Unwanted hair on the face and elsewhere on the body have been an object of disgust for many people, specially among aesthetically conscious ladies. There exist many modalities of hair removal like threading, waxing, shaving, plucking, depilatories, abrasives like pumice stone but are temporary. Laser hair removal techniques may be sought as better alternatives.

Acne scars can really pose a psychological distress to people who have scars.  You could get rid of these scars without going under the knife. Scientific US FDA approved treatments with minimal downtime help you get a smooth and scar free face.

Common skin problems like warts and skin tags can be treated with electrosurgery. Refined electrosurgical techniques give good result with minimal scarring. Newer technique of Radiosurgery has the advantage of a 'knife like' sharpness while cutting with no charring of the surrounding tissue. Face lift without surgery with Radiofrequency equipment is a new and fascinating application.

Argi Peel for Dark Circles

It is a combination of arginine, lactic acid, allantoin and aloe vera. It is a very mild soothing and effective peel for dark circles as well as sensitive skin. It should be done once in 10-15 days and about 10 – 12 sessions are usually required.

Arginine
Arginine is an amino acid derived from brown sugar.
It has moisturizing and healing properties.It boosts collagen production and increases elasticity. It does not cause any skin irritation.

Lactic acid
Lactic acid is a very soft AHA: Perfect for sensitive skin that cannot tolerate high concentrations of glycolic acid.
Exfoliates, moisturizes and lightens the skin and maintains skin  pH.

Allantoin
Allantoin is a healing agent which stimulates healthy tissue formation.

Aloe vera
Regenerates skin. Has soothing and moisturizing actions.

Botulinum Toxin (Botox)

Looking good does wonders for the inner self. It improves our face value, builds our confidence & helps us be successful in every field. Medical science now makes it possible to renew our youthful appearance. Wrinkles are the primary lines of concern. They are formed on the face over time due to sun exposure & continuous muscle activity. These lines can often make us look tired, angry or older than we are.

Botulinum Toxin is one of the best & the most popular wrinkle reduction treatment available today.

Botulinum Toxin is a natural purified protein approve by US FDA & is used to relax the muscles which cause wrinkles. Usually injected to reduce frown lines on forehead & crows feet around eyes. Effect lasts for 3-6 months.

	What is the role of diet ?
	A well-balanced, regular diet along with adequate amount of water is all that you need. One must avoid the so-called junk food, too much of starvation in the form of dieting & eating at odd irregular hours.
	What is Botulinum Toxin?
	Botulinum Toxin is a natural, purified protein that relaxes wrinkle-causing muscles & creates a rejuvenated and more youthful appearance.
	Is Botulinum Toxin only for older age group?
	According to US FDA, anybody in the age group of 18-80 yrs of age who desires to get rid of their wrinkles & have a smoother appearance can get the treatment done.
	What are the indications for Botulinum Toxin?
	To remove frown lines between the eyebrows, Crows feet around the eyes, horizontal forehead wrinkles, Bunny Lines on the nose, Downturned corners of the lips, Neck bands (chicken legs) and horizontal lines, Chin creasing, to reduce broad jaws , to improve the facial contour, to lift a sagging jowls. Hyperhidrosis : to reduce excessive sweating on palms & underarms for the treatment of migraine. The results are seen within 3-4 days but the effect is best seen after 7-15days of injection. The effects gradually wear off in 5-6months. Intradermal Botulinum Toxin is used to add a glow to the skin.
	What is the treatment like?
	This procedure involves a few tiny injections and can take as little as five minutes to complete.
	Is the treatment painful?
	Very fine, small sterile needles are used to inject Botulinum Toxin. No anesthesia is required. The pain is minimal, often described like an ant bite sting. For those who have a low pain threshold, ice packs can be used to alleviate pain. One can resume normal activities immediately.
	How long does it take to show effect?
	It takes effect after 4-5 days, with full effect 7-15 days post treatment.
	How Long Does it Last?
	Effect may last for 4-6 months or longer, results vary from patient to patient. May last longer with repeated treatments. But result will wear off progressively (not suddenly).
	Will my lines worsen if I discontinue Botulinum Toxin?
	NO. Eventually, wrinkles will return as they were before the treatment.
	What are the side effects?
	No long-term side effects reported in the 20 years of use. Most common side effect is tenderness and bruising at the site of injection. Some people may have a feeling of heaviness in the head for a few hours.
	Who should not use Botulinum Toxin?
	Botulinum Toxin should not be given to pregnant or breastfeeding women or to patients who have a neuromuscular disorder.
	Is it safe?
	Botulinum Toxin is a purified protein derivative of botulinum toxin A & has been used for the last 20 years safely. It is US FDA approved. It is used for treatment of migraine. Botulinum Toxin is also approved for use in children over 2 years of age with cerebral palsy. CAUTION: IT SHOULD BE ADMINISTERED BY QUALIFIED TRAINED DOCTORS ONLY .
	Will I have a plastic, expressionless face after Botulinum Toxin?
	No. This will happen only if too much of Botulinum Toxin is given. A qualified & trained doctor will give adequate doses of Botulinum Toxin injections just to soften the expression lines & give you a youthful appearance.
	If I take Botulinum Toxin once will I have to take it for the rest of my life?
	If you do not want to take a second injection after 6 months, it’s alright as there will be no tell tale signs nor will the wrinkles worsen.

