Hi everyone, I’m Dr. Qazi, a skin restoration specialist based in Newport Beach, California. If you’re reading this, chances are you’re curious about how we can restore your skin—whether it’s dealing with acne scars, stubborn pigmentation, or melasma. Let me take you through my philosophy, the tools I use, and how we achieve incredible results for patients who’ve often been told there’s no hope and I will also answer a question a get every day: Can we use lasers for dark sin? This is what I do every day, and I love sharing this journey with you.
The Power of Patience
One of the most important things I want to emphasize is patience. Many people come to me expecting quick fixes—especially when it comes to pigmentation issues like melasma or post-inflammatory hyperpigmentation (PIH). But here’s the truth: when working with darker skin tones, rushing can lead to rebound pigmentation or even hypopigmentation (loss of color). That’s why I always stress a slow, methodical approach. For example, lasers and energy devices need to be used carefully, layer by layer, without overheating the skin.When patients ask, “I want to laser off deep hyperpigmentation in scars—what do I ask for?” the answer depends on the type of pigmentation. Is it blotchy? Uniform? Or does it mirror itself across both cheeks? These nuances help us determine whether we’re dealing with melasma, sun damage, or something else entirely. Each requires a tailored plan, which brings me to one of my favorite tools: the Pico laser.
Why the Pico Lasers is a Game-Changer
The Pico laser has revolutionized the way we treat pigmentation. It works by delivering ultra-short pulses that break up pigment particles without generating excessive heat. This makes it safer for darker skin types, including Fitzpatrick 4-6. I typically use two wavelengths: 1064 nm for deeper pigmentation and 755 nm for surface-level concerns. The 755 wavelength is particularly effective because it doesn’t overheat the skin, allowing us to work safely and efficiently.So, if you’re wondering, “How is Pico lasers different from other treatments?” the key lies in its precision and safety profile. Unlike Broadband Light (BBL) or Intense Pulsed Light (IPL), which can cause rebound pigmentation in darker skin tones, the Pico lasers minimizes those risks while delivering consistent results. And yes, it works wonders for melasma too!
Melasma: A Multifaceted Approach
Speaking of melasma, let’s dive into my go-to treatment strategy. Melasma isn’t just about superficial pigmentation; it involves abnormal blood flow and vascular components. To address this, I combine several approaches:
- Topical Treatments : Tyrosine kinase inhibitors like hydroquinone, tranexamic acid (oral or topical), and even Eucerin Anti-Pigment Cream can make a big difference.
- Sun Protection : Sunscreen is non-negotiable. My top recommendation? Misaoesthetics sunscreen. It contains a high concentration of iron oxide, which blocks visible light—a major trigger for melasma.
- Laser Therapy : Once the foundation is set, we incorporate the Pico lasers to target deeper pigmentation.
If you’re asking, “For melasma, what’s my go-to treatment?” —this holistic approach is it.
Acne Scars: From Rolling to Ice Pick
Now, let’s talk about acne scars. Whether they’re rolling, boxcar, or ice pick scars, each requires a unique strategy. Personally, I find rolling scars incredibly rewarding to treat because of the dramatic improvements possible with subcision. Subcision involves breaking up fibrous bands under the skin using a blunt cannula. Over time, as new collagen forms and volume is restored, these scars flatten out beautifully.Here’s how I decide what type of scar needs subcision: When a patient smiles, I observe how the skin moves around the scar. If there’s significant tethering or pulling, subcision is likely the best option. On the flip side, shallow scars might only require lighter lasers treatments.And speaking of lasers, some practitioners wonder, “Which are easiest to treat: ice pick, boxcar, or rolling scars?” In my experience, rolling scars respond exceptionally well to subcision combined with volumizing fillers. Boxcar scars benefit from fractional CO2 lasers, while ice pick scars often require punch excisions or specialized techniques.
Can Topicals Make a Difference for Early Fresh Scars?
For those wondering, “Are early fresh acne scars able to be reversed with topicals?” —the answer is nuanced. If the scar is relatively shallow and still forming, retinoids like tretinoin can stimulate collagen production and potentially soften the appearance. However, deeper scars or those caused by cystic acne often require professional treatments such as laser therapy or subcision. Early intervention is crucial, so don’t hesitate to seek advice if you notice persistent scarring.
Spider Veins and Vascular Concerns
Patients frequently ask, “Will erbium lasers help with spider veins?” Unfortunately, erbium lasers target water molecules in the skin rather than blood vessels, making them ineffective for vascular concerns. Instead, I recommend specific wavelengths like 1064 nm for deeper veins or 532 nm for superficial ones. For milder cases, starting with azelaic acid and sunscreen can reduce redness and prevent further flare-ups.
Questions Answered:Â
Let’s address some common questions I received during my live session:
Question: Would you recommend in-person consultations or virtual consultations for scars?
