BLU-U®

BLU-U® offers effective, non-invasive and pain-free treatment for moderate acne. This treatment is not a laser. It emits safe, cool, visible, blue light to provide an effective solution for acne treatment.

BLU-U® treatment is a process by which a photosensitizing agent (Levulan®) is applied to your skin. The Levulan® is then activated with a specific wavelength of light, which "turns it on." Levulan® has been used extensively for the treatment of a variety of different skin conditions, and it is approved by the FDA and Health and Welfare Canada for the treatment of sun damaged skin.

Levulan® is a 20% solution of Aminolevulinic Acid (ALA). ALA is a natural substance found throughout your body, as it is a precursor for hemoglobin synthesis. You would be unable to make a red blood cell to carry oxygen without ALA in your body. Consequently, it is a "natural" product found in all humans.

Acne results from the obstruction and inflammation of the sebaceous glands, and it affects 80% of the human population. Acne typically begins in adolescence with hormonal changes. However, there are many older individuals who suffer from Adult acne.

There are several different presentations of acne ranging from comedonal (blackheads and whiteheads), papular, pustular, and cystic acne. In many cases, many of these presentations of acne can be present on an individual simultaneously.

After 30 minutes from the initial application of Levulan®, the treatment continues with the BLU-U light session which lasts approximately 8 minutes, killing acne bacteria.

Some patients typically require up to 4 treatments approximately 6 weeks apart to clear their acne. Adolescents may require an additional treatment in six months to a year.

There may be minimal discomfort because of the nature of the Levulan® topical solution, which usually improves immediately after treatment and ends within 24 hours.

After treatment is completed, patients may experience some temporary reddening and minimal swelling of the acne and surrounding skin. Generally reddening will disappear by 4 weeks and swelling will reduce or become non-existent after 2 to 7 days.

The skin is very sensitive to sunlight for 24-48 hours after treatment. For the first 24 hours patients should remain indoors, and then apply a minimum of an SPF 45 for the following weeks. Sunscreen must be applied, to ensure that there is no tanning during the course of treatment.

Naturally, you can use your topical acne lotions in between your Levulan® treatments once the redness has settled down after a few days.

Brown Age Spots

Brown spots can be caused by birth, age, or sun exposure. The Q-Switch YAG laser, also known as the N G YAG or Medlite can treat brown spots in the skin caused by age or sun damage. These spots are also known as age spots, sun spots, or liver spots. These spots can be tan or brown in colour and may appear flat and freckle like. The YAG laser can also treat brown based birth marks such as café au lait spots, and pigmented lesions. This laser was designed to target the abnormal concentrations on melanin in the skin and remove it.

The YAG laser emits short pulses of light energy, targeting the excess pigment or melanin, which are found in the superficial layers of the skin. The area being treated will absorb this light, destroying and breaking down that pigmentation. This does not affect the surrounding areas, as it will only target the abnormal concentrations of pigmentation. The result will leave the skin with a more uniform colour and texture. This treatment can also be combined with other treatments such as bleaching agents or peels, however this must be pre-determined by the physician.

Patients with darker pigmented skin do risk some changes to the natural pigment in their skin in some cases. A small test patch can be performed prior to treatment to see how the patient will respond. Patients who have trouble with healing, or who tend to scar may want to consider the risks very carefully, as this may not be the appropriate procedure. If any of the spots are suspected of being malignant or pre-malignant, the physician will perform a biopsy prior to treatment to determine if it is safe to proceed.

Patients will feel slight discomfort during the treatment, similar to that of an elastic band snap with each pulse. Patients may also feel the sensation of slight sunburn after treatment. Redness can remain for 2-4 weeks. Any discomfort will subside within a day or two. Blistering may also occur, or very minor pinpoint bleeding, though this is very rare. Antibacterial ointment is applied to the area post treatment. The area must be kept clean, and the ointment should be applied regularly. Showers can be taken the following day, but the area should not be scrubbed. Please ask questions if the instructions are not clear. The risk of scarring is between one and five percent and the risk of increased or decreased pigmentation is as high as 30%, although this is usually only temporary.

It is very important that all patients apply sun protection, and try to avoid any excess sun exposure, up to 6 weeks following their treatment. An SPF of 60 is preferable. The laser treatment will make the treated area photosensitive, which means more susceptible to the sun. This can counteract what the treatment is trying to achieve, and leave the area darker in appearance.

Brown Birth Marks

Brown birth marks are usually present at birth and will slowly increase in size in proportion to the individual. Flat brown birth marks can occasionally be treated with good result with the use of our Accolade or YAG laser.