Chemical Peels

Chemosurgery is commonly known as 'chemical peeling'. It involves using chemical agents to treat a number of skin conditions like increased pigmentation on the face or body, superficial scars due to acne and fine wrinkles. Chemical peeling is a widely used and poorly understood procedure. We will discuss few frequently asked questions about chemical peeling.

We have a wide array of peels for skin brightening, skin lightening, acne scar reduction, open pore reduction, fine line reduction, pigmentation ,acne . Dr Jaishree examines every patients skin to decide on the customised peel

Peels done are :

• Alpha hydroxy glycolic peels
• Beta hydroxy salicylic peels
• Kojic acid peel
• Melaspeel
• Glicopeel s
• Nomelan phenol peel
• Argi peel
• Agera peel
• Lactic acid peel
• Retises CT peel
• TCA peel
• SPA peel
• Co2 cryopeel
• Laser peel

	What are the chemicals used in chemical peeling?
	Trichloroacetic acid (TCA I0%-70%), alpha hydroxy acid (such as glycolic acid GA 20%-70%),Salicylic( beta hydroxy) acid, Carbolic acid (phenol 88%) are the most commonly used agents.The newer peels contain lactic acid, kojic acid, arginine, pyruvic acid, citric acid,all of which are either fruit peels or plant extracts.
	What are the skin problems where chemical peeling is helpful?
	Chemical peeling is useful in: Melasma, pigmentation (dark circles), skin discoloration like pigmentation due to sun exposure (photo), pregnancy, birth control pills, drug reaction, post-inflammatory hyperpigmentation i.e. pigmentation as a result of a healing skin disease or infection. Superficial scars as a result of acne, Freckles and lentigenes, Fine wrinkles, Dilated pores.
	How is chemical peeling performed?
	Chemical peeling is an office procedure. It does not require any hospitalization. After properly studying the skin type and its sensitivity, the dermatosurgeon decides on the type of peeling agent or agents and their concentration. The selection of the chemical agent also depends on the extent and depth of skin damage. The skin is first cleaned with soap water to remove excess oil. The peeling agent is then applied gently onto the lesion or on the full face till the 'end point' is achieved. During or shortly after the procedure, the patient might experience warmth or stinging sensation for a few minutes. pigmentation persists, the procedure can be repeated after 3 weeks.
	What happens after chemical peeling?
	After a superficial peel, redness appears and there is peeling of skin over three to seven days. More than one sitting may be required. In the Indian skin type, only superficial and medium depth peeling is recommended

Cryosurgery

Cryosurgery involves local freezing of tissues for their controlled destruction or removal. Here we will discuss the role of cryosurgery in skin diseases. The various cryogens used are Nitrous oxide (-75°C), Carbon-dioxide snow (-79°C) and liquid Nitrogen (-196°C). We will discuss two cryosurgical techniques that the author uses in her dermatosurgical practice.

