Laser Treatment for Acne Scars – Q&A with Dr. Biesman

Home » Blog » 2022 » January

Many of us remember what it was like to battle acne in our teen years or early adulthood. Adding insult to injury, many people who experience acne are left with visible scarring. Dr. Biesman has been treating acne scarring for more than 25 years, often using advanced laser therapies. We asked Dr. Biesman to share some insights into the best laser treatments for acne scarring.


How do laser treatments correct the appearance of acne scarring on the face?

Lasers can play a very important role in the treatment of acne scarring

There are many different kinds of acne scars, and there are many different kinds of lasers. In order to determine which treatment is best for an individual patient, we need to examine the patient to see which type of scarring they have, then select the laser or device that is best suited to correct those acne scars.

We can correct acne scars that are depressed. We can correct acne scars that are elevated. We can correct acne scars that are discolored, either red or brown. We can correct acne scars that have irregular surface textures, such as a tissue paper-type surface texture. There are all types of acne scars we can treat, and we use an array of lasers. In some patients, we use several lasers, all in the same setting.


How do you determine laser treatments are right for someone struggling with acne scarring?

For patients who struggle with acne scarring, there can be lots of options available.

It’s important that the acne must be under control before we try to correct scarring. We look for the appearance of the scars, and the depth of the scars. Some acne scars need to be treated surgically. Other acne scars need to be treated with lasers for discoloration. Some acne scars that are treated with lasers will have a very short recovery time, and other types of acne scarring require a more aggressive type of treatment with lasers that have up to a week of recovery time.


What can a patient expect during laser treatment for acne scars?

Laser skin treatments themselves usually are done in the office. Typically they are performed with either topical anesthesia, which is just numbing cream, or for some of the deeper acne scars, we might inject a numbing agent, like when you go to the dentist or have something removed by the dermatologist. 

Once the area is numb, we’ll do the treatment. Depending on which treatment we do, there may or may not be some discomfort, but usually not very much.

After the treatment is done we’ll put some type of dressing on the skin. We’re big fans of using things like Aquaphor right afterward. Sometimes we’ll use PRP, which is platelet-rich plasma. We’ll take some of your blood, spin it in the centrifuge, and separate the platelet-rich area, which we apply onto the freshly-lasered skin to help it heal and to enhance the results.


Describe the pre and post-laser treatment procedure.

Doing a laser treatment is a team procedure. We need our patients to work with us, and we need to work with our patients.

What do I mean? It’s extremely important that our patients follow their instructions carefully, and that we do our treatments according to plan. With that lockstep cooperation, usually, we can get nice results.

For example, patients need to avoid the sun before most laser treatments. After laser treatments, it’s super important to follow instructions on how to take care of the skin. We’ll go over it with you in great detail, but the devil’s in the details when it comes to getting the best results. You want the skin to heal as quickly as possible following treatment with a laser. That will assure you of the best possible outcomes. We’ll tell you everything you need to know, and someone is available 24/7 if you ever have questions.


Are there any risks or side effects?

There are risks to every treatment. As we use such a wide variety of lasers, we will go over carefully with you, before your treatment, all the things you need to be aware of that could go wrong. We’ll tell you what to look out for so we can catch something early in the event it’s not going the way that we want.


What is recovery like after laser treatments?

Recovery after laser treatment will vary depending on the type of laser that was used. In some cases, people may have just a little bit of redness or swelling. In other cases, it may take up to a week to heal. Again, there tends to be very little discomfort after a laser treatment, but it’s super important to follow instructions.


Schedule a Consultation for Laser Treatment and Acne Scarring 

Are you ready to learn more about laser treatment for acne scars? Contact our practice to schedule a consultation with Dr. Biesman.

Do Facial Fillers Make You Look Older?

Home » Blog » 2022 » January

Facial fillers are often used to restore a natural, youthful appearance to areas that appear older due to wrinkles, fine lines, or loss of volume. Dr. Biesman has decades of experience providing patients with minimally-invasive treatments, including facial fillers, to achieve their desired results. For this article, we asked Dr. Biesman to share some of his insights into the uses and potential misuses of facial fillers. Here are his responses.