Cautery/Electrocautery

Cautery, also known as electrocauterization (or electrosurgery) is the process of destroying tissue with electricity and is widely used in modern surgery. The procedure is frequently used to stop bleeding of small vessels or for cutting throuh soft tissue. When lower voltage is used with a continuous alternating current (AC), heat is produced very fast and tissue is completely vaporized at the tip of the probe, creating a ‘cutting’ effect.

Cautery is effective in the treatment of; skin tags, solar keratoses, milia and sebaceous gland hyperplasia.

Chemical Peel

About Chemical Peeling

Your skin is a living organ, made up of millions of cells. Everyday, thousands of cells die, fall off, and are replaced by new cells from below. This is a slow and haphazard process that does not allow your skin to shed dark spots, sun damage, or a dull, lifeless complexion.

The purpose of a facial peel is to cause the even, controlled shedding of several layers of damaged cells, so you are left with a new fresh layer of skin, with a more even texture and color.

Many types of facial peels have been performed in this country during the past 20 to 30 years.

During a chemical peel, a solution is applied to various areas of the skin. These applications produce separation and eventual peeling of layers of skin, enabling new, regenerated skin to appear. During this procedure, most patients experience a warm to somewhat hot sensation which lasts about 5-10 minutes, followed by a stinging sensation.

What Does It Do?

Chemical peeling is often used to treat fine lines under the eyes and around the mouth. Wrinkles caused by sun damage, aging and hereditary factors can often be reduced or even eliminated with this procedure. However, sags, bulges and more severe wrinkles do not respond well to peeling and may require other kinds of cosmetic surgical procedures.

Mild scarring and certain types of acne can be treated with chemical peels. In addition, pigmentation of the skin in the form of sun spots, age spots, liver spots, freckles, blotchiness due to taking birth control pills, and skin that is dull in texture and colour may be improved with chemical peeling. Areas of sun-damaged skin, spots of precancerous keratoses and scaling patches may improve after chemical peeling. Following treatment, new lesions or patches are less likely to appear.

The procedure can be performed on the face, neck, chest, hands, arms and legs. Superficial, medium, or deep chemical peels may be used to improve damaged skin.

Different Types of Chemical Peels

During your consultation, you will want to explain the level of skin improvement you hope to achieve. We will then review your medical history and examine your skin type and pigmentation to determine if you are a good candidate for a chemical peel. We can help determine the most appropriate type of treatment for each individual case. We, at The Institute of Cosmetic & Laser Surgery, perform three types of chemical peels including:

1. Kojic Acid Peels

   This peel is a natural product used in the treatment of pigmentation problems of the skin, by inhabiting the production of brown pigment. Kojic acid is used to improve brown-spotting of the skin (hyperpigmentation). Kojic acid is performed by providing the patient with a series of peels, done at four week intervals. During that time, the pigmented areas slowly become lighter, leaving the skin tone much more even. Following the peel, expect to be slightly pink for usually about two hours. The skin will feel dry and tight for a couple of days, with a minor amount of flaking. You are able to wear makeup during this time. There is no "down time" period.

2. Jessner's Peels

   Jessner's peeling is a chemical treatment designed to remove superficial layers of skin. It is used to help dry out active acne, to reduce shallow wrinkling and scarring, and to lighten hyperpigmented, dark patches on the skin. As you continue with light peel treatments, they will be spaced at 2-to 4-week intervals. The solution is applied to your skin with gauze, cotton applicators, or a small brush. Because the solution is a combination of mild acids, some stinging usually occurs during application. After the solution is applied, your face may have white areas called frosting and usually fades within 15 to 30 minutes. Your face may appear slightly redder than usual for some time after the treatment. Your skin will probably become very dry, and some small cracks may develop. You may apply makeup as usual. In general, the peeled area will appear mildly or moderately sunburned.

3. TCA Peels

   The main ingredient in this peel is trichloroacetic acid (TCA) which creates a peel that offers less risk of scarring and pigmentation changes than the phenol chemical peel. It can make marked improvements in blotchy pigmentation, freckling, sun damage, fine wrinkles, and some types of acne scars. It consists of the application of one or several layers of medication to your skin to create a controlled chemical burn. There is normally a few minutes of stinging and burning after the medication is applied. This usually stops within 2 or 3 minutes, and there is no more discomfort during the rest of the time you are peeling, although most people experience itching during the healing process. During the next several days, your skin turns darker, feels tight, then cracks and peels off, leaving you with a new fresh layer of skin. There are no scabs, bleeding, or bandages. During healing, you should have no pain. Most people look strange during peeling, but if you don't mind your appearance, you are able to go out and even go to work. However, you will not be able to be in the sun or do anything that would cause you to perspire heavily.