- LIQUID NITROGEN CRYOSURGERY
- CRYOSLUSH WITH CARBON DIOXIDE ICE
- CRYO-PEEL WITH LIQUID NITROGEN

LIQUID NITROGEN CRYOSURGERY
Above are the pictures of the cryocan and the cryojet. Cryocan is a container that stores liquid nitrogen and cryojet is a hand held unit that is used to spray the liquid nitrogen over the diseased part. Liquid nitrogen has a temperature of -196 °C and freezes tissues to -40 to -60 °C.

	What are the indications of liquid nitrogen cryosurgery?
	There are numerous indications but to enumerate a few : Warts, molluscum contagiosum, pyogenic granuloma, skin tags, seborrhoeic warts, milia, cystic acne, acne scars and keloids. Precancreous conditions like leukoplakias, Bowen's disease, actinic keratosis. Cancers of the skin which are very small and have no deep or distant spread
	When should liquid nitrogen cryosurgery not be done?
	It should not be preformed in immuno-suppressed conditions like certain cancers, patients on immunosuppressive drugs, people allergic to cold temperatures, people having vasospastic disorders and cold intolerance.
	What happens during the treatment?
	The procedure involves spraying liquid nitrogen over the diseased part leading to freezing of the tissues. This causes a stinging sensation and numbness initially. Later on there may be varying degree of pain which may need analgesics or elevation of the part.
	What happens after spraying?
	After a few hours of spraying the area shows colour changes due to controlled destruction. The part may become dark or red and swollen. A blister is formed which later turns into an eschar, thus the desired tissue is destroyed. The blister should not be disturbed as it prevents infection. The sprayed part takes 1 to 3 weeks to heal. Multiple sessions of cryosurgery may be required till the desired result is achieved.
	What are the advantages?
	No anaesthesia is required. No hospitalization is necessary. Multiple lesions can be treated at the same time. Good for small local cancer recurrences. It is a no touch technique, hence beneficial while treating HIV Positive cases
	Are there any complications?
	Hyperpigmentation, hypertrophic scars, milia may be a few transient problems. Hypopigmentation, scarring could be the long term consequences.

Laser 360 skin rejuvenation

Laser360™ skin care combines multiple technologies to treat the most common symptoms of premature aging: color, texture and skin tightness. Laser360 is different from other skin rejuvenation systems, because it's non-invasive and customized exclusively for you.

	How Does Laser360 Skin Care Therapy Work?
	Laser360 uses three technologies to provide complete skin rejuvenation: AFT intense pulsed light for color Pulses of light even out your skin color and reduce tiny broken blood vessels and other color irregularities. Near-infrared for tightness Deep heating helps firms up any loose skin so you regain a more youthful, contoured appearance. Pixel® for texture and tone This precision laser creates thousands of microscopic perforations, which stimulate new collagen to grow. The new collagen improves your skin's texture and tone to smooth fine lines and wrinkles. The skin around each of these perforations remains intact, which allows the skin's top layer to heal from the edge of these tiny holes very rapidly. Each technology is delivered through a simple handpiece that is placed against your skin. The treated area will gradually rejuvenate over the course of your customized treatment plan.
	Is Laser360™ safe?
	The device that delivers Laser360™, the Harmony®XL System, has been cleared by the FDA for more than 60 aesthetic and medical applications. Laser360 combines three of Harmony's 10 unique laser treatment technologies to provide comprehensive skin rejuvenation. It improves skin color, wrinkles and skin texture to achieve outstanding results in 60 days.
	How long will a treatment take?
	Each laser treatment takes just a few minutes. During each session, you may have treatments that involve more than one of the Laser360 technologies. Your exact treatment regimen will depend on your individual condition. Before you get started, your doctor will explain each of the treatments you should have and how long you should wait between treatments.
	Do I need to plan for time off, for the treatments?
	No. Laser360 requires no "down" or recovery time. You can have a treatment and can usually return to work or school immediately, certainly by the following day.
	What alternatives to Laser360 are available?
	Creams and lotions can be used at home, but usually provide only a slight benefit and must be used indefinitely to maintain even modest results. Other laser and light-based devices work well, but they typically focus on just one aspect of skin rejuvenation (color, texture, or tightening). They may be quite painful, have significant downtime and may not be suitable for all skin types. Surgery may be indicated for extreme cases, but it is much riskier than any non-invasive technique. Laser360 is a non-invasive, comfortable, no downtime procedure that provides lasting results in just 60 days. It combines three technologies to address all aspects of skin rejuvenation and can be used on any skin type.
	How long will my results last?
	Laser360 is the ideal procedure to eliminate the discoloration and textural irregularities that make your skin look older. But even after the procedure, you will continue to age and to be affected by the sun and elements. To maintain the healthy glow that Laser360 can bring, patients may choose to come back periodically for touch-up treatments.

