Recent posts

Treatment for Large Pores

What can I do about large pores on my face?


Dear B:

Large pore size is a very common complaint in my clinic.  Unfortunately, pore size is relatively unchangeable.  Pores can actually enlarge with time with the loss of elasticity in the skin as well as sun damage.  The good news is that there are many treatments that can help reduce the appearance of your pores.

First and foremost, I always recommend a prescription retinoid cream for nightly use.  Retinoid creams (i.e. Retin-A, Atralin, Tazorac, Differin) help keep your pores unclogged and therefore they appear to be smaller.  Another helpful tool is the Clarisonic Pro- this will work synergistically with the retinoid cream to keep those pores as clean and clear as possible.

If you’re still unhappy with your pore size after initiating the appropriate topical treatments, there are some laser treatments that may help.  The Fraxel laser is used for acne scarring, scarring, brown spots (hyperpigmentation) and can also help with pore size in some cases.

So, don’t despair- there are some options to reduce the appearance of pores.  We’re always happy to see you in consultation in Renton or Northgate.

Erica Linnell, MD

Pacific Dermatology and Cosmetic Center

Renton, WA



Treating brown spots on Asian skin

Are lasers to treat brown spots on Asian skin safe? -K

Dear K:

Asian skin is more susceptible to scarring and discoloration after laser treatments.  That being said, there are absolutely some great treatments for hyperpigmentation of Asian skin- a very common complaint.First and foremost you must always wear sunscreen with SPF 30 or above.  Remember to re-apply every couple of hours if out in the sun.  If possible, wear a broad brimmed hat and sunglasses.Secondly I recommend a series of in-office chemical peels and prescription lightening creams (the Obagi NuDerm System is an outstanding at home treatment for pigmentation).  If these treatments are inadequate, laser treatments are an option.  The laser used would depend on the type of pigment that you have (superficial pigment vs deeper hyperpigmentation).  In my Asian patients I typically use more conservative settings initially and gradually increase the settings if tolerated.  The IPL device (intense pulsed light) is good for superficial pigment.  The Fraxel laser (using the 1927 wavelength) is also excellent for more stubborn pigment.Please schedule a consultation with us at Pacific Dermatology and Cosmetic Center here in Renton so we can determine the best treatment for you!

Erica Linnell, MD

Pacific Dermatology and Cosmetic Center, Renton, WA

Treatment for red birthmarks

I am looking to have some red birthmarks removed around my nose and on my forehead. What is the best treatment option for this? -Lori


Hi Lori. Thank you for the inquiry. We would be happy to see you to have your red birthmarks removed. It sounds like we will need to use a laser for this. We have 3 different lasers to treat redness. The VBeam Perfecta is one. It is the main laser that we use to treat red birthmarks. If you have a port-wine-stain, this would be the laser that we would use. It takes multiple treatments for most conditions. We also have a KTP laser, and the Intense Pulse Light (IPL). Both of these two also treat redness.

We can likely treat you at the same time as your consultation if you would like. Make sure to mention that you found us on realself and the $80 consultation fee is waived.
Thanks again.

Jennifer Reichel MD

Director, Pacific Dermatology & Cosmetic Center

11011 Meridian Avenue N Suite 102
Seattle WA 98133
phone: 206-859-5777
fax: 206-859-5776


Laser treatment for Hidradenitis Supurativa?

Megan, I am a 34 year old female and have recently been diagnosed with hidradenitis suppurativa. Can laser hair removal help with my condition? -E

Dear E.

Thank you for asking Megan Larson, one of our wonderful PA-C’s at Pacific Dermatology & Cosmetic Center in Renton about Hidradenitis Supurativa and laser hair removal.

Here is Megan’s answer:

Yes, laser hair removal can be helpful for many patients with this condition. We use either Intense Pulse Light (IPL) or the LightSheer Duet Diode laser. It takes a series of treatment sessions, and should be used in combination with other forms of treatments.

Hidradenitis suppurativa, or acne inversa, is a chronic inflammatory condition that causes painful bumps and nodules in areas that rub, like the armpits and groin.  This condition affects mostly women between puberty and 40-years-old, and about 1-4% of the population has it.  The bumps and nodules can become swollen and painful, can become inflamed and leak pus, and can lead to scarring and disfigurement.  As one can imagine, this condition can cause significant psychological distress and can affect people’s self-esteem and the way they interact with others.  There are many treatments for hidradenitis suppurativa, and some people are able to attain full clearance while others suffer a more chronic and relapsing course.  A few of the treatment options include topical medications, oral medications, injections, surgery, and lasers.  At Pacific Dermatology and Cosmetic Center in NorthGate Seattle, or in Renton, we do everything we can to try and help our patients achieve full clearance and maintain it.  We tailor our treatment plans to the needs of the individual patient, and will work with them to attain their optimal result.