   The average peel takes 5 or 6 days to complete. Deeper peels, for heavily sun-damaged and wrinkled skin, may take 8 or 10 days. You may have some swelling during the first 2 or 3 days after your peel, particularly if it is a medium or deep peel.

Post Treatment

Depending upon the type of peel, a reaction similar to a mild to severe sunburn occurs following a chemical peel. Superficial peeling usually involves redness, followed by scaling that ends within 3-5 days. Medium-depth and deep peeling can sometimes result in swelling and blisters that may break, crust, turn brown, and peel off over a period of 7-14 days.

It is important to avoid overexposure to the sun immediately after a chemical peel since the new skin is fragile and more susceptible to injury.

Risks After Chemical Peeling

In certain skin types, there is a risk of developing a temporary or permanent colour change in the skin. Taking birth control pills, pregnancy, or a family history of brownish discoloration on the face may increase the possibility of developing abnormal pigmentation.

Although low, there is a risk of scarring after chemical peels. If scarring does occur, it can usually be treated with good results. There is also a small incidence of the reactivation of cold sores or Herpes Simplex infection in patients with a history of fever blisters.

CO2 Laser Resurfacing

Dr. Sheetal Sapra is a leading Dermatologist, who has been performing CO2 laser resurfacing for many years. In some cases of acne scarring, C02 laser resurfacing is able to remove the damaged layers of skin and expose a smoother surface. Also known as the laser peel or the Feather touch laser, C02 is also used to correct the texture of the skin and reduce the signs of aging. This laser will minimize wrinkles and lines caused by sun damage. The intended result is smoother, more youthful appearing skin, with uniform color and better texture. Dr. Sapra will recommend either a full face resurfacing or only specific areas such as around your eyes or mouth.

Laser resurfacing cannot repair very deep scarring. For deeper facial scarring such as "ice pick" acne scaring, the physician may recommend a 2 part treatments involving some minor surgery first. This surgery usually involves the scarring being stitched to eliminate the depth of the scar. After this has healed the laser can be used to resurface the area smoothing the texture.

The laser procedure is performed sometimes I. V. sedation and or local anesthesia. This laser is targeting water in the cells of the skin surface. The laser vaporizes the outer layers of damaged skin. This is basically a controlled burn of the skin surface. The advantage of the laser is that the depth of treatment is extremely controlled and predictable. This allows a new layer of skin cells and collagen to form. This in no way is comparable to, or a substitute for a surgical facelift. Laser resurfacing is focused on repairing texture, it does not remove excess skin, however, a tightening effect will sometimes be noted.

Following the procedure, your skin will weepy and oozing for a period of 7-10 days. Your skin will then heal and make-up can be worn to cover the redness. This redness will fade to pink over the next couple of months, but in extremely rare cases may still be noted for up to one year.

It is very important that patients avoid sun exposure and always wear sun protection following laser resurfacing. This is to protect the new skin that has formed. The new skin is photosensitive and is more susceptible to pigment changes until it has completely healed. Sun protection is also recommended to preserve the longevity of this treatment. CO2 laser resurfacing will achieve a long lasting result, but is not permanent. As the body ages, the skin will also begin to age again, and lines and texture changes will eventually recur.

Complications such as scarring or loss of pigmentation from this laser are extremely rare, but can occur.

CoolGlide™ Vessels Laser

The CoolGlide Vessels Laser is a long pulse 1064 nm laser that is used for the long term reduction of blood vessels on the face. This laser uses light to destroy the vessels without damaging the skin’s surface. This procedure provides a greater comfort level for patients with minimal down time. The refrigerated cool tip of the hand piece protects and cools the skin allowing the deep penetration of the laser. The haemoglobin in the blood absorbs the laser light pulse. This destroys the vessel without damaging the surrounding tissues. The body will then re-absorb the vessel, and the blood flow is redirected through the deeper veins, where it should be.

Cryotherapy/Cryosurgery

Cryotherapy, also known as Cryosurgery is the application of extreme cold to destroy abnormal or diseased tissue, and is used for the treatment of various benign and malignant skin conditions.

Cryotherapy is effecitve in the treatment of ; warts, skin tags, solar keratoses, as well as small skin cancers.

