Q: I am due to have Juvederm injected in my smile creases but I want to have Fraxel Restore laser resurfacing for my sun damage. Which should I do first?

A: As there is no evidence that the Fraxel restore damages the filler because the filler is injected in between the deep dermis and the subcutaneous tissues, and the laser penetrates to the mid dermis, there usually is not a problem. You could do the series of lasers first but this could take four to six months and then after you complete this series you could do your filler. In my practice and many other cosmetic dermatologists and plastic surgeons in New York City, patients are not willing to wait and we have not found there to be problems with lasers and collagen injections in the 1980s and hyaluronic acid fillers such as Restylane and Juvederm, Radiesse, and Sculptra now.

Q: What can I do to minimize the pore size of my facial skin?

A: There are some cosmeceuticals that help minimize the appearance of pores. There is no treatment that can guarantee an improvement, but I have found a number of patients that improved the appearance of their pores after a series of Fraxel Restore laser treatments.

Q: My wedding is scheduled for one year from now. I have light-colored skin, acne scars and some freckles that I would like to improve. Can I start Fraxel now and be improved before the wedding?

A: Yes, you could have monthly treatments with the Fraxel Dual, and have the 1550nm treat the acne scars and the 1927nm. wavelength treat the pigmentation. The acne scars may continue to improve in appearance even after the Fraxel treatments are over as your collagen will continue to develop in the dermis. Make sure you protect your skin from the sun!

Q: Can anything be done to thin out the thick skin of my nose?

A: This is a difficult problem and surgical treatment carries the risk of scarring. Fraxel laser may help, or may not.

Q: If I want to have the groove under my eyelids filled and the wrinkled skin of the lower eyelids, can this be risky?

A: This is commonly done, although some physicians do it on different days to allow healing. There can be a risk of ectropion, which is a tightening of the lower eyelid skin. If a patient is more elderly than young, or if the patient has had excessive sun exposure, the skin might have lost its elasticity and there is an increased risk in having the eyelid pull away from the eye after the treatment. This can dry out the eye because the tears will not keep the cornea moist. Sometimes, using drops or eye gel may help and the situation can resolve itself, but in more severe cases, surgery may have to be done to fix the lower eyelid. There is a simple test that is usually done by the examining physician, which does not hurt, and tells the physician if you are at risk of having this problem after resurfacing.