What To Do (And NOT Do) Before & After Lasers

Speaker 3 (00:07):
You are listening to The La Jolla Cosmetic Podcast.

Monique Ramsey (00:14):
Welcome everyone to The La Jolla Cosmetic Podcast. I'm your hostess, Monique Ramsey. Today I have Khanh who's one of our wonderful standout providers in our med spa. His patients lovingly refer to him as Dr. Khanh and I brought him in to talk about lasers and laser season. It's in full swing. I wore a sweater even, so I thought it would be a good time to go over how to get ready for your laser treatment to get the very best possible result. And there are some things that you need to do maybe before and maybe in your post-care. And so Khanh, welcome.

Khanh (00:49):
Thank you. Thank you. Thanks for having me.

Monique Ramsey (00:51):
So let's dive right in. Getting ready for lasers. Is it as simple as, gosh, I've got this event in a few weeks. Can I come in on Friday and get my laser done or does there need to be some planning?

Khanh (01:06):
There definitely needs to be some planning and I'll answer a lot of your other questions, but some of the things that we go into is what type of laser are you doing, how much downtime do you have? What are you trying to accomplish? Are you coming in with a tan or a sunburn? What medications have you been on? Have you prepped your skin? So there's a lot of questions and planning that goes into a laser process.

Monique Ramsey (01:29):
So let's talk about, let's kind of go into maybe medications and what are some things that you would maybe want your patients to not be taking ahead of a laser?

Khanh (01:40):
Some of the basics are anything that's an irritant front of the skin, so a retinol, hydroquinone, any types of acid washes. Think of your salicylic, your beta acids, your alpha acids. You want to stay away from those. For I just say a week just to be easy. I know the PCs will fine tune and I think they say five days, but everyone remembers a week. So I say a week, it's a little bit easier. You don't want any antibiotics on your skin within, I say two weeks when it comes to antibiotics because some antibiotics, I think one of them is doxy and one of them is clindamycin. It actually exacerbates the laser. So whatever laser setting we put onto it, if you have antibiotics either within your system or on your face, it can amplify the laser process. Another one is, I think you said what's on your skin. Think of spray tan. That's a big one. So you don't want to be darker than what you naturally are, but then if you artificially put on a spray tan, a laser, all it sees is color. So if it sees darkness, especially pigmentation from a tattoo or even spray tans, those are all big. Those are some of the big ones. You don't want to have your face.

Monique Ramsey (02:47):
And how long with a spray tan, like a week again, that same sort of thing or more?

Khanh (02:53):
It's got to be all off. So depending on the quality of your spray tan, it has to be all off your skin.

Monique Ramsey (02:59):
And I've seen just because you just mentioned it, I've seen at Sephora there's actually little tan pills that they sell. Is that something that also would be a no-no.

Khanh (03:11):
That's new to me so I can't answer that. I've never even heard of tanning pills, so I dunno how to answer that one.

Monique Ramsey (03:18):
Yeah, it's this one line where they've got an oil and a spray and a this and a that, and then they have these little vitamins and I was like, okay, that scares me a lot, but what do I know? I just go get my vitamin D the natural way. So I know for some skin types I've heard about you and the providers talking about we need to pre-treat your skin. So who would need a pre-treatment before a laser and what is that?

Khanh (03:46):
Pre-treatment involves, can we suppress the existing pigmentation? So assuming, well lasers do two things for me. Lasers will color correct pigmentation or ill texture, correct. If you are darker skin tone, think of my skin tone, all skin tone, Mediterraneans, Hispanics, anything darker than a very all tone you typically want to pre-treat because what a laser does is a laser is heat, it's stress and it's light. So it's almost like mimicking the sun if you don't pre-treat the skin, meaning we want to suppress as much pigment as possible and correct as much pigment as possible with a hydrocodone with a retinol. Then when we come in with a laser, one of two things will happen. The laser may exacerbate the pigmentation or two, the laser will detect too much pigment, meaning that it will attack inappropriately the pigment. And then lastly, we can't treat as aggressively. If we can suppress the pigmentation ahead of time, then we can dial up the laser a little bit to address more of what we're trying to correct.