Facial Blood Vessels

At the Institute of Cosmetic & Laser Surgery, we now offer Coolglide® laser for the long term reduction of blood vessels on the face and legs. The Coolglide® laser uses laser light instead of needles to destroy the vessels without damaging the skin surface. This procedure provides a greater comfort level for patients with minimal down time. Coolglide® can also be used for hair removal. The wavelengths are modified to target the pigment in the hair follicle.

The refrigerated cool tip of the hand piece protects and cools the skin allowing the deep penetration of the laser. The pigment in the blood absorbs the laser light pulse. This destroys the vessel without damaging the surrounding tissues. The body will then re-absorb the vessel, and the blood flow is re-directed through the deeper veins, where it should be. The procedure can be safely used on all areas of the body. Coolglide® can also be used to treat prominent vessels in the eye area.

Pre-treatment Preparation:

• When treating the face. do not wear make up.
• No tanning 2 weeks prior to treatment. This also can interfere with the effectiveness of the treatment.
• The area being treated should be clipped or shaved 1 day prior to treatment. Any dark hair on the skin surface will absorb the laser light, and possibly cause a minor burn.
• Some patients may want to take a Tylenol or Advil 2 hours prior to treatment, to help minimize any discomfort.

Patients may feel a slight tingling or snapping sensation during the procedure. The Coolglide® treatments will cause no bleeding or open areas on the skin. The first treatment is often the most uncomfortable, as most of the vessels are being destroyed during this visit. Patients can take a Tylenol or Advil 2 hours prior to their visit if they have a low pain threshold. It is recommended that the area being treated be clipped or shaved. Hair on the surface of the skin can reduce the energy level of the treatment, and possibly cause a minor burn.

There are many factors that can cause un-wanted blood vessels such as, age, rosacea, medications, sun exposure, genetic background, and pregnancy. All of these factors will also have an effect on the re-growth, or the appearance of new vessels, and the number of treatments that will be required. The number of treatments needed can also be affected by the depth of the vessel as well as the size and colouration.

Post-treatment Care:

• Avoid tanning or excess sun exposure for 2 weeks following treatment. A good sunscreen should be worn at all times.
• The skin may be dry or tight around the area that has been treated. A good moisturizer is recommended.
• Unlike sclerotherapy (injections using needles), there is no need to wear support stockings, or apply a dressing.
• If blistering or scaling appears, contact your physician immediately, this is a very rare occurrence. This will usually resolve within a few days.

Please note that larger leg veins, such as varicose and sometimes even some spider veins, require sclerotherapy. Often the smaller vessels, which are too tiny to inject are easily treated with Coolglide®.

Intense Pulse Light Fotofacials

These are excellent for treatment of sun damage. This system is very useful in removing the mottled hyperpigmentation and blood vessels that occur on the face, neck, chest and body as a result of sun exposure. It is also helpful in improving fine wrinkles predominately on the face and neck. The response is usually dramatic. Anywhere from 50-60% improvement can be seen in unwanted facial blood vessels and brown spots as well as wrinkles.

Fraxel® Laser

Up until now, there have been two primary categories of laser skin rejuvenation. These two technologies are known as ablative and non-ablative laser or light-based therapy. Ablative techniques regenerate aging and sun-damaged skin with superior cosmetic results, but can be associated with more significant risks as well as prolonged healing and recovery times. Non-ablative techniques, generally carry fewer risks but require numerous treatments over several months, producing sometimes limited clinical results of cosmetic improvement.

Fraxel® laser treatment represents a new science and category of cosmetic skin surgery that offers patients the positive results of ablative resurfacing with the low-impact benefits of non-ablative therapies. Unlike older ablative lasers that remove the top layer of skin, Fraxel® produces tiny, microscopic sites of thermal impact separated by areas of unaffected, healthy tissue. The innovative Fraxel® laser is specially designed to alter only fractional volumes of target tissue. This significantly diminishes the amount of downtime experienced. The spared healthy tissue between treatment zones contains viable cells that promote rapid renewal of the outer skin layers. At the same time, each microthermal abrasion penetrates between 400-700 microns into the dermis to remodel collagen. Fraxel® strives to achieve the skin improvements obtained with conventional CO2 laser resurfacing but without the associated side effects or downtime.

It is advisable to have at least 4 treatments 4-6 weeks apart. It is important to remember that while changes in colour and texture may be noticeable after your first few treatments, improvement in wrinkles and scars is slow. It often takes 4-6 months after your last treatment to see the best results in scar and wrinkle therapy.

Pre-Treatment

Patients cannot be tanned during the course of this treatment, as it increases the risk of pigmentation problems. A sunscreen should be used daily.

