Did you know it IS possible to actually reverse sun damage?  Fifteen or twenty years ago, our only option was plastic surgery.  Now we no longer have to go under the knife or have painful chemical peels   to tighten our skin and clear out all of our sins in the sun.  One of our favorite procedures here at Torrey Pines Dermatology is the Active FX laser. It is a remarkable way to turn back the hands of time and wipe the slate clean of sun damage so that your skin has a brand new fresh start.  Unlike the CO2 lasers of the past, the Active FX incorporates advanced technology to allow us to get amazing results with minimal downtime.  Because of the reduced downtime, this is a procedure we perform ALL YEAR LONG!

The key to the reduced downtime with the Active FX lies in the unique action of the “fractionated” technology, in which only a fraction of the skin’s surface is treated by the laser, leaving small “bridges” of untouched skin.  This technique makes the healing process dramatically quicker, as the skin rapidly regenerates across the tiny gaps produced by the laser.  This technique preserves the skin’s outer layers, which act as a protective dressing until the underlying new skin regenerates. Downtime is reduced to days instead of weeks of healing. Even on the most powerful settings, healing typically occurs in just about a week.

A simple procedure with dramatic results…

Active FX is a simple procedure which takes about 45 minutes to perform.  Old sun-damaged collagen is replaced with significant amounts of new collagen and elastin tissue- with studies demonstrating continued skin regeneration for months after a treatment. Because of ongoing collagen production, improvements following a treatment become even more dramatic over time.

The power to deliver high impact results…

While most treatments address one or two conditions, the Active FX has the unique power to smooth away wrinkles, eliminate brown spots, brighten, tighten and tone your skin- all at the same time.  A more vibrant and youthful appearance is attained as more and more collagen is laid down. Active FX can treat the full face including around the mouth and eyelids as well as the neck, chest and hands.

We feel that the science of beauty has taken a great leap forward with the Lumenis Active FX procedure. Smoother, wrinkle-free skin free of sun damage can now be achieved with less downtime and faster healing. This approach to skin rejuvenation is one of the most important advances for those who would like to create high impact results with less recovery time.  Active FX creates new life for your skin at its very foundation.  Please call us for your free consult to learn about the amazing ways we can rejuvenate your skin at Torrey Pines Dermatology!

Kristen A. Richards, MD

What are the highlights of your professional career?

Starting my own practice in October of 2001 was the highlight of my professional career.  It was nerve-wracking and tiring getting a new practice off the ground but since that time, the rewards have been so great.  Having grown up in La Jolla, I am able to see my friends and their families on a regular basis in my practice and it is wonderful to be able to contribute back to the community in which I was raised.

What are your proudest achievements?

Identifying my favorite aspects of my practice: cosmetic and surgical dermatology and making that a reality for my patients.  Having completed a year- long fellowship in Mohs micrographic surgery at Vanderbilt has given me a confidence in my surgical skills that I enjoy passing on to my patients.  It is incredibly rewarding to operate on a patient with skin cancer and restore their normal appearance all in one setting. This also translates into the cosmetic realm where I am constantly learning and evolving and trying to bring the most cutting edge procedures and products to my patients.

What is your favorite procedure?

Besides Mohs surgery, my favorite procedure is the Active FX resurfacing laser.  I so enjoy treating a patient with long-standing chronic sun damage and seeing their smiling face a week later when they are newly rejuvenated.  Most of the time I am able to “turn back the clock” about 10 years with this laser and it is incredibly rewarding for both me and my patients to be able to do this with minimal downtime.

What advice do you give to your patients looking to improve their skin and appearance?

I see the process of rejuvenation as analogous to remodeling a house.  Just like some houses have better “bones” to begin with, so do some patients.  I advise my patients to first work on their “bones” or the construct of their face through the use of volume fillers and deep tightening with Ultherapy.  After the construct is improved then we can start working on the “wrapping” or the skin.  I recommend patients start with removing all of the brown spots, red vessels and fine wrinkles from the sun by doing the Active FX resurfacing laser.  Following that we do a variety of line fillers and Botox to complete the rejuvenation process.

What are you currently reading? What’s your favorite book?

I am currently reading “First Break All the Rules”.  It is an outstanding book on an alternative but very practical way to run a business and motivate employees.  I have tried to incorporate a lot of the author’s ideas into running my practice more efficiently.