Monique Ramsey (04:48):
And a lot of people, if they're trying to correct sun spots, aging spots, that's going to be really critical and you certainly as a patient wouldn't want to get more pigment when you're trying to get less with the laser. And so how long would you pretreat somebody?

Khanh (05:04):
Anywhere from about two to four weeks. If it's mild and you're on a time crunch, your first question where you have an event coming up or you really need to get this treatment done as quick as possible. Probably our limitation is two weeks, but it depends on how much pigment there is and how dark your skin tone is. We can pretreat up to a month or even beyond that.

Monique Ramsey (05:23):
Okay. So again, suppressing that pigment with the pre-treatment. So what about somebody, I was talking to somebody yesterday and she was talking about cold sores and that she's had multiple laser treatments. She loves getting laser treatments, but she keeps forgetting to tell her provider that she gets cold sores. And so what do you do for people who might get an outbreak?

Khanh (05:48):
Depending on the laser, if we go low, medium, high in terms of the aggression of the laser, anything from median and above, we pre-treat with antivirals. And then depending on the laser, again, we treat with antibiotics and then also antifungal. But we do just prescribe antivirals anywhere from three to five days, sometimes beyond.

Monique Ramsey (06:09):
And I think that actually is her comment yesterday really keys into something that it's one thing if you're a laser newbie and you call, no, this person's never gone through this and you're very good about telling them everything. But if they're coming back for halo number three, I think we consumers think, oh yeah, I remember what to do and what not to do. Well we don't. So and her own experience was just that and just said, gosh, I think I know what I'm doing but I don't really know what I'm doing. And actually protocols over the years could change. So I think having that really good dialogue with you as the provider so that we are talking about everything, supplements and anything you're putting on your skin, anything you're doing that might be affecting the outcome I see on the internet, of course, on the internet all the time. I see different light, stem, red light, different light therapies. Is that something that they need to be careful of as well?

Khanh (07:11):
Not really. However, we can't exclude everything just because we can't know everything. Just like the pills that you mentioned to me, I've never even heard of those pills. So now that's something I probably have to look up. The less you do coming up to a laser, probably the better. Take away all the unnecessary stuff, take away the unnecessary medications that aren't prescription of course. And if they are prescription, go over it with us like antibiotics, even though you think antibiotics is a good thing, antibiotics we just talked about can flare up and perpetuate the laser that we're treating. So we'll run through all prescriptions, but if they're not prescription likely stop it for at least a week or two. Anything that's unnecessary for your skin other than lotion and sunscreen probably take that off. Minimum is better. When it comes to lasers, it is a hot, stressful procedure. We just don't want to bring in any extracurricular stuff to your face and to your body.

Monique Ramsey (08:02):
Yeah. So after the procedure, and I know that we have six different kinds of lasers or I think Brittany was saying we have a bunch of lasers that treat the six different things that whether it's brown or red or. So after, I'm sure it's somewhat depends on which laser they had, but afterwards is there anything specific that you like your patients to put on their skin after the treatment?

Khanh (08:27):
Yeah, it would just be dependent on the laser. So we talked about low, medium, high, low, minimal downtime, similar results. The higher you go, the more results you get, but the more downtime and the more education that you need. The highest laser that we have, essentially we're just taking away layers and layers of skin to the point where you have fresh new skin, but because you have no protection from the elements, you have no skin, you're going to be very red, very raw for an extended period of time. So you have to put on the creams, you have to put on the laser bombs, you have to put on the ointments, you have to put on sunscreen, protected vinegar, soaks, washing day and night. So it's really detailed and that's why when you come to us, you'll speak to a MA, you'll speak to a PC, you'll speak to a coordinator, you'll get your treatment and then you'll again, you'll speak to a PC and then you'll talk to your provider as well. So it's very specific when it comes to this treatment. Not only is this a safety profile, meaning you have to take care of your skin and your treatment laser, but the other part of it is you've dedicated so much time, emotion and financial investment into this, don't ruin it. Protect your treatment. The better you protect your treatment after the better results that you'll get.

