There are lots of facial rejuvenation treatments on the market these days, but the gold standard for skin resurfacing remains the CO2 laser.




It’s been giving great results for years, clocking in high levels of patient satisfaction. We’ve just purchased the UltraPulse® EncoreTM CO2 laser system, widely regarded as a top-of-the-line system for CO2 laser resurfacing.



I like it for its versatility. It’s got a wide range of settings, giving me the kind of finely calibrated control that lets me tailor your treatment precisely to your particular skin issues.



Which skin issues does it treat best?

The CO2 laser is most commonly used to treat mild to severe wrinkles, pigmentation changes (discoloration), acne scars, pucker marks and photo damage. While removing damage, it also stimulates the formation of new underlying collagen.



Over time, its collagen-stimulating properties will improve your skin’s elasticity and help you retain fullness where you need it, resulting in a more rested, youthful appearance. Collagen, as you probably know, resides in the substructure of the dermis, supporting the upper layers. When there isn’t enough of it, you get that tired, drawn look. When restored, healthy collagen adds a certain brightness and radiance to your features.



How do CO2 laser treatments work?

A high-energy beam of CO2 light is sent through a handpiece that I will apply gently to the surface of your skin. The light vaporizes lines, wrinkles, scars, dark spots and other irregularities, layer by layer. As with all resurfacing techniques, the deeper the penetration, the more efficacious the procedure. (And the longer the recovery period.)



Depending on the severity of your skin problems, I will choose different settings, and use my judgment regarding the number of times to pass the handpiece over each area.



What results can I expect?

Laser resurfacing restores your skin to a healthy state, similar to that of skin that has not experienced sun damage or scarring.



Are there skin types that don’t respond well to CO2 laser treatments?

I don’t like to use this resurfacing technique on olive complexions and darker types of skin. There’s a danger of lightening the skin pigment.



Is this treatment completely safe?

If post operative care is not followed carefully, scarring, infection and color changes can appear. It’s important that you follow my post-operative instructions to the letter.



How long is the recovery period?

The recovery time is approximately two weeks, but if you need deeper penetration to address your skin issues you may require up to 30 days’ healing time. Since this technique causes thermal injury to the skin, I will be monitoring your recovery closely.



How long will the benefits of treatment last?

With proper sun protection, results can last for more than five years. In areas where muscle activity is strong, lines may begin to reappear sooner. As skin continues to age at a normal rate, you may want to maintain your results with occasional 'touch-up' resurfacing treatments.



Are there dangers?

Prolonged redness and hypo-pigmentation are possible complications with these lasers.



What’s the biggest benefit of laser resurfacing over less invasive skin rejuvenation treatments?

While all rejuvenation treatments have different benefits, CO2 laser resurfacing is known to be a very thorough treatment for blemished skin. You will find at the end of your healing that you’ve definitively “turned back the clock.”



While intense, it’s an extremely effective way to undo the damage caused by sun exposure and the passage of time.

One of the most important advantages of liposuction is that the procedure requires only small, discrete incisions. If it is being incorporated into another procedure, liposuction can typically be performed through the incisions made for it. When performed as a standalone procedure, liposuction may require only a local anesthesia while many patents prefer intravenous sedation. To remove the fat, Dr. O'Toole inserts a suction tube called a cannula. He breaks up and removes unwanted fat deposits, sculpting the body as desired, before closing the surgical incisions.




Liposuction recovery times vary widely depending on the size of the treated area. Some patients recover in a few days, while others require months. In most cases, patients are well enough to return to work and other normal activities within a week and are able to see their final results within about two months. Dr. O'Toole's patients from Beverly Hills, Pasadena, and elsewhere are usually asked to wear a compression garment after liposuction for about two weeks to control swelling. It is normal for patients to experience some skin looseness during recovery, but the skin should ultimately tighten within a few months of surgery to reveal the full benefits of the procedure.



Dr. O'Toole favors the use of the power assisted lipoplasty technique. This motorized tool helps to break up the fast cells more evenly and with less effort. Since smaller canulae are used, there is less chance of post-operative contour irregularity. Dr. O'Toole also occasionally uses the ultrasonic technique.



>>Watch a 3D animation of liposuction

http://content.understand.com/Players/Flash/?presentationid=95cb75cc-05da-452e-9984-932da46ba5c2&languageid=6574fa28-0a40-49af-88c8-3ce366c8c580&accountid=6cb41e13-191f-454e-8cc0-81304b467f30

Liposuction is performed by using a hand-held instrument (called a cannula) to vacuum the fat layer that lies deep beneath the skin. By pushing and pulling the cannula, the fat cells are broken up and then sucked out with a vacuum or syringe and deposited into bags, bottles or other containers. While fat is removed by suctioning fat through small tunnels, the skin remains connected to the underlying muscles. This helps preserve the nerves and blood vessels supplying the skin and also helps to decrease the laxity of the skin. The surgeon is also careful to leave a thin blanket of fat attached to the skin to prevent the cannula from getting too close to the skin and thus avoiding excessive rippling or other irregularities. The tumescent solution injected under the skin helps to decrease bleeding, provide anesthesia to the surgical site and improve postoperative patient comfort.

Most patients are back to work in 1 week. A support garment is worn for 3 weeks and no heavy exercise is performed for 3 weeks. Mild bruising and swelling are expected along with potential changes in sensitivity contour and texture of the skin. Although complications following liposuction are unusual, it is important that every patient be well informed about the procedure, the options available and potential problems. Ask Dr. Kotoske if you are a candidate for this exciting procedure.

Liposuction, also known as lipoplasty or suction lipectomy, is the process of removing unwanted fat from specific areas of the body. The most common treatment areas include the upper outer thigh area known as “saddlebags”, the abdomen, the flanks or “love handles”. Other treatment areas include facial/neck fat, (“double chins”), hips, buttocks, thighs, knees, arms and ankles. For men, liposuction can be used to correct gynecomastia (enlarged breasts). While no method of liposuction is a substitute for good nutrition and physical exercise, liposuction can remove stubborn areas of fat that won’t respond to traditional weight loss methods. The latest advance in liposuction is the microtumescent technique with liposculpture. Using very small cannulas, the fat is sculpted away with minimal down time and recovery.