Do facial fillers make you look older? 

Facial fillers, if not used appropriately, can have all kinds of effects that are undesirable, and one of them can be looking distorted or even older.

Like any other tool, if it’s used properly by someone who understands how to get the best outcomes, using facial fillers should make you look better— not older.


Can too much dermal filler age you?

Using too much dermal filler can distort your face, make it look asymmetric and aesthetically out of balance, and in some cases, it can even make you look older than you actually are.


Are fillers anti-aging?

Dermal fillers are not anti-aging from the standpoint of preventing changes from occurring in our face, but they are wonderful for helping to camouflage changes that have occurred already so that people look younger. So, they definitely correct some of the signs of aging to make us look more youthful when used properly, but they won’t prevent those changes from happening. Those are going to be genetically predetermined.


Describe your approach to facial filler treatments. 

My overall approach to facial fillers is a conservative one. 

First, I like people at a comfortable professional or social distance to just look good— not look a certain age, not have a certain “look,” just look good.

How do you do that? We use fillers in three ways. We use fillers to correct volume or to replace facial volume if there has been a loss or change. We use fillers to recontour the face, whether that’s the cheekbones, jawline, forehead, or nose. Finally, we use fillers to fill in fine wrinkles or lines. That’s the minority of the work we do, revising wrinkles. Most of what we do is contouring and volume.

So, we use injectable fillers to aesthetically balance the face, balance the upper face with the lower face, and make sure everything is harmonious in such a way that it doesn’t look like people have had something done… they just look good.


At what age should women start getting facial filler treatments?

There’s no absolute minimum age at which you should start getting facial filler treatments. We do see younger people who are born with, for example, hollow under-eyes get filler treatments as early as their twenties. The majority of the treatment we do in people who have started to see changes over time, or if they look back over photographs from when they were younger, tend to be for people who are in their thirties or even a little bit older.

A majority of our patients who use fillers regularly are probably between the ages of 30 and 80.


What age group do you typically see women consistently getting facial fillers?

It’s very common to start seeing people regularly, women and men, in their thirties. In many cases, we can use fillers as the best option to keep people looking youthful. It’s important to maintain skincare, to use sunblock, to take care of ourselves in terms of what we eat and drink, and to use fillers appropriately. 

For many patients who are in a younger age group, surgery isn’t an option for them. As people start to get older, sometimes fillers can be used in conjunction with cosmetic surgery, skincare, and injectables like Botox and other neuromodulators for a combination approach.


What do you want to share with women who have had a bad experience with facial fillers and are hesitant to try them again?

Unfortunately, we do see people regularly whose experience with fillers has not been the best.

Why does that happen? Usually, it’s because someone’s expectations weren’t met. In other words, they were hoping to get one thing and they got something else that they weren’t happy with.

Most often, we can fix that. We can get rid of filler that was put in the wrong place or the wrong quantity or was the wrong product, and replace it with something that gives a better result.

It’s disheartening to people when they’ve had a treatment and it doesn’t go the way they want, but do be reassured that in most cases we really can use fillers successfully, even in someone who’s had a bad experience to start with, to get a nice result.


Get More Information About Facial Fillers

To schedule a facial fillers consultation with Dr. Biesman, contact our office at your convenience.

Overview Of Surgical Brow Lift Vs. Botox Eyebrow Lift

Home » Blog » 2022 » January

Sagging eyebrows may contribute to the appearance of heavy eyelids, something that many patients do not realize until they examine old photographs of themselves. For those who wish to lift their brows, there are many surgical and non-surgical options available. 

Dr. Biesman is an expert in providing these brow treatments. We asked him about some of the most common options, including the surgical brow lift and Botox brow lift.


What is an eyebrow lift?

An eyebrow lift refers to any procedure that, as you might guess, lifts the brows.

There are several different ways we can do that. Non-surgically, we can sometimes use Botox, which is an injection, to relax the muscles that pull down the eyebrows and let the muscle that pulls the eyebrows up act unopposed. In other words, we change the balance between the pull-up and pull-down muscles of the forehead. This way, you can get some degree of lifting for the eyebrows. It varies as to how much, and it’s not as much as with surgery, but you can in many cases get some degree of lifting from the brows with Botox.