Laser Hair Removal (for hirsutism)

Virtually your entire body is covered with hair. Because most of this hair is fine and pale, it usually isn't viable to the naked eye.

But, when darker, coarser hair appears in places which may make you uncomfortable – like on the face, neck, abdomen, breast, legs or underarms in women or on the shoulders chest and back in men, it may be time to consider hair removal with the laser.

	What is laser hair removal?
	Hair removal temporary or long term has become an easier task with advent of lasers. Largely, laser hair removal gives excellent results in fair skinned people. Listed below are a few lasers used for hair removal. Long pulsed Nd YAG long pulsed Alexandrite laser Long pulse diode Super hair removal system The lasers are absorbed by hair follicle and spares other skin appendages. Cooling devices further prevent the heat damage to rest of the skin. Laser hair removal needs multiple sessions. Re-growth of hair after each session may take from 3 months to up to a year where latter is considered as a 'very good result'. The re-growth is thinner, slower and scantier after each session
	How does hair removal laser work?
	The laser has a wavelength that specifically targets the pigment ‘melanin’ contained in the hair follicle & shaft. It penetrates the skin to the depth of 1.5mm which is where the hair bulb is located. Thus it works on the principle of selective ‘photothermolysis’.The laser pulses for a fraction of a second, penetrates the hair bulb without destroying the surrounding skin & vaporizes the pigment in the hair follicle.Thus the follicle is either destroyed or its re-growth is impeded. This is a non- invasive procedure & a large number of hairs are targeted in a single flash of light .
	Is it painful?
	During the treatment, patient may experience a mild stinging sensation described by most as snapping of a rubber-band. However, most patients tolerate this.Also,a chill tip cooling hand piece is incorporated in the laser which protects the surrounding skin & reduces pain too. A local anaesthetic gel may be applied to those who are very sensitive to pain.

Radio Surgery (for moles, warts)

The Electrocautery machine has been standard equipment in the dermatologist’s arsenal since ages. Skin cautery, which is a finer version of surgical cautery is being used for removal of amenable skin lesions. The skin cautery achieves tissue destruction by two methods: electric current or spark and secondly by producing heat. This heat production is uncontrolled and a lateral spread of this heat also destroys normal tissue unseen on gross examination. This leads to a larger area of tissue damage than intended, subsequently leading to visible scar or hyper-pigmentation. Principally, electro-cautery produces current of less than 2 megahertz frequency and this is the cause of excess heat dissipation.

Radiofrequency (RF) surgery involves passage of radio waves at the frequency of 1.5 to 4.5 MHz. In case of skin lesions, the most commonly used frequency is 3.8 MHz. A radio-surgical unit consists of an electrode, a ground plate and a transformer. The radio waves generated, travel from the electrode tip to the lesion and return to the unit through the ground plate. Radio energy produces steam and vaporizes the tissue fluid resulting in cutting and coagulation of the tissues.

Four types of radio waves are generated by the unit viz:

The power settings can be adjusted to obtain the type of radio wave desired.

Different types of electrodes are used depending on the type of lesion e.g. fine needle electrode, wire loop electrode, scalpel blade electrode etc. The lesion should be touched with the tip of the electrode. It generates very little heat as compared to conventional electro-cautery. This results in negligible collateral damage, resulting in faster healing and minimal scarring.

Factors causing lesser collateral heat damage are:

Uses of RF in dermatosurgery:

Advantages of radio-surgery:

As with any equipment, over treatment may produce greater tissue destruction & scarring. To conclude, radio-surgery is a faster evolving technique being effective, simple, quick & cost effective.