# Coastal Dermatology + Aesthetics > Medical, surgical and pediatric dermatology plus aesthetics on California's Central Coast. Board-certified care in San Luis Obispo and Santa Maria. - **Website:** https://coastaldermaesthetics.com/ - **Last updated:** 2026-10-06 - **Publisher:** Coastal Dermatology + Aesthetics - **Sitemap:** https://coastaldermaesthetics.com/wp-sitemap.xml - **Index version:** https://coastaldermaesthetics.com/llms.txt ## Locations ### San Luis Obispo ### Santa Maria ## Concerns ### Acne & Acne Scarring Acne develops when pores become clogged, and what type of acne you get depends on what clogs your pores. [1] That single sentence undoes most of what people believe about it. **It is not a hygiene problem**, which is why scrubbing harder, washing more often and using something stronger tend to make skin angrier rather than clearer. The main driver is hormones. Through puberty they enlarge the oil glands, which produce more oil, which clogs pores. [1] Family history matters too: the risk is higher if one or both parents, or another close blood relative, had severe acne. [1] Adults get it as well, and adult acne is not a sign that something went wrong or that you never grew out of anything. A few things make existing acne worse without having caused it: too little sleep, oily makeup and skin care, oily hair products, and stress. [1] So does picking. **Never pick, pop, scratch or squeeze a breakout**, which is the single most useful sentence on this page, because that is where a good many scars come from. [2] **Worth knowing it might not be acne** - Bumps and pustules across the cheeks and nose that acne products do not touch looks a lot like adult acne and is treated completely differently - Breakouts that appeared suddenly in adulthood, in a pattern you have never had before - Anything that started after a new medication, a new product or a new supplement This is the most useful question on the page and most people get it wrong in the expensive direction, buying scar treatment for something that was going to clear on its own. There is a test, it takes ten seconds, and you can run it at a bathroom mirror. **Stand square to a mirror under an overhead light, then tip your chin down and look up.** Watch what happens to the spot as the light angle changes. A markA scarWhat you seeA flat spot of color where a breakout was [2]An indent or a raised area, with the surface changedUnder angled lightNothing changes. It stays a flat patch of colorIt casts a small shadow, or catches the light on one edgeWhat it actually isPost-inflammatory pigment, the skin's color reaction to inflammation [2]Lost or disordered tissue where the skin healedWhat happens if you leave itDiscoloration generally fades over time [2]Scars can soften and they rarely go away completely on their own [2]What it needsTime, daily sun protection, and a routine that does not irritateAn in-office treatment aimed at rebuilding the surface **If it does not cast a shadow, it is color and time is on your side.** Sun makes that color darker and slower to clear, so daily sun protection genuinely is the treatment for it, and [sun makes those marks darker](/conditions/sun-damage/) is the reason. If it does cast a shadow, that is where [tiny needles that carry energy down to the scar](/treatments/potenza-rf-microneedling/) and [the strongest resurfacing we have](/treatments/smartskin-laser-skin-resurfacing/) earn their place. One order matters underneath all of it: **active breakouts get cleared before scars get treated.** Resurfacing skin that is still breaking out treats a surface that is about to change again. AreaWhat tends to happen thereForehead and templesOften where hair products play a part, and one of the easiest things to change. [1]CheeksWhere marks and scars both show most, because it is the flattest, most lit part of a face.Jawline and chinThe classic adult and hormonal pattern, and often the most stubborn.Nose and around itWhere it gets confused with rosacea, which is treated differently.Chest and upper backFrequently overlooked, harder to reach, and worth mentioning at the visit.ShouldersWhere friction from straps and bags keeps it going. ![Close-up on acne and acne scarring](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-acne-acne-scarring.webp) The order is clinical rather than commercial. Active acne gets cleared before scarring gets treated, because resurfacing skin that is still breaking out works on a surface that is about to change again. A practice that sells a scar course to somebody with active acne has sold the second step before the first. The other half is telling a scar from a mark, which the shadow test above walks through and which we will do properly with you in person. A flat spot of color is not a scar and generally fades on its own. [2] That distinction saves people real money, and telling somebody their marks will clear with sun protection and patience is a normal outcome of this appointment. It is also where a dermatology practice differs from a treatment room: prescription treatment for the breakouts, in-office work for the scars, and [a routine that works with your treatment](/treatments/zo-skin-health/) underneath both. **Book an appointment if:** - You have had breakouts for more than a few months and over-the-counter products have not settled them - Your breakouts are deep, sore lumps rather than surface spots - Acne is leaving marks or indents behind - You have started breaking out in adulthood in a pattern you have not had before - Acne products are not touching what you have, which sometimes means it is not acne looks a lot like adult acne - You are picking at it, which is worth solving early rather than late **Sooner rather than later if:** - Anything is already leaving indents. Scars are prevented far more easily than they are treated [2] - Acne is affecting how you feel about being seen, which is a real reason to treat it and not a frivolous one The recommendation is to treat acne from the first breakouts rather than waiting to see how bad it gets, precisely because preventing the acne is how the scarring gets prevented. [2] Most of the result comes from what happens between appointments, and most of it is about doing less rather than more. **Worth doing** - Wash gently, twice a day, and stop there. Scrubbing an inflamed pore inflames it further - Give a treatment its full run before judging it. Skin turnover takes weeks, not days - Daily broad-spectrum sun protection, SPF 30 or higher, water resistant [3] - Check your hair products, since what runs down a forehead in the shower ends up on it - Bring everything you currently use to the visit. Going through it is part of the appointment **Worth knowing** - Never pick, pop, scratch or squeeze a breakout. [2] It is the fastest route from a spot to a scar - Flat spots of color left behind are usually pigment rather than scarring, and they generally fade [2] - Sun makes those marks darker and slower to clear, which is why sunscreen counts as treatment for them - Where the same kind of discoloration appears across a whole face rather than at old breakout sites, that may be the same discoloration on the rest of a face instead - Stress worsens existing acne rather than causing it, so a flare during a hard month is not a failure of your routine [1] Clear the breakouts first, then treat what they left behind. Pick a treatment to see how it works. Treatment of active acne is medical care and is handled differently from the aesthetic treatments on this site. Our office will go through what applies to you when you book. Treatment of acne scarring is a separate conversation with its own plan, and you will have that plan and its cost before anything is scheduled. **Q: Is acne caused by not washing enough?** No. Acne develops when pores become clogged, driven by hormones and family history. [1] Washing harder or more often tends to irritate skin rather than clear it. A gentle wash twice a day is enough, and what you use on your skin and hair matters more than how vigorously you scrub. **Q: I am an adult. Why am I breaking out now?** Adult acne is common and it is not a sign that anything went wrong. Hormonal changes drive it, and a family history of severe acne raises the odds. [1] It also tends to sit along the jawline and chin rather than across the forehead. If acne products are not touching it, that is worth investigating, because rosacea produces breakouts that look like adult acne and responds to entirely different treatment. **Q: Will my acne leave scars?** Not necessarily, and treating it is the best protection there is. Preventing acne is how acne scars get prevented, which is why treatment is recommended from the first breakouts rather than after things have gone deep. [2] The other half is not picking: never pick, pop, scratch or squeeze a breakout. [2] **Q: How do I know if I have scars or just marks?** The shadow test above is the ten-second version. A flat spot of color is usually post-inflammatory pigment rather than a scar, and discoloration generally fades over time. [2] Something that indents or catches the light is a scar, and scars rarely go away completely on their own. [2] Knowing which you have decides whether you need a treatment or a sunscreen. **Q: Can acne scars be treated?** Yes, and the depth and type of scar decides how. Tiny needles that carry energy down to the scar and the strongest resurfacing we have are the two main routes here. What comes first is clearing the active acne, because resurfacing a surface that is still breaking out is work you will be redoing. **Q: Does what I eat cause it?** Diet is not the cause. Some people find particular foods coincide with a flare, and that is worth noticing for yourself rather than acting on a general rule. The things known to make existing acne worse are more mundane: too little sleep, oily makeup and hair products, and stress. [1] **Q: Do I need a referral?** Yes. This is medical dermatology, and the practice is currently accepting new medical patients by referral from your primary care physician. Once you have that, call the office and we will get you in. 1. American Academy of Dermatology Association. "Acne: Causes." States that "acne develops when pores become clogged" and that "what type of acne you get depends on what clogs your pores." Describes hormones during puberty enlarging the oil glands so they produce more oil that clogs pores, states that "you have a higher risk if one or both of your parents (or other close blood relative) had severe acne," and names too little sleep, oily makeup and skin care products, oily hair products such as pomade, and stress, which worsens existing acne rather than causing it, among the things that make acne worse. [https://www.aad.org/public/diseases/acne/causes/acne-causes](https://www.aad.org/public/diseases/acne/causes/acne-causes) · Medical Organization 2. American Academy of Dermatology Association. "Acne scars: Overview." States that "if you see a flat spot of color on your skin when acne clears, this usually isn't an acne scar. It's likely post-inflammatory hyperpigmentation (PIH)," that "while acne scars can fade, they rarely go away completely on their own," that discoloration generally disappears over time while the scar remains, describes depressed or sunken acne scars that give skin "a rough, uneven appearance," states that "preventing acne can prevent acne scars. That's why dermatologists recommend treating acne when you get your first breakouts," and advises "never pick, pop, scratch, or squeeze breakouts." [https://www.aad.org/public/diseases/acne/derm-treat/scars](https://www.aad.org/public/diseases/acne/derm-treat/scars) · Medical Organization 3. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant, reapplied every two hours outdoors and after swimming or sweating. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Not every breakout is acne, and several conditions produce similar bumps. Response to treatment varies from person to person, and acne treatment usually takes weeks rather than days to show its effect. Resurfacing and microneedling carry risks including redness, swelling, infection, and lightening or darkening of the skin, which are discussed individually before anything is scheduled, and the risk of pigment change is higher on deeper skin tones. Prescription treatment is determined by your physician. Individual results may vary. ### Actinic Keratosis An actinic keratosis is a small area of skin where years of ultraviolet light have changed how the cells behave. It shows up as a rough, dry, scaly patch, and its most reliable feature is not how it looks but how it feels: like fine sandpaper on skin that is otherwise smooth. Most people find their first one while washing their face or running a hand over a forearm. They can look like a reddish spot, a new age spot, a pimple, or a patch of irritated skin, which is exactly why they are so easy to dismiss. [2] On a lip they look like a chapped lip that will not settle, and that version has its own name, actinic cheilitis. [2] They are also rarely solitary. The sun that produced one landed on a whole area, so where there is one there are usually several, including some that have not surfaced yet. Precancerous means what it says: an actinic keratosis is not a cancer, and some of them turn into a type of [skin cancer](/conditions/skin-cancer/) called squamous cell carcinoma. [2] The practical version of that sentence is the reason this page exists. Found at this stage, these are treated. That is a much better position than the alternative, and it is entirely available to anyone who books. **What people usually notice first** - A rough patch that flakes off and comes back in the same place - Something you can feel more easily than you can see - A reddish or scaly spot that looks a bit like irritated skin [2] - A lip that stays chapped no matter what you put on it [2] - Several of them at once, across an area that has had a lot of sun These four turn up on the same sun-exposed skin and get mistaken for one another constantly. Texture is the quickest way to separate them, and so is what happens over the following month. This narrows it down. It does not replace an examination, and an actinic keratosis can look like a new age spot or a patch of irritated skin. [2] Actinic keratosisAge spotDry patchSeborrheic keratosisHow it feelsRough, like fine sandpaper, on skin that is otherwise smoothFlat and smooth, level with the skin around itRough all over while dry, smooth once moisturizedRaised and waxy, with a stuck-on-the-skin look [3]What it looks likeA reddish or scaly spot, sometimes mistaken for a new age spot, a pimple or irritated skin [2]An even tan or brown mark with a clear edgeFine flaking, often over a wider area than one spotBrown, though the range runs from white to black, often warty on the surface [3]Where it turns upFace, ears, balding scalp, hands, neck or lips [2]The same sun-exposed skinAnywhere, and it follows the seasonChest, back, stomach, scalp, face or neck, but never the palms or soles [3]What it does nextFlakes off, then returns in the same placeStays as it isSettles with moisturizer and stays settledThickens slowly and stays benign [3]Worth an appointmentYesIf it changesNoIf it changes, itches or catches on clothing The single most useful test is the one-month one. Something that flakes away and then comes back in exactly the same spot is behaving like an actinic keratosis, whatever it looks like. That is the one to bring in. Where an examination cannot settle it, [a biopsy](/treatments/skin-cancer-diagnosis/) does, usually at the same visit. AreaWhy it matters hereFace, forehead and noseThe most consistently exposed skin on the body, and where most people find their first one. [2]EarsEasy to miss entirely, and the top edge of the ear takes sun from directly above all day.Balding or thinning scalpOne of the most common sites, and almost impossible to check yourself. [2]LipsWhere the same growth is called actinic cheilitis, and where it is mistaken for chapping. [2]Neck and chestDecades of Central Coast sun concentrate here, usually from a long time ago.Backs of the hands and forearmsSteady exposure through a car window, year after year, on skin nobody thinks to protect. ![Close-up on actinic keratosis](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-actinic-keratosis.webp) Freezing off the patches you can feel deals with the patches you can feel. The sun that produced them landed on a whole region of skin, and the rest of that region is still there. [Photodynamic therapy](/treatments/photodynamic-therapy/) treats the area rather than the spots, which is why it suits people who keep finding new ones on the same forehead, scalp or forearm. It is performed on site at our San Luis Obispo office. The other half of the visit is the part you cannot do at home. Telling an actinic keratosis from an early squamous cell carcinoma is a judgment made by a board-certified dermatologist looking at your skin, and where looking is not enough, [a biopsy](/treatments/skin-cancer-diagnosis/) settles it here rather than somewhere else. The same examination also checks for signs of skin cancer elsewhere, which means one appointment answers both questions. [1] **Book an appointment if you notice:** - A rough patch that keeps coming back in the same place after it flakes off - Something you can feel more clearly than you can see - A scaly or reddish spot that has been there more than a few weeks [2] - A lip that stays chapped and rough whatever you put on it [2] - Several rough spots across one area of sun-exposed skin **Worth booking if:** - You have had actinic keratoses before, since new ones are common in the same skin - You have spent years outdoors on the Central Coast and have never had a skin exam - You have fair skin that burns easily, or you used tanning beds at any point - You take a medication that suppresses your immune system If you are not sure whether a rough spot is worth an appointment, book it. Sorting that out is exactly what the visit is for, and it is far easier to do at this stage than at any later one. Treatment clears what is on your skin now. What keeps the count down afterward is the sun you get from here, and on the Central Coast that is the part worth being deliberate about. **Worth doing** - Broad-spectrum sunscreen, SPF 30 or higher, water resistant, every day before you go outside [4] - Reapply every two hours outdoors, and after swimming or sweating [4] - A hat with a brim, which covers the scalp, ears and nose all at once - Daily sun protection taken consistently, for people who are outdoors a lot and want another layer - Run a hand over your forehead, scalp, ears and forearms every month or so, and bring in anything that comes back **Worth knowing** - Overcast days still deliver ultraviolet light, which the marine layer does not change - New patches can appear in skin that has already had a lot of sun, so a check every so often is normal rather than a sign anything went wrong - Treating the area rather than the spots is what suits people who keep finding new ones - Your lips need sun protection too, and most sunscreen routines skip them Diagnosis, treatment and the sun protection that keeps new ones down, in one practice. Pick a treatment to see how it works. Diagnosis and treatment of actinic keratoses are medical care rather than a cosmetic service, and are handled differently from the aesthetic treatments on this site. Our office will go through what applies to you when you book. Where a biopsy is taken, laboratory fees are billed separately by the laboratory that examines the sample, and we will tell you when a sample is being sent. **Q: Is an actinic keratosis cancer?** No. It is a precancerous growth, which means it is a change in the skin rather than a cancer. Some actinic keratoses turn into a type of skin cancer called squamous cell carcinoma, which is why they are treated. [2] Found at this stage they are dealt with, and that is the whole advantage of catching them. **Q: How do I tell one from an age spot or a dry patch?** Mostly by feel, and by what it does next. An actinic keratosis is rough like fine sandpaper on skin that is otherwise smooth, and it comes back in the same place after it flakes off. An age spot is flat and stays put. A dry patch settles with moisturizer. The comparison above sets all four out side by side. **Q: How are they treated?** That depends on how many you have and where they are. In-office procedures suit one or a few, including cryosurgery and photodynamic therapy, and prescription creams applied at home suit skin that has many. [1] Photodynamic therapy is performed at our San Luis Obispo office and treats a whole sun-damaged area rather than individual spots. Your dermatologist recommends the approach after examining your skin. **Q: What does photodynamic therapy involve?** A solution goes on the treated area and stays there for about 60 to 90 minutes, then a light is used to activate it. [1] Most patients need two treatments a few weeks apart. [1] For 48 hours afterward you need to stay out of daylight completely, including through a window and on a cloudy day, because treated skin is highly sensitive to light during that window. [1] Plan the two days before you book. **Q: Will they come back?** New ones can appear in skin that has already had a lot of sun, and that is expected rather than a sign that treatment failed. Sunscreen, a hat and a check every so often are what keep the count down. [4] It is far easier to clear a few new patches than to catch up after several years. **Q: Do I need a referral?** Yes. This is medical dermatology, and the practice is currently accepting new medical patients by referral from your primary care physician. Once you have that, call the office and we will get you in. 1. American Academy of Dermatology Association. "Actinic keratosis: Diagnosis and treatment." States that a board-certified dermatologist can "often diagnose you by looking carefully at your skin," that during the examination the dermatologist also checks for signs of skin cancer, that treatment "can reduce your risk of developing skin cancer," names cryosurgery, chemical peels, curettage, photodynamic therapy and laser resurfacing as in-office procedures for one or a few AKs and 5-fluorouracil cream, diclofenac sodium gel, imiquimod cream and tirbanibulin ointment as at-home medications where there are many, states that during photodynamic therapy "a solution that makes your skin extremely sensitive to light is applied to the area with AKs. You'll sit in the office with this on your skin for about 60 to 90 minutes. Afterward, you'll be treated with either a blue or red light," that "for 48 hours after treatment, you'll need to avoid the outdoors during daylight. The UV light, even on a cloudy or snowy day, can cause a serious skin reaction," and that "most patients with AKs need 2 PDT treatments, with the second treatment given 3 weeks after the first." [https://www.aad.org/public/diseases/skin-cancer/actinic-keratosis-treatment](https://www.aad.org/public/diseases/skin-cancer/actinic-keratosis-treatment) · Medical Organization 2. American Academy of Dermatology Association. "Actinic keratosis: Overview." Describes an actinic keratosis as "a precancerous skin growth caused by the sun or indoor tanning," also called a solar keratosis, states that it "often appears as a reddish spot" and can "look like a new age spot, pimple, or patch of irritated skin," that these growths "tend to appear on skin that's been the most badly damaged by the sun" including "the face, ears, balding scalp, hands, neck, or lips," that "when an AK forms on a lip, the medical name for this precancerous growth is actinic cheilitis" and that on the lips it "can look like a badly chapped lip," that "it is estimated that more than 40 million Americans develop actinic keratoses (AKs) each year," and that "some AKs and actinic cheilitis turn into a type of skin cancer called squamous cell carcinoma." [https://www.aad.org/public/diseases/skin-cancer/actinic-keratosis-overview](https://www.aad.org/public/diseases/skin-cancer/actinic-keratosis-overview) · Medical Organization 3. American Academy of Dermatology Association. "Seborrheic keratoses: Signs and symptoms." States that seborrheic keratoses "have a waxy, stuck-on-the-skin look," "can look like stucco splattered on the skin," are usually brown "though they range in color from white to black," "start as small, rough bumps, then slowly thicken and develop a warty surface," "form on the chest, back, stomach, scalp, face, neck, or other parts of the body (but not on the palms and soles)," and "cause no pain, though some itch." [https://www.aad.org/public/diseases/a-z/seborrheic-keratoses-symptoms](https://www.aad.org/public/diseases/a-z/seborrheic-keratoses-symptoms) · Medical Organization 4. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant, reapplied every two hours outdoors and after swimming or sweating. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Not every rough or scaly patch is an actinic keratosis, and appearance alone does not establish what a growth is; diagnosis is made by examination, with a biopsy where the appearance is not clear-cut. Treatment choice depends on the number, size and location of the growths. Where photodynamic therapy is used, treated skin is highly sensitive to light for approximately 48 hours afterward and must be kept out of daylight during that period, and redness, swelling and peeling across the treated area for several days are expected. Individual results may vary. ### Alopecia Alopecia areata is an autoimmune disease. [3] That means the immune system mistakes a part of your body as foreign and attacks it, and in this case it attacks hair follicles, and sometimes nails. [3] The hair itself is fine. What has changed is the environment around it. It causes sudden hair loss that often begins as a round or oval, smooth balding patch. [2] Most people lose hair on the scalp or in the beard area, and it can occur anywhere on the body. [1] It usually begins in children and young adults and can start at any age. [1] **People of all skin tones and genders get it.** [2] Some people notice itching, tingling or a burning sensation where hair loss is about to begin or has already occurred. [2] About 10 to 20 percent of people with alopecia areata see [changes in the nails](/conditions/nail-disorders/), most commonly tiny dents. [2] Where more hair is involved, it has its own names: complete loss on the scalp, loss of all body hair, or a band of loss around the back and sides of the head. [2] **What distinguishes it from ordinary thinning** - The patch is round or oval, and the skin inside it is smooth rather than scaly - It arrived suddenly rather than gradually - The hair around the edge is unaffected rather than thinning - It can appear in the beard, the eyebrows or the lashes as well as the scalp [2] - The gradual, inherited kind of thinning behaves nothing like this and is a different page This is the part most pages skip, and skipping it is why people feel blindsided. Alopecia areata does not follow one path, and knowing the range in advance is worth more than any single reassurance. What can happenHow common, in the terms availableHair regrows on its own, without treatmentHappens "for many people" [1]Hair regrows and never falls out againHappens to "some people" [1]Hair regrows and then falls out again, in cycles"More often" than the single-episode course [1]Hair does not regrowHappens "sometimes" [1]Hair loss extends to the whole scalp, or the whole bodyNamed as recognized patterns, with no frequency published [2] **Three things are true at once, and all three belong in the same paragraph.** Hair can grow back. Relapse is common. And at this time alopecia areata cannot be cured, though treatment can help people regrow their hair. [4] Anyone telling you only the first of those is selling something, and anyone telling you only the last is doing you a disservice. What follows practically is that treatment is worth starting and worth judging on a realistic clock, and that a plan includes what happens if hair falls out again. That conversation is a normal part of the visit rather than bad news delivered later. AreaWhat tends to happen thereScalpThe most common site, usually starting as one round or oval smooth patch. [2]Beard areaThe other common site, and frequently the first place men notice it. [1]Eyebrows and eyelashesLoss here has its own practical consequences and its own options. [4]Back and sides of the headWhere a band of loss can extend toward the temples. [2]NailsTiny dents most commonly, and also ridges, roughness or brittleness. [2]Anywhere on the bodyHair loss can occur anywhere hair grows. [1] ![Woman suffering from alopecia](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-alopecia.webp) Patchy hair loss gets treated as stress, as a vitamin deficiency, as a shampoo problem and as [the gradual, inherited kind of thinning](/conditions/hair-loss/) for months before anybody looks at it properly. A board-certified dermatologist examines the scalp and the nails, often with a magnifier, and where the picture is not clear adds a small sample or blood work, including thyroid testing. [4] That is a short appointment and it changes everything downstream, because almost nothing sold for hair does anything at all for an autoimmune condition. The treatment range is wider than most people know and it depends on how much hair is involved. For one or two patches there is watchful waiting, topical treatment, and corticosteroid injections, where more than 80 percent of people treated had at least half their hair regrow within 12 weeks. [4] For more extensive loss there is contact immunotherapy and a class of oral medication approved specifically for severe alopecia areata. [4] Which route fits is a clinical judgment, and it is the reason to be assessed rather than to keep trying things. **Book an appointment if:** - A round or oval patch of hair loss has appeared, on the scalp or in the beard - The skin in the patch is smooth rather than flaky or inflamed - Hair loss arrived suddenly rather than gradually - You have noticed tingling, itching or burning where hair is being lost [2] - Your eyebrows or lashes are thinning - Your nails have developed tiny dents alongside hair loss [2] **Worth raising at the same visit:** - Any personal or family history of thyroid disease, vitiligo, psoriasis, asthma, hay fever or eczema [3] - Whether hair has fallen out and regrown before, which shapes the plan - Anything about a scalp that flakes and itches, which points at a different condition Diagnosis is by examining the scalp and nails, often with a magnifier, sometimes with a small sample or blood work. [4] Nothing about it requires preparation. This is a condition that affects how you look and how you feel about being seen, and both are legitimate reasons to treat it. **Worth doing** - A soft-bristled brush, a wide-tooth comb, and loose hairstyles rather than tight ones [5] - Air-dry where you can, rather than blow-drying, and avoid harsh chemicals [5] - Sunscreen on any exposed scalp, broad spectrum, SPF 30 or higher, water resistant [5] - A wide-brimmed hat, or a wig, for scalp protection and for comfort [5] - Where brows or lashes are affected, glasses and a hat do a practical job that nothing else does [5] - Managing stress with something that works for you may help reduce cycles of hair loss [5] **Worth knowing** - Hair can regrow, including after a long time, and relapse is common. Both are normal [1] - The condition is associated with a higher risk of thyroid disease, which is worth mentioning to your regular doctor [5] - If nasal hair has been lost, a little petroleum jelly inside the nostrils does more than people expect [5] - The National Alopecia Areata Foundation is a genuine support resource and is worth knowing about [5] - Nothing sold over the counter for general hair thinning is aimed at this condition Diagnosis first, then a plan sized to how much hair is involved and how long it has been going on. Pick a treatment to see how it works. Diagnosis and treatment of alopecia areata are medical care rather than a cosmetic service, and are handled differently from the aesthetic treatments on this site. Our office will go through what applies to you when you book. Where blood work or a small sample is sent for testing, laboratory fees are billed separately by the laboratory, and we will tell you when anything is being sent. **Q: Will my hair grow back?** It can. Some people lose hair, regrow it, and never have another episode. More often, hair regrows and falls out again. For many people it regrows on its own without treatment, and sometimes it does not. [1] All four of those are recognized courses, which is why the honest answer is a range rather than a promise, and why the table above sets it out plainly. **Q: Is this the same as ordinary hair thinning?** No, and it is treated completely differently. The gradual, inherited kind of thinning comes on slowly, thins hair over an area, and follows a pattern. Alopecia areata arrives suddenly as a round or oval smooth patch, and it is an autoimmune condition. [2] [3] Telling them apart is the first thing an appointment does. **Q: Did stress cause this?** No. Some people remember intense stress or a crisis before seeing patchy hair loss, and those are not causes, though they may increase the risk of the immune system attacking hair follicles. [3] That distinction matters. People arrive carrying a lot of blame for this condition and none of it is warranted. **Q: What does treatment involve?** It depends on how much hair is involved. For one or two patches, options include watchful waiting, topical treatment, and corticosteroid injections given every four to six weeks, where more than 80 percent of people treated had at least half their hair regrow within 12 weeks. [4] For more extensive loss there is contact immunotherapy and oral medication approved for severe alopecia areata. [4] Your route gets decided after your scalp has been examined. **Q: Can it be cured?** Not at this time, and treatment can help people regrow their hair. [4] What that means practically is that this is managed rather than finished, and that a plan should include what happens if hair falls out again rather than treating that as a failure. **Q: Is it connected to anything else?** It can be. Psoriasis, thyroid disease and vitiligo are named alongside alopecia areata, and there is an increased association with asthma, hay fever and eczema. [3] People with alopecia areata also have a higher risk of thyroid disease, which is worth a sentence with your regular doctor. [5] None of that is a reason to expect anything; it is a reason to give your full history at the visit. **Q: Do I need a referral?** Yes. This is medical dermatology, and the practice is currently accepting new medical patients by referral from your primary care physician. Once you have that, call the office and we will get you in. 1. American Academy of Dermatology Association. "Alopecia areata: Overview." States that "alopecia areata is a disease that causes hair loss. Most people lose hair on their scalp or beard area, but hair loss can occur anywhere on your body," that "this type of hair loss usually begins in children and young adults, but it can start at any age," that "yes, hair can grow back. Some people who lose their hair, regrow it, and never have another episode," that "more often, people lose their hair, only to see it regrow and fall out again," and that "for many people, their hair regrows on its own without treatment" while "sometimes, hair doesn't regrow." [https://www.aad.org/public/diseases/hair-loss/types/alopecia](https://www.aad.org/public/diseases/hair-loss/types/alopecia) · Medical Organization 2. American Academy of Dermatology Association. "Alopecia areata: Signs and symptoms." States that the disease "causes sudden hair loss, which often begins as a round or oval, smooth balding patch," that "people of all skin tones and genders get alopecia areata," that "about 10% to 20% of people who have alopecia areata see changes to their nails. Tiny dents are the most common," and that some people notice "itching, tingling, or a burning sensation where hair loss will soon begin or has already occurred." Describes alopecia totalis as "complete loss of hair on the scalp," alopecia universalis where "some people lose all the hair on their body," and ophiasis as "a band or strip of bald skin on their scalp" that "usually appears at the back of the head and can extend to the temples." [https://www.aad.org/public/diseases/hair-loss/types/alopecia/symptoms](https://www.aad.org/public/diseases/hair-loss/types/alopecia/symptoms) · Medical Organization 3. American Academy of Dermatology Association. "Alopecia areata: Causes." States that "alopecia areata is an autoimmune disease. This type of disease develops when your immune system mistakes a part of your body as foreign and attacks," that the immune system "mistakenly attacks hair follicles (where hair grows) and sometimes your nails," that "alopecia areata can run in families. People who develop alopecia areata at any early age often have a blood relative who has the disease," names psoriasis, thyroid disease and vitiligo among associated autoimmune conditions along with an increased risk alongside asthma, hay fever and atopic dermatitis, and states that "some people remember experiencing intense stress or a crisis before seeing patchy hair loss. While these aren't causes, they may increase the risk of your immune system attacking your hair follicles." [https://www.aad.org/public/diseases/hair-loss/types/alopecia/causes](https://www.aad.org/public/diseases/hair-loss/types/alopecia/causes) · Medical Organization 4. American Academy of Dermatology Association. "Alopecia areata: Diagnosis and treatment." Describes diagnosis by scalp and nail examination, often with a dermatoscope, sometimes with a biopsy, blood tests for thyroid function and family history questions. States that for patchy alopecia areata treated with corticosteroid injections given every 4 to 6 weeks, "more than 80% who were treated with these injections had at least half of their hair regrow within 12 weeks," with results possible "within 3 months of getting the first injection," that success with contact immunotherapy "ranges from 17% to 75%," and that "at this time, alopecia areata cannot be cured. However, treatment can help people regrow their hair." Names topical corticosteroids, minoxidil, anthralin, contact immunotherapy and oral medications approved for severe alopecia areata. [https://www.aad.org/public/diseases/hair-loss/types/alopecia/treatment](https://www.aad.org/public/diseases/hair-loss/types/alopecia/treatment) · Medical Organization 5. American Academy of Dermatology Association. "Alopecia areata: Self-care." Recommends a soft-bristled brush and wide-tooth comb, avoiding harsh chemicals, air-drying rather than blow-drying, loose hairstyles, and to "apply sunscreen to your scalp. Use a sunscreen that offers SPF 30 or higher, broad-spectrum protection, and water resistance." Names a wide-brimmed hat or wig, hats, sweatbands and glasses where brows or lashes are lost, and petroleum jelly inside the nostrils where nasal hair is lost. States that "learning how to manage your stress with a technique that works for you, such as meditation or yoga, may help reduce cycles of hair loss," that people with alopecia areata "have higher risk for thyroid disease and other conditions," and names the National Alopecia Areata Foundation as a support resource. [https://www.aad.org/public/diseases/hair-loss/types/alopecia/self-care](https://www.aad.org/public/diseases/hair-loss/types/alopecia/self-care) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Several conditions cause hair loss and they are treated differently; diagnosis is made by examination and sometimes by biopsy or blood testing. Alopecia areata follows an unpredictable course, regrowth is not guaranteed, and hair that regrows may fall out again. It cannot currently be cured. The figures on this page describe results reported in groups of patients and do not predict any individual outcome. Corticosteroid injections, immunotherapy and oral medications each carry their own risks, which are discussed individually before anything is started. Individual results may vary. ### Atopic Dermatitis Atopic dermatitis is a common condition that causes itchy, dry and inflamed skin. [1] It usually begins in childhood but can start at any age, and it is chronic, which means it lasts a long time. [1] **It is not contagious and cannot spread from person to person.** [1] What sits underneath it is a skin barrier that does not seal properly. That lets too much moisture escape, which is the dryness. It lets everyday things from dust mites to fragrance get inside, which is the inflammation. And it lets germs in, which is why infection is a real complication rather than a rare one. [3] Understanding that changes what treatment looks like: repairing and protecting the barrier is not an add-on to the medication, it is half the treatment. The itch is the part that does the damage. Scratching breaks the barrier further, which produces more inflammation, which produces more itch. Over time skin that has been through that cycle becomes thickened, scaly and leathery, and can crack. [2] Breaking the cycle early is worth more than treating the result of it. **What it looks like** [2] - Itchy skin, often intensely so, which is the defining feature - Dry, scaly areas - A red rash, especially on lighter skin tones - Small, rough bumps, which are more common on darker skin tones - Skin that feels warm and may be swollen - Over time, skin that has become thickened, scaly, leathery or cracked Eczema is one condition that presents in several ways, and the two axes that matter most are age and skin tone. This is the table people need and almost nobody publishes. Where it sitsWhat it looks likeBabies and young childrenCheeks, forehead or scalp [2]On lighter skin, a red rash with bumps and swelling that may ooze or crust. On darker skin tones, babies are more likely to develop small bumps, extremely dry skin, and dark brown, gray or purple skin where they have it [2]ChildrenCreases of the elbows and knees on lighter skin tones; children with brown or black skin are more likely than white children to have it on the trunk [2]On darker skin tones, several bumps with or without redness, and darker areas of skin [2]AdultsMore likely on the hands, and around the eyes, than in children [2]Often thickened, scaly and leathery from years of the itch and scratch cycle, and prone to cracking [2]Any age, darker skinAnywhere the above appliesDark brown, purple or grayish areas rather than red. Bumps tend to be gray to violet-brown [2] **The reason this matters is diagnostic.** Eczema described as "a red rash" is eczema described on fair skin. On darker skin the redness may not read at all, and what shows instead is bumps and a change in tone. That is why it gets missed, treated as something else, or dismissed as dry skin for years. It is also why Black children in the United States are twice as likely as white children to develop atopic dermatitis and still frequently arrive without a diagnosis. [3] Naming it correctly is the first thing a visit does. AreaWho tends to get it thereCheeks, forehead and scalpBabies and young children. [2]Creases of the elbows and kneesChildren, particularly on lighter skin tones. [2]TrunkMore likely in children with brown or black skin. [2]HandsMore likely in adults than in children, and often the version that follows people to work. [2]Around the eyesMore likely in adults, and one of the hardest areas to treat gently. [2]Neck and behind the earsFrequently affected, frequently missed, and where a scalp that flakes and itches can be part of the same picture. ![Eczema](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-atopic-dermatitis.webp) Eczema treatment looked one way for decades and it does not look that way now. Alongside topical steroids there are non-steroid creams, and for people whose eczema has not responded there are injectable and oral treatments that did not exist a few years ago. [4] Somebody managing eczema with the same drugstore routine they were given years ago is very likely working from an out-of-date map, and that is the single most common reason a first appointment here changes something. The other half is the barrier. Prescription treatment settles a flare; [a short, gentle routine](/treatments/skin-care-products/) and [a barrier-first routine](/treatments/zo-skin-health/) are what keep the next one further away. Going through what you already use, and often removing more than we add, is part of the visit rather than a separate consultation. And where the picture looks more like [something your skin touched](/conditions/contact-dermatitis/) or like [psoriasis](/conditions/psoriasis/), naming that correctly is worth more than any product. **Book an appointment if:** - Itchy, dry or inflamed skin is not settling with what you have been using - The itch is affecting sleep, which is the sign most worth acting on - Skin has become thickened, leathery or is cracking [2] - A child has a rash on the cheeks, in the elbow creases, or across the trunk that keeps returning - You are using a steroid cream continuously rather than in courses - Your routine has not been reviewed in several years **Sooner rather than later if:** - Skin looks infected: weeping, crusting, spreading redness, or feeling unwell alongside it - A flare followed a new medication, and you are unsure whether the two are connected Diagnosis is by examination and questions, sometimes with a small sample of skin to confirm. [4] Bring what you currently use, including anything you have tried and abandoned. This condition cannot be cured, and proper treatment can control it. [1] Most of that control happens between appointments. **Worth doing** - Moisturize, generously and often, on skin that is still damp after bathing. Being gentle with your skin is half the plan [4] - Cut the routine back to what is necessary while skin is flared, and add things back one at a time - Fragrance-free, and check the labels rather than the front of the bottle - Lukewarm water rather than hot, and pat dry rather than rub - Keep a short note of what preceded a flare. Two weeks finds most triggers [4] **Worth knowing** - Atopic dermatitis is not contagious and cannot be spread to anyone [1] - Treatment can lead to clear or almost clear skin, and it does not cure the underlying condition [1] - Wool, harsh detergents, fragrance, stress and weather at either extreme are the common triggers [4] - Scratching feeds the cycle, so treating the itch is treating the eczema rather than treating a symptom - Infection is a genuine complication of a broken barrier rather than a rare event, which is why weeping or crusting skin gets seen promptly [3] Diagnosis, prescription treatment, and the routine that holds the result between flares. Pick a treatment to see how it works. Diagnosis and treatment of atopic dermatitis are medical care rather than a cosmetic service, and are handled differently from the aesthetic treatments on this site. Our office will go through what applies to you when you book. Where a small sample of skin is taken, laboratory fees are billed separately by the laboratory that examines it, and we will tell you when a sample is being sent. **Q: Is eczema contagious?** No. Atopic dermatitis cannot spread from person to person. [1] It is a barrier and immune condition happening inside your own skin, and there is nothing to catch or pass on. **Q: Will my child grow out of it?** Some do and some do not, and it is not possible to say which at the outset. What is known is that it usually begins in childhood, often between two months and five years of age, and that it is a chronic condition. [1] [3] Treating it properly through childhood is worth doing regardless, because the itch and scratch cycle is what does the lasting damage to skin. **Q: What does eczema look like on darker skin?** Frequently not red. On darker skin tones you are more likely to see small bumps, dark brown, purple or grayish areas, and extremely dry skin, and the bumps tend to be gray to violet-brown. [2] Children with brown or black skin are also more likely to have it on the trunk rather than in the elbow creases. [2] The comparison above sets all of that out, and it is the reason eczema is missed on darker skin. **Q: Can it be cured?** No. At this time atopic dermatitis cannot be cured, and treatment can ease symptoms and lead to clearer, if not completely clear, skin. [1] Managed properly it spends most of its time quiet, which is a very different experience from managing it badly. **Q: Is it caused by something I am eating?** Food is not the cause. The drivers are genes, the immune system and what touches your skin. [3] Some people notice a food coincides with a flare and that is worth mentioning at the visit, but eliminating foods on a general rule is a common and unproductive detour. **Q: I have been using the same cream for years. Is there anything new?** Very likely. Alongside topical steroids there are now non-steroid creams, and injectable and oral options for eczema that has not responded to topical treatment. [4] If your plan predates those, a fresh look is worth the appointment on its own. **Q: Do I need a referral?** Yes. This is medical dermatology, and the practice is currently accepting new medical patients by referral from your primary care physician. Once you have that, call the office and we will get you in. 1. American Academy of Dermatology Association. "Eczema types: Atopic dermatitis overview." States that "also called eczema, atopic dermatitis is a common condition that causes itchy, dry, and inflamed skin," that "it usually begins in childhood but can start at any age," that "atopic dermatitis is a chronic disease, which means it can last a long time," that "no, atopic dermatitis is not contagious, so this condition cannot spread from person to person," that "at this time, atopic dermatitis cannot be cured. However, treatment can ease symptoms and lead to clearer, if not completely clear, skin," and that "this condition cannot be cured, but proper treatment can control it." [https://www.aad.org/public/diseases/eczema/types/atopic-dermatitis](https://www.aad.org/public/diseases/eczema/types/atopic-dermatitis) · Medical Organization 2. American Academy of Dermatology Association. "Eczema types: Atopic dermatitis signs and symptoms." Names itchy skin, dry scaly areas, a red rash "especially on lighter skin tones," "small, rough bumps (more common in darker skin tones)," skin that "feels warm and maybe swollen," and over time skin that is "thickened, scaly, and leathery" and "cracked." States that "babies with darker skin tones are more likely to develop small bumps, extremely dry skin, and dark brown, gray, or purple skin where they have atopic dermatitis," that "children with darker skin tones may have several bumps with or without redness and darker areas of skin," that "on darker skin tones, the bumps tend to be gray to violet-brown in color," that "children with brown or black skin are more likely than white children to have atopic dermatitis on their trunk," that "babies and young children often develop it on their cheeks, forehead, or scalp," that "children with lighter skin tones often develop an itchy rash in the creases of their elbows," and that "adults are more likely than children to have atopic dermatitis on their hands" and "around their eyes." [https://www.aad.org/public/diseases/eczema/types/atopic-dermatitis/symptoms](https://www.aad.org/public/diseases/eczema/types/atopic-dermatitis/symptoms) · Medical Organization 3. American Academy of Dermatology Association. "Eczema types: Atopic dermatitis causes." States that genes, the immune system and what touches the skin all play a role, that a compromised barrier allows "too much moisture to escape from the skin, causing dryness," allows "everyday things in the environment from dust mites to fragrances to get inside the protective barrier, leading to inflammation," and allows "germs like virus and bacteria to get inside the barrier, which can lead to an infection." States that "many people who develop atopic dermatitis have one or more blood relatives with atopic dermatitis or an allergic disease like asthma or hay fever" and that "studies have found this to be true for 70% of patients," that atopic dermatitis "often appears between 2 months and 5 years of age," that "in the United States, Black children are twice as likely as white children to develop atopic dermatitis," and that "people living in a city are more likely than people living in a rural area to develop atopic dermatitis" and that "living in a dry climate or far from the equator, where it's cooler, may also increase your risk." [https://www.aad.org/public/diseases/eczema/types/atopic-dermatitis/causes](https://www.aad.org/public/diseases/eczema/types/atopic-dermatitis/causes) · Medical Organization 4. American Academy of Dermatology Association. "Eczema types: Atopic dermatitis diagnosis and treatment." States that "to diagnose atopic dermatitis, also called eczema, a board-certified dermatologist carefully examines your (or your child's) skin and asks questions," that a skin biopsy may be used to confirm, that "common triggers include skin care products, weather (cold or hot), wool clothing, stress, fragrance, perfumes, and harsh detergents," and names topical corticosteroids, non-steroid topical options, light therapy, wet wrap therapy, and injectable and oral treatments for disease that has not responded to topical treatment. Names "applying moisturizer" and "being gentle with your skin" as self-care. [https://www.aad.org/public/diseases/eczema/types/atopic-dermatitis/treatment](https://www.aad.org/public/diseases/eczema/types/atopic-dermatitis/treatment) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Atopic dermatitis is diagnosed by examination, and several conditions can look similar. It is a chronic condition that is managed rather than cured, and response to treatment varies from person to person. Prescription treatments, including topical, oral and injectable options, each carry their own risks, which are discussed individually before anything is started. Skin affected by eczema is more prone to infection; weeping, crusting or spreading redness should be seen promptly. Individual results may vary. ### Autoimmune Disorders Lupus is a group of diseases that can cause inflammation in different parts of the body, and **when lupus affects the skin it is called cutaneous lupus.** [1] Some types stay in the skin. Others are a sign the disease reaches further. That distinction is most of what an appointment is for. **Discoid lupus is the most common type of cutaneous lupus.** It causes a rash of disc-shaped patches that are raised, thick and scaly. [1] It affects only the skin. [3] **Subacute cutaneous lupus** produces a rash that usually develops on the upper back, upper chest or arms, and strong sun protection helps prevent it. [2] **Acute cutaneous lupus** often causes the butterfly-shaped rash across the nose and cheeks, and a butterfly rash can be a sign that lupus affects more than the skin. [1] Less common types include lupus tumidus, lupus panniculitis and chilblain lupus. [1] **Morphea is the most common type of scleroderma**, and scleroderma is a condition in which the body makes too much collagen. [6] [7] People see one or a few patches of thickened skin, usually red or purple, and the patches may not feel especially hard. [6] [7] Where it affects the skin and sometimes the tissue underneath, it is called localized scleroderma; where it affects an internal organ, it is systemic sclerosis. [6] Morphea is the skin-only version, and that is the reassuring part of the name. **Blistering diseases are rarer and are treatable.** Bullous pemphigoid is a rare autoimmune disease that can cause large blisters on the skin, and it often begins after 60 years of age. [10] Pemphigus is a group of rare diseases that cause blisters, with several distinct types. [11] Neither is contagious, and treatment reduces itching, rash and the number of new blisters. [10] **Several conditions on this site are autoimmune and have their own pages**, including [vitiligo](/conditions/vitiligo/), which is an autoimmune disease in which the immune system attacks the cells that give skin its color, [12] and [alopecia areata](/conditions/alopecia/), which occurs when the immune system attacks hair follicles. [13] [Psoriasis](/conditions/psoriasis/), thyroid disease and vitiligo are all linked to alopecia areata, and having one of them raises the likelihood of another. [13] This is a category page, and the useful thing a category page can do is help someone work out which conversation they are about to have. ConditionWhat shows on the skinWhat it doesDiscoid lupusDisc-shaped patches that are raised, thick and scaly [1]Affects only the skin. Can leave scarring, and scarring on the scalp is permanent [2] [3]Subacute cutaneous lupusA rash on the upper back, upper chest or arms [2]Can be a sign lupus reaches beyond the skin. Strong sun protection helps prevent the rash [1] [2]Acute cutaneous lupusA butterfly-shaped rash across the nose and cheeks [1]A butterfly rash can be a sign that lupus affects more than the skin [1]Morphea, or localized sclerodermaOne or a few patches of thickened skin, usually red or purple [6] [7]Stays in the skin and the tissue beneath. Hardened skin often clears in 3 to 5 years [6] [8]Bullous pemphigoidLarge blisters, most often beginning after age 60 [10]Rare, not contagious, and treatment reduces itching, rash and new blisters [10]PemphigusBlisters, in several distinct forms [11]A group of rare diseases. Treatment is what keeps it controlled [11]DermatomyositisA violet or dusky red rash on the face and eyelids, and small bumps on the hands near the knuckles [14] [15]Also affects muscle, and it comes with a cancer-screening conversation in adults [14]VitiligoPatches that lose pigmentAutoimmune. Has its own page on this site [12]Alopecia areataRound patches of hair lossAutoimmune. Has its own page on this site [13] **The line that matters most in that table is in the discoid row.** With discoid lupus, hair loss can be permanent because scarring develops, and [hair does not grow back where a scar has formed](/conditions/hair-loss/) on the scalp. [2] Treating the condition early can prevent cutaneous lupus from progressing and causing damage. [4] That is the whole argument for not waiting a year on a scalp rash. **Dermatomyositis carries one specific piece of advice worth repeating.** Alongside the rash, it involves weakness in the muscles closest to the center of the body: hips, thighs, shoulders, upper arms and neck. [14] In adults it has been linked to a higher risk of certain cancers, and the guidance is to ask what cancer screenings apply to you. [14] That is a question for your physician, and it belongs on this page because the rash is often what brings someone in first. **Light, including the light in your house** Lupus can make skin extremely sensitive to sunlight and other types of light. [2] The standard guidance is more specific than most people expect: - Apply broad-spectrum sunscreen, SPF 30 or higher, water resistant, to all skin that clothing will not cover [5] - Apply it 15 minutes before going outdoors, and reapply every two hours and after swimming or sweating [5] - Wear sun-protective clothing: long sleeves, pants, a wide-brimmed hat and sunglasses where possible [5] - Replace fluorescent, compact fluorescent and halogen bulbs, which emit some UV light [5] - Sun protection can prevent new flare-ups and keep lupus from worsening [4] - Ask about a vitamin D supplement, since bodies need vitamin D for healthy bones and a blood test will show whether you are getting enough [5] **Smoking, and what happens when it stops** Smoking can worsen cutaneous lupus. [5] Research suggests that smoking cigarettes can prevent an antimalarial from working as well as it can, [4] and studies have shown that when patients quit smoking, medication that had failed to clear their rashes and other skin problems starts to work. [5] **Those two paragraphs are the highest-yield things on this page for anyone already diagnosed.** They cost nothing, they are within a person's control, and they change what the medication is able to do. ![Serious-looking older man](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-autoimmune-disorders.webp) Most people with one of these conditions arrive having been treated for something else first. A scaly patch gets treated as eczema. A thickened patch gets watched. A rash that appears every summer gets attributed to the sun in a general way rather than a specific one. **Board-certified dermatologists are experts in treating cutaneous lupus,** [1] and the reason that matters is that the diagnosis is made from the skin. **If lupus could be the cause of a rash, sores or another skin problem, the examination covers skin, hair and nails.