Lasers | Dr. Forley
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Archive for the ‘Lasers’ Category


Saturday, March 31st, 2018

As the aging process progresses, facial veins may appear more visible. The area around the eye, known as the periorbital region, is a frequent site for visible veins. These can become quite prominent and detract from the aesthetics of the eye. They are difficult to conceal and are a frequent complaint of patients concerned about their appearance. Fortunately, a safe and effective treatment option exists with the Ellipse Nordlys Nd:YAG laser. This device uses a specific wavelength of light that is absorbed by the red blood cells found within veins. The resulting heat that occurs results in the eventual elimination of blood flow through the veins due to the collapse of the vessel walls. The veins will disappear when blood doesn’t flow through them. The deeper veins remain untouched so there is no functional effect when treating the superficial veins. Minimal discomfort is associated with this rapidly performed treatment. One or more laser sessions may be required depending on the extent of the problem.

45 year old female 4 months following laser treatment of periorbital vein

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Sunday, August 20th, 2017

The Ellipse Nordlys is a state of the art device with multiple light and laser based treatment options for effectively managing various conditions. Superficial veins around the eye and temporal region are a frequent complaint that can be very visible and difficult to conceal due to the thin skin in this region. Treatment with the Nordlys Nd:YAG laser can reduce or eliminate the veins by using a specific wavelength of light to deliver energy that is absorbed by the red blood cells contained within these vessels. The energy is converted to heat which is transmitted to the inside surface of the vein. This results in eventual collapse and sealing of the veins so no further blood flow occurs. The lack of blood flow is what makes the veins gradually disappear. There are plenty of deeper veins in this area so eliminating the superficial ones that are visible is not a problem. There is minimal discomfort and the treatment only takes a few minutes. Frequently one treatment is sufficient but additional treatments may be indicated depending on the response of the veins.

38 year old female 8 months after Nd:YAG laser treatment of veins

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Sunday, December 25th, 2016

The Nd:YAG laser applicator on the multi-platform Nordlys system is very effective in treating vascular skin conditions that appear as red spots on the face. These clusters of small dilated blood vessels are called spider angiomas and respond to the wavelength of light energy that is delivered by the Nd:YAG laser. The energy is selectively absorbed by the red blood cells of the angioma and causes the inside wall of the vessels that are targeted to heat up and collapse. This prevents any further blood flow and the redness disappears. The treatment is very rapid with minimal discomfort and may require 1-3 sessions about 6 weeks apart with no downtime.

39 year old female 3 weeks after 2 Nordlys Nd:YAG laser treatments of the red spider angioma of her forehead

39 year old female 3 weeks after completing 2 Nordlys Nd:YAG laser treatments of the red spider angioma of her forehead

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Wednesday, June 29th, 2016

You can add a type of benign nodular vascular growth, known as a venous lake, to the many negative effects of sun exposure. It is commonly found in areas of the body that are often unprotected such as the vermillion or red part of the lip. It appears as a dark blue or purple collection of dilated, blood filled channels. It is compressible and tends to be very slow growing. It can mimic melanoma or basal cell carcinoma and must be distinguished from these malignant conditions prior to treatment.

74 year old female following 2 treatments of lower lip venous lake with Nordlys Nd:YAG laser

74 year old female following 2 treatments of lower lip venous lake with Nordlys Nd:YAG laser

The Nordlys Nd:YAG laser delivers energy at a wavelength that is selectively absorbed by the blood cells in the vascular channels of the venous lake. This causes a heating of the channel lining and collapse of the vessel wall that ultimately results in shutting down blood flow. Without blood flow, the venous lake will disappear. Treatment of the venous lake is quick, often requiring only 1 or 2 pulses of laser energy with minimal discomfort. In most cases, one or two treatment sessions at 6-8 week intervals is sufficient.

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Friday, March 14th, 2014

Patients who have facial surgery are often concerned with how best to maintain and improve upon their result. The elta MDfirst step that is emphasized is sun protection. If a patient does nothing else, minimizing UVA and UVB contact will reduce exposure to the environmental factor most responsible for the appearance of aging. Consistent application of an effective sunscreen such as eltaMD will reduce collagen and elastic fiber damage. As a result, recurrent sagging, skin laxity, and wrinkles will be lessened thereby prolonging the benefits of the surgery.

Dr. Forley utilizes the VitaMedica Recovery Support Program to provide nutritional supplements that are important to support the healing process following surgery. Once the initial phase of healing is done, Dr. Forley recommends transitioning to VitaMedica’s Anti-Aging Formula. It is a well balanced blend of vitamins and supplements that continue to benefit the skin long after surgery has been completed.