Megan Larson, PA-C

Pacific Dermatology & Cosmetic Center, Renton


Acne Scarring: CO2 vs Fraxel Restore

Having performed traditional CO2 treatments and both fractional CO2 (Lumenis, Total FX) and Fraxel Restore for over 10 years, I have noticed positives and negatives about Fraxel vs the CO2 laser. I have asked colleagues around the country what their impressions are, and, for the most part, we agree. Doing one fractional CO2 laser treatment for acne scarring is often times NOT ENOUGH to achive really good results. Most patients need at least 2 treatments with the CO2 laser for acne scarring, and sometimes more than that. The bummer about that is the long down-time and intensity of the treatment.
I have performed hundreds of Fraxel laser treatments for acne scarring, and really feel like we get very good results. It does take a series of treatments (at least 4). They need to be spaced about 4-6 weeks apart for optimal results. This is almost always what I recommend for patients. The down-time is only a few days, you can drive yourself home from the appointment, and you don't have raw skin. What I usually tell patients, is that we should start with a series of Fraxel Restore treatments and then we will evaluate their skin and might decide to follow the Fraxel series with one CO2 treatment. This has given really good results. Now, I realize that it is a major project to undergo so many treatments, but it seems, in my hands, to be the best.
Dr. Jennifer Reichel
Seattle and Renton Dermatologic Surgeon
Director, Pacific Dermatology & Cosmetic Center

Acne Treatment Options

Hi Dr. Reichel, I'm a student & trying hard on a research task I've been given to ask world's best Dermatologists about the best practices to get rid of acne in few concise sentences. Hope you'll take a few minutes to help me in completing my research.



I don't know that I would be considered a world expert on acne - as my practice focuses on Skin cancer surgery and Cosmetic Surgery. However, I would say treatment for acne depends on the type of acne that an individual has, and how severe the acne is. For mild cases, topical medications such as Retin-a, Benzyl Peroxide, and Clindamyacin can be very effective. For more severe cases, oral medications are indicated. The front line for oral meds would be antibiotics such as minocycline or doxycycline. For females with acne that tends to be hormonal, a medication called spironolactone works very well. For really severe cases, and those that are scarring, then Accutane would be indicated. This is a difficult medicine to take, and does have side-effects, but is absolutely imperative to use in patients with scarring cystic acne. Non-medications such as chemical peels and intense pulse light can also be used to treat acne effectively.
Jennifer Reichel MD
Director, Pacific Dermatology & Cosmetic Center
Seattle, WA and Renton, WA

Which laser for fine lines around eyes?

Dr. Reichel, do you recommend Fraxel for fine lines around the eyes?

Hi M,
I normally try to steer patients toward CO2 for lines around the eyes - but will sometimes do Fraxel. For fraxel, it takes 4 treatments usually - spaced 4-6 weeks apart. about 3 days of down-time. You have to put in eyeshields (which is part of why I steer them toward CO2 - 1 treatment, but 5-7 days downtime). The cost is $500 per treatment.
You can also do chemical peels for fine lines - 30% TCA (can't do upper lid) - stronger and will have 5-7 days of raw skin. or a series of Vitalize peels. With those, I would recommend doing the whole face.
I  also recommend Botox - and I do put 1 unit under each eye - along with doing the crows feet. Retin A can also be used under the eyes.

Jennifer Reichel MD
Director, Pacific Dermatology & Cosmetic Center

Laser treatment for acne scarring

I just want to ask for the percentage of getting rid of acne and acne scars. In addition, I also want to ask for the cost of the treatments.

Hi V,
Thank you for the inquiry from RealSelf. The most important thing would be for you to come in for a consultation so that we can look at your acne scarring together. There are different types of scarring. Some types respond better to treatment than others. The most common treatment for acne scarring is using a laser to resurface the area and try to make the scars more even with the surrounding normal skin. Sadly, it is impossible to completely get rid of the scarring – it is, as you asked, a matter of “how much better” can we get the scarring. The two most common lasers that I use for acne scarring are the Fraxel Restore, and the Fractional CO2 laser (Total FX). I usually tell people that we are aiming for a 40% improvement. Sometimes my patients will say that they feel 80% better, and sometimes (uncommon) they say that they only feel 10% better. Some of this is that different people have different opinions on what the percentage is.
For the Fraxel Restore, it takes multiple treatments. Usually 4 to 6 treatments spaced 4 to 6 weeks apart. For cost, it depends on what we decide to do. It is usually around $2000 to $4000 total.

