MEDICAL & SURGICAL TREATMENT

Effective Decision Making

3.1 HOW TO SELECT COSMETIC MEDICAL TREATMENT?


Multiple Problems! Multiple methods!! Multiple choices in treatment!!!

Multiple Problems: Due to lapses in routine, non-medical& medicalskin care, most of us face multiple types cosmetic medical problems of the skin simultaneously e.g. roughness of surface, acne, acne scar, other scars, photo damage, aging problems, non-uniformity in colour tone of the skin, dark spots or patches, dark areas around eyes / mouth, thick layer of pigmentation, wrinkles, active acne, scars, moles / DPN spots / Junctional naevi, oiliness or dryness of the skin. So also we may have problems in size & shape of eyebrow, eye lid, lip, cheek, nose, chin etc.

Why most of us have beauty problem of the skin?

Skin is one of the most dynamic organ. Medical maintenance care service to skin is often neglected because individual has certain other important medical or non medical problems. Same is the case about body. When person has problem of multiple system in the body it tends to pay more attention to the problems of vital organs like heart, liver, kidney etc. rather than skin. Vitamins and other vital elements are supplied to these organs rather than skin. Thus there is natural negligence. Skin is often exposed to home preparations, cosmetics and environmental trauma. Skin on the face is sensitive to hormonal changes and metabolic changes in the body. So skin on the face is most susceptible to problems of beauty.

Due to exposure to ultra violet rays in sunlight, TV/Computer screen, stress, modern lifestyle problem, nutritional deficiency, over use of cosmetics and chemical trauma caused by bleaching and facial procedures by non-medical beauty expert, problems among general population is on increase. Most of us want to make skin more beautiful than it can become. Due to such intention, blind use of cosmetics and over use/ wrong use of cosmetics skin slowly get spoiled.

Most of us need medical maintenance care of the skin of the face.

Factors Spoiling Beauty: Beauty of the skin on the face always needs maintenance care because skin on the face is often affected by our hormonal status, aging, sunlight or strong artificial light, T.V./ Computer health quality, cosmetics and many diseases. Advanced problems of acne scars, dark circles, dark areas on the face, wrinkles often indicate insufficient past treatment, incompletely taken treatment or selection of poor techniques or improper follow up etc. done in past. It indicates that person needs stronger cosmetic treatment and combination multiple types of cosmetic medical treatment.

To choose treatment procedures and their varieties; we need to identify priorities given to treatment of particular problems &then start treatment. Some of these problems can be treated either by cosmetic medical treatment or surgical treatment or both. Most of us take medical cosmetic treatment when problems are much advanced. There are multiple types of cosmetic medical treatment procedures. So one may also feel confused about which procedure should be best for you considering budget finance. In long standing cases or advanced problems one may need combination of two or more types of treatment and repetition of treatment at certain interval during treatment or after finishing treatment due to aging. Persons who take cosmetic treatment tend to behave like customer and not like patients. So they tend to keep poor follow up and less faith. Some problems need one time treatment but some need repetition of treatment. Some problems are partially curable or incurable (e.g. melasma, deep & thick pigmentation layer, advanced wrinkles, loose skin in middle age). They need maintenance treatment at certain intervals regularly.

Wrong decision making: Person who takes treatment often wants to play dominant part in selecting treatment. So even if person needs ablative treatment they ask for non-ablative treatment. They read or hear somewhere that some particular treatment is good. Then they insist doctor to do that types of treatment irrespective of whether they really need it or not. Some hear that particular treatment causes certain side effect, they do not find out whether it is true or false. So they do not take that particular treatment even though it is very effective for them. So they remain devoid of good benefits of cosmetic treatment.

Right decision making: Always aim to eradicate or treat all cosmetic medical problems & not just aim for fairness & tightness. Some cosmetic problems are not important to everybody. Find out which cosmetic problems are important to you. Decide priorities of problems for which you feel to take treatment. Assess your budget. Find out varieties of treatment, techniques & technologies, their qualities & limitations. Find out which treatment methods, their varieties & qualities are offered to you by your doctor. Enquire about which type of cosmetic treatment technique and technology (laser machine) is more effective & safe. Then take decision.