Details of Procedure

Photos will be taken prior to treatment. A topical numbing cream (Lidocaine) will then be applied to the area and left on the skin for 1 hour. This will help to diminish discomfort, which has been described as a mild to moderate prickling/burning sensation. Treatment is well tolerated, but pain can vary from patient to patient. Patients should expect to be in the office for approximately 2½ - 3 hours.

Post Treatment Care

Cicaplast (accelerated topical healing ointment) and SPF 60 will be applied to your skin following your treatment. We do recommend purchasing both of these products at the Skin Spa to use in between your treatments. It is very important to wear a minimum SPF 60 post treatment. Side effects typically involve swelling and redness.

Swelling usually subsides within 1-3 days, and can range from mild to severe. The redness may resemble a moderate sunburn and will fade over several days. Patients can use makeup immediately following treatment to cover some of the residual redness.

The Skin Spa offers complimentary consultations and colour matching if you are interested in purchasing an anti-microbial/anti-inflammatory mineral makeup which is fantastic for use after any skin treatments.

Patients can return to routine activities right away, however in order to reduce the amount of swelling, it is preferable to take a day or two off from any vigorous exercise, use ice packs regularly, 10 minutes on and 10 minutes off, sit up for the rest of the day, and use some extra pillows to sleep. Also, if you have a history of cold sores, Valtrex may be prescribed for you to reduce the risk of an outbreak.

Some patients have also experienced itching, dryness and flaking after treatment. Some roughness and a sandpaper feeling on the surface of your skin are common for several days after your treatment. Use non-reactive moisturizers and moisturizing sunscreens that do not cause irritation to help this condition. Please do not scrub the treated area aggressively when cleansing after your treatment. You may wash with a mild cleanser, but do not use any harsh or active topical products during the Fraxel treatment series. Avoid the use of retinoids and topical corticosteroids for 1-2 weeks following treatment. Avoid systemic steroids (ie Prednisone, Dexamethasone) throughout the course of the Fraxel® treatment.

Possible Risks

There are limited risks associated with Fraxel® laser. The risk of infection or scarring is extremely rare.

Products to compliment the procedure

If Fraxel® is being performed for pigmented acne scarring, facial rejuvenation or overall pigmentation concerns, SkinTx™ would be an excellent addition to this treatment program. SkinTx™ is a skincare program that helps to eliminate pigmentation problems while simultaneously rejuvenating the skin by evening skin tone and texture, reducing pore size and restoring a youthful glow. There are many different options when using the SkinTx™ line so it would be best if you spoke with either Dr. Sheetal Sapra or one of his staff members if you are interested in starting this program.

Hair Removal

Laser hair removal is a new advancement that can result in significant decrease in the amount of hair. Usually anywhere from 80-100% of the hair on a given surface is permanently removed. Small areas such as the bikini line, underarms and face respond best. Larger areas also respond but require frequent treatments.

The Lightsheer™ Laser is effective for dark hair on most skin types and is also effective in the treatment of pseudofolliculitis barbae. The Lightsheer™ Laser uses a high-power diode technology, and is a rapid, non-invasive treatment that entails virtually no patient downtime.

Hypertrophic/Keloid Scars

These are thick red scars that usually occur at the site of injury or surgery. Development is dependant upon heredity as well as the kind of trauma and especially the site. They tend to be much more common on the neck and the chest.

They are treated with a triple therapy consisting of injections of the scar with a cortisone preparation, treatment of the scar with the laser usually either the pulsed dye laser or the V-Star laser followed by topical silicone gel therapy. With 8-9 treatments, one should see a very significant improvement in these scars.

IPL Photorejuvenation treatments with or without Levulan®

Any patient with scattered blood vessels and brown blotchy pigmentation (sun damage), can benefit from treatments with the IPL (intense pulsed light). Patients with either of these conditions can expect an excellent improvement.

Photorejuvenation removes the pigmentation in the sun damaged skin, and improves the texture. A layer of gel is placed on the area being treated, and the hand piece is placed on the same area and light is emitted. The patient does have to have the area clean and free of any make-up before treatment can begin. The patient should also avoid tanning before and after treatments, as this will enhance blotchiness. Skin that is tanned either naturally or artificially, can not be treated.

The effects of IPL can be expedited with the application of a medication pre-treatment, called Levulan®. This medication has been used extensively for the treatment of a variety of different skin conditions, and it is approved by the FDA and Health and Welfare Canada for the treatment of sun damaged skin.

