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  • IPL Photorejuvenation – A Guide for Patients

    IPL photorejuvenation emits a concentrated pulsed light from a laser device to fragment melanin and hemoglobin. The body absorbs the broken pigment and vessels, making them less noticeable. IPL laser treatments are effective at lightening sun spots and brown blotches, enhancing skin texture, reducing pore size and decreasing skin oiliness. In addition, IPL photorejuvenation can minimize the appearance of rosacea, skin redness, wrinkles and dilated blood vessels. This technology even facilitates collagen growth by heating the body’s fibroblast cells, which are responsible for collagen production.

    The IPL Photorejuvenation Procedure

    A board-certified dermatologist at OC Skin Institute, Dr. Tony Nakhla, can provide an in-office IPL photorejuvenation treatment. During the intense pulsed light laser procedure, the patient is given a special cover to protect the eyes. Next, the dermatologist applies a cool gel on the patient’s affected skin. Finally, light pulses are directed toward the skin from a hand-held device that the dermatologist carefully places on the targeted area. Some patients may feel a mild sting.

    Afterward, the area is cleaned, and the patient is given a sunscreen-infused moisturizer. If mild swelling occurs, the patient can apply a cold compress for 10 minutes. The entire treatment can take as little as 30 minutes. Photorejuvenation is an excellent option for many people; however, pregnant patients should avoid this treatment due to the lack of testing on gestating women.

    Additional Treatments

    IPL photorejuvenation typically requires three to five treatments, which are given at approximately one-month intervals. The total number of treatments depends on the severity of the patient’s condition. Patients can expect to see improvement after each treatment. Those who properly care for their skin often only need one maintenance treatment every year. However, two treatments per year may be necessary for people who want to control redness or retain collagen growth.

    The Recovery Period

    Minor swelling, skin redness and brown-spot darkening commonly occur after a patient’s first treatment. These issues usually subside anywhere from a few hours to one week. Slight bruising is another side effect; however, this symptom is rare, and it usually takes up to two weeks for the bruises to disappear. Patients who have sun spots may notice crusting, which can last a little over one week. If desired, patients can carefully apply makeup to cover the signs of healing. It is crucial for patients to habitually use sunscreen and wear protective clothing in order to maintain their treatment results.

  • The Causes and Treatment for Wrinkles

    For many people, wrinkles are a serious skin concern. In order to effectively treat wrinkles, it is important for patients to know the causes of wrinkles. There are four main facilitators of wrinkles. Regular long-term muscle action that occurs in the same area can eventually create wrinkles like vertical frown lines. Environmental damage to the epidermis is another contributor to wrinkles. Also, the loss of age-related elastin and collagen can result in wrinkles. Finally, decreased fat, muscle and bone volumes can lead to a sagging jawline.

    Cosmetic Treatments for Wrinkles

    Board-certified dermatologist and dermatologic surgeon Dr. Tony Nakhla, at OC Skin Institute will suggest a treatment plan based on the depth of the patient’s wrinkles. Resurfacing lasers or light peels are effective at addressing superficial lines. Some patients who have fine lines around the eyes may be candidates for cosmetic injectables that relax the muscles and minimize wrinkles, such as Dysport or Botox.

    Since one cause of deep folds and wrinkles is the loss of bone, muscle and fat, treatment for severe wrinkles must add volume and provide support to the area. Therefore, grooves and deep lines tend to respond better to two-part treatments that include injectables and facial fillers, which are designed to support and plump wrinkles. Facial fillers commonly used by dermatologists include Perlane, Radiesse and Sculptra.

    If sun damage also contributed to the patient’s deep wrinkles, the dermatologist may use Juvederm or Restylane to provide additional support. CO2 lasers or Fraxel lasers can be utilized as part of the patient’s treatment plan in order to enhance the epidermis’ color and texture and improve the patient’s general complexion.

    Although cosmetic injections and fillers are effective at addressing lines, wrinkles and folds, they are not able to regenerate bone, fat or muscle. These products are also unable to restore the dermis’ collagen levels. However, cosmetic injections can improve the appearance of fine lines and deep wrinkles overall without the need for surgical intervention.