Usual routine approach with wrong attitude: Most of women in India give lot of importance to fairness, glow & even colour tone but they do not bother much for texture and multiple small moles, DPN spot, dark thick layers. So they continue to take facials & bleaching procedure at certain interval in beauty parlours or spas for months or years without bothering for improvement of health & quality of the skin. They do not visit or less commonly visit cosmetic clinic to improve and to maintain quality & health of the skin. They visit clinic very late for treatment of medical cosmetic problems like multiple dark spots, & moles, dark patches, dark areas, dark circles, wrinkles. They tend to take incomplete treatment and tend to keep insufficient follow up of medical cosmetic maintenance care of the skin.

Increase your information, knowledge and conselling quality

Various difficulties we often face: Most of us are confused due to inability to get confident answer of following questions: What cosmetic medical care of the skin should take? When skin is healthy and when skin is unhealthy? For which skin and hair problem one should go to parlour? For which skin and hair problem one should go cosmetic doctor instead of parlour? What is difference between cosmetic medical skin care and cosmetic medical skin treatment? What one should do when skinbecome dull, rough, oily-dry-mixed, darker? What to do when one finds acne, fine wrinkles, and darkers layer on the skin which do not respond inspite of using cosmetics or undergoing parlour treatment? Which treatment should be undertaken first when one has multiple cosmetic problems? How long one should take treatment? How long one should continue to keep follow up treatment and skin care regimen? What changes one should do from time to time to maintain health and cosmetic care of the skin? Find proper answer from your cosmetic physician. Read additional literature given in this website.

Do assessment of your beauty and health at certain intervals.

One needs to find out why one looks less attractive? What are various cosmetic medical problems? Then, one should find out the possible causes and aggravating factors of these problems e.g. wrinkles can be due to aging and photo damage but these are aggravated by sagging of the skin and repetitive facial expressions. Pigmentation and acne can be due to certain disease in the body like specific type of hormonal imbalance or sensitive skin or environment factors.

Understand dilemma and difference between cosmetic medical skin care and cosmetic non-medical skin care (parlour procedures)

If one has mild cosmetic problems but healthy skin one may choose non-medical or beauty parlour procedures such as facial, bleaching, masks, packs etc. which may improve skin appearance for few days. These parlour procedures may increase susceptibility of the skin for photo damage in absence of concurrent photo protection. If one has mild cosmetic skin problem but if skin is unhealthy take doctor's cosmetic medical treatment to improve health & quality of the skin. Beauty parlour procedures are not medical treatments & these treatments do not support to treat medical & health problems of the skin. Sensitive skin, oily skin, dry skin indicate medical problem of the skin.

Cosmetic medical treatment of the skin:

Laser facial skin rejuvenation, non-surgical face lift procedure, mild peels, electroporation, ultrasonic treatment, more intense crystal or diamond microdermabrasion, etc. are commonly used medical procedure to improve rejuvenation of the skin i.e. fairness, glow, smoothness, pore size, dark spots, wrinkles, mild scars and acne of the skin. Laser facial rejuvenation is most effective in all these medical procedures. We use most effective and most advanced (Ref. www.conbio.com) flat top beam of Q-switch laser skin rejuvenation method (Nano technology). Botox helps to reduce dynamic wrinkles. For deep wrinkles folds and sagging additional skin laser resurfacing, soft tissue fillers or face lift should be done. Less intensive procedures like crystal/ diamond microdermabrasion has no down time and is suitable for temporary improvement in mild problems. In mild to moderate problems of skin darkening, tanning, dark spot, acne scars, wrinkles, looseness, mild dullness, mild to moderate pimples, tanning, mild under eye dark circle, darkness around mouth choose Q switch Nd:YAG laser facial skin rejuvenation.

Surgical Cosmetic treatment: To soften deep crevices, acne scars, dark thick layers, dark spots and discolorations, UltraPlus® fractional carbon dioxide laser skin resurfacing is done 2-3 times. This procedure gives dramatic results. Usually tendency of most of us is to select treatment which is cheaper, painless & does not have any down time. This type of decision is good for mild problems& sometime for mild to moderate problems. For correcting moderate & severe cosmetic medical problem one often needs to choose ablative or surgical cosmetic procedure which may cause temporary pain & down time of 5-7 days but long term benefit. There is no short cut if one wants good results & longer lasting results. To improve depressed scars, depressed areas on the skin tissue transplant, fat graft, procedures are used to improve lightness of the skin micro-needling radio frequency treatment is done.