** [4] Where a diagnosis needs confirming, [a small sample examined under a microscope](/treatments/skin-cancer-diagnosis/) gives the answer, and in scleroderma a blood test for elevated antinuclear antibodies is part of the picture. [8] Cutaneous lupus often responds quickly to a corticosteroid, applied to the skin or taken as a pill. [4] For scleroderma, narrowband UVB and UVA-1 phototherapy can help, and methotrexate and other systemic options are used where they are warranted. [8] There is no cure for scleroderma, and treatment reduces the effects of the disease. [6] That pattern holds across most of this page, and it is a better sentence than it reads: these are conditions that respond well to being named early, and the naming is the part that keeps getting postponed. **Book an appointment if:** - You have a rash across the nose and cheeks, or one that appears or worsens after time outdoors [1] [2] - You have disc-shaped patches that are raised, thick and scaly, particularly on the scalp, face or ears [1] - A patch of skin has become thickened, tight, red or purple [6] [7] - You have developed blisters, particularly larger ones, or blisters that keep returning [10] [11] - You have a violet or dusky rash on the eyelids or face, or small bumps on the hands near the knuckles [14] [15] - You have been diagnosed with an autoimmune disease elsewhere in the body and something has changed on your skin - You have patchy hair loss with scarring, redness or scaling on the scalp [2] Treating the condition early can prevent cutaneous lupus from progressing and causing damage to the skin. [4] For a scalp rash that scars, that timing is the difference between hair that regrows and hair that does not. [2] **Sun and light** - Broad-spectrum sunscreen, SPF 30 or higher, water resistant, on all skin clothing will not cover, 15 minutes before going out and reapplied every two hours [5] - Sun-protective clothing, a wide-brimmed hat and sunglasses [5] - Replace fluorescent, compact fluorescent and halogen bulbs [5] - Ask your dermatologist about vitamin D, since heavy sun avoidance affects it and a blood test will show where you are [5] **Medication and habits** - Give a treatment its full run before judging it. Cutaneous lupus often responds quickly to a corticosteroid, and other treatments take longer [4] - If you smoke, this is the single change with the clearest published payoff for skin lupus [4] [5] - Keep a photograph record of a rash or patch in consistent light. Flares are easier to describe with pictures than with memory **Worth knowing** - No type of lupus is contagious, and neither are the other conditions here [1] - Discoid lupus affects only the skin [3] and is most common in Black people [3] - With a darker skin tone and discoid lupus, dark, blue-black nails can develop [2] - In scleroderma the hardened skin often clears on its own in 3 to 5 years, and some changes do not reverse [8] - Linear scleroderma in a child can interfere with bone growth, which is why pediatric cases are followed closely [7] - Having one autoimmune disease raises the likelihood of another, which is part of why follow-up matters [13] Diagnosis, including the tests that name the condition, and treatment of the skin disease itself. Pick a treatment to see how it works. Diagnosis and treatment of autoimmune skin conditions are medical care rather than a cosmetic service, and are handled differently from the aesthetic treatments on this site. Our office will go through what applies to you when you book. Where a skin sample or blood work is sent for examination, laboratory fees are billed separately by the laboratory, and we will tell you at the time that anything is being sent. **Q: Does a lupus rash mean I have lupus throughout my body?** Not necessarily, and which type it is tells you a lot. Discoid lupus affects only the skin. [3] A butterfly rash across the nose and cheeks can be a sign that lupus affects more than the skin, [1] and subacute cutaneous lupus can also indicate disease beyond the skin. [1] Working out which one is present is the point of the appointment, and it usually starts with examining skin, hair and nails. [4] **Q: Will discoid lupus leave scars?** It can, and that is the reason to treat it early. With discoid lupus, hair loss can be permanent because scarring develops, and where scars form on the scalp, hair cannot grow. [2] Treating the condition early can prevent cutaneous lupus from progressing and causing damage. [4] **Q: Does smoking really affect this?** Yes, and it is one of the more actionable findings in dermatology. Smoking can worsen cutaneous lupus, and research suggests it can prevent an antimalarial from working as well as it can. [4] [5] Studies have also shown that when patients quit smoking, medication that had failed to clear their rashes starts to work. [5] **Q: Do I really need to change light bulbs?** It is standard self-care guidance for lupus, and it surprises almost everyone. Sunlight, tanning beds and fluorescent light bulbs all expose skin to ultraviolet light, [3] and the recommendation is to replace fluorescent, compact fluorescent and halogen bulbs because they emit some UV. [5] Alongside daily sunscreen and protective clothing, sun protection can prevent new flare-ups. [4] [5] **Q: What is morphea, and will it go away?** Morphea is the most common type of scleroderma and it affects the skin rather than internal organs. [6] [7] People see one or a few patches of thickened skin, usually red or purple. [6] The hardened skin often clears on its own in 3 to 5 years, and scleroderma can also cause changes that do not reverse, [8] which is why it is treated rather than simply waited out. Narrowband UVB and UVA-1 phototherapy are among the options. [8] **Q: Is any of this contagious?** No. No type of lupus is contagious, [1] and neither are scleroderma, the blistering diseases, vitiligo or alopecia areata. **Q: I have a rash on my eyelids and my shoulders feel weak. What is that?** That combination is worth an appointment rather than a search. A violet or dusky red rash on the face and eyelids with small bumps on the hands near the knuckles, alongside weakness in the muscles closest to the center of the body, describes dermatomyositis. [14] [15] In adults it has been linked to a higher risk of certain cancers, and the guidance is to ask your physician what cancer screenings apply to you. [14] **Q: Do I need a referral?** Yes. This is medical dermatology, and the practice is currently accepting new medical patients by referral from your primary care physician. Once you have that, call the office and we will get you in. 1. American Academy of Dermatology Association. "Lupus: Overview." States that "lupus is a group of diseases that can cause inflammation in different parts of your body," that "when lupus affects the skin, it's called cutaneous (skin) lupus," and that "no. In fact, no type of lupus is contagious." Describes discoid lupus as "the most common type of cutaneous lupus," which "causes a rash of disc-shaped patches that are raised, thick, and scaly"; describes acute cutaneous lupus as a type that "often causes a butterfly-shaped rash across the nose and cheeks," and states that "if you develop a butterfly rash, it can be a sign that lupus affects more than your skin"; describes subacute cutaneous lupus with the note that "without strong sun protection, this type of lupus can quickly cause a rash." Also names lupus erythematosus tumidus, lupus panniculitis and chilblain lupus. States that "board-certified dermatologists are experts in treating cutaneous lupus." [https://www.aad.org/public/diseases/a-z/lupus-overview](https://www.aad.org/public/diseases/a-z/lupus-overview) · Medical Organization 2. American Academy of Dermatology Association. "Lupus: Signs and symptoms." States that "lupus can make your skin extremely sensitive to sunlight and other types of light," that the subacute rash "usually develops on the upper back, upper chest, or arms" and that "effective sun-protection helps to prevent this rash," that "if you have discoid lupus, hair loss can be permanent because scarring develops," that "when scars develop on the scalp, hair cannot grow where there are scars," and that "if you have discoid lupus and a darker skin tone, you may develop dark, blue-black nails." [https://www.aad.org/public/diseases/a-z/lupus-symptoms](https://www.aad.org/public/diseases/a-z/lupus-symptoms) · Medical Organization 3. American Academy of Dermatology Association. "Lupus: Causes." Lists ultraviolet light among triggers, stating that "sunlight, tanning beds, and fluorescent light bulbs expose you to UV light." States that "discoid lupus erythematosus (DLE): Affecting only the skin, DLE is most common in Black people," and that "people of all races and ages can get lupus and develop rashes, sores, and other signs of lupus on their skin." [https://www.aad.org/public/diseases/a-z/lupus-causes](https://www.aad.org/public/diseases/a-z/lupus-causes) · Medical Organization 4. American Academy of Dermatology Association. "Lupus: Diagnosis and treatment." States that "if lupus could be the cause of a rash, sores, or other skin problem, your dermatologist will closely examine your skin, hair, and nails," that "cutaneous (skin) lupus often responds quickly to a corticosteroid. You may apply this medication to your skin or take it as a pill," that "sun protection can prevent new flare-ups and stop lupus from worsening," that "research suggests that smoking cigarettes can prevent an antimalarial from working as well as it can," and that "treating the condition early can prevent cutaneous (skin) lupus from progressing and causing damage." [https://www.aad.org/public/diseases/a-z/lupus-treatment](https://www.aad.org/public/diseases/a-z/lupus-treatment) · Medical Organization 5. American Academy of Dermatology Association. "Lupus: Self-care." Advises to "apply sunscreen to all skin that clothing won't cover, using a sunscreen that offers broad-spectrum protection, SPF 30 or higher, and water resistance," to "be sure to apply it 15 minutes before going outdoors. While outdoors, reapply your sunscreen every two hours and after swimming or sweating," to "wear sun-protective clothing like pants, long sleeves, a wide-brimmed hat, and sunglasses when possible," and to "replace fluorescent, compact fluorescent, and halogen light bulbs. These light bulbs emit some UV light." States that "findings from research studies suggest that smoking can worsen cutaneous (skin) lupus," and that "studies have also shown that when patients quit smoking, medication that failed to clear their rashes and other skin problems starts to work." Advises asking about a vitamin D supplement, noting "our bodies need vitamin D for healthy bones" and that "a blood test can tell your dermatologist whether you're getting enough vitamin D." [https://www.aad.org/public/diseases/a-z/lupus-self-care](https://www.aad.org/public/diseases/a-z/lupus-self-care) · Medical Organization 6. American Academy of Dermatology Association. "Scleroderma: Overview." States that "when a person has scleroderma, the body makes too much collagen," that "when scleroderma affects the skin and sometimes the underlying tissue, a person has localized scleroderma. When scleroderma affects an internal organ, the person has a type of scleroderma called systemic sclerosis," that "morphea: People see 1 or a few patches of thickened skin, which are usually red or purple," and that "there is no cure for scleroderma, but treatment can help reduce the effects of this disease." [https://www.aad.org/public/diseases/a-z/scleroderma-overview](https://www.aad.org/public/diseases/a-z/scleroderma-overview) · Medical Organization 7. American Academy of Dermatology Association. "Scleroderma: Signs and symptoms." States that "if you have morphea (more-fee-uh), the most common type of scleroderma, the patches may not feel too hard," that "some people develop 1 or 2 patches of hard, thick skin. Others have widespread patches on their body," that "some types of scleroderma affect the skin and internal organs like the lungs and kidneys," and that "when a child gets some types of scleroderma, such as linear scleroderma or en coup de sabre, the scleroderma can interfere with bone growth." [https://www.aad.org/public/diseases/a-z/scleroderma-symptoms](https://www.aad.org/public/diseases/a-z/scleroderma-symptoms) · Medical Organization 8. American Academy of Dermatology Association. "Scleroderma: Diagnosis and treatment." States that "while the hardened skin often clears on its own in 3 to 5 years, scleroderma can cause irreversible changes," that "your dermatologist will remove a bit of affected skin so that it can be examined under a microscope," that "a blood test can tell your doctor whether you have something in your blood called 'elevated antinuclear antibodies,'" that "a type of light treatment called narrowband UVB treatment can be helpful," and that "UVA-1 phototherapy may be prescribed. UVA-1 produces long wavelengths that can deeply penetrate the skin to reduce hardness." Also lists methotrexate, oral corticosteroids and calcipotriene with a strong corticosteroid. [https://www.aad.org/public/diseases/a-z/scleroderma-treatment](https://www.aad.org/public/diseases/a-z/scleroderma-treatment) · Medical Organization 9. American Academy of Dermatology Association. "Scleroderma: Who gets and causes." States that "women are more likely than men to get most types of scleroderma," that "one type, linear morphea, tends to develop before 18 years of age," that "the other types are most likely to begin between the ages of 30 and 50," and that "something in the person's immune system goes wrong, causing the body to make too much collagen." [https://www.aad.org/public/diseases/a-z/scleroderma-causes](https://www.aad.org/public/diseases/a-z/scleroderma-causes) · Medical Organization 10. American Academy of Dermatology Association. "Bullous pemphigoid: Overview." States that "this is a rare autoimmune disease that can cause large blisters on the skin," that "it often begins after 60 years of age," that it is not contagious, and that "treatment can prevent (or reduce) itching, rash, and how many new blisters you get." [https://www.aad.org/public/diseases/a-z/bullous-pemphigoid-overview](https://www.aad.org/public/diseases/a-z/bullous-pemphigoid-overview) · Medical Organization 11. American Academy of Dermatology Association. "Pemphigus: Overview." States that "pemphigus is a group of rare diseases that causes blisters," and lists types including pemphigus vulgaris, pemphigus foliaceus, drug-induced pemphigus, fogo selvagem and paraneoplastic pemphigus. [https://www.aad.org/public/diseases/a-z/pemphigus-overview](https://www.aad.org/public/diseases/a-z/pemphigus-overview) · Medical Organization 12. American Academy of Dermatology Association. "Vitiligo: Causes." States that "vitiligo is an autoimmune disease," in which the immune system attacks and destroys "pigment-producing cells called melanocytes," and that a dermatologist can watch for signs of another health condition developing, "such as another autoimmune disease like thyroid disease, some hearing loss, or a problem with your eyesight." [https://www.aad.org/public/diseases/a-z/vitiligo-causes](https://www.aad.org/public/diseases/a-z/vitiligo-causes) · Medical Organization 13. American Academy of Dermatology Association. "Alopecia areata: Causes." States that "alopecia areata is an autoimmune disease that occurs when your immune system mistakenly attacks hair follicles," that "psoriasis, thyroid disease, or vitiligo: These are autoimmune diseases linked to alopecia areata," and that "having one of these autoimmune diseases may increase your risk of developing alopecia areata, which is another autoimmune disease." [https://www.aad.org/public/diseases/hair-loss/types/alopecia/causes](https://www.aad.org/public/diseases/hair-loss/types/alopecia/causes) · Medical Organization 14. Mayo Clinic. "Dermatomyositis." States that "dermatomyositis is a condition in which swelling and irritation, called inflammation, attacks the body's tissues," that "a violet-colored or dusky red rash appears, most often on the face and eyelids and on the knuckles, elbows, knees, chest and back," that "there also may be small bumps on the hands, mainly near the knuckles," that "muscle weakness involves the muscles closest to the center of the body, called the trunk. This includes the muscles in the hips, thighs, shoulders, upper arms and neck," and that "dermatomyositis in adults has been linked to a higher risk of getting certain types of cancer. Ask your healthcare professional what cancer screenings you may need." [https://www.mayoclinic.org/diseases-conditions/dermatomyositis/symptoms-causes/syc-20353188](https://www.mayoclinic.org/diseases-conditions/dermatomyositis/symptoms-causes/syc-20353188) · Medical Organization 15. Cleveland Clinic. "Dermatomyositis." States that "dermatomyositis is a rare disease that causes muscle weakness and rashes on your skin," and names "discoloration and bumps (sometimes referred to as Gottron papules) on your hands, especially near your knuckles." Describes muscle weakness that "might make it hard for you to do common motions," including sitting upright, getting up from a seated position and climbing stairs. [https://my.clevelandclinic.org/health/diseases/15701-dermatomyositis](https://my.clevelandclinic.org/health/diseases/15701-dermatomyositis) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. The conditions described here overlap in appearance and are distinguished by examination, laboratory testing and sometimes a skin biopsy rather than by description. Several of them can involve organs beyond the skin and are managed alongside a rheumatologist or other specialist. Medications used for these conditions, including corticosteroids, antimalarials, methotrexate and phototherapy, carry their own risks and monitoring requirements, which are discussed before treatment. Individual results may vary. ### Contact Dermatitis Contact dermatitis is what happens when something your skin touched leaves a rash behind. It comes in two kinds, and the difference is not cosmetic. It changes what caused it, how long it took to appear, and what you do next. **Irritant contact dermatitis is direct damage.** Something injures the skin and then irritates it. [1] No allergy is involved, so anyone who touched enough of it would react the same way. Detergents, bleach, hand sanitizer, soaps, gasoline, disinfectants, fertilizers, pesticides and even fruit juice all do it. [1] This is the kind that turns up on hands that stay wet all day. **Allergic contact dermatitis is an actual allergy.** Your immune system has learned to react to one specific substance and now reacts every time it meets it. [1] **Because the immune system has to process the substance first, it can take hours or days before the rash appears.** [1] That delay is the single most useful clue you have, and it is why so many people go looking through everything they used that morning when the culprit was two days ago. **What it looks and feels like** [3] - Itchy skin, often intensely so - A rash where the skin is discolored, swollen and hot - Skin that is excessively dry and may crack - Tenderness, burning or stinging - Hives, meaning round welts that itch intensely - Fluid-filled blisters Where the rash appears is often your biggest clue. [4] Shape helps too. A band around a wrist, a rectangle where a bandage sat, a stripe down one side of the face. Here is what each location most often points at. Where the rash isWhat it most often points at [4]Around the eyesSkin care, makeup, a makeup sponge or remover; metal on tweezers, an eyelash curler, keys or a doorknob; nail polish or artificial nailsOne side of the faceA cell phone, shampoo or conditioner, or hair color and perming solutionLipsLipstick, lip balm or lip gloss, a musical instrument, or an e-cigaretteLips and one hand togetherAn e-cigarette, which often contains nickelUnder jewelry or glassesNickel, brass or palladium in jewelry; metal frames or the plastic parts of eyeglasses and sunglassesLegsDyes or fabrics in clothing, fragrance in skin care, or contact with plants including poison ivy and poison oakFeetShoes or socks, foot cream, scrubs or nail polish, or a medication, powder or deodorantHands, both of themUsually the irritant kind: soaps, sanitizer, cleaning products, or hands that stay wet [1] That map narrows it. It does not close it, because more than 15,000 substances can cause an allergic skin reaction. [4] Where the pattern is not obvious, or where a rash keeps returning, patch testing is the test that names it: small amounts of allergens taped to your skin for 48 hours, read on removal and again after four to seven days, because it takes time for a reaction to develop. [5] AreaWhat tends to be behind itHandsThe most common site of the irritant kind, and the one that follows people to work every day.Face and eyelidsThin skin that reacts to products applied elsewhere, including in the hair, and to whatever the hands have touched. [4]Wrists, ears and neckJewelry and watch backs, where nickel is the usual answer. [1]Forearms and lower legsWhere poison oak makes contact on a Central Coast trail, in the shape of the brush you walked through.Waist and abdomenSnaps, buckles and the metal button inside a waistband. [1]FeetShoes, socks and what has been applied to them. [4] ![](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/contact-dermatitis.jpg) This gets called [eczema](/conditions/atopic-dermatitis/), a fungal infection, [psoriasis](/conditions/psoriasis/), [rosacea](/conditions/rosacea/) or plain sensitive skin, and every one of those is handled differently. Telling them apart is what a board-certified dermatologist is for, and it is also what stops another month of drugstore hydrocortisone on something that was never going to respond to it. The other half of the appointment is the history. The visit is exactly that: the rash examined carefully, and questions about your health, your job, your hobbies and your everyday activities. [2] That is not small talk. With more than 15,000 possible allergens, the conversation is the diagnostic tool, and at our San Luis Obispo office it is the appointment rather than a formality before it. **Book an appointment if:** - An itchy rash will not clear, or clears and then comes back [4] - You cannot work out what caused it - The rash keeps returning in the same place - Over-the-counter hydrocortisone has not done much after a week or two - Your hands are affected and your job keeps them in water, gloves or cleaning products - You want to know whether it is contact dermatitis at all, since several conditions look alike [4] **Get seen promptly if:** - The rash is spreading quickly, or blistering badly - It involves your eyes or your mouth - It comes with a fever, or with any trouble breathing The rule of thumb is short: if you cannot get rid of the itchy rash, or it returns, it is time to see a board-certified dermatologist. [4] Once the cause has a name, most of this becomes straightforward. While the rash is active, the goal is to stop adding to it. **Worth doing** - Cut back to a short, boring routine while skin is flared: plain cleanser, moisturizer, sunscreen, and nothing else - Cool compresses for the itch [2] - Wash skin, clothes, tools, gloves and the dog after any poison oak contact, because it is the oil left behind that keeps spreading it, not the rash itself - The right gloves for the job, and dry hands in between - A barrier-first routine for a few weeks after a flare, while skin that has been irritated repeatedly settles down **Worth knowing** - Contact dermatitis is not contagious. It is your own skin reacting to something it touched - Poison oak blister fluid does not spread the rash. Unwashed oil on skin, clothing or a pet does - Actives, fragrance and scrubs keep an irritated barrier irritated. They can go back in later - An allergy is learned, so a product you have used for years is not automatically innocent - Skin that has flared repeatedly stays reactive for a while afterward and settles with time Identifying the cause, treating the flare, and settling the skin afterward. Pick a treatment to see how it works. Diagnosis and treatment of contact dermatitis are medical care rather than a cosmetic service, and are handled differently from the aesthetic treatments on this site. Our office will go through what applies to you when you book. Where allergy patch testing is the right next step, we will explain what it involves and where it is done before anything is arranged. **Q: Is it contagious?** No. It is your own skin reacting to something it touched, so there is nothing to catch and nothing to pass on. Poison oak is the one people ask about most: the blister fluid does not spread it. What spreads it is unwashed urushiol oil still sitting on skin, clothes, tools or a pet. **Q: How do I know if it is an allergy or just irritation?** Timing is the best clue you have on your own. The allergic kind can take hours or days to appear, because your immune system has to process the substance first. [1] The irritant kind does not wait like that. Where it landed helps too, which is what the location map above is for. For a definite answer, patch testing is the test. **Q: What is patch testing?** Small amounts of allergens are placed on your skin and covered with patches. [5] The patches stay on for 48 hours, they are read when they come off, and there is a second reading after four to seven days, because a reaction takes time to develop. [5] It exists because more than 15,000 substances can cause an allergic skin reaction and guessing does not narrow that down. [5] Whether it is your next step, and where it is done, is something we sort out at your visit. **Q: I have used this product for years. Can it really be the cause?** Yes, and that is typical of the allergic kind. An allergy is learned, so you can use something happily for months or years and then start reacting to it. The first exposure often does nothing at all. **Q: How long does it take to clear?** That depends mostly on whether the contact has stopped. It is simple in principle: avoid the cause and the rash and symptoms go away. [2] Where a flare needs more than that, prescription treatment is used, and a rash can hang on for a while after contact ends, especially if you are still touching the cause without knowing it. **Q: Can it be prevented?** Once you know the trigger, largely yes. Avoid it, wear the right gloves for the job, and keep your skin barrier in decent shape in between. Skin that has been irritated over and over stays touchy after the rash clears and reacts to things it used to shrug off, which is why the weeks after a flare matter. **Q: Do I need a referral?** Yes. This is medical dermatology, and the practice is currently accepting new medical patients by referral from your primary care physician. Once you have that, call the office and we will get you in. 1. American Academy of Dermatology Association. "Eczema types: Contact dermatitis causes." States that "when something injures and then irritates your skin, it causes this type of contact dermatitis," describing irritant contact dermatitis, and that "if what touches your skin causes an allergic reaction, you develop this type of contact dermatitis," describing allergic contact dermatitis. States that with the allergic type "it can take hours or days before you develop a rash and symptoms" because the immune system must process the allergen first. Names detergents, bleach, plants, fruit juice, hand sanitizers, soaps, gasoline, disinfectants, fertilizers and pesticides as "just a few of the many things that can irritate your skin," and names nickel, fragrance, balsam of Peru, latex and urushiol, the oil in poison ivy, poison oak and poison sumac, as the most common allergens. [https://www.aad.org/public/diseases/eczema/types/contact-dermatitis/causes](https://www.aad.org/public/diseases/eczema/types/contact-dermatitis/causes) · Medical Organization 2. American Academy of Dermatology Association. "Eczema types: Contact dermatitis diagnosis and treatment." States that a dermatologist will "examine your rash(es) carefully" and "ask you questions about your health, job, hobbies, and everyday activities, when necessary," that "the best way to treat contact dermatitis is to avoid what's causing it. If you can avoid the cause, the rash and symptoms will go away," names topical medication and medication that works throughout the body for symptom relief, and names cool compresses for itching and calamine lotion or colloidal oatmeal baths for weeping sores. [https://www.aad.org/public/diseases/eczema/types/contact-dermatitis/treatment](https://www.aad.org/public/diseases/eczema/types/contact-dermatitis/treatment) · Medical Organization 3. American Academy of Dermatology Association. "Eczema types: Contact dermatitis signs and symptoms." Names itchy skin, often intense; a rash where skin is discolored, swollen and hot; excessively dry skin that may crack; tender skin; burning or stinging; hives, described as round welts on the skin that itch intensely; and fluid-filled blisters. [https://www.aad.org/public/diseases/eczema/types/contact-dermatitis/symptoms](https://www.aad.org/public/diseases/eczema/types/contact-dermatitis/symptoms) · Medical Organization 4. American Academy of Dermatology Association. "Itchy rash could be contact dermatitis." States that where a rash appears "often provides your biggest clue," and sets out likely culprits by location: around the eyes, skin care product, makeup, makeup sponge or remover, metal on tweezers, an eyelash curler, a doorknob or keys, and nail polish or artificial nails; on one side of the face, a cell phone, shampoo or conditioner, or hair color or perming solution; on the lips, a musical instrument, lipstick, lip balm or lip gloss, and e-cigarettes; on the lips and one hand, e-cigarettes, which "often contain nickel"; beneath jewelry or glasses, nickel, brass or palladium, and metal frames or plastic parts; on the legs, clothing dyes and fabrics, fragrance in skin care products, and certain plants including poison ivy; on the feet, shoes or socks, foot cream, scrubs or nail polish, and medications, powders and deodorants. States that "with more than 15,000 allergens, it can be difficult to find what's causing a rash," and that "if you cannot get rid of the itchy rash or it returns, it's time to see a board-certified dermatologist." [https://www.aad.org/public/everyday-care/itchy-skin/rash/itchy-rash-contact-dermatitis](https://www.aad.org/public/everyday-care/itchy-skin/rash/itchy-rash-contact-dermatitis) · Medical Organization 5. American Academy of Dermatology Association. "Patch testing can find what's causing your rash." States that where a dermatologist suspects an allergic reaction, "your dermatologist will place small amounts of allergens on your skin and cover each allergen with a patch," that "you will leave the patches on your skin for 48 hours," that the patches are read on removal and again "after 4 to 7 days" because "it can take time for your skin to develop an allergic reaction," and that "more than 15,000 substances can cause an allergic skin reaction." [https://www.aad.org/public/diseases/eczema/types/contact-dermatitis/patch-testing-rash](https://www.aad.org/public/diseases/eczema/types/contact-dermatitis/patch-testing-rash) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Not every rash is contact dermatitis, and several conditions look alike. The location guidance on this page narrows the possibilities and does not identify a cause; only an examination, and where appropriate patch testing, can do that. Seek care promptly for a rash that is spreading quickly, blistering badly, involving the eyes or mouth, or accompanied by fever or difficulty breathing. Individual results may vary. ### Cyst Removal A skin cyst is a closed sac under the skin. [9] Most of the ones people bring in are epidermoid cysts, which are benign, sit just under the surface, and are filled with keratin, the same protein your skin and hair are made of. [1] They form from the upper part of a hair follicle. [1] Often there is a small dark pinpoint opening in the center of the lump, which is the follicle it came from. [9] [10] **The word "sebaceous" attached to these is a misnomer, and it is worth clearing up because it is on most of the pages you will read.** These cysts do not involve the sebaceous gland and they do not contain sebum. [1] The contents are keratin and cellular debris, which is where the thick, pale, strong-smelling material comes from when one ruptures. [1] [10] **The second common type is the pilar cyst**, also called a trichilemmal cyst, which comes from the outer sheath of the hair root and contains keratin. [3] They mostly affect the skin of the scalp, though they can also appear on the face, neck, arms and legs. [3] [8] They present as flesh-colored, smooth, mobile, firm, well-circumscribed nodules, most commonly as multiple lesions, and they may be inherited as a dominant trait, so more than one person in a family often has them. [3] [8] They do not give rise to malignant lesions. [3] **What a cyst usually looks and feels like** [9] [10] - A round lump under the skin that moves when you press it - Most often on the face, neck, trunk or scalp - Frequently a tiny pinpoint opening in the center - Slow growing and usually painless - Thick, pale, strong-smelling contents if it opens - Red, warm, tender and swollen if it has ruptured or become inflamed This is the single most useful thing on this page, and it is the reason people end up having the same lump treated two and three times. What was doneWhat happens nextNothingSome shrink. Others keep growing. Without treatment a cyst can stay for the rest of your life [6]Squeezed at homeThe contents move rather than leave, and the risk is infection and a lump that refills [6]Drained or lanced onlyFast relief from pressure, and the lining stays behind, so it can fill again [6] [7]Removed whole, sac includedRemoving the entire lining is what lowers the chance of it returning [1] [2] [3] [9] **A cyst is a sac with contents, and the two are not the same problem.** Emptying it addresses the contents. The sac is a functioning structure that keeps producing keratin, so as long as it is in place the lump has a way back. [6] [7] Incomplete excision is the main reason a cyst reappears in clinical practice. [2] **What removal actually involves.** The area is numbed with a local anesthetic, so you are awake and the procedure is not painful. [6] A small incision is made, sized to the cyst, the cyst is lifted out in one piece with its lining, and the skin is closed with sutures. [7] Small sites heal in a few days to a couple of weeks. Larger ones with a longer incision can take several weeks. [7] Any incision leaves a mark, and where it is placed and how it is closed are part of the plan rather than an afterthought. [10] **Where a cyst is actively inflamed or infected, the sequence changes.** Complete excision is delayed while an active infection is present, and an initial drainage or an injection to reduce swelling comes first, with full removal scheduled once the inflammation has resolved. [1] [10] That is standard practice, not a delay. TypeWhere it usually appearsWorth knowingEpidermoid cystFace, neck and trunk [10]Keratin filled, from a hair follicle, often with a pinpoint center [1] [9]Pilar, or trichilemmal, cystMostly the scalp, and sometimes the face, neck, arms and legs [3] [8]Firm and mobile, most commonly multiple, and possibly inherited [3] [8]Digital mucous cystOver the last joint of a finger or toe, near the nail [5]Originates from the joint, is often associated with arthritis in that joint, and can cause a deep lengthwise groove in the nail [5]Acne cysts and nodulesFace, chest and backA different thing entirely. These are inflammatory acne cysts and nodules, not sacs, and they are treated as acne **The last row causes real confusion, and it is worth separating.** A deep, painful acne lesion is sometimes called a cyst, and it is not the kind of cyst this page is about. Those are handled as part of acne treatment. The lumps on this page are sacs with linings, and removing the lining is the whole point. **The digital mucous cyst is the one with a knack for coming back**, and the reason is the same as everywhere else on this page: it grows from a stalk connected to the joint, and removing the cyst along with that stalk is what settles it. [5] Where the stalk is left, it returns. ![A cyst](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-cyst-removal.webp) Most lumps under the skin are exactly what they look like. A few are not. The list of things a suspected cyst can turn out to be is longer than people expect, and it includes lipomas, neuromas, other benign growths, and skin cancers. [2] A lump that moves, that feels familiar under a fingertip and that has been there a while is usually ordinary. Sorting the usual from the unusual is a five-minute job for someone who does it every week. **That is the argument for having a lump looked at by a dermatologist rather than removed by whoever is nearest.** When a cyst is taken out here, the tissue is [examined under a microscope](/treatments/skin-cancer-diagnosis/), because while the great majority of these cysts are benign it matters to send the excised sample for evaluation and confirm there is no malignancy. [1] The lining and the contents are exactly what a pathologist reads to classify it. [4] Most of the time that confirms the obvious. Occasionally it identifies [a lump that turns out to be something else](/conditions/skin-cancer/), and identifying it early is the entire value of doing it that way. **Book an appointment if a lump:** [10] - Is growing quickly, or several have appeared - Has opened, or is red, warm, swollen and tender - Is painful, or shows signs of infection - Sits somewhere that keeps getting caught, scratched or knocked - Is somewhere unusual, such as a finger or toe - Bothers you because of how it looks **Signs a cyst has become infected** [9] - Redness of the skin over it - Tenderness or soreness - Warmth in the area - Grayish white, cheesy, foul smelling material draining from it Contact us about any new growth you notice. [9] In most cases the diagnosis is made by examining the skin. [9] Most cysts are not dangerous and do not need to be treated unless they cause symptoms or show signs of inflammation, [9] so an appointment is often about knowing what something is and deciding what you want to do about it. **Worth doing** - Leave it alone. Do not try to pop or drain a cyst yourself, since that risks infection and it will likely regrow [6] [10] - A warm, moist cloth held over the area can help a cyst drain and heal [10] - If a lump becomes red, warm and tender, have it seen rather than waiting it out [10] - Bring in a lump that keeps getting caught by a collar, a razor or a hairbrush before it is inflamed, since removal is more straightforward when the area is quiet [1] **After removal** - Keep the site clean and covered as directed, and follow the suture care instructions you are given - Small sites heal in a few days to a couple of weeks, and larger ones can take several weeks [7] - Any excision leaves a mark, and that trade is discussed before anything is scheduled [10] - New cysts can appear elsewhere, particularly with pilar cysts, which most commonly come in numbers [3] [8] **Worth knowing** - Most skin cysts are benign [1] [3] - The contents are keratin, not sebum [1] - A cyst that is emptied but not removed has a route back [6] [7] - Pilar cysts may be inherited, and one is often followed by others [3] [8] - A digital mucous cyst near a nail settles when it is removed along with the stalk connecting it to the joint [5] Evaluation, in-office removal, and where a lump needs an answer rather than a procedure, the test that gives one. Pick a treatment to see how it works. Evaluation and removal of a skin cyst are medical care rather than a cosmetic service, and are handled differently from the aesthetic treatments on this site. Our office will go through what applies to you when you book. Where tissue is sent for examination, laboratory fees are billed separately by the laboratory, and we will tell you at the time that anything is being sent. **Q: Why does my cyst keep coming back?** Because the sac is still there. A cyst is a lining with contents inside it, and draining it removes the contents while leaving the structure that produced them, so it can fill again. [6] [7] Removing the entire lining is what lowers the chance of it returning, [1] [3] and incomplete excision is the main reason one reappears in practice. [2] That is another reason to have one looked at while it is quiet. **Q: Can I just pop it?** It is worth not trying. Squeezing pushes contents into the surrounding skin rather than out of it, raises the risk of infection, and leaves the sac in place so the lump refills. [6] [10] A warm, moist cloth over the area is the reasonable thing to do at home. [10] **Q: Is a sebaceous cyst the same as an epidermoid cyst?** Usually, yes, and the older name is inaccurate. What most people call a sebaceous cyst is an epidermoid cyst: it comes from a hair follicle, not a sebaceous gland, and it contains keratin rather than sebum. [1] The name persists because it has been in use for a long time. **Q: Will it go away on its own?** Some get smaller. Others keep growing until they are treated, and without treatment a cyst can stay for the rest of your life. [6] That said, most cysts are harmless and do not need to be removed unless they cause symptoms or show signs of inflammation. [9] It is a decision, not an obligation. **Q: Does removal leave a scar?** An incision leaves a mark, and the size of it depends on the size of the cyst. [10] Small sites heal in a few days to a couple of weeks, larger ones in several weeks. [7] Where the incision is placed and how it is closed are part of the plan, and for a visible location that conversation happens before anything is scheduled. **Q: What if it is red and painful right now?** Then it is likely inflamed or infected, and the order of operations changes. Full removal is delayed while an active infection is present, and drainage or an injection to reduce swelling comes first, with excision scheduled once the area has settled. [1] [10] Call us rather than waiting for it to resolve. **Q: I have several lumps on my scalp. Is that normal?** It is a familiar pattern. Pilar cysts mostly affect the scalp, they most commonly appear as multiple lesions, and they may be inherited. [3] [8] They do not give rise to malignant lesions. [3] Having them looked at establishes what they are and how you want to handle them. **Q: Do I need a referral?** Yes. This is medical dermatology, and the practice is currently accepting new medical patients by referral from your primary care physician. Once you have that, call the office and we will get you in. 1. StatPearls, National Center for Biotechnology Information. "Epidermoid Cyst." States that an "epidermoid cyst, also known as a sebaceous cyst, is a benign encapsulated, subepidermal nodule filled with keratin material," that "epidermoid cysts are derived from the follicular infundibulum," that "the term sebaceous cyst is commonly used; however, it is a misnomer, as it does not involve the sebaceous gland," and that "cysts may progress slowly and remain present for years." On rupture, states that "when the cysts rupture, an inflammatory reaction occurs due to the displacement of soft, yellow keratin into the dermis and surrounding tissue," and that "epidermoid cysts are usually asymptomatic; however, if ruptured, they may closely resemble a furuncle with tenderness to palpation, erythema, and swelling." On treatment, states that "the most effective treatment involves complete surgical excision of the cyst with the cyst wall intact," that "removing the entire cystic lining is important in decreasing recurrence," and that "the complete excision should be delayed if an active infection is present," with an initial incision and drainage indicated in those cases. On pathology, states that "while the majority of these cysts are benign, it is important to send the excised sample for evaluation to ensure that there is no malignancy," and that "histological examination reveals an epithelial-lined cyst filled with laminated keratin located within the dermis." [https://www.ncbi.nlm.nih.gov/books/NBK499974/](https://www.ncbi.nlm.nih.gov/books/NBK499974/) · Medical Reference 2. StatPearls, National Center for Biotechnology Information. "Epidermal Inclusion Cyst." States that the differential diagnosis "includes pilar cyst, lipoma, abscess, neuroma, benign growths, skin carcinomas, metastatic cutaneous lesions, pilomatrixoma, ganglion cyst, neurofibroma, dermoid cyst, brachial cleft cyst, pilonidal cyst, calcinosis cutis, pachyonychia congenita, steatocystoma simplex, and steatocystoma multiplex," and separately that it "also include lipomas, neuromas, benign cutaneous growths, metastatic skin lesions, squamous cell carcinoma of the skin, basal cell carcinoma of the skin." States that "epidermoid inclusion cysts can be confirmed by histologic examination," that "there is a risk of the cyst reoccurring if the capsule is not completely excised during the surgical procedure," and that "the main complication seen in clinical practice is reoccurrence due to incomplete excision." [https://www.ncbi.nlm.nih.gov/books/NBK532310/](https://www.ncbi.nlm.nih.gov/books/NBK532310/) · Medical Reference 3. StatPearls, National Center for Biotechnology Information. "Pilar Cyst." States that "pilar or trichilemmal cysts are common dermal cysts," that "the cysts contain keratin and are outlined by stratified squamous epithelium" similar to the outer root sheath of the hair follicle, that "they mostly affect the skin of the scalp," that they "usually present as flesh-colored, smooth, mobile, firm, and well-circumscribed nodules," that "most commonly, they are multiple lesions," that "trichilemmal cysts may be inherited as an autosomal dominant trait," and that "trichilemmal cysts never give rise to malignant lesions." States that ruptured cysts leak contents into the dermis "leading to the formation of a foreign-body reaction," that "the mainstay of treatment is radical surgical excision of the lesion, including the wall of the cyst," and that "if the surgeon does not remove the sac completely, then the recurrence rate will be high." [https://www.ncbi.nlm.nih.gov/books/NBK534209/](https://www.ncbi.nlm.nih.gov/books/NBK534209/) · Medical Reference 4. StatPearls, National Center for Biotechnology Information. "Dermatopathology Evaluation of Cysts." States that "a structured approach to the histopathologic diagnosis of cutaneous cysts involves the assessment of the following features: Epithelial lining, Cyst contents, Ancillary histopathologic features," and that pilar cysts "usually present as a solitary nodule most commonly located on the scalp of a female adult." [https://www.ncbi.nlm.nih.gov/books/NBK603737/](https://www.ncbi.nlm.nih.gov/books/NBK603737/) · Medical Reference 5. StatPearls, National Center for Biotechnology Information. "Digital Mucous Cyst." States that "digital mucous cysts (also known as digital myxoid cysts or digital mucous pseudocysts) are ganglion cysts that originate from the dorsal aspect of the distal interphalangeal joint (DIP)," that they "typically manifest as slow-growing masses located in the subcutaneous tissue overlying the dorsal aspect of the DIP joint," that they "most commonly affect the fingers but can also affect the toes and are frequently associated with underlying DIP joint osteoarthritis, although arthritis may be absent in some cases," and that "cysts in this location cause deep longitudinal grooves of the nail plate." On recurrence, states that "after surgical excision of digital mucous cysts, recurrence occurs in approximately 2%, provided the excision includes the stalk of the cyst," and that removal without the stalk carries a substantially higher recurrence rate. [https://www.ncbi.nlm.nih.gov/books/NBK559092/](https://www.ncbi.nlm.nih.gov/books/NBK559092/) · Medical Reference 6. Cleveland Clinic. "Sebaceous Cysts (Epidermal Inclusion Cysts)." States that "an epidermal inclusion cyst (epidermoid cyst) is a fluid-filled pocket under the surface of your skin," that the term sebaceous cyst is misleading because keratin and cell debris rather than sebum fill these cysts, and that "some cysts decrease in size, while others continue to grow until you get treatment. Without treatment, you may have the cyst for the rest of your life." Advises: "don't try popping or draining the cyst yourself. This could cause an infection, and the cyst will likely grow back (recur)." States that drainage "won't resolve the cyst, since your provider won't remove the cyst capsule," and that "the removal of the capsule prevents the cyst from growing back." Notes that removal uses "a local anesthetic (you won't be asleep and you won't feel pain)." [https://my.clevelandclinic.org/health/diseases/14165-sebaceous-cysts](https://my.clevelandclinic.org/health/diseases/14165-sebaceous-cysts) · Medical Organization 7. Cleveland Clinic. "Cyst Removal." States that "your provider removes the entire cyst from under your skin, including the lining (sac)," that "this lowers the chance of it coming back," and describes the steps as making "a cut in your skin based on the size of the cyst," removing "the entire cyst in one piece," and closing "the cut in your skin with stitches." States that "some cysts can come back, especially after drainage. This happens when the sac or lining isn't fully removed," and that "small cysts that don't need stitches usually heal in a few days to a couple of weeks. Larger cysts with bigger cuts may take several weeks or even months." [https://my.clevelandclinic.org/health/procedures/cyst-removal](https://my.clevelandclinic.org/health/procedures/cyst-removal) · Medical Organization 8. Cleveland Clinic. "Pilar (Trichilemmal) Cyst." States that "pilar cysts are relatively rare noncancerous (benign) cysts that grow from your hair follicles," that "most pilar cysts surface on your scalp (head), but they can appear on your face, neck, arms and legs," that "for the most part, trichilemmal cysts are benign, meaning they don't become cancerous," that "pilar cysts are hereditary, meaning you may inherit a tendency to develop these cysts," that "if you have one cyst, more may develop," and that "you may end up with an infection if you try to pop or slice open your cysts." Notes that a provider may "examine the cysts under a microscope to confirm your cysts aren't cancerous." [https://my.clevelandclinic.org/health/diseases/23092-pilar-trichilemmal-cyst](https://my.clevelandclinic.org/health/diseases/23092-pilar-trichilemmal-cyst) · Medical Organization 9. MedlinePlus, U.S. National Library of Medicine. "Epidermoid cyst." States that "an epidermoid cyst is a closed sac under the skin, or a skin lump, filled with dead skin cells," that they "are very common" and their cause "is unknown," that they form "when elements of the surface skin get under the skin surface," that "the main symptom is usually a small, non-painful lump beneath the skin," and that "it will often have a tiny hole or pit in the center." Lists infection signs as "skin redness," "tender or sore skin," "warm skin in the affected area," and "grayish-white, cheesy, foul-smelling material that drains from the cyst." States that "epidermoid cysts are not dangerous and do not need to be treated unless they cause symptoms or show signs of inflammation," that "in most cases, your health care provider can make a diagnosis by examining your skin," that "they may return if they are not completely removed by surgery," and to "contact your provider if you notice any new growths in your body." [https://medlineplus.gov/ency/article/000842.htm](https://medlineplus.gov/ency/article/000842.htm) · Government Organization 10. Mayo Clinic. "Epidermoid cysts." States that "epidermoid cysts are harmless small bumps beneath the skin," that "epidermal cells form the walls of the cyst and then secrete the protein keratin into it," that "keratin is the thick, cheesy substance that can leak from the cyst," and that "sometimes this type of cyst forms due to irritation or injury of the skin or a hair follicle." Lists signs including "a small, round bump under the skin, often on the face, neck or trunk," "a tiny blackhead plugging the central opening of the cyst," "a thick, smelly, cheesy substance that leaks from the cyst," and "an inflamed or infected bump." Advises seeing a health professional for a cyst that "grows or multiplies rapidly," "breaks open," "is painful or infected," "is in a spot that keeps getting scratched or bumped," "bothers you because of how it looks," or "is in an unusual spot, such as a finger or toe." Recommends "placing a warm, moist cloth over the area to help the cyst drain and heal" and "not squeezing a cyst yourself." States of drainage that "cysts might recur after this treatment," and of excision that "your healthcare professional removes the entire cyst," which "is safe and effective and often prevents the cyst from regrowing," but "may leave a scar." Also notes that "injecting a steroid into the cyst can ease swelling and inflammation." [https://www.mayoclinic.org/diseases-conditions/epidermoid-cysts/symptoms-causes/syc-20352701](https://www.mayoclinic.org/diseases-conditions/epidermoid-cysts/symptoms-causes/syc-20352701) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Most skin cysts are benign, and not every lump under the skin is a cyst. Removal is a minor surgical procedure that carries the usual risks of any incision, including bleeding, infection and scarring, all of which are discussed before treatment. Cysts can recur, particularly where a cyst has ruptured before removal or where the lining cannot be taken out intact. Tissue removed here is examined by a laboratory. Individual results may vary. ### Facial Volume Loss Underneath the skin, a face is built on layered pads of fat, a collagen framework and the bone beneath both. From roughly your late twenties onward, all three thin and shift. The pads get smaller and slide downward, the framework loosens, and the bone itself gradually recedes at the eye socket and the jaw. **The skin has not necessarily changed at all. What changed is what it was draped over.** That is why the effect reads as tiredness rather than as age. A flat cheek casts a different shadow than a full one. A hollow at the eye socket reads as being run down. A crease beside the mouth deepens not because a line formed there but because the tissue above it has less to sit on. **The most useful thing on this page:** the folds people most want treated are usually not lines. They are shadows, and a shadow does not respond to anything applied to the surface. That is the whole reason "I have tried everything for this line" is such a common sentence, and why the answer is often in a different layer entirely. **What people usually notice first** - Looking tired in photographs when they feel fine - Cheeks that have flattened, so makeup sits differently than it used to - A crease from nose to mouth that keeps deepening - Under-eye hollows that no amount of concealer covers - A jawline that has lost its edge without any weight gain These two look identical in a mirror and they need entirely different treatment. Getting it wrong is the most expensive mistake in this category, because replacing volume in a face that is actually loose does not fix it, and tightening skin over a face that has emptied does not either. **Sit in front of a mirror, place two fingers flat on your cheek just below the cheekbone, and lift the tissue gently upward and slightly outward.** Then watch what happens to the crease beside your mouth and to the jawline. What you see when you liftWhat it points atWhat that meansThe crease beside the mouth flattens out and the cheek looks full againVolume loss. You have restored, with two fingers, roughly what support doesReplacing or stimulating support is the route, and it is what this page is aboutThe crease stays where it is but skin gathers in a fold above your fingersLoose skin rather than emptiness, where the skin has more surface area than the frame under itTightening is the route, and filling would make the fold heavierThe crease stays and there is a fine etched line inside it that does not moveA line in the skin itself, which sits on top of whichever of the above you also haveSurface treatment is what reaches it, usually alongside one of the othersLying flat on your back does most of what your fingers didGravity is doing the work, which usually means volume with some laxityBoth conversations, in an order decided in person Most faces show a mix, and the mix is the plan. **What the check gives you is a much better first sentence at a consultation:** "when I lift here, this flattens" tells a dermatologist more than any description of what bothers you. ![Older woman looking concerned](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-facial-volume-loss.webp) The instinct with a hollow is to fill the hollow. Often the better answer is to restore support somewhere else entirely, because a face is a structure and the place that looks empty is not always the place that gave way. Rebuilding the cheek frequently softens the crease beside the mouth without anything being placed in the crease at all. That judgment is the whole service. It is anatomy rather than product, and it is why the same materials produce a natural result in one pair of hands and an obvious one in another. **A board-certified dermatologist deciding where and how much, with several materials available and no reason to prefer one, is a different consultation from a room that carries a single product.** It is also why the honest answer here is sometimes that you need less than you came in expecting. **This is a good conversation to have if:** - You look tired in photographs when you feel fine - The two-finger check above flattened a crease you have been trying to treat on the surface - Your cheeks have flattened and makeup sits differently than it used to - You have lost a significant amount of weight and your face went with it - You have tried surface treatment on a fold and it did not reach **Worth knowing before you book:** - If lifting the skin produced a fold rather than a flattening, loose skin rather than emptiness is the conversation to have - A fine etched line inside a crease is a line in the skin itself and needs its own treatment on top - Restoring support and stimulating your own collagen work on different timescales, and plans often use both Some people leave this consultation being told they need less than they expected, or need it somewhere other than where they thought. That is a normal outcome and it is worth the visit on its own. **Worth doing** - Broad spectrum sunscreen, SPF 30 or higher, water resistant, every day, because sun accelerates the collagen side of this [2] - Come back on the interval you agreed rather than waiting for the result to disappear, which usually means less work - Keep your weight reasonably steady if you can, since the face empties along with everything else - Photograph yourself in the same light every few months, since the change is gradual enough to be invisible day to day **Worth knowing** - Results built on your own collagen arrive slowly and keep developing for months - Your face carries on changing underneath any result, which is what maintenance is for - Restoring support in one area sometimes changes how a neighboring area reads, which is why plans are staged rather than done all at once - The most natural results are almost always the ones built gradually Replacing support, and stimulating your own. Pick a treatment to see how it works. What a plan costs depends on which areas are being treated and which materials suit them, and that is worked out at the consultation. You get the plan and its cost before anything is booked. **Q: Why do I look tired when I feel fine?** Because hollowing changes how light falls on your face. A flat cheek and a hollow under the eye cast shadows that read as tiredness regardless of how you feel, and they arrive gradually enough that most people notice them first in a photograph rather than in a mirror. **Q: Is this the same as sagging?** No, and telling them apart is the most valuable thing on this page. Volume loss is emptiness underneath; sagging is skin with more surface area than the frame under it. The two-finger check above separates them in about ten seconds, and they need different treatment. **Q: Will filling my face make me look done?** That is the fear and it is a reasonable one. It comes from volume placed in the wrong layer, in the wrong place, or in too much quantity at once. Restoring support where the structure actually gave way, staged over more than one visit, is what produces a result people cannot point at. Say plainly that this is your goal at the consultation, because it changes the plan. **Q: How long does it last?** That depends entirely on the material, the area and how your body handles it, and you will get a realistic range for your plan at the consultation rather than a number from a website. What is common to all of them is that your face carries on changing underneath, which is what maintenance is for. **Q: Should I treat the crease beside my mouth directly?** Often not, and that surprises people. Rebuilding support in the cheek frequently softens that crease without anything being placed in it, because the crease is a shadow cast by what is missing above it. Where a fine etched line sits inside the crease as well, that part is a line in the skin itself and gets its own treatment. **Q: Can I do anything about it without treatment?** You can slow the collagen side of it, which is worth doing whatever else you decide. Daily sun protection is the main lever, since ultraviolet light breaks collagen down faster than time alone does. [2] Nothing applied to the skin restores fat pads or bone. 1. American Academy of Dermatology Association. "Many ways to firm sagging skin." States that non-surgical options give "modest lifting and tightening" and "still cannot give you the results of a surgical procedure like a facelift, eyelid surgery, or neck lift," and that these treatments should be performed by a board-certified dermatologist. [https://www.aad.org/public/cosmetic/younger-looking/firm-sagging-skin](https://www.aad.org/public/cosmetic/younger-looking/firm-sagging-skin) · Medical Organization 2. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant, reapplied every two hours outdoors and after swimming or sweating. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice. The self-assessment described on this page narrows the possibilities and does not replace an examination. Results and how long they last vary by material, area, technique and individual anatomy. Injectable treatments carry risks including bruising, swelling, lumps, asymmetry and, rarely, vascular complications, all of which are discussed individually before anything is scheduled. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### Genetic Skin Disorders **Ichthyosis is a group of skin diseases that causes extremely dry, thick and scaly skin, and about 95% of people who develop ichthyosis have the same type: ichthyosis vulgaris.** [1] Children usually develop it by inheriting a gene from one or both parents. [1] It is not contagious. [1] The reason it goes unnamed for years is that it looks like ordinary dryness, and it responds partially to ordinary moisturizer, which is enough to keep anyone from asking the question. The scale tends to be worse in dry, cold months and better in humid weather, which reinforces the impression that it is a seasonal nuisance rather than a diagnosis. **The genetics are unusually well understood for a skin condition, and they explain a lot.