My favorite book was “Last Child in the Woods.”  As the proud mother of three boys, ages 12, 10 and 5, I am wary of technology getting in the way of normal face to face communication as well as appreciation of the beauty of the world around them.  This book helped me to be more conscious of trying to expose my boys to nature on a regular basis and encourage   “screen-free” time at home.

What quality do you value most in patients? In colleagues?

I truly value an honest, transparent relationship with my patients.  If my patients are comfortable enough expressing their true desires and goals for their skin, I have a much better chance of getting them there.  I appreciate my colleagues practicing the same philosophy I do of putting our patients first and going above and beyond patient expectations

What are you passionate about?

Having grown up in La Jolla, I am passionate about the ocean and exercise, particularly swimming.  I am a member of the Tri Club of San Diego and love the excitement of racing and the camaraderie of being with other athletes that value healthy minds, bodies and spirits.

What is your motto?

My motto is “Life is not a dress rehearsal.”  I value living each day to its fullest and living it in the best way possible.

If you knew you could not fail, what would you attempt?

I would find a way to invent a “sunscreen pill”.  I struggle with getting my patients to protect themselves with  sunscreen on a daily basis and taking a pill would be such a simple solution.

One of our favorite products at Torrey Pines Dermatology is SkinCeuticals C E FERULIC serum.  This formula is an antioxidant combination that works to neutralize free radicals that cause signs of aging, like wrinkles and fine lines. It also increases skin’s firmness and replenishes skin’s lipids – working to fill and smooth wrinkles.

Vitamins C and E are network antioxidants that reinforce the power of one another. When one antioxidant donates its electron to neutralize a free radical, it can “borrow” another electron from the second antioxidant to renew itself. In the case of vitamins C and E, this combination is potent enough to prevent the formation of cancerous compounds  called carcinogenic nitrosamines.

As far as anti-aging skin care goes, vitamins C and E enhance the photoprotective effects of sunscreen.  Vitamin C has been reported to enhance UVA protection, whereas vitamin E is more effective against UVB. Either way, the combination makes a great daily addition under sunscreen. Vitamin C also prevents and treats age spots and general hyperpigmentation, though far less significantly than 4% hydroquinone. Vitamin E is the dominant natural hydrator within the skin, and application leaves skin soft and supple.

To use it, you should cleanse your skin as you normally would.   After applying toner, apply 4-5 drops of  the C E FERULIC on your dry face, neck and chest area.  Although the serum might feel like it has been absorbed, it actually continues working for at least 72 hours after application.

We recommend using the product once a day and in the morning. It’s a great option for sun damaged skin, dry or sensitive skin, skin with poor elasticity, hyperpigmentation or those preparing (30 days before) or recovering from (7-10 days after) non-invasive procedures.

C E FERULIC contains…

15% L-Ascorbic Acid is an active form of Vitamin C that neutralizes free radicals caused by environmental damage and encourages your skin to produce more collagen.  Collagen is what makes young skin look young.  As we age, we lose the ability to make enough.  This potent form of Vitamin C helps change that.

1% Alpha Tocopherol is an active form of Vitamin E that also neutralizes free radicals and helps soothe and heal sun-damaged skin.

0.5% Ferulic Acid is a plant based antioxidant that’s fairly new on the scene.  Preliminary research is encouraging.  The findings are that it neutralizes free radicals like the others, and also inhibits melanogensis caused by the sun.

At Torrey Pines Dermatology it is said that beautiful skin is not just a hopeful thought, it can be a reality.  Let us help you get that bright, youthful skin this summer!

Hopefully by now you have heard the buzz on PRP or Platelet Rich Plasma and that we at Torrey Pines Dermatology are ushering in a new generation of anti-aging therapy.

What is PRP Skin Regeneration Therapy?

PRP (Platelet Rich Plasma) skin regeneration therapy is the cutting-edge, anti-aging procedure…to actually repair the damage caused by time and cumulative sun exposure. It is a natural product created from your own blood so it can cause no risk of allergy. Your blood consists of four main constituents: red blood cells, white blood cells, plasma and platelets. We filter out the red cells and white cells from the plasma. Within the plasma filtrate, we can identify the area with the most platelets and use these to your benefit. Platelets are involved in wound repair and injury. When there is an injury, platelets are attracted to the site of injury where they start releasing their contents to help tissues heal and repair. PRP has the effect of potentiating your innate natural healing power and tissue reorganization potential.