VitaMedica’s Anti-Aging FormulaFacelift surgery creates more youthful contours and removes excess skin. However, it does not change skin quality. The Fraxel®Dual laser provides an effective means to improve skin texture and wrinkles as well as treat age spots. It improves skin quality in a way that surgery does not and a series of 4 monthly sessions is often recommended beginning three months following the facelift.

Finally, Dr. Forley likes to implement a comprehensive skin care program with all his facelift patients. The active components in  SkinCeuticals and SkinMedica include growth factors, antioxidants, and hydrating/exfoliating products that will give the aging skin a more youthful appearance. Improved skin quality will complement the lifted facial contours achieved by the surgical procedure.

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Monday, January 28th, 2013

A scar is  the normal outcome of healing after the skin has been injured. The final appearance of the scar is dependent on the remodeling of collagen fibers that are deposited to enable the wound to heal. The scar will frequently be red and slightly raised during the initial healing phase. When an excessively thick or hypertrophic scar forms, it is raised above the skin surface but stays within the immediate area of the original wound. Keloids are raised and dense scars that spread beyond the borders of the original wound and frequently are resistant to therapeutic intervention. Several techniques are used  by Dr. Forley to improve the appearance of scars.

Topical Gel


Silicone gel that is applied topically to scars has been shown to prevent scar thickening and lessen discoloration by creating a favorable environment for scar maturation. The silicone gel is paired with a sunscreen in bioCorneum®+ to protect the scar from the damaging effects of UV exposure.

Silicone Sheeting

all shapes labelsSilicone sheeting has been shown to help reduce scar size, thickness, height, and color. It can be effective in both new and old scars, post-surgery scars, keloids, and hypertrophic scars. By helping to blend the scar with surrounding healthy skin, silicone sheeting such as Oleeva Scar Shapes® help make the scar far less noticeable. The sheets are made of a highly flexible material that can be easily cut to fit any scar size and can be used on almost any location of the body. A primary benefit of silicone sheeting is the direct pressure produced by the sheeting on the scar itself thereby helping to prevent or reduce scar thickening.


Steroid Injections

Steroid injections inhibit fibroblast growth, reducing the amount of collagen deposited into the scar. Side effects include lightening of the skin color, thinning of the skin, and blood vessel overgrowth causing skin discoloration. The use of conservative amounts of steroids is considered a safe and effective treatment modality for scar reduction.

Laser Treatment

Progress in laser technology and refinements in technique have made laser therapy a preferred treatment choice for scars. Fraxel-LasersNon-ablative lasers, such as the Fraxel DUAL 1550/1927 laser, work beneath the surface layer of the skin to help improve the thickened collagen layer of the scar. Two wavelengths are used to deliver energy in “fractional” zones of heating with every microscopic treatment zone surrounded by unaffected skin to enable more rapid healing and less downtime.

Scar Revision

Surgery is available as an option to improve a scar that has not responded sufficiently to other techniques. The scar is excised, usually under local anesthesia, and the wound is precisely repaired in layers.  The key to reducing recurrence of the scar is to reduce tension on the wound closure. The healing process is monitored closely, with use of the measures described above, to enhance the likelihood of a favorable outcome.

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Monday, August 20th, 2012

A troublesome problem that accompanies the onset of wrinkles and skin laxity with aging is the development of age spots. They are primarily caused by years of exposure to ultraviolet (UV) light from the sun and are typically brown, black, or gray in color. They commonly appear on the face, chest, shoulders, upper back, arms, and hands. The pigment in the upper layer of skin (epidermis) that gives your skin its normal color is called melanin. The tan that is created from exposure to the UV rays of the sun is the result of accelerated melanin production. This is the skin’s defense mechanism to protect the deeper layers of skin from damage. On areas of the skin that have years of frequent and prolonged sun exposure, age spots appear when melanin becomes “clumped” or is produced in particularly high concentrations and is known as hyperpigmentation.


Although anyone can develop age spots, you may be more likely to develop the condition if you have light-colored or fair skin, have a history of frequent or intense sun exposure, or have a genetic predisposition to extra production of melanin.

When to be Concerned

Although you may not like the way age spots look, they are usually harmless and don’t require medical care. You should see your doctor if the following changes occur to make sure a skin cancer, such as melanoma, is not present:

  • Dark pigmentation
  • A rapid increase in size
  • An irregular border
  • An unusual combination of colors
  • Itching, redness, tenderness, or bleeding

A Treatment Strategy for Age Spots

The cosmetic treatment of age spots requires a multifaceted approach to be successful.  Dr Forley utilizes a program of topical lightening products, the Fraxel® DUAL 1550/1927 laser, and sunscreens to achieve a beneficial outcome for his patients.