** The gene involved makes a protein that plays an important role in the skin's barrier. [3] More than 40 changes in that gene are known to cause ichthyosis vulgaris. [3] **How many copies are affected is what determines severity.** With one altered copy people are typically mildly affected, may have symptoms only seasonally, and may never have obvious skin problems at all. With two altered copies symptoms are more severe and can be present year-round. [3] **The same gene sits behind a lot of eczema**, which is why [atopic dermatitis, better known as eczema](/conditions/atopic-dermatitis/) turns up in the same people and the same families. Between 20% and 30% of people with atopic dermatitis carry a change in this gene, against 8% to 10% of people without it. [3] **Other inherited conditions affect the skin, and their range is wide.** Epidermolysis bullosa is a group of rare diseases that cause the skin to blister easily, [4] and it is covered below, alongside what gets managed here and what gets referred. Some [pigmented birthmarks](/conditions/moles/), including café au lait spots, are among the marks that do not fade with time. [7] There is no cure for inherited ichthyosis vulgaris, and treatment focuses on reducing the scale and the dryness. [2] The routine below is unglamorous and it is the whole of it, and the specifics are what separate it from generic dry-skin advice. StepWhat to doWhySoakBathe or soak rather than showering quicklySoaking hydrates skin and softens the scale [2]Apply on damp skinMoisturize within two minutes of getting out, while skin is still dampThe window is what traps the water in [2]Use an active ingredientLook for urea, alpha hydroxy acid or lactic acid in the moisturizerThese are what work on scale, rather than a plain emollient [2]Repeat, indefinitelyDaily, year round, heavier in dry monthsThe condition is inherited, so the routine is maintenance rather than a course **Diagnosis is usually straightforward.** A dermatologist can often diagnose ichthyosis vulgaris by looking at the skin. [2] What the appointment adds is the name, the correct products, and the connection to eczema if it is present, which changes how both are handled. **The eczema connection is the part worth taking away.** Between 20% and 30% of people with atopic dermatitis carry a change in the same gene, against 8% to 10% of people without it. [3] If you have had lifelong dry, scaly skin and you also have eczema, those are not two coincidences. Treating the barrier properly helps both. Where scaling is severe, does not respond to this routine, or is accompanied by other findings, the diagnosis may be a different form of ichthyosis, and that is worth establishing rather than assuming. Inherited skin conditions run from very common and easily managed to very rare and genuinely complex. Being clear about which is which is more useful than implying that one practice covers all of it. ConditionWhere it is handledIchthyosis vulgarisDiagnosed and managed here [1] [2]Dry, scaly skin alongside eczemaManaged here, and the two are treated together [3]Café au lait spots and other pigmented birthmarks that do not fadeExamined here [7]Rarer forms of ichthyosisDiagnosed here, with onward referral where genetic evaluation is warrantedEpidermolysis bullosaCare belongs with a specialist center. Evaluation and coordination here, referral onward [4] [6]Inherited conditions with findings beyond the skinCo-managed, with the skin part handled here **On epidermolysis bullosa specifically.** It is a group of rare diseases that cause the skin to blister easily, [4] and it covers a wide range: some children have a mild form that mainly calls for precautions against injury, and others live with a severe form that needs specialist care throughout life. [4] Blistering and skin fragility are usually noticeable at birth or shortly after, [5] and it is estimated that between 25,000 and 50,000 people in the United States have it. [5] In the more severe types, skin cancer surveillance is part of ongoing specialist care. [6] The university centers in California run dedicated programs for it, and **the right move for a family is a referral there rather than a local page claiming otherwise.** ![Serious-looking woman](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-genetic-skin-disorders.webp) Most people who have ichthyosis vulgaris have never been told they have it. They have been told they have dry skin, and they have bought a great deal of moisturizer that was never formulated for scale. **The practical value of the appointment is small and real: a name, the right active ingredients, and a routine with a two-minute window in it.** [2] **The second thing an appointment produces is the connection.** Where inherited dry skin and eczema occur together, they share a mechanism, and knowing that changes how both are managed rather than treating them as separate complaints in separate visits. [3] The same logic applies where a rash turns out to belong with [psoriasis](/conditions/psoriasis/) or with [autoimmune skin conditions](/conditions/autoimmune-disorders/) instead. **The third thing is honest scoping**, which is the managed-or-referred table above. There is real value in a local practice saying plainly which inherited conditions it manages and which belong at a specialist center, because the alternative is a family spending months finding that out on their own. **Book an appointment if:** - You have had dry, scaly skin for as long as you can remember, particularly on the shins and arms - The scale is plate-like or fish-scale in pattern rather than simply rough - Ordinary moisturizer helps a little and never quite resolves it - Other people in your family have the same skin - You have eczema alongside lifelong dryness - A child has blistering or fragile skin from birth or shortly after [5] - A birthmark has not faded and you would like it identified [7] A dermatologist can often diagnose ichthyosis vulgaris by looking at the skin, [2] so this is usually a single appointment that produces a name and a plan rather than a diagnostic process. **The routine** - Soak or bathe rather than showering quickly, because soaking hydrates skin and softens the scale [2] - Moisturize within two minutes of getting out, on damp skin [2] - Use a moisturizer containing urea, alpha hydroxy acid or lactic acid rather than a plain emollient [2] - Expect to do it year round, and expect to do more of it in dry, cold months - There is no cure for inherited ichthyosis vulgaris, and treatment reduces the scale and the dryness effectively [2] **Worth knowing** - Ichthyosis is not contagious [1] - About 95% of ichthyosis is ichthyosis vulgaris, the mild and common form [1] - It is inherited from one or both parents, and severity tracks with how many gene copies are affected [1] [3] - Between 20% and 30% of people with atopic dermatitis carry a change in the same gene [3] - Some inherited marks, including café au lait spots, do not fade with time [7] - Where a condition belongs with a specialist center, a referral is part of what an appointment produces Diagnosis, a management plan built around the specific condition, and referral where a condition belongs with a specialist center. Pick a treatment to see how it works. Diagnosis and management of an inherited skin condition are medical care rather than a cosmetic service, and are handled differently from the aesthetic treatments on this site. Our office will go through what applies to you when you book. Prescription moisturizers and topical treatments are dispensed through a pharmacy and are billed separately from the visit. **Q: Is lifelong dry, scaly skin actually a condition?** Often, yes. Ichthyosis is a group of skin diseases causing extremely dry, thick and scaly skin, and about 95% of people who develop it have ichthyosis vulgaris, the mild and common form inherited from one or both parents. [1] It is frequently treated as ordinary dryness for decades, because it partially responds to ordinary moisturizer. **Q: Why does eczema run in my family alongside it?** Because it is the same gene. That gene makes a protein central to the skin's barrier, and changes in it cause ichthyosis vulgaris. [3] Between 20% and 30% of people with atopic dermatitis carry one of those changes, against 8% to 10% of people who do not have atopic dermatitis. [3] The two conditions turning up together in a family is a mechanism, not a coincidence. **Q: Can it be cured?** No, and it can be managed well. There is no cure for inherited ichthyosis vulgaris, and treatment focuses on reducing the scale and the dry skin. [2] The routine matters more than the product: soak, moisturize within two minutes on damp skin, and use something containing urea, alpha hydroxy acid or lactic acid. [2] **Q: Why does it get worse in winter?** Dry, cold air pulls moisture out of skin that already holds it poorly because of the barrier protein involved. [3] The routine does not change in winter, it just needs doing more often and more heavily. **Q: Will my children have it?** It is inherited, and severity varies with how many altered gene copies a person has. One copy is typically mild and sometimes seasonal, and two produce more severe symptoms that can be present year round. [3] That is a conversation worth having at an appointment, with the actual pattern in your family in front of you. **Q: Do you treat epidermolysis bullosa?** Evaluation and coordination, yes. Ongoing care belongs with a specialist center. Epidermolysis bullosa is a group of rare diseases that cause skin to blister easily, [4] blistering is usually noticeable at birth or shortly after, [5] and in the more severe forms skin cancer surveillance is part of ongoing specialist care. [6] California's university centers run dedicated programs, and a referral there is the right answer rather than a local claim to the contrary. **Q: Do I need a referral?** Yes. This is medical dermatology, and the practice is currently accepting new medical patients by referral from your primary care physician. Once you have that, call the office and we will get you in. 1. American Academy of Dermatology Association. "Ichthyosis vulgaris: Overview." States that "ichthyosis is a group of skin diseases that causes extremely dry, thick, and scaly skin," that "about 95% of people who develop ichthyosis get this type," that "children usually develop it when they inherit a gene(s) for the disease from one or both parents," and that "ichthyosis isn't contagious, so you cannot catch it from someone." [https://www.aad.org/public/diseases/a-z/ichthyosis-vulgaris-overview](https://www.aad.org/public/diseases/a-z/ichthyosis-vulgaris-overview) · Medical Organization 2. American Academy of Dermatology Association. "Ichthyosis vulgaris: Diagnosis and treatment." States that "a dermatologist can often diagnose ichthyosis vulgaris by looking at a patient's skin," advises to "apply moisturizer to damp skin within two minutes of bathing," states that "your dermatologist may recommend a moisturizer that contains an active ingredient like urea, alpha hydroxyl acid, or lactic acid," that "soaking helps hydrate your skin and soften the scale," and that "there is no cure for inherited ichthyosis vulgaris. Treatment focuses on reducing the scale and dry skin." [https://www.aad.org/public/diseases/a-z/ichthyosis-vulgaris-treatment](https://www.aad.org/public/diseases/a-z/ichthyosis-vulgaris-treatment) · Medical Organization 3. MedlinePlus Genetics, U.S. National Library of Medicine. "FLG gene." States that "the FLG gene provides instructions for making a large protein called profilaggrin, which is found in cells that make up the outermost layer of skin (the epidermis)," that "filaggrin plays an important role in the skin's barrier function," that "more than 40 FLG gene mutations have been found to cause a relatively common skin disorder called ichthyosis vulgaris, which is characterized by dry, scaly skin," that "typically, individuals with a mutation in one copy of the FLG gene are mildly affected; they may have symptoms only seasonally, or they may never have obvious skin problems," that "individuals with two mutated copies of the gene have more severe symptoms that may be present year-round," that "mutations in the FLG gene are strongly associated with a skin disorder called atopic dermatitis (also known as atopic eczema)," and that "twenty to 30 percent of people with atopic dermatitis have an FLG gene mutation compared with 8 to 10 percent of the general population without atopic dermatitis." [https://medlineplus.gov/genetics/gene/flg/](https://medlineplus.gov/genetics/gene/flg/) · Government Organization 4. American Academy of Dermatology Association. "Epidermolysis bullosa: Overview." States that "epidermolysis bullosa (EB) is a group of rare diseases that cause the skin to blister easily," that "epidermolysis bullosa simplex (EBS): This is the most common type," that "Kindler syndrome: This is a very rare type of EB," and that "some children have a mild disease that requires taking precautions to prevent injuries," while at the other end of the spectrum EB can be severe and lifelong. [https://www.aad.org/public/diseases/a-z/epidermolysis-bullosa-overview](https://www.aad.org/public/diseases/a-z/epidermolysis-bullosa-overview) · Medical Organization 5. American Academy of Dermatology Association. "Epidermolysis bullosa: Causes." States that "all but one type, epidermolysis bullosa acquisita (EBA), are caused by gene mutations," that "it is estimated that between 25,000 and 50,000 people in the United States have EB," and that "most types of EB begin in childhood. The fragile skin and blistering of EB are usually noticeable at birth or shortly thereafter." [https://www.aad.org/public/diseases/a-z/epidermolysis-bullosa-causes](https://www.aad.org/public/diseases/a-z/epidermolysis-bullosa-causes) · Medical Organization 6. National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health. "Epidermolysis Bullosa." Describes it as "a group of rare diseases that cause the skin to be fragile and to blister easily," states that "most people who have epidermolysis bullosa inherit a mutated (changed) gene from their parents," names the four groups as epidermolysis bullosa simplex, junctional epidermolysis bullosa, dystrophic epidermolysis bullosa and Kindler syndrome, states that "the symptoms of the disease usually begin at birth or during infancy and range from mild to severe," and notes an elevated risk of skin cancer that warrants ongoing surveillance. [https://www.niams.nih.gov/health-topics/epidermolysis-bullosa](https://www.niams.nih.gov/health-topics/epidermolysis-bullosa) · Government Organization 7. American Academy of Dermatology Association. "Birthmarks: Diagnosis and treatment." States that "birthmarks that don't fade with time include café au lait spots, moles, and port-wine stains," and that a dermatologist should examine a birthmark as soon as it is noticed. [https://www.aad.org/public/diseases/a-z/birthmarks-treatment](https://www.aad.org/public/diseases/a-z/birthmarks-treatment) · Medical Organization 8. Foundation for Ichthyosis and Related Skin Types. "Eczema and Ichthyosis." States that mutations in the filaggrin gene "confer a substantial risk of atopic dermatitis," and that "the gene involved codes for the precursor form of filaggrin, a protein involved in the final stages of formation of the barrier of the epidermis." [https://www.firstskinfoundation.org/eczema-and-ichthyosis](https://www.firstskinfoundation.org/eczema-and-ichthyosis) · Nonprofit Organization Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Inherited skin conditions vary widely in severity and in what they involve beyond the skin, and the descriptions here are general rather than specific to any individual. Genetic testing and genetic counseling are separate services and are arranged by referral where they are appropriate. Several inherited skin conditions are managed by specialist centers, and referral is part of what an evaluation produces. Individual results may vary. ### Hair Loss & Thinning Almost everyone who books this appointment has already been told it is stress, or genetics, or just something that happens. Sometimes that is right. Often it is one of half a dozen other things, several of which are straightforwardly correctable once somebody actually looks. The causes include pattern hair loss, alopecia areata, traction from how hair is worn, postpartum shedding, scalp infections, and deficiencies in iron, zinc, protein and biotin. [1] Some of those need a prescription. Some need a supplement. One of them needs you to stop wearing a tight ponytail. They look similar in the mirror and they are not similar at all. The difference matters more than it sounds, because a handful of causes affect the follicle permanently if they run long enough, while most do not. Identifying which one you have is what protects your options, and it is a single appointment rather than a project. **What brings people in** - A part that has been getting wider in photographs - More hair in the drain, the brush or on the pillow than there used to be - A ponytail that feels noticeably thinner in your hand - Patchy areas, or a hairline that has moved - Shedding a few months after a birth, an illness, surgery or a stressful stretch - Thinning that started after beginning a new medication How your hair is thinning narrows the list considerably before you get here. Look at your part in daylight, and think about the timing rather than the amount. What you noticeWhat it often points toWhy it mattersA part that has widened gradually over years, thinning through the crownPattern hair lossTreatable, and treatment works better the earlier it starts [1]Heavy shedding that began two to four months after a birth, illness, surgery or a hard stretchShedding triggered by an eventFrequently recovers on its own, and we can confirm that rather than guess [1]Round, smooth patches that appeared quicklyAlopecia areataA specific condition with specific treatment, worth identifying properly [1]Thinning at the temples or along the hairline where hair is pulled tightTraction from stylingChanging the style is part of the treatment, and early is much better than late [1]Diffuse thinning all over, with tiredness, cold, or changes in your nails or skinPossibly a deficiency or a thyroid issueFound on blood work and corrected directly [1]Scalp that is itchy, sore, scaly or red in the thinning areasOverlaps with scalp healthThe scalp is treated alongside the hair, not separately This narrows it, it does not settle it. Several of these overlap and two of them can look identical for the first year. Bring what you have noticed and the timing, and it makes the appointment considerably faster. AreaWhat it looks likeThe partThe earliest place most women notice it, and the easiest to track in photographs.CrownGradual thinning that is often seen by somebody else first.Hairline and templesWhere pattern loss and traction from styling both show, and where they can look alike.Patches anywhereRound, smooth areas that appear over weeks rather than years.Eyebrows and lashesSometimes affected by the same conditions, and worth mentioning if they are. ![Woman inspecting her hairline](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-hair-loss.webp) Supplements, shampoos, serums and devices are sold on the assumption that all thinning is the same problem. It is not, and the thing that separates a plan that works from one that does not is somebody examining your scalp, testing how your hair is growing, and running blood work where it will actually tell us something. [1] That is what this appointment is. You leave knowing which cause you are dealing with, whether it is the kind that recovers on its own, and what the options are for yours. If the answer is [Nutrafol](/treatments/nutrafol/), you will hear that. If the answer is a prescription, [platelet-rich fibrin](/treatments/platelet-rich-fibrin-prf/)), correcting a deficiency, or simply changing how you wear your hair, you will hear that instead. **Worth booking an appointment when:** - You have noticed it in photographs, which is usually earlier than you notice it in the mirror - Shedding has been going on longer than about three months - There are patches, or bare areas, rather than general thinning - The scalp is itchy, sore, scaly or red where the hair is thinning - Thinning started within a few months of a new medication - You are considering a supplement or a device and want to know whether it is the right one **Also worth knowing:** - Sooner is better. Treatment generally works better begun early [1] - Come with your hair down and unstyled, so the scalp can be seen - Bring a list of your medications and supplements, including anything over the counter - Mention any recent illness, surgery, birth, weight change or major stress, with rough dates If you are unsure whether it is worth an appointment, it is. The most common regret we hear is having waited, and there is nothing to lose by having it looked at early. It depends entirely on the cause, which is the point of the whole page. Some causes recover on their own once the trigger has passed, and knowing that is itself worth the appointment. [1] Deficiencies are corrected and the hair follows. Pattern hair loss is treated and maintained. Conditions affecting the follicle are treated and monitored. **Whatever the cause, do** - Give any treatment a fair run, because hair grows slowly and three months is the earliest anything shows - Photograph your part in the same light every couple of months, since day-to-day comparison is unreliable - Keep the scalp health side of it in good order, because hair grows out of skin - Wear sun protection on any thinning or exposed scalp [2] **Whatever the cause, don't** - Judge progress by what is in the drain on any given day - Layer several unrelated products and lose track of which one is doing anything - Pull hair tight in styles that put steady tension on the hairline - Stop a working treatment without telling us, since most of them are maintenance Tell us if it does not seem to be working after a fair run. There is usually another option, and the second choice often suits better than the first. Once the cause is clear, the plan is straightforward. Pick a treatment to see how it works. A hair loss evaluation is medical care rather than a cosmetic service and is handled differently from the aesthetic treatments on this site. Our office will go through what applies to you when you book. Where the plan includes a treatment or a product rather than a prescription, that is quoted like anything else and you will know the cost before you commit. **Q: How much shedding is normal?** Everyone sheds daily, and the number matters far less than the trend. What is worth an appointment is a change: more than there used to be, for more than about three months, or a part that is visibly wider in photographs. **Q: Is it stress?** Sometimes, and shedding after a stressful stretch, an illness, surgery or a birth is common and often recovers on its own. [1] The catch is that several other causes look exactly the same, so "it is probably stress" is a reasonable guess rather than an answer. **Q: Will I need blood work?** Sometimes. A blood test or scalp biopsy is part of diagnosis where a deficiency, hormone imbalance or infection may be involved. [1] It is ordered when it will change the plan. **Q: Does it grow back?** Often, yes. Hair frequently regrows on its own after pregnancy, illness, surgery, cancer treatment, significant weight loss and mild alopecia areata. [1] Other causes need treatment to hold or improve things, and a small number affect the follicle permanently, which is why the timing of the appointment matters. **Q: Do supplements work?** For a genuine deficiency, correcting it works well. Beyond that it depends on the cause, which is why we would rather look first and then tell you whether Nutrafol is the right thing for you specifically. **Q: Is my scalp the problem?** Sometimes, and the two show up together often enough that they are examined together. Scalp health has its own page, and a scalp that is irritated or inflamed is a less good place to grow hair from. 1. American Academy of Dermatology Association. "Hair loss: Diagnosis and treatment." Describes diagnosis through questions about onset and speed, close examination of the scalp, nails and other areas of hair loss, and a gentle pull test, and states that "you may need a blood test or scalp biopsy" where a disease, deficiency, hormone imbalance or infection is suspected. Names pattern hair loss, alopecia areata, traction alopecia, frontal fibrosing alopecia, central centrifugal cicatricial alopecia, postpartum shedding, scalp ringworm and deficiencies in biotin, iron, zinc and protein among the causes. Notes that hair may regrow on its own after pregnancy, major illness, surgery, cancer treatment, significant weight loss and mild alopecia areata, and that treatment "tends to be more effective if you begin taking it when you first notice hair loss." [https://www.aad.org/public/diseases/hair-loss/treatment/diagnosis-treat](https://www.aad.org/public/diseases/hair-loss/treatment/diagnosis-treat) · Medical Organization 2. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Hair loss has many causes and they are diagnosed by examination, and in some cases by blood work or a scalp biopsy. Results from any treatment depend on the cause, and hair grows slowly enough that several months are needed before progress can be judged. Some causes of hair loss affect the follicle permanently, which is why an early appointment matters. Individual results may vary. ### Hyperhidrosis Hyperhidrosis is a medical condition that causes the body to produce more sweat than the body needs to cool itself. [1] **It is treatable.** [1] That is the whole of the framing, and it matters because most people arrive at this page having spent years treating it as a personal failing rather than as something a doctor addresses. The primary form affects the underarms, palms, soles, scalp and face, usually starting in childhood or adolescence. [2] It stops while you sleep. [2] The secondary form causes heavy sweating over most of the body, can wake you at night, and is driven by a medication or another condition. [2] [3] **That distinction is the first thing an appointment establishes**, because it changes what gets treated. The consequences are real and they are rarely asked about: sweat visible on skin or on clothing, sweating that interferes with everyday things like shaking hands or writing, body odor, soft skin that may peel, chafing or frequent skin infections, and feeling embarrassed, frustrated or insecure. [2] The last one is a symptom rather than an overreaction, and it is a legitimate reason to treat. **What tends to set it off** [2] - Hot weather and high humidity - Feeling anxious or nervous - Physical activity - Caffeine There is a real order to this, and almost nobody gets told what comes after the first step. This is the whole ladder, with the honest duration on each rung where one is published. StepWhat it isWhat to expect1. Antiperspirant, properly usedAn antiperspirant temporarily blocks your sweat glands, and there are prescription-strength versions [4]Non-prescription antiperspirants are only effective for mild hyperhidrosis. [4] Applied to dry skin at night, with deodorant in the morning [5]2. Prescription topicalMedicated cloths and gels approved for primary hyperhidrosis of the underarms, from age 9 upward [4]Applied at home, no procedure involved3. Botulinum toxin injectionsApproved for hyperhidrosis of the underarms, hands, feet and face, working by temporarily reducing sweat where it is injected [4]Less sweating within 7 to 10 days. Underarms or hands, 3 to 10 months. Feet, 3 to 6 months. Face, about four and a half months [4]4. DevicesIontophoresis, cleared for the hands and feet; microwave thermolysis and a sweat-control patch, both cleared for the underarms [4]Site-specific, and each suits a different pattern5. Oral medicationMedications that work throughout the body to reduce the ability of sweat glands to produce sweat, and a separate option where sweating is driven by anxiety or stress [4]Discussed where topical and injection routes have not been enough6. SurgerySweat gland removal, or surgery on the nerves [4]Can permanently stop excessive sweating in the treated area [4] Two notes on the language above, because they are not interchangeable. The drugs in this sequence are **FDA approved**; the devices are **FDA cleared**. And step six is the only one described as permanent, and only for the area treated. [4] **Most people have only ever been at step one, and often not even at the prescription version of it.** That is the single most common reason somebody has concluded nothing works. AreaWhat tends to happen thereUnderarmsThe most treated area, and where the most options are approved or cleared. [2] [4]PalmsWhere it interferes with handshakes, writing and touchscreens. [2]SolesWhere it produces soft skin that peels, and frequent shoe and sock changes. [2] [5]Face and scalpNamed in the primary form, and the hardest area to conceal. [2]Skin folds generallyWhere chafing and repeat skin infections follow the moisture. [2]Most of the body at oncePoints toward the secondary form rather than the primary one. [2] ![Woman's sweaty armpit](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-hyperhidrosis.webp) The reason to have this looked at rather than managed is that half the work is diagnostic. Which form you have, whether a medication you are already taking is driving it, which areas are involved, and how much it is actually affecting your life are all questions with consequences, and they get asked at [the visit where somebody looks](/treatments/skin-care-consultations/). [3] Nobody sells you a treatment before that conversation happens. After it, the range is genuinely wide and it is mostly unknown to the people who need it. Prescription antiperspirants, medicated cloths and gels, [botulinum toxin injections](/treatments/botox-cosmetic-xeomin/), devices for hands, feet and underarms, oral medication and surgery are all established routes with different fits. [4] A practice that offers one of those finds one of those suitable for everyone. Having the whole ladder available is what makes step three the right recommendation only when it actually is. **Book an appointment if:** - You sweat more than seems necessary, in one or two areas, and it has been that way since childhood or adolescence [2] [3] - Sweating interferes with everyday things: shaking hands, writing, holding a phone, wearing what you want [2] - Over-the-counter antiperspirant has not been enough - You are changing clothes, shoes or socks during the day to manage it - You get chafing, peeling skin or repeated skin infections in the affected area [2] - It is affecting how you feel about work, dating or being in a room. That is a symptom, not a complaint [2] **Mention it at the visit if:** - You sweat heavily while you are asleep, or over most of your body, which points at the secondary form [3] - You have started a new medication, or changed a dose - Sweating came on suddenly in adulthood rather than gradually from childhood The visit is mostly questions: medications, how long, how often, which areas, family history and how it affects your life, sometimes with a physical exam or testing. [3] There is no cure for hyperhidrosis at this time, and a dermatologist can build a plan around it. [1] These are the parts you run yourself. **Worth doing** - Use antiperspirant rather than deodorant to reduce sweating, and apply prescription antiperspirant to dry skin at night, with deodorant on waking [5] - Keep a short sweat journal to find what actually triggers yours: heat, spicy food, caffeine, alcohol, emotional stress [5] - Breathable fabrics like cotton, a spare set of clothes, and underarm shields [5] - For sweaty feet, change shoes and socks often, choose leather shoes and moisture-wicking socks, and use absorbent powder or insoles [5] - Drink plenty of water, because sweating dehydrates you [5] **Worth knowing** - Excessive sweating can be lifelong, and it tends to lessen with age [2] - Skin that stays damp is more prone to chafing, peeling and infection, and to skin that is irritated by what it touches [2] - Taking care of your mental health is named as part of managing this, and counseling or a support group is a legitimate part of the plan [5] - The sequence above is real. If you have only tried a supermarket antiperspirant, you have tried one rung of six Assessment first, then the step in the sequence that fits where you sweat and what you have already tried. Pick a treatment to see how it works. Evaluation and medical treatment of hyperhidrosis are handled differently from the aesthetic treatments on this site. **Botulinum toxin for excessive sweating is a medical use of that treatment rather than a cosmetic one**, and our office will go through what applies to you when you book. You will have the plan and its cost before anything is scheduled rather than partway through a course. **Q: Is this actually a medical condition?** Yes. Hyperhidrosis is a treatable medical condition that causes the body to produce more sweat than it needs to cool itself. [1] It has a name, a diagnostic process and a treatment sequence, and it is not a hygiene issue or a matter of managing it better. **Q: Does Botox work for sweating, and how long does it last?** Yes, and it is approved for the underarms, hands, feet and face. It works by temporarily reducing the amount of sweat where it is injected. [4] Most patients notice less sweating within 7 to 10 days. Results last 3 to 10 months for the underarms or hands, 3 to 6 months for the feet, and about four and a half months for the face. [4] **Q: What should I try before injections?** An antiperspirant, used properly, and there is a prescription-strength version. [4] Non-prescription antiperspirants are only effective for mild hyperhidrosis, and most people apply them at the wrong time. Applied to dry skin at night, with deodorant in the morning, is the correct method. [5] There are also medicated cloths and gels approved for underarm hyperhidrosis. [4] The sequence above sets the whole thing out. **Q: Why do I sweat at night?** That is worth mentioning, because primary hyperhidrosis stops while you sleep. [2] Sweating that happens while you are asleep points toward the secondary form, which is driven by a medication or another condition. [3] It changes what gets treated, which is why the question gets asked first. **Q: Can it be cured?** Not at this time, and a dermatologist can build a treatment plan around it. [1] Surgery is the only option described as permanently stopping excessive sweating, and only in the treated area. [4] For most people the realistic goal is a treatment that holds well enough for long enough, repeated on a schedule that suits their life. **Q: Will it get better on its own?** Excessive sweating can be lifelong, and it does tend to lessen with age. [2] That is not much comfort in your twenties and thirties, which is precisely when it interferes with the most. **Q: Do I need a referral?** Yes. This is medical dermatology, and the practice is currently accepting new medical patients by referral from your primary care physician. Once you have that, call the office and we will get you in. 1. American Academy of Dermatology Association. "Hyperhidrosis: FAQs." States that hyperhidrosis is "excessive sweating, this medical condition causes the body to produce more sweat than the body needs to cool itself," that "this is a treatable medical condition that causes people to sweat excessively," and that "at this time, there isn't a cure for hyperhidrosis. However, a dermatologist can customize a treatment plan for you." [https://www.aad.org/public/diseases/a-z/hyperhidrosis-overview](https://www.aad.org/public/diseases/a-z/hyperhidrosis-overview) · Medical Organization 2. American Academy of Dermatology Association. "Hyperhidrosis: Signs and symptoms." States that primary hyperhidrosis affects the underarms, palms, soles, scalp and face while secondary hyperhidrosis "usually causes heavy sweating over most of the body," names "beads of perspiration on your skin or wet areas on your clothing," sweating that "interferes with everyday activities," onset "in childhood or adolescence," that it "stops while you sleep" in the primary form, and names body odor, "soft skin that may peel," "chafing or frequent skin infections," and feeling "embarrassed, frustrated, or insecure." Names as triggers "hot weather, high humidity, feeling anxious or nervous, physical activity, and caffeine," and states that "although excess sweating can be lifelong, sweating tends to lessen with age." [https://www.aad.org/public/diseases/a-z/hyperhidrosis-symptoms](https://www.aad.org/public/diseases/a-z/hyperhidrosis-symptoms) · Medical Organization 3. American Academy of Dermatology Association. "Hyperhidrosis: Causes." Describes primary hyperhidrosis as arising from "faulty signals coming from certain nerves, which tell the body when to sweat," affecting one or two areas of the body in typically otherwise-healthy people, with risk factors including blood relatives with excessive sweating and being aged 24 or younger. Describes secondary hyperhidrosis as caused by medications including antibiotics, antivirals, insulin and antidepressants, or by conditions including diabetes, Parkinson's disease, rheumatoid arthritis, heart failure, stroke and menopause, plus substance withdrawal, and states that secondary hyperhidrosis "can cause you to sweat while you're asleep." States that diagnosis involves questions about medications, duration, frequency, body areas affected, family history and life impact, and that "to give you an accurate diagnosis, you may need a physical exam, medical testing, or both." [https://www.aad.org/public/diseases/a-z/hyperhidrosis-causes](https://www.aad.org/public/diseases/a-z/hyperhidrosis-causes) · Medical Organization 4. American Academy of Dermatology Association. "Hyperhidrosis: Diagnosis and treatment." States that "an antiperspirant temporarily blocks your sweat glands" and that "non-prescription antiperspirants are only effective for treating mild hyperhidrosis." States that botulinum toxin is "FDA approved to treat hyperhidrosis" of the "underarms, hands, feet, and face," that it "treats excessive sweating by temporarily reducing the amount of sweat where it's injected," that "most patients notice less sweating within 7 to 10 days of being treated," and gives duration by area as "underarms or hands: 3 to 10 months," "feet: 3 to 6 months," and "face: 4 1/2 months." Names a glycopyrronium medicated cloth and a sofpironium gel, both FDA approved from age 9, iontophoresis "cleared" for the hands and feet, microwave thermolysis "cleared" for the underarms, a sweat-control patch "cleared" for the underarms in people 18 and older, oral glycopyrronium and oxybutynin which "work throughout the body to reduce the ability of sweat glands to produce sweat," propranolol for sweating due to anxiety or stress, and surgery, of which it states "surgery can permanently stop excessive sweating in the treated area." [https://www.aad.org/public/diseases/a-z/hyperhidrosis-treatment](https://www.aad.org/public/diseases/a-z/hyperhidrosis-treatment) · Medical Organization 5. American Academy of Dermatology Association. "Hyperhidrosis: Tips for managing." Advises to "use antiperspirant instead of deodorant to reduce sweating," applying prescription antiperspirant to dry skin at night and deodorant on waking; to "keep a sweat journal to find what triggers your sweating," naming heat, spicy foods, caffeine, alcohol and emotional stress; to "wear breathable fabrics like cotton," with spare clothes and underarm shields; for sweaty feet to change shoes and socks often, choose leather shoes, "moisture wicking" socks, absorbent powder and insoles; to "drink plenty of water. Sweating can dehydrate you"; and to "take care of your mental health," naming counseling and support groups. [https://www.aad.org/public/diseases/a-z/hyperhidrosis-self-care](https://www.aad.org/public/diseases/a-z/hyperhidrosis-self-care) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Excessive sweating can be a symptom of another condition or of a medication, which is why evaluation comes before treatment. There is no cure for hyperhidrosis; treatments reduce sweating for a period and are repeated. Durations given on this page describe results reported in groups of patients and do not predict any individual outcome. Botulinum toxin injections carry risks including injection-site discomfort, bruising and temporary muscle weakness in the treated area, which are discussed before treatment. Oral medications and surgery carry their own risks. Individual results may vary. ### Infantile Hemangiomas An infantile hemangioma is a birthmark made of blood vessels. In the classification system used for vascular birthmarks it is a benign vascular tumor, which is a different category from a vascular malformation such as [a port-wine stain, which behaves differently](/conditions/vascular-anomalies/). [9] The practical difference is the one that matters to parents: a hemangioma grows and then goes, and a malformation stays. **The superficial type looks like a strawberry-colored lump that feels firm and rubbery.** [1] Most appear on the head or neck, though they can develop anywhere on the skin or on moist tissue inside the mouth. [1] **The deep type sits further down**, appears skin colored or bluish-purple, and feels warm and firm. [1] **The growth phase is short and it is the part that alarms people.** A superficial hemangioma tends to grow quickly, usually until the child is 4 to 6 months old, and some grow for longer. [1] A deep one can grow for up to a year. [1] Watching a birthmark get bigger week over week is frightening if nobody has told you it was going to happen, and knowing it is coming is most of what makes it manageable. [4] **Then it turns around.** In time, all of them shrink. [1] The color changes toward slate gray and the lump begins to soften. [1] About 10% of superficial hemangiomas are gone by age 1 and about 90% by age 10. [1] Deep ones run slower, with about half gone by age 5 and nearly 90% by age 10. [1] Almost every question parents ask about a hemangioma is really a question about timing. Here is the whole arc in one place. StageRoughly whenWhat is happeningAppearsAt birth or in the first weeksA mark that may be faint at first [1]GrowsUsually until 4 to 6 months, sometimes longer. Deep ones up to a yearThe fast phase, and the one that worries people [1]Treatment decision, if there is oneOften before 6 monthsTreatment starts while it is still growing, which is what makes early evaluation matter [3]Plateau and turnThrough the first yearGrowth stops. Color begins shifting toward slate gray and the lump softens [1]FadesYears, not monthsAbout 10% gone by age 1, about 90% by age 10 [1]What is leftAfter it has goneOften little evidence it was there. Sometimes excess fibrofatty tissue, fine surface vessels or loose skin [1] [7] **The reason the timing matters is simple.** A hemangioma that is going to need treatment needs it during the growth phase, and the growth phase is mostly over by six months. [1] [3] An appointment at eight weeks and an appointment at eight months are two different conversations. **Have a dermatologist examine a birthmark as soon as you notice it, so you know what type it is and whether it needs treatment.** [2] **Watching it is a legitimate plan and it is the usual one.** Most hemangiomas fade without treatment, and formally deciding to watch a birthmark is one of the options a dermatologist will put on the table. [2] The value of the appointment is that watching becomes a choice with a timeline attached rather than a default. **What treatment looks like when it is needed.** An oral beta blocker called propranolol is the first and only medication approved by the FDA for this birthmark. [3] It can prevent a hemangioma from growing and can shrink one that is growing. [2] The birthmark may feel softer within 24 hours of the first dose, and treatment usually runs six months or longer to keep it from returning. [3] A related medication, timolol, comes as a liquid applied to the skin and is used at a lower dose than it would be for its original purpose. [2] Corticosteroids and surgery are used in specific situations. [2] **Pulsed dye lasers are safely used on infants and children**, including for hemangioma birthmarks. [6] LocationWhy it changes the planNear the eyeIt can grow over the eye quickly, which can cause a serious eye problem [3]Near the mouth or lipIt can grow over the lips and make feeding or breathing difficult [3]Near the noseTreatment can prevent it from covering that part of the face [2]In the groin or diaper areaTreatment can prevent pain later on [2]Large or in a highly visible placeTreatment may be recommended where the birthmark affects appearance enough to matter to the child later [2]Anywhere it has broken downAs a hemangioma shrinks the skin over it can break down and become painful. That is a call, not a wait [1] **A small hemangioma on a thigh and a small hemangioma on an eyelid are not the same clinical situation**, and that is the single most useful thing to understand before an appointment. Size gets the attention. Position drives the decision. ![Infantile Hemangiomas](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-infantile-hemangiomas.webp) [The pulsed dye laser we use](/treatments/vbeam-photorejuvenation/) is a Candela Vbeam®. Its FDA clearance covers a pediatric indication in plain terms: treatment of cutaneous capillary malformations, also known as port wine stains, and infantile hemangiomas and congenital hemangiomas. [8] That is the device sitting in this building, cleared for exactly this use. Pulsed dye lasers are safely used on infants and children. [6] **The alternative for most Central Coast families is a drive.** The vascular birthmark programs are at the university children's hospitals, and they are excellent and they are hours away. Having a board-certified dermatologist who can look at a birthmark in San Luis Obispo, tell you what it is, tell you whether the timeline needs anything from you, and treat it here when treatment is warranted is a different proposition from booking a day trip to find out that watching it is the answer. The same device handles vascular concerns in adults, including [the fine surface vessels on a face or leg](/conditions/spider-veins/). A birthmark that is [pigmented rather than vascular](/conditions/moles/) is a separate evaluation, and telling the two apart is the first thing that happens at the appointment. **Call sooner if the birthmark:** - Is near the eye, on or near the lips or mouth, or near the nose [2] [3] - Is growing quickly and is large, or is in a place that is hard to keep clean - Has broken down, opened, or is causing the baby pain [1] - Is in the groin or diaper area [2] - Is one of several Seeing a birthmark grow quickly is unsettling, and knowing it is going to happen and what to watch for is what settles it. [4] A dermatologist can also tell you whether treatment is recommended at all. [4] **During the growth phase** - Expect it to get bigger before it turns around. That is the normal course, usually through 4 to 6 months [1] - Photograph it in the same light, from the same distance, every couple of weeks. It makes the plateau obvious when it arrives - Keep the area clean and protected from rubbing, particularly in the diaper area and under collars - If the surface breaks down, call rather than treating it at home. That can be painful and it is worth seeing [1] **During the fading years** - Color shifts toward slate gray and the lump softens before it flattens [1] - The process runs in years. About 10% of superficial hemangiomas are gone by age 1, about 90% by age 10 [1] - Deep ones are slower, with about half gone by age 5 [1] **What can be left behind** - Often little evidence that it was ever there [1] - The skin may return to normal, and often there are residual changes: excess fibrofatty tissue, fine surface vessels, or loose skin [7] - Around 8% leave a cosmetic change that warrants some intervention [7] - Residual changes are treatable, and that conversation happens after involution rather than during it Evaluation first, then either a plan to watch it or a plan to treat it. Pick a treatment to see how it works. Evaluation and treatment of an infantile hemangioma are medical care rather than a cosmetic service, and are handled differently from the aesthetic treatments on this site. Our office will go through what applies to you when you book. Where laser treatment is part of the plan, it is being used for a medical indication, and our office will explain how that is handled before anything is scheduled. **Q: Will it go away on its own?** Almost certainly, and it will take years rather than months. All of them shrink in time. [1] About 10% of superficial hemangiomas are gone by age 1 and about 90% by age 10, and deep ones follow a slower version of the same curve, with about half gone by age 5. [1] **Q: It is getting bigger. Is that normal?** Yes, and it is the part nobody warns parents about. A superficial hemangioma tends to grow quickly, usually until the child is 4 to 6 months old, and some grow longer. A deep one can grow for up to a year. [1] Growth stops, and then the color starts shifting toward slate gray and the lump softens. [1] **Q: When does a hemangioma need treatment?** Mostly it is about location. Near the eye it can grow over the eye and cause a serious eye problem. Near the mouth it can grow over the lips and make feeding or breathing difficult. [3] In the groin, treatment can prevent pain later. Large or highly visible birthmarks are sometimes treated for that reason alone. [2] And if the surface breaks down as it shrinks, that needs to be seen. [1] **Q: If it needs treatment, when does that start?** Early. Because this birthmark starts growing early in life, treatment often begins before a child is 6 months old. [3] That is the reason to have a birthmark examined as soon as you notice it rather than at the next well-child visit. [2] **Q: What is the treatment?** Usually a medication. Propranolol, an oral beta blocker, is the first and only medication approved by the FDA for this birthmark. [3] It can prevent growth and shrink a hemangioma that is growing. [2] The birthmark may feel softer within 24 hours of the first dose, and a course usually runs six months or longer. [3] Timolol, applied to the skin as a liquid, is used in some cases. [2] Corticosteroids, surgery and laser treatment are used in specific situations. [2] [6] **Q: Can a laser be used on a baby?** Yes. Pulsed dye lasers are safely used on infants and children for a range of conditions including hemangioma birthmarks. [6] The pulsed dye laser in this office carries an FDA clearance that names infantile hemangiomas in the pediatric population. [8] **Q: Will anything be left behind?** Sometimes. Often there is little evidence a hemangioma was ever there. [1] The skin may return to normal, and often there are residual changes, usually excess fibrofatty tissue, fine surface vessels or loose skin. [7] Around 8% leave a cosmetic change that warrants some intervention. [7] Those are addressed after it has resolved, not during. **Q: Do I need a referral?** Yes. This is medical dermatology, and the practice is currently accepting new medical patients by referral from your primary care physician. Once you have that, call the office and we will get you in. 1. American Academy of Dermatology Association. "Birthmarks: Signs and symptoms." Describes the superficial infantile hemangioma, called a strawberry hemangioma, as a birthmark that "usually looks like a strawberry-colored lump that feels firm and rubbery," notes that "most occur on the head or neck, but this birthmark can develop anywhere on the skin or moist tissue inside the mouth or anus," and that "this birthmark tends to grow quickly, usually until the child is 4 to 6 months old." Describes the deep or cavernous type as a birthmark that "looks like a lump that sits deep in the skin," which "can grow quickly and grow for up to a year." States that "in time, all strawberry hemangiomas shrink," that the color changes to slate gray as it shrinks, that "about 10% disappear by the age 1 and 90% are gone by the time a child is 10 years old," and for the deep type that nearly 90% "will be gone by the time a child is 10 years old" with about half gone by age 5. Notes that when the birthmark shrinks "the skin may break down, causing pain," and that a superficial hemangioma "usually goes away on its own, leaving little evidence that it was ever there," while a deep one "can leave a light spot or scar on the skin." [https://www.aad.org/public/diseases/a-z/birthmarks-symptoms](https://www.aad.org/public/diseases/a-z/birthmarks-symptoms) · Medical Organization 2. American Academy of Dermatology Association. "Birthmarks: Diagnosis and treatment." States: "Have a dermatologist examine a birthmark as soon as you notice it, so you know what type of birthmark your child has and whether it needs treatment." Lists watching the birthmark as a formal option, noting it "can be an effective approach for a strawberry hemangioma, a type of birthmark that can grow quickly." On location, states that "if one appears near your child's eye, mouth, or nose, treatment can prevent it from covering that part of your child's body," and that "in the groin area, treatment can prevent pain later on"; on size, that "if the birthmark affects the child's appearance and could cause problems with self-esteem, your dermatologist may recommend treatment." Describes propranolol as a medication that "can effectively prevent a hemangioma from growing" and "can also shrink a growing hemangioma," which "has been approved to treat this type of birthmark," and timolol as a medication that "can also help shrink a growing hemangioma," which "comes in liquid form" and is prescribed at "a lower dose of the medication than would be used to treat glaucoma." Also lists corticosteroids, interferon, surgery and makeup. [https://www.aad.org/public/diseases/a-z/birthmarks-treatment](https://www.aad.org/public/diseases/a-z/birthmarks-treatment) · Medical Organization 3. American Academy of Dermatology Association. "Heart medicine can clear strawberry birthmarks." States: "Since this birthmark starts to grow early in life, treatment often begins before a child is 6 months old," and "you want to treat your child when the birthmark starts to grow. This helps prevent a serious health problem." States that "propranolol is the first and only FDA-approved treatment for this birthmark," that "within 24 hours of giving your child the first dose, the birthmark may feel softer" and "soon after, you may see the birthmark start to shrink," and that "you may need to give your child propranolol for 6 months or longer. This helps prevent the birthmark from returning." On location, states that "if a hemangioma appears near your child's eye, it could quickly cover the eye. This could cause a serious eye problem," and that "near the mouth, this birthmark can grow over the lips," making it difficult for a baby to eat or breathe. [https://www.aad.org/diseases/a-z/heart-medicine-can-clear-strawberry-birthmarks](https://www.aad.org/diseases/a-z/heart-medicine-can-clear-strawberry-birthmarks) · Medical Organization 4. American Academy of Dermatology Association. "Birthmarks: Overview." States that "it's estimated that between 3% and 10% of babies are born with a type of birthmark called a hemangioma," that "one thing that most birthmarks have in common is that they're harmless. Yet, if you see a birthmark on your child's skin, it's wise to have a dermatologist examine it," that "what you think is a birthmark could be the first sign of a skin disease," that "some birthmarks are a sign that something is going on inside your baby's body," and that "it's also possible that your baby has a harmless birthmark that will grow quickly. Seeing a birthmark grow quickly can be scary. Knowing this will happen and learning what to watch for can help put your mind at ease." [https://www.aad.org/public/diseases/a-z/birthmarks-overview](https://www.aad.org/public/diseases/a-z/birthmarks-overview) · Medical Organization 5. American Academy of Dermatology Association. "Birthmarks: Causes." Lists factors associated with a higher likelihood of a hemangioma, including premature birth, birth weight under about five and a half pounds, female sex, white race, and multiple births. [https://www.aad.org/public/diseases/a-z/birthmarks-causes](https://www.aad.org/public/diseases/a-z/birthmarks-causes) · Medical Organization 6. American Academy of Dermatology Association. "Skin conditions lasers treat." States that "some lasers, such as pulsed dye lasers and intense pulsed light therapy, are safely used on infants and children to treat a wide range of conditions, including port wine stain and hemangioma birthmarks." [https://www.aad.org/public/diseases/a-z/skin-conditions-lasers-treat](https://www.aad.org/public/diseases/a-z/skin-conditions-lasers-treat) · Medical Organization 7. StatPearls, National Center for Biotechnology Information. "Infantile Hemangioma." States that after involution "the skin may return to normal, but often there are residual changes (excessive fibrofatty tissue, telangiectasia, skin laxity)," and that "approximately 8% of IH leave cosmetic disfigurement and require some intervention." States that "ulceration is the most common complication and occurs in up to 10% of cases," with higher risk in the anogenital area, lower lip, axilla and neck. [https://www.ncbi.nlm.nih.gov/books/NBK538232/](https://www.ncbi.nlm.nih.gov/books/NBK538232/) · Medical Reference 8. U.S. Food and Drug Administration. 510(k) Premarket Notification K230990, "Candela Vbeam Family of Pulsed Dye Lasers (Vbeam Prima, Vbeam Perfecta)," Candela Corporation, decision date June 1, 2023, product code GEX, regulation 878.4810, Class 2, found substantially equivalent. The cleared indications include, at 595 nm, a pediatric population indication for "treatment of cutaneous capillary malformations, also known as port wine stains (PWS), and infantile hemangiomas (IH) / congenital hemangiomas." [https://www.accessdata.fda.gov/cdrh_docs/pdf23/K230990.pdf](https://www.accessdata.fda.gov/cdrh_docs/pdf23/K230990.pdf) · Government Organization 9. International Society for the Study of Vascular Anomalies. "ISSVA Classification of Vascular Anomalies (2018)." Divides vascular anomalies into vascular tumors and vascular malformations, and classifies "infantile hemangioma / hemangioma of infancy" as a benign vascular tumor, separately from capillary malformations such as port-wine stain. [https://www.issva.org/UserFiles/file/ISSVA-Classification-2018.pdf](https://www.issva.org/UserFiles/file/ISSVA-Classification-2018.pdf) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Infantile hemangiomas vary widely, and the descriptions here are general rather than specific to any child. Medications used to treat hemangiomas, including propranolol and timolol, carry their own risks and monitoring requirements, which are discussed before treatment begins. Laser treatment is used in selected cases. FDA clearance of a device describes the uses for which the device may be marketed and is not a statement about any individual outcome. Individual results may vary. ### Melasma Melasma is a common skin condition that causes patches and spots on the face darker than your natural skin tone. [1] The color runs from tan and brown to grayish brown or bluish gray, and it settles on the cheeks, forehead, chin and above the upper lip. [1] Less often it turns up on the arms or the neck. [1] What gives it away is the symmetry: melasma tends to arrive in matching areas on both sides of the face rather than as separate spots. It is most common in women, and most likely in people with medium to deep skin tones. [1] It is so common in pregnancy that it has a nickname, the mask of pregnancy. [1] Men get it too, less often, and it is frequently missed in them. **Not every brown patch on a face is melasma, and that is the first thing worth settling.** [Sun spots](/conditions/sun-damage/) are separate, individual marks and they clear well with light-based treatment. [Dark marks left behind by old breakouts](/conditions/acne-acne-scarring/) fade on their own timeline. Melasma is spread out, matches side to side, and behaves differently from either. Telling them apart changes the whole plan. **What people usually notice first** - Brown or gray-brown patching across the cheeks that arrived gradually - A shadow above the upper lip that no amount of washing shifts - Darkening that started in pregnancy, or after starting a hormonal medication - Patching that gets worse every summer and eases off in winter - Something that lightens with a product and then comes straight back Most people who are frustrated with melasma are not using the wrong product. They are using it in the wrong order, or without the layer underneath it. The sequence below is what gets people there, and each step keeps running once the next one starts. StepWhat it isWhy it comes here1. Protection, every dayA tinted sunscreen with iron oxide, SPF 30 or higher, broad spectrum, water resistant, plus shade, a wide-brimmed hat and an oral sun-protection supplement where you are outdoors a lot [2]Light is what makes the pigment. Without this layer, everything above it is being undone daily, and this is the step people skip or get wrong2. Prescription-strength topical treatmentThe creams and gels that do the steady lightening, chosen for your skin at the visit [3]This is where most of the improvement actually comes from. It runs for months, not weeks3. In-office treatment, on topA light peel kept deliberately shallow, or light treatment, and laser resurfacing where earlier steps have not gotten there [3]Adding a laser or light treatment improves results for people who are already applying medication and protecting their skin from the sun. [3] On its own it tends to buy a few good months4. MaintenanceProtection continues, with topical treatment stepped down to what holds itMelasma is a condition rather than a mark. Holding a result is the normal state, not a setback The steps are cumulative, not sequential replacements. Nobody gets to step three and stops wearing sunscreen. **The single most common version of "melasma treatment did not work for me" is step three without steps one and two underneath it.