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Treatment for older white stretch marks

Greetings, I have indented white stretch marks on my inner thighs. I am not interested in treating the color, I am only interested in treating the INDENTIONS. Is this something that is possible? They are all very small, but when I bend my body in certain ways - you can see the indentions, and I just don't like that at all. Please let me know if there is a way to treat these small indented, old white stretch marks. Like I said, I only want to improve the indention. (the color is hardly noticeable) Is there a laser treatment that will resurface the skin on the marks?

Hi V,
First of all, sadly, older stretch marks can be very difficult to treat. We have 2 resurfacing lasers here at Pacific Dermatology & Cosmetic Center. The first is the Fraxel Restore laser. This laser can work for stretch marks. It primarily is BETTER for the texture/indentation that you are talking about, than it is for the COLOR. It does take multiple treatments to make an improvement. There is little risk, but some patients do get a temporary brownish discoloration at the treatment site. The other laser that we have is the Lumenis Total FX CO2 laser. This is a ?bigger gun? as it totally removes the top layers of the skin that is being treated. It can be good for stretch marks, and generally takes 2-3 treatments.
For all of my stretch mark patients, I recommend that we do a ?TEST PATCH? of skin to see how you respond. Everyone responds differently. So, I would say that it would be best to come in and we can treat a small area with the Fraxel, and a small area with the CO2 Total FX laser. We would do a series of 2-3 treatments on the test patches, and then go on to treat a wider area if you are happy with the results. The cost for the test patches is bundled into the total cost for the treatment.
I would be happy to see you in consultation. We can do the test treatments when you come in, or at another appointment. Make sure that you are not tan.
Please call 206-859-5777 to set up an appointment with me.
Thanks, Sincerely
Dr Reichel

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

Lasers for Stretch Marks

Dr Reichel, I am interested in treatment for white stretch marks. I heard that a CO2 laser is the gold standard for treatment. What is the difference between the Fraxel Repair, Fraxel Restore, and the Total FX lasers? Also, I understand that the dermis is made of 70% collagen, what is the other 30% made of?


Dear MW,
Both the Fraxel Repair and the Total FX lasers are ablative fractional CO2 lasers. Fraxel Restore is a non-ablative fractional Erbium laser.
Sadly, once they turn white, stretch marks are very hard to treat (with anything). They are best treated when they are new, and are still red. I have very good luck treating red stretch marks with the Vbeam Perfecta laser (pulsed dye laser). It takes a series of treatments, but can basically make the stretch marks 80% better.
For white stretch marks, what I always recommend, is doing a “test patch”. We choose an area that is a couple of inches in size, and do either one or maybe two fractional CO2 treatments. I use the Lumenis Total FX CO2 laser. For me, I consider this laser to be the gold standard for CO2 lasers. CO2 lasers are more risky when you are treating areas that are off of the face (the face has a lot of sebaceous glands – which makes healing much easier). Since stretch marks are off of the face, you have to turn the energy down. That is why we often need to treat them more than once. The other option is to use the Fraxel Restore laser. I do a series of 4 treatments on the test patch. I would say that about 30% of patients feel that there is enough improvement to treat larger areas. So, as I said, it is hard to treat white stretch marks. I make the test treatments very affordable, and I will bundle the payment into the cost of the whole treatment if a patient decides to go on to treat a larger area. I have had very good luck with treating other types of scars with the Fraxel Restore (surgical, injury, acne).
About the dermis: The dermis is the 2nd layer of skin. It provides pliability and elasticity. The main cell type in the dermis is called a fibroblast. Fibroblasts make the matrix of the dermis. Collagen accounts for 75% of the dermis. Elastin, 5%. The rest is Hyaluronic acid, cells, vessels, nerves and hair follicles.

About the lasers: Fraxel Restore and Fraxel Repair. Fraxel Repair and Total FX are fractional CO2 lasers. Fraxel Restore is a fractional Erbium laser. Both Fraxels are made by Solta (originally made by Reliant). Ablative lasers (CO2) completely destroy the tissue that is treated (the skin literally goes "up in smoke"). However, since they are "fractionated", they only treat a percentage of the area. This is done by laying down columns of laser light, rather than a "sheet" of laser light.
Fraxel Restore causes coagulation, rather than ablation. So, while it also knocks out tiny columns of skin, the top layer is left intact. If you were to look at a biopsy of skin after treatment with the Fraxel Restore, you would see columns of dead tissue surrounded by areas of live tissue. The live tissue begins to regenerate the dead tissue columns - making new collagen, elastin, and new cells. This regeneration process is what causes visible improvement in texture, lines, and pigment.