Common PRP rejuvenation treatments

PRP has been used for years with orthopedic and dental procedures. The most common conditions, in dermatology, for PRP therapy include: fine wrinkles around the eyes, lips, forehead and neck, nasolabial grooves, acne marks, bags and dark circles under the eyes and loose and saggy skin. The newest application is to assist with hair restoration by applying PRP after a microneedling procedure on the scalp.

PRP can be administered either as an injection for “filler” purposes or it can be used topically following microneedling or laser resurfacing procedures.

As natural dermal filler it acts as a matrix that promotes one’s own collagen to grow, regenerate and repair tissue…so it acts to naturally smooth and tighten the skin.

 

When microneedling is performed tiny channels are formed that allows solutions applied to the skin to get directly into the dermis without passing through the epidermis. PRP is applied topically after microneedling to get directly into the areas of the dermis most receptive to growth factor release and subsequent collagen stimulation.  Newly formed collagen causes immediate tightening of the skin as well as improved texture and tone.

The science behind how PRP can help rejuvenate the skin

The science behind PRP is very interesting. PRP contains platelets and growth factors. Platelets are cell fragments that circulate through your bloodstream. When platelets are made aware of injury, they stick to the site of injury and they release the growth factors that are stored within them. Growth factors are necessary for wound healing, repair and inflammation. These processes are important for tissue regeneration. Therefore by injecting PRP into the skin, we are injecting growth factors into the skin. Since growth factors heal tissues, we know PRP will rejuvenate your skin.

Treatment procedure

The process of PRP injection takes about an hour from start to finish. The steps are as follows…

First, the blood is collected from the patients arm with a tiny needle stick. We take the equivalent of one syringe full of blood and withdraw this into a test tube.

Second, the blood that was collected in a tube is placed in a centrifuge and is spun down for 15 minutes. The centrifuge spins the blood and separates it into its constituent parts.  Once the centrifuge has separated the blood components, we are able to see the test tube with two different parts. There is a red part that contains the red blood cells, there is a separation gel, and there is a clear straw colored fluid called plasma. At the bottom of the plasma layer, there is a “buffy coat” layer and this contains most of the platelets and white blood cells. The platelets are extracted from the test tube and are made ready for injection back into the skin.

While the sample is being prepared, the patient’s area of treatment will be prepared with a topical anesthetic and then cleansed.

Last, platelet-rich plasma (PRP) with autologous white blood cells is injected into the area of concern or it is applied over the skin following a micro-needling or procedure.

With one blood sample we can inject the cheeks or use it with our micro-needling procedure and with two blood samples we can inject multiple areas of the face.

There can be some slight bruising after the procedure, and it usually takes a couple of weeks to settle. If there is bruising, it can be covered with a mineral make-up.

PRP Skin Regeneration Therapy is expected to provide great benefit a wide variety of cosmetic concerns on the face and scalp. It can also be layered with a hyaluronic acid filler such as Juvederm, Voluma or Restylane for a more complete rejuvenating effect.

How long before I see improvement after PRP injections?

Since PRP is thought to rejuvenate the skin internally, we see results over the course of 3-4 weeks and continue to improve with time. Initially, there is a youthful swelling caused by the procedure, and this subsides over the course of a few days. As the weeks go by, the growth factors start to work in the skin making the skin thicker, with greater amounts of collagen, elastic fibers, and hyaluronic acid laid down in the dermis. There is an increase in the blood supply to the skin as vascular channels open up, and all these processes together help to rejuvenate the skin internally leading to improvement in skin tone and texture, tightening of skin, softening of lines and pores.

Treatment sessions are spaced 1-2 months apart, to achieve the best outcome.

OUR GOAL at Torrey Pines Dermatology is to provide our patients with cutting edge technology and the ability to maintain the natural, refreshed, healthy appearance of their skin. We offer a wide variety of treatment modalities and skin care regimens and we are thrilled to now be able to offer PRP treatments.  We hope you will stop in for your free consult and give PRP a try!

The world of aesthetics made the cover of the June 2015 issue of TIME magazine. Clearly face and body aesthetics are an integral part of our lives today but can be a difficult maze through which to navigate.  Education is essential to determine which of the myriad of options available would best help each patient achieve his or her goals. No one wants to appear “done” or unnatural.  Fortunately the tide is turning and now more and more patients are seeking a more natural look with simple restoration of volume loss not overfilling of these areas.