Monique Ramsey (09:34):
Yeah, I think that is true. Even if it's a medium depth laser, there's still maybe the medium amount of care aftercare and downtime and I think it's like once you get through the hard part then you kind of forget and you're like have your new face, but that's when you really want to kick in with some different skincare or maintenance things that are going to keep that result as long as possible. So what do you sort of recommend for people? Let's say they get through the first couple of weeks and they look great, and then what would you like your laser patients to know about maintaining the result?

Khanh (10:15):
Yeah, so the maintenance, the analogy I use is think of it as going to the gym. You may hire a trainer for a couple months now have you held onto all those rules and education that the trainer puts on you? Trainer may train you for six times in the next six months, but it's you hitting the gym every single day. That's what skincare is. If you're going to do a laser, whether you're correcting pigment or texture, you have to be on a good skincare regimen. So every time I do a consultation, I put 'em on a skincare regimen, I put absolutely everyone on the same skincare unless they can't tolerate it all the way up to the point of the laser. After the laser, you're going to do the very specific things that we just chatted about and you're only going to do those educational items until you see us in office again. Usually two weeks when you do your post laser hydration after that you're jumping right back onto your skincare routine that we put you on. Now in the future can we add on a peptide? Can we add on a tissue nutrient system? Yeah, absolutely. But we want to get you on the basics first. Do all the basics we can add on into the future. But skincare is crucial and it's not that over the counter fluff stuff you have to do either medical grade or above when it comes to skincare.

Monique Ramsey (11:21):
Yeah, I think we all like to think that we could go to Costco and buy a three pack of some Oil of Olay face something, but it's not going to do it as much as we want those things. And I think that's a really good point is good skincare is part of this. It's a holistic part of it. It's got to happen before, it's got to happen after. And if you're going to put in the time and the money, put it in there. And I think for people who are considering lasers and the cost of that, we do financing and they can bundle in all your skincare too to that financing so that you can pay a low monthly amount and get that skincare as part of it and it just makes it easier I guess. And plus our Glam Fam members, they save too. So we'll put a link in the show notes for our Glam Fam people to learn about that and how they can save. You mentioned the gym as your analogy. So working out after lasers, how long do you usually want people to stay away from the gym or stay away from a jacuzzi or a massage table, anything like that?

Khanh (12:27):
Yeah, usually our two week is a good timeline. However, if you're red and you're raw, then you don't want to do anything that you would do If you had a sunburn. If you had a sunburn, you wouldn't heat up the body, you wouldn't go tanning, you wouldn't go as sauna, you wouldn't go to jacuzzi. You likely wouldn't work out just because you're so hot, irritated. Now the other part of this, you have to keep it clean pools, sauna, jacuzzi, all dirty places. If your skin is raw, that means you have no protection from no elements. If you throw on a bunch of dirty things like jumping into the pool, you're likely going to get an infection. We'll go over all this on our educational pieces when the PC that MAs and myself talked to you, but the easiest way to think about it is you had a very, very severe sunburn. Those are the things you want to do the same thing.

Monique Ramsey (13:12):
So we've got a lot of great lasers. Which ones are your go-to and really the popular ones and that you really love to recommend?

Khanh (13:22):
Right now? Probably our most popular one is the one up in Carlsbad. It's called Morpheus. It's a combination of microneedling with radial frequency, so you get texture, a little bit of pigment, but then you also get tightening from the radial frequency as well. The other benefit that I love that it's very minimal downtime depending on the setting that I put it at. Your downtime could be 24 hours. And the longest downtime I've had is like a week. And what I mean by downtime is the next day you can put on mineral makeup, you can put on tinted sunscreen and you can cover it all. You'll look like you have a sunburn for 24, 48 hours and then all those little dry holes from the microneedling, it just flakes off. So you just look like you have a dry face, you're not weeping, you're not oozing. It's nothing over the top.