Choose Lunch time procedures:

These are chosen for mild to moderate improvement or in mild cosmetic skin problems. Procedures like non-ablative laser facial skin rejuvenation, crystal/ diamond microdermabrasion / non laser skin polishing, iontophoresis, electroporation, mild peels, are called as lunch time procedures. Our Medlite C-6 Q Switch Nd: YAG laser machine is one of few most advanced laser machines used as lunch time procedure of laser facial skin rejuvenation Refer.www.conbio.com. These procedure are done for mild cosmetic medical problems or when one wants mild improvement.

These are shorter procedures. So, person resumes his / her routine activities immediately and there is no down time or recovery time. Results of these procedure depends upon degree of problems. If these procedures are done more aggressively, results are more. If these procedures are taken at regular interval of 4 weeks for 4-10 times percentage of improvement increases gradually & result tend to last longer.

Choose stronger or surgical cosmetic medical procedure: These procedures give very good improvement in moderate to severe cosmetic skin problems. Lack of improvement or less improvement after these above mentioned mild treatment procedures does not mean that treatment is failed. It indicates that you need to undergo these above medical procedures stronger intensity. It may also indicate you need other stronger or surgical cosmetic medical treatment procedures. So choose stronger or surgical cosmetic procedures or combinations of various treatments for improvement in moderate to severe problem.

Approach of usual insufficient treatment: Many persons choose mild procedures for moderate to severe problems. They think that doing mild procedure for more number times will reduce moderate to severe problems. Many of the persons just gels and lotions to apply locally and no medical cosmetic procedure to eradicate cosmetic medical problem. Use of mild methods or short cut in treatment indirectly aggravate cosmetic problem or land make it resistant for response. Many of the person want just gels and lotion to apply locally and no medical cosmetic procedure to eradicate cosmetic medical problem. Use of mild methods or short cut in treatment indirectly aggravate cosmetic problem or make it resistant response. Such decision often leads to complications after certain period. So use moderate to severe aggressive medical treatment procedure for moderate to severe cosmetic problems e.g. "Ultra-Pulse® CO2 laser skin resurfacing, deeper chemical peels for, acne scars, thick dark layers, static wrinkles, dark circle. Use cosmetic medical treatment products rather than cosmetics in case of treating cosmetic medical problem. In market costly cosmetics are available. Many of us spend lot of money on these cosmetics. Costly cosmetic does not mean very good cosmetic medicine for your skin problem. If you use cosmetics for improving tanning, wrinkles, acne, acne spots, acne scars, you are trying temporary solution and you tend to convert temporary problem into permanent problem. So also skin slowly become sensitive due to use of these cosmetic preparations. So do not use cosmetics to treat cosmetic medical problems. Take guidance of your doctor to select proper medical cosmetics which maintains & protects skin. If you want to use cosmetics to treat cosmetic medical problem or to improve cosmetic medical problem like, acne, dryness/oiliness, of skin, dark tone of skin, dark patch, wrinkles, aging changes, sun-damage changes, better take doctors treatment. Many cosmetics are often cosmeceuticals which are low dose medicine. Use of such low dose medicine containing cosmetics for such cosmetic medical problem may make your problem resistant to treatment or may slowly aggravate the cosmetic skin problem. Thus person suffers from side effects created by use of these cosmetics. Thus these so called safe cosmetics are safely unsafe. So it is better to take doctor's treatment.

Select proper treatment procedure or combinations of procedures: There are multiple types of cosmetic medical treatment modalities. Depending upon severity of the problem, extent of expectation about results, & one's financial budget one should select treatment plan. Try to know various treatment modalities available & their limitations. Stronger treatment gives better & longer lasting results. Unnecessary use of mild methods may frequently cause side effects or may allow to grow the existing cosmetic problem.

Take treatment at the centre where good technology is available.

Spoiled skin, diseased skin, sensitive skin: Skin is spoiled or become sensitive due to self use of cosmetics or medicine without proper medical supervision. When skin does not remain smooth, fair or glowing for long time one needs medical cosmetic help. Sensitive, diseased and spoiled skin are medical/discased conditions which must be maintained under medical supervision because its beauty tends to spoil easily in future. Duration & frequency of such supervision varies from case to case. It may vary from few days to few years or decades. Interval between two visits may vary from person to person.