Topical Lightening Products

Prescription bleaching creams containing hydroquinone, often in combination with Retin-A and a mild steroid, may gradually fade age spots over several months. However, a significant number of patients will develop irritation and increased sun sensitivity from the use of hydroquinone on their skin.

Lumixyl™ Topical Brightening Crème is a lightening cream that utilizes naturally occurring peptides to decrease the availability of tyrosinase, the skin enzyme that is required for the production of melanin. Hyperpigmentation and age spots will improve over a period of 2-3 months of daily use and can be combined with Retin-A to enhance the result. Lumixyl™ does not cause the skin irritation or sun sensitivity that can result from the use of hydroquinone based lightening products.


Elure™ is a new lightening cream for treating age spots. The active ingredient is Melanozyme™, which is based on the naturally occurring enzyme lignin peroxidase, and helps to reduce melanin in the skin. It can be used in combination with Lumixyl™ to yield improved results in resistent age spots.

68 year old female before treatment

68 year old female before treatment

68 year old female 7 months following Fraxel®

7 months following Fraxel® DUAL 1550/1927 laser series of 4 treatments and Lumixyl™ Topical Brightening Crème



Dr Forley uses the Fraxel® DUAL 1550/1927 laser to treat age spots with limited downtime. The two wavelengths of energy are delivered in microscopic treatment zones, which do not affect the surface layer and enable rapid healing. Redness and swelling of 2-4 days duration with flaking and exfoliation occurring during the first week can be expected. Treatments with the Fraxel® DUAL laser typically require 3-5 sessions at monthly intervals. Age spots fade gradually over several weeks or months following each treatment. Dr. Forley uses Lumixyl™ as a pre-treatment for 4 weeks prior to the start of the Fraxel® DUAL laser series and between each laser treatment to maximize the lightening of age spots.


Sun Protection

Any effort at treating age spots will be counteracted by exposure to the UV rays of the sun. It is imperative to utilize sun protection if you want to benefit from the age spot treatments discussed. Dr. Forley recommends physical sunscreens, such as EltaMD®, because of their long lasting, broad spectrum UVA and UVB protection.

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Wednesday, July 25th, 2012

The redness and dryness associated with laser skin treatments can be reduced with the use of skin care products that are specifically formulated for this purpose. Dr. Forley will help you select the products that will work best for your individual needs:

Epidermal Repair: (SkinCeuticals)Epidermal Repair: (SkinCeuticals)

This post-treatment hydrating product also contains a pure concentrated form of two highly effective, proven healing ingredients. Beta Glucan and Centella Asiatica provide a protective barrier layer and help accelerate the biological processes involved in skin healing while reducing redness and soothing irritation.

TNS Ceramide Treatment Cream: (SkinMedica)TNS Ceramide Treatment Cream: (SkinMedica)

The dry skin that frequently occurs following a laser treatment be soothed and hydrated with this rich treatment cream. It contains NouriCel-MD, human growth factors and other naturally occurring elements that are crucial to the regeneration of healthy skin. It can also be used for treating dry skin as a complement to TNS Essential Serum in your daily skin care regimen.

Redness Neutralizer: (SkinCeuticals)Redness Neutralizer: (SkinCeuticals)

This pharmaceutical grade formulation prevents and controls the inflammation cascade that produces redness. It calms the irritation that may occur immediately following your laser treatment, and helps relieve post-procedure flushing.

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Monday, April 30th, 2012

An area of the body that often is overlooked in our anti-aging efforts is the hand. Recent attention has been directed to creating a more youthful appearing hand to match the facial rejuvenation treatments more commonly performed. The aging process in the hand is characterized not only by the changes in the appearance of the skin with wrinkling and brown spots but also by the increased visibility of the tendons and blue colored veins. This is the result of the loss of volume on the back of the hand and thinning of the skin. A key component in restoring a youthful appearing hand is the replacement of the volume that has diminished over the course of time. Here we will discuss a few treatment options that can help your hands to look younger: Radiesse®, Sculptra®Aesthetic, fat grafting, and Fraxel® re:store Dual laser.




After Radiesse®


Radiesse® is an injectable filler used to thicken the tissue on the back of the hand. It is FDA-approved and consists of calcium-based microspheres suspended in a water-based gel that will immediately restore volume to the hand when injected just below the deep layer of the skin. It also has a collagen stimulating effect that may prolong its usual one-year duration.