** AreaWhat tends to happen thereCheeksThe most common site, and where the side-to-side symmetry is most obvious. [1]ForeheadOften a broad band across the top, which people mistake for a tan line. [1]Above the upper lipThe patch that reads as a shadow and is the hardest to cover. [1]ChinFrequently overlooked, and often the last area to lighten. [1]JawlineWhere it gets confused with other causes of darkening and is worth having identified.Forearms and neckLess common than the face, and it does happen. [1] ![Close-up on melasma](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-melasma.webp) Melasma is one of the conditions where the wrong procedure sets you back, and holding off is often the right call. Adding a laser or light treatment improves results for people who are already applying medication and protecting their skin from the sun. [3] That is a real and useful finding, and it is also a precise one: the improvement belongs to the combination, not to the laser on its own. So we build the plan from the bottom up, and the in-office work goes on top of a foundation rather than in place of one. The other half is naming it correctly before treating it. A dermatologist can usually diagnose melasma by looking closely at your face and neck, sometimes with a specialized light or a dermatoscope. [3] [Sun spots](/conditions/sun-damage/) and [dark marks left behind by old breakouts](/conditions/acne-acne-scarring/) both get treated as melasma and respond to entirely different things. At our San Luis Obispo office the diagnosis, the prescriptions that do the heavy lifting and the in-office work that supports them are planned together at one visit. **Book an appointment if:** - Brown or gray-brown patching has appeared across your cheeks, forehead, chin or upper lip - Something you assumed was sun damage has not responded to anything you have tried - Patching started in pregnancy, or after starting a hormonal medication - Your darkening gets worse every summer and never fully clears in winter - You want to know whether it is melasma at all before you spend anything on treating it **Especially worth booking if:** - You have a medium or deep skin tone, where melasma is most likely and where the wrong procedure carries the most risk [1] - You have already had a treatment elsewhere that made it darker - You are planning a pregnancy or a change in hormonal medication and want a plan in place first Melasma may go away on its own, and it can also last for years. [1] For some women it fades after a baby is born or after stopping birth control pills. [1] Either way, having it named properly costs one appointment and changes what you do next. This is the part that decides your result, and it runs every day rather than at appointments. **Worth doing** - A tinted sunscreen containing iron oxide, SPF 30 or higher, broad spectrum and water resistant [2] - Apply it 15 minutes before going outside, and reapply at least every two hours [2] - Every day, including cloudy days, and again after swimming or sweating [2] - Shade, a wide-brimmed hat and sunglasses with UV protection, ideally with a UPF label [2] - Start the heavier work in the darker months if you can, since melasma rises and falls with how much light you get **Worth knowing** - Visible light worsens melasma, especially on deeper skin tones, which is exactly what a clear sunscreen does not cover [2] - If a skin care product burns or stings, it is irritating your skin, and that can darken dark spots [2] - Indoor tanning worsens melasma and stops treatment from working [2] - Results take between three and twelve months, and longer if you have had melasma a long time [3] - It commonly returns without ongoing protection. Maintenance is the plan working, not the plan failing Sun protection, prescription-strength skin care and in-office treatment on top, in that order. Pick a treatment to see how it works. What a melasma plan costs depends on which steps it includes, and most of the work happens in the daily layers rather than in the office. You get the plan and its cost at the consultation, before anything is booked. Where a plan includes in-office treatment, the number of visits depends on how your skin has responded to the steps underneath it, and you will have that number before anything is scheduled. **Q: Will it go away by itself?** Sometimes. Melasma may go away on its own, and it can also last for years. [1] For some women it fades after a baby is born or after they stop taking birth control pills. [1] Melasma you have had for years generally needs treating, and it comes back if you stop protecting your skin from light. **Q: Why is my melasma getting worse when I wear sunscreen every day?** Most likely because your sunscreen does not cover visible light, the ordinary light you can see, which worsens melasma and does so more on deeper skin tones. [2] A clear formula does very little against it. What melasma needs is a tinted sunscreen containing iron oxide, with an SPF of 30 or higher. [2] The tint is not cosmetic. It is the part that blocks the light. **Q: Is it the same as age spots?** No. Sun spots are separate, individual marks and they clear well with light-based treatment. Melasma is spread out, matches on both sides and behaves differently. Telling them apart is the first thing a visit settles, and it changes everything that follows. **Q: Can laser get rid of it?** It can help, in the right position in the plan. Adding a laser or light treatment improves results for people who are already applying medication to their skin and protecting it from the sun. [3] Used on its own it usually buys a few good months. That is why a light peel kept deliberately shallow, light treatment and laser resurfacing all sit at step three here rather than step one. **Q: How long before I see a difference?** It usually takes between three and twelve months to see results, and longer if you have had melasma for a long time. [3] Creams are judged at months, not at weeks. Summer is harder than winter, so starting the heavy lifting in the darker months helps if your timing allows it. **Q: Will it come back?** Very likely, if daily protection stops. Maintenance is part of the plan rather than evidence that treatment failed. If you are on hormonal birth control that is worth discussing, not automatically a reason to change anything, but it belongs in the conversation. 1. American Academy of Dermatology Association. "Melasma: Overview." States that "melasma is a skin condition that causes patches and spots, usually on the face, which are darker than your natural skin tone," describes "tan, brown, grayish brown, or bluish gray patches and freckle-like spots," names the cheeks, forehead, chin and above the upper lip, and notes that "while less common, melasma can develop on the arms, neck, or elsewhere." States that "melasma is most common in women," that "women who have medium to dark skin tones are most likely to develop melasma," that it is "so common during pregnancy that it's sometimes called the 'mask of pregnancy,'" that "while melasma may go away on its own, this skin condition can also last for years," and that "for some women, the melasma goes away after their baby is born or they stop taking birth control pills." [https://www.aad.org/public/diseases/a-z/melasma-overview](https://www.aad.org/public/diseases/a-z/melasma-overview) · Medical Organization 2. American Academy of Dermatology Association. "Melasma: Self-care." States that "visible light has been shown to worsen melasma, especially for people with darker skin tones," advises protecting skin "every day, even on cloudy days and after swimming or sweating," a sunscreen offering "broad-spectrum protection, water-resistance, SPF of 30 or more" applied "15 minutes before going outside" and reapplied "at least every two hours," and specifically to "use a tinted sunscreen that contains iron oxide in addition to having an SPF of 30 or higher." Recommends shade and sun-protective clothing including a wide-brimmed hat and UV-protective sunglasses with a UPF label. States that "if a skin care product burns or stings when you use it, the product is irritating your skin. This may darken dark spots," and that "indoor tanning devices can worsen melasma and prevent treatment from working." [https://www.aad.org/public/diseases/a-z/melasma-self-care](https://www.aad.org/public/diseases/a-z/melasma-self-care) · Medical Organization 3. American Academy of Dermatology Association. "Melasma: Diagnosis and treatment." States that "a dermatologist can often diagnose melasma by looking closely at your face and neck," sometimes using a Wood's lamp or dermatoscope and occasionally a skin biopsy to rule out other conditions. Names hydroquinone, tretinoin with a mild corticosteroid, triple combination cream, azelaic acid, kojic acid, vitamin C and, for stubborn cases, tranexamic acid among topical and oral options, and names chemical peels, microneedling, laser and light treatments and platelet-rich plasma among procedures. States that "it usually takes between 3 to 12 months to see results. It may take longer if you've had melasma for a long time," and that "a few studies have found that adding a laser or light treatment can improve results for patients who are already applying medication to their skin and protecting their skin from the sun." States that sunlight "causes the skin to make more pigment, which can darken existing melasma and cause new patches," and recommends sunscreen containing zinc oxide, titanium dioxide or iron oxide at SPF 30 or higher, plus wide-brimmed hats and shade. [https://www.aad.org/public/diseases/a-z/melasma-treatment](https://www.aad.org/public/diseases/a-z/melasma-treatment) · Medical Organization 4. American Academy of Dermatology Association. "Melasma: Causes." States that "when sunlight hits our skin, it triggers the body to produce more melanin," that "an increase in the hormones estrogen and progesterone, which occurs during pregnancy, is thought to trigger melasma," and names birth control pills, anti-seizure medications and "medications that make your skin more sensitive to sunlight (includes retinoids, some antibiotics, and some blood pressure medications)." States that "some research findings suggest that stress can trigger melasma," that a tanning bed or sunlamp "tends to produce stronger ultraviolet (UV) rays than sunlight," that a thyroid problem "may increase your risk of developing melasma," and that "patients with melasma often have one or more blood relative(s) who also had melasma." [https://www.aad.org/public/diseases/a-z/melasma-causes](https://www.aad.org/public/diseases/a-z/melasma-causes) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Not every darker patch on the face is melasma, and diagnosis is made by examination. Melasma is a chronic, relapsing condition; treatment manages it and it commonly returns without ongoing protection from light. Laser and light treatment carries a risk of relapse and of darker marks left behind, particularly on deeper skin tones, and is discussed individually before anything is scheduled. Prescription treatment is determined by your physician. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### Moles A mole is a cluster of pigment-producing cells that has grouped together instead of spreading evenly through the skin. Nearly every adult has a few, and most people with light skin acquire somewhere between ten and forty of them over a lifetime. [2] They can appear anywhere, including the scalp, between the fingers and toes, on the palms and soles, and under the nails. [1] A common mole has a recognizable profile. One color, usually brown but sometimes tan, black, red, pink, blue, skin-toned or without color at all. Round. Flat or slightly raised. And, most usefully, unchanged from month to month. [1] A mole that has looked the same for twenty years is behaving exactly as it should. Some moles simply look different from the rest. Atypical moles tend to be larger than a pencil eraser, irregular in shape, and made up of more than one color. [2] Having several of them is a reason to be checked on a schedule rather than a reason for alarm, and having them checked is the whole of what is being asked. **What is worth bringing in** - A mole that has changed in size, shape or color [1] - A new spot that does not look like your other spots [1] - A mole that itches, bleeds or will not heal [1] - A mole with an irregular edge, more than one color, or larger than a pencil eraser [2] - Anything on your skin you have started keeping an eye on Almost every question about mole removal gets easier once you separate these. They are different appointments, decided in a different order, and the method follows from which one you are in. The medical reasonThe practical reasonWhy it is coming offSomething about it needs an answer: it has changed, it looks atypical, or it does not match your other spotsIt has already been examined and found harmless, and it catches on a collar, a razor or a bra strap, or you would simply rather not have itWho decidesYour dermatologist, after examining itYou do, once the medical question is settledHow it is doneRemoved whole and sent to the laboratory, so the tissue can be read properlySurgical excision or a surgical shave, chosen for the mole and the location [3]Where the tissue goesTo the laboratory, every timeTo the laboratory, every time [3]What you get backA diagnosisA confirmation, because we do not skip that stepThe orderThis always comes firstThis always comes second The one rule underneath all of it: **every mole we remove is examined under a microscope, including the ones removed purely because you did not like them.** [3] Nothing is judged harmless on appearance alone and then discarded. That is also why over-the-counter mole removal products and at-home methods are a bad trade. They can scar, they can leave cancer cells behind, and they delay a diagnosis. [3] If something needs an answer before a decision can be made, [a biopsy](/treatments/skin-cancer-diagnosis/) provides it, usually at the same visit. AreaWhy it matters hereBack and shouldersThe most common site of melanoma in men, and the hardest area to watch yourself.LegsThe most common site of melanoma in women, and easily overlooked.ScalpMoles form here too, and hair hides them completely. [1]Face, neck and chestThe most examined skin on the body, and where a change gets noticed first.Palms, soles and under the nailsMoles occur here, and these are places nobody thinks to check. [1]Between fingers and toesMoles form here too, and this is one of the most routinely missed places. [1] ![moles on the back](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-moles.webp) Telling an unusual but harmless mole apart from an early melanoma is one of the things a board-certified dermatologist trains longest for, and it is done with a lighted magnifier rather than a glance. A dermatologist's trained eye can often tell whether a spot is a mole. [3] Where looking is not enough, the tissue answers the question instead of a guess. All of it happens in one place. The check, [a biopsy](/treatments/skin-cancer-diagnosis/) if one is needed, the removal, and the follow-up visits afterward are at our San Luis Obispo office, with the same practice that has seen your skin before. That history is worth a great deal on this particular question, because "has this changed?" is much easier to answer when someone has looked at it before. **Book an appointment if you notice:** - A mole changing in size, shape or color [1] - A mole that itches, bleeds, or has a sore that will not heal [1] - A new spot that looks different from all your other spots [1] - A mole with an uneven edge, more than one color, or a diameter larger than a pencil eraser [1] - A mole that has started to look different from its neighbors **Worth being on a schedule if:** - You have a lot of moles, or several that look atypical [2] - You or a close relative has had a melanoma [2] - You have fair skin that burns easily, or you used tanning beds at any point - You have spent years outdoors on the Central Coast and have never had a full skin exam A mole that has looked identical for years and does not itch or bleed is behaving normally. If you are not sure whether what you are seeing counts as a change, book the appointment. That is precisely what ten minutes is for. Both methods are done in the office under local anesthetic, at the same visit where the decision is made where that is practical. - Surgical excision. The mole is cut out and the skin closed with stitches where they are needed. [3] - Surgical shave. The mole is removed at the surface with a blade, which suits raised moles. [3] Either way, the tissue goes to the laboratory and is examined under a microscope. [3] You get the result, and you get it whether or not there is anything to report. **Afterward** - Keep the area clean and covered as instructed, and leave any dressing on for as long as you are told to - Expect some tenderness for a few days, and follow the aftercare sheet rather than the internet - Every removal leaves some mark. How noticeable it ends up depends on the size of the mole, where it sits, which method was used and how your skin heals, and your dermatologist will go through that with you before anything comes off - A mole removed by shave can leave pigment at the base and regain color over time, which is one of the things weighed when the method is chosen - Come back if the area gets more painful, redder or swollen after the first few days rather than less Examination, biopsy, removal and follow-up, all in one practice. Pick a treatment to see how it works. Evaluation, biopsy and medically indicated removal are medical care rather than a cosmetic service, and are handled differently from the aesthetic treatments on this site. Our office will go through what applies to you when you book. Where tissue is sent for examination, laboratory fees are billed separately by the laboratory that reads the sample, and we will tell you when a sample is being sent. **Q: Are moles dangerous?** Nearly every adult has a few and most people carry harmless moles their whole lives. [2] The ones worth attention are the ones that change, and the new spots that were never moles to begin with. **Q: If I have a lot of moles, should I have some removed?** No. A high mole count and several atypical moles both go with a higher melanoma risk, and the right response to that is a regular skin exam rather than preemptive removal. [2] Removing a harmless mole does not lower your risk. Being on a schedule does. **Q: Can a mole be removed with a laser?** Not as a first step. Mole removal is a surgical excision or a surgical shave, both of which preserve the tissue so it can be examined under a microscope. [3] That examination is the point. Anything that destroys the tissue takes the answer with it. **Q: Will removal leave a mark, and can a mole come back?** Some mark, yes, and how noticeable depends on the mole, the location, the method and how you heal. Your dermatologist goes through that before the procedure rather than after. A mole removed completely does not return; one removed by shave can regain color at the base over time, which is part of how the method gets chosen. **Q: Should I photograph my moles?** It helps a lot. A photo with a coin or a ruler in it for scale turns "has this changed?" into a question with an actual answer at your next visit. It does not replace an exam, and it is worth photographing the areas you cannot see as well as the ones you can. **Q: I have a new spot and it was never a mole. Does this page apply to me?** Yes, and yours is the more important case. In a meta-analysis of 38 studies covering more than 20,000 melanomas, about 7 in 10 had arisen on skin where there had been no mole at all. [4] Watching your existing moles is worth doing, and it is not the whole job. Bring in the new spot. **Q: Do I need a referral?** Yes. This is medical dermatology, and the practice is currently accepting new medical patients by referral from your primary care physician. Once you have that, call the office and we will get you in. 1. American Academy of Dermatology Association. "Moles: Signs and symptoms." States that a common mole is "one color," which is "often brown, but a mole can be tan, black, red, pink, blue, skin-toned, or colorless," that it is "round in shape," "flat or slightly raised," and "unchanged from month to month," and that "moles can appear anywhere on the skin. They can develop on your scalp, between your fingers and toes, on the soles and palms, and even under your nails." Also sets out the ABCDEs of melanoma: asymmetry, irregular border, more than one color, a diameter greater than about 6 millimeters, and a spot that is evolving. [https://www.aad.org/public/diseases/a-z/moles-symptoms](https://www.aad.org/public/diseases/a-z/moles-symptoms) · Medical Organization 2. American Academy of Dermatology Association. "Moles: Who gets and types." States that "nearly every adult has a few moles" and that "most adults have a type of mole called a common mole, which is harmless," that most people with light skin acquire roughly 10 to 40 moles over a lifetime, that congenital moles are present at birth in about 1 in 100 people, that atypical moles "are often larger than an eraser on the end of a pencil," irregular in shape and more than one color, and that having four or more atypical moles, or 50 or more common moles, is associated with an increased risk of melanoma. [https://www.aad.org/public/diseases/a-z/moles-types](https://www.aad.org/public/diseases/a-z/moles-types) · Medical Organization 3. American Academy of Dermatology Association. "Moles: Diagnosis and treatment." States that "a dermatologist's trained eye can often tell whether a spot is a mole," that "most moles do not require treatment," that a dermatologist removes a mole that is bothersome, unattractive or suspicious for cancer, describes surgical excision and surgical shave as the two removal procedures, states that removed tissue is examined under a microscope for cancer cells and that the patient is notified if any are found, and warns against at-home removal because cancer cells can be left behind and spread, because scarring can result, because equipment is not sterile, and because "products that remove moles can cause scarring and delay a skin cancer diagnosis." [https://www.aad.org/public/diseases/a-z/moles-treatment](https://www.aad.org/public/diseases/a-z/moles-treatment) · Medical Organization 4. Pampena R, Kyrgidis A, Lallas A, Moscarella E, Argenziano G, Longo C. "A meta-analysis of nevus-associated melanoma: Prevalence and practical implications." Journal of the American Academy of Dermatology. 2017;77(5):938-945. Pooled 38 observational studies covering 20,126 melanomas and found that "29.1% of melanomas likely arose from a preexisting nevus and 70.9% de novo." PMID 28864306. https://pubmed.ncbi.nlm.nih.gov/28864306/ · Peer-Reviewed Study Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Appearance alone does not establish what a growth is; a diagnosis comes from tissue examined in a laboratory. Not every changing mole is a cancer, and not every skin cancer looks like a changing mole. Every removal leaves some mark, and healing varies by person, method and location. A mole removed by surgical shave can regain pigment over time. A skin examination is not a guarantee that every problem will be found, and anything that changes between appointments should be reported rather than waited on. Individual results may vary. ### Nail Disorders Most nail appointments are about one of three things: an infection, an ingrown nail, or a change in a nail that turns out to be a sign of something else. The third category is the reason nails are worth a dermatologist rather than a nail salon, because a nail is one of the places where a skin condition, and occasionally a serious one, shows up first. **Nail fungus, also called onychomycosis, is the most common.** [1] It causes color change, a brittle nail that cracks, splits or crumbles, buildup under the nail, lifting so the nail is no longer firmly attached, thickening, a misshapen nail, and sometimes pain. [2] Changes typically start at the tip and move toward the cuticle. Colors run from yellow and white through brown, orange and greenish-black. [2] On darker skin tones, a thickened nail is often brown, and the infected skin around the nail tends to be a bit darker than your natural skin tone. [2] **Nails also carry signals from elsewhere.** Pitting can come from [psoriasis](/conditions/psoriasis/), atopic dermatitis or [alopecia areata](/conditions/alopecia/). Spoon-shaped nails are associated with iron deficiency. Yellow nails are associated with lung disease and rheumatoid arthritis. Curving of the nails is associated with disease in the lungs, heart, liver, stomach or intestine. Deep grooves mean something slowed or stopped nail growth. [4] None of that means a nail change is bad news; it means it is information worth reading properly. **Changes worth having examined** [4] - A dark streak in a nail, which is the important one - A nail lifting away from the nail bed - Redness and swelling around a nail - A greenish-black color - Pitting, deep grooves, spoon-shaped nails or clubbing - Any change in a nail that swells or causes pain This is the honest timeline, and it is the reason so many people give up partway. Nail fungus is highly treatable with a dermatologist's help, and it is slow, because a nail can only grow at the speed a nail grows. [3] RouteHow long it runs [3]Topical solution applied to the nailUsually 48 weeksOral treatment, fingernailsAbout 6 weeksOral treatment, toenailsAbout 12 weeksWaiting for the nail to fully grow outA year or longer, whatever the treatmentIf a nail is removed, fingernail regrowth6 months or longerIf a nail is removed, toenail regrowth12 to 18 months **The most important thing on that table is the last column of the fourth row.** Even when the fungus is gone, the nail you can see is still the old damaged one until it has grown out entirely, and that takes a year or more. People stop treatment at month four because the nail still looks bad, and the nail still looks bad because nails are slow. What you seeWhat it can indicate [4]A dark streak in the nailMelanoma. This is the one to bring in rather than watch [4] [5]The nail lifting away from the bedFungal infection, psoriasis, or injuryRedness and swelling around the nailInfection around the nailGreenish-black discolorationA bacterial nail infectionPitting, meaning tiny dentsPsoriasis, atopic dermatitis or alopecia areataYellow nailsAssociated with lung disease and rheumatoid arthritisDeep grooves or gaps across the nailSomething slowed or stopped nail growthSpoon-shaped nailsAssociated with iron deficiencyCurving nails, or clubbingAssociated with disease in the lungs, heart, liver, stomach or intestine **This table is not a diagnostic tool and it is not meant to be read as one.** Most nail changes turn out to be ordinary. What it is for is the last line of the section: if your nails change, swell or cause pain, see a dermatologist, because these can be signs of serious nail problems. [4] ![a nail disorder in the thumb](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-nail-disorders.webp) Almost everything on this page is ordinary. One thing is not. **A brown or black band in a nail, often on the thumb or big toe, is the first sign of melanoma under the nail**, and the other signs are darkened skin near the nail, the nail separating from the bed, a crack down the center, or a bump under the nail. [5] Nail melanoma is more common in older people and **in people with skin of color**, and prior nail trauma is a risk factor. [5] The reason that belongs on a nail page rather than a skin cancer page is that people bring dark streaks to a nail salon, a podiatrist or nobody at all, and treat them as bruises. **Found early, melanoma, even on the nails, is highly treatable.** [5] Where a nail change needs an answer rather than a treatment, [a small sample sent to a laboratory](/treatments/skin-cancer-diagnosis/) gives one, here, usually at the same visit. That is the whole argument for this appointment, and everything else on the page is the ordinary work that comes with it. **Book an appointment straight if you notice:** - A new dark band or streak in a nail. [5] This is the one that does not wait - Darkened skin next to a nail, a nail separating from its bed, a crack down the center of a nail, or a bump under a nail [5] **Book an appointment if:** - A nail is thickening, discoloring, crumbling or lifting [2] - You have tried an over-the-counter nail treatment without result - A nail or the skin around it is red, swollen or painful [4] - Your nails have developed pitting, grooves, spooning or curving [4] - You have an ingrown toenail, particularly one that is sore or infected [6] If your nails change, swell or cause pain, see your dermatologist, because these can be signs of serious nail problems. [4] Diagnosis usually involves an examination plus nail clippings or scrapings examined under a microscope. [3] **Worth doing** [6] [7] - Cut nails straight across, using sharp scissors or clippers, rounding slightly at the tips for strength. That is also how ingrown toenails are avoided [6] [7] - Do not dig out an ingrown toenail, especially if it is infected and sore. That is an appointment rather than a project [6] - Keep feet dry, change socks when they are damp, and wear something on your feet in pools, locker rooms and communal showers [1] - Do not share clippers, files or towels, since nail fungus spreads that way [1] - Give a treatment its full run. Stopping at month four because the nail still looks bad is the most common way this goes wrong **Worth knowing** - Nail fungus is contagious, to other people and to your own other nails [1] - It does not clear on its own [1] - A dark streak in a nail is never something to monitor at home [4] [5] Diagnosis, prescription treatment, and where a nail change needs an answer rather than a treatment, the test that gives one. Pick a treatment to see how it works. Diagnosis and treatment of nail conditions are medical care rather than a cosmetic service, and are handled differently from the aesthetic treatments on this site. Our office will go through what applies to you when you book. Where nail clippings or a small sample are sent for examination, laboratory fees are billed separately by the laboratory, and we will tell you when anything is being sent. **Q: How long does nail fungus take to treat?** Longer than most people expect, and the treatment and the appearance run on different clocks. Topical solution usually runs 48 weeks. Oral treatment runs about six weeks for fingernails and twelve for toenails. And a nail takes a year or longer to completely grow out, whatever the treatment, so the nail keeps looking damaged after the infection is handled. [3] The timeline table above sets it all out. **Q: What is the dark line in my nail?** Have it looked at. A brown or black band in a nail, often on the thumb or big toe, is the first sign of melanoma under the nail. [5] Most dark lines turn out to be something else, and this is the single nail change that is not worth monitoring at home. Found early, melanoma, even on the nails, is highly treatable. [5] **Q: Can a dermatologist treat an ingrown toenail?** Yes, and it is worth going rather than digging. The guidance is direct: avoid digging out ingrown toenails, especially if they are infected and sore, and see a dermatologist for treatment. [6] Cutting nails straight across is what prevents the next one. [6] [7] **Q: Can my nails really show other health problems?** Sometimes. Pitting is associated with psoriasis, atopic dermatitis and alopecia areata; spooning with iron deficiency; yellow nails with lung disease and rheumatoid arthritis; curving with disease in several organs. [4] Most nail changes are ordinary. The value is in having somebody who knows the difference look at them. **Q: Do I need a referral?** Yes. This is medical dermatology, and the practice is currently accepting new medical patients by referral from your primary care physician. Once you have that, call the office and we will get you in. 1. American Academy of Dermatology Association. "Nail fungus: FAQs." States that "nail fungus, also called onychomycosis, is a fungal infection that can affect both your toenails and fingernails," that it is contagious through direct contact with infected nails or skin and through shared towels and clippers, that walking barefoot in warm moist shared places raises the risk, that it can arise from athlete's foot, and that it does not clear on its own. [https://www.aad.org/public/diseases/a-z/nail-fungus-overview](https://www.aad.org/public/diseases/a-z/nail-fungus-overview) · Medical Organization 2. American Academy of Dermatology Association. "Nail fungus: Signs and symptoms." Names "color change," "brittle nail that cracks, splits, or crumbles," "buildup under a nail," "lifting, so the nail is no longer firmly attached," "thickened nail," "misshapen nail or nail falls off" and "pain." States that changes tend to start at the tip and move toward the cuticle, that colors include yellow, brown, white, orange and greenish-black, that a "thickened nail is often brown," and that "if you have a darker skin tone, infected skin around the nail tends to be a bit darker than your natural skin tone." [https://www.aad.org/public/diseases/a-z/nail-fungus-symptoms](https://www.aad.org/public/diseases/a-z/nail-fungus-symptoms) · Medical Organization 3. American Academy of Dermatology Association. "Nail fungus: Diagnosis and treatment." Describes diagnosis by examination for "color change, buildup beneath a nail, and other signs of nail fungus" plus nail clippings or scrapings viewed "under a microscope" to rule out psoriasis or injury. Gives treatment durations of "usually for 48 weeks" for efinaconazole and tavaborole topical solutions, "6 weeks" for terbinafine for fingernails and "12 weeks" for toenails, and "12 weeks" for itraconazole for toenails; states it takes "a year or longer for your nail to completely grow out," and that after nail removal fingernail regrowth takes "6 months or longer" and toenail regrowth "12 to 18 months." States that "with a dermatologist's help, nail fungus is highly treatable," and that maintenance therapy may run "for a year or longer" particularly with diabetes, damaged blood vessels or previous nail injury. [https://www.aad.org/public/diseases/a-z/nail-fungus-treatment](https://www.aad.org/public/diseases/a-z/nail-fungus-treatment) · Medical Organization 4. American Academy of Dermatology Association. "12 nail changes a dermatologist should examine." Names a dark streak, which "could be melanoma, the most serious type of skin cancer"; nail lifting up; redness and swelling around a nail; greenish black color from bacterial infection; pitted nails, associated with psoriasis, atopic dermatitis and alopecia areata; yellow nails, associated with "lung disease and rheumatoid arthritis"; deep grooves or gaps, meaning "something slowed (or stopped) your nails from growing"; thick overgrown nails; spoon-shaped nails, associated with iron deficiency; washboard nails; curved nails or clubbing, associated with disease in the "lungs, heart, liver, stomach or intestine"; and color changes. States that "if your nails change, swell, or cause pain, see your dermatologist because these can be signs of serious nail problems." [https://www.aad.org/public/everyday-care/nail-care-secrets/basics/nail-changes-dermatologist-should-examine](https://www.aad.org/public/everyday-care/nail-care-secrets/basics/nail-changes-dermatologist-should-examine) · Medical Organization 5. American Academy of Dermatology Association. "How to check your nails for melanoma." Names five signs: a dark streak, described as a brown or black band in the nail, often on the thumb or big toe; darkened skin near the nail; nail separation from the nail bed; nail splitting down the center; and bumps or nodules under the nail. States that nail melanoma "is more common in older individuals and people with skin of color," names personal or family melanoma history and prior nail trauma among risks, states that melanoma found early, including on the nails, is "highly treatable," and advises that "if you notice any changes to your nails, including a new dark band on your nail, make an appointment to see a board-certified dermatologist." [https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma/nail-melanoma](https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma/nail-melanoma) · Medical Organization 6. American Academy of Dermatology Association. "11 dermatologists' tips for healthy nails." States "to reduce your chances of getting an ingrown toenail, cut straight across when trimming your toenails," and advises to "avoid 'digging out' ingrown toenails, especially if they are infected and sore. If you are suffering from an ingrown toenail, see a dermatologist for treatment." [https://www.aad.org/public/everyday-care/nail-care-secrets/basics/healthy-nail-tips](https://www.aad.org/public/everyday-care/nail-care-secrets/basics/healthy-nail-tips) · Medical Organization 7. American Academy of Dermatology Association. "How to trim your nails." States "cut nails straight across. Use sharp nail scissors or clippers. Round the nails slightly at the tips for maximum strength." [https://www.aad.org/public/everyday-care/nail-care-secrets/basics/how-to-trim-nails](https://www.aad.org/public/everyday-care/nail-care-secrets/basics/how-to-trim-nails) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. The associations listed on this page describe conditions that can produce particular nail changes; they do not establish that any individual has any condition, and most nail changes are not serious. A new dark streak in a nail should be examined by a board-certified dermatologist rather than monitored at home. Nail fungus is confirmed by laboratory examination, and treatment is slow because nails grow slowly; recurrence is possible. Oral and topical antifungal treatments carry their own risks, which are discussed before treatment. Individual results may vary. ### Psoriasis Psoriasis causes the body to make new skin cells in days rather than weeks. [1] As those cells pile up on the surface, you get thick, scaly patches called plaques. [1] Dry, thick and raised patches are the most common sign, they are often covered with a silvery-white coating called scale, and they tend to itch. [2] Plaques can appear anywhere, and they turn up most often on the knees, elbows, lower back and scalp. [2] About 80 to 90 percent of people living with psoriasis get plaques, which is why plaque psoriasis is what most people mean by the word. [1] Other forms exist: small salmon-colored spots that can clear on their own in weeks or months, patches in skin folds, and forms involving pustules. [2] The nails are often involved too, with tiny dents, discoloration under the nail, or crumbling. [2] **It is not contagious and it is not caused by anything you did.** [3] It is an immune condition: something goes wrong in the immune system, so T-cells attack the body's own skin cells. [3] People with certain genes are more likely to get it, and having a parent, grandparent or sibling with psoriasis raises the odds. [3] **What people usually notice first** - Thick raised patches with a silvery-white scale, most often on knees, elbows, lower back or scalp [2] - Itch, which tends to come with the plaques whatever their size [2] - Flaking and itching on the scalp that shampoo does not settle - Dents and changes in the nails, including discoloration or crumbling [2] - Patches that flare and settle rather than staying the same Almost every photograph of psoriasis you will find shows it on fair skin, as red or pink plaques with silvery-white scale. **That is one presentation out of several**, and if it is the only one you have seen, psoriasis on your own skin may not look like anything you recognize. Skin toneHow psoriasis tends to appear [4]Fair skinRed or pink plaques, and the scale is often silvery whiteHispanic skinMore likely salmon-colored plaques with silvery-white scaleAfrican American skinOften violet plaques with gray scaleDeeply pigmented skinCan be dark brown and genuinely difficult to see There is a second half to this that matters just as much. **When psoriasis clears on medium to deeply colored skin, you may be left with lighter or darker patches where the psoriasis used to be.** [4] Those patches are not scars and they do eventually go, though clearing can take three to twelve months or longer. [4] Knowing that in advance is the difference between a treatment that looks like it failed and one that worked exactly as expected. One practical consequence for treatment: light therapy can cause treated skin to tan or darken, and on skin of color it can make existing dark spots more noticeable. [4] That is a reason for the plan to be built around your skin rather than a reason to avoid treatment. AreaWhat tends to happen thereElbows and kneesThe classic sites, and usually the first plaques people notice. [2]ScalpThick scale along the hairline, frequently mistaken for flaking and itching on the scalp from another cause. [2]Lower backCommon, easy to ignore, and often the plaque that has been there longest. [2]NailsTiny dents, white, yellow or brown discoloration under the nail, crumbling or rough nails. [2]Skin foldsWhere plaques look smoother and shinier than elsewhere and get treated as a rash. [2]Anywhere at allPlaques can appear on any skin, which is why an examination covers more than the obvious places. [2] ![Psoriasis on the arms](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-psoriasis.webp) There is no single best treatment for psoriasis and no one treatment that works for everybody. [5] That sounds like a caveat and it is actually the argument: the range of options is wide, they work differently for different people, and matching them is a clinical judgment rather than a product choice. A board-certified dermatologist examines your skin, nails and scalp, takes a small sample where the picture is not clear, and builds from there. [5] The range runs from topical treatment through light therapy to medication that works throughout the body, and it has changed considerably in recent years. [5] Alongside whichever route suits you, [a routine that does not fight your treatment](/treatments/zo-skin-health/) matters more than people expect, because skin care plays a real part in reducing flares. [5] Both halves get planned in the same visit at our San Luis Obispo office. **Book an appointment if:** - You have thick, raised, scaly patches that have not cleared - Scale on your scalp is not settling with anything you have tried - Your nails have developed dents, discoloration, crumbling or lifting [2] - Patches keep coming back in the same places - Something has been treated as eczema or a rash without improving - You have a family member with psoriasis and something on your skin looks similar **Especially worth booking if:** - You have a darker skin tone and something violet, gray-scaled or dark brown has appeared that nobody has named [4] - You have joint pain or stiffness alongside skin changes, which is worth raising at the visit - A flare followed an infection, a new medication or a stressful period Psoriasis is diagnosed by a dermatologist examining your skin, nails and scalp, and sometimes by taking a small sample of skin. [5] There is nothing to prepare for. Most people who get psoriasis have it for life. [1] That sounds heavier than it is in practice: it is a condition that is managed, and managed well it spends most of its time quiet. **Worth doing** - Keep skin moisturized. Skin care plays a real part in reducing flares [5] - Learn your own triggers rather than everybody's. Keep a short note when a flare starts [3] - Treat a cut or a sunburn promptly, since skin injury is a recognized trigger [3] - Broad spectrum sunscreen, SPF 30 or higher, water resistant, every day [6] - Give a treatment its full run before judging it, and say so if it is not working rather than stopping quietly **Worth knowing** - Cold, dry weather is a recognized trigger, which on the Central Coast makes winter the season to be deliberate about moisturizing [3] - Tobacco and heavy drinking are both on the trigger list [3] - Psoriasis is not contagious, to anyone, ever [3] - On medium to deeply colored skin, lighter or darker patches after clearing are expected and temporary, and can take three to twelve months or longer to even out [4] - Small salmon-colored spots can clear on their own in a few weeks or months without treatment [2] Diagnosis, prescription treatment and a skin care routine that works with it rather than against it. Pick a treatment to see how it works. Diagnosis and treatment of psoriasis are medical care rather than a cosmetic service, and are handled differently from the aesthetic treatments on this site. Our office will go through what applies to you when you book. Where a small sample of skin is taken, laboratory fees are billed separately by the laboratory that examines it, and we will tell you when a sample is being sent. **Q: Is psoriasis contagious?** No. Unlike chickenpox or a cold, you cannot catch psoriasis from someone. [3] It is an immune condition, which means the process driving it happens inside your own body and there is nothing to pass on. **Q: Is it just very dry skin?** No, and that is the most common misunderstanding. Psoriasis is the body making new skin cells in days rather than weeks, so they pile up on the surface. [1] Moisturizer helps how skin feels and it does not slow the process producing the scale, which is why treatment aimed at the immune side is what actually clears plaques. **Q: What does it look like on darker skin?** Frequently not like the photographs. On African American skin psoriasis often looks violet with gray scale; on Hispanic skin more often salmon-colored with silvery-white scale; on deeply pigmented skin it can be dark brown and hard to see at all. [4] The comparison above sets those out side by side, and it is the reason psoriasis is missed on darker skin more often than it should be. **Q: Why do I have light or dark patches where my psoriasis cleared?** That is expected. On medium to deeply colored skin, clearing psoriasis often leaves lighter or darker patches behind. They are not scars and they do go, though it can take three to twelve months or longer. [4] Your dermatologist may call it dyspigmentation. It is a sign treatment worked rather than a sign it went wrong. **Q: Can it be cured?** Most people who get psoriasis have it for life. [1] What it is, is manageable, and the range of treatment is wide enough that there is no one best option for everyone. [5] The realistic goal is skin that is clear or close to it most of the time, and a plan for the flares. **Q: What sets off a flare?** The recognized triggers are stress, skin injury such as a cut or a bad sunburn, infection such as strep throat, certain medications including lithium, prednisone and hydroxychloroquine, cold dry weather, tobacco and heavy drinking. [3] Yours will be a shorter list than that, and finding it is worth doing early. **Q: Do I need a referral?** Yes. This is medical dermatology, and the practice is currently accepting new medical patients by referral from your primary care physician. Once you have that, call the office and we will get you in. 1. American Academy of Dermatology Association. "Psoriasis: Overview." States that "psoriasis is a condition that causes the body to make new skin cells in days rather than weeks," that "as these cells pile up on the surface of the skin, you may see thick, scaly patches," that those patches "are called plaques," that "about 80% to 90% of people living with psoriasis get plaques," and that "most people who get psoriasis have it for life." [https://www.aad.org/public/diseases/psoriasis/what/overview](https://www.aad.org/public/diseases/psoriasis/what/overview) · Medical Organization 2. American Academy of Dermatology Association. "Psoriasis: Signs and symptoms." States that "dry, thick, and raised patches on the skin are the most common sign of psoriasis," that "these patches are often covered with a silvery-white coating called scale, and they tend to itch," that plaques "can appear anywhere on the skin, but you're most likely to find them on the: Knees, Elbows, Lower back, Scalp," that "no matter the size, plaques tend to be itchy," describes guttate psoriasis as "small and scaly," "salmon-colored to pink" and "temporary, clearing in a few weeks or months without treatment," and names nail signs including "tiny dents in your nails (called 'nail pits')," "white, yellow, or brown discoloration under one or more nails" and "crumbling, rough nails." [https://www.aad.org/public/diseases/psoriasis/what/symptoms](https://www.aad.org/public/diseases/psoriasis/what/symptoms) · Medical Organization 3. American Academy of Dermatology Association. "Psoriasis: Causes." States that "when a person has psoriasis, something goes wrong in the immune system, so T-cells also attack the body's skin cells," that "scientists have found that people who have certain genes are more likely to get psoriasis," that "if a parent, grandparent, brother, or sister has psoriasis, you have a higher risk of getting it," that "it's possible to have genes that increase the risk of getting psoriasis and never develop psoriasis," that "psoriasis is not contagious. Unlike chickenpox or a cold, you cannot catch psoriasis from someone," that "about 2% of people living in the United States have this condition," and names as triggers stress, skin injury such as a cut or bad sunburn, infection such as strep throat, some medications including lithium, prednisone and hydroxychloroquine, weather especially cold dry weather, tobacco, and heavy drinking. [https://www.aad.org/public/diseases/psoriasis/what/causes](https://www.aad.org/public/diseases/psoriasis/what/causes) · Medical Organization 4. American Academy of Dermatology Association. "Can you get psoriasis if you have skin of color?" States that "in fair-skinned people, psoriasis tends to be red or pink, and the scale is often silvery white," that "a Hispanic person is more likely to have salmon-colored psoriasis and silvery-white scale," that "in African Americans, the psoriasis often looks violet and the scale gray," that "in dark skin, the psoriasis can also be dark brown and difficult to see," that "when psoriasis clears on medium to darkly colored skin, you may see lighter or darker patches of skin where the psoriasis once was," that "these patches are NOT scars and will eventually disappear," that "clearing can take 3 to 12 months or longer," that a dermatologist may call these patches "dyspigmentation," and that light therapy "can cause the treated skin to tan or darken" and on skin of color "can also cause dark spots on your skin to become more noticeable." [https://www.aad.org/public/diseases/psoriasis/treatment/could-have/skin-color](https://www.aad.org/public/diseases/psoriasis/treatment/could-have/skin-color) · Medical Organization 5. American Academy of Dermatology Association. "Psoriasis: Diagnosis and treatment." States that "to diagnose psoriasis, a dermatologist will examine your skin, nails, and scalp for signs of this condition," that "sometimes, a dermatologist will remove a small piece of skin. This is called a skin biopsy," that "there is no one best treatment for psoriasis, and no one treatment works for everyone," that "light therapy: this treatment uses special light bulbs or lasers to treat psoriasis," that "skin care also plays an important role in treating psoriasis because it can help reduce flare-ups," and names topical corticosteroids, synthetic vitamin D, topical calcineurin inhibitors, salicylic acid, tazarotene, roflumilast, tapinarof and coal tar among topical options, and apremilast, biologics and biosimilars, cyclosporine, methotrexate, acitretin and TYK2 inhibitors among treatments that work throughout the body. [https://www.aad.org/public/diseases/psoriasis/treatment/treatment](https://www.aad.org/public/diseases/psoriasis/treatment/treatment) · Medical Organization 6. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant, reapplied every two hours outdoors and after swimming or sweating. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Psoriasis is diagnosed by examination, sometimes with a skin biopsy, and several conditions can look similar. It is a long-term condition that is managed rather than cured, and response to treatment varies considerably from person to person. Prescription and light-based treatments each carry their own risks, which are discussed individually before anything is started. Individual results may vary. ### Rosacea Rosacea is a common, long-term condition that mainly affects the face. [1] It has six recognized signs, and almost nobody has all six: flushing, color that stays put, breakouts that look like acne, [visible veins](/conditions/spider-veins/), irritated eyes, and skin that thickens. [3] Which of those you have is the single most useful thing to establish, because it changes what will help you. It usually begins with flushing. [3] Over time the warmth or color lasts longer, and eventually the color stays for weeks or months rather than fading between episodes. [3] On lighter skin that reads as red across the nose and cheeks; the same skin on other people reads as violet or brown. [3] **It develops in people of all skin tones.** [1] That matters more than it sounds, because the early signs are easiest to miss on deeper tones, where flushing may show up only as a warm feeling and where the acne-like bumps are often the first sign anybody notices. [3] [4] Rosacea on darker skin gets mistaken for acne, seborrheic dermatitis, an allergic reaction or lupus. It is missed rather than rare. [4] **What people usually notice first** - A face that flushes easily, or feels warm for longer than it used to [3] - Redness, or a violet or brown cast, that stops washing out between flares [3] - Bumps and pustules that look like adult acne but do not respond to acne products [4] - Fine visible vessels across the cheeks or the sides of the nose [3] - Eyes that feel gritty, dry, watery or sensitive to light [3] - Skin care that stings or burns going on, when it never used to [4] This is the part that makes the difference, and it is why "you have rosacea" on its own is only half an answer. The six signs respond to different things. A treatment that transforms one of them does very little for another. The signWhat it looks likeWhat generally helpsFlushingWarmth or color that comes and goes, and lasts a little longer each year [3]Identifying your triggers, daily sun protection, and a routine that does not irritate [2]Color that staysRed, violet or brown across the nose and cheeks that no longer fades [3]Pulses of light across the whole area, which reduces flushing, plus a prescription that narrows vessels for the day [2]Acne-like breakoutsBumps and pustules, often the first sign on deeper skin tones [3]Prescription creams and gels, with a low-dose oral option where those are not enough [2]Visible blood vesselsFine lines of vessel across the cheeks or beside the nose [3]A laser tuned to the red of blood. Best performed by a board-certified dermatologist [2]Irritated eyesGritty, dry, watery or light-sensitive eyes [3]Warm compresses, lid care and artificial tears, sometimes alongside an eye doctor. Light treatment is among the options [2]Thickening skinGradual thickening, usually on the nose, and more common in men [3]Prescription treatment to prevent progression, and laser resurfacing to reshape the area [2] Most people have two or three of these, which is why plans are usually combinations rather than a single treatment. What you get at the first visit is a name for each of the signs you actually have, and the route that goes with each. AreaWhat tends to happen thereCheeksThe most common site for lasting color and for visible vessels. [3]NoseWhere vessels cluster beside the nostril, and the one place thickening usually appears. [3]Chin and around the mouthWhere the acne-like bumps often sit, and where they get mistaken for adult acne.ForeheadFlushing and lasting color, often the last area anybody connects to the rest.Eyes and eyelidsGritty, dry or light-sensitive eyes, which are part of the same condition rather than a separate problem. [3]Neck and chestFlushing frequently runs past the jawline, which surprises people who thought this was only a face condition. ![rosacea on a woman's face](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-rosacea.webp) Rosacea gets called acne, an allergy, or nothing at all, and on deeper skin tones it gets missed more often than it gets diagnosed. [4] Getting that right is what decides whether anything works. Somebody who has spent three years putting cream on a face full of visible vessels is not being failed by the cream. No cream removes a vessel you can see, and that is a diagnosis problem rather than a product problem. The other half is having the routes in one building. Both light treatments are here, so you get the one that suits your face rather than the one that happens to be in the room. Prescription treatment, [a routine built for reactive skin](/treatments/zo-skin-health/) and the laser work all sit under the same roof, which is what most rosacea plans need, because most people have more than one of the six signs. **Book an appointment if:** - Your face flushes easily, or stays warm and colored longer than it used to - Redness, or a violet or brown cast, has stopped fading between flares - You have bumps and pustules that acne products are not touching [4] - You can see fine vessels on your cheeks or beside your nose - Your eyes are chronically gritty, dry or light-sensitive and your face is red [3] - Skin care has started to sting or burn when it never used to [4] **Especially worth booking if:** - You have a darker skin tone and something on your face has been called acne or an allergy without improving [4] - You have been treating this yourself for more than a few months - Skin on your nose has slowly changed shape or texture Rosacea is diagnosed by a dermatologist examining your skin and your eyes. [2] There is no test you have to prepare for, and the visit is mostly conversation and a look. Skin care, sun protection and trigger management hold onto a result as much as the treatment does. [2] It is the part you run day to day, and it is not complicated. **Worth doing** - Broad-spectrum sunscreen, SPF 30 or higher, water resistant, every day before you go outside [5] - A short, gentle routine. Cleanse, moisturize, protect, and stop there while your skin settles - Keep a two-week note of what preceded a flare, which finds triggers faster than eliminating everything - Lukewarm water rather than hot, and patting dry rather than rubbing - Bring your current products to your appointment. Going through them is part of the visit **Worth knowing** - Triggers are personal. Plenty of people's rosacea ignores wine or spice entirely, so test before you give anything up - Rosacea is managed rather than cured. [1] Well managed, most people describe the difference as substantial and lasting - Products that sting or burn are telling you something. That is worth reporting rather than pushing through [4] - Eye symptoms belong on this page and in this conversation, not filed as a separate problem [3] Light and laser, prescription treatment and a skin care routine that suits reactive skin, in one practice. Pick a treatment to see how it works. Diagnosis and medical treatment of rosacea are handled differently from the aesthetic treatments on this site, and our office will go through what applies to you when you book. Where a plan includes light or laser treatment, the number of visits depends on which signs are being treated, and you will have that number before anything is scheduled rather than after. **Q: Can rosacea be cured?** No. There is no cure for rosacea at this time. [1] It is managed rather than finished, and managed well it usually looks substantially better and stays that way with maintenance. The distance between untreated rosacea and well-managed rosacea is large enough that most people describe it as a different face. **Q: Is it acne?** No, and treating it as acne usually goes badly. The bumps can look exactly like adult acne and they respond to different treatments. [2] On darker skin tones the breakouts are often the first sign of rosacea anyone sees, which is one reason it gets called acne for years. [4] If acne products are not working on this, that is information rather than failure. **Q: Can I get rosacea if I have darker skin?** Yes. Rosacea develops in people of all skin tones. [1] The signs read differently: flushing may show up only as a warm feeling, lasting color as a dusky brown rather than red, and vessels are harder to see. [3] [4] It is commonly missed rather than uncommon. Breakouts that will not respond to acne treatment, dry swollen skin with darker patches, and burning or stinging from skin care are all signs worth acting on. [4] **Q: Why do my eyes bother me too?** Because irritated eyes are one of the six signs of rosacea rather than a separate complaint. [3] Gritty, dry, watery or light-sensitive eyes are treated with warm compresses, lid care and artificial tears, sometimes with an eye doctor working alongside us. [2] If your eyes are chronically irritated and your face is red, say so at the visit. **Q: Do I have to give up wine and spicy food?** Not until you know whether they are actually your triggers, which is a different question from whether they are anybody's. Keeping a short note for a couple of weeks answers it far better than eliminating everything at once, and most people end up with a much shorter list than they expected. **Q: Can I keep using my usual skin care?