Jennifer Reichel MD
Director, Pacific Dermatology & Cosmetic Center

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

Treating Acne Scars with Dr. Reichel

I'm currently suffering from acne scars on my cheeks.I've undergone 2 treatments with fraxel laser but am still not satisfied with the result. Can you give me your opinion?


Hi MB,

Thank you for your question.

Treating Acne scars can be difficult, and definitely requires some persistence. I would be so happy to see you to evaluate your cheeks, give you my opinion, and help make a plan for you.

The Fraxel Restore resurfacing laser is a great laser for acne scarring on the face. It does take more than one treatment. I tell most patients that it will be at least a series of 4 treatments.  I have some patients that we have done 8 or more Fraxel treatments for acne scarring. Other options can include chemical peels, or other resurfacing lasers (such as the fractional CO2 laser). I usually reserve chemical peels for patients with mild scarring that are willing to come in every 2-3 months for treatment. The chemical peels that we use here at Pacific Dermatology & Cosmetic Center are superficial to medium depth.

The fractional CO2 laser (Total FX by Lumenis) can be a great option for acne scarring, but there is increased risk if you have a darker skin type. There is also more down-time with the CO2 laser.

For some patients, we will also do filler (such as Restylane) under the scars to help decrease the depth of the scars.

Again – I would be very happy to see you. Please schedule a consultation – 206-859-5777.
Thank you.

Jennifer Reichel MD
Director, Pacific Dermatology & Cosmetic Center
11011 Meridian Avenue N Ste 102
Seattle, WA 98133
ph 206.859.5777


Does Your Neck Need Special Anti-Aging attention?

There is a cream for everything these days. From your under eyes to your feet—no area of the body has been neglected by beauty brands looking to sell you a new way to look your best. But do all these areas actually need their own skin-care regimen? We wanted to know, especially when it comes to the neck—a lesser-known area of the body that can really tattle tale our true age.

Anti-aging creams and serums designed specifically for the neck are popping up everywhere, and it's true that this area and the décolletage are commonly neglected areas of the body when it comes to maintenance and care. "One of the largest mistakes I see women make in their skin-care regimens is neglect of the neck and upper chest," says Dr. Jennifer Reichel of Pacific Dermatology & Cosmetic Center. And it turns out, the neck is just as susceptible to damage and aging as the face. "Over the course of a lifetime, necks and chests are exposed to as much UV light as faces, but don't get the same good consistent skin care routine that most women establish for their faces," she says.

Over time, neglect of the neck leads to mottled red and brown pigmentation with sagging and wrinkling of the skin. But that doesn't mean you have to run out and purchase a cream designed specifically for the skin of the neck if you already have one for your face.

"In general women do not need specific different products for their necks/upper chests, but it is important to remember that this can often be more sensitive skin (thinner with fewer oil glands) that can become irritated more easily by aggressive topical products," says Dr. Reichel.

That means that the best rule of thumb for neck care is to give it the same treatment you give your face. When exfoliating or applying moisturizer, don’t stop at your jawline. Antioxidant protection and sunscreen are of utmost importance as well. "I encourage my patients to think of their neck as an extension of their face to ensure it gets the benefit of daily sunscreen and other skin maintenance products; we are big fans of Skinceuticals A.G.E. Interrupter as well as their vast line of zinc-oxide sunscreens." she says.

And if you have neglected your neck over the years, it's not too late to reverse the sagging and wrinkling. When treated early, neck wrinkles can be softened with neurotoxin injections, such as Botox, to help release constricting muscles. Slack skin on the neck can also be treated with Ultherapy, this FDA-cleared device used in the procedure utilizes the safe, time-tested energy of ultrasound to stimulate the deep structural support layers of the skin.

If the wrinkling and sagging is really bothering you, Seattle Dermatologist Jennifer Reichel, says you "can tighten the skin using nonsurgical treatments such as Fraxel Dual or Fractional CO2."  Call our office to schedule your consultation, and get the results you've always wanted.