Clinics, spa and beauty parlour: Improper non-medical& paramedical treatment, negligence in taking treatment & follow up care, environmental factors tend to aggravate medical cosmetic problems of the skin. To solve medical cosmetic problem & moderate to severe cosmetic skin problems do not depend on parlour facial & bleaching procedures. Bleaching and various types of facials have limitations and some side effects. These are supposed to use on normal skin. If you use them, medical treatment is not taken or postponed and so slowly these cosmetic problems grow.

vProblems in communication gap: Most of good doctors are busy. They are not able spend time for enough counseling. So take help of their assistant doctors to clear your doubts. Doctors do not advertise their skill. Doctors do not over assure you but paramedical &non-medical persons & advertises over assure you. Advertise, non-medical cosmetic experts, parlours, spas tend to over assure you in comparison to doctors. They tend to spend enough time for counselling. They tend to promote non-medical procedure for medical cosmetic problems. So persons often tend to take non-medical cosmetic treatment from these later group. So their problems are temporarily solved or partially treated. This results into gradual increase in problem & conversion of simple problem into complicated problem or mild cosmetic medical problems into severe cosmetic medical problem.

Most of us need medical care for maintenance of the skin beauty: So most of us need medical care of the skin at certain interval to preserve fairness, uniformity of colour tone, glow smoothness & normal health of the skin. We need such care to prevent acne scars, dark spots darker colour tone, wrinkles dullness, roughness, aging effects, oiliness, dryness, depressed areas etc.

Choosing treatment procedure: If mild skin cosmetic problem is increased to moderate to severe extent then one may choose to undergo moderately stronger medical cosmetic procedures like Laser facial skin rejuvenation moderate chemical peels, more number of sittings of skin polishing or iontophoresis, ultrasonic wave treatment or electroporation. If one wants better improvement & longer lasting results then one may choose more treatment session of 'laser facial' 'skin rejuvenation and for combination with laser facial Ultra-Pulse® fractional CO2 laser skin resurfacing treatment which improves total outlook of the skin.

A) Non- ablative laser skin rejuvenation of laser facial skin rejuvenation :

On Indian skin Topflat 'Q-Switch Nd:YAG laser facial' skin rejuvenation gives better results in comparison to other lasers like long pulse Nd:YAG laser, IPL (Intense Pulse Light, variable pulse light, UPL, etc). It improves fairness of colour, uniformity of colour tone, smoothness, acne, acne scars, pigment layers, wrinkles, oiliness, dryness etc. It is safe.

B) Ablative laser skin rejuvenation or skin resurfacing: Those who want better improvement in texture, wrinkles, dark thick layer on some part of the skin, acne scars / burn scar or other scars then one may choose to undergo Ultra-Pulse® fractional DeepFXTM & SCAAR-FXTM CO2 laser skin resurfacing. Micro needling (dermaroller) procedure is cheaper method but it has its limitation to produce results. In case of mild aging problems one may undergo non-surgical treatment of skin tightening & strengthening of facial muscles e.g. Radio frequency infrared rays, non-ablative laser (erbium glass YAG laser) can be used. If one has chronic or longer lasting or moderate to severe problem then one should choose strong treatment & ablative treatment. Due to fear of ablative treatment or pain many persons tend to avoid such stronger treatment and tend to choose mild treatment. Such mild treatment has always some limitation. If you have normal skin, then you can take help of your beauty parlours to make skin better look for few days by using facials, bleaching procedures, non-medical exfoliants. But if your skin develop medical cosmetic problem like tanning, undue reduction in fairness of the skin, stuborn enlarged pores, acne, pigmented patches, problem of frequent oiliness or dryness of the skin, sensitive skin, matured skin, aging. Problem of the skin, consult your cosmetic physician or skin specialist. Every above procedure has its limitations.

In moderate to severe case of acne scars, other scars, wrinkles, photo damage changes, darker skin colour, darker thick layers on the surface of the skin wrinkles, looseness of the skin, one need to choose strong treatment & more number of treatment sittings. One may use same method more number of times or for longer period after medical consultation. One may undergo treatment with more than 2 technologies simultaneously or in sequence. One may undergo UltraPlus® fractional CO2 laser skin resurfacing,deep (stronger) chemical peels, micro needling, insulated RF needle treatment.


Types of laser skin Resurfacing: See chapter 4.4

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