Frequently Asked Questions

Dr. Nightingale answers your questions regarding skin care services

What's the best way to get rid of acne scars?

Acne scars can be minimized using laser devices
Based on my experience, acne scars can be greatly minimized, but are impossible to completely clear, even with deep laser peels. The deeper the scar (like ice pick scars), the more difficult it is to treat. Combination therapy seems to work best.

For mild acne scars, we tend use chemical peels, light erbium peels or 1064 q switch laser treatments. It will often take a series of these treatments to get optimal results.

It is important to make sure that active acne is treated, and several of these treatments have the added advantage of helping to reduce acne breakouts.

For moderate scars we use moderate depth erbium laser peels. It may take 2-3 peels over 9-12 months for optimal results. Using various parameters, we can resurface the scars and stimulate collagen, thus filling the depressed defects.

Severe acne scars are treated with papillary dermal erbium peels. These are rather deep peels, done in the office with both topical anesthetic and selected nerve blocks on the face. Healing time is 7-10 days.

As always, with any of these treatments, a good retinol based skin care regimen is required for long term maintenance.

What's the best way to get rid of melasma?

Treatment of melasma is always difficult
I have found, as have most physicians who treat melasma, that nothing is a sure bet. We have used IPL, erbium lasers, q-switch lasers, photodynamic therapy with levulon as well as multiple topical preparations, all with limited success.

I have found that the most effective therapy has been with topicals, such as Epiquin Micro by Skin Medica combined with the 1064 q-switch laser. The 1064 q-switch is designed to treat dark dermal pigmented lesions and as a result seems to lighten melasma. It takes multiple treatments, but it does work. A maintenance program with high quality cosmeceuticals including Epiquin Micro, a laser treatment every 3-4 months, and most importantly, sun protection with both an SPF and sunblock will give you a good chance at controlling your melasma.

Good Luck!

Is BLU-U better than IPL for treating acne?

Blue light & red light combo is usually best
In our office, light treatment augments traditional treatment for acne. For mild comodomal/pustular acne, we still use traditional topical treatment. For more progressive inflammatory acne, we use topical and light therapy. Cystic acne is often treated with oral and topical medications along with light therapy. Light therapy typically comes in two types:

• 410nm blue light
• 1064nm red light

Blue light initiates a chemical reaction that causes the proliferation of endogenic porphrins (chemicals that you have within the skin), which attack and kill p. acnes, the bacteria that is responsible for acne. Since the reaction is not antibiotic-mediated, one never develops a resistance to blue light therapy.

Red light, however, works on the sebaceous glands rather than the bacteria that cause acne. The sebaceous glands produce sebum, which flows out of the follicle to protect the skin. Bacteria tend to live within the follicular-sebum mileu. 1064nm light can penetrate deeply into the skin and destroy the sebaceous glands, thus decreasing sebum production. The end result is less p. acnes and less acne.

IPL typically has wavelengths of 510-1200nm, thus theoretically covering both the effects of blue and red light. Unfortunately, the absorption spectrum of the porphyrins within the skin is pretty specific. Blue light concentrates all its energy at 410nm, the ideal wavelength, whereas IPL only has a small amount of energy within this range. The same applies in the red light spectra. A 1064nm laser emits concentrated energy in this spectra and has a better effect on destroying sebaceous glands than IPL, which again devotes less energy to this wavelength region.

In our office, we combine the use of blue light and 1064nm lasers to both kill p. acnes and reduce sebum production. The result, I feel, is better than IPL or either device alone.

- Stephen Nightingale, M.D.