3 Non-Surgical Ways to Rejuvenate the Face

Credit: Thinkstock

When you want to look and feel younger, your face is the front and center battleground of that fight. And while there are a few ways to surgically make the face look years younger (facelift, neck lift, nose job), many women might not be ready for the commitment or cost of a surgical procedure. If not, there are "best practices" for rejuvenating the face without reaching for the scalpel. We went to the experts to find out what they individually believe are the best treatments to get a younger face without surgery.

Seattle, WA, dermatologist Jennifer Reichel, MD, says first and foremost, start with a good skin-care routine. "Routine skin care by trained, experienced aestheticians is invaluable in producing, improving and monitoring the skin. Let's face it—beautiful skin always creates a more youthful look. A comprehensive skin-care program that may include professional products and treatments (like facial peels and photo facials) can minimize sun damage, soften fine lines, reduce acne, rehydrate dry skin and brighten dull, aging skin."

If you want to take it one step further, there are more options available to make the face look younger. Seattle Dermatologist Jennifer Reichel, MD, says before finding the best method for facial rejuvenation, your doctor has to take into account the age demographic of the patient. "When they are younger, we’re getting rid of wrinkles with products like Botox and hyaluronic acid fillers such as Restylane and Juvéderm. For restoring more volume [in older patients] we like Radiesse. If the patient needs more volume, we like to use the patient’s own fat and stem cells as fillers," this is called fat harvesting or fat transfer.

Dr. Reichel also says, noninvasive radio-frequency treatments, on the right patient, can work wonders: "We’re fans of Ultherapy,a new type of non-surgical, non-invasive procedure for the face and body that uses ultrasound and the body’s own natural healing process to lift, tone, and tighten loose skin.. I think you can also count Fractional CO2 in this area. It is an ablative laser, but it’s not as invasive as making incisions. It is a very effective tool in treating fine lines, irregularities and brown spots."

The physicians and skin care specialists at Pacific Dermatology & Cosmetic Center are a dedicated team with expertise in medical dermatology, Mohs skin cancer surgery, and aesthetic surgery. Dr. Reichel and her wonderful staff are committed to excellence in patient care.  Call us today to schedule your cosmetic consultation or medical dermatological appointment, 206.859.5777, we look forward to meeting you,

Scars? We can help you......


Good News For Future Scars

Scars are often thought of as battle wounds—reminders of a time and place when the body was put to the test and survived with a story. Anyone who has had a C-section can attest to this. After all, a scar—the fibrous tissue that replaces normal skin after injury—is your body's way of repairing itself and is a natural part of the healing process.

For instance, while a healthy baby is a good trade out for a C-section scar, some scars, especially those from cosmetic surgery, are not typically ones women want to show off. This explains why so much research continues to be done to improve the look of post-surgery scars. New strategies are constantly being developed and tested and now, scientists at New York University have found a new treatment to reduce or in some cases, stop scars from forming on the skin. Researchers found that applying agents that block certain receptors in healing skin can greatly reduce the scar, producing skin that feels more like the original, unscarred skin. Research is still in the beginning stages, but it could mean that post-operative scar care could be greatly improved.

At this time, there are some good options already available for scars. Nonablative lasers can stimulate the production of collagen from within the body to improve texture and tone on the surface of the skin. "In the past, the go-to in-office treatment for treating scars was cortisone injections and silicone-based sheeting, but today the trend is to use laser devices," says Seattle dermatologist Jennifer Reichel. "They are more predictable, offer better results in many (but not all) patients, and are especially effective at treating raised, red scars. Plus, they can safely be used on facial scars." I generally recommend the Fraxel DUAL or the Vbeam Perfecta, both are excellent options and offer a gold-standard of treatment.  Injectable fillers can also be used with success to treat deep facial scars, especially those caused by acne.

Most doctors agree that it is also important to continue to treat your scars at home in conjunction with any in-office scar treatment. There are also over-the-counter options like Mederma. The good news is, much time and research is going into scar treatment, so hopefully one day, they really will be a thing of the past.