(14:01):
I think that's why I love it so much, just because it's happy medium. You get very, very good results with not a ton of downtime. The other one I probably love is probably Moxie. Moxie is on our cyan platform. It's only, no, no, it's at both locations. So you can have it at La Jolla in La Jolla or La Jolla in Carlsbad and I consider our baby laser, but it's great for pigment and pores with almost no downtime. It'll look like you have a sunburn when you leave the office and that's about it. Usually the next day or even two days, the little flakes will come off, but you can go about your daily business tend to sunscreen again, mineral makeup. But I love it because it's a laser I can use on almost everyone. I've used it up to about if it's five, I haven't done a fit six. So when we say the Fitzpatrick scale, 1, 2, 3, 4, 5, 6, 1 is your, think of your Irish redhead with absolutely no pigmentation on their face all the way up to your African-Americans or your darker skin tones of number six. I think one of our providers does treat all the way up to the dark skin tone six, but I treat from five and below and it's a safe treatment. It helps correct pigmentation, and that's the toughest is when your dark skin tone, but you still have pigment, you're very limited on options. So Moxie really helps that.

Monique Ramsey (15:13):
Oh, that's good. And I'm going to just hop in and assume something. And you're the provider though, if it's a lower level or easier, do you need to do more of them to get the result or not necessarily?

Khanh (15:29):
Yeah, that's usually the span. The lower the level, the less aggression the laser is, the more treatments that you'll need. But also there's a limit. If you compare Moxie, which is on the same platform, Sciton platform as the T R L. T R L is our biggest one, fully ablative multiple layers. No matter how many Moxies you do, you will never achieve what a T R L can do in one session no matter what. Even if you do one Moxie for the rest of your life, you'll never achieve what you can do with the T R L. So yes, you need more treatments, but there's also a max on the results that you can get when it comes to the little lasers all the way up to the big lasers.

Monique Ramsey (16:07):
Okay. So lastly, talking about finding the right provider for you as the patient. So what is your advice for what people should look for when they're looking for a laser provider?

Khanh (16:25):
Similarly to everything else you do in life, you have to gel with the person first. If you gel from the get-go, even from the first consultation, likely you're in the right place. Now, if we want to get into the nitty gritty of it, it's a medical procedure. So have they answered all your questions? Are the PCs selling you something? Are the providers, national trainers, how many procedures is this office actually doing? Did they just get their training last week? So those are all the things that you want to consider. If we go back to Morpheus, even though we've had Morpheus only since, I want to say December, just because we've been hesitant to bring it on as La Jolla, although we are a grounded theory place where we research a lot of procedures, we also don't bring on procedures unless we trust it and we know about it. I think Morpheus has been trying to get in with us for like three years now, and then we finally picked it up.

Monique Ramsey (17:16):
Oh really?

Khanh (17:16):
But from December, January to now almost end of year, I think we've become the top practice in San Diego or one of the top practices in how much we do. And that's at one machine, at one location. That's how rigorous we are when it comes to treatments. And because we have a national trainer in Brittany at our office, we can get other devices and we can get the training and we have the education that we need in-house when it comes to lasers.

Monique Ramsey (17:45):
Yeah, I think having national trainers on our staff and we've got several, you, Brittany, Amy, they're talking to her about coming on for Sculptra. I mean, we've got so many talented people, but your point about gelling is huge because if you don't gel, I think there's some almost lack of trust because trust is sort of needed for that connection and you want to feel comfortable and you want to feel like you can trust your provider. But then seeing the reviews of other patients who have had the treatment or seeing the reviews or the pictures, the before and after pictures of here's where this person started, here's where they ended up, did it solve their problem? What was the journey? And I know that when you do your consultations, you bring up some pictures to help people visualize what that journey's going to be. Is there anything else that you recommend for people who are having a consultation like certain questions they need to ask?

Khanh (18:49):
Probably the same questions I ask for even just simple Botox or fillers is what's your timeline? What are you trying to achieve? And for lasers is how much downtime can you afford? You may want to only do it once because you don't want to keep coming back into the office. But if I tell you you need two weeks of being indoors and you're probably going to look like you have a sunburn for a month and a half, then those two things may not equal up. I had a lady three months ago, she wanted to start a laser procedure for her, I think it was her son or daughter's wedding coming up in November, December. However, she was olive of skin tone, Mediterranean. We were limited on what we can do. We can probably get one laser in, but if we got that one laser in, would it get her enough of a result to get her to this wedding?