A perfect example of this is a new cutting edge treatment for double chins called Kybella. This revolutionary treatment is injected into the fat under the chin and essentially “melts” the fat cells away. When paired with our ultrasound treatment, Ultherapy, lifting and tightening can occur as well.  As both of these treatments occur under the skin, patients have very little, if any, downtime associated with these procedures.

It’s not all about vanity. If we take the time to take care for our houses, cars, and clothes why would we not maintain ourselves and our appearance?  Fortunately we live in an era of minimally invasive procedures, and it is easy to put together a custom strategy involving both products and procedures that will help each patient to meet his or her skin care goals.   Come see us soon at Torrey Pines Dermatology so we can help you design your skin care plan!

At Torrey Pines Dermatology we want to help you look and feel your absolute best. When rejuvenating the face we generally like to start at the deeper levels of the skin and then move more superficially. The natural aging process begins at the ripe old age of 27!!  We lose volume gradually in our temples, our medial cheeks and below the corners of the mouth.  All of this leads to deep creases around the mouth, sagging jowls and concave temples.  To make matters worse, with each decade we age a little bit faster than we did in the previous decade.   Our technology needs to be targeted to the actual science behind aging.  We have worked hard to develop a strategy at TPD to disrupt this process and maintain youthful skin throughout life.

Starting at the deeper levels, specifically the layer just above the muscle and below the fat, we utilize the amazing ultrasound tightening technique called Ultherapy.  Ultherapy is unique because it does not treat the skin itself, but below the skin it jump starts a repair process leading to rapid generation of new collagen and elastin.  Because the skin is attached to the fibromuscular layer treated by Ultherapy it plumps up and tightens too but without any downtime.

To further stimulate collagen production, we inject volume filler called Sculptra or poly-L-lactic acid about 2 weeks after Ultherapy.  As the repair process is already taking place, Sculptra then super stimulates collagen production and can last up to 2 years.   In addition to volume fillers, we will often use line fillers such as Juvederm and Restylane at this point to pinpoint and improve fine lines and deeper folds.

Moving more superficially, we then use a resurfacing laser called Active FX to treat the entire face approximately 2 weeks after Sculptra is injected.  Active FX works on the skin itself to reduce fine lines and wrinkles and soften deeper frown lines.  It improves tone and texture, gets rid of discoloration from the sun and tightens as well.  Downtime is approximately 5-7 days of being red and scaly like a sunburn but, unlike a sunburn, there is no pain during the recovery process.

The final touches!!!..

Neuromodulators, Botox, Dysport and Xeomin are popular tools used to soften the appearance of established wrinkles in those over the age of 40. However, beginning regular use much earlier – in the 20s and 30s – can prevent those repetitive muscle contracture lines from ever becoming etched into skin.  At Torrey Pines Dermatology we call this “prejuvenation” or preventing the process of aging.

In addition to the above procedures, a daily skin care regimen with the right products for your skin type and environment helps to keep the complexion firm and supple, hydrated and blemish-free. Regular professional facial treatments like chemical peels and microdermabrasion maintain refined, youthful skin.

All combined the above treatments and products are a proven way to get the maximal benefit out of noninvasive technology to ensure your skin remains youthful for a lifetime.  We look forward to rejuvenating you!

A simple way to treat depression has been in our face all along. A swipe of lipstick can put a smile on your face, but when it comes to depression beauty products usually don’t do the trick. Recent studies have proven that Botox injections can help treat depression. Botox doesn’t only help erase fine lines, stop sweating and even squelch migraines but it may have the power to make you happier and not just because your wrinkles have disappeared.

Here is the science behind this amazing discovery…

30 patients with major depressive disorder were assigned to receive either placebo or Botox injections in the forehead. Female participants received 29 units and male participants received 39 units. At week 12 the groups were crossed over. After several weeks of evaluation, study showed that patients who received Botox had a significant reduction in depression symptoms as compared to those who received the placebo injections.

Botox is a purified toxin. There is no bacteria and no chance of infection and that means it’s safe.

So feeling blue? A dose of Botox may be just what the doctor ordered.