Levulan® is a 20% solution of Aminolevulinic Acid (ALA). ALA is a natural substance found throughout your body, as it is a precursor for hemoglobin synthesis. You would be unable to make a red blood cell to carry oxygen without ALA in your body. Consequently, it is a "natural" product found in all humans.

When we combine the application of Levulan® with regular Photorejuvenation treatments using IPL, we turbo boost the light therapy and enhance the overall results. IPL treatments also stimulate the formation of more collagen in the skin, thus giving your skin a renewed, refreshed, smoother texture and appearance. This is termed an activated Fotofacial, or photodynamic skin rejuvenation when PDT (Levulan®) is added to regular IPL photorejuvenation.

A patient having a full facial treatment will feel a bit of discomfort. A burning or stinging sensation may also be felt a few hours after treatment and this is normal.

After the treatment is completed the area will have a flushed look and there is a possibility of some swelling. The pigmented spots may appear darker after treatment this is normal and will disappear as the spots come off. The area should be kept clean, however, be careful not to scrub the area for the first few days after. We recommend that a good sunscreen be used, preferably a 30-60 SPF. Make up can be applied within 24 hours after the treatment.

Facial, neck and chest treatments are usually repeated at 4 week intervals. A session of 5 treatments for each area is recommended for the best result. The sessions are usually reduced to 3 with Levulan®. Once your treatments are completed you may need to return for a treatment once a year to maintain this result.

What are Moles/Skin tags?

Moles are generally benign lesions that you may want to remove for cosmetic reasons. They may interfere with the wearing of eyeglasses, jewellery or possibly bleed when shaving.  If a mole is suspicious, meaning it has changed in colour, or shape or is bleeding spontaneously, you should see your family physician or Dermatologist for signs of malignancy. Moles come in a variety of shapes, sizes and colours. The most appropriate removal technique often depends upon the type, colour and location of the mole itself. Skin tags are often flesh coloured and are a result of the repeated rubbing of skin. These benign skin lesions can appear where clothing rubs the skin (ex. underarms).

Details of Procedure

Moles: can be removed using a variety of methods. Most moles respond well to a procedure called a shave technique where a small amount of local anaesthetic is injected and then the mole is simply shaved off.  There are no sutures required as an application of aluminum chloride will immediately stop any bleeding. If the shave is performed on the face or on an area of your body that is exposed to sunlight, it should be kept covered with a band-aid to avoid hyper-pigmentation. In approximately 5-7 days, once the area has healed, sunscreen should be applied during sun exposure. Some moles respond well to excision only and in that case sutures would be required. If the mole is on the face, the sutures would stay in for 5-7 days or on the body for 10-14 days. Laser is generally not used in the treatment of moles. Freckles can sometimes be removed with laser, but these are not true moles. Patients should expect to be in the office anywhere from 30 minutes to 1 hour.
 
Skin tags: smaller tags can be removed by using liquid nitrogen or by cauterizing them. We generally will apply a topical freezing called Emla or Maxilene, 1 hour prior to treatment.  The area where the tags have been removed using cautery will blister and scab for a few days and you should wash the area with soap and water, as usual.  If the tags are larger, they may need to be excised or shaved.  In this case, a small amount of local freezing will be injected, prior to treatment.

Post Treatment Care

Patients can wash the area with a mild soap and water daily. Polysporin should also be used twice daily for approximately 5 days. Although the use of band-aids is not necessary, they can be used if the removal site is in an area of irritation.

Possible Risks

There is a risk of scarring when removing skin tags or moles. Any discolouration should fade over time and can be reduced by applying a topical silicone gel for scars. Dermatix-C is available in the Skin Spa if you require. Dr. Sapra should also be notified if you have ever experienced keloid scarring in the past. There is also a minimal risk of infection, which also can be significantly reduced by proper daily care of the removal site and by following patient instructions.

 

Port Wine Stains

Port wine stains are hereditary flat red birth marks that usually occur on the face, trunk or the extremities. Initially treatment of these is very difficult and results in scarring. With new laser technology, these can be treated and the younger the age at which we start, the better the response. They can clear anywhere from 50-100%.

Smoothbeam™ Laser

The smoothbeam laser is an excellent new technology developed to help patients who are suffering from oily, acne-prone skin and acne scarring. Smoothbeam will also renew the skin and minimize pores, wrinkles and lines.