(19:34):
So we ended up changing the game plan to just some Botox and fillers. But those are some of the nuances we need to find out. It needs to be what's your motivation, what's your timeline? The PCs of course will go over what's your budget. And then for us, for me it's how much downtime can you afford? Just like we talked about lowest of lasers all the way up to the biggest of lasers. Some people want a one and done, they'll disappear for two weeks. They're like, I just wanted one. Whereas others, now we have Morpheus, you can have a downtime of 24 48 hours and still get reasonable results, but do it over a session of three, four or five, six sessions.

Monique Ramsey (20:07):
So Khanh, if somebody wanted to set up a consultation with you, what's their first step and where will you see them or how will you see them?

Khanh (20:16):
Probably the easiest way is give us a phone call because when you give us a phone call, you actually speak to someone, you speak to one of our PCs and our PCs really dive into those questions that we just asked, what's your motivation? What's your timeline, what's your downtime? And then from there they can fine tune on where we can go with our Zoom. After you're like, okay, great. Answered all my questions, let's speak to one of our providers. They'll set you up with one of our providers, again, based on your timeline, your timeframe, what day of the week you need, and then you'll usually speak to us over Zoom because that's a comfortable place. You can sit at home, at your office, in your car, in your bedroom and just have an initial conversation with us on Zoom. You'll send us pictures so we can see what you're looking to do, and then we'll just dive into all your needs and your wants.

(20:58):
From there, we develop that game plan between you, me, the provider, the patient, and the pc. We come up with a collaborative plan. It's not the patient coming online and I'm like, okay, we're doing T R L. And you're like, well, I have 24 hours of downtime. It has to be a collaborative effort. Or let's say worst case scenario, you come to me, I'm like, Nope, you're going down to surgery. Like, well, I wasn't even thinking about surgery. So it has to be a collaborative game plan and we all have to agree. Once we agree, then you're back with the PCs, you're back with MAs, and we do all the scheduling and the education with you.

Monique Ramsey (21:31):
And I think that's something what we've always been known for is really good instructions for patients and really good education because the more that as you're about to go down this path, the more you can see ahead. It's not a dark tunnel, which is scary. When it's a dark tunnel, the more, and you kind of like, oh, okay, then they said it would be like this at 24 hours or 48 hours and that you can get prepped and that helps you have that inner confidence so that as you go through it, it's less scary. And I think that's a really important thing. And you guys are just terrific at helping patients have that information. Before, during, after, even during, I mean Brittany and I were talking the other day and we will put a link in the show notes, we have some more. We are doing a whole laser series, but she was talking about during the treatment itself how the provider will explain what's happening or what's about to happen because you're sitting there with your eyes closed or goggles on and you don't know as the patient. So is there anything else we didn't cover about getting ready for lasers?

Khanh (22:34):
I think there's a huge important thing that's actually been brought up multiple times when it comes to our patients and our practice. Lemme give you a story. At my other practice in Orange County, there was a person who came in that worked for a laser company and she's like, I worked for this laser company, I've had multiple lasers, and they usually just train on me. She was joking around, she's like, it's the worst pain in the world. I'm like, so you work for a laser company and you're doing trainings with these people who are experts and you're having the worst pain in the world. And we'll hear this all the time. Take Morpheus for example. You go on Google, one of the big things that turn people off about Morpheus is pain, Botox, injections, pain filler injections, pain. Anyone will do something once, but if they're miserable, they'll never do it again.

