Hello, I wanted to contact you in regard to Fordyce Spots. I've been living with Fordyce Spots on my upper lip since age 17 or so. A few years ago, a dermatologist "tested" the hyfrecator on a couple areas - this seemed to help minimize them a bit, but they kind of reappeared. I also noticed that while I was on Accutane, the appearance of them pretty much dissipated entirely as it dried out the glands. Of course they reappeared after my Accutane cycle was complete. Over the years, it looks like they've become more prominent. I know some doctors simply say not to worry about them, but I find myself becoming very depressed by them every couple months as I have large lips and many, many spots. This has led to many hours of research and I'm very curious about trying CO2 laser treatment as it seems like the most effective treatment. I'm wondering if you have experience treating these. Thanks.
Hi C. Thanks for the email. We do treat Fordyce spots on the lip. I agree that the CO2 is usually the most effective option. We just treated a young male patient with Fordyce spots. We did a test patch first and then full treatment once we were satisfied with how he responded. I like to do it like that as every patient is different. We don’t want to leave scars that look worse that the spots – so a conservative approach with a test patch is good.
You need to be sure that you have been off of Accutane for at least a year before we can treat you with the CO2 as Accutane decreases the ability for the skin to heal itself. It is otherwise a wonderful medication for acne (obviously).
Please call at 206-859-5777 to make an appointment for a consultation. Do know, that insurance will not cover the treatment of Fordyce spots. It is out of pocket (cosmetic). We can discuss cost when I see how large the area is.
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.
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 www.pacificdermcenter.com
I had Liposonix done on my anterior thighs 4 months ago. Sometimes when I rest, I feel shooting pain in nerves, in right anterior thigh area, at random time intervals. Is this normal?
Thank you for your input after your Liposonix treatment.
Yes, this is totally normal - can do that for months after treatment. Just like with liposuction or other ultrasound devices, such as Ultherapy, there can be temporary nerve injury. Nerves tend to "let you know" when they are injured and trying to heal. They will cause those annoying twinges and tingles and shooting pains. And, it is always random (but can occur more when you are rubbing the area - like in a massage, or working out because you are stretching the nerves. I would not worry about this unless it is really painful. Nerve tenderness after Liposonix usually resolves or several months, but in some rare cases, it can take longer. Please call if you have any other concerns.
Hi Dr, I was wondering how long does it take to reach the final result after mole removal? I saw pictures of mole removals on the realself website and it look like you did good work. The scars of the patient were small thin almost unrecognizable lines. I had one removed 3 months ago and it is still red and stands out. I just want it to reach its final result so I can stop thinking about it cause it bothers me and stresses me out. I wanted to know how long after were the after mole removal pictures taken? It would help ease my mind a lot thank you
Thank you for commenting on my “good work”. I do a lot of cosmetic mole removals and I always have a long discussion with the patient about healing time BEFORE we do the removal. It can take months for the redness and scar to resolve and look good. The photos on RealSelf that you saw were taken at 12 months and 3 years after the surgery. I comment to patients that at 2 months, you may very well be saying “why did I do this, it looks worse than the mole”. BUT, let me reassure you. In 90% of cases, the redness clears and the scar improves greatly and the cosmetic result is nice. It can take 4-12 months for that good end-point. So I hope this eases your mind.
I would give it another month, and then if the redness is still present, or the scar is not looking good, I would recommend that you 1. Talk to the doctor that removed the mole and see if they will see you – it is always good to let the physician that did the work know how things are going. He/She may have a laser or other options to improve scars. After you do that, you can 2. Always make an appointment here at Pacific Dermatology & Cosmetic Center and I would be happy to look at the scar and see if we can improve it, or at least reassure you that it will get better. I have many lasers (Vbeam, Fraxel, CO2) that can improve scars.
I have cheek hollows that need help. Would a filler work? Fat transfer? Do you accept carecredit financing?
Thank you for your email inquiry.
We do accept Care Credit. The very best option would be to see you in person for a cosmetic consultation. We can look at your cheeks and really determine what will be best for you. Please call 206-859-5777 to set up an appointment.
It does sound like one of the fillers would be a good option for you. In the right patient, I love doing fat transfers. The positive aspects of fat transfer include
1. Being able to really replace volume. You can use 10 to 20 cc of fat for someone if they need it. You can't use that kind of volume with the fillers that are pre-packaged (it would be too expensive, and could look artificial).
2. Fat is very soft and malleable so it plumps nicely and can look very smooth.
3. Fat transfers tend to last longer than most fillers. I like to do fat transfers as a series. You get the initial one done at the time that we harvest your fat (usually from the belly). We process and store the fat in a special freezer system. You return after 3-4 months and get a second transfer done. We keep the fat for 2 years from the date of harvest. Most patients do 3-4 transfers in that time.