Smoothbeam can drastically reduce acne and improve the skin. The laser is safely passed through the upper layer of skin known as the epidermis causing no damage. The laser light targets the sebaceous glands. These glands are responsible for the production of sebum or oil, which cause oily skin. These are also the same glands that become clogged and form blackheads, pustules, and cysts. The laser heats up the gland causing changes to the gland. The treatment will slow down the production of sebum from the glands, thus causing less clogging in the pores. Patients will notice an improvement in their skin 2 weeks post treatment. The skin will continue to improve over the next 6 to 12 months. Some patients may experience a flare up of acne 3-4 weeks post treatment. Patients will require 4 treatments of smoothbeam, at least 4 weeks apart.

Patients, who would like to minimize wrinkles can also benefit from this treatment. Smoothbeam offers an alternative to facial surgery or facial injections. This non-invasive laser generates heat that targets the collagen, and causes it to contract. This procedure will also stimulate the skin to produce new uniform collagen. This collagen will strengthen and thicken the skin, minimizing and filling in the lines, and wrinkles. Again, the laser is safely passed through the epidermis and targets the collagen. Smoothbeam treatments along with BOTOX® Cosmetic injections in the crows feet, is an excellent means of "Turning back the clock".

Patients may require 3-6 treatments 4-6 weeks apart. It will take approximately 2 months to see the full result of the treatment.

Pre-treatment:

• Arrive 1 hour prior to the procedure as a topical anaesthetic will be applied, it will take 45 minutes to 1 hour to take effect.
• Do not wear make up to the appointment.
• Make up can be applied following the procedure, to help conceal any redness and swelling.
• Do not rub the skin; make up must be applied very gently. Avoid abrasive skin cleansers
• Patients cannot be tanned, or tan for 2 weeks following this procedure .
• Exercise is not recommended for 24 hours post treatment.

Tattoo Removal

At the Institute of Cosmetic & Laser Surgery, we are able to safely remove almost all colours of tattoos, offering one of the most greatest selections of lasers in North America . We are on the cutting edge of technology and are continually adding to our already extensive line of lasers.

Getting a tattoo is easy, removing it takes a great deal of patience and technology. Tattooing is simply injection of ink into the skin via small holes made in the skin with a needle. Regardless of who injects the pigment whether it is done professionally by a tattoo artist or fashioned by someone untrained, generally the ink injected into the skin is permanent. For various personal reasons and preferences, people are turning to physicians to have these tattoos removed. Green is the most difficult colour to remove; reds, black and blues are removed more easily.

The process of having a tattoo removed can be painful. Commonly the area to be treated is injected with local freezing prior to the treatment. This will help to minimize the pain during treatment. Topical numbing cream can also be applied to area instead of injected freezing. This should be applied at least one hour before the treatment. It can be applied liberally, covering the whole area being treated and cover it tightly with plastic wrap. The laser light is used to break up the colour in the tattoo, which is then reabsorbed by the body and excreted by the normal body systems. After the treatment has been performed, some normal crusting occurs. It is essential to keep the area clean, and apply a topical antibiotic (polysporin). An antibiotic cream and dressing instructions may also be given, depending on the size of the area being treated. The patient may feel a slight burning sensation for a few days, similar to a sunburn and this is also normal.

The Accolade laser is used for the removal of "difficult to remove" tattoos, it specifically targets green, blue, orange and black ink. The laser breaks down the tattoo pigment, and the body reabsorbs and excretes it. With the dual pulse design of this laser there is a benefit of quicker treatment, larger area coverage, greater penetration, and quicker healing time.

Tattoo removal patients can expect multiple treatments (6-20), the average is eight; some tattoos can take quite a long time to treat, depending on the variables involved. . A consultation is required prior to treatment. These treatments are performed 6-8 weeks apart to allow adequate healing time. When removing a tattoo by laser, there is always a chance of scarring. The doctor or nurse at the initial consultation will determine the risk involved. When a tattoo is quite deep, it may not completely disappear, it may still be slightly visible.

VelaSmooth™

VelaSmooth™ is a technology that utilizes bipolar radiofrequency (RF) , optical energy (infrared light), negative pressure and tissue manipulation to reduce cellulite. Vacuum and specially designed rollers manipulate and smooth out the skin to provide safe and efficient energy delivery. The combination of the infrared light and conducted RF energies increases oxygen to the cells by heating the skin. This increases the metabolism of stored energy which reduces the size of the fat chamber. The result is a smoother appearance of the skin.