If for whatever reason someone is not a good candidate for Botox brow lifting, because their brows are too heavy or they need more elevation than what Botox can give, then a surgical brow lift might be the best option.


What surgical and non-surgical options do you provide for eyebrow lifting?

Non-surgical options for eyebrow lifting involve, primarily, Botox to relax the muscles that pull the eyebrows down. We can also use fillers, which pick the eyebrow up. We can sometimes use devices, like non-invasive skin tightening devices, a couple of which have FDA indications for lifting the brow area.

When it comes to surgery, we need to make an incision that allows us to get access to the tissue around the eyebrows and lift the brows. In most cases, we try to do that from behind the hairline. In severe cases, we might have to make incisions right above the eyebrow itself, but that’s something we try to avoid.


What are some of the common issues you treat with an eyebrow lift?

Common issues we treat with eyebrow lifting include asymmetry of the eyebrows and hooding of the eyelids caused by eyebrows pushing down. We also contour the brows sometimes. The eyebrows can flatten over time. Sometimes we aren’t lifting the brow so much as reshaping the brow, so it depends on what the underlying anatomic concern is and what the goal is when it comes to adjusting eyebrow position.


What does an eyebrow lift do for a patient?

Eyebrow lift surgery can elevate the entire eyebrow. It can elevate just the outer part of the eyebrow. And, it can reshape and recontour the eyebrow to make it aesthetically more pleasing or more youthful.


What is a Botox eyebrow lift?

A Botox eyebrow lift refers to the use of Botox or other drugs that have a muscle-relaxing effect. 

There is a set of muscles that pull the eyebrows down. If you relax the muscles that pull the eyebrows down, and you let the muscles that pull the eyebrows up act against the weakened muscles, you can achieve the upward elevation of the eyebrows. That’s what we refer to as a Botox eyebrow lift.

A common misconception is that injection of Botox in the forehead lifts the brows. It does the opposite. There’s only one muscle that picks the eyebrows up, and if you relax that muscle, the eyebrows are going to come down.


What is the difference between a surgical eyebrow lift and a Botox eyebrow lift?

Surgery and Botox can both be used to recontour brows. 

Surgery is a much more dependable and reliable way to contour brows. For patients who require very little elevation of the brows, Botox can be a good option. For people who don’t need much correction and don’t want surgery, again, Botox can be a good option. 

You do have to keep up on Botox injections, usually three or four times a year to maintain results. Surgery, of course, provides a longer-lasting result. Surgery does have the relative downside of having to undergo a procedure. Even with brow lift surgery, though, once the brows are corrected, for someone with deep furrows between their eyebrows, they may still need to use Botox. This isn’t to lift their eyebrows, but to control the frowning lines.


Can dermal fillers lift eyebrows?

Dermal fillers can be used to lift eyebrows in some patients, but not in everyone. There’s a fat pad that lives underneath the eyebrow that becomes deflated over time. Sometimes just reinflating that fat pad with a little bit of filler does wonders for brow height, brow shape, and even brow projection. If you look at young people, their brow has a nice three-dimensional contour, but when you get older, the brows become flatter and tend to sag a little bit.

For the right patient, fillers can be nice for recontouring brows and making them look more youthful.


What are some of the best options for lifting the skin around the eye and especially the upper eyelid?

There are several options for lifting eyelid skin.

We can lift the eyebrows. If the eyebrows are pushing skin into the eyelids and you try to surgically remove that skin, you’re going to end up sewing the eyelid to the eyebrow, which isn’t good. So, to treat the eyelid skin, we sometimes need to lift the brows.

Sometimes, we can use procedures like laser resurfacing to tighten and lift the eyelid skin. Laser resurfacing does not do a good job lifting brows, but it can do a beautiful job of tightening eyelid skin.


Learn More About Eyebrow Lift Treatments

Do you have additional questions about brow lift procedures? Schedule a consultation with Dr. Biesman at your convenience.