  • Common Skin Cancer Symptoms and Causes

    People can develop skin cancer from spending time in the sun without protection. The sun emits ultraviolet light that can cause mutations in the DNA of skin cells. Those who live near the equator have an increased risk of developing cancer from sun exposure. It is imperative that people understand what causes skin cancer so that they can take adequate steps to protect themselves from this risk. People also need to learn about the symptoms so that they can seek treatment from a board-certified dermatologis like Dr. Tony Nakhla.

    What are Some Common Skin Cancer Symptoms?

    The most common symptom is a persistent spot on the skin that bleeds and produces a superficial erosion. Individuals should examine their skin regularly and have all unusual growths examined by a licensed dermatologist. If an existing spot on the skin starts changing in size, color or shape, have it examined by a professional.

    UVA, UVB & UVC Sun Rays and Exposure Can Cause Skin Cancer

    Exposure to ultraviolet light is the main cause of skin cancer. There are three types of ultraviolet light: UVB, UVA and UVC.

    UVC rays are the most dangerous. Fortunately, the ozone layer prevents these rays from reaching the earth’s surface. With that said, people can still develop skin cancer from exposure to UVA and UVB radiation.

    UVA light can penetrate the skin’s surface level and damage the connective tissue. Even when people are standing in shady areas, they still receive 50% of UVA exposure. Those who have light skin are more vulnerable to UVA rays than those who have dark skin. Approximately 55% of UVA light can pass through light skin. Dark skin only allows 17.5% of UVA light to pass through.

    Most sunburns are the result of UVB radiation. Thanks to the ozone layer, only five percent of UVB light reaches the earth’s surface. UVB light does not penetrate as far into the skin as UVA light, but it can still cause skin cancer. DNA absorbs UVB rays directly. Those who have light skin are more likely to suffer the effects of UVB radiation than those who have dark skin.

    How Does Skin Cancer Develop?

    When UV light penetrates the skin, it damages the body’s cellular DNA. This damage occurs from the hyperactive molecules that UV light contains. Those who spend time in the sun without wearing protection should undergo a skin cancer detection test.

    Click here to learn more about skin cancer in general, prevention, detection and treatment available at the OC Skin Institute.

  • Types of Psoriasis & Treatment with the XTRAC Laser

    Patients who suffer from psoriasis need a treatment plan tailored to their specific kind of psoriasis. There are seven types of psoriasis a board-certified dermatologist or skin care specialist can potentially see.

    Plaque Psoriasis or Psoriasis Vulgaris

    Plaque psoriasis is the most common variety of psoriasis, afflicting 80 percent of patients. Plaque psoriasis is characterized by red, inflamed patches with white scales that itch and burn.

    Guttate Psoriasis

    Guttate psoriasis often appears in younger patients, accounting for almost 2 percent of cases. Patients will notice tiny, salmon-colored spots on their thighs, trunk, scalp and upper arms that last for several weeks. This condition is triggered by beta-blockers, skin injuries, stress and upper respiratory infections.

    Inverse Psoriasis or Flexural Psoriasis

    Triggered by yeast, inverse psoriasis may present itself with bright red, non-scaly lesions in the folds of the skin. Sweating and chaffing can worsen this condition.

    Pustular Psoriasis

    Pustular psoriasis causes pus-filled blisters to crop up on the body. This conditions’ triggers include topical steroids, systemic medication, ultraviolet light, chemical exposure, stress, infections and pregnancy. Patients may have a fever, nausea, chills, a rapid heart rate and muscle weakness.

    Erythrodermic Psoriasis

    Erythrodermic psoriasis is the least common yet the most serious kind of psoriasis. During a flare-up, patients may experience widespread redness of the skin along with skin shedding, a burning sensation on the affected areas, an increased heart rate and body temperature fluctuations. Infections and severe sunburns are two common triggers. Coal tar products, cortisone, anti-malarial drugs and lithium are other triggers. Complications from erythrodermic psoriasis include congestive heart failure and pneumonia.

