NEWSLETTER 

The old saying that the eyes are the window to the soul ceases to be true when your eyes start to show your chronological age while your spirit still feels youthful and vibrant.  

There are 3 aspects of aging that influence the eye area: volume loss, muscle hyperactivity, and loss of skin collagen/elasticity.

Volume replacement is probably the number one improvement for most patients, although it is usually the least requested in consultation. Patients usually ask about surgery for “bags” under the eyes, when very few of them actually need to have their bags removed.  The great majority have normal fat pads under the eye, but the upper cheek fat has gone south, so that there is an obvious groove between the eye and the cheek tissue.  Volume loss can also change the shape of the eye due to loss of support to the lid area.  The simple solution is to rebuild the upper cheek and tear trough with a filler such as Restylane, Juvederm, or Radiesse to restore the natural contours. No scars or surgery needed!  Results last a year or longer because the area has such low movement.

Muscle hyperactivity from squinting leads to Crow’s feet and wrinkles around the eye.  These are best diminished with Botox.

Fine lines due to loss of skin collagen and elasticity can be improved with laser resurfacing.  CO2 resurfacing gives the most dramatic improvement, but the Fraxel laser is also a favorite because the downtime is less intense.

When we think of skin rejuvenation, there are so many new and high tech choices available that chemical peels are often overlooked.  However, they can be a practical, cost-effective option to improve skin texture, mottled pigmentation, and uneven tone.  

I am often asked what is the difference between a chemical peel and a laser peel.  A chemical peel uses a chemical solution to nonspecifically damage layers of the skin to a desired depth (depending on the strength of the peel).  As this heals, the response stimulates skin turnover and some degree of collagen growth.   Resurfacing lasers use light energy to peel away very precise layers of skin. Not only does the healing response stimulate skin renewal, but the additional benefit of thermal heating causes some degree of skin tightening plus a greater amount of new collagen growth. Laser peels are not necessarily better than chemical peels, it depends on what laser you are using, the setting of the laser, and what you are trying to treat.

Two of the most popular peeling agents are TCA (Trichloracetic Acid) and Glycolic Acid.  TCA peels are my personal favorite because they are so versatile and in my opinion give more noticeable results.  However, many patients prefer Glycolic peels because they can pretty much continue their normal routine with limited downtime. 

A medium depth TCA peel will have 4-5 days of heavy peeling and you will want to plan your schedule accordingly. A superficial Glycolic Acid peel is better suited for patients who cannot tolerate downtime, have very sensitive skin, or have skin of color.   With these peels, you may be pink or red for a day and may not necessarily have actual “peeling” of the skin.  Because of their gentle nature, these types of peels will have to be done in a series of  6 treatments for best results.  Heavier Glycolic peels are still considered fairly superficial, but will cause somewhat more redness and peeling.

The ideal patient for a chemical peel is someone with brown, blotchy freckling on the face or chest, melasma, or fine textural complaints.  Chemical peels can also help clear residual color left on the skin after acne breakouts. Those who have deeper lines or wrinkles and true acne scars should consider laser treatment.

The one exception to this is that some patients with ice pick scars can do quite well using what is called the CROSS technique, where 100% pure TCA is placed in the divot of the scar with a fine tipped toothpick.  The goal is to stimulate excessive granulation tissue (which is basically collagen) to fill up just that tiny hole.  It can take 1 to 6 treatments and usually this technique is done before laser resurfacing in a select subset of patients.  It is not recommended for patients with dark skin types.

Whatever approach is used for skin rejuvenation, fillers and Botox should be discussed as part of the treatment armamentarium since chemical peels do not have an effect on volume loss due to normal aging or muscle relaxation.   Combination therapy leads to the highest degrees of patient satisfaction when performed appropriately, however not everyone needs all three approaches.

All in the Family Research shows that parents play an important role in teen tanning habits.  Teens whose parents tan are more likely to tan than their peers, especially when parents use indoor tanning beds.  This underscores the need to set a good example with sun protection from an early age to protect our children from potentially devastating skin cancers.

One of the key advantages to the   Laser & Cosmetic Surgery Center of Houston is Dr. Melissa Bogle’s role in the scientific advancement of lasers and cosmetic medicine.  She has worked closely with numerous laser companies to develop new equipment and optimize existing technology for a wide variety of conditions.

Dr. Bogle serves on the Standards of Training Committee of the American Society for Laser Medicine and Surgery and is appointed chairperson of the Electronic Communication and Publications Committee for a 3 year term.   She has also been appointed to serve on the Harris County Medical Society’s Public Grievance Committee.

This quarter Dr. Bogle was featured in the magazine Healthy Aging with an article on newly discovered laser wavelengths that target fat.  She also published a textbook chapter on fractional skin resurfacing.  This year she was selected by H Magazine as one of Houston’s Top Doctors, Top Professionals on the Fast Track, and Top Doctors for Kids.