Microneedling is one of the top new cosmetic procedures that can help treat skin concerns and reverse the effects of aging by using collagen induction therapy. Microneedling can help reduce and eliminate fine lines, wrinkles, hyperpigmentation, acne scars, stretch marks, alopecia, and more; and it is performed using a cosmetic tool known as the CosmoPen. Using the CosmoPen, both our providers can induce the production of collagen, and help restore a youthful glow and appearance to your skin.

How does microneedling work?

During microneedling, the CosmoPen creates thousands of tiny channels in your skin to help induce the production of collagen. Right after the procedure, our provider applies topical products that will be more efficiently absorbed by your skin due to the thousands of micro channels created by the CosmoPen. Throughout the healing process, the skin heals optimally as a result of induced collagen and from having the ability to absorb a higher percentage of topical skin care products.

How does microneedling affect product absorption?

On average, your skin only absorbs about 3 percent of the skin care products you apply topically to your skin. Microneedling with CosmoPen allows your skin to absorb about 80 percent of the skin care product applied during treatment for a tighter, plumper, and more youthful appearance. This is because the CosmoPen creates thousands of micro channels in your skin to promote optimal absorption.

What areas can be treated with CosmoPen?

CosmoPen can be used nearly anywhere on the body to treat skin concerns such as acne scarring, surgery, stretch marks, pigmentation disorders, aging, and alopecia, also known as baldness. Consult with our providers to find out if microneedling can help improve the appearance of your specific skin concern.

Is microneedling with CosmoPen painful?

In most cases, our providers will treat the affected area with topical anesthetic prior to using the CosmoPen to help reduce any pain and discomfort. Most patients report that microneedling is pain-free due to the topical anesthesia.

Will microneedling result in any downtime?

The downtime associated with microneedling is minimal, and patients can normally return to their everyday activities within a day of treatment. Individuals who wear makeup can go back to doing so the day following treatment. While there is minimal downtime, you may experience redness in the affected area between 12 and 48 hours.

 

When will I see results from microneedling?

The length of time it will take for you to see results will vary depending on your health and on the area being treated. Most patients will notice improvement after three or four treatments, which are often spaced four weeks apart. Results will depend on how long your skin takes to produce and regenerate collagen, but in most cases, your skin will continue to improve for up to 12 months after receiving CosmoPen treatments.

Torrey Pines Dermatology offers a variety of minimally invasive cosmetic procedures to help you look and feel your best. Come see us soon!

When injecting Botox, or filler we know that unfortunately sometimes bruising happens.  Tiny vessels can hide under the skin and despite our best efforts sometimes a small bruise still occurs.

The good news is that Dr. Richards and I have recently started using a blunt tipped cannula for fillers such as Juvederm, Restylane, Voluma, Sculptra, and PRP because the cannula can not penetrate tiny vessels under the skin as a needle would. We can now treat a lot of different areas with little or no bruising.  If we are lucky no one will know that you had anything done…except you’ll look well rested and more youthful.

Any bruise from a needle poke will resolve typically in 3-7 days.  Application of make-up (especially a peach tint) should be able to cover up any mark or discoloring.

Ideally, there should be no down time with any of these procedures…..however if you wanted one of these procedures done, and tomorrow is your wedding, I would not recommend doing it.

There are several things that patients can do to hopefully help prevent and minimize any potential bruising.

1. Stop all anticoagulants.
2. Avoid all anti-inflammatory medications for 7, but prefer 10 days, prior to the procedure. These include aspirin, ibuprofen, Naprosyn, aleve, advil, motrin, etc…
3. No alcohol for 2 day before and the day of procedure.
4. No fish oil for 1 week prior.
5. Stop all vitamin E and any other herbal supplements…especially anything that starts with an “F” or “G”
6. Start Arnika Forte capsules morning and night…the day before, the day of the procedure, and the day after.

If a bruise does develop, we can help it fade a little faster by using our V-Beam laser to zap the bruise and speed up its resolution.

I hope this calms any anxieties and we’ll get to see you soon in our office.

“What is the difference between Botox and Xeomin?” and “Which is the best one?” are two questions about facial injectables that commonly get asked. Botox is a leading cosmetic treatment that drastically reduces the appearance of crow’s feet, lines on the forehead and frown lines. With US FDA approval and launch of this revolutionary anti-aging product in 1989, millions continue to turn to Botox over 20 years later as part of their aesthetic regimen for looking younger. However, two other neurotoxins  have entered the market as well and are having equally great success :Dysport (US FDA approved 2009) and Xeomin (US FDA approved 2011).