What To Expect During Blepharoplasty Surgery

Home » Blog » 2022 » January

When the excess tissue of the eyelids makes the eyes appear aged and tired, a procedure known as blepharoplasty may be an option to make the eyelids appear more youthful and awake. Dr. Biesman is an experienced Oculofacial Plastic Surgeon who has provided countless patients with outstanding blepharoplasty surgery results. We asked him a few questions about what to expect during blepharoplasty surgery and to describe the eyelid rejuvenation process, recovery time, and more.


What is blepharoplasty and eyelid rejuvenation surgery?

Blepharoplasty, or eyelid rejuvenation surgery, is a surgical procedure that we perform to help eyelids look less tired and more youthful. Blepharoplasty can also allow eyelids to have more definition, be tighter, and just look fresher.

Blepharoplasty can be performed on both the upper eyelids and the lower eyelids. One of the important pieces of information to keep in mind is that the upper eyelids and the eyebrows are closely related. When the brow is low, it may look like you just need a blepharoplasty when what you need is a brow lift as well. And if your upper eyelid is droopy, we may need to tighten the muscle in the eyelid. So, eyelid rejuvenation surgery can involve blepharoplasty in conjunction with brow lifting or other procedures.


How do you know if someone is a candidate for blepharoplasty eyelid surgery?

Almost anyone can be a candidate for blepharoplasty eyelid surgery if they are unhappy with the appearance of their eyelids. The vast majority of people who either have asymmetry of the eyes or just don’t like the way their eyelids look are good candidates for blepharoplasty surgery.

Note that there are certain degrees of limitation we have when doing cosmetic surgery. If the differences between the eyes are extraordinarily minute, it can be difficult to make them exactly perfect. Candidates with these very minute differences may not be the best candidates for blepharoplasty surgery.


How do you recommend a patient prepare for blepharoplasty eyelid surgery?

Blepharoplasty surgery is very easy for most patients to tolerate. It’s usually a very good experience. 

One of the most important things that we ask our patients to do before blepharoplasty surgery is to hold off on Aspirin, Motrin, Advil, Ibuprofen, or any blood-thinning products. Those can even include some vitamins, supplements, and things that you may not think about as blood thinners. We provide patients with a full list of what those products look like.

Aside from that, take care of yourself, get plenty of rest, and try to avoid alcohol for about 24 to 48 hours before surgery.

Describe the day-of surgery. What can a patient expect?

On the day of blepharoplasty surgery, people are typically a little bit nervous. That’s very normal. If you’re not nervous the day of surgery, that makes me a little bit nervous.

Usually, you’ll come to the outpatient surgery center, where we do many of our procedures, or straight into our office, where we do some as well. We’ll get you comfortable, and make sure all the paperwork is taken care of. I’ll begin to draw some lines on the eyelids indicating what I want to do surgically, where I want to make my incisions. We can take a few minutes to talk one more time about what we’re going to do, and if you need to ask any questions, you can.

Once we’re all ready to go, we’ll make sure that you’re comfortable and take you back to the operating room.


What does recovery look like for blepharoplasty eyelid surgery?

Recovery after blepharoplasty surgery is very well-tolerated by almost all patients. Probably 90 percent or more of our patients take only extra-strength Tylenol for pain relief. 

There’s always going to be bruising and swelling after surgery. The better you can be about using cold compresses on your eyelids, the better you tend to do in terms of the amount of bruising and swelling that develops.

We had one patient who had almost no bruising or swelling, just three or four days after surgery, and we asked him: “What was the secret?” He said: “Ice and Netflix.” He used ice and watched Netflix, and he was very diligent. Just make sure you don’t put an ice cube on your skin. Always have a cloth or something in between. But, the more diligent you can be with ice, staying relaxed, and trying not to do much in the way of heavy exertion, the better you’ll do with recovery.


More Questions About Blepharoplasty and Eyelid Rejuvenation?

With any additional questions about eyelid surgery, we welcome you to schedule a consultation with Dr. Biesman. Contact our practice whenever you are ready to schedule an appointment.