    Psoriatic Nail Disease

    Approximately 50 percent of psoriasis patients have psoriatic nail disease, particularly individuals who have psoriatic arthritis. Some symptoms of nail psoriasis are nail tenderness, pitting, separation and yellowness.

    Psoriatic Arthritis

    Psoriatic arthritis occurs when the patient has arthritis and psoriasis. This type of psoriasis can cause red skin with pustules, stiffening and pain in the joints, swelling of the toes and fingers and a warm feeling in the joints.

    XTRAC Laser Treatment

    The laser treatment with the XTRAC laser targets only the skin that is affected by psoriasis in order to penetrate the layers of skin and break down the T-cell’s DNA, with no damage to healthy skin. This dermatological treatment is safe and effective, producing noticeable results after only several sessions without the inconvenience of messy creams.

  • The Benefits of Intense Pulsed Light Laser Treatments

    Intense pulsed light therapy, also known as IPL is a dermatological cosmetic treatment that can effectively reduce the appearance of vascular lesions, age spots, freckles, fine lines and wrinkles and unwanted dark hair.

    How Does Intense Pulsed Light Therapy Work?

    IPL uses high-energy pulses of light that are converted into heat energy and then absorbed by specific cells in the lower layers of the skin. Most intense pulsed light systems produce different wavelengths of light so that the treatment can be customized to the area and issue being treated.

    Issues Treated With Intense Pulsed Light Therapy:

    • IPL can reduce the appearance of vascular birthmarks and spider veins by targeting the red pigment in the blood without damaging the skin or surrounding tissue.
    • IPL can be targeted at the melanin-producing cells on the surface of the skin to remove discoloration caused by melasma, birthmarks, freckles, and age spots.
    • IPL can be directed at the hair follicles on the face, neck, back, chest, underarms, and bikini line to eliminate unwanted hair. The treatment is most effective on dark hair.

    What to Expect:

    IPL treatment should only be performed by an expert in cosmetic dermatology. Treatment sessions typically last approximately 20 minutes. Most patients require a series of four to six sessions spaced over several weeks to achieve the desired results. A gel is applied to the skin at the area to be treated. The treatment head of the IPL device, which is a smooth, glass surface, is applied to the area to deliver the light pulses. Most patients describe the sensation of the light pulses as similar to being snapped with a rubber band or a light pinch. Since IPL dermatology treatment is non-invasive and does not damage the surface of the skin, patients are able to resume their normal activities immediately.

  • Hemangiomas & Infants, Toddlers and Babies

    Hemangiomas are benign tumors comprised of a tangled mass of blood vessels. They are most common in Caucasian infants, especially fair-skinned females. The exact cause of hemangiomas is not known; however, they do not appear to be associated with heredity, environmental factors, or activities during pregnancy.

    Signs and Symptoms of Hemangiomas:

    Most infants develop hemangiomas within two weeks to four months following birth. Approximately 60 percent of hemangiomas develop on the surface of the skin on the head or neck; however, they can also occur on the trunk, arms, legs, or even in an internal organ. Only about 20 percent of infants develop multiple hemangiomas. These infants have a greater likelihood of also having a hemangioma involving an internal organ. If the hemangioma develops along the spine, the child should be evaluated for possible spinal malformations.

    Potential Complications:

    While most hemangiomas are harmless and fade with age, the size and location of the growth may cause difficulty with breathing or vision. Hemangiomas affecting the internal organs have the potential to cause various complications depending on the organ affected. In very rare cases, the skin around the hemangioma can stretch and leave a wound or scab.

    It is not unusual for extra blood vessels, skin, or fatty tissue to remain even after the hemangioma has faded. Orange County parents of children with large or disfiguring hemangiomas should consult a board-certified dermatologist at OC Skin Institute to find out the most appropriate method of correcting cosmetic issues and reducing the possibility of future complications.