** Possibly, and it is worth going through. Rosacea skin reacts to ingredients other skin ignores, and burning or stinging when you apply a product is a recognized sign. [4] A routine built for reactive skin often changes the result more than anything added on top. **Q: Do I need a referral?** Yes. This is medical dermatology, and the practice is currently accepting new medical patients by referral from your primary care physician. Once you have that, call the office and we will get you in. 1. American Academy of Dermatology Association. "Rosacea: Overview." States that "rosacea is a skin condition that mainly affects the face," that "rosacea develops in people of all skin tones," and that "at this time, there is no cure for rosacea." Names flushing, lasting color described as "red, violet, or brown," acne-like breakouts, visible blood vessels, irritated eyes and thickening skin as its signs. [https://www.aad.org/public/diseases/rosacea/what-is/overview](https://www.aad.org/public/diseases/rosacea/what-is/overview) · Medical Organization 2. American Academy of Dermatology Association. "Rosacea: Diagnosis and treatment." States that "a dermatologist diagnoses rosacea by examining your skin and eyes," that treatment aims to "reduce (or eliminate) signs of rosacea, ease your discomfort, prevent rosacea from worsening," that "intense pulsed light therapy can reduce flushing and improve your skin's texture," that prescription gels and creams can fade persistent color by narrowing blood vessels, names topical and low-dose oral prescription options for acne-like breakouts, states that "laser or light treatments" are used for visible blood vessels and recommends choosing "a board-certified dermatologist" to perform them, names prescription treatment to prevent progression of thickening skin alongside surgical removal, laser surgery, radiofrequency and electrosurgery, names warm compresses, eyelid hygiene, artificial tears and light treatment among options for eye involvement, and states that "skin care, sun protection, and trigger management are essential" to maintaining results. [https://www.aad.org/public/diseases/rosacea/treatment/diagnosis-treat](https://www.aad.org/public/diseases/rosacea/treatment/diagnosis-treat) · Medical Organization 3. American Academy of Dermatology Association. "Rosacea: Signs and symptoms." States that "rosacea often begins with a tendency to flush easily," that "if you have a darker skin tone, the only sign of flushing may be a warm feeling on your cheeks," that "the redness or violet color remains for weeks, months, or longer" and that "you may see red, violet, or brown across your nose and cheeks," that "if you have a darker skin tone, the papules (bumps) and pustules may be the first sign of rosacea that you see," that "if you have a lighter skin tone, you may see blood vessels on your cheeks or nose. These are difficult to see on darker skin tones," that eyes may feel "gritty, noticeably dry, or itchy" with tearing, burning, soreness, light sensitivity and redness, a condition called ocular rosacea, and that "thickening skin usually develops on the nose" and "men are more likely to develop this sign than women." [https://www.aad.org/public/diseases/rosacea/what-is/symptoms](https://www.aad.org/public/diseases/rosacea/what-is/symptoms) · Medical Organization 4. American Academy of Dermatology Association. "People with darker skin tones can get rosacea." States that "when people with darker skin tones develop rosacea, the early signs, such as flushing, can be missed or mistaken for another condition," that "rosacea can look like many other conditions, including acne, seborrheic dermatitis, an allergic reaction, or lupus," that in skin of color rosacea is "not a rare diagnosis" but commonly missed, and lists a persistent warm feeling, dry swollen skin with darker patches, dusky brown discoloration, acne-like breakouts that do not respond to treatment, yellowish-brown bumps near the mouth or eyes, and facial burning or stinging when applying skin care as signs to look for. [https://www.aad.org/public/diseases/rosacea/what-is/skin-color](https://www.aad.org/public/diseases/rosacea/what-is/skin-color) · Medical Organization 5. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant, reapplied every two hours outdoors and after swimming or sweating. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Rosacea is diagnosed by examination, and several other conditions can look like it. It is a long-term condition that is managed rather than cured, and maintenance treatment is usually required. Response varies by which signs you have and from person to person. Laser and light treatment carries risks including temporary bruising, swelling and pigment change, which are discussed before treatment. Prescription treatments carry their own risks and are discussed at the visit. Individual results may vary. ### Sagging Skin Skin holds its shape because of a springy network of collagen and elastin underneath it. That network is what makes skin snap back when you pinch it, and it loses tension steadily from your twenties onward. When it does, the skin does not shrink to match. There is now more skin than there is frame to hold it, and gravity does the rest. That shows up as jowls along a jawline that used to have an edge, a softening under the chin, crepe texture on the neck and inner arms, and skin on the abdomen and above the knees that has stopped springing back. **It is a different problem from having lost the support underneath**, and the two get confused constantly, because [a face that has emptied](/conditions/facial-volume-loss/) looks a great deal like a face that has loosened. The distinction matters commercially as well as clinically. Tightening skin that is actually empty makes a drawn face look tighter and more drawn. Filling a face that is actually loose makes the fold heavier. **The pinch and the lift above separate them in ten seconds, and it is worth doing before you book anything.** **What people usually notice first** - A jawline that has lost its edge, with softness starting to sit below it - Skin under the chin that has begun to gather - Crepe texture on the neck, the chest or the inner arms - Skin on the abdomen that no longer springs back after weight change or pregnancy - Photographs from a lower angle looking noticeably different from a mirror Two tests, ten seconds each, and between them they sort out the question that decides your entire plan. Do them at a mirror in decent light. **The pinch.** Take a fold of skin on your cheek or your neck between finger and thumb, hold it for two seconds, and let go. **The lift.** Place two fingers flat below your cheekbone and lift the tissue gently upward and outward, then watch the crease beside your mouth and the jawline. What happensWhat it meansWhere the answer isSkin springs straight back, and lifting flattens the creaseVolume, not laxity. The frame emptied and the skin is behaving fineA face that has emptiedSkin stays folded for a beat, and lifting gathers skin above your fingersLaxity. There is more skin than frameThis page, and non-surgical tightening is aimed hereSkin stays folded and the fold stays folded even at rest, and a jowl can be lifted with a fingerReal laxity, past what non-surgical treatment reaches. [1]A surgeon, and we will say so at the consultationSkin springs back but the surface looks etched and crepeyLines and surface texture rather than laxityResurfacing and collagen treatmentA softness under the chin that does not change when you liftOften fat rather than skinA body contouring conversation Most people land between two rows, and that is normal. **What the tests give you is the right first sentence at a consultation**, and they save the appointment where somebody has come in for tightening and actually needs something else. ![woman with sagging skin on her arm](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-sagging-skin.webp) Non-surgical tightening gives modest lifting and firming, and it does not give what a facelift, eyelid surgery or a neck lift gives. [1] That is a real ceiling and knowing where you sit relative to it before you commit is worth more than any machine specification. Somebody early in laxity gets a genuinely good result here. Somebody with a fold that stays folded is better served by a surgeon, and hearing that at the first appointment saves a year. The second thing is that this is one of three possible answers, and we carry all three. If the pinch test says your skin is fine and your face has emptied, the honest recommendation is [a face that has emptied](/conditions/facial-volume-loss/) rather than a tightening course. **A practice that only owns a tightening device finds laxity in every face that walks in.** That is not dishonesty so much as inventory, and it is the reason to have this assessed somewhere that has no reason to prefer one answer. **This is a good conversation to have if:** - Your pinch test showed skin that stays folded for a beat, which is early to moderate laxity - Your jawline has softened but nothing is hanging - You have crepe texture on the neck, chest or arms - You have had weight change or a pregnancy and skin has not fully returned - You would rather start while there is still recoil to work with **A surgeon is the better answer if:** - A fold stays folded at rest, or a jowl can be lifted with a finger [1] - You are hoping for the result of a facelift, an eyelid surgery or a neck lift **A different conversation entirely if:** - Lifting the skin flattens the crease, which means a face that has emptied - The softness does not change when you lift, which is often fat rather than skin Being told plainly which of those you are is the point of the appointment, and it is the same answer we would give a friend. **Worth doing** - Broad spectrum sunscreen, SPF 30 or higher, water resistant, every day, because sun is the accelerant on this one [2] - Judge a course at about six months rather than at six weeks, since the effect builds gradually [1] - Treat the neck and chest as part of the face, because they loosen ahead of it - Come back for maintenance on the interval you agreed rather than starting over later - Keep weight reasonably steady, since repeated stretching is what wears recoil down **Worth knowing** - Results are at their best around six months and tend to last two to three years with good skin care [1] - Your skin carries on aging underneath any result, which is what maintenance is for - Non-surgical tightening is modest by design, and starting earlier means less ground to make up [1] - Smoking accelerates collagen loss faster than almost anything else you control Tightening what is there, and building more of what holds it. Pick a treatment to see how it works. What a plan costs depends on the area, on how much laxity there is and on whether tightening is the right answer at all, which is what the consultation establishes. You get the plan and its cost before anything is booked. **Q: How do I know if it is loose skin or lost volume?** Pinch a fold of skin and let go, then lift your cheek with two fingers. Skin that springs straight back while lifting flattens a crease means volume. Skin that stays folded while lifting gathers skin above your fingers means laxity. The two tests above cover all five outcomes. It is the most useful ten seconds on this page. **Q: Can non-surgical treatment replace a facelift?** No, and any page that suggests otherwise is selling something. Non-surgical options give modest lifting and tightening and cannot give the results of a facelift, eyelid surgery or a neck lift. [1] What they do well is firm skin that still has recoil in it, which is why starting earlier gets more out of them. **Q: When will I see it, and how long does it last?** It builds gradually rather than appearing. Results from radiofrequency tightening are at their best at around six months, and tend to last two to three years with good skin care. [1] Almost nothing has changed the day you leave, which is expected rather than a bad sign. **Q: Does it work on the body as well as the face?** Yes, and the areas people ask about most are the abdomen, the upper arms and above the knees. What differs is how much laxity there is to begin with, since body skin is often looser than facial skin by the time people ask about it. That gets assessed honestly rather than assumed. **Q: What if what bothers me is under my chin?** That area is frequently a mix of laxity and fullness, and treating one without addressing the other only gets you halfway. If the softness does not change when you lift the skin, fat rather than skin is likely part of it, and the plan needs to address both. **Q: Is there anything I can do myself?** Sun protection is the one with real leverage, since ultraviolet light breaks down the collagen and elastin that hold skin taut faster than time alone does. [2] Nothing applied to the surface restores recoil that has already gone, but protecting what you have left is genuinely worth doing whatever else you decide. 1. American Academy of Dermatology Association. "Many ways to firm sagging skin." States that radiofrequency gives "modest lifting and tightening," with best results in about 6 months and results that "can last 2 to 3 years with the right skin care," that treatment should be performed by a board-certified dermatologist, and that non-surgical options "still cannot give you the results of a surgical procedure like a facelift, eyelid surgery, or neck lift." [https://www.aad.org/public/cosmetic/younger-looking/firm-sagging-skin](https://www.aad.org/public/cosmetic/younger-looking/firm-sagging-skin) · Medical Organization 2. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant, reapplied every two hours outdoors and after swimming or sweating. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice. The self-assessments described on this page narrow the possibilities and do not replace an examination. Non-surgical tightening produces modest results that build over months and vary with how much laxity is present, with age, and with individual skin. It does not produce the results of surgery. Radiofrequency and microneedling treatments carry risks including redness, swelling, and rarely burns or changes in skin color, which are discussed individually before anything is scheduled. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### Scalp Health Everything that happens to skin happens to your scalp. It gets dry, it gets oily, it reacts to what you put on it, and it develops the same conditions your face does. The difference is that it sits under hair, so you feel it long before you can see it, and by the time flakes are landing on your shoulders you have usually been managing it alone for a while. It also has more oil glands than almost anywhere else on your body, which is why the conditions that thrive in oily skin turn up here first. That is the reason a scalp can be flaking and greasy at the same time, which feels contradictory and is completely ordinary. Almost all of it comes down to four causes, and telling them apart is what the appointment is for. Three of the four are not solved by a bottle from the store, and knowing which one you have is the difference between a clear scalp in a few weeks and another year of trying shampoos. **What brings people in** - Flaking that comes back no matter which shampoo is tried - Itching, sometimes intense, and usually worst on the scalp [2] - A scalp that is oily again by the same afternoon - Redness or scale that runs past the hairline, onto the face or behind the ears - Soreness, tenderness or burning - Buildup that feels like a film, particularly with fine hair or frequent styling You can narrow this down yourself before you come in, and it makes the appointment faster. Look at the scale rather than the amount of it, in good light, on a day you have not washed. What you seeWhat it usually points toWhat it needsFine, dusty, white flakes, mild itchDryness, or very mild seborrheic dermatitisThe right routine, and often a medicated shampooGreasy, yellowish scale, oily scalp, itch that can be intenseSeborrheic dermatitis [2]Prescription treatment, then maintenanceThick, silvery, well-defined patches you can feel the edge ofScalp psoriasisA different prescription entirelyA film or grit that comes off when you scratch, little rednessProduct and oil buildupClearing, then a routine that stops it returningRedness spreading onto the face, eyebrows or behind the earsSeborrheic dermatitis beyond the scalp [2]Treatment across all the affected areas at onceScaly patches with hair loss in the same spotWorth an appointment soonerExamination, because a few scalp conditions do affect hair None of this is a diagnosis, and two of the rows genuinely can look alike under hair. It is a head start, and bringing what you have noticed to the appointment is genuinely useful. AreaWhat happens thereScalpFlaking, itching and oiliness, and the place it is felt first and seen last.Hairline and behind the earsWhere scale often spreads, and where people first notice redness.Eyebrows and the sides of the noseOily areas that seborrheic dermatitis favors as much as the scalp. [2]Beard areaThe same condition, in the same kind of skin, treated the same way.Chest and skin foldsOther oily areas the same condition can appear in. [2] A stylist will notice your scalp is flaking. A board-certified dermatologist can tell you whether that flaking is seborrheic dermatitis, psoriasis, a reaction to something you are putting on it, or simply dryness. Those four have four different answers, and only one of them comes off a shelf. That is the whole value of having your scalp looked at here. Prescriptions and clearing treatments sit under one roof, so the plan does not wait for a second appointment somewhere else. It is also why scalp complaints so often turn out to be the visible corner of something else, which is easier to catch when the person looking has spent a career looking at skin. **Worth booking an appointment when:** - The scale is thick, sticky or silvery rather than fine and dusty - Redness runs past your hairline, into your eyebrows or beside your nose - Your scalp is sore, tender or burning rather than simply itchy - There are scaly patches with hair loss in the same spot - You have worked through several shampoos without a lasting change - Something is bleeding, crusting or not healing, which matters because a scalp takes a lot of sun and hair hides it **Also worth knowing:** - Come on a day you have not washed your hair, so the scale can be seen - Bring the shampoos and products you have been using, or photograph the labels - Tell us how long it has been going on and what has helped, even briefly If you are unsure whether it is worth an appointment, it is. Most scalp conditions are straightforward once they are identified, and identifying them is the part that needs somebody looking. Most scalp conditions are controlled rather than cured, and that is a better outcome than it sounds: a clear, comfortable scalp that stays that way with a small amount of upkeep. The pattern is straightforward: treatment to clear the rash and scale first, then a maintenance step such as a medicated shampoo once a week to keep flare-ups away. [1] **Once you have a diagnosis, do** - Use the treatment you are given for as long as you are told, including after it looks better - Keep the maintenance step going, because that is what prevents the next flare [1] - Wash on the schedule that suits your scalp rather than the one that feels productive - Wear sun protection on any thinning or exposed areas of scalp [3] **Once you have a diagnosis, don't** - Switch shampoos every couple of weeks looking for the one that works - Scratch or pick at scale, which keeps the cycle going - Assume a flare means the treatment failed, since flares are part of the pattern - Leave a new, bleeding or non-healing spot on your scalp unexamined Tell us if the plan is not working after a fair run at it. There is usually another option, and the second choice often suits better than the first. Once we know which of the four you have, the plan is straightforward. Pick a treatment to see how it works. A scalp examination is medical care rather than a cosmetic service and is handled differently from the aesthetic treatments on this site. Our office will go through what applies to you when you book. Where the answer turns out to be a clearing treatment and a better routine rather than a prescription, that is quoted like any other treatment and you will know the cost before anything is booked. **Q: Is this just dandruff?** Sometimes. But dandruff is a description rather than a diagnosis. What most people mean by it is mild seborrheic dermatitis. Psoriasis, reactions to products and plain dryness all flake too, and they are treated differently, which is why it is worth knowing which one you have. **Q: Why is my scalp oily again by the same afternoon?** Your scalp has more oil glands than most of your body, and washing very often can leave it producing more rather than less. It can also be seborrheic dermatitis, where oil and irritation feed each other. The pattern tells us which. **Q: Can a treatment fix it, or do I need a prescription?** Both exist and they answer different problems. Buildup, dryness and general condition respond well to a scalp treatment and a better routine. Seborrheic dermatitis, psoriasis and fungal infections need medicine. [1] Plenty of people have one and then the other. **Q: Does my scalp condition affect my hair?** Hair grows out of skin, and skin that is irritated or inflamed is a less good place to grow it. Most scalp conditions do not cause lasting loss. A few can if they are left alone long enough, which is one more reason to get an answer rather than manage it indefinitely. **Q: Is my scalp why my hair is thinning?** Sometimes yes, often no. They are two separate questions that tend to show up together, and the examination separates them. Hair loss and thinning has its own page and its own list of causes. **Q: Will it come back?** Seborrheic dermatitis is managed rather than cured, and people often keep using a medicated shampoo about once a week to hold it. [1] Once you know what you have and what controls it, staying clear is straightforward. 1. American Academy of Dermatology Association. "Seborrheic dermatitis: Diagnosis and treatment." Describes diagnosis by examination with a skin biopsy where another condition such as psoriasis is suspected, notes that having both conditions together "is often called sebopsoriasis," lists medicated shampoos, topical treatments including ketoconazole and roflumilast foam, corticosteroids and oral antifungals, and describes ongoing management in which patients "often continue to use dandruff shampoo once a week" to prevent flare-ups. [https://www.aad.org/public/diseases/a-z/seborrheic-dermatitis-treatment](https://www.aad.org/public/diseases/a-z/seborrheic-dermatitis-treatment) · Medical Organization 2. American Academy of Dermatology Association. "Seborrheic dermatitis: Signs and symptoms." States that the rash "can develop on any area of the body except the palms and soles," commonly affecting the scalp, face, ears, chest and skin folds; that it "can be dry, have greasy scales, or both"; that the itch "is usually mild, but it can be intense, especially on the scalp"; and that on deeper skin tones the rash "tends to look pink, slightly purple, or lighter than your natural skin tone" while on lighter skin it "is usually red and raised." [https://www.aad.org/public/diseases/a-z/seborrheic-dermatitis-symptoms](https://www.aad.org/public/diseases/a-z/seborrheic-dermatitis-symptoms) · Medical Organization 3. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Scalp conditions are diagnosed by examination and several of them look alike under hair. Most are controlled rather than cured, and flares can recur. Any spot on the scalp that is bleeding, crusting or not healing should be examined. Individual results may vary. ### Shingles If you had chickenpox, the virus that caused it is still inside your body. When the chickenpox cleared, the virus moved from your skin to your nerves, where it went dormant. [3] Shingles is that virus waking up. Most people who get it develop a painful, blistering rash. [1] **The rash appears on one side of the body only**, most often on the torso, in a band. [2] That one-sided band is the most recognizable thing about it. For one to two days before the rash appears, you may have pain, burning or tingling in the area, which is why people often describe a strange sensation before there was anything to see. [2] On lighter skin tones the bumps tend to be red. **On darker skin tones you may see grayish, pink, dark brown or purplish bumps** rather than red ones. [2] That is worth knowing, because a rash that does not look like the pictures still needs the same two-to-three-day response. **What it looks and feels like** - Pain, burning or tingling for one to two days before anything appears [2] - A painful, blistering rash on one side of the body, often on the torso [2] - A band-like pattern, which is where it gets the name shingles band [2] - Blisters that clear in seven to ten days [4] - A rash that goes completely within two to four weeks [2] [4] This is the only page on this site organized around a clock, and it is organized that way because the evidence is unusually clear about it. WhenWhat to doPain, burning or tingling, nothing visible yetNote the date. This can precede the rash by one to two days [2]A rash appears on one side of the bodyCall. Aim to be seen within two to three days of the rash appearing [1] [5]The rash is anywhere on your faceThis is a medical emergency. Be seen immediately. Even if the rash is not on your eye, it can still affect your eyesight [1]More than three days have passedStill call. Treatment after the window still helps, and there is no point at which it stops being worth being seen [4]While you have blistersCover the rash. Avoid pregnant women, infants under 12 months, anyone immunocompromised and anyone unvaccinated, until it clears [5]After the rash clearsIf pain persists, say so. That has a name and its own treatment [1] **Why the window matters, in plain terms.** Starting prescription medication within two to three days of the rash appearing can dramatically reduce your symptoms, shorten how long you have shingles, and lower your risk of developing other health problems. [1] Nothing else on this site has a lever that specific. **What you can and cannot pass on.** You cannot give anyone shingles. While you have blisters you can spread a virus, and if it infects somebody who has never had chickenpox or the chickenpox vaccine, that person can get chickenpox. [5] That is why the covering and the avoiding matter, and why the answer to "am I contagious" is more precise than yes or no. AreaWhat tends to happen thereTorsoThe most common site, and where the one-sided band is most obvious. [2]FaceA medical emergency, and it can affect eyesight even when the rash is not on the eye. [1]Around one eyeThe highest-urgency presentation, and the reason face rashes are not watched at home. [1]Neck and shoulderCommon, and often mistaken for a muscular problem during the pain-before-rash phase.One side of the backFrequently reported as a strange burning before anything appeared. [2]Anywhere, on one sideThe rule is the one-sidedness rather than the location. [2] ![Shingles on the legs](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-shingles.webp) There is not much to say about competitive advantage on a condition where the whole game is the calendar. What matters is that somebody looks at the rash promptly, confirms what it is, and starts treatment inside the window. A dermatologist can often diagnose shingles by looking at the rash, and where it is not clear, fluid from a blister is examined under a microscope. [4] The reason to call a dermatology practice rather than wait is that a one-sided painful rash gets mistaken for a lot of things, including [a rash from something your skin touched](/conditions/contact-dermatitis/), and the cost of waiting to see whether it settles is measured in the window closing. **If you think you might have shingles, ask for [an appointment](/treatments/skin-care-consultations/) rather than a callback.** And if the rash is anywhere on your face, do not wait for us: that is an emergency. **Be seen immediately if:** - The rash is anywhere on your face. It is a medical emergency, and it can affect eyesight even when the rash is not on your eye [1] **Call for an appointment today if:** - A painful, blistering rash has appeared on one side of your body [2] - You have had pain, burning or tingling in one area, and now a rash has followed it [2] - You suspect shingles at all. The window is two to three days from the rash appearing [1] [5] **Still call, even if:** - More than three days have passed. Treatment after the window still helps [4] - The rash is clearing but pain is not. That has a name and its own treatment [1] Diagnosis is usually by looking at the rash, sometimes with fluid from a blister examined under a microscope. [4] Nothing about it requires preparation, and speed is the only thing that matters. **While you have it** [5] - Wash the rash with a fragrance-free cleanser - Apply a thin layer of clean pure petroleum jelly, and cover with a new, sterile, non-stick bandage - Wash your hands after touching the rash - A cool, damp washcloth for five to ten minutes, several times a day - A cool oatmeal bath, and calamine once the blisters have scabbed - Loose cotton or linen clothing, rest, and less stress where that is available to you - Cover the rash and stay away from pregnant women, infants under 12 months, anyone immunocompromised and anyone unvaccinated, until it clears **About the pain afterward** - Pain typically settles within one or two months [4] - For some people it lingers after the rash clears. That is called postherpetic neuralgia, and it can cause constant tingling, burning and pain [1] - It can last months, years, or the rest of a person's life, and treatment can help reduce the amount of pain you feel [1] - If pain is still there after the rash has gone, say so at a follow-up rather than waiting it out Diagnosis and prescription treatment, promptly. Pick a treatment to see how the appointment works. Diagnosis and treatment of shingles are medical care rather than a cosmetic service, and are handled differently from the aesthetic treatments on this site. Our office will go through what applies to you when you book. **Do not let a question about cost delay a call.** The window on this condition is two to three days, and the practical answer to any billing question is faster than the answer to a rash that was left alone. **Q: How quickly do I need to be seen?** Within two to three days of the rash appearing. Starting prescription medication in that window can dramatically reduce your symptoms, shorten how long you have shingles, and lower your risk of other health problems. [1] If more than three days have passed, still call: treatment after the window still helps. [4] **Q: What if the rash is on my face?** Be seen immediately. A shingles rash on the face is a medical emergency, and even if the rash is not on your eye it could still affect your eyesight. [1] That is not a call to make in the morning. **Q: Is it contagious?** Yes, and in a specific way: you cannot give anyone shingles. While you have blisters you can spread a virus, and if that virus infects somebody who has not had chickenpox or the chickenpox vaccine, that person can get chickenpox. [5] Cover the rash and stay away from pregnant women, infants under 12 months, anyone immunocompromised and anyone unvaccinated until it clears. [5] **Q: How long does it last?** Blisters tend to clear in seven to ten days, and the rash goes completely within two to four weeks. [2] [4] Pain typically resolves in one or two months. [4] **Q: What if the pain does not stop?** Pain that lingers after the rash clears is called postherpetic neuralgia. It can cause constant tingling, burning and pain, and it can last months, years or longer. [1] Treatment can help reduce the amount of pain you feel, so it is worth raising rather than enduring. [1] **Q: Should I get the vaccine, and do you give it?** The shingles vaccine is recommended for healthy adults aged 50 and over, and in studies it reduced the risk of developing shingles by 96.6 percent in people aged 50 to 59, 97.4 percent in people aged 60 to 69, and 91.3 percent in people aged 70 or older. [1] [3] We do not administer it here. Ask your primary care physician or your pharmacy. **Q: Do I need a referral?** Yes, this is medical dermatology and the practice is currently accepting new medical patients by referral. If you think you have shingles right now, call the office anyway and say so. Do not let the referral process cost you the treatment window. 1. American Academy of Dermatology Association. "Shingles: Overview." States that "most people who get this disease develop a painful, blistering rash," that "starting prescription medication within 2 to 3 days of developing the rash can dramatically: reduce your symptoms... lessen the amount of time you have shingles... lower your risk of developing other health problems," that "having a shingles rash on your face is a medical emergency. Even if the rash isn't on your eye, it could still affect your eyesight," that postherpetic neuralgia is "pain that can linger for months or years after the rash clears," that "PHN can cause constant tingling, burning, and pain," that "you can have PHN for months, years, or the rest of your life," that "treatment can help reduce the amount of pain you feel," and that the shingles vaccine "reduced the risk of developing shingles by: 96.6% in people 50-59 years old, 97.4% in people 60-69 years old, 91.3% in people 70 or older." [https://www.aad.org/public/diseases/a-z/shingles-overview](https://www.aad.org/public/diseases/a-z/shingles-overview) · Medical Organization 2. American Academy of Dermatology Association. "Shingles: Signs and symptoms." States that "shingles causes a painful, blistering rash on your skin," that "a painful, blistering rash appears. It usually appears on one side of your body, often on the torso," that "the rash only develops on one side of your body," describing "the shingles band because it looks like a band that appears on one area of your body," that "for 1 to 2 days before the rash appears, you may have pain, burning, or tingling," that "for most people, the rash will clear within 2 to 4 weeks," that "people with darker skin tones may see grayish, pink, dark brown, or purplish bumps," and that "on lighter skin tones, the bumps tend to be red." [https://www.aad.org/public/diseases/a-z/shingles-symptoms](https://www.aad.org/public/diseases/a-z/shingles-symptoms) · Medical Organization 3. American Academy of Dermatology Association. "Shingles: Who gets and causes." States that "if you had chickenpox, the virus that caused it is still inside your body. When the chickenpox cleared, the virus moved from your skin to your nerves," that the virus "moves to nerves inside your body, where it goes to sleep," that it is "rare to get shingles before 40 years of age" with risk rising in the fifties, names leukemia and lymphoma, HIV, organ transplant with immunosuppressants, severe psoriasis and advanced psoriatic arthritis, and ongoing chemotherapy among risk factors, and notes the CDC recommendation of shingles vaccination for healthy adults aged 50 and over. [https://www.aad.org/public/diseases/a-z/shingles-causes](https://www.aad.org/public/diseases/a-z/shingles-causes) · Medical Organization 4. American Academy of Dermatology Association. "Shingles: Diagnosis and treatment." States that "a dermatologist can often diagnose shingles by looking at the rash on your skin," and that where it is uncertain fluid is scraped from a blister and examined under a microscope. States that blisters "tend to clear in 7 to 10 days," that the rash "goes away completely within 2 to 4 weeks," that pain typically resolves "in 1 or 2 months," advises seeking care "within 3 days of getting the rash," and notes that treatment after that window still helps. Names antiviral medications and pain relief among treatments. [https://www.aad.org/public/diseases/a-z/shingles-treatment](https://www.aad.org/public/diseases/a-z/shingles-treatment) · Medical Organization 5. American Academy of Dermatology Association. "Shingles: Tips for managing." Advises to "see a doctor within 2 to 3 days of getting the rash," to "wash the rash with a fragrance-free cleanser," to "apply a thin layer of clean pure petroleum jelly," to "cover the rash with a new, sterile, non-stick bandage," to "wash your hands after touching the rash," to use a cool damp washcloth for five to ten minutes several times daily, to soak in "a cool, oatmeal bath," to apply calamine after scabbing, and to wear loose cotton or linen clothing, rest and reduce stress. States that "yes, but you cannot give anyone shingles. While you have blisters, you can spread a virus. If that virus infects someone who hasn't had chickenpox (or the chickenpox vaccine), the person can get chickenpox," and advises covering the rash and avoiding pregnant women, infants under 12 months, immunocompromised people and unvaccinated people until it clears. [https://www.aad.org/public/diseases/a-z/shingles-self-care](https://www.aad.org/public/diseases/a-z/shingles-self-care) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. A shingles rash on the face is a medical emergency and requires immediate care. Several conditions can produce a painful rash, and diagnosis is made by examination. Antiviral and pain medications carry their own risks, which are discussed at the visit. Vaccination is not provided at this practice; discuss it with your primary care physician. Individual results may vary. ### Skin Cancer Skin cancer is an abnormal growth of skin cells, and it has one property that sets it apart from almost every other cancer: it happens on the outside, where you and a dermatologist can look at it. That is an enormous advantage, and it is the reason so much of the good news in this area comes down to timing. It develops mostly where ultraviolet light has done its work over years, which on the Central Coast means the face, ears, scalp, neck, chest, forearms and the backs of the hands. It also occurs on skin that has seen very little sun, including the palms, the soles and under the nails, which is why a full exam looks everywhere rather than only at the obvious places. The three common types behave differently from one another. Two of them grow slowly and stay put. One can move. Knowing which is which is what a biopsy settles, and treatment follows from there. **What people usually notice first** - A spot that bleeds easily, scabs, and then does it again - A sore that does not heal after several weeks - A rough or scaly patch that will not clear up - A pearly or shiny bump, often on the face, ears or neck [1] - A mole that is changing in size, shape or color, or a new dark spot unlike the others [1] - Rough, scaly precancerous patches, which are treatable well before they become anything These are not one condition. They look different, they behave differently, and they are treated differently, so knowing which one is being talked about changes what the conversation means. Basal cell carcinomaSquamous cell carcinomaMelanomaHow commonThe most common type of skin cancer [1]The most common type in people with darker skin tones [1]The most serious of the three [1]Where it appearsHead, neck, chest or upper back [1]Head, neck, arms or shins [1]Anywhere, including skin that gets little or no sun [1]What it looks likeA round, pearly or shiny bump, or a raised and scaly patch [1]A rough, scaly patch, a firm dome-shaped growth, or a sore that will not heal [1]A change within an existing mole, or a new dark spot unlike your others [1]How it behavesGrows slowly and rarely spreads beyond the skin. Can scab and bleed easily [1]May grow slowly or rapidly, and can spread or return after treatment [1]Can grow rapidly and spread beyond the skin [1]Found earlyEarly treatment prevents it growing deeper into the skin [1]Highly treatable when caught early [1]The outcome can be good when diagnosed early and properly treated [1] The pattern across all three is the same, and it is the reason this page exists: early changes everything. A biopsy is what tells you which one you are dealing with, and [a skin check and a biopsy](/treatments/skin-cancer-diagnosis/) usually happen at the same appointment. AreaWhy it matters hereFace, ears and noseThe most exposed skin on the body, and where basal cell carcinoma most often appears. [1]ScalpFrequently affected and almost impossible to check yourself, especially where hair has thinned.Neck, chest and shouldersDecades of Central Coast sun concentrate here, often from a long time ago.Arms, forearms and handsIncluding the backs of the hands, which take steady sun through a car window.LegsThe most common site of melanoma in women, and easily overlooked.Palms, soles and under the nailsWhere skin cancer more often appears in deeper skin tones, and where nobody thinks to look. ![Young woman in a white shirt](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-skin-cancer.webp) A spot gets examined, and if it needs an answer the biopsy happens here, usually at the same visit. If a result needs treating, the surgery is planned here. Where [Mohs surgery](/treatments/cancer-surgery-mohs-referrals/) is the better operation, we arrange it and pick your care back up afterward. And the skin checks that follow for years are with the same practice that has your history. That continuity is the practical difference. Skin cancer is rarely a single event: having had one is the strongest reason there is to keep being checked, and every check is more useful when the person doing it has seen your skin before. **Book an appointment if you notice:** - A spot that bleeds, scabs, and then bleeds again - A sore that has not healed after a few weeks - A rough or scaly patch that will not clear - A new spot that looks different from the rest of your spots [2] - A mole changing in size, shape or color, or one that itches or bleeds [2] - Anything on your skin that has changed and you cannot explain **Worth booking a routine check if:** - You have never had a full skin exam and have spent years in Central Coast sun - You have had a skin cancer before, or someone in your family has - You have a lot of moles, or fair skin that burns easily - You used tanning beds at any point If you are unsure whether something is worth an appointment, book it. That is exactly what the ten minutes is for, and the answer is usually reassuring. This is the part you control, and on the Central Coast it matters more than most places. None of it is complicated. **Worth doing** - Broad-spectrum sunscreen, SPF 30 or higher, water resistant, every day before you go outside [3] - Reapply every two hours outdoors, and after swimming or sweating [3] - Shade and clothing, which do more than sunscreen alone - Skip tanning beds entirely, since indoor tanning is one of the causes rather than a safer alternative - Keep an eye on your own skin between appointments, and photograph anything you want to compare **Worth knowing** - Overcast days still deliver ultraviolet light, which coastal fog does not change - A car window blocks some ultraviolet light and not all of it - Sun protection matters at every skin tone, including tones that rarely burn - Rough, scaly precancerous patches can be treated well before they become anything, and that is the easiest win available Prevention does not replace the exam and the exam does not replace prevention. Doing both is what puts you well ahead. Diagnosis, treatment and follow-up, all in one practice. Pick a treatment to see how it works. Skin cancer diagnosis and treatment are medical care rather than a cosmetic service, and are handled differently from the aesthetic treatments on this site. Our office will go through what applies to you when you book. Where a biopsy is taken, laboratory fees are billed separately by the laboratory that examines the sample, and we will tell you when a sample is being sent. **Q: What does skin cancer actually look like?** It depends which type. A pearly or shiny bump, a rough scaly patch, a firm dome-shaped growth, a sore that will not heal, or a mole that has changed. [1] The comparison above sets the three types out side by side, and anything that bleeds, scabs and bleeds again is worth an appointment whatever it looks like. **Q: Can I get skin cancer if I have darker skin?** Yes. Skin cancer occurs in every skin tone, and squamous cell carcinoma is the most common type in people with darker skin tones. [1] It also appears more often in places that see little sun, including the palms, soles and under the nails, which is why a full examination covers everywhere. **Q: How often should I be checked?** It depends on your own risk: your history, your family history, how much sun you have had and how many moles you have. Your dermatologist sets the interval that suits you at your first visit. **Q: What happens if something looks suspicious?** A small sample is taken under local anesthetic, usually at the same appointment, and sent to a laboratory. Skin check and biopsy explains that visit in full. You get the result either way, not only if there is something to report. **Q: Is it treatable?** Found early and properly treated, skin cancer is highly treatable. [2] That is the reason a ten minute exam is one of the best-value appointments in medicine. **Q: Do I need a referral?** Yes. This is medical dermatology, and the practice is currently accepting new medical patients by referral from your primary care physician. Once you have that, call the office and we will get you in. 1. American Academy of Dermatology Association. "Types of skin cancer." States that basal cell carcinoma is the "most common type of skin cancer," often develops "on the head, neck, chest, or upper back," "often looks like a round, pearly or shiny bump or a raised and scaly patch of skin," "grows slowly and rarely spreads beyond the skin," "can scab and bleed easily," and that "early treatment is recommended to prevent basal cell carcinoma from growing deeper into the skin." States that squamous cell carcinoma is the "most common type of skin cancer in people with darker skin tones," usually develops "on the head, neck, arms, or shins," "often looks like a rough and scaly patch, firm and dome-shaped growth, or a non-healing sore," "may grow slowly or rapidly," "can spread or return after treatment," and "is highly treatable when caught early." Describes melanoma as "the most serious skin cancer," which "can appear suddenly, developing on skin that gets lots or little, if any, sun," "can appear within a mole that you already have or show up as a new dark spot that looks different from the rest of your moles," "can grow rapidly and spread beyond the skin," and whose "outcome can be good when diagnosed early and properly treated." [https://www.aad.org/public/diseases/skin-cancer/types/common](https://www.aad.org/public/diseases/skin-cancer/types/common) · Medical Organization 2. American Academy of Dermatology Association. "How to check your skin for skin cancer." States that "found early and properly treated, skin cancer is highly treatable," that self-exams "can be lifesaving," that anyone who finds "a spot on your skin that's growing, bleeding, or changing" should see a board-certified dermatologist, and that the frequency of full-body skin exams is determined by individual risk factors. [https://www.aad.org/public/diseases/skin-cancer/find/know-how](https://www.aad.org/public/diseases/skin-cancer/find/know-how) · Medical Organization 3. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant, reapplied every two hours outdoors and after swimming or sweating. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Skin cancer is diagnosed by examination and biopsy, and the appearance of a growth alone does not establish what it is. A skin examination is not a guarantee that a skin cancer will be found, and any spot that changes between appointments should be reported rather than waited on. Treatment depends on the type, size, location and pathology of the individual cancer. Individual results may vary. ### Skin Tags A skin tag is a little tag of ordinary skin with a core of loose tissue and small blood vessels inside it, attached by a narrow stalk. That is the whole of it. The short version is worth taking at face value: skin tags are harmless growths. [1] They are not contagious, they are not made of anything foreign, and nothing happens if you leave one alone for the rest of your life. **What they look like.** Soft, usually the same color as your skin or slightly darker, sometimes pink, and sometimes red when something has been rubbing on them. [1] Most run from about a pinhead to a grain of rice. The giveaway is the stalk: a skin tag hangs off the skin and moves when you touch it rather than sitting flat in it. **Not everything small and soft is a skin tag.** [Moles](/conditions/moles/) sit in the skin rather than hanging off it and are usually more pigmented. [Warts](/conditions/warts/) are rough and firm. A few other growths look similar enough to need [a laboratory answer](/treatments/skin-cancer-diagnosis/). That is the one genuinely useful reason to have a small growth looked at, and it takes a few minutes. **Worth having looked at if a growth:** - Changes color, or has more than one color in it - Bleeds without having been caught on anything - Grows steadily, rather than staying the size it arrived at - Hurts, or stays sore - Simply looks unlike the others you have Start with the part that does not change: a skin tag is harmless, it does not turn into anything, and having several does not make them less harmless. [1] What is true alongside that is that skin tags are more common in people with diabetes or metabolic syndrome, meaning high blood pressure, unhealthy blood sugar, excess abdominal fat or unhealthy cholesterol. [1] Multiple skin tags are also associated with insulin resistance, and in younger women a crop of them is sometimes associated with polycystic ovary syndrome, a common hormone condition. [2] **None of that is a diagnosis and none of it is a reason to worry.** Plenty of people with a lot of skin tags have nothing else going on at all. The association runs the other way round from how it usually gets described: it is not that skin tags cause anything, it is that the same conditions that make skin fold and rub also happen to be worth knowing about. **So the useful thing is small:** What to doMention it in one sentence at your next visit with your regular doctorWhat to sayThat you have picked up a number of skin tags over the last year or twoWhyBecause it costs nothing, and because routine blood work is the thing that answers itWhat not to doAnything urgent, anything dramatic, or any searching that ends in a self-diagnosisWhat we will doTell you the same thing, plainly, and look at the growths themselves That is the whole recommendation. We would rather say it here, once, than have you find a worse version of it somewhere else. AreaWhy it happens hereNeck and neck creasesCollars, necklaces and skin folding on itself, all day, for years. [1]UnderarmsWarm, damp and in constant motion, which is the exact combination. [1]EyelidsThin, mobile skin that rubs with every blink. [1]Under the bustA bra line is a friction line, and this is one of the most common sites. [1]GroinSkin folding against skin, warm and covered. [1]Upper chest and shouldersStraps, collars and seams, on skin that already folds. ![skin tags on the body](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-skin-tags.webp) Anyone can look at a small growth and call it a skin tag. A board-certified dermatologist can tell you whether it is one, and can tell it apart from a mole, a wart, a harmless age-related growth and the small number of things that need to go to a laboratory. That distinction is the whole reason to have it looked at, and a photograph does not settle it. It also means you get told when nothing needs doing, which is most of the time. When you do want one gone, it can be [taken off in the office](/treatments/skin-tag-removal/) at the same visit, by someone who has already confirmed what it is. The alternative is a bad trade: at-home removal products are not recommended, and the FDA warns that they can cause skin injury, infection, scarring and a delayed [skin cancer](/conditions/skin-cancer/) diagnosis, with none of them FDA approved. [3] Ten minutes here is a better trade than any of that. **Book an appointment if:** - A growth has changed color, or has more than one color in it - Something bleeds without having been caught on anything - A growth is getting steadily larger - One hurts, catches, or keeps getting irritated by a collar, a strap or a razor - A growth simply does not look like the others you have - You want one gone and would rather it was done properly **No appointment needed if:** - It has looked exactly the same for years, does not hurt and does not bother you Skin tags are one of the few things in dermatology where doing nothing is a completely reasonable plan. If you are here because one is annoying you, that is reason enough on its own. Most people manage skin tags by ignoring them, and that works. Where they are catching or multiplying in one spot, a few small things help. **Worth doing** - Softer collars, better-fitting straps and clothing that does not sit in the same crease all day - Keeping skin folds dry, which takes the moisture out of the friction equation - Moving a necklace or a watch that keeps landing on the same patch of skin - Having one removed if it catches on a razor or a zipper, rather than repeatedly nicking it **Worth knowing** - Removing a skin tag does not cause more to appear - They are not contagious. You cannot spread them to yourself or to anyone else [1] - Occasionally one twists on its stalk, darkens and drops off by itself. It looks alarming and it is harmless - Ones that appeared during pregnancy sometimes settle on their own afterward - Do not remove one at home. The FDA warns that at-home removal products cause skin injury, infection, scarring and delayed diagnosis, and none of them is FDA approved [3] Examination first, removal only if you want it. Pick a treatment to see how it works. How a visit is handled depends on why the growth is being looked at. A growth that is bleeding, painful or needs identifying is medical care. A growth removed because you would simply rather not have it is not. Our office will go through what applies to you when you book. Nothing is removed before it has been examined, and you will know which conversation you are in before anything happens. **Q: Are skin tags dangerous?** No. They are harmless growths. [1] They do not turn into anything and there is no medical requirement to remove one. People have them taken off because a collar or a necklace catches, or because of how they look, and both are perfectly good reasons. **Q: What causes them, and who gets them?** Skin rubbing against skin, jewelry or clothing over time, in a warm fold. [1] Roughly 50 to 60 percent of adults get at least one, they become more likely after the fourth decade, and men and women get them at about the same rate. [2] Family history, pregnancy and loose skin all make them more likely. [1] **Q: Will they go away on their own?** Usually not. Occasionally one twists on its stalk, loses its blood supply, turns dark and falls off, which looks dramatic and is harmless. Otherwise a skin tag stays until somebody removes it. Ones that arrived during pregnancy sometimes settle afterward. **Q: How does a dermatologist remove them?** Cryosurgery, electrodesiccation or surgical snipping, and one or more can be done during an office visit. [1] Which method suits depends on the size and the site. Skin tag removal walks through the appointment itself. **Q: Can I remove one at home?** No, and this is the one firm answer on this page. At-home removal products are not recommended, and the FDA warns they can cause skin injury, infection, scarring and a delayed skin cancer diagnosis. None of them has FDA approval. [3] String, floss and nail scissors carry the same problems plus bleeding you may not be able to stop. [3] An office visit takes minutes. **Q: Is it definitely a skin tag?** That is exactly the right question and it is the reason to have it looked at. Several things are small, soft and easy to mistake for one, including moles, warts and a few growths that need a laboratory answer. 1. American Academy of Dermatology Association. "Skin tags: Why they develop, and how to remove them." States that "skin tags are harmless growths that can appear anywhere on your skin, but often develop on the neck, eyelids, or underarms," that they "usually develop where skin has been rubbing against skin, jewelry, or clothing for some time," naming the breasts, eyelids, groin, neck creases and underarms, that they "may be the same color as your skin or darker. Some are pink. Others turn red when irritated," that "people who are overweight, pregnant, or have loose skin are more likely to get skin tags" along with people who have diabetes, metabolic syndrome or a family history, defines metabolic syndrome as high blood pressure, unhealthy blood sugar, excess abdominal fat or unhealthy cholesterol, states that "a dermatologist can quickly and safely remove one or more skin tags during an office visit" using cryosurgery, electrodesiccation or surgical snipping, and that "products that you can use at home to remove skin tags are not recommended." [https://www.aad.org/public/diseases/a-z/skin-tags](https://www.aad.org/public/diseases/a-z/skin-tags) · Medical Organization 2. Pandey A, Saleh HM. "Skin Tag (Acrochordon)." StatPearls. StatPearls Publishing. States that "approximately 50% to 60% of adults develop at least 1 of these harmless growths during their lifetime," with "the likelihood of occurrence increasing after the fourth decade of life," that "by the fifth or sixth decade, approximately two-thirds of individuals may develop acrochordons," that "skin tags affect men and women equally," that "the presence of multiple cutaneous tags is significantly associated with insulin resistance, independent of other risk factors," and that in young women in the second and third decades of life skin tags may be associated with polycystic ovarian syndrome. NBK547724. https://www.ncbi.nlm.nih.gov/books/NBK547724/ · Peer-Reviewed Study 3. American Academy of Dermatology Association. "5 reasons to see a dermatologist for mole, skin tag removal." Gives five reasons: to find and treat skin cancer, to control infection risk, to minimize scarring, to prevent loss of movement due to scarring, and to avoid difficult-to-stop blood loss. States that the FDA warns products sold online for removing moles, skin tags and other growths at home cause "potentially harmful side effects and serious risks," including skin injuries, infection, scarring and delayed cancer diagnosis, and that "none of the products sold for removing moles, skin tags, and other growths at home has received FDA approval." [https://www.aad.org/public/diseases/a-z/mole-skin-tag-removal](https://www.aad.org/public/diseases/a-z/mole-skin-tag-removal) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Not every small skin growth is a skin tag; some need to be examined and a few need to be sent to a laboratory. Removal carries the ordinary risks of a minor skin procedure, including bleeding, infection and a small permanent mark. The associations described on this page are associations only and do not establish that any individual has any condition. Healing varies from person to person and by site. Individual results may vary. ### Spider Veins A spider vein is a small blood vessel that has widened and settled close enough to the surface to show through. The branching pattern is where the name comes from. On a face they usually appear beside the nose, across the cheeks and on the chin. On legs they tend to arrive in clusters on the thigh, behind the knee or around the ankle. **They lie flat.** Run a finger over one and you feel nothing. That single fact is the most useful thing on this page, because it separates a cosmetic concern that a laser clears from a circulation problem that needs a different specialist entirely. Spider veins carry no health risk of their own. Nothing happens if you leave them alone for the rest of your life, and people have them treated because of how they look. That is a perfectly good reason and it does not need dressing up as anything else. **Worth having looked at rather than assumed** - A vein that bulges above the skin, or that you can feel with a fingertip - Leg veins that ache, throb or feel heavy by the end of the day - Swelling in the ankle on the same leg - Skin changes around the ankle, or a sore that will not heal - A cluster that appeared suddenly rather than gradually These three get grouped together constantly and they go to three different places. Three questions sort out which one you are looking at, and you can answer all of them yourself. Ask yourselfIf yesWhat that meansCan I feel it? Run a fingertip lightly over it with your eyes closedYou can feel a cord or a bulgeNot a spider vein. Raised, ropey veins are the varicose kind, and they belong with a vein specialist rather than hereDoes the leg ache, throb, swell or feel heavy by evening?YesSymptoms point at circulation rather than appearance, and that is a medical assessment first, whatever the veins look likeOn my face, is there a general flush as well as the lines?YesLikely flushing and background redness alongside the vessels, and the plan should treat both rather than only the lines **If the answer to all three is no, what you have is a cosmetic concern with a straightforward answer.** Flat facial veins and flat leg spider veins clear well with light-based treatment, and most people see a substantial reduction after one to three sessions. [1] Two things this cannot sort out on its own: leg veins can be flat at the surface and still sit downstream of a circulation problem, which is why symptoms matter more than appearance on legs; and [birthmarks and other vessel problems](/conditions/vascular-anomalies/) are their own category and are assessed rather than assumed. ![leg with spider veins](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-spider-veins.webp) Individual vessels and general redness are different targets and they respond to different tools. A pulsed dye laser tuned to the color of blood is what clears a distinct line beside the nose. Pulses of light across a whole area are what lift a background flush. **Both are here, which means the choice follows your skin rather than what happens to be in the room.