The physicians at Pacific Dermatology & Cosmetic Center would like to consult with you concerning your scars, whether they are acne-related, pregnancy related, or from auto accident.  Call our office to schedule your consultation with Dr. Jennifer Reichel or Dr. Laurie Jacobson.

Kim Kardashian Loves Lasers and Here's Why!

Posted Thursday, July 12, 2012 by Anna Jimenez, Senior Interactive Editor

Yes, it's true. Kim Kardashian has gorgeous skin. Being that she is 31 and has a seemingly limitless amount of resources to keep her face a flawless canvas, no one should be surprised by this fact. But that doesn't mean we don't want to know exactly which products and procedures she is doing to get her skin looking its absolute best, as many a starlet has the means she does, but not quite the complexion.

Well, the cat's out of the bag. She recently told Oprah that she frequently gets Fraxel laser treatments to keep her skin glowing and line-free. She's not the first to admit love for this fractional laser that resurfaces the skin. Jennifer Aniston and Ellen Barker also openly fawn over the treatment, and for good reason. It provides dramatic improvement in the skin with very little downtime (aka stars don't have to hide behind closed doors for up to two weeks like they used to with non-fractionating lasers).

The Fraxel re:pair CO2 laser is a favorite among dermatologist and plastic surgeons alike. "What I love about Fraxel is that it can improve multiple skin issues at once," says Seattle, WA, dermatologist Jennifer Reichel. "It treats spotting, wrinkling, mild jowling and gives us a great foundation to work with so that when we do injectable treatments, the results look even better.”

Patients can see the difference they want after a single treatment and "it's unique in that on a microscopic level, it is basically ablative, so it tends to offer the best of both worlds, a shorter down time with same results as an ablative laser," says Dr. Reichel.

It costs anywhere from $1,000 to $5,000 for continued session and patients are usually advised to do multiple treatments to get Kim Kardashian-worthy results.

Smoker's Face CO2 Treatment As seen on The Doctors

Non-surgical treatments for treating scars

Dear Dr. Reichel

I am looking for Scar revision of 8 inch scar from chest surgery 15 years ago. What none surgical treatment can improve the look of this scar?

Thank you for the email inquiry. There are several non-surgical options for treating scars. It would be very important for me to see the scar in order to decide what treatment would be best. The consultation would be at no cost for you, and we may be able to do treatment on the same day.
The non-surgical options for scar improvement include injections of medications (such as kenalog) to help flatten scars. The other options include laser work. The Vbeam Perfecta laser can work very well if the scar is "heaped up" and/or red in color. It is the laser of choice if you have keloid scar formation. The Fraxel Restore laser can be used on older scars to help blend them in with the surrounding skin. Finally, a CO2 laser, such as the Lumenis Total FX can be used on tougher scars to also help to blend them in. The right procedure for you would depend on your scar.
I would be happy to see you in consultation. Please call 206-859-5777.
Thank you.
Dr R.
Jennifer Reichel MD
Director, Pacific Dermatology & Cosmetic Center

Q:  Greetings, I had a question if there was any treatment for a small raised scar (color is white) on my the left tip of my nose that was caused by acne a few years back. I was wondering if there is some kind of treatment to help flatten it. Thank you for your time and assistance.

A: Thank you for your email inquiry.

For scars like you are  describing, the options would include doing whats called a "dermabrasion" - which is a sanding down of the scar tissue to make it blend better in with the surrounding skin. For this type of dermabrasion, I usually just use a topical numbing cream for about 30 to 40 minutes and then use a medical grade sand-paper to smooth out the scar. The result is what looks like a "rug-burn", and lasts about 5 to 10 days.
Other options would include laser procedures, such as the Fraxel Restore, or the Fractional CO2, Total FX laser. These lasers would be used to achieve the same results, and it will really depend on what the scar looks like.  Vbeam can be used for newer scars that have redness in them as it will improve redness and also cause scar remodeling.
It sound like, in your case, that a surgical revision would be a less likely option, and finally, if there is any portion of a scar on the nose that is indented, we can use a tissue filler, such as Radiesse, to fill in the indentation.  It is helpful if we know what caused the scar and how old the scar is in order to help best determine the course of treatment.
I would very much like to see you in consultation, please call my office at your earliest convenience to schedule an appointment.
Thank you, Dr. Jennifer Reichel

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