  • What You Can Do About Alopecia Hair Loss

    While there are no Food and Drug Administration-approved treatments for hair loss caused by alopecia, a variety of drugs approved for other conditions may help some patients with alopecia slow the rate of hair loss and even regrow hair.

    Corticosteroid Injections:

    The corticosteroids are injected directly into the bald patches of skin every four to six weeks. The injections do not stop additional hair loss but may stimulate regrowth in as little as four weeks.

    Topical Minoxidil:

    This treatment involves applying the minoxidil solution to the scalp a couple of times a day to stimulate hair growth. While the treatment is easy to use and has minimal side effects, it generally is not effective unless combined with topical corticosteroid medications.

    Anthralin Ointment or Cream:

    Anthralin is normally used to treat psoriasis, but it may also stimulate hair growth in alopecia patients with two to three months of continuous usage. The tar-like substance is applied to the bald areas of skin once a day and then washed off within 30 to 60 minutes. The medication may cause temporary skin irritation or discoloration.

    Topical Corticosteroids:

    Topical corticosteroids come in a variety of forms and strengths and can help decrease the inflammation around hair follicles that can lead to hair loss. Although the effectiveness of the medication is based on how well it is absorbed into the scalp, most patients experience a decrease in hair loss and hair regrowth of about 25 percent.

    Oral Corticosteroids:

    Oral corticosteroids may help slow extensive hair loss and promote hair regrowth by suppressing the disease activity or immune response triggering the alopecia. As a general rule, oral corticosteroids are only taken for short periods of time, since they can cause serious side effects.

    Topical Immunotherapy:

    Squaric acid dibutyl ester, diphencyprone, or dinitrochlorobenzene may be applied directly to the scalp in order to modify the immune response triggering the hair loss. As many as 40 percent of patients regrow hair within six months when using this treatment. Topical immunotherapy is not as widely available as other treatments and typically causes a poison ivy-like rash at the application site.


    Immunotherapy drugs, including ruxolitinib and tofacitinib commonly used to treat rheumatoid arthritis and certain blood disorders, have shown promise in helping patients with extensive hair loss regrow hair. The drugs are currently in clinical trials to determine their efficacy and safety in the long-term treatment of alopecia.

    Regardless of the treatment used, it is possible for the hair loss to return once the treatment is discontinued. Patients should consult a board-certified dermatologist to determine the most appropriate treatment for their circumstances.

    If you are interested in learning more about how to prevent hair loss in its initial stages or feel like you missed the boat, do not hesitate. Contact OC Skin Institute as our team and board-certified dermatologist can help combat the effects of hair loss, no matter the stage.

  • XTRAC Laser for Psoriasis Treatment

    At OC Skin Institute, our team of professionals and board-certified dermatologist Dr. Tony Nakhla routinely use the XTRAC laser to treat psoriasis. During this therapy, a laser penetrates the skin to break up the cells that form plaque. The laser transmits an ultraviolet light to treat psoriasis lesions. Since the XTRAC device is small, we perform this treatment in our office. Those who undergo this laser treatment often have long periods of remission between outbreaks.

    How is XTRAC Therapy Beneficial?

    Each laser therapy session only takes a few minutes to complete. Dr. Nakhla targets specific regions of the skin, which means that patients do not need to worry about the laser affecting or spreading to other areas of the skin. XTRAC laser therapy can treat psoriasis spots faster than artificial UV light. The laser is even effective on areas that are difficult to treat. For example, it is commonly used to treat psoriasis on the knees, elbows and scalp.

    Are There Any Side Effects?

    The side effects are usually minimal. Those who undergo this form of laser therapy may experience redness, blistering and itching. Some patients may also experience a burning sensation or an increase in pigmentation.

    What are the Risks?

    Researchers have yet to identify any medical risks. With that said, doctors do not recommend this treatment for those who have lupus or a history of skin cancer. Those who are pregnant should wait until their baby is born before undergoing XTRAC laser therapy. Some patients are highly sensitive to light. In these cases, the dermatologist can use a lower dose to treat the patient.