Wart Removal

Warts are skin growths caused by a viral infection in the top layer of the skin (commonly on the hands, feet, knees or elbows) or the mucous membranes (mouth or genitalia). The virus usually enters the skin through an opening, such as a cut or scratch, and incubates for a few months before actually forming a visible wart. As a rule they heal without scarring and generally this gives lasting immunity. Warts can be spread from on part of the body to another and this usually happens through picking and scratching. Although general warts are not spread very easily from person to person they can be transmitted. It is important to know that genital warts are spread easily from person to person, usually from direct or sexual contact. Where the wart appears and what it looks like depends largely on the type of virus that the wart stems from. There are several kinds of warts including:

Common Warts - There are the most frequently see and develop singly or group in multiple warts together. There are firm to the touch and have a rough-textured surface. They tend to be a slightly different colour than the surrounding skin, such as yellowish, brownish or even gray in colour. This type of warts generally appears on the fingers, around the nails, on the knees, toes, face or scalp.

Plantar Warts - These warts occur on the sole of the foot and tend to become imbedded in the foot causing a pressure area that can be quite painful to walk on.

Flat Warts - These are small, flat, flesh colour or brown smooth areas that appear in groups usually on the face. They are most common in children and young adults.

Filiform Warts - Most commonly occurring on the eyelids, face or neck, these warts are usually long and soft, moving out in a finger-like appearance. They can often be mistaken for something else, perhaps a rash.

Genital (or Venereal) Warts - Considered to be a sexually transmitted disease, genital warts occur on the penis or the vulva. They can present as a single wart or can spread into large cauliflower-like masses that can be painful.

Because warts are viral in nature, they can last from a few months to years for some people. Most are not painful, but most are irritating and frustrating. It is important to see a dermatologist and have the suspected wart diagnosed properly before beginning treatment. This may save time and costly home treatments that may be ineffective in treating the problem. OHIP has taken the view that warts are a limited infection of the skin and treatment of many of these is of cosmetic concern only. At the present time they will cover treatment of warts concerning the bottom of the feet, in the genital area or in people who are immunosuppressed, such as those with AIDS or HIV, or are taking medications that suppress the immune system.

There are several different methods of treating warts. Some of these include:

Naturopathic or Folk Remedies - Tea tree oil is a natural antiseptic agent which is readily available in most health food stores. Continued use may result in clearing of the warts. However it is possible to develop an allergy to the oil and this can result in a blistering reaction at the site of treatment.

Topical Agents - Topical agents that contain salicylic acid, lactic acid or trichloroacetic acid are readily available over the counter and go by such trade names as Tiacid, Duoplant, Sol-U-Ver and Compound W. Depending on the size and depth of the wart, continued use over the course of days or weeks may result in clearing of the warts. The Dermatologist may use a stronger topical agent called Cantharone that is used under medical supervision to treat the wart. Another possibility may be to inject the wart with an antibiotic called Bleomycin, which is also performed by the Dermatologist.

Liquid Nitrogen - This is sprayed on the wart and is a very cold sensation that burns the wart by way of a frostbite reaction. The intent is to kill the wart and cause it to fall off the skin. This can be painful and following treatment the formation of a blister at the site is common. It can often take 2-4 treatments with Liquid Nitrogen to clear common warts.

Laser Treatment - The more successful of wart treatments, there are two different laser systems that can be used with most warts:

Pulsed Dye Laser (PDL) emits a powerful beam of light into the wart. This results in damage to the blood vessels that supply the warts, heat damage to the wart and hopefully stimulation of the immune system that is battling the wart virus. Pulsed Dye Laser is very successful in treating warts that occur on the fingers, toes, feet and other areas of the body or face. Immediately after the treatment, bruising at the site is common and expected. This generally fades in 5-10 days. Multiple treatments are required and are spanned 3-4 weeks apart.

Carbon Dioxide (CO2) laser is useful for single planter warts. It is also used for persistent warts on the fingers. This laser allows well-controlled, surgical destruction of the wart and is performed only by the Dermatologist. There is a wound at the site that will require daily dressing changes for 10-14 days and approximately 8-12 weeks to heal well and form a scar. Because it is similar to a surgical procedure, steps to reduce the chance of infection must be taken. These include proper cleansing, antibiotic cream and post-operative follow-up with the Dermatologist. Any pain following the procedure is generally well controlled with Tylenol or a similar over the counter analgesic. It is possible that PDL treatments following this procedure may be necessary to optimize the chance of eradicating the warts.

As warts are a viral infection of the skin, time is often needed for the virus to run its course. Unfortunately, NO GUARANTEE can be given for complete, successful eradication of warts. The response rate for all treatments is approximately 80%. As a note, some treatments, including laser treatments are generally not performed on genital warts.