I would be happy to see you for a free consultation. Please call 206-859-5777. Make sure to ask for Dr. Reichel and tell the receptionist that we communicated by email and that you found me on RealSelf.


Dr. Reichel

Jennifer Reichel MD
Director, Pacific Dermatology & Cosmetic Center
11011 Meridian Ave N Ste 102
Seattle WA, 98133


Am I a good candidate for Total FX CO2 laser?

Hi TM.


Thank you for the inquiry. I would be happy to see you to determine if you are a good candidate for the Total FX CO2 laser. It is a great laser. We have had ours for about 3 years and I have treated over 100 people. I love this laser. It is really versatile, and the results are amazing. It is great for deeper wrinkles, pigment changes, eye rejuvenation and acne scarring. The treatment settings can be changed to do lighter treatments, or more aggressive ones. I think it is the “gold standard” for fractional CO2 lasers.


I would also be happy to look at your leg veins and make a plan for treatment. I prefer sclerotherapy over laser treatment for small leg veins. I think that sclero is more effective, and causes less bruising and other side effects. It does often take more than one treatment, and you do have to wear compression stockings after the procedure. Sclerotherapy is easy to undergo. Most patients tolerate it really well.


Please call us at Pacific Dermatology & Cosmetic Center  206-859-5777 to make an appointment. Mention that we conversed via email and RealSelf and the consult is free.


Thank you.



Dr. Reichel



Jennifer Reichel MD

Director, Pacific Dermatology & Cosmetic Center

11011 Meridian Ave N Ste 102

Seattle WA, 98133





Surgical treatments for excessive sweating

The website suggested that for excessive sweating, there are some surgical treatments that could be applied. What exactly are these surgical treatments and what are there success rates? Thank you. JM


Hi JM. Thank you for sending your inquiry.

Yes, there are surgical treatments for excessive sweating. The treatment options may vary depending on which areas of your body you are having excess sweating.

In the armpits (axillae), you can have Botox or Dysport injections done. This is not permanent. Most patients respond well to the injections and will have decreased sweating for 6 to 9 months. This is the most popular treatment right now. It wouldn’t be considered surgical.

Another option for the armpits is to have a procedure done called retro-dermal curettage (axillary suction curettage). Retro-dermal curettage is a liposuction type procedure where you inject a large volume of a dilute anesthetic into the armpit area. You then take a liposuction cannula and insert it through tiny ports (little incisions made in the skin) and scrape the underside of the skin where the sweat glands live. The cannula is a small hollow metal tube. It has holes at the end and the edge of the hole is a little bit sharp. For liposuction, you point the “hole” on the cannula downward to suck out fatty tissue. For sweating, you point the cannula up toward the skin and basically scar the sweat glands down so that you no longer sweat. This is really a pretty easy procedure to undergo, and is very safe. It is effective for most patients and can give a permanent decrease in sweating of 50 to 90% or so. This would be considered a surgical procedure.

The other procedure that we offer for excess sweating can be performed in the armpits, and on the palms and soles of the feet. It is called Ultherapy. Ultherapy is an ultrasound device that sends high frequency ultrasound waves below the skin. It is most often used to tighten the skin of the neck, jawline, and face. However, when Ultherapy is done for sweating, the ultrasound waves penetrate the skin to the depth of the sweat glands and actually destroy the sweat glands. The preliminary studies done with this procedure showed a 70% reduction in the amount of sweating after 2 treatments. We believe it should have permanent, or very long-standing effects. It is NOT invasive, and is a great option for sweat reduction.

Finally, you can have the nerves that are associated with sweating cut. Depending on where you are sweating will change where the nerves should be cut. This procedure is called a sympathectomy. It is usually performed by a thoracic surgeon.

I hope this helps. I would be happy to see you in consultation to discuss the treatments further and pick the one that is right for you.
Thank you for your inquiry.



Jennifer Reichel MD

Director, Pacific Dermatology & Cosmetic Center

11011 Meridian Ave N Ste 102

Seattle WA, 98133



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