(23:21):
And we never want that with aesthetics. We want people to journey with us from, they're 21 years old all the way up to when they're 81 years old, because oddly enough, the only things that happen in life is aging in gravity. So every single day we're getting older every single day our skin's getting more south. So it's a lifelong journey. But going back to the pain piece, why can our practice have so little negative feedback when it comes to pain, but yet all over Google, all over medical review boards or sites, medical review sites. Morpheus is one of the most painful procedures you can do. Flip that to threads. If you read about the threads, no one does threads because the fear of pain and yet you go on our review site, there's probably nothing when it comes to pain, it's actually the opposite. If you look up even my reviews, I think one of the things is I came into threads so fearful that I was going to hurt and then I left half hour later and it was absolutely no big deal.

(24:19):
So going back to providers, being national trainers, how do we treat so differently but still stay within protocol? Because we understand pain, we want you to be as comfortable as possible. Like Monique said, you're vulnerable. You got eye shields in, you've got goggles in, you're trusting us to do a procedure, but yet if the whole time I'm blindfolded and I'm having so much pain, is this procedure actually being done correctly? You don't know until 2, 3, 4 weeks later when you're fully healed. But even then you're fully healed and you're like, I'm never going through that again. That was the most awful thing I've ever done in my life. But the way we treat pain is very, very different. Yes, lidocaine on top of your face pain medications if you need it and any other number of things. But even with Morpheus, why do my patients don't need pain medications?

(25:04):
They show up, give 'em some lidocaine, they can drive home. Because with lasers, if you're taking pain medication now you're looking for a driver. Another family member has to help you out. You're groggy for the rest of the day. So I think that's one of the big things about lasers I should have mentioned earlier, is that pain piece. You'll do anything once if it hurts, but if you're comfortable, you're going to continuously do it and you're going to wonder why at La Jolla, we don't really have a low star review when it comes to pain.

Monique Ramsey (25:34):
And is it just because of your technique in doing that laser or is it more about that plus however you treat pain or how do you decrease pain, I guess is the real question.

Khanh (25:49):
With lasers, the more comfortable a patient is, the more we can dial it up. So you can't really go wrong when it comes to that. Unlike threads, if you're hurting the patient, I tell patients, you're likely in the wrong place. The provider is doing it wrong, just outright wrong if it hurts you. But lasers, we do lidocaine injections, we do tumescent, we do pain medications. It's also understanding the type of laser. So if you go back to Morpheus, that radio frequency piece, because there's radial frequency underneath the skin, it almost feels like you're getting shocked. So if you don't dial back the nerve endings, no matter how many pain meds you give the patient, they're still going to feel it. It gets to the point where you dial up the energy way too high, you'll see muscle spasms on the face and on the neck. No amount of pain medication is going to dial that back. I can give you all the Percocets in the world, but if your nerves are still firing, you're going to feel that pain. If I dumb those nerves down with lidocaine or any other method I have, then those nerves aren't firing when I do that Morpheus. So it's also understanding of anatomy and what that laser is actually doing.

Monique Ramsey (26:56):
I love that you touched on that because it is one of the big fear factors that people have. And way back in the day, way back, I did experience pain with a laser a long time ago, and we had a dermatology division, and I was sort of a on TV Guinea pig, and I'm trying to be stoic for the camera, but it hurt. And I wasn't prepared that they had a little numbing cream, but really it was a lot. And so did I ever do it again? No. Have I not had a laser with you yet, Khanh? Yeah, because you're right, it sticks in there. Even if it was 15 years ago, it still does stick with you. So it's nice to know that you as providers do consider this because I think Brittany said, pain is whatever the patient says it is. All of us experience pain differently. Some people are just fine, other people are really highly sensitive. And so I love that you work with your patients to really talk about it and make that one of the things that it's controllable. So let's control it. But thanks again for joining us and for talking about laser season. And is there any advice as we go into the holidays, do it now so you're ready for the holidays or what would you say?

Khanh (28:17):
It's like buying real estate. There's no good time to do lasers. You just got to do it.

Monique Ramsey (28:22):
Just do it. Yeah. Fit it in. Okay. Well thanks Khanh for joining us again on the podcast and for everybody in the audience, if you have any questions, put 'em in the chat or send it to us, call us and we'll give links to the other episodes about the laser season and how to contact us. So thanks everybody and we'll see you on the next one.

Speaker 3 (28:49):
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