** Most faces need some of each, and having both available is what lets a plan say so. The other half is what gets ruled out first. A vein you can feel is a different condition. Symptomatic legs are a circulation question before they are a cosmetic one. And a face full of fine vessels frequently has [a flush that comes and goes](/conditions/rosacea/) underneath it, which is treatable and which most people have never had named. A board-certified dermatologist sorting that out before anything is aimed at your skin is the actual service. **This is a good conversation to have if:** - You have fine flat red or purple lines on your nose, cheeks or chin - You have flat clusters of leg veins with no aching, swelling or heaviness - You have both visible lines and a general flush, which is common and treatable together - Makeup covers it and you would rather it did not have to **Start somewhere else if:** - A vein bulges above the skin or you can feel it. That belongs with a vein specialist - Your legs ache, throb, swell or feel heavy, which is a circulation assessment first - There are skin changes around the ankle, or a sore that will not heal We would rather tell you at the first appointment that a vein specialist is the right call than treat the surface of something that needs looking at properly. That is a short conversation and it is worth having early. **Worth doing** - Broad spectrum sunscreen, SPF 30 or higher, water resistant, every day, since sun weakens the support around the vessels [2] - Note what makes your face flush and how often, because the same triggers drive new facial vessels - Move rather than stand still where you can, and elevate legs at the end of a long day - Come back for a top-up when new vessels appear rather than waiting for a full return **Worth knowing** - Treated vessels do not come back, and new ones can form over time [1] - Results tend to last three to five years, and occasional maintenance is normal rather than a sign anything failed [1] - Facial vessels and facial flushing often travel together, and treating only one leaves the other doing its work - Legs and faces behave differently, and a plan for one does not transfer to the other A laser tuned to the color of blood for individual vessels, and pulses of light for a general flush. Pick a treatment to see how it works. What a plan costs depends on the area, on how many vessels there are and on whether a general flush is being treated alongside them, which is worked out at the consultation. You get the plan and its cost before anything is booked. **Q: Are spider veins dangerous?** No. They carry no health risk of their own and nothing happens if you leave them alone. People have them treated because of how they look, which is reason enough. What is worth checking is whether what you have is actually a spider vein, which the three questions above cover. **Q: What is the difference between spider veins and varicose veins?** Feel for it. Spider veins are flat and you feel nothing when you run a finger over them. Varicose veins are raised, ropey and often uncomfortable, and they belong with a vein specialist rather than with a dermatologist. Aching, throbbing, swelling or heaviness in the leg point the same way, whatever the veins look like. **Q: Does treatment work, and how many sessions?** Most patients see a 50 to 75 percent reduction in visible blood vessels after one to three treatments, usually spaced three to four weeks apart. [1] Your own number depends on how many vessels there are and where they sit, and you will have it after the area has been looked at rather than from a website. **Q: Will they come back?** The vessels that are treated do not reappear. New ones can form over time, and results tend to last three to five years. [1] That is why occasional maintenance is normal here rather than a sign that something went wrong. **Q: I have veins on my nose and my face also goes red. Are those connected?** Very likely. The same widened surface vessels that show as lines also produce background flushing, and flushing and background redness is one of the most common companions to facial spider veins. Treating only the visible lines leaves the flush behind, so the plan usually addresses both. **Q: Can leg veins be treated the same way as facial ones?** Sometimes, and legs need more care than faces do. Flat leg spider veins with no symptoms respond to light-based treatment. Legs that ache, swell or feel heavy get assessed for circulation first, because treating the surface of a vein that sits downstream of a larger problem does not hold. 1. American Academy of Dermatology Association. "Lasers and lights: How well do they treat rosacea?" Reports that most patients see a 50% to 75% reduction in visible blood vessels after 1 to 3 treatments, that treatments are usually spaced 3 to 4 weeks apart, and that results tend to last 3 to 5 years, with treated vessels not reappearing but new ones able to form. [https://www.aad.org/public/diseases/rosacea/treatment/lasers-lights](https://www.aad.org/public/diseases/rosacea/treatment/lasers-lights) · Medical Organization 2. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant, reapplied every two hours outdoors and after swimming or sweating. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. The self-assessment described on this page narrows the possibilities and does not replace an examination. Not every visible vein is a spider vein, and leg veins in particular can sit downstream of a circulation problem that requires a different specialist. Laser and light treatment carries risks including temporary bruising, swelling and changes in skin color, and the risk is higher on tanned skin and on deeper skin tones. Results and the number of treatments needed vary from person to person. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### Stubborn Fat Fat is not stored evenly and it is not lost evenly. Where your body puts it is decided largely by genetics and hormones, which is why two people can do exactly the same things and end up with completely different shapes. It is also why the last area to change is the same area for most of your life, and why it is usually the one you would have chosen to change first. **A stubborn pocket is not a failure of effort.** It is the area your body prioritizes holding onto, and that priority does not respond to being tried harder at. That is the fact that makes this a treatable concern rather than a discipline problem, and it is worth saying plainly because a lot of people arrive assuming the opposite. Non-invasive body contouring exists for exactly this: a small, defined bulge that has stayed put while the rest of the body responded. The people it suits best have a small bulge of fat that remains despite diet and exercise, and a weight that falls within the normal range for their height. [1] **Where it usually shows up** - The lower abdomen, below the navel, which is the most common of all - The flanks, along the waistband - Under the chin - The bra line and upper back - Inner and outer thighs - The area just above the knee Body contouring and skin tightening are different treatments aimed at different tissue, and the area under a chin or across a lower abdomen frequently has some of each. Ten seconds tells you which conversation you are in. **Pinch the area between finger and thumb, take note of what you are holding, then let go and watch it.** What you are holding, and what it doesWhat it isWhere the answer isA thick, soft mass that springs back cleanly when releasedFat, with good skin over it. The best case for contouringThis page. A defined pocket on a flat area suits the laser; a curved area suits radiofrequencyA thin fold of skin with very little inside it, which stays folded for a beatLoose skin rather than fat. Reducing fat here would make it looserTightening, and loose skin is generally treated first [1]A thick mass that also stays folded after releaseBoth, which is common on the abdomen after weight change or pregnancyA staged plan, and the order matters. It gets decided in personNothing much to pinch, but the contour still bothers youOften muscle and frame rather than fatAn honest conversation, and sometimes the answer is that there is nothing here to treat **The order in the second and third rows is not a preference.** Where there is loose skin as well as fat, treating the skin first tends to produce a better result from the fat reduction afterward. [1] A plan that goes the other way round can leave you with less fat and looser skin, which is not the outcome anybody came in for. ![Woman checking her weight](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-stubborn-fat.webp) A defined pocket of fat on a flat area, a curved area where contact matters, and skin quality over either of them are three different problems. We carry a tool for each, which means the recommendation can follow the area rather than the inventory. A practice with one body device finds work for that device on every body that walks in. It also means we can tell you when the answer is none of them. If the pinch test found loose skin with very little underneath, reducing fat there makes it looser rather than better, and you will hear that at the consultation rather than eight sessions in. **The measurement that matters is taken before you start, not after**, which is also why you get a number of treatments before you commit rather than a course sold open-ended. **This is a good conversation to have if:** - You have a small bulge of fat that has stayed put despite diet and exercise, and your weight sits in the normal range for your height [1] - Your pinch test found a thick mass with skin that springs back cleanly - There is one area you would change and the rest of your body is roughly where you want it - You want a specific number of treatments before you commit to anything **A different conversation if:** - The pinch found thin skin with little underneath, which is loose skin rather than fat - What you want is a change in your overall weight, which is a goal worth naming out loud so the plan matches it - The area has both, which is treatable and needs to be staged in the right order Results here are real and they are subtle by design. Most people see it in how clothes fit before they see it anywhere else. [1] If that is what you are after, this works well. If you are hoping to see a different number on a scale, say so at the consultation and we will talk about what would actually get you there. **Worth doing** - Take measurements and a photograph before you start, in the same light and the same clothes - Use a pair of pants you already own as your instrument rather than a scale [1] - Give it the full window. Most people see the complete effect between three and six months after the last treatment [1] - Keep your weight reasonably steady, since remaining fat cells still respond to weight change - Come back for the assessment appointment even if you think nothing has happened yet **Worth knowing** - The change is subtle by design. Pants that feel a little looser and a belly that looks a little flatter is the outcome [1] - It is aimed at a specific area rather than at your overall shape - Skin quality over the area decides how good the result looks, which is why it gets assessed first - Photographs taken in different light at different times of day are the main reason people misjudge their own result Different tools for a defined pocket, a curved area and the skin quality over both. Pick a treatment to see how it works. What a plan costs depends on the area, on how many treatments it needs and on whether skin quality needs addressing alongside it. That is worked out at the consultation, and you get the plan, the number of treatments and the cost before anything is booked. **Q: Why does this one area never change?** Because where your body stores fat is set largely by genetics and hormones rather than by effort, and you cannot choose where the body draws from when you lose weight. The area your body prioritizes holding onto stays proportionally the same however hard the rest of it works. That is physiology rather than a discipline problem. **Q: Who does this suit?** People who have a small bulge of fat that remains despite diet and exercise, and whose weight falls within the normal range for their height. [1] It is aimed at a specific area rather than at overall shape, which is worth being clear about before you start. **Q: When will I see something?** Most people see the full effect between three and six months after the last treatment. [1] It builds gradually rather than appearing, which is why the measurement and the photograph taken before you start matter so much. **Q: How do I know if it is fat or loose skin?** Pinch the area, note what you are holding, and watch what it does when you let go. A thick mass that springs back is fat. A thin fold that stays folded is skin that has lost its recoil. The pinch test above covers all four outcomes, and it decides which treatment you actually need. **Q: What if I have both?** That is common, particularly on the abdomen after weight change or pregnancy, and it is treatable. The order matters: where there is loose skin as well as fat, treating the skin first generally produces a better result from the fat reduction afterward. [1] The staging gets decided in person. **Q: Will this change my weight?** It is aimed at the shape of a specific area rather than at what a scale says, which is why a pair of pants you already own is the better instrument. [1] If a change in weight is what you are after, that is worth naming at the consultation so the conversation is about the right thing. 1. American Academy of Dermatology Association. "Non-invasive fat removal: What can you expect?" States that good candidates "have a small bulge of fat that remains despite diet and exercise and their weight falls within the normal range for their height," that results are subtle, that "your pants will feel a little looser or your belly a little flatter," that most people see the full effect between 3 and 6 months after the last treatment, and that where there is also loose skin "your dermatologist may recommend treating this first." [https://www.aad.org/public/cosmetic/fat-removal/non-invasive-what-to-expect](https://www.aad.org/public/cosmetic/fat-removal/non-invasive-what-to-expect) · Medical Organization 2. American Academy of Dermatology Association. "Many ways to firm sagging skin." States that non-surgical options give "modest lifting and tightening," with best results in about 6 months, and that they "still cannot give you the results of a surgical procedure." [https://www.aad.org/public/cosmetic/younger-looking/firm-sagging-skin](https://www.aad.org/public/cosmetic/younger-looking/firm-sagging-skin) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice. The self-assessment described on this page narrows the possibilities and does not replace an examination. Non-invasive body contouring produces subtle, gradual changes in the shape of a treated area and is not a treatment for overall weight. Results vary with the area, with skin quality and from person to person, and remaining fat cells still respond to weight change. Treatments carry risks including temporary redness, swelling, tenderness and firmness in the treated area, which are discussed individually before anything is scheduled. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### Sun Damage People say sun damage as though it were a single thing. It is at least four, and they arrived together because they share a cause rather than because they are the same condition. Which of the four you actually have decides everything that follows, and most people have some of all of them. **The brown.** Sun spots and age spots. Flat, tan to dark brown, with clear edges, across the face, chest, shoulders, forearms and the backs of the hands. If instead of separate spots you have [a soft symmetrical patch across the cheeks](/conditions/melasma/) or upper lip, that is a different condition with a different plan. **The red.** A general flush across the nose, cheeks and upper chest, plus the fine broken veins you can pick out when you look closely at the sides of the nose. **The rough.** Dry, coarse, uneven skin and pores that look larger than they used to. Sometimes [rough, scaly patches](/conditions/actinic-keratosis/) that catch on a towel and come back after they flake off. **Those are a separate matter entirely and they get examined rather than polished over.** **The lined.** Fine lines, deeper wrinkles, crepey skin and a jawline that has softened, because years of ultraviolet light wore down the support underneath. Because it is four concerns, it is treated in categories rather than with one thing. Pigment, surface redness, texture and [lines that stay when your face is still](/conditions/wrinkles-and-fine-lines/) each respond to a different family of in-office treatment, with prescription-strength skin care and daily sun protection sitting underneath all of them. Which combination fits depends on how much of each you have and on your skin. The chips above are where each of those goes. Here is a comparison you can run right now, and it settles the question better than any before-and-after photograph. Look at the skin on the inside of your upper arm. Then look at the back of your hand, or your forearm, or your chest. **Same person. Same age. Same genes. Same diet, same sleep, same everything.** The only meaningful difference between those two patches of skin is how much light they have taken over your lifetime. Whatever gap you can see is not aging. It is exposure. What to compareProtected skin, inner upper armExposed skin, back of hand or chestColorEven, one tone throughoutScattered brown spots with clear edges, and a general unevennessTextureSmooth, fine surfaceCoarser, drier, with pores that read as largerFirmnessSprings back when you pinch itSlower to settle, and thinner to the touchLinesFew, and only where the skin foldsFine crosshatching that stays when the skin is stillRednessNone to speak ofBackground flush and fine visible vessels Two things follow from that. The first is that a good part of what people call looking older is not a fixed inheritance, which is why treatment works as well as it does. The second is more useful: **whatever the gap looks like today, protection from here changes how wide it is in ten years.** In a trial of 903 adults over four and a half years, the group asked to use sunscreen daily showed no detectable increase in skin aging, 24 percent less than the group who used it when they thought of it. [1] Broad spectrum, SPF 30 or higher, water resistant, applied before you go outside and reapplied every two hours out there. [2] That is the whole instruction, and it is the only part of this page you can start today. ![woman with sun damage on her face](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-sun-damage.webp) Sun-damaged skin is exactly where skin cancers turn up, so this is a face that gets a medical eye on it before anything cosmetic is planned. If something in the area needs [a skin check](/conditions/skin-cancer/) rather than a cosmetic plan, you are already in the right building. **Rough, scaly patches can be an early precancer, and they are examined rather than resurfaced over.** That order is not a preference. It is the correct sequence, and it is the practical difference between a dermatology practice and a treatment room. The second job is telling the four apart, and telling them apart from the things that imitate them. A soft brown patch across the cheeks is not a cluster of sun spots and behaves differently. Background redness can be flushing rather than sun. [Skin that has lost its firmness](/conditions/sagging-skin/) is not the same as skin that has lost its evenness. Sorting that out is the first ten minutes of the visit, and it decides everything after it. **This is a good conversation to have if:** - You have brown spots, background redness, rough texture or fine lines you would like improved - You have spent years outdoors on the Central Coast and your skin shows it - You want to know which of the four you actually have before you spend anything - Something has changed in your skin and you would like it looked at properly at the same time - You want a plan rather than a product **Bring it in first if:** - You have a rough or scaly patch that flakes and returns in the same place - A spot has changed in size, shape or color - You have a soft, symmetrical brown patch rather than separate spots There is no obligation attached to finding out. Some people come away with a course of treatment and some come away with a sunscreen recommendation and a plan to check back, and we will tell you plainly which one you are. Whatever you have done, the thing that decides how long it lasts is what happens on ordinary days afterward. **Worth doing** - Broad spectrum, SPF 30 or higher, water resistant, before you go outside and reapplied every two hours out there [2] - Every day, including the overcast ones, which on this coast is most of the point - A hat with a brim, which covers scalp, ears and nose at once - Sunglasses with UV protection, since the skin around the eyes shows it early - Treat the backs of your hands and your chest as part of your face, because they age on the same schedule **Worth knowing** - A tan is the injury showing rather than a defense against it, and tanning beds do the same thing indoors - Fog and cool air hide how strong the light is. The exposure lands regardless - A car window blocks some ultraviolet light and not all of it - Skin tone does not exempt anybody. On deeper tones sun damage shows more as uneven color than as lines - Anything rough, scaly or changing gets looked at rather than treated cosmetically Pigment, redness, texture and lines each have their own route, with daily protection underneath all of them. Pick a treatment to see how it works. What a plan costs depends entirely on which of the four you are treating and how much of each. That is worked out at the consultation, where you get a plan and the cost of it before anything is booked. **Q: Can sun damage be undone, or is it permanent?** A lot of what you can see can be improved, and the underlying wear does not reverse. Color, surface redness, roughness and fine lines all respond to treatment. What happened to the structure deeper down stays, which is why protection from here on changes the picture more than anything else does. **Q: Why do I have sun damage when I have never laid out to tan?** Because most of it came from ordinary days rather than deliberate ones. Commuting, errands, walking, gardening and standing outside at kids' games account for most people's lifetime total. Cool coastal air makes that worse rather than better, because it hides how strong the light is. **Q: Does sunscreen really prevent aging, or is that marketing?** It was actually tested. In a randomized trial, 903 adults were followed for four and a half years. The group asked to use sunscreen every day showed no detectable increase in skin aging over that period, 24 percent less than the group using it at their own discretion. [1] Broad spectrum, at least SPF 30, water resistant. [2] **Q: Does having a lot of sun damage mean I will get skin cancer?** Not on its own, and it does put you in the group worth checking. The same exposure that made the spots and the roughness is what raises the risk, so heavily sun-damaged skin is worth having looked at on a regular schedule rather than only when something worries you. That check happens here. **Q: I have rough, scaly patches as well as brown spots. Is that the same thing?** No. A flat brown spot is a color change. A patch you can feel, that flakes and comes back in the same place, is a texture change and it can be an early precancer. Rough, scaly patches live on the same skin as sun spots and they are a different conversation. Have those looked at. **Q: I have a soft brown patch across my cheeks. Is that sun damage?** Probably not, or not only. Separate spots with clear edges are usually sun spots. A soft symmetrical patch across the cheeks, forehead or upper lip behaves differently, is tied to hormones as well as light, and darkens with heat. Knowing which you have matters, because treating one as the other is how people end up frustrated. 1. Hughes MCB, Williams GM, Baker P, Green AC. "Sunscreen and Prevention of Skin Aging: A Randomized Trial." Annals of Internal Medicine. 2013;158(11):781-790. Randomized, controlled, community-based intervention in 903 adults younger than 55, followed for four and a half years. States that "skin aging from baseline to the end of the trial was 24% less in the daily sunscreen group than in the discretionary sunscreen group (relative odds, 0.76 [95% CI, 0.59 to 0.98])" and that "the daily sunscreen group showed no detectable increase in skin aging after 4.5 years." PMID 23732711. https://pubmed.ncbi.nlm.nih.gov/23732711/ · Peer-Reviewed Study 2. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant, applied before going outside and reapplied every two hours outdoors and after swimming or sweating. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice. Results vary with your skin, how much damage there is, which treatment you have and whether you keep up sun protection. Light and laser treatment carries risks including burns, blistering and lasting changes in skin color, and that risk is higher on deeper skin tones and on recently tanned skin. Rough or scaly spots are examined before any cosmetic resurfacing. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### Unwanted Hair Hair pattern is inherited and hormonally driven. How much you grow, how coarse it is and where it turns up is set by your family and by your hormones rather than by anything you have done, and it changes across a life as hormones do. That is why a pattern can appear in your thirties that was never there before, and why two people the same age look completely different. Whether any of it is unwanted is entirely your call. There is no clinical threshold for too much hair and no version of this where a preference needs justifying. What a dermatology practice adds is a route that actually reduces it rather than removing it again every week, and an eye on the small number of cases where a sudden change is worth understanding. **The thing that decides your result is color, not effort.** Laser reduction works by the light being absorbed by pigment in the hair, so it works best on dark hair. It works least well on hair with little pigment in it, which is why gray, white, red and very blonde hair respond poorly whatever the machine. That is physics rather than a limitation of one device, and anybody promising otherwise is selling something. **Worth having looked at rather than assumed** - Coarse dark hair that appeared suddenly on the face, chest or abdomen - A noticeable change in pattern over a short period - New growth alongside irregular periods, or alongside thinning hair on your head - Persistent bumps, ingrown hairs or dark marks in a shaved or waxed area This is the question worth answering before you spend anything, and most of it you can work out yourself. Four factors decide how well laser reduction performs on a given person, and only one of them is about the machine. FactorWhat favors a strong resultWhat makes it harderHair colorDark brown or black hair, where the pigment gives the light something to absorbGray, white, red or very blonde hair, which has little pigment. This is the one that cannot be worked aroundHair coarsenessThicker, coarser hair, which responds more readilyFine downy hair, which responds less well even when it is darkSkin toneAny skin tone can be treated effectively, and advances have made that possible in experienced hands [1]A recent tan, which changes the settings that are safe to use whatever your skin toneThe areaLarger areas with dense growth, treated as a courseSmall scattered patches, which are sometimes better handled another way **Skin tone deserves its own sentence, because the old advice was wrong.** Laser hair reduction was historically described as suiting light skin with dark hair, and that framing persists on plenty of pages. Deeper skin tones can be treated very effectively now, and what it requires is the right settings and somebody experienced choosing them. [1] Tanned skin is the genuine constraint, and it is temporary. If your hair is gray, white or very light, say so before you book. It saves a consultation fee and it is the honest answer. ![woman without unwanted hair](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-unwanted-hair.webp) Every laser in this category does roughly the same thing. What differs between a good result and a poor one is the judgment about settings: how much energy, what pulse, how it is adjusted for your hair color and your skin tone, and what gets changed between sessions as your hair responds. **That judgment is the service. The machine is the easy part.** It is also why the assessment comes first here. Your hair color, your coarseness, your skin tone and whether you have any color on your skin right now all change what is safe and effective, and they are looked at before anything is aimed at you. If your hair is unlikely to respond, you will be told that at the start rather than after three sessions. And where something in the pattern is worth understanding rather than only treating, you are already in a dermatology practice. **This is a good conversation to have if:** - Your hair is dark and you are tired of shaving, waxing or threading the same area - Shaving leaves you with bumps, ingrown hairs or the bumps and dark marks left behind - You have a deeper skin tone and have been told elsewhere that laser is not for you, which is out of date [1] - You want to know the number of treatments before you commit to anything **Worth raising at the consultation:** - Gray, white, red or very blonde hair, which responds poorly whatever the device - A recent tan, which changes what settings are safe. That one is temporary - Coarse dark hair that appeared rapidly, especially alongside irregular periods or scalp thinning - Any medication you take, and any history of cold sores in a facial treatment area Preparation is simple and it matters: no tanning, indoors or out, no sunless tanner, and daily broad-spectrum SPF 30 or higher on the area beforehand. [2] **Worth doing** - Keep your appointments on the interval you were given, since the spacing is what catches hair in different growth phases [1] - Shave the area rather than waxing or plucking between sessions, because the follicle needs its hair to be there - No tanning, indoors or out, and no sunless tanner before a session [2] - Daily broad-spectrum sunscreen, SPF 30 or higher, on the treated area [2] - Expect a course rather than an appointment, and know your number before you start **Worth knowing** - Most patients need two to six treatments, and hair grows in shifts, which is the whole reason for the spacing [1] - Most people stay hair free for months or years, and what returns is finer and lighter [1] - Occasional maintenance is normal and is not a sign anything went wrong [1] - Reducing the hair usually reduces shaving irritation and ingrown hairs along with it - It generally does not require any real downtime [1] Assessment first, then a course sized to your hair and your skin. Pick a treatment to see how it works. What a course costs depends on the area and on how many treatments your hair needs, which is established at the consultation. **You get the number of treatments before you commit**, rather than an open-ended course. **Q: Does laser work on gray or white hair?** Not well, and that is worth knowing before you spend anything. The light is absorbed by pigment in the hair, so hair with little pigment gives it nothing to work with. Gray, white, red and very blonde hair all respond poorly, and that is physics rather than a limitation of a particular machine. Say so before you book. **Q: Can I have it if I have a deeper skin tone?** Yes. Deeper skin tones can be treated very effectively, and advances have made that possible in experienced hands. [1] The older advice that this only suits light skin with dark hair is out of date and it still appears in plenty of places. What it takes is the right settings and somebody experienced choosing them, which is what The Coastal difference below is about. **Q: How many treatments will I need?** Most patients need two to six. [1] Hair grows in shifts rather than all at once, so the sessions are spaced to catch follicles at different points in the cycle, and each one reaches hair the last could not. You get your own number after your hair and skin have actually been looked at. **Q: Is it permanent?** It is a reduction rather than an erasure, and the reduction is substantial. Most patients stay hair free for months or even years, and hair that does return comes back finer and lighter than it was. [1] Occasional maintenance is normal. **Q: Why do I suddenly have hair I never had before?** Usually hormones. Hair pattern shifts across a lifetime and around pregnancy, perimenopause and any significant hormonal change, and some medications do it too. Where coarse dark hair appears rapidly alongside irregular periods or thinning hair on your head, that combination is worth understanding rather than only treating, and it is a short conversation to have. **Q: Will it help with ingrown hairs and razor bumps?** Frequently yes, because fewer and finer hairs means less of what causes them. The bumps and the dark marks they leave behind are their own concern as well, and where those are the main complaint rather than the hair itself, that is worth saying at the consultation so the plan addresses both. **Q: How should I prepare?** No tanning, indoors or out, no sunless tanner, and daily broad-spectrum SPF 30 or higher on the area. [2] Shave rather than wax or pluck between sessions, since the follicle needs its hair present. Tell us about any medication you take. [2] 1. American Academy of Dermatology Association. "Laser hair removal: FAQs." States that "most patients need 2 to 6 laser treatments," that "you can expect a 10% to 25% reduction in hair after the first treatment," that "most patients remain hair free for months or even years" but that "some of the hair regrows" and is "finer and lighter in color," that maintenance treatments may be needed, that the treatment "works best for patients with light-colored skin and dark-colored hair" while advances now allow treatment of light hair and dark skin, that it "generally does not require any real downtime," and to "choose a board-certified dermatologist to perform laser treatments." [https://www.aad.org/public/cosmetic/hair-removal/laser-hair-removal-faqs](https://www.aad.org/public/cosmetic/hair-removal/laser-hair-removal-faqs) · Medical Organization 2. American Academy of Dermatology Association. "Laser hair removal: Preparation." "Do not tan (outdoors and indoors)," "do not use sunless tanners," apply sunscreen that is "broad-spectrum, SPF 30+, and water-resistant" every day before going outdoors, and tell your dermatologist about any medicine you take, including isotretinoin. [https://www.aad.org/public/cosmetic/hair-removal/laser-hair-removal-preparation](https://www.aad.org/public/cosmetic/hair-removal/laser-hair-removal-preparation) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice. Laser hair reduction reduces hair rather than removing it permanently, and results vary with hair color, hair coarseness, skin tone, the area treated and hormonal factors. Hair with little pigment responds poorly. Treatment carries risks including temporary redness and swelling, and less commonly blistering, burns and lasting changes in skin color; the risk is higher on recently tanned skin. This treatment is not suitable on tanned or sunburned skin, during pregnancy, alongside medications that increase sensitivity to light, or on or shortly after a strong oral acne medication. Tell us about any history of cold sores before a facial treatment. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### Vascular Anomalies "Vascular anomaly" covers birthmarks and growths made of blood vessels, and the classification used for them splits into two groups that behave in opposite ways. [11] **Vascular tumors grow and then involute**, which is [an infantile hemangioma, which grows and then fades](/conditions/infantile-hemangiomas/). **Vascular malformations are present at birth and do not involute.** [11] A port-wine stain is a capillary malformation, and that is the category it belongs to. [11] **A port-wine stain, medically a nevus flammeus, is visible at birth as a flat spot or patch that can be pink, red or purple.** [1] It usually develops on the face, though it can appear anywhere on the skin. [1] [7] It is the most common vascular malformation, it is present at birth, and it persists throughout life. [7] **As the child grows, so does the birthmark, and its texture changes.** It tends to thicken and darken over time. Ridges can develop, and sometimes the surface comes to feel like cobblestones. [1] Progressive thickening and nodularity are part of the natural course. [7] Port-wine stains do not go away without treatment. [5] Without treatment, this birthmark remains on the skin for life. [1] **Some vascular malformations run deeper than the skin**, including arteriovenous malformations and combined and syndromic forms. Superficial ones are treated here. Where an anomaly needs a multidisciplinary vascular anomalies program, that referral is part of what an evaluation produces. This section publishes the real numbers, because the alternative is a page that implies these clear completely and a family who finds out otherwise on session six. QuestionThe honest answerWhat is the treatmentIn the United States the pulsed dye laser is the standard for all port-wine birthmarks, whatever the size, location or color [8]How many sessionsMost patients need 8 to 10 treatments or more, and touch-up treatments are frequently needed even after a successful series [8]What that achievesPulsed dye laser can achieve 50% to 90% clearance, and most patients will have more than 50% lightening [8]Whether it clears completelyMore than 50% improvement is seen in most cases, and complete clearance may not be [7]How oftenSessions run at intervals of roughly 1 to 3 months [7]Does age matterTreatment at an earlier age, particularly in the first year of life, is associated with better outcomes [8]Is it safe for childrenPulsed dye lasers are safely used on infants and children, including for port-wine stains [3] **Read the third and fourth rows together.** Substantial lightening is a realistic goal for most port-wine stains, over a course measured in years rather than visits, and complete clearance is not what the evidence describes. [7] [8] Anyone promising erasure is describing something the published results do not support. **The timing argument is the strongest one on this page.** A port-wine stain does not fade, it grows with the child, and it thickens and darkens over time. [1] [5] [7] Greater lightening, and possible prevention of future darkening and thickening, are associated with starting treatment at an earlier age. [8] Early treatment tends to be more effective. [2] **This is also true for adults, and it is worth saying.** Progressive thickening and nodularity make an older port-wine stain harder to treat, [7] and it is still treatable. The session count runs longer and the improvement is real. What you are seeingHow it behavesWhat it isFlat pink or salmon patch, often on the eyelids, forehead or back of the neck, irregularly shaped with feathery or undefined edges, that fades when gently pressed and brightens when the baby cries or gets warm [1] [6]On the face it tends to disappear between 1 and 3 years of age. On the back of the neck it may fade without disappearing [1]A salmon patch, called an angel's kiss on the face and a stork's bite on the neck [1]Flat pink, red or purple patch present at birth, usually on the faceGrows with the child, thickens and darkens, and remains for life without treatment [1] [7]A port-wine stain, a capillary malformation [1] [11]Raised strawberry-colored lump that appeared in the first weeks and is getting biggerGrows for a few months, then shrinks over years [see Infantile Hemangiomas]An infantile hemangioma, a vascular tumor [11] **The distinguishing test parents can do at home is gentle pressure.** A salmon patch tends to lighten temporarily under a fingertip and has feathery, undefined edges. [1] [6] A port-wine stain is present at birth and persists. [7] That is a useful observation to bring to an appointment, and it is not a substitute for one, because the appointment is where the answer gets made. ![woman sitting on the couch](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-vascular-anomalies.webp) In the United States the pulsed dye laser is the standard treatment for port-wine birthmarks, whatever the size, location or color. [8] [The pulsed dye laser here](/treatments/vbeam-photorejuvenation/) is a Candela Vbeam®, and its FDA clearance names the indication in plain terms: treatment of cutaneous capillary malformations, also known as port wine stains, in the pediatric population, alongside infantile and congenital hemangiomas. [10] That is the device sitting in this building, cleared for exactly this use. Pulsed dye lasers are safely used on infants and children. [3] **The nearest alternatives for a Central Coast family are the university children's hospitals.** Those programs are excellent, they are the right answer for a complex or syndromic anomaly, and they are several hours away in either direction. For a superficial vascular birthmark, the useful thing is a board-certified dermatologist within driving distance who can identify it, treat it on a schedule a family can actually keep, and refer onward when the situation calls for it. The same device is used for [broken surface vessels in adults](/conditions/spider-veins/) and for [persistent facial redness](/conditions/rosacea/), which is why it is in the building at all. The pediatric vascular indication is the part of its capability that is least well known locally. **Book sooner if:** - A flat red or purple patch was present at birth and has stayed put - The patch does not lighten when gently pressed - It sits on the face, particularly across the forehead or around one eye [9] - It has become darker, raised, ridged or uneven in texture [1] [7] - An adult has carried one for years and wants to know what treatment would involve now Most birthmarks are harmless, and having one examined is still worthwhile, because what looks like a birthmark can be the first sign of something else. [4] For a port-wine stain specifically, the reason to come early is that treatment starting in infancy is associated with better outcomes. [8] **A rare association worth knowing about** - A port-wine stain on the face, usually on one side around the eye or forehead, is occasionally linked to a rare condition called Sturge-Weber syndrome, which involves the small blood vessels of the brain, eyes and skin as well [9] - The great majority of facial port-wine stains are not associated with it. Where the pattern raises the question, the evaluation is straightforward: an eye examination, and imaging such as an MRI or CT scan if a doctor suspects it [9] - Where Sturge-Weber is confirmed, yearly monitoring for glaucoma is the standing recommendation, because raised pressure inside the eye is treatable and is worth catching early [9] - Seizures are part of the condition and usually begin in infancy, and that care is led by a neurologist [9] - This is on the page because a facial port-wine stain is the visible sign that prompts the question. It is not on the page to suggest that a birthmark means a syndrome **Day to day** - Sun protection over the area is sensible practice and does not change what the birthmark does - Camouflage makeup is a legitimate option at any age and is not a lesser choice than treatment - Treatment runs as a course, with sessions at intervals of roughly 1 to 3 months [7] - Bring photographs taken in consistent light. Change across a long course is easier to see in a series than in a mirror **Worth knowing** - Port-wine stains are present at birth and persist throughout life [7] - They do not go away without treatment [5] - They tend to thicken and darken over time [1] [7] - Treatment starting at an earlier age is associated with better outcomes [8] - Substantial lightening is a realistic goal. Complete clearance may not be [7] [8] Evaluation, laser treatment for superficial vascular birthmarks and vessels, and onward referral where an anomaly runs deeper. Pick a treatment to see how it works. Evaluation and treatment of a vascular birthmark are medical care rather than a cosmetic service, and are handled differently from the aesthetic treatments on this site. Our office will go through what applies to you when you book. Treatment for a port-wine stain runs as a course rather than a single visit, and our office will set out how that is structured before anything is scheduled. **Q: Will a port-wine stain fade as my child grows?** No. It grows with the child, and it tends to thicken and darken over time, developing ridges and sometimes a cobblestone texture. [1] It is present at birth and persists throughout life. [7] Port-wine stains do not go away without treatment. [5] That is what separates it from the birthmarks that do fade. **Q: Is this the same as a stork bite or an angel's kiss?** Different thing. A salmon patch, called an angel's kiss on the face and a stork's bite on the back of the neck, is flat, irregularly shaped with feathery or undefined edges, and it lightens temporarily when you press it. [1] [6] On the face it tends to disappear between 1 and 3 years of age. [1] A port-wine stain is present at birth and persists. [7] **Q: How many laser treatments does it take?** Most patients need 8 to 10 treatments or more, and touch-up treatments are frequently needed even after a successful series. [8] Sessions run at intervals of roughly 1 to 3 months. [7] What that achieves is 50% to 90% clearance, with most patients seeing more than 50% lightening. [8] Those are the published figures, and they are a realistic basis for planning: substantial lightening across a course measured in years, rather than clearance in a handful of visits. **Q: When should treatment start?** Early, where the choice exists. Treatment at an earlier age, particularly in the first year of life, is associated with better outcomes, greater lightening, and possible prevention of future darkening and thickening. [8] Early treatment tends to be more effective. [2] Starting in infancy is also associated with a lower chance of the raised, thickened change that comes with age. [7] **Q: Can it be treated in an adult?** Yes. It is a harder target than the same birthmark in a child, because progressive thickening and nodularity make an older port-wine stain more resistant, [7] and improvement is still achievable. The course generally runs longer. It is worth an evaluation rather than an assumption. **Q: Is laser treatment safe for a baby?** Yes. Pulsed dye lasers are safely used on infants and children for a range of conditions, including port-wine stains and hemangioma birthmarks. [3] The pulsed dye laser in this office carries an FDA clearance that names port wine stains in the pediatric population. [10] **Q: My child's port-wine stain is on the face. Should I be concerned about anything else?** There is one rare association worth knowing about, and the answer for most families is no. A facial port-wine stain, usually around one eye or the forehead, is occasionally linked to Sturge-Weber syndrome. [9] Where the pattern raises the question, an eye examination and imaging settle it, and where it is confirmed, yearly glaucoma monitoring is the standing recommendation. [9] The section below on living with it covers it properly. **Q: Do I need a referral?** Yes. This is medical dermatology, and the practice is currently accepting new medical patients by referral from your primary care physician. Once you have that, call the office and we will get you in. 1. American Academy of Dermatology Association. "Birthmarks: Signs and symptoms." On the port-wine stain, medical name nevus flammeus, states that "at birth, you'll see a spot(s) or patch(es) that can be pink, red, or purple," that "as the child grows, so will this birthmark," that in time it "tends to thicken and darken, and as it thickens, the texture can change. Ridges may develop, and sometimes the birthmark feels like cobblestones on the skin," that "a port-wine stain usually develops on the face; however, it can appear anywhere on the skin," and that "without treatment, this birthmark remains on the skin for life." On the salmon patch, medical name nevus simplex, states that "you'll see a flat, pink, red, or salmon-colored spot or patch," that "if you gently press on this birthmark, the color tends to fade," that the color becomes more noticeable when a baby cries or becomes overheated, that "when a salmon patch appears on the face, it's often referred to as an angel's kiss," that "on the back of the neck, people often call this birthmark a stork's bite," and that "on the face, this birthmark tends to disappear between 1 and 3 years of age." [https://www.aad.org/public/diseases/a-z/birthmarks-symptoms](https://www.aad.org/public/diseases/a-z/birthmarks-symptoms) · Medical Organization 2. American Academy of Dermatology Association. "Birthmarks: Diagnosis and treatment." States of the port-wine stain: "This birthmark will not go away with time. It can grow and thicken. Early treatment tends to be more effective." Lists port-wine stains among "birthmarks that don't fade with time," alongside café au lait spots and moles, and states: "Have a dermatologist examine a birthmark as soon as you notice it, so you know what type of birthmark your child has and whether it needs treatment." [https://www.aad.org/public/diseases/a-z/birthmarks-treatment](https://www.aad.org/public/diseases/a-z/birthmarks-treatment) · Medical Organization 3. American Academy of Dermatology Association. "Skin conditions lasers treat." States that "some lasers, such as pulsed dye lasers and intense pulsed light therapy, are safely used on infants and children to treat a wide range of conditions, including port wine stain and hemangioma birthmarks." [https://www.aad.org/public/diseases/a-z/skin-conditions-lasers-treat](https://www.aad.org/public/diseases/a-z/skin-conditions-lasers-treat) · Medical Organization 4. American Academy of Dermatology Association. "Birthmarks: Overview." States that "one thing that most birthmarks have in common is that they're harmless. Yet, if you see a birthmark on your child's skin, it's wise to have a dermatologist examine it," and that "what you think is a birthmark could be the first sign of a skin disease." [https://www.aad.org/public/diseases/a-z/birthmarks-overview](https://www.aad.org/public/diseases/a-z/birthmarks-overview) · Medical Organization 5. Cleveland Clinic. "Port Wine Stain." States that "about 3 of every 1,000 babies have a port wine stain," that "a port wine stain is a permanent birthmark that usually appears on the face," that "over time, port wine stains usually get darker and thicker. They also may become raised rather than flat and smooth," that "port wine stains don't go away without treatment," and that "the most common treatment is laser therapy to shrink the blood vessels and fade the birthmark." Notes that port wine stains rarely occur in people with Klippel-Trenaunay syndrome or Sturge-Weber syndrome. [https://my.clevelandclinic.org/health/diseases/24389-port-wine-stain](https://my.clevelandclinic.org/health/diseases/24389-port-wine-stain) · Medical Organization 6. Cleveland Clinic. "Stork Bite (Nevus Simplex)." Describes the appearance as irregularly shaped, with feathery or undefined borders, and states that these marks "might get lighter temporarily when you put pressure on them, like if you press your finger against one, then let go." [https://my.clevelandclinic.org/health/diseases/21975-stork-bite](https://my.clevelandclinic.org/health/diseases/21975-stork-bite) · Medical Organization 7. StatPearls, National Center for Biotechnology Information. "Nevus Flammeus." States that "PWS is the most common vascular malformation, typically presenting as pink or red homogenous, variably sized macules and patches with geographic borders at birth that persist throughout life," and that "it is a congenital skin condition that can affect any part of the body and persists throughout life." States that "a 585-nm short pulsed dye laser (PDL) is considered the gold standard in treating PWS," that "multiple treatment sessions may be required at intervals of 1 to 3 months," that "although more than 50% improvement will be seen in the majority, a complete clearance of the lesion may not be seen," that "treatment initiation as early as infancy is found to have consistent improvement, better outcomes, and decreased risk of cutaneous hypertrophy and disfigurement," and that "laser therapy at an early age gives better results as the progressive thickening and nodularity seen with age make it recalcitrant to treatment." [https://www.ncbi.nlm.nih.gov/books/NBK563254/](https://www.ncbi.nlm.nih.gov/books/NBK563254/) · Medical Reference 8. Sabeti S, Ball KL, Burkhart C, Eichenfield L, Fernandez Faith E, Frieden IJ, Geronemus R, Gupta D, Krakowski AC, Levy ML, Metry D, Nelson JS, Tollefson MM, Kelly KM. "Consensus Statement for the Management and Treatment of Port-Wine Birthmarks in Sturge-Weber Syndrome." *JAMA Dermatology.* 2021;157(1):98–104. PMID 33175124. A multi-institutional United States expert consensus statement. States that "in the US, pulsed dye laser is the standard for all PWBs regardless of the lesion size, location, or color," that "pulsed dye laser has the longest history of efficacy and safety for treatment of PWBs, and many studies support this device as the standard," that "pulsed dye laser can achieve 50% to 90% clearance, and most patients will have more than 50% lightening," that "most patients require 8 to 10 treatments or more for optimal results; however, touch-up treatments are frequently needed even after an initial successful series of lightening," that "based on expert observations and limited studies, treatment of PWBs at an earlier age, particularly in the first year of life, results in better outcomes," and that "greater rates of lightening and possible prevention of future darkening and hypertrophy may be attained if treatments are started at an earlier age." [https://jamanetwork.com/journals/jamadermatology/fullarticle/2772814](https://jamanetwork.com/journals/jamadermatology/fullarticle/2772814) · Scholarly Article 9. National Institute of Neurological Disorders and Stroke, National Institutes of Health. "Sturge-Weber Syndrome." Describes it as "a rare neurological condition characterized by abnormal development of the small blood vessels (called capillaries) in the brain, eyes, and skin." States that it involves "a port-wine stain birthmark, which is usually present at birth on one side of the face around the eye or forehead," that it can involve "glaucoma (increased pressure within the eye), which can cause the eyeball to enlarge (buphthalmos). This usually starts in infancy and can cause blindness if not treated," that "people with Sturge-Weber syndrome should be monitored yearly for glaucoma," that "seizures usually begin in infancy and may get worse with age," that "most infants with SWS will develop seizures during their first year of life," that "if the doctor suspects SWS, they will use imaging tests, such as an MRI... or CT... scan," and that "laser treatment may lighten or remove the birthmark." [https://www.ninds.nih.gov/health-information/disorders/sturge-weber-syndrome](https://www.ninds.nih.gov/health-information/disorders/sturge-weber-syndrome) · Government Organization 10. U.S. Food and Drug Administration. 510(k) Premarket Notification K230990, "Candela Vbeam Family of Pulsed Dye Lasers (Vbeam Prima, Vbeam Perfecta)," Candela Corporation, decision date June 1, 2023, product code GEX, regulation 878.4810, Class 2, found substantially equivalent. The cleared indications include, at 595 nm, a pediatric population indication for "treatment of cutaneous capillary malformations, also known as port wine stains (PWS), and infantile hemangiomas (IH) / congenital hemangiomas." [https://www.accessdata.fda.gov/cdrh_docs/pdf23/K230990.pdf](https://www.accessdata.fda.gov/cdrh_docs/pdf23/K230990.pdf) · Government Organization 11. International Society for the Study of Vascular Anomalies. "ISSVA Classification of Vascular Anomalies (2018)." Divides vascular anomalies into two top-level categories, vascular tumors and vascular malformations. Classifies "infantile hemangioma / hemangioma of infancy" as a benign vascular tumor, and classifies "cutaneous and/or mucosal CM (also known as 'port-wine' stain)" as a simple capillary malformation, with nonsyndromic and syndromic subtypes. [https://www.issva.org/UserFiles/file/ISSVA-Classification-2018.pdf](https://www.issva.org/UserFiles/file/ISSVA-Classification-2018.pdf) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Vascular anomalies vary widely and the descriptions here are general rather than specific to any individual. Laser treatment of a port-wine stain is a course of treatment with variable results, and the published figures cited describe averages and expert consensus rather than any individual outcome. Laser treatment carries risks including changes in skin color, blistering and scarring, which are discussed before treatment. FDA clearance of a device describes the uses for which the device may be marketed and is not a statement about any individual outcome. Deeper and syndromic vascular anomalies are managed by multidisciplinary programs, and referral is part of what an evaluation produces. Individual results may vary. ### Vitiligo Vitiligo is a condition that causes skin to lose color. Areas of skin may look lighter than your natural skin tone, white, or even pink. [1] It is autoimmune: **the immune system mistakes the cells that give skin, hair and eyes their color as foreign, and attacks and destroys them.** [3] Those cells are called melanocytes, and where they are gone, color is gone. The first patches usually appear on the face, arms, hands and feet, and it can develop anywhere on the skin. [2] When it is actively spreading, patches can look pink, or show three tones at once, with a band of tan between your natural color and the white patch. [2] Hair growing in an affected area can turn white, and color can be lost inside and around the mouth and nose. [2] **Two things it is not.** It is not contagious: you cannot catch vitiligo from anyone or give it to anyone. [1] And it does not increase your risk of skin cancer. [1] What it does do is leave skin without its natural protection from light, which is why sun protection is treatment here rather than general advice. **Worth knowing at diagnosis** - About half the people who develop vitiligo get it before they turn 20 [3] - People of all races and skin tones develop it [3] - It is most visible when someone has a darker skin tone or a tan [1] - It can run in families, and having a close relative with it does not mean you will get it. A number of genes are involved [3] - It travels with other autoimmune conditions, including alopecia areata and thyroid disease [3] Vitiligo is one of the conditions where people are told either far too much or nothing at all. Here is the actual shape of it, with the figures that exist rather than the ones that would be convenient. The questionThe honest answerCan it be cured?No. Treatment cannot cure vitiligo, and it may restore lost skin color [5]Does treatment work?For a substantial share of people. In clinical trials of one prescription cream, about 30 percent of patients saw 75 percent of their skin color restored by week 24 [5]How fast?Slowly. That 24-week figure is the point at which results were measured, not the point at which they start [5]Will it hold?Often, with maintenance. Within a year of stopping treatment, an estimated 40 percent of patients see some color loss [5]What if I do nothing?Vitiligo is not harmful to your health and does not raise skin cancer risk. [1] Doing nothing is a legitimate choice, and skin without pigment still needs sun protection **Read those two percentages together rather than separately.