    The Treatment Process

    Treatment time varies based on each patient’s skin type and severity of skin lesions. Some patients may need to undergo multiple treatment sessions. According to the American Academy of Dermatology, most patients need two to three treatments per week. Doctors prefer waiting at least 48 hours between each therapy session. Most patients need 10 to 12 treatment sessions to clear their psoriasis. Some patients notice results after a single session.

  • Kybella Injections for Fat Under the Chin

    The dreaded double chin is a reality of aging for many of us. As we age, our bodies tend to deposit fat in the submental area beneath the chin, producing a rounded, sagging mass. In the past, people have tried double chin treatments ranging including bandages, massage and jaw exercises, but surgery was the only reliable solution.

    Yet, another cosmetic treatment for double chins is now available. Kybella (deoxycholic acid) is an injectable treatment that attacks under-chin fat directly, eventually melting it away and restoring the smooth contours of the chin and jaw.

    How Does Kybella Work?

    Kybella’s active component, deoxycholic acid, is a synthetic version of an acid your digestive system normally produces to break down fat. When injected into the submental chin deposit, it destroys the membranes of fat cells, causing them to literally melt and be reabsorbed by the body.

    Note that Kybella only treats fat deposits. It does not do anything for loose skin, obvious tendons and veins, or other cosmetic problems that may appear in the chin and neck area. Further cosmetic treatment, such as Botox, may be needed to get the best-looking chin and neck possible.

    How Is Kybella Administered?

    A session of Kybella treatment usually involves several subcutaneous injections with a light needle. This can take up to 15 or 20 minutes. Topical anesthesia or sedative may be used if the patient finds the process uncomfortable.

    Usually, more than one session is necessary to completely achieve the desired results. No more than six sessions should be required, however. Sessions are scheduled 1-2 months apart, and can be arranged as necessary for the patient’s convenience.

    Side effects can include light bruising at the injection site, numbness, and temporary hardening of the skin. These are usually not serious and go away on their own in a few days. More serious side effects, such as difficulty swallowing or weakness of the facial muscles that produces an uneven smile, are rare but possible.

  • Tests for Detecting Melanoma

    If you or your physician notice an unusual spot on your body that might be a sign of melanoma, there are a number of tests and questions that you will need to go through. These will help confirm or disprove a skin cancer diagnosis. The usual procedure is as follows:

    • Questions about symptoms. The doctor will ask you whether you remember when the possible melanoma appeared and whether you have noticed any change. You will also be asked about any cancer risk factors. These can include high exposure to sunlight, a family history of cancer, or previous cancerous growths on the skin.
    • Physical examination. The doctor will note the appearance of the potential melanoma and examine it with a magnifying lens called a dermatoscope. He or she may examine the rest of your body for other possible melanomas. The doctor may ask to feel your lymph nodes, which are clusters of small cells in your neck, armpits, and groin. When cancer spreads, it often does so through the lymph nodes, so swollen lymph nodes are a potential trouble sign.
    • Biopsies. If the doctor suspects melanoma, the next step is to remove some of the suspicious area and have it laboratory tested. This is referred to as a skin biopsy. When performed by a board-certified dermatologist, biopsies are simple and painless. Local anesthesia will be used to numb the area. There are several ways to perform a biopsy. The doctor may remove part of the affected skin with a scalpel or shaver. A punch can also be used to take a deeper sample of the affected skin. In some cases, the biopsy can even be performed directly on the body, without having to remove any skin.

    If the melanoma has already spread inside the body, more complex biopsy procedures may be needed. A fine needle can be used to remove cells from lymph nodes or tumors inside the body for examination. A more complex method, sentinel lymph node biopsy, tracks the
    spread of cancerous cells in the lymphatic system using radioactive dye. In especially serious cases, the doctor may order surgery to remove tumors or lymph nodes for direct examination

    The material collected from a biopsy will be sent to a laboratory for examination by a pathologist. If melanoma cells are detected, the pathologist will determine the stage of the cancer. This will enable the treating doctor to decide on a course of action.