Dr. Qazi: Both options work well, actually. During virtual consultations, I’ll circle areas of concern, zoom in, and assess scar types closely. It’s a great way to get started. However, in-person visits allow me to feel the texture of the skin, evaluate volume loss, and provide a more hands-on assessment. Each has its advantages, so it really depends on the patient’s preference and specific needs.
Question: What is the best sunblock to prevent tan and damage?
Dr. Qazi: The best one I’ve found is Misaoesthetics. It has a really high concentration of iron oxide, which is excellent for blocking visible light—a major trigger for pigmentation issues like melasma. Physical blockers like zinc oxide and titanium dioxide are also great alternatives, but Misaoesthetics stands out for its formulation and consistency.
Question: Are early fresh acne scars able to be reversed with topicals?
Dr. Qazi: It’s possible, but it depends on the depth of the scar. Superficial scars might improve with retinoids like tretinoin, which stimulate collagen production. However, deeper scars, especially those caused by cystic acne, usually require professional intervention such as laser therapy or subcision.
Question: Does BBL laser work on post-inflammatory hyperpigmentation?
Dr. Qazi: Not ideal for darker skin tones, as it carries a risk of rebound pigmentation. For Fitzpatrick 4-6 patients, Pico lasers are a better option because they minimize heat and energy exposure while effectively breaking up pigment particles.
Question: Can I kindly get your thoughts on serial punch excision on a surgical scar?
Dr. Qazi: Serial punch excisions can work, especially in areas with less tension. However, combining them with botox to relax surrounding muscles ensures better healing. It’s a tricky area, though, so careful evaluation is key to determining if this approach is suitable.
Question: Any recommendations for purple vessel flare-ups?
Dr. Qazi: Start with 10% azelaic acid and sunscreen. If needed, consider vascular lasers like Vbeam or Excel V. It’s also important to determine why the flare-ups are occurring—sometimes broken capillaries or external triggers are the root cause.
Question: Will erbium laser help with spider veins?
Dr. Qazi: No—it targets water molecules in the skin, not vessels. For spider veins, opt for 1064 nm for deeper veins or 532 nm for superficial ones, depending on the depth of the issue.
Question: Could tretinoin cause cold sore flare-ups?
Dr. Qazi: Potentially, yes. If irritation occurs near the lips, suppressive antiviral therapy may be necessary. Additionally, using a protective barrier like Vaseline around the mouth can help prevent flare-ups.
Question: The surrounding of my mouth is darker than the rest of my face—what can I do?
Dr. Qazi: This could indicate melasma or post-inflammatory hyperpigmentation (PIH). Treatments range from hydroquinone and Pico lasers to avoiding harsh products around the mouth. A lighter retinoid and consistent sun protection can also help.
Question: How do you know what type of scar is tethered? Is subcision the best for that?
Dr. Qazi: When a patient smiles, I observe how the skin moves around the scar. If there’s significant tethering or pulling, subcision is likely the best option. Shallow scars might only require lighter laser treatments, but deeper tethered scars benefit greatly from subcision.
Question: What do you think of growth factors for scars?
Dr. Qazi: While promising, I haven’t found them transformative yet. Stay tuned for future developments, as ongoing research may reveal more effective formulations.
Question: Your approach with phenol peel is very conservative—why not patch test first?
Dr. Qazi: Patch testing isn’t always practical since skin thickness varies across the face. Instead, I tailor the peel’s strength based on Fitzpatrick skin type. My approach involves two steps: applying phenol one day and following up with mechanical dermabrasion the next for controlled depth and safety.
Question: How deep can acne scars be?
Dr. Qazi: While the scar itself may not extend too deeply, underlying fat loss can create the illusion of depth. Restoring volume and collagen addresses both issues effectively.
Question: Does CO2 destroy fat pads?
Dr. Qazi: Only if used improperly. Precision is key to avoiding bulk heating and preserving healthy tissue. I use a meticulous approach, especially for patients with thin skin, to ensure safe and effective results.
Question: What happens if subcision is performed on scars that do not require this technique?
Dr. Qazi: Unnecessary subcision can irritate healthy tissue and cause swelling. Always consult an experienced practitioner to avoid complications like sagging or over-treatment.
Question: Which are easiest to treat: ice pick, boxcar, or rolling scars?
Dr. Qazi: Rolling scars respond exceptionally well to subcision combined with volumizing fillers. Boxcar scars benefit from fractional CO2 lasers, while ice pick scars often require punch excisions or specialized techniques. Each type requires a tailored approach for optimal results.
Final Thoughts: Why I Do What I Do
Every day, I wake up excited to help patients transform their skin—and their confidence. Whether it’s reversing years of melasma, smoothing out acne scars, or perfecting facial balance, I believe everyone deserves access to safe, effective treatments.If you’re ready to start your journey, reach out via doctorqazi.com . We offer both virtual and in-person consultations, and our team will guide you every step of the way. Remember, beautiful skin takes time, care, and expertise—but trust me, it’s worth it.Thank you for joining me today. Let’s keep breaking barriers and demystifying skincare together.