Sculptra®Aesthetic is an injectable material composed of poly-L-lactic acid that stimulates the production of collagen in the skin. A very natural appearing restoration of hand volume is produced by the gradual thickening of the skin that occurs over a three-month period. Generally, a series of 2-3 treatments at 6-week intervals are necessary to achieve the desired effect. The results from the treatment can last up to three years at which time maintenance treatments will be necessary.

Fat Grafting

A simple technique of injecting fat under the skin of an aging hand can achieve long-lasting rejuvenation. Your own fat is obtained using liposuction and then specially prepared prior to injecting it under the skin in fine tunnels. Survival of fat depends on it getting a good blood supply and may require several sessions to achieve the desired result. The physical presence of a thin layer of tissue will not only decrease the blue of the dorsal hand veins and the white of the extensor tendons but will also soften the shape of veins and tendons.

Fraxel® re:store Dual Laser

The new Fraxel® re:store Dual Laser can be used in addition to volume restoration to improve the surface texture of the skin and lighten brown spots. The new, more superficial Thulium fiber laser (1927 nm) wavelength can better address skin discoloration with minimal discomfort. In addition, the deep penetrating Erbium fiber laser (1550 nm) improves skin quality with collagen remodeling.

Microscopic treatment zones delivered by the Fraxel® re:store Dual laser produce “fractional” zones of heating with every zone surrounded by unaffected skin. This technology enables rapid initial healing with redness and swelling lasting for 2-4 days. There is no visible wound healing but some dryness and flaking will occur during the first week. The treatment regimen consists of 3-5 sessions at about 4 week intervals with beneficial changes continuing to occur for 2 to 3 months after each treatment.

During your consultation, Dr. Forley will discuss which treatment options would be best for you.


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Saturday, January 14th, 2012

What is a laser?
A laser is a wavelength source of high-energy light that is accurately focused and transmitted onto a very small area of the skin. The light travels in one direction, heating the skin selectively based on the wavelength and energy settings of the laser. In some cases, the skin is vaporized with an ablative laser when wrinkles are more severe. Current lasers such as the Fraxel re:store Dual and the Fraxel re:pair are precise and selective, allowing treatment of wrinkles, pores, brown spots, acne scars, and sun-damaged skin.


Ablative vs. Nonablative
There are two kinds of lasers: non-ablative and ablative. Non-ablative lasers, such as the Fraxel re:store Dual, work beneath the surface skin layer, using two wavelengths to deliver energy in “fractional” zones of heating with every microscopic treatment zone surrounded by unaffected skin. By maintaining the integrity of the surface layer of the skin, the downtime is kept to a minimum with this type of laser. Ablative lasers, such as the Fraxel re:pair, provide deeper dermal remodeling of more severely sun damaged skin by heating and vaporizing the treatment zones using fractional carbon dioxide (CO2). Both approaches stimulate collagen growth, improve skin tone, and decrease fine lines and skin discoloration. During your consultation, Dr. Forley will discuss which laser will work best for you.


Treatment and Healing Expectations
Topical numbing cream is applied for 1 hour prior to the treatment to decrease skin sensitivity. During the laser procedure, cold air is used on the skin, making any discomfort manageable but pain medication can also be used if desired. A sedation or “twilight” type of anesthesia may be indicated when an ablative laser is used. A full face treatment takes about 30 minutes.

Fraxel re:store Dual laser treatment produces a variable amount of redness and swelling over the first 3-4 days and dryness and flaking will occur throughout the first week. You are able to return to routine activities within 3-4 days but must use sun protection. Benefits are most evident with three to five treatments, spaced every 4-6 weeks.

Fraxel re:pair laser has a more involved recovery period and requires the area of treatment to be kept moist with gauze soaks and ointment for 5-7 days. The skin will be red and may be covered with a fine crust. Pinpoint areas of bleeding may also occur in the first 48 hours. The treated sites must be protected from sunlight after the procedure. In some cases, a pink surface color may remain for several weeks. You are able to return to routine activities and use make-up after 7-10 days although concealer may be necessary. Often, one treatment is all that is required to achieve the desired result.

Areas of Treatment

The Fraxel re:store Dual laser can treat wrinkles, acne scars, surgical scars, age spots/sunspots, melasma and actinic keratoses. The Fraxel re:pair laser is used for advanced sun damage and wrinkles, irregular texture, and age spots/sunspots. Laser treatment is not a substitute for a facelift nor can the procedure eliminate excessive skin or jowls. However, when combined with surgery, laser resurfacing can enhance the outcome of a facelift by improving skin quality.

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