Better or worse than Botox?

Xeomin is the first neurotoxin that does not need to be refrigerated before use, which may simplify distribution. Xeomin also has no additives, just botulinum toxin type A. This may mean that there is less risk of developing antibodies against Xeomin than other available neurotoxins. The body can develop antibodies in response to a foreign substance making it less effective.  Another difference is onset of action. The effects of Xeomin occur within one to two days, which makes it the perfect choice for a quick treatment before a big event the next day.  Like Botox the results are very natural and last from three to four months.

May gray and June gloom… we’re all aware of our weather, but this year it seems we have had continued morning overcast with a deep marine layer.

With the gray overcast and the mugginess we may think that we don’t need to apply any sunscreens… don’t be fooled.

80% of the damaging, burning, aging UV rays… goes right through that cloud cover. Five minutes here and five minutes there of unprotected sun exposure all adds up to brown sun spots, splotchy skin tone, broken little blood vessels, lines, wrinkles, and sagging skin.

So here is my tip…each and every morning after you brush your teeth apply a sun block. I don’t care too much about the SPF number, but I do care about the ingredients. Your broad spectrum sunblock needs to have zinc oxide and titanium dioxide listed as the active ingredients. These ingredients will actually block or reflect the UV from off the skin.

If I’m headed to the office or running errands, I like the Elta MD 46.  It has the ingredients that I want and it’s clear…so I’m not pasty. It also rubs completely in and it doesn’t feel greasy or sticky.

If I’m going surfing, I use the Elta MD 50 sport. I have to rub this in a little more, but it’s still not greasy.     I will also re-apply every 2.5-3 hours that I’m outside.

So that’s my simple tip for this month…regardless of the weather outside, apply your sunblock every morning after you brush your teeth…you won’t regret it. And if you happen to have any of those sun damage spots or wrinkles we can help you with that too.

Skin cancer is the most commonly diagnosed cancer annually. Many skin cancers develop from precancerous lesions called actinic keratoses, and here at Torrey Pines Dermatology we perform procedures and prescribe medications that “search and destroy” these lesions before they turn into cancer. One of our most powerful preventative procedures is a fractional resurfacing laser called Active FX.

Fractional lasers work on the top 2 layers of skin, the epidermis and dermis, in effect “erasing” precancerous cells.  The use of resurfacing procedures to treat skin pre-cancers (actinic keratoses) and prevent skin cancer has produced promising results — and fewer recurrences than treatment with the topical chemotherapy drugs. More recently, treatment with fractional lasers, which permit a very careful and controlled delivery of light, has also reduced the number of actinic keratoses from developing further into Squamous Cell Carcinoma.

Clinical Study of Laser Resurfacing and Skin Cancer Prevention

“Basil M. Hantash, M.D., Ph.D., and colleagues at Veterans Affairs Palo Alto Health Care System and Stanford University Medical Center, California, evaluated three alternative treatments for actinic keratoses in 24 patients with a history of lesions or of carcinoma. The participants had an average age of 73 years and were randomly assigned to undergo skin resurfacing with either a carbon dioxide laser, a chemical peel using 30 percent trichloroacetic acid or a cream with 5 percent fluorouracil, a medication used in chemotherapy, applied twice daily for three weeks. Dermatologists charted patients’ actinic keratoses on a diagram of the head at the beginning of the study and again every three months for a period of at least 24 months. Five patients who were eligible for the study but declined treatment were used as controls.

After three months, the number of actinic keratoses had decreased significantly in all three treatment groups: 83 percent in the fluorouracil group, 89 percent in the acid group and 92 percent in the laser group. None of the participants experienced adverse effects from treatment. The risk of cancer was also lower in all three treatment groups than in the control group.”

At Torrey Pines Dermatology Dr. Richards highly recommends having an Active FX resurfacing procedure to eliminate the build up of years of sun damage and to lessen the possibility of developing many more skin cancers in the future.  It is best performed 2-4 weeks following your skin cancer surgery and is also used to remodel scar tissue that can occur after skin cancer surgery. It is wonderful we now have such an effective tool to wipe the slate clean of past sun damage and to ensure healthier skin for a lifetime.