Ask Dr. Barber

Barber QA - Sept 15Q. I have brown spots (age spots) all over my face.  I do not have that many wrinkles.  Is there anything that can be done to fade these hideous spots?

A. Not all brown spots are the same, but if what you have are flat pigmented spots on your face, then yes, they can usually be addressed non-surgically.  These spots are typically caused by repeated sun exposure over many years, creating irregular pigment deposits on the face. They are often referred as age spots or dyschromias.  A good starting point for treating these discolorations is to use a medically directed skin care program that incorporates a skin bleacher such as hydroquinone 4%.  I like the Obaji skin treatment program that combines the use of tretinoin (Retin-A®), hydroquinone, and alpha-hydroxy acids.  The Retin-A stimulates collagen and helps with fine wrinkles, the hydroquinone will fade the brown spots, and the alpha-hydroxy acids will help exfoliate the dull, dead skin.  If after 6 months of treatment with these creams the spots have not resolved completely, then consideration can be given to laser treatment or the use of an intense pulsed light treatment to fade the spots.  It is important before proceeding with any laser treatment that the pigmented spots be evaluated by a doctor who is familiar with skin problems in order to make sure that what is being treated is in fact benign pigmentation.  An evaluation by a board certified dermatologist or plastic surgeon is your best bet in order to get started with treatment. 

Q. I recently had my third and final child, finished nursing, and my breasts are a mess.  They are empty and saggy.  Can they be rescued?  I want them to look the way they were before children. 

A. Unfortunately, your breasts may never be just like they were before children, but the changes you describe are common in many women who have multiple children and have breast fed.  Following the many cycles during pregnancy and nursing, the breasts get bigger, smaller, bigger, smaller etc.  The breasts can often end up looking rather lifeless. Fortunately, this look can be improved with surgery.  

In most women who have breast ptosis (sagginess) and some size loss, the treatment is to both lift the breasts and to restore the lost volume with breast implants.  Some plastic surgeons will separate these two procedures, lifting at one operation and placing an implant at another.  For the most part, I prefer to combine these two surgeries if the patient is a good candidate for a combined procedure.  The surgery consists of placing an appropriate size implant, (usually not a very large one), and then tightening the skin of the breasts to create the lift. The reason the breasts sag is because there is too much skin for the amount of breast tissue and therefore they droop.  The skin tightening surgery will leave a permanent scar, but the scar fades very nicely over the course of a year or so.  The surgery is performed under general anesthesia and is an outpatient procedure.  You can expect to drive in about a week and back to work in 10 days.  You can resume unrestricted activities, such as jogging and going to the gym after 4-6 weeks. Consider a consultation with a board certified plastic surgeon so you can discover what can be done to improve your breasts.

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