4. There can be less bruising with fat transfers because we are using blunt instruments for injecting (rather than a sharp tipped needle).
However, fat transfers are not right for everyone. They are best if you have hollowing of the outer part of your cheeks, or if you need a lot of volume replaced. Otherwise, the other fillers (Radiesse, Juvederm, Restylane etc) can be great. I look forward to seeing you soon.
Jennifer Reichel MD Director, Pacific Dermatology & Cosmetic Center 11011 Meridian Ave N Ste 102 Seattle WA
I was interested in jaw reduction botox. Does your office perform this procedure? If so what is the estimated cost?
Thank you for your inquiry. Yes, we do Botox for jaw reduction. It usually takes a few treatments. I space the treatments about 3-4 months apart. It will help to soften a round face, make your face look more feminine, and lengthen your jawline. I have had good success with it for the right person, and really think it can make a nice difference if you have a very angular jaw, or large jaw muscles, or a very round face. I use between 20 and 40 units of botox with each treatment, depending on the individual. The basic cost is $15 per unit of Botox – so between $300 and $600 each treatment. We do have special programs that patients can take advantage of to decrease the cost of the Botox.
Jennifer Reichel MD Director, Pacific Dermatology & Cosmetic Center 11011 Meridian Avenue N Ste 102 Seattle, WA 98133 ph 206.859.5777
Dull Skin Diaries: When It's Time for a Chemical Peel
Chemical peels. They combat a host of skin issues from acne, discoloration, fine lines and wrinkles to just plain old dullness. And they happen to be the treatment de rigueur for aestheticians looking to give clients clear, glowing complexions this year.
Peeling off the dead skin of your face with a handful of peeling agents like alphahydroxy, betahydroxy and salicylic acids, glycolic acid, lactic acid, malic acid, retinoic acid and trichloroacetic among others—can be done every few months. The results are somewhat dramatic, although it may take up to a few days and a series of sessions to see it. Regardless of the peeling agent used, your skin is left regenerated—revealing smoother, more youthful-looking skin.
Chemical peels are easy to do, often times we call them "lunch-time peels" because they are so quick and require very little downtime. Depending on the type and strength of your peel you will experience some facial redness and varying degrees of peeling. That being said, its a small price to pay for that "refreshed" feeling we all want, especially during these dull, drying winter months. Call the skincare specialists today and Pacific Dermatology & Cosmetic center to schedule your appointment, 206.859.5777, chemical peels are a quick, easy, affordable way to look and feel your best!
Hi, I have wanted to get a nose job since I can remember the bump appearing right in the middle of my nose! I read on a blog that you can have a non surgical nose job. I also read that it can be done for very little cost. I am a collage student and can't afford Rhinoplasty. So maybe this is right for me to hide the bump for now. My question is if I do the filler to hide the bump how long does it usually last and can I still have a nose job in the future? Thanks so much for your time!
Thank you for your question. I have treated dozens of patients in my office for a non surgical nose job and have acheived amazing results. I usually use Radiesse and with the first treatment you can expect it to last at least 6 months, with subsequent treatments that can then last 12 to 18 months. In rare cases you may need a touch up in a little as 3 months. And Yes, you absolutely can have a nose job in the future! I would be happy to meet with you in consultation and show you some of my before and after results, please call my office at 206-859-5777 and schedule a cosmetic consultation.
Dr. Jennifer Reichel of Pacific Dermatology & Cosmetic Center in Seattle
I would like to know what can be done about my leg veins
Q: I have had spider veins on my legs for years and am very self-conscious about them. I would like to know what the recovery time is after treatment and how long I have to wait before exercising again. Do I need to wear a special garment or tights? What can I expect to pay for this treatment so I can prepare.
A: First off, Thank you for your question. You will be in what are called "compression stockings" for the first 24 hours and will then need to wear them whenever possible during the first two weeks, such as standing, walking, working, etc. You should avoid strenuous exercise for 3 days and then you can return to your normal routine. The cost for the first sclerotherapy session can range from $400 to $550, however for very small areas it can be less than $400. On average, you can expect to see results and complete treatment in 2-4 sessions, generally with an 80% overall improvement. I like to space treatments about four weeks apart and recommend patients to start this treatment in fall or winter so they can be ready for summer. Please call my office to schedule a consultation with me at 206.859.5777, I look forward to meeting you.
Dr. Jennifer Reichel of Pacific Dermatology & Cosmetic Center in Seattle