your care from the initial evaluation and consultation to treatment, and follow-up.