** Thirty percent reaching three-quarters restoration in under six months is a real result for a condition that had very little a decade ago. Forty percent seeing some loss within a year of stopping is the reason maintenance is part of the plan rather than a sign anything failed. Everything on that list assumes the one thing that is not optional: protection from light. Skin that has lost its color sunburns easily, [skin that burns easily](/conditions/sun-damage/) is the practical consequence, and severe sunburn is itself a trigger for more vitiligo. [3] [4] AreaWhat tends to happen thereFaceOne of the first sites, and where it is most visible. [2]HandsThe other common first site, and the hardest area to keep protected. [2]ArmsFrequently affected, and where sun exposure compounds it. [2]FeetCommon, and often noticed late. [2]Around the mouth and noseIncluding inside the mouth and inside the nose. [2]Hair in affected areasCan turn white where pigment cells are gone. [2] ![vitiligo on hands](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-vitiligo.webp) The range for vitiligo has widened. Alongside topical corticosteroids used for limited periods, there are non-steroid creams that can be used for longer, a prescription cream approved specifically for vitiligo, light-based treatment, and for stable disease, procedures that move pigment cells. [5] There is also the option people are least often offered: camouflage makeup or self-tanner, used deliberately, which restores appearance immediately and commits to nothing. [4] [5] Which combination suits you depends on where it is, how much there is, whether it is spreading, and, honestly, on what you want out of it. Some people want repigmentation and will run a course for months. Some want their hands covered for a wedding. Some want to be told it is harmless and go home. **All three are legitimate outcomes of this appointment**, and a board-certified dermatologist who says so is more useful than one who assumes. **Book an appointment if:** - Areas of your skin have lost color, or look lighter than your natural tone - Patches are appearing in new places, or an existing patch is spreading - Hair in an affected area has turned white [2] - You have lost color around the mouth, the nose or the lips [2] - You want to know what it is before deciding whether to treat it **Worth raising at the same visit:** - Any personal or family history of thyroid disease or alopecia areata [3] - Any change in hearing or eyesight, both of which are named alongside vitiligo [3] - Any plan to get a tattoo, which is worth discussing first [4] Diagnosis is by reviewing your medical history and examining your skin, sometimes with a specialized light. [5] Nothing about it requires preparation. Two things run in parallel here: protecting skin that has lost its defenses, and deciding for yourself how much you want to change how it looks. **Worth doing** - Protect your skin from the sun. Skin that has lost its natural color sunburns easily. Broad spectrum, water resistant, SPF 30 or higher [4] - Long sleeves, long trousers, a wide-brimmed hat and sunglasses with UV protection [4] - Avoid indoor tanning entirely [4] - Avoid cuts, scrapes and burns where you reasonably can, since injury can trigger new spots [4] - Use makeup, self-tanner or skin dye if you would like to add color. Waterproof options exist and they work [4] **Worth knowing** - New spots from a skin injury tend to appear about 10 to 14 days afterward, which is why tattoos over affected skin are worth discussing first [4] - Vitiligo is not contagious and does not raise your risk of skin cancer [1] - Hearing and eyesight problems are named alongside vitiligo, so mention any change [3] - Looking after your mental health is named as part of self-care, and it belongs there [4] - The opposite problem, where skin makes too much pigment, is a different condition entirely and gets confused with this one surprisingly often Diagnosis, prescription treatment, light-based treatment, and the sun protection that everything else depends on. Pick a treatment to see how it works. Diagnosis and treatment of vitiligo are medical care rather than a cosmetic service, and are handled differently from the aesthetic treatments on this site. Our office will go through what applies to you when you book. Where a plan runs over months, you will have the shape of it and its cost before anything is started rather than partway through. **Q: Is vitiligo contagious?** No. You cannot catch vitiligo from someone or give it to anyone. [1] It is an autoimmune condition happening inside your own body. **Q: Is it harmful to my health?** No. Vitiligo can change your appearance and it is not harmful to your health. [1] It also does not increase your risk of developing skin cancer. [1] What it does do is remove your skin's natural protection from light in the affected areas, which is why sun protection matters more here than almost anywhere. **Q: Can it be cured?** No. Treatment cannot cure vitiligo, and it may restore lost skin color. [5] The section above sets out what that means in practice, including the figures, because a realistic picture is more useful than either extreme. **Q: How well does treatment work, and how long does it take?** In clinical trials of one prescription cream, about 30 percent of patients saw 75 percent of their skin color restored by week 24. [5] Within a year of stopping treatment, an estimated 40 percent of patients see some color loss. [5] Both numbers matter: the first is why treatment is worth starting, the second is why maintenance is part of the plan. **Q: Will it spread?** It can, and it does not always. Severe sunburn, skin injury and certain chemicals are named triggers, and skin injury in particular can produce new spots about 10 to 14 days later. [3] [4] Protecting your skin and avoiding cuts and burns where you can is the practical version of managing that. **Q: Do I have to treat it?** No, and that is a real answer rather than a polite one. Vitiligo is not harmful to your health. [1] Some people treat it, some use camouflage, and some do neither. What everybody should do regardless is protect skin that has lost its pigment from the sun. **Q: Do I need a referral?** Yes. This is medical dermatology, and the practice is currently accepting new medical patients by referral from your primary care physician. Once you have that, call the office and we will get you in. 1. American Academy of Dermatology Association. "Vitiligo: FAQs." States that "vitiligo is a condition that causes skin to lose color. Areas of skin may look lighter than your natural skin tone, white, or even pink," that "vitiligo is most visible when someone has a darker skin tone or a tan," that "no. You cannot catch vitiligo from someone or give it to anyone," that vitiligo "can change your appearance, it isn't harmful to your health," and that in answer to whether vitiligo increases the risk of developing skin cancer, "no." [https://www.aad.org/public/diseases/a-z/vitiligo-overview](https://www.aad.org/public/diseases/a-z/vitiligo-overview) · Medical Organization 2. American Academy of Dermatology Association. "Vitiligo: Signs and symptoms." Describes patches that when active can appear "pink or tricolor (causing a zone of tan skin between a person's natural skin color and the white vitiligo)," names the face, arms, hands and feet as common first sites and states it "can develop anywhere on a person's skin," that affected skin "sunburn[s] easily," that hair in affected areas can "turn white," and describes "loss of color in the mouth, on the lips, around the mouth, around the nose, or inside the nose." [https://www.aad.org/public/diseases/a-z/vitiligo-symptoms](https://www.aad.org/public/diseases/a-z/vitiligo-symptoms) · Medical Organization 3. American Academy of Dermatology Association. "Vitiligo: Causes." States that "vitiligo is an autoimmune disease. This type of disease develops when your immune system mistakes part of your body as foreign," that "your immune system mistakes as foreign cells in your body that give skin, hair, and eyes their color. This case of mistaken identity causes the immune system to attack and destroy pigment-producing cells called melanocytes," that "while vitiligo can run in a family, having a close blood relative with vitiligo doesn't guarantee that you will get vitiligo. A number of genes are involved," that "about half the people who develop vitiligo get it before they turn 20 years of age," that it affects "people of all races and skin tones," names severe sunburn, injured skin such as a cut, scrape or burn, and "getting certain chemicals on your skin, such as those used in some hair dyes or products" as triggers, and names alopecia areata, thyroid disease, hearing loss and eyesight problems among associated conditions. [https://www.aad.org/public/diseases/a-z/vitiligo-causes](https://www.aad.org/public/diseases/a-z/vitiligo-causes) · Medical Organization 4. American Academy of Dermatology Association. "Vitiligo: Self-care." States "protect your skin from the sun. Skin that has lost its natural color tends to sunburn easily," recommending sunscreen with "broad-spectrum protection, water-resistance, SPF 30 or higher" plus long sleeves, trousers, a wide-brimmed hat and UV sunglasses. States "use makeup, self-tanner, or skin dyes if you'd like to add color to your skin," "avoid cuts, scrapes, and burns. For some people, a skin injury triggers new spots or patches," and warns that "when you get a tattoo, you wound your skin. A wound can lead to something called the Koebner phenomenon, which can cause new spots of vitiligo to develop," with new spots appearing "about 10 to 14 days after the injury." Also advises avoiding indoor tanning and taking care of mental health. [https://www.aad.org/public/diseases/a-z/vitiligo-self-care](https://www.aad.org/public/diseases/a-z/vitiligo-self-care) · Medical Organization 5. American Academy of Dermatology Association. "Vitiligo: Diagnosis and treatment." States that "a board-certified dermatologist diagnoses vitiligo by reviewing your medical history and examining your skin," sometimes using a Wood's lamp; that "treatment cannot cure vitiligo. While researchers are looking for a cure, treatment cannot currently cure this disease"; that "while vitiligo cannot be cured, treatment may restore lost skin color"; that "it takes time to work. In clinical trials, about 30% of patients saw 75% restored skin color at week 24"; and that "within a year of ending treatment, it's estimated that about 40% of patients see some color loss." Names topical corticosteroids used for limited periods, pimecrolimus cream and tacrolimus ointment, ruxolitinib cream, phototherapy, laser therapy for targeted areas, oral prednisone to slow new patches, skin grafts and cell transplants, depigmentation described as "rarely used," and camouflage makeup and self-tanner. [https://www.aad.org/public/diseases/a-z/vitiligo-treatment](https://www.aad.org/public/diseases/a-z/vitiligo-treatment) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Vitiligo is diagnosed by examination and history, and other conditions can cause loss of skin color. Treatment cannot cure vitiligo and results vary considerably from person to person and by body site; the figures on this page describe results reported in groups of patients and do not predict any individual outcome. Skin that has lost its pigment sunburns easily and requires daily protection. Prescription and light-based treatments each carry their own risks, which are discussed individually before anything is started. Individual results may vary. ### Warts A wart is a common, non-cancerous skin growth caused by the human papillomavirus. [1] There are more than 200 different types of HPV, and different types produce different warts in different places. [1] Once you understand that a wart is an infection rather than a lump of thickened skin, everything else about it makes sense. It explains the spread: **warts are contagious, and you can pass the virus to other people and to other parts of your own body.** [1] When it spreads, new warts form. [1] It explains the timeline: it usually takes a few months for a wart to grow large enough to see, so the one you noticed this week arrived a while ago. [1] And it explains why treatment aims at the whole thing rather than the surface. **The black dots are blood vessels**, not seeds and not dirt. [2] That is worth knowing because it is the single most common misconception about warts, and because picking at them to get the "seeds" out is how they spread. **What they look like** [2] - Round, flat, rough, smooth, or shaped like a cauliflower - The same color as your skin, or brown, gray, black, pale yellow, white or pink - A common wart is often a round or oval, rough bump, usually on hands, knuckles or around a nail - A plantar wart on the sole is a rough, thickened growth that often contains small black dots - A flat wart is smaller and smoother, with a flat surface, often on the face or on skin you shave - A filiform wart looks like it has threads or tentacles sticking out of it Most warts are harmless and will go away on their own if you have a healthy immune system, and it can take a few months to years for that to happen. [1] So "do nothing" is a legitimate option, and it is not the right option for every wart. Here is how the three routes actually divide. Your situationThe reasonable routeWhyOne or two warts, on a hand, not painful, not spreading, and you are not botheredWaitMost clear on their own in a healthy immune system, though it can take months to years [1]A wart you would rather be rid of, in an ordinary spot, and you have not tried anything yetHome treatment firstSoften in warm water, apply salicylic acid, cover with duct tape or a bandage [4]Home treatment has not worked, or the wart is spreadingCome inStubborn warts have in-office options that home treatment does not [4]A wart on your face or genital areaCome in [4]Site changes what is safe and appropriate to useA wart that is changing, painful, itching, burning or bleedingCome in [4]Those are the features worth having examined rather than treatedMany warts, or new ones keep appearingCome in [4]A pattern is worth understanding rather than treating one at a timeYou have a weakened immune system or diabetesCome in [4]Both change the calculation on anything done at homeAny doubt about whether it is a wart at allCome in [4]This is the important one, and The Coastal difference below is about it Two things the table cannot decide for you. The first is patience: "a few months to years" is a real range, and choosing to wait is choosing to live with it for an unknown stretch. [1] The second is spread. A wart you are waiting out is contagious the entire time, to you and to other people, until you no longer see or feel it. [1] AreaWhat tends to appear there [2]Hands, knuckles, around a nailThe most common site, and where common warts turn upSoles of the feetPlantar warts, rough and thickened, often with black dots, and often uncomfortable to stand onFaceFlat warts, smaller and smoother, and a site where treatment choice matters moreSkin you shaveWhere microtears let the virus in and where warts spread in a line [3]Elbows and kneesCommon in children, and easily passed alongAnywhere with a break in the skinWhich is why a small cut is worth covering rather than ignoring ![large wart on finger](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-warts.webp) Plenty of things look like warts. [Skin tags](/conditions/skin-tags/), [moles](/conditions/moles/) and a handful of other growths get treated at home as warts for months, and a small number of things that look like a stubborn wart are [a growth that needs an answer](/conditions/skin-cancer/) instead. A wart that is growing rapidly, looks like an open sore, or fails to clear with treatment is exactly the situation where a sample gets sent to a laboratory rather than another round of acid applied to it. [4] That is the actual argument for coming in, and it costs one appointment. After that the range is wide: freezing, a medication painted on in the office that raises a blister under the wart, burning it off, cutting it out, immunotherapy that gets your own immune system to fight the virus, and [a laser aimed at one spot](/treatments/smartskin-laser-skin-resurfacing/) for warts that have not cleared with anything else. [4] Which one suits depends on the wart, the site and what has already been tried, and that is a judgment rather than a menu. **Book an appointment if:** [4] - You have warts on your face or genital area - A wart is changing, hurts, itches, burns or bleeds - You have many warts - You have any doubt about whether it is a wart - Home treatment has not cleared it - You have a weakened immune system, or diabetes **Also worth booking if:** - Warts keep appearing in new places, which usually means the virus is being spread by something in your routine - A wart on the sole is painful to walk on - You shave over a wart, which spreads it reliably A dermatologist can usually diagnose warts by looking at them. [4] Where a wart is growing rapidly, looks like an open sore, or has not cleared with treatment, a small sample goes to a laboratory. [4] Warts stay contagious until you no longer see or feel them. [1] Everything below is aimed at that window. **Worth doing** - Cover a wart, particularly one on a hand or a foot that touches shared surfaces - Do not shave over a wart. Shave around it, or leave that area until it has cleared - Wear something on your feet in pool areas, communal showers, gyms and locker rooms [3] - Keep your own towel, and do not share nail clippers or files - Wash your hands after touching one, including your own **Worth knowing** - The black dots are blood vessels. Digging at them does not remove anything and does spread the virus [2] - Most warts clear on their own in a healthy immune system, and it can take months to years [1] - It usually takes a few months for a wart to grow large enough to see, so a new one was not caught this week [1] - Home salicylic acid works better on skin softened in warm water first, and covered afterward [4] - Freezing in the office usually heals within four to seven days and may be repeated every two to four weeks [4] Identification first, then the treatment that suits the wart, the site and how stubborn it has proven. Pick a treatment to see how it works. Diagnosis and treatment of warts are medical care rather than a cosmetic service, and are handled differently from the aesthetic treatments on this site. Our office will go through what applies to you when you book. Where a sample is sent for examination, laboratory fees are billed separately by the laboratory that reads it, and we will tell you when a sample is being sent. **Q: Are warts contagious?** Yes. Warts are contagious, and they stay contagious until you no longer see or feel them. [1] You can spread the virus to other people and to other parts of your own body, and when it spreads, new warts form. [1] That is the strongest argument for treating one rather than waiting it out. **Q: What are the little black dots?** Blood vessels. [2] Not seeds, not dirt, and not something to be extracted. The "seeds" idea is the most persistent myth about warts and it leads directly to people digging at them, which is one of the more reliable ways to end up with several. **Q: Will it go away on its own?** Probably, eventually. Most warts are harmless and will go away on their own if you have a healthy immune system, and it can take a few months to years. [1] Whether that is acceptable depends on where it is, whether it hurts, and whether you are comfortable being contagious for that long. **Q: Does freezing hurt, and how many times?** Freezing is done in the office and the treated area usually heals within four to seven days. [4] It may be repeated every two to four weeks. [4] How many rounds a particular wart needs is not something anyone can promise in advance, and you will get a realistic picture after it has been looked at. **Q: Why do I keep getting new ones?** Usually because something in your routine keeps letting the virus in or moving it around: shaving over one, going barefoot in a shared wet space, or picking at one. [3] A pattern of new warts is worth a visit rather than treating each one as it appears. **Q: Can a wart be something else?** Sometimes, and that is the reason to have one looked at rather than assumed. A wart that is growing rapidly, looks like an open sore, or has not cleared with treatment gets a small sample sent to a laboratory. [4] Skin tags and moles also get treated at home as warts more often than you would expect. **Q: Do I need a referral?** Yes. This is medical dermatology, and the practice is currently accepting new medical patients by referral from your primary care physician. Once you have that, call the office and we will get you in. 1. American Academy of Dermatology Association. "Warts: FAQs." States that "a wart is a common, non-cancerous skin growth caused by the human papillomavirus (HPV)," that "there are more than 200 different types of HPV," that "if you have a wart, you can spread the virus that causes it to other people and to other parts of your body," that "when the virus spreads, new warts can form," that "yes. Warts are contagious," that "warts are contagious until you no longer see or feel them," that "it usually takes a few months for a wart to grow large enough to see," and that "most warts are harmless and will go away on their own if you have a healthy immune system. However, it can take a few months to years for a wart to disappear." [https://www.aad.org/public/diseases/a-z/warts-overview](https://www.aad.org/public/diseases/a-z/warts-overview) · Medical Organization 2. American Academy of Dermatology Association. "Warts: Signs and symptoms." States that "a wart can be round, flat, rough, smooth, or cauliflower shaped," that "a wart may be the same color as your skin, or it may be brown, gray, black, pale yellow, white, or pink," that of the black dots inside a wart "the dots are blood vessels," that "a common wart often looks like a round or oval, rough bump," that plantar warts "often look like rough, thickened growths that often contain small, black dots," that flat warts "are smaller than common warts and have a smooth, flat surface," that filiform warts "look like they have tentacles or threads sticking out," and that most warts appear on the hands, especially the knuckles or around a nail, the feet usually on the bottom, elbows, knees, skin that you shave, the face, or the genitals. [https://www.aad.org/public/diseases/a-z/warts-symptoms](https://www.aad.org/public/diseases/a-z/warts-symptoms) · Medical Organization 3. American Academy of Dermatology Association. "Warts: Causes." States that "shaving creates microtears in the skin. HPV can infect you through a microtear," that warts are common in children and teens because they "frequently touch each other's skin, have a cut or scrape, or share unwashed clothing or towels," and names as risk factors having skin that is softened by water, walking barefoot in a pool area, communal shower, gym or locker room, having a weakened immune system, being pregnant, having atopic dermatitis with asthma or hay fever, and handling raw meat or poultry. [https://www.aad.org/public/diseases/a-z/warts-causes](https://www.aad.org/public/diseases/a-z/warts-causes) · Medical Organization 4. American Academy of Dermatology Association. "Warts: Diagnosis and treatment." States that "your dermatologist can usually diagnose warts by looking at them," and that a biopsy may be taken if "a wart is growing rapidly, looks like an open sore, or fails to clear with treatment." Names salicylic acid, cryosurgery ("the treated area usually heals within 4 to 7 days" and treatment "may be repeated every 2 to 4 weeks"), occlusion, cantharidin ("also known as beetle juice, cantharidin causes a blister to form around and under the wart"), electrosurgery and curettage, excision, laser ("a laser can effectively treat stubborn warts and may clear them quickly"), bleomycin, immunotherapy ("this treatment stimulates your immune system, so it can more effectively fight the wart-causing virus"), 5-fluorouracil and trichloroacetic acid. Lists reasons to see a dermatologist including "warts on your face or genital area," "a wart that is changing, hurts, itches, burns, or bleeds," "many warts," "doubts about whether you have a wart(s)," failed at-home treatment, a weakened immune system, and diabetes. Describes home care as softening in warm water, applying salicylic acid, and covering the treated wart with duct tape or a bandage. [https://www.aad.org/public/diseases/a-z/warts-treatment](https://www.aad.org/public/diseases/a-z/warts-treatment) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Not every rough growth is a wart, and a growth that is changing, growing rapidly, bleeding or failing to clear should be examined rather than treated at home. Warts are caused by a virus and can recur or spread; the number of treatments needed varies from person to person and from wart to wart. In-office treatments carry risks including discomfort, blistering, temporary changes in skin color and, less commonly, scarring, which are discussed before treatment. Individual results may vary. ### Wrinkles and Fine Lines Lines are not one problem with one answer, and that is the single most useful thing to understand before spending money on them. Almost every line on a face belongs to one of three groups, and the treatment that transforms one of them does very little for another. **Muscle lines.** The crease between your brows when you concentrate, the crow's feet when you smile, the horizontal lines when you raise your eyebrows. These are made by the muscle folding the skin, over and over, for years. They are the ones people notice first because they arrive earliest. **Skin lines.** Fine crosshatching on the cheeks, crepe texture under the eyes, the vertical lines on the upper lip. These sit in the skin itself, where collagen and the springy fibers underneath have thinned. [Years of sun](/conditions/sun-damage/) is the biggest single contributor to this group. **Folds from lost volume.** The crease running from the nose to the corner of the mouth, hollowing under the eye, a softening along the jaw. These are not really lines at all. They are shadows and creases that appear because [the volume underneath has gone](/conditions/facial-volume-loss/), and treating the surface does not address them. Most people over thirty have some of all three. The mix is what the plan is built from. You can narrow this down yourself in about a minute, and it will make your consultation a much better conversation. Stand at a mirror in good light and do these three things in order. StepWhat to doWhat it tells you1Make the expression that creates the line, then relax your face completely. Watch the lineIf it vanishes when you are still, it is a muscle line. That is the group that responds to a neuromodulator2With your face still relaxed, look at what is left. Is there a fine line etched into the skin?A line still visible at complete rest is a skin line. That group responds to resurfacing, microneedling and collagen treatment3Lie back, or lift the skin of your cheek gently upward with two fingers. Does the crease flatten out?If lifting from underneath flattens it, it is a volume problem rather than a line, and a face that has emptied is where the answer is Most people find they have all three, in different places. The forehead is often muscle, the cheeks often skin, the fold beside the mouth often volume. **That is why a single product rarely satisfies anyone**, and why the useful question at a consultation is not "what should I get" but "which of these do I have the most of." One thing the test will not tell you is whether what you are seeing is [loose skin](/conditions/sagging-skin/) rather than a line, because loose skin and an emptied face look alike in a mirror and need different treatment. That one takes a person. ![woman without wrinkles or fine lines](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-wrinkles-and-fine-lines.webp) This is the most contested term in this market and almost every page competing for it is a page about a single product. That is the structural problem with the category: if a practice offers one route, every face that walks in turns out to need that route. We carry all three routes, which means the recommendation can follow your face instead of the inventory. Sometimes the honest answer is a neuromodulator and nothing else. Sometimes it is that the crease you dislike is a volume problem and no amount of surface work will reach it. Sometimes it is sunscreen, a retinoid and a conversation in a year, and that is a real outcome of this appointment rather than a polite deferral. **A board-certified dermatologist assessing all three at once is a different consultation from a treatment room with one machine in it.** **This is a good conversation to have if:** - You have run the mirror test and found more than one kind, which most people do - You have had a treatment elsewhere that did not do what you hoped, which often means it was aimed at the wrong group - You want to know what you actually have before you spend anything - Lines have started staying visible when your face is at rest - You would rather start early and lightly than wait and do more later **Worth knowing before you book:** - Muscle lines respond earliest and most predictably. Skin lines take a course and time - A fold that flattens when you lift the skin is a volume conversation, not a line one - Everything here works better on skin that is protected daily from the sun There is no obligation attached to finding out which you have, and some people leave with a skin care plan rather than a treatment. **Worth doing** - Broad spectrum sunscreen, SPF 30 or higher, water resistant, every day before you go outside [3] - Treat your neck and chest as part of your face, because they show skin lines early - Keep a routine simple and consistent rather than long and occasional - Come back on the interval you agreed rather than when the result has fully worn off, which is easier and usually less work **Worth knowing** - Muscle lines return as movement returns. That is the treatment wearing off rather than failing - Skin lines improve gradually over a course and keep improving for months after it ends - Your face carries on aging underneath any result, which is what maintenance is for - Sun protection is the only part of this you do every day, and it is the part that compounds A different route for each of the three, and most plans use more than one. Pick a treatment to see how it works. What a plan costs depends entirely on which of the three you are treating and how much of each, which is worked out at the consultation. You get the plan and its cost before anything is booked. **Q: How do I know which treatment I need?** Start with the mirror test above. A line that vanishes when your face is completely still is a muscle line. One that stays is a skin line. A crease that flattens when you lift the skin from underneath is a volume problem rather than a line. Most people have all three, and the mix is what the plan is built from. **Q: Will one treatment fix everything?** Rarely, and that is a feature of the anatomy rather than a sales position. The three kinds sit in different layers and respond to different things. A plan that combines two routes usually gets further than either one pushed harder. **Q: Am I too young, or have I left it too late?** Neither is a real category. Lines start staying at rest at different ages for different people, depending on sun exposure, genetics and how expressive a face is. Starting earlier tends to mean lighter treatment, and starting later means there is more to work with. Both are ordinary reasons to come in. **Q: Is it true that treating lines early prevents worse ones?** Softening the movement that folds the skin means the skin gets folded less, and that is the reasoning behind starting earlier rather than later. What is certain is that the sun side of it compounds: protecting your skin daily slows the collagen loss that turns expressions into permanent lines. [3] **Q: What if my lines are from sun rather than age?** They are usually both, and it does not change the treatment much. Years of sun accelerates collagen loss, which produces the same skin lines that time produces more slowly. What it does change is the priority of daily protection, since that is the part still in your hands. **Q: Will I look done?** That is the most common worry and it is a reasonable one. It comes down to how much is used and where, which is a judgment rather than a formula. Say plainly at your consultation that you want it to look like nothing was done, because that is a legitimate goal and it changes the plan. 1. American Academy of Dermatology Association. "Many ways to firm sagging skin." States that non-surgical options give "modest lifting and tightening," that best results from radiofrequency appear at about 6 months and "can last 2 to 3 years with the right skin care," and that non-surgical options "still cannot give you the results of a surgical procedure like a facelift, eyelid surgery, or neck lift." [https://www.aad.org/public/cosmetic/younger-looking/firm-sagging-skin](https://www.aad.org/public/cosmetic/younger-looking/firm-sagging-skin) · Medical Organization 2. American Academy of Dermatology Association. "Skin conditions that lasers can treat." Laser and light treatments are listed as useful to reduce wrinkles and fine lines, alongside age spots, scars and other concerns. [https://www.aad.org/public/diseases/a-z/skin-conditions-lasers-treat](https://www.aad.org/public/diseases/a-z/skin-conditions-lasers-treat) · Medical Organization 3. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant, reapplied every two hours outdoors and after swimming or sweating. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice. The self-assessment described on this page narrows the possibilities and does not replace an examination. Results vary by which kind of line is being treated, by individual anatomy and by how consistently sun protection is maintained. Neuromodulators, fillers, resurfacing and microneedling each carry their own risks, which are discussed individually before anything is scheduled. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ## Treatments ### Belotero Balance® There is a version of tired that sleep does not fix. The shadow under your eye is still there on a Sunday morning after nine hours, because it is not fatigue, it is a hollow, and light falls into it the same way every day. Belotero is one of the few fillers approved to treat exactly that. [1] It does the same job around the mouth. The fine vertical lines through the lip that lipstick travels into, the crease that has started to run from the corner of your mouth downward, the softening along the smile lines. These are shallow, constantly moving areas where a firmer gel sits above the tissue instead of in it, and shows as a ridge or a bluish line the moment the light changes. What lets Belotero go there is how the gel is built. Merz calls it a Cohesive Polydensified Matrix, or CPM. In plain terms it disperses through fine tissue and supports it evenly rather than holding its shape as a distinct lump, which is precisely why it works in the places other fillers are too heavy for. **What Belotero is good at** - The hollow under the eye, with an FDA-approved indication for that area rather than an off-label workaround - The fine vertical lines around the lips that make lipstick bleed - Softening smile lines without adding weight to the lower face - Sitting shallow in thin skin without showing an edge or a bluish cast - Being reversible, which matters more under the eye than anywhere else on the face - Small, conservative corrections where a syringe of something firmer would be too much Under-eye darkness is at least four different problems wearing the same face, and only one of them is a filler problem. This is the most useful thing on this page, so it is worth two minutes. **A hollow.** The tissue that used to sit under your eye has thinned, so there is a genuine dip and the light falls into it. This is the one Belotero treats, and the one it treats well. **Pigment.** The skin itself is darker in that crescent, often for reasons that run in families. Filler underneath does nothing to a stain on the surface. Pigment responds to topical treatment and to the right kind of light-based work. **Thin skin.** The skin is translucent enough that the blue-violet vessels underneath show through it. Adding volume can help a little by pushing the surface forward, but the real answer is thickening the skin, which is a resurfacing and collagen question rather than a filler one. **A fat pad sitting forward.** Puffiness rather than hollowness, sometimes with a hollow directly below it. Filling around a bulge makes the bulge more obvious. This is a surgical conversation and we will say so. Most people have some combination of two. Working out which ones you have, and in what proportion, is the whole job, and it takes a face in the room and good light. It is exactly what your consultation buys, and it is credited toward whatever you decide to do. These are our own patients, photographed at our offices and published with their consent. Individual results vary. There are more in the practice's private gallery, and we are happy to show you cases similar to yours at your consultation. ![Happy young woman](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-belotero-balance.webp) The hollow under your eye sits over vessels that connect to the circulation around the eye itself. That is the reason this area is treated carefully everywhere it is treated well, and the reason an approved indication makes it a treatable area rather than a routine one. Your assessment and your injection both happen inside a board-certified dermatology practice, by people who look at this anatomy every day for medical reasons as well as cosmetic ones. It is also the area where matching the treatment to the cause pays off most. If your shadow is pigment or thin skin rather than [facial volume loss](/conditions/facial-volume-loss/), there are better tools for it and you will leave with a plan built around the right one. When it is the wrong tool, the right one is usually something else we do: resurfacing for the skin, a [neuromodulator](/treatments/botox-cosmetic-xeomin/) for the lines that come from movement, or a firmer gel from the [JUVÉDERM](/treatments/juvederm-fillers/) family where the correction needs real structure. **Belotero is probably a good fit if:** - You look tired in photographs no matter how much you have slept, and there is a visible dip under the eye - The fine lines around your mouth have started catching lipstick - You have been told elsewhere that your under-eye area is too delicate for filler - You want a small, careful correction rather than a visible change - You want something you can have dissolved if you change your mind **We will steer you somewhere else if:** - Your under-eye darkness is pigment or very thin skin, where filler will not help - There is significant puffiness from a fat pad sitting forward, which is a surgical conversation - You have an infection or active breakout in the area, which needs to clear first - You are pregnant or breastfeeding, when we defer elective treatment - What you want is structural lift in the cheek or jaw, where a firmer gel is the right tool Not sure which of these you are? Almost nobody is, and working it out is the appointment. That is why the consultation is with a dermatologist and why the fee comes back to you. Expect some swelling and a real chance of a bruise, especially under the eye, where the skin is thin and bruises show. Plan it around your calendar rather than the week of an event. The area can feel firm or slightly uneven for the first week and that settles as the gel integrates. **In the first week, do** - Use a cool compress for the first day if we told you to - Sleep with your head slightly elevated for a couple of nights - Wear sunscreen, and sunglasses if you have a bruise - Come back for the follow-up, which is where we judge the real result **In the first week, don't** - Press, rub or massage the area unless we specifically asked you to - Judge it while you are swollen, and do not chase a small asymmetry on day three - Book a facial, a peel or a laser in the same two weeks - Ignore anything that feels wrong, which is the only instruction that really matters Call us about anything severe, worsening, or simply not what we described: significant or increasing pain, skin that changes color or goes pale or dusky, any change in your vision, or signs of infection. Do not wait to see whether it settles. We would far rather hear from you. Belotero is the filler we choose when the area is delicate and the correction needs to be small. Pick a concern to see how we approach it. Belotero is priced by the syringe, and the under-eye area is one of the rare places where a single syringe often covers both sides with product left over. We tell you the number for your plan at your consultation, before you commit to anything. We do not treat off a promotional price and we do not sell you a full syringe if half of one is the right correction. Under the eye in particular, less is usually the better answer. **Q: Is Belotero actually approved for under the eyes?** Yes. Belotero Balance (+) is FDA approved for volume augmentation to improve the infraorbital hollow in adults over the age of 21, alongside its approval for moderate to severe facial wrinkles and folds such as nasolabial folds. Most hyaluronic acid fillers used in that area do not carry a labeled indication for it. [1] **Q: Am I a candidate for under-eye filler?** Only if the hollow is genuinely a volume problem. If the darkness is pigment, if the skin is very thin and translucent, or if there is puffiness from a fat pad sitting forward, filler will not fix it. We work that out before offering treatment rather than after, and there is a whole section above on how to tell the difference. **Q: How is Belotero different from a thicker filler?** It is built to integrate through fine tissue rather than hold its shape as a distinct mass. Merz calls the gel technology Cohesive Polydensified Matrix. What that buys you is shallow placement in delicate skin without an edge showing. What it does not buy you is structural lift, so if you want a cheekbone or a jawline rebuilt, a firmer product is the right one. **Q: How long does it last?** It varies by area and by person, and the areas that move most break it down fastest. The manufacturer states that long-term safety and effectiveness beyond 96 weeks have not been investigated, which tells you the outer bound of the studied period rather than how long your result will hold. We give you a realistic range for your area at consultation. [1] **Q: Can it be dissolved if I do not like it?** Yes. Belotero is hyaluronic acid, and a qualified medical professional can dissolve it when that is the right call. The FDA notes that filler not made from materials such as hyaluronic acid may be difficult or impossible to remove. [2] Under the eye especially, that reversibility is a large part of why hyaluronic acid is the material of choice. **Q: Does it hurt?** Less than the location suggests. Belotero Balance (+) contains lidocaine, so the area numbs as we work, and we numb the surface beforehand as well, which is routine for the under-eye. Most people describe brief pressure and pinching. **Q: Is Belotero the same as BOTOX?** No, and they solve opposite problems. Belotero is a filler that physically restores support where tissue has thinned. A neuromodulator temporarily softens the muscle movement that creates expression lines. If your concern appears when you move, filler is the wrong tool. If it is there whether you move or not, it is the right one. Plenty of plans use both, in different places. 1. BELOTERO BALANCE® (+) Important Safety Information, Merz Aesthetics. Indicated for injection into the mid-to-deep dermis for correction of moderate-to-severe facial wrinkles and folds, such as nasolabial folds, and for volume augmentation for the improvement of the infraorbital hollow in adults over the age of 21. Long-term safety and effectiveness beyond 96 weeks have not been investigated. https://www.belotero.com/hcp/ · Regulatory / Prescribing Information 2. U.S. Food and Drug Administration. "Dermal Fillers (Soft Tissue Fillers)." Notes that the duration of effect depends on the filler material and the area injected, and that it may be difficult or impossible to remove filler material that is not made of materials such as hyaluronic acid. [https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/dermal-fillers-soft-tissue-fillers](https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/dermal-fillers-soft-tissue-fillers) · Regulatory Content on this page is for educational purposes and is not a substitute for professional medical advice. Belotero Balance® is a registered trademark of Merz Pharma. Individual results may vary. Common effects after filler include swelling, bruising, tenderness and temporary firmness or asymmetry, and bruising is more visible in the thin skin under the eye. Serious complications are uncommon but can occur; call the practice immediately about increasing pain, skin color change or any change in vision. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### BOTOX® Cosmetic & Xeomin® Some lines on your face are creases in the skin. Others are the result of a muscle pulling the same way ten thousand times. A neuromodulator only works on the second kind. It quietly turns down the signal telling that muscle to contract, the pull stops, and the line it was carving softens over the following week. That distinction is the whole treatment, and it is why the assessment matters. Lines that are there when your face is completely still are usually a filler question or a resurfacing question, not this. Lines that appear when you frown, squint or raise your brows are this. Most people have some of both, which is normal and worth knowing before you pay for the wrong one. The word people are afraid of is frozen. Frozen is a dosing decision, not a property of the drug. Treated conservatively and placed properly, your forehead still moves, your brows still lift and your face still reads as yours. That is the standard here, and it is easier to hold to when the person injecting does this every day. **What it is good at** - Softening the vertical frown lines between your brows that make you look angry - Smoothing horizontal forehead lines without dropping your brows - Easing crow's feet at the corners of the eyes - Small refinements: bunny lines on the nose, chin dimpling, a gummy smile, vertical neck bands - Stopping heavy underarm sweating, which is a medical treatment rather than a cosmetic one - Slowing new lines from setting in, if you start before they are permanent These are our own patients, photographed at our offices and published with their consent. Individual results vary. There are more in the practice's private gallery, and we will show you cases close to yours at your consultation. ![Woman receiving a BOTOX® Cosmetic injection](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-botox-cosmetic-xeomin.webp) Neuromodulators are prescription drugs, and where you have them done changes the result far more than which brand goes in the syringe. Here they are given inside a dermatology practice, by providers who look at faces all day and who are not working to a fixed template of units per area. We treat conservatively on purpose. It is easier to add a small amount at a two-week review than to wait three months for too much to wear off, and the people who look untouched are almost always the ones whose injector held back. If you come in asking for something we think will make you look done, you will hear that. We also carry both. BOTOX Cosmetic and Xeomin are not interchangeable and the reasons to choose between them are real, which is the next section. Both are botulinum toxin type A. Both work by turning down the signal to a muscle. What differs is what comes along with the toxin, and what each one is approved to treat. **Xeomin is the naked one.** It is the same active toxin with the surrounding accessory proteins stripped out, so it contains no complexing proteins. [2] Those proteins are one of the things an immune system can learn to recognize, which is why a product without them is less likely to lose its effect on you over years of treatment. If you have been having injections for a long time and feel they do not last the way they used to, this is a conversation worth having. **BOTOX Cosmetic is approved for more areas.** Xeomin is FDA approved for the three upper-face areas: frown lines, forehead lines and crow's feet. BOTOX Cosmetic is approved for those three plus vertical neck bands. [1][2] Their units are not interchangeable either, so a dose of one cannot simply be converted into a dose of the other. Which you get depends on your area, how you have responded before, and clinical judgment. Neither is universally better, and anywhere that only stocks one will always recommend the one it stocks. **It is probably a good fit if:** - The lines that bother you appear when your face moves - You look tired or cross in photographs and you do not feel that way - You want something with no recovery that you can have at lunchtime - You want to start before the lines become permanent - You sweat heavily through your clothes regardless of temperature **We will steer you somewhere else if:** - The lines are there when your face is completely still, which is usually filler or resurfacing - You are pregnant or breastfeeding - You have a neuromuscular condition that makes this unsafe - You have an infection at the injection site - What you are describing to us sounds like it will end up looking overdone Almost nothing. You may have small red bumps at the injection points for twenty minutes and the odd bruise. Some people get a mild headache the first time. You go straight back to your day. **For the rest of the day, do** - Stay upright for about four hours - Use your face normally: frowning and raising your brows is fine and may even help - Go back to work, the school run, whatever you had planned **For the rest of the day, don't** - Rub, massage or press the treated areas - Lie flat, work out hard, or sit in a sauna - Panic at day three if one side looks ahead of the other. It evens out. Call us about anything severe, worsening or simply not what we described, including significant pain, signs of infection, drooping, or trouble swallowing, speaking or breathing. Botulinum toxin products carry an FDA boxed warning about effects spreading beyond the injection site. It is rare with cosmetic treatment, and it is the reason this is done by a medical provider rather than at a party. Pick a concern to see how we approach it. Neuromodulators are priced by the number of units used, and how many units you need depends on the area and on how strong the muscle is. That is why nobody can quote you a real number before looking at your face, and why a per-area flat price usually means a fixed dose whether it suits you or not. You will be told the number of units and the cost before anything is injected. No surprises at the desk. **Q: Will I look frozen?** Not unless someone overdoes it. Frozen is a dosing decision, not a property of the drug. We treat conservatively and review you rather than aiming for the maximum on the first visit, and the people who look best are the ones whose injector held back. **Q: What is the difference between BOTOX and Xeomin?** Xeomin is the same toxin with the accessory proteins stripped out, which is why it is called a naked toxin. [2] Those proteins are what an immune system can learn to recognize, so Xeomin is less likely to lose its effect over years. BOTOX Cosmetic is approved for one more area, the vertical neck bands. [1] Their units are not interchangeable. We carry both and choose based on your area and your history. **Q: How long will it last?** Three to four months for cosmetic treatment. Muscle strength, dose, area, metabolism and how long you have been having it all change that. Retreatment is not recommended more often than every three months, and we would rather set your interval from your actual response than from a calendar. [1] **Q: What happens if I stop?** Nothing bad. The muscle gradually goes back to working the way it did, and your lines return to where they would have been. It does not make anything worse than it was. People who stop simply go back to their starting point. **Q: Can it prevent wrinkles?** It can slow the ones caused by movement. A line that is repeatedly folded eventually stays folded, so easing the movement early means less of that folding. It does nothing for sun damage, which is the other half of why skin ages, and daily sunscreen matters at least as much. **Q: Does it help with sweating?** Yes, and it works very well. Heavy underarm sweating is treated with the therapeutic formulation rather than BOTOX Cosmetic, it is usually a medical rather than a cosmetic visit, and results last considerably longer than they do on the face. See hyperhidrosis. Both offices offer neuromodulator treatment. San Luis Obispo offers BOTOX Cosmetic and Xeomin. Santa Maria offers Xeomin. 1. BOTOX® Cosmetic (onabotulinumtoxinA) Prescribing Information, Allergan Aesthetics, October 2024. Approved for temporary improvement in the appearance of moderate to severe glabellar lines, lateral canthal lines, forehead lines and platysma bands in adults. Duration of effect for glabellar lines is approximately 3 to 4 months. https://www.botoxcosmetichcp.com/indications/ufl-indications · Regulatory / Prescribing Information 2. XEOMIN® (incobotulinumtoxinA) Prescribing Information, Merz Pharmaceuticals, July 2024. Indicated in adults for temporary improvement in the appearance of upper facial lines: moderate to severe glabellar lines, horizontal forehead lines and lateral canthal lines. Retreatment no more frequently than every three months. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/125360s074lbl.pdf · Regulatory / Prescribing Information Content on this page is for educational purposes and is not a substitute for professional medical advice. Botulinum toxin products carry an FDA boxed warning regarding distant spread of toxin effect. BOTOX® Cosmetic is a registered trademark of Allergan. Xeomin® is a registered trademark of Merz Pharmaceuticals. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### Chemical Peels A peel puts a carefully chosen acid on your skin, lifts off the damaged surface, and lets your body replace it. What comes up underneath is newer skin: more even in tone, smoother to the touch, and clearer of the marks that made you start looking at treatments in the first place. The word "peel" makes people picture the same thing every time, and that is the misunderstanding worth clearing up. A light peel is a lunch-hour treatment that leaves you glowing and slightly flaky. A medium peel is a genuine resurfacing that will visibly shed for one to two weeks and can change your skin in a single session. They are the same idea at completely different intensities. We pick the lightest one that will actually get you where you want to go. That is not caution for its own sake. Going deeper than a concern requires buys you more recovery and more risk without buying you a better result. **What a peel is good at** - Lifting dull, tired-looking skin and giving back some brightness - Evening out blotchy tone and superficial brown patches - Smoothing rough, bumpy texture - Clearing congestion and calming acne-prone skin - Softening the fine lines that sit right at the surface - Doing all of it on your chest, back and hands, not only your face ![Smiling brunette wearing a winter jacket](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-chemical-peels.webp) Anyone can apply a solution. Choosing which solution, at what strength, for which skin, is the part that takes a dermatologist, and it is the part that decides whether you walk out evenly bright or with a patch of dark pigment that takes months to settle. Depth is tied directly to both results and complications. [1] The assessment is the treatment. It matters more here than it would elsewhere. Peeled skin is new skin, and new skin burns, and we live somewhere with a great deal of sun. We plan peel courses around the sun you actually get, not the sun you would get in Seattle, and existing sun damage often changes which depth makes sense to start with. **A peel is probably a good fit if:** - Your skin looks dull, blotchy or rough and good skincare has taken it as far as it goes - You have superficial brown patches, sun spots or the marks left behind by acne - Your skin is congested and breaking out - You can follow sun protection instructions properly afterward - You understand that the depth you choose sets both the recovery and the result **We will steer you somewhere else if:** - You have an infection, broken skin or significant irritation in the area right now - You are on a medication or have had a recent procedure that makes peeling unsafe - Your pigment carries a risk that another approach handles more safely If you are not sure which of those you are, that is the consultation. Melasma in particular is a case where the wrong depth makes things worse rather than better, and it is not a decision to make from a website. Your skin will feel tight and look pink, the way it does after a day outside. Depending on depth you will get flaking or genuine peeling, and pigment often darkens briefly before it sheds, which surprises people who were not warned. All of it is the treatment working. **While you are healing, do** - Keep it simple: gentle cleanser, plenty of moisturizer - Wear broad-spectrum sunscreen every day, without negotiating with yourself about it - Let the skin come away in its own time - Follow whatever plan your provider sends you home with **While you are healing, don't** - Pull, pick or help anything off - Go back to retinoids, acids or scrubs until we clear you - Book a peel a week before an event you care about - Let new skin see direct sun Call us about anything severe, worsening, or simply not what we described: significant pain, blistering, signs of infection, or any reaction that does not match what we discussed. We would far rather hear from you. Peels are one of the few treatments that work across pigment, texture and acne at once. Pick a concern to see how we approach it. A peel is priced by depth and by the area treated, and lighter peels are usually planned as a short course rather than a single visit. You get the cost of the whole plan at your consultation, not a starting price that moves later. We do not sell the deepest peel you will tolerate. If a lighter one gets you there, that is what you will be offered. **Q: Does it hurt?** Not really. Most people describe tingling or a warm sting for five to ten minutes while the solution is on. Deeper peels are more intense and we manage that with you. **Q: Will I actually peel?** After a light peel, often barely, just some flaking. After a medium peel, yes, visibly, over about one to two weeks. Plan the timing around your life rather than hoping. **Q: How many will I need?** Light peels run as a course, roughly every four weeks until you get where you are going. A medium peel can do its work in one. **Q: Can I have a peel with melasma or rosacea?** Often yes, and peels are one of the treatments we use for both. Melasma needs a careful hand, because too deep makes it worse rather than better. That is exactly what the consultation is for. **Q: How soon can I be in the sun?** New skin burns and marks easily, so daily broad-spectrum sunscreen is not optional afterward. SPF 30 or higher, water resistant. [3] How long you need to be extra careful depends on the depth you had, and your provider will tell you. **Q: How is this different from a HydraFacial?** A HydraFacial cleans and hydrates the surface with no injury and no recovery. A peel deliberately takes the surface off so it rebuilds. They work well one after the other rather than instead of each other. 1. Lee KC, Wambier CG, Soon SL, Sterling JB, Landau M, Rullan P, Brody HJ; International Peeling Society. "Basic chemical peeling: Superficial and medium-depth peels." *Journal of the American Academy of Dermatology.* 2019 Aug;81(2):313-324. Peel depth is directly related to improved results and to the number of complications that can occur. PMID 30550830. https://pubmed.ncbi.nlm.nih.gov/30550830/ · Peer-Reviewed Study 2. StatPearls, NCBI Bookshelf. "Chemical Peels for Skin Resurfacing." Chemical peels benefit acne vulgaris, melasma, wrinkles, actinic keratosis, photodamage, pigmentation disorders and acne scars. NBK547752. [https://www.ncbi.nlm.nih.gov/books/NBK547752/](https://www.ncbi.nlm.nih.gov/books/NBK547752/) · Medical Reference 3. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### Clear + Brilliant® This is the treatment for skin that is not damaged, just not what it was. Tone that has gone flat, texture that catches the light wrong, pores that look larger than they used to, [early lines](/conditions/wrinkles-and-fine-lines/) that were not there two years ago and [mild sun damage](/conditions/sun-damage/) from a life spent outdoors here. The laser treats your skin in thousands of microscopic columns and leaves all the skin in between completely untouched. That untouched skin is what heals the treated columns quickly, which is the entire reason this costs you a few days instead of a few weeks. Nothing is taken off the surface, so you are not raw and you are not hiding. It is a series rather than a single visit. Four to six treatments is typical, each one adding another layer of improvement, and people generally come back for a round of it once or twice a year. It is the most straightforward entry point into laser treatment we offer, and it is the one people start with when they are not ready to lose two weeks. **What Clear + Brilliant is good at** - Brightening dull, flat tone so skin catches the light properly again - Smoothing texture you can feel with your fingers more than you can see - Making enlarged pores look smaller and more refined - Softening the earliest lines before they set in - Improving mild sun damage on skin that is not yet heavily weathered - Fitting into a normal week, which is why people actually finish the series People come in having read about four different treatments and no idea how they relate. They are rungs on a ladder, and the honest job of a consultation is telling you which rung you are on. RungWhat it doesWhat it costs youA HydraFacialCleans, exfoliates and hydrates the surface. Upkeep, and you look better that afternoonNothing. An hourClear + BrilliantActually changes tone, texture and pore size, gently, over a seriesA few dry days per sessionBrown spots and red veinsTargets pigment and vessels specifically, which a gentle laser does notA week or two of spots darkening and flakingA CO2 laserResurfaces properly. Deep lines, real scarring, heavily weathered skinA week or more of genuine recovery Clear + Brilliant is the rung most people are actually on and the one most often skipped, because it is easy to be sold either something that will not change anything or something that costs you two weeks you cannot spare. If what you have is scattered brown spots, this is not the treatment and we will tell you. If what you have is deep, set-in damage, this will not reach it and we will tell you that too. "Suitable for all skin types" is the sentence every page selling this treatment uses, and it is doing a lot of work. A laser is safe on a given skin at given settings, chosen by someone who has looked at that skin. More pigment in the skin means more of it absorbs the energy, and settings that suit one person can leave another with light or dark patches that take months to fade. That decision is a dermatologist's, and here it is made before you book rather than while you are lying down. The same goes for a tan. This is a coastal town and half the people who ask about lasers here have been in the sun in the last two weeks. Treating tanned skin raises the risk of exactly the marks you came in to avoid, so if you arrive with color we will move you rather than treat you. And we will tell you when this is not the treatment. It is a gentle laser and gentle has a ceiling. Deep lines and set-in scarring want [a CO2 laser](/treatments/smartskin-laser-skin-resurfacing/) and a real recovery, and scattered brown spots want [a different tool](/treatments/ipl-photofacial/) altogether. Being sent to the right rung first time is cheaper than working up the ladder by trial and error. **Clear + Brilliant is probably a good fit if:** - Your skin looks dull or flat rather than damaged - Texture and pore size bother you more than lines do - You have early lines and would rather stay ahead of them than chase them later - You cannot lose a week and have been putting off laser treatment because of that - You are willing to do a series rather than expecting one visit to do it **We will steer you somewhere else if:** - You are tanned or sunburned right now, from the sun, a bed or a bottle - What you have is deep lines or set-in scarring, which needs a stronger laser - Your main concern is brown spots or broken veins, which want a different tool - You are pregnant, or taking a strong acne pill, or recently finished one - There is an active infection or broken skin in the area Not sure which of those you are? That is what the consultation is for, and it is the reason we do not sell laser treatment over the phone. For the first few hours you look flushed, like you have been out in the wind. Over the next day or two your skin feels dry and faintly rough, a bit like fine sandpaper, and may look slightly bronzed. That clears on its own by day three or four and what is underneath is smoother. **In the first week, do** - Wear broad spectrum SPF 30 or higher every day without exception [1] - Keep moisturizer on and let the roughness clear on its own - Use a gentle cleanser and nothing else for the first few days - Drink water and expect your skin to feel thirsty **In the first week, don't** - Scrub, exfoliate or pick at rough skin - Go back to retinoids or acids until we clear you - Sit in the sun, use a sunbed or apply self-tanner - Book a sauna, a hot workout or a hot tub on the first day Call us about blistering, real pain or any sign of infection. We would far rather hear from you. Clear + Brilliant works on tone, texture and early change rather than on damage that has already set in. Pick a concern to see how we approach it. Clear + Brilliant is priced per session, and most people are booking a series of four to six rather than a single visit. We quote you the whole series at your consultation, including what upkeep looks like over a year, rather than one number that grows once you have started. We do not discount our way into a treatment. If a gentler option would serve you, or a stronger one would serve you better, that is the one you will be offered. **Q: Does it hurt?** Numbing cream first, then a warm prickling sensation as the handpiece passes over. Most people find it comfortable and describe the heat rather than the pain. A full face is done in about half an hour. **Q: How much downtime is there really?** A few hours of looking flushed, then two to four days of skin that feels dry and slightly rough. You can wear makeup the next day and nobody at work is going to ask. That is the honest version, and it is the trade that makes this treatment worth it. **Q: How many sessions will I need?** Four to six is typical, with your provider setting the interval after looking at your skin. Each one adds to the last, and you get the number and the price for the whole series before you book the first. **Q: Will it fix my brown spots?** Not the way a treatment aimed at pigment will. This evens out overall tone rather than targeting individual spots, so if what bothers you is scattered sun spots, a different tool is the better answer and we will say so at your consultation. **Q: Is it safe on darker skin?** It can be, and the settings are the reason rather than the marketing. More pigment in the skin means more of it absorbs the energy, so the settings have to account for that. That is a decision a dermatologist makes after looking at your skin, and it is a good reason to have laser treatment done in a dermatology practice. **Q: How long does the result last?** Months rather than years, and most people repeat the series once or twice a year. Daily sunscreen is what decides how long you keep it, more than anything else you do. [1] 1. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice. Clear + Brilliant® is a registered trademark of its owner. Redness for several hours, mild swelling on the first day, and dry, rough, flaking skin for a few days afterward are expected. Blistering, infection and lasting light or dark patches are uncommon but possible, and the risk rises on skin that is tanned or sunburned at the time of treatment and on skin that carries more pigment. This treatment is not suitable during pregnancy, while taking a strong acne pill, or where there is an active infection in the area. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### Collagen Boost Collagen is the scaffolding under your skin. It is what makes skin snap back instead of crease, and you lose it steadily from your twenties on, faster in the places the sun got to. Filler puts volume back where volume went missing. It does not make thin skin thick again. Only new collagen does that. All three treatments on this page ask your body for new collagen, from three different directions. A heavily diluted skin wash spreads a signal across a wide area and improves overall quality. [PRF](/treatments/platelet-rich-fibrin-prf/)) uses a concentrate made from your own blood. Dissolving threads hold tissue up and leave collagen along their path as they disappear. Same destination, three roads, and which one suits you depends on what actually changed. The trade is the same with all three. Nothing much shows the same day. What arrives over the following months reads as better skin rather than as work, because it is your own tissue. **What Collagen Boost is good at** - Improving crepey, thin skin across the neck, chest, arms and backs of the hands - Firming early looseness along the jaw and cheeks without surgery - Softening fine lines from underneath instead of filling them in - Restoring some support where tissue has started to drop, using threads - Improving under-eye quality and scalp health, where PRF is the right road - Building a result that keeps looking like you, because your body made it Most practices in this market sell one collagen-stimulating treatment and everyone who walks in gets it. Here is the actual decision, written out, so you can see where you land before you book. If this is what changedThe road isWhyCrepey, thin, dull skin over a wide area: neck, chest, arms, backs of the handsThe diluted skin washIt spreads a thin signal across a large area rather than adding volume in one spot, so it improves quality where there is nothing to fillYou want your own material used, and the under-eyes or scalp are part of the picturePRFIt is made from your own blood at your appointment, and it is the one that goes comfortably into delicate areasTissue has started to drop and you want support, not just textureDissolving threadsThey physically hold tissue and leave collagen along their path as they dissolve, which nothing injected can doPitted acne scars and rough textureNot this pageRF microneedling reaches scarring better than any of these threeSkin that has gone past holding upNot this page eitherThat is a surgical conversation and we will say so Plenty of people end up doing two of these in sequence rather than choosing one. That is a plan, not an upsell, and you will get it costed in full before anything is booked. ![Woman in black top looking left](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-collagen-boost.webp) A practice that owns one of these recommends it to everybody. Having all three means the recommendation follows what is on your face rather than what is in the cupboard, and sometimes the honest answer is none of them. A [chemical peel](/treatments/chemical-peels/), a course of [RF microneedling](/treatments/potenza-rf-microneedling/), or simply the right products at home can be a better use of your money, and we would rather tell you that than sell you a course. It also matters that a board-certified dermatology practice is doing it. The diluted skin wash is a calcium-based material and it cannot be dissolved the way a water-based filler can, so it is placed carefully and slowly by someone who knows exactly where it is going. [1] Threads go into layers where knowing the anatomy is not optional. And when [loose skin](/conditions/sagging-skin/) has gone past what any of this reaches, we will tell you that too, because that is a conversation with a surgeon rather than a course of treatment here. **Collagen Boost is probably a good fit if:** - Your skin has gone thin, crepey or dull and products are not touching it - You want firmer skin without surgery and without looking filled - You would rather build a result over three months than chase a quick one - You are willing to do a short course and keep it up over time - You like the idea of a result made from your own tissue **We will steer you somewhere else if:** - What is actually bothering you is lost volume, which is a filler conversation - Your main concern is pitted acne scarring, where RF microneedling reaches further - Your skin is infected or inflamed in the area right now, which needs settling first - You have a condition or medication that slows healing - What you want is a lift, which is surgery and not this Not sure which of those you are? That is what the consultation is for, and it is why we do not sell any of these over the phone. Expect some swelling, tenderness and possibly a little bruising at the treated spots. With the skin wash and PRF most people look normal within a day or two. With threads, expect a pulling or tight feeling for several days and a few days of looking slightly different before everything settles. **In the first week, do** - Keep the area clean and leave it alone - Sleep on your back for the first few nights after threads - Wear sunscreen every day, because UV is what took the collagen in the first place - Tell us about anything that feels wrong rather than waiting for your follow-up **In the first week, don't** - Massage, press or work on the treated area unless we tell you to - Book a facial, a peel or dental work in the days right after - Do heavy exercise or anything that overheats you until we clear you - Expect to see the result yet Call us immediately about unusual pain, skin that turns white, dusky or blotchy, vision changes or any sign of infection. We would far rather hear from you. Collagen Boost works on skin quality and support rather than volume. Pick a concern to see how we approach it. The price follows which of the three you take, how much area we are covering and how many visits it needs. All three are treatments where more than one visit is normal, so a single-session price is a misleading number and we do not lead with one. You get an estimate across the whole plan before anything is booked, including what keeping it up looks like over a year. We do not discount our way into a treatment, and if a cheaper option would serve you better that is the one you will be offered. **Q: What is the diluted skin wash?** It starts as a filler, a gel carrying tiny particles of a calcium-based mineral, the same kind your bones are made of. At full strength it adds volume in one place. Watered right down it spreads thinly across a wide area and works as a nudge for your own collagen instead. Same product, different job, different dilution. **Q: Can it be dissolved?** No. Water-based fillers have a dissolving injection and this one does not. That is a real difference, and it is why it goes in slowly and conservatively here. [1] **Q: Is the Fibrin Collagen Boost the same as PRF?** Yes. It is PRF), platelet-rich fibrin, which has its own page here covering the face, the under-eyes and the scalp. Fibrin Collagen Boost is just the name this practice has used for it over the years. It is not PRP, which is a different preparation. **Q: Are dissolving threads a facelift?** No, and anyone selling them that way is overselling. They hold tissue up and leave new collagen along their path as they dissolve. They do not remove anything and they do not do what surgery does. What they can do is hold and improve for a reported 12 to 15 months. **Q: How many visits will I need?** More than one is normal with all three, and how many depends on the area and how you respond. You get a plan and a price for the whole course up front rather than one visit and a wait and see. **Q: When will I see something?** First signs at about four weeks, the real thing at three to four months. That is the trade these treatments ask you to make: nothing the same day, and something that looks like your own skin later. 1. U.S. Food and Drug Administration. "Dermal Fillers (Soft Tissue Fillers)." Calcium-based fillers cannot be dissolved the way hyaluronic acid fillers can; supports the warning signs in the footer note. [https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/dermal-fillers-soft-tissue-fillers](https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/dermal-fillers-soft-tissue-fillers) · Regulatory 2. U.S. Food and Drug Administration. "Surgical Sutures: Class II Special Controls Guidance Document for Industry and FDA Staff." Absorbable surgical suture is a long-established regulated device class; supports the description of the thread material. [https://www.fda.gov/medical-devices/guidance-documents-medical-devices-and-radiation-emitting-products/surgical-sutures-class-ii-special-controls-guidance-document-industry-and-fda-staff](https://www.fda.gov/medical-devices/guidance-documents-medical-devices-and-radiation-emitting-products/surgical-sutures-class-ii-special-controls-guidance-document-industry-and-fda-staff) · Regulatory 3. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice. Radiesse® and NovaThreads® are registered trademarks of their respective owners. Swelling, bruising, tenderness, firmness and small lumps at the treated site are common and usually settle. With threads, a pulling or tight feeling for several days is expected, and puckering, thread migration, visible thread ends and infection are recognized risks. The FDA notes that filler injected into a blood vessel is rare but can block blood flow and cause skin loss, sores or, very rarely, blindness or a stroke. Calcium-based fillers cannot be dissolved. Call us immediately about unusual pain, skin that turns white, dusky or blotchy, vision changes or signs of infection. These treatments are not suitable where the skin is infected or inflamed, and your medications and medical history are reviewed first. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### DAXXIFY® Nobody comes in asking about their glabellar complex. They come in because someone at work asked what was wrong, or because they saw a photograph of themselves listening to a friend and looked furious. The two vertical lines between the brows carry more social information than anything else on the face, and most people have no idea theirs are doing it until they see it. DAXXIFY softens the muscles pulling those lines together. It is botulinum toxin type A, the same family as everything else in this category, and what makes it its own product is the formulation: it is stabilized with a peptide rather than with human serum albumin. Its approved cosmetic use is that one area, the frown lines between the brows. [1] Done well, the effect is that your face stops sending a signal you did not mean to send. Done badly, it drops your brow and gives you a heavy, surprised, or oddly arched look that everyone can see and nobody can name. The difference between those two outcomes is entirely in where the units go, which is the argument for having this done in a dermatology practice rather than wherever it is cheapest. **What DAXXIFY is good at** - Softening the vertical frown lines that make you look angry when you are concentrating - Keeping your brow where it belongs, which is the part that separates good work from obvious work - Letting you still look like you have expressions, because frozen is a dosing decision and not an inevitability - Giving you an alternative if you have not been happy with the result or the interval from another neuromodulator - A treatment that takes under half an hour with essentially no recovery - Being a genuinely conservative first step, because it wears off You will have seen a number for this, and the number you saw was probably bigger than the real one. Here is what the company that makes DAXXIFY actually claims, in its own words. **The manufacturer's claim is six months, for at least half of people.** DAXXIFY's own marketing says "at least 50% of patients in clinical studies had no or minor frown lines 6 months after treatment," and sells that as "as few as 2 treatments a year." [2] Read the first half of that sentence again. At least half. Which tells you nothing about which half you are in, and that is not a criticism of the product, it is just what the number means. **The prescribing information adds the floor.** DAXXIFY should not be given more often than every three months, and trial participants were followed through at least week 24. [1] **Duration is mostly about you, not the product.** How fast you metabolize it, how strong the muscles are, how much you use them, how many units went in, and how many times you have had this done before all move the number, and they move it a lot. Two people treated on the same afternoon with the same product can be four months apart. **So we measure yours instead.** You come back at two weeks, and we log what your face did and when. By your second or third treatment we know your interval specifically, which is more useful than any range in a brochure and is the actual answer to the question you are asking. If a practice quotes you a firm number for how long a neuromodulator will last, they are quoting you a study population and calling it a prediction. We would rather find out yours. ![](https://coastaldermaesthetics.com/wp-content/uploads/2026/07/daxxify-1.jpg) Softening a frown line is easy. Softening it without dropping the brow or leaving a strange arch is not, because the muscles that pull the crease together are also part of what holds the brow up. That judgment comes from knowing the anatomy in front of you, and it is why the same product produces a good result in one pair of hands and a heavy, slightly startled face in another. It also means being told when this is not your answer. If your line is etched into the skin and still visible when your face is completely still, softening the muscle will improve it and will not erase it, and the rest is a texture problem that needs resurfacing. If the shadow is deepening because the area has hollowed, a [dermal filler](/treatments/juvederm-fillers/) or a [collagen stimulator](/treatments/sculptra/) does more than another round of units. And if you are already happy with the neuromodulator you use, at an interval that suits you, we will tell you that switching to the newest product is not an upgrade. **DAXXIFY is probably a good fit if:** - The lines between your brows show when you are concentrating, and people read them as a mood - You want the frown softened without losing the ability to make a face - You have used another neuromodulator and were not happy with the result or how quickly it went - You want to start with something that wears off rather than something permanent - You would rather have this done by a dermatology practice than by whoever is running a special **We will steer you somewhere else if:** - You have an infection or broken skin where the injections would go - You have had a reaction to a botulinum toxin product before - You have a neuromuscular condition, or difficulty swallowing or breathing, which needs real care here - You are pregnant or breastfeeding, when we defer elective treatment - Your line is a crease at complete rest, where this helps but resurfacing is the other half of the answer Not sure which of these you are? That is the consultation, and it is a dermatologist's assessment rather than a sales appointment. There is essentially no recovery. You may have small red bumps at the injection sites for an hour or so, a bruise if you are prone to them, and a mild headache the first day. Then nothing happens for a few days, which is normal, and then it starts working. **In the first days, do** - Stay upright for the first few hours - Let it develop before judging it, and keep your two-week review - Tell us right away about any drooping or unexpected weakness - Carry on with your normal skin care and sun protection **In the first days, don't** - Rub or massage the injection sites - Assume more units would have been better, because that is how faces end up looking treated - Book a facial or a massage that presses on the area for a couple of days - Ignore any difficulty swallowing, speaking or breathing Call us about anything severe, worsening, or simply not what we described: significant pain, signs of infection, drooping, or any difficulty swallowing, speaking or breathing. We would far rather hear from you. DAXXIFY treats the lines that come from movement, not the ones that come from lost volume. Pick a concern to see how we approach it. Neuromodulators are priced by the unit, and how many you need depends on how strong your muscles are rather than on how old you are. That is why we do not quote a flat price for an area over the phone: the honest number comes from looking at your face. We also will not talk you into more units than your anatomy calls for, and we do not run treatment off a promotional price. If a smaller dose is the right one, that is the one you get. **Q: How is DAXXIFY different from BOTOX?** Both are botulinum toxin type A. The real difference is the formulation: DAXXIFY is stabilized with a peptide rather than with human serum albumin. Their approved cosmetic uses also differ in breadth, with DAXXIFY approved for the frown lines between the brows and BOTOX Cosmetic approved for several upper-face areas plus neck bands. Units are never interchangeable between two neuromodulators, so a unit count from one tells you nothing about the other. [1] **Q: Does it really last longer?** Longer than some, and the honest number is smaller than the one you have probably seen. DAXXIFY's own marketing claims that at least 50% of patients in clinical studies had no or minor frown lines six months after treatment, which it frames as as few as two treatments a year. [2] The prescribing information adds that it should not be given more often than every three months. [1] Anything you have read promising eight or nine months is going beyond what the manufacturer itself claims. There is a whole section above on how we handle this, and the short version is that we measure your interval rather than quote you a study population. **Q: What does it treat?** Its approved cosmetic use is the moderate to severe vertical frown lines between the eyebrows. We assess the forehead and the brow at the same appointment because those muscles work against each other and you cannot plan one without the other, but the approved area is the frown complex. **Q: When will I see it work?** Usually within several days, settled by about two weeks. We book your review at two weeks and any adjustment is decided then, rather than the day of treatment when nothing has happened yet. **Q: Who should not have it?** Anyone with an infection where the injections would go, or a known hypersensitivity to the product. Neuromuscular conditions and any difficulty swallowing or breathing need particular care. We go through your full medical history before treating, and it is a real part of the appointment rather than a form to sign. **Q: Should I switch from what I already use?** Only if you have a reason. If your current neuromodulator gives you a result you like at an interval that suits you, changing brands is not an upgrade and anyone telling you otherwise is moving inventory. The conversation worth having is about your response and your timing, not about which product launched most recently. 1. DAXXIFY® (daxibotulinumtoxinA-lanm) for injection, Prescribing Information, Revance Therapeutics, revised 8/2023. Indicated for temporary improvement in the appearance of moderate to severe glabellar lines associated with corrugator and/or procerus muscle activity in adult patients, and for the treatment of cervical dystonia in adult patients. Should be administered no more frequently than every three months for any indication. https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/761127s002lbl.pdf · Regulatory / Prescribing Information 2. DAXXIFY® consumer website, Revance Aesthetics. Manufacturer marketing claim, verified live 2026-08-10: "At least 50% of patients in clinical studies had no or minor frown lines 6 months after treatment," presented as "as few as 2 treatments a year." [https://www.daxxify.com/](https://www.daxxify.com/) · Manufacturer Marketing Content on this page is for educational purposes and is not a substitute for professional medical advice. DAXXIFY® is a registered trademark of Revance Therapeutics. Individual results may vary. Common effects include headache, injection-site reactions, bruising and temporary asymmetry or unwanted muscle effect. Botulinum toxin products carry a boxed warning regarding distant spread of toxin effect; call the practice immediately about any difficulty swallowing, speaking or breathing, or any unexpected muscle weakness. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### FlexSure™ RF Body Sculpting Every other body device we run puts a flat, rigid panel against you. That works beautifully on a stomach and it is why so many treatments quietly only treat stomachs. The moment the area curves, an upper arm, an outer thigh, the roll along the side of the waist, a flat panel sits on it like a book on a football and most of the energy never reaches the tissue. FlexSure is a wrap. It conforms to the shape of the area, holds full contact all the way around a curve, and then warms the tissue underneath for fifteen minutes at a time while you sit and read. Nothing is held, nothing is worked back and forth, and nothing needs a spare set of hands. That warmth does two things over a course of sessions. It works on [a pocket that will not move](/conditions/stubborn-fat/) in the treated area, and it works on the quality and firmness of the [skin that has lost its firmness](/conditions/sagging-skin/) above it. Both arrive gradually, over weeks, and both are real rather than dramatic. **What FlexSure is good at** - The curved places other body devices cannot properly sit on: upper arms, outer thighs, the side of the waist - The roll along the back and the fold at the bra line - Softening the look of a stomach that is close but not quite where you want it - Firming skin quality across an area rather than shrinking one defined pocket - Fitting into a lunch break, hands free, with nothing to recover from - Working year round and across skin tones, because heat does not care what color your skin is - Easing muscle soreness and improving local circulation in the treated area, which the manufacturer builds it to do [3] If you have been told a body treatment is not suitable for your arms, or you booked one for your outer thighs and the result was underwhelming, this is usually why. It was a shape problem, not a you problem. The areaWhy a flat panel strugglesWhat a wrap doesUpper armsAn arm is a cylinder. A flat panel touches a strip down the middle and lifts away at both edges.Holds contact the whole way around, so the whole arm is treated rather than a stripe of it.Outer thighsThe saddlebag curve falls away sharply. Panels either slide or sit proud of the skin.Follows the curve down the outside of the hip and stays in contact.The side of the waistThe one place on the torso that is convex in two directions at once.Bends in both directions and stays flush.Back and bra lineA folded, uneven surface that shifts when you breathe.Conforms to the fold instead of bridging over it.StomachNothing. This is the one shape flat panels handle well.Works fine, and so does the laser treatment for a defined pocket, which is often the better choice here. That last row matters. On a flat stomach pocket we will often point you at the laser instead, because it is fewer sessions for a defined pocket of fat. This one earns its place on everything above that row, and on skin quality across a whole area rather than one bulge. ![](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-flexsure-rf-body-sculpting.webp) Running one body device means every patient gets that device. We run three, which means the interesting question at your consultation is which one, or whether the answer is none of them. A defined pocket of fat on a flat area usually belongs to the laser, which does it in fewer sessions. Skin quality and contour across a curved area belongs here. Real loose skin, the kind that stays folded after you pinch it, does not belong to any of the three, and we will say so rather than sell you a course that cannot get there. There is a real ceiling on non-surgical firming: it gives modest lifting and tightening, and it does not give the results of a surgical procedure. [2] We would rather you heard that here than found it out over ten appointments. **FlexSure is probably a good fit if:** - The area you want treated curves, and you have been turned down or underwhelmed elsewhere - You want the whole area improved rather than one bulge removed - You are near a stable weight and looking to refine rather than to lose - You would rather have more short, easy sessions than fewer intense ones - You are prepared to judge it at three to six months **We will steer you somewhere else if:** - You have one defined pocket on a flat area, where the laser is fewer sessions - What you have is real loose skin rather than skin quality, where the honest answer is a surgeon - Losing weight is the actual goal, because no device on this site does that - You have a pacemaker, defibrillator or other implanted electronic device - You have metal implants or permanent filler in the area to be treated - The area is infected, inflamed or has a recent surgery site - You are pregnant Not sure which of these you are? That is what the consultation is for, and the section above on where flat machines cannot reach is most of that conversation in advance. There is almost nothing to this one. The area stays warm and slightly pink for an hour or so and then goes back to normal. No compression, no restrictions, no recovery. People book it between other things and go straight back to their day. **Afterward, do** - Carry on as normal, workouts included - Drink water and keep moving - Finish the course, because a radiofrequency course is built out of repetition rather than intensity [1] - Give it three to six months from your last session before you decide what you think **Afterward, don't** - Expect to see anything the same week - Skip sessions and then judge the result - Assume more heat in one session would replace more sessions - Weigh yourself looking for the answer, because this changes shape and skin quality, not weight Call us about anything severe, worsening or surprising: a burn, blistering, real pain, or any reaction that does not match what we described. We would far rather hear from you early. This is the body treatment for the shapes other body treatments avoid. Pick a concern to see how we approach it. FlexSure is priced by the area and by the number of sessions that area needs, and a radiofrequency course runs longer than a laser course by design. Paired areas, like both arms or both outer thighs, are quoted as a pair. You get the cost of the whole course at your consultation rather than a per-session number that quietly multiplies over three months. If a different machine would get you there in fewer visits, we will tell you and it will usually cost you less. If none of them can get you where you want to go, we will tell you that too, before you have paid for anything. **Q: How is this different from the laser body treatment?** Different tool, different job. The laser treats one defined pocket of fat on a flat area in fewer, longer sessions. This wraps around a curved area and works on contour and skin quality across the whole of it, over more sessions that are shorter and easier. If your target is a stomach bulge, ask about the laser. If it is your arms, ask about this. **Q: How many sessions will I need?** A radiofrequency course usually runs to several. The typical range for non-invasive radiofrequency is four to ten treatments. [1] You get your number after the area has actually been looked at. **Q: Does it hurt?** No. Most people describe a steady, pleasant heat, like a heat pack working from the inside, and the applicator is left in place rather than worked across you. It is one of the easier things we do. **Q: Will I lose weight?** No. Nothing on this site does that. This changes the shape and the quality of a treated area. It is a different goal from changing your weight, and naming which one you are after at the consultation is what gets the plan right. **Q: Is it true this helps muscle soreness?** Some people notice it. The applicator delivers deep tissue heating and the manufacturer builds it for increased local circulation in the treated area as well as for contour. [3] It is a side benefit rather than a reason to book, and nobody here will sell it to you as one. **Q: Can I have this if my skin is darker, or in summer?** Yes to both, which is not true of everything on this site. This works with heat rather than color-seeking light, so skin tone is far less of a limit, and there is no tanning season to plan around. You still get assessed first. **Q: Will it tighten loose skin?** It improves skin quality and firmness. It does not remove loose skin, and if what you have is the kind that stays folded when you let go of a pinch, no amount of heat will fix it. We will tell you which one you have at the consultation, which is a lot cheaper than finding out at session eight. 1. American Academy of Dermatology Association. "Non-invasive fat removal: What can you expect?" States that radiofrequency requires 4 to 10 treatments, that "you may notice some changes as early as 3 weeks" and that "most people see the full effect between 3 and 6 months after the last treatment," that good candidates "have a small bulge of fat that remains despite diet and exercise and their weight falls within the normal range for their height," and that where there is also loose skin "your dermatologist may recommend treating this first." [https://www.aad.org/public/cosmetic/fat-removal/non-invasive-what-to-expect](https://www.aad.org/public/cosmetic/fat-removal/non-invasive-what-to-expect) · Medical Organization 2. American Academy of Dermatology Association. "Many ways to firm sagging skin." States that non-surgical firming gives "modest lifting and tightening" and "still cannot give you the results of a surgical procedure like a facelift, eyelid surgery, or neck lift." [https://www.aad.org/public/cosmetic/younger-looking/firm-sagging-skin](https://www.aad.org/public/cosmetic/younger-looking/firm-sagging-skin) · Medical Organization 3. Cynosure Lutronic. "FlexSure wrappable RF applicator." Manufacturer's US product page. Describes "the world's first wrappable RF applicator," a "peel & stick wrappable applicator" that "curves and conforms to the anatomy of your patients," a "15-minute hands-free RF treatment," treatment of the abdomen, flanks, back, arms, buttocks, thighs and knees, multiple applicator sizes across six zones, and "deep tissue heating that penetrates the subcutaneous fat layer," including for increased local circulation. [https://www.cynosure.com/product/flexsure/](https://www.cynosure.com/product/flexsure/) · Manufacturer Content on this page is for educational purposes and is not a substitute for professional medical advice. FlexSure™ is a trademark of Cynosure Lutronic, Inc. Warmth and mild pinkness in the treated area are expected and usually settle within an hour. Burns and blistering are uncommon but possible. This treatment is not suitable during pregnancy, or for people with a pacemaker, defibrillator or other implanted electronic device, or with metal implants or permanent filler in the area to be treated, or where the area is infected, inflamed or has a recent surgery site. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### Heliocare® Everybody on this coast has the same gap in their sun protection, and it is not the morning application. It is hour four. You put sunscreen on at nine, you get on a boat or a bike or a chairlift, and the reapplication that was supposed to happen at eleven does not happen at all. That gap is where most people's sun damage actually comes from. Heliocare is a capsule you swallow, made from an extract of a tropical fern, and what it targets is the damage that gets past everything else. It works from the inside, so it covers the spot on your ear you missed and the back of your neck you always forget, and it does not sweat off or rub off on a towel. Now the part that matters more than any of that. **This is not sunscreen. It has no SPF, it blocks nothing, and it is not a substitute for anything.** Somebody who takes a capsule and then goes lighter on the sunscreen has made their day worse rather than better. It is a second layer on top of a first layer that still has to be there. **Where Heliocare fits** - Days you know you will not reapply: a boat, a hike, a long day outdoors, a trip somewhere sunny - People who are outside most days for work or for life, which on this coast is a lot of people - Skin that already carries a lot of sun damage, or a history of skin cancer - Melasma, where light drives the problem and every stray hour of it costs you progress - The spots you always miss, because a capsule does not have edges - On top of sunscreen, shade and clothing, never in place of any of them Sun protection gets sold as a shelf of equivalent options. It is not. It is a ranked list, and the ranking barely changes. Here it is, best first, with the capsule where it belongs. **1. Not being in it.** Shade between ten and four does more than anything you can buy. Unglamorous and undefeated. **2. Clothing and a hat.** A long-sleeved shirt does not wear off at hour four, does not need reapplying, and does not depend on you remembering anything. A wide brim covers the ears, the nose and the back of the neck, which between them account for a large share of what we biopsy. **3. Sunscreen, properly.** Broad spectrum, SPF 30 or higher, water resistant, and applied again every couple of hours and after swimming. The single biggest failure here is not the product, it is the quantity: most people use somewhere around half of what the number on the bottle was measured with. [2] **4. Sunglasses.** Eyelid skin is thin, hard to treat, and a genuinely common site for skin cancer. **5. This capsule.** Fifth, deliberately. It is a useful addition for the days the first four are going to be imperfect, which on this coast is most days between May and October. It is not a way to move up the list without doing the things above it. If you take one thing from this page: nobody at this practice will ever tell you a capsule bought you room to skip step three. The easiest thing to sell in a beach town is a pill that sounds like sunscreen you never have to reapply. That is not what this is, and a dermatology practice saying so plainly is the reason to buy it here rather than from an ad. Somebody who takes a capsule and then skips the sunscreen has made their day worse, not better. Skin cancer and sun damage are the heart of what a board-certified dermatologist here treats, which means we are looking at the outcome this product is meant to prevent, on real people, every week. That is also why the recommendation comes attached to a real look at your skin. A capsule is a reasonable addition inside a whole sun-protection plan. At both of our offices it is recommended that way, or it is not recommended at all. ZO® Skin Health **Heliocare is probably worth it if:** - You are outside most days and reapplying sunscreen is not realistically going to happen - You have a big exposure coming up: a boat, a trip, a hike, a season of watching games outdoors - You already have a lot of sun damage, or a history of skin cancer - You are working on melasma and want everything possible on the prevention side - You want a second layer, knowing full well it is the second one **Skip it if:** - You are looking for a way to use less sunscreen, which is the one thing it must never be - Your first layer is not in place yet, in which case fix that first and it is cheaper - You are pregnant or breastfeeding, when this is a conversation to have with your physician first - You would rather put the money toward a sunscreen you will actually enjoy wearing, which is a completely reasonable answer and one we will agree with Not sure? Bring it up at any appointment. This is a two-minute conversation, not a consultation. There is no recovery and nothing to plan around. You take a capsule daily, and on a heavy sun day you take another. Nothing visible happens, which is the point: it is prevention, and prevention never shows you anything. **Do** - Take it daily rather than only on sunny days, since protection is cumulative - Keep doing everything on the protection list above, all of it, all the way down - Tell us about every other medication and supplement you take - Get your skin checked on the schedule we set, which is the actual measure of whether your sun protection is working **Don't** - Use it as a reason to apply less sunscreen or to reapply less often - Read the three-times figure as an SPF, because it is not one and does not convert into one - Start it in pregnancy or while breastfeeding without speaking to your physician first - Expect to see anything, because there is nothing to see Tell us about any digestive upset or anything else that does not seem right. We would far rather hear from you. This is prevention, and it belongs inside a plan rather than on its own. Pick a concern to see how we approach it. Heliocare is priced per bottle and you can buy it without an appointment. It is a modest cost next to almost anything else on this site, and we are happy to tell you plainly whether it belongs in your routine. If your sunscreen habit is not yet where it needs to be, the honest advice is to spend the money on a sunscreen you like enough to actually use, and revisit this later. That advice has cost us sales and it is still the right advice. **Q: Is this sunscreen in a pill?** No, and that phrase does real harm in this category. Sunscreen works at the surface of your skin, on the spots you actually covered, for as long as it lasts. This is an antioxidant you swallow, aimed at the damage that gets past all of that. It does not replace sunscreen and it never will. **Q: Does "three times as long" mean SPF 3?** No. Those are two different measurements and one does not convert into the other. Anybody doing that math is either confused or selling you something. **Q: Can I use less sunscreen if I take it?** No. If anything the opposite, because the people this suits are the people out in the sun the most, and they need sunscreen the most. [2] **Q: Will it help my melasma?** It can be a useful piece of the plan, since melasma is driven by light and is famously stubborn. It is not a melasma treatment on its own, and the treatment plan is the main event. **Q: Who do you actually suggest it to?** People outside most days who cannot realistically reapply. Anyone facing a big exposure day: a boat, a hike, a trip somewhere sunny. People who already carry a lot of sun damage or a history of skin cancer. And people who mean to reapply and never do, which is most of us. **Q: Is there a version I put on my skin?** Yes, there are topical products as well as the capsules. Which one makes sense depends on what the rest of your routine already covers, so it is a conversation rather than a default. 1. González S, Pathak MA, Cuevas J, Villarrubia VG, Fitzpatrick TB. "Topical or oral administration with an extract of Polypodium leucotomos prevents acute sunburn and psoralen-induced phototoxic reactions as well as depletion of Langerhans cells in human skin." *Photodermatology, Photoimmunology & Photomedicine.* 1997;13(1-2):50-60. Supports the tile and the FAQ: people taking the oral fern extract could stay in the sun almost three times as long before their skin turned red. Small early study of 21 people, and the author group was tied to the company that sells the extract. The measure is not SPF and does not convert into one. Research since has been mixed. PMID 9361129. https://pubmed.ncbi.nlm.nih.gov/9361129/ · Peer-Reviewed Study 2. American Academy of Dermatology Association. "How to select a sunscreen." Supports the first layer and stat tile 4: broad spectrum, SPF 30 or higher, water resistant, reapplied. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice. Heliocare® is a registered trademark of Cantabria Labs. This is a dietary supplement and is not intended to diagnose, treat, cure or prevent any disease. Dietary supplements are not approved by the FDA before sale. **This product is an addition to sunscreen, shade and clothing and is not a replacement for any of them. It does not carry an SPF rating.** The study cited on this page was small, was published in 1997, and its authors were tied to the company that commercializes the extract. Tell us about every medication and supplement you take before starting, and speak with your physician first if you are pregnant or breastfeeding. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### HydraFacial® Four things happen in one appointment. Your skin is cleansed and gently exfoliated, a light peel lifts the dull surface layer, vortex suction pulls the debris out of your pores, and hydrating serums go back in. You see the difference on the drive home, which is not something most treatments can claim. It is comfortable the whole way through. No stinging, no needles, no going home to hide. Most people find it genuinely relaxing, and the extractions, which sound like the unpleasant part, are the part that feels the most satisfying. A HydraFacial is maintenance, and it is superb at it: making good skin look its best and keeping congestion under control, appointment after appointment. Being inside a dermatology practice means that if what you actually have is something else, you find out in the same visit instead of six facials later. **What a HydraFacial is good at** - An immediate, visible glow before an event, a shoot or a Monday - Clearing congestion, blackheads and the roughness that comes with them - Making enlarged-looking pores less obvious - Softening dryness and the tired, flat look that goes with it - Evening out surface tone and texture - Sitting comfortably alongside almost every other treatment we offer These are our own patients, photographed at our San Luis Obispo office and published with their consent. Individual results vary. There are more in the practice's private gallery, and we will show you cases close to yours at your consultation. ![Smiling brunette outside surrounded by trees](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-hydrafacial.webp) The machine is the same one the med spas use. What is not the same is who is in the building. Your HydraFacial here is delivered by a trained aesthetic provider working under board-certified dermatologists, which matters the same day something turns up that is not cosmetic. A mole that has changed, a rash that is not going away, redness that turns out to be [rosacea](/conditions/rosacea/) rather than sensitivity: you are already where you need to be, and you do not spend three months finding out. Performed by a dermatologist, this class of treatment has an excellent safety record. [2] Not every place offering it can say that. We will also tell you when a facial is not the answer. If what you want fixed is [sun damage](/conditions/sun-damage/) or real scarring, a HydraFacial is the maintenance that sits alongside the treatment, not the treatment. You will hear that here rather than after the sixth appointment. **A HydraFacial is probably a good fit if:** - You want your skin to look noticeably better today, with nothing to recover from - Your skin is congested, dry, dull, or all three - You want something to keep between your bigger treatments - You have an event and three days to get ready - Your skin is calm enough right now for exfoliation and extraction **We will steer you somewhere else if:** - You have an infection, open skin or significant inflammation - Your rosacea, eczema or acne is actively flaring, which needs settling first - You have had a recent procedure that still needs healing time - What you actually want fixed needs a laser, a prescription or an injectable Almost nothing, which is the appeal. Some people are slightly pink for an hour. Your skin may feel tight or a little more sensitive than usual for a day. Occasionally an extraction brings something to the surface a day or two later, which settles on its own. **Afterward, do** - Put your makeup straight back on if you want to - Wear sunscreen, which matters a bit more than usual for the first week - Keep your routine gentle for a day or two **Afterward, don't** - Book a strong exfoliating product for that evening - Sit in a sauna or steam room the same day - Pick at anything that surfaces after an extraction Call us about anything severe, worsening, or simply not what we described. We would far rather hear from you. A HydraFacial is safe for nearly every skin type and tone. Pick a concern to see how we approach it. A HydraFacial is priced per session, and what you pay depends on the length of the treatment and any boosters chosen for your skin. If you are planning to come regularly, ask about that at your visit rather than paying a single-session price every time. **Q: How long does it take?** Usually 30 to 60 minutes depending on what is included. Boosters and longer extractions add time, and you will know before you book. **Q: Is there any downtime?** None. Most people go back to their day and their makeup right away. Sunscreen matters slightly more than usual for the first week. **Q: How often should I have one?** Every two to four weeks gives the strongest, longest-lasting result. Dark patches and acne scarring usually need a series rather than one visit. **Q: Does it hurt?** No. The vortex suction that clears your pores is painless, and most people find the whole thing relaxing. There is none of the sting a strong chemical peel can deliver. **Q: Will it help my acne?** It helps with congestion, blackheads and rough surface texture, which is what a lot of people mean by acne. Inflammatory acne and scarring need a medical plan, and being inside a dermatology practice means you can have that conversation in the same visit instead of starting over somewhere else. **Q: How is it different from a regular facial?** Consistency. The device does the same thing at the same settings every time, so you are not depending on who is on shift. And the boosters are chosen for your skin and your fine lines rather than for the room's standard protocol. Offered in San Luis Obispo, and coming soon to Santa Maria. 1. American Academy of Dermatology Association. "Microdermabrasion: Overview." Non-invasive exfoliation is safe for all skin colors and produces no downtime. [https://www.aad.org/public/cosmetic/age-spots-marks/microdermabrasion-overview](https://www.aad.org/public/cosmetic/age-spots-marks/microdermabrasion-overview) · Medical Organization 2. American Academy of Dermatology Association. "Microdermabrasion: FAQs." You will not have downtime or a recovery period; performed by a dermatologist, the procedure has an excellent safety record. [https://www.aad.org/public/cosmetic/age-spots-marks/microdermabrasion-faqs](https://www.aad.org/public/cosmetic/age-spots-marks/microdermabrasion-faqs) · Medical Organization 3. Freedman BM. "Hydradermabrasion: an innovative modality for nonablative facial rejuvenation." *Journal of Cosmetic Dermatology.* 2008;7(4):275-280. Randomized controlled trial, 20 volunteers, six treatments at 7 to 10 day intervals. PMID 19146604. https://pubmed.ncbi.nlm.nih.gov/19146604/ · Peer-Reviewed Study 4. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice. HydraFacial® is a registered trademark of HydraFacial LLC. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### HydraScalp® Your scalp is skin. It is skin you never exfoliate, never properly cleanse, and cover daily in dry shampoo, styling product and whatever the water in your area leaves behind. Then you wonder why it itches, flakes or feels greasy two days after washing. HydraScalp treats it like skin. The same technology behind [a HydraFacial](/treatments/hydrafacial/) is used on your head: it lifts away dead skin, oil and product buildup from around the follicles, then delivers a nourishing serum into the skin underneath rather than onto the hair sitting over it. Shampoo cannot do the second part, and no shampoo you buy is designed to. It takes under an hour, there is nothing to recover from, and your scalp feels noticeably different when you walk out. It is comfortable enough that people book it the way they book a facial. **What HydraScalp is good at** - Clearing product and dry shampoo buildup that ordinary washing leaves behind - Settling an itchy, tight scalp that feels irritated no matter what you wash it with - Reducing the visible flaking that shows on dark clothing - Balancing a scalp that goes greasy within a day or two of washing - Getting hydration into the skin rather than onto the hair - Giving hair a cleaner starting point at the root, where it grows from This is where a dermatology practice is a different proposition from a spa, and it is worth two minutes of reading before you book anything anywhere. Flaking, itching and irritation on a scalp have several different causes that look nearly identical to the person they are happening to, and they do not all want the same answer. What is actually going onWhat it looks likeWhat it needsProduct and oil buildupGreasy roots within a day or two, dull hair, flakes that are more like grime than skinA treatment like this one. It is exactly the problem HydraScalp was built forA genuinely dry scalpFine flaking, tightness, worse in winter or after sun and salt waterHydration and a gentler routine. This helps, and so does changing what you wash withDandruffLarger, oilier flakes that keep coming back no matter how well you washA medicated approach. A scalp facial makes it feel better without changing why it is happeningAn inflamed scalp conditionRedness, scaling in patches, sometimes soreness rather than itchA diagnosis and treatment first. A cleansing treatment over an inflamed scalp is not the right orderThinning or sheddingWider part, more hair in the brush, scalp showing throughA different conversation entirely. See below We look before we treat. If what you have is buildup or dryness, this is the right treatment and you will feel it the same day. If it is something that needs treating medically, we will say so and treat that first, and this can come afterward when it will actually hold. A scalp treatment is a pleasant hour anywhere that offers one. What you cannot get everywhere is someone qualified to tell you whether a scalp treatment is the right answer for what is on your head. Flaking that keeps coming back, patches that are sore rather than itchy, and a part that has quietly widened are three different problems, and only one of them is solved by cleaning. So here is the clear line, because it matters. **This is a scalp care treatment.** It cleans and hydrates the skin your hair grows out of, and a healthier scalp is a better place to grow hair from. For regrowth itself, there are treatments built for that. If [thinning or shedding](/conditions/hair-loss/) is what actually brought you here, say so when you book, because that is a different appointment with different options, including [PRF made from your own blood](/treatments/platelet-rich-fibrin-prf/)) and [a supplement with a study behind it](/treatments/nutrafol/). Plenty of people end up doing both. Nobody should do this one expecting the other. **HydraScalp is probably a good fit if:** - Your scalp itches, flakes or feels tight and you have worked through several shampoos already - You use dry shampoo, styling product or hard water and your roots feel coated - Your scalp goes greasy within a day or two of washing - You are already doing something about your hair and want the scalp in better shape underneath - You want a treatment with no recovery attached to it **We will steer you somewhere else if:** - Your scalp is broken, infected or actively inflamed right now, which is treated first - You have flaking or scaling that has never been looked at, which needs a diagnosis first - What is actually worrying you is thinning hair, which is a different appointment - You have had a recent scalp procedure that needs to settle Not sure which of those you are? Say so when you book. Sorting that out takes two minutes and saves you paying for the wrong thing. Nothing dramatic. Your hair is damp when you leave, and your scalp usually feels cleaner and calmer right away. Some people get mild redness, tenderness or a little itching for a few hours, and it settles on its own the same day. **Do** - Tell us about scalp conditions, allergies and recent scalp procedures beforehand - Let your hair dry naturally that day if you can - Go back to your normal washing routine the next day - Tell us what your scalp is like a week later, because that shapes what we suggest next **Don't** - Reach straight for dry shampoo the next morning - Use a harsh clarifying shampoo or a scrub on the same day - Color or chemically treat your hair on the same day - Expect a treatment to fix a routine that is causing the problem Tell us about anything that does not settle within a day, and about anything sore rather than itchy. We would far rather hear from you. HydraScalp treats the skin your hair grows out of. Pick a concern to see how we approach it. HydraScalp is priced per session, and how many you want depends on what your scalp is like and what you are doing at home. Plenty of people have one, change two things about their routine and are happy. Some prefer it as regular upkeep. We will tell you which of those you are before you book a series. If cleaning is not what your scalp needs, a series of cleaning treatments is not a good use of your money and we would rather say so. **Q: Will this help my hair grow?** No, and we would rather say that plainly. This treats the skin your hair grows out of, and healthier skin is a better place to grow hair from, but it is not a hair loss treatment and it does not regrow hair. If thinning is what brought you here, tell us when you book and we will talk about the options that do address it. **Q: Is it just a fancy shampoo?** No. Washing works on hair. This works on the skin underneath, lifting buildup from around the follicles and putting hydration into the scalp itself. It is closer to a facial than to a wash, which is why your scalp feels different rather than just your hair. **Q: Does it hurt?** No. Most people find it pleasant. You feel suction and coolness, and the whole thing is comfortable enough that people book it in a lunch hour. **Q: How often should I have it?** That depends on your scalp and your routine, and you will get a straight answer after we look. Some people want one and a change of shampoo. Others prefer it as upkeep every few weeks. You will know which one you are before you book anything. **Q: What if my flaking keeps coming back?** Then cleaning is probably not the whole answer, and that is useful information rather than a failure. Persistent flaking often needs a medicated approach or a diagnosis. That is a conversation we can have in the same practice on the same day. **Q: Can I have it with a HydraFacial?** Yes, and people often do. Same technology, two different areas, one appointment. Ask when you book and we will schedule the time for both. Content on this page is for educational purposes and is not a substitute for professional medical advice. HydraFacial® is a registered trademark of HydraFacial LLC and HydraScalp® is a trademark of its owner. This is a scalp care treatment and is not a treatment for hair loss. Temporary redness, tenderness or itching of the scalp can occur and usually settles the same day. This treatment is not performed where the scalp is infected, broken or inflamed, or over a condition that needs medical treatment first. Tell us about scalp conditions, allergies and recent scalp procedures before your appointment. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### ICON™ Laser Hair Reduction The laser finds the pigment in your hair, follows it down to the follicle, and heats it until that follicle stops producing. A chilled glass tip sits against your skin and cools it before and after every pulse, which is why the follicle underneath takes the energy and the surface does not. Most people describe the pulse as a rubber band snapping, and then it is over. It works on [hair you have been shaving, waxing or threading for years](/conditions/unwanted-hair/), and it works on the areas where that gets tedious: underarms in fifteen minutes, a bikini line, a chin, a back. What it gives you back is not really smooth skin. It is the twenty minutes a day you were spending on it, and the freedom to stop planning around it. Most people stay hair free for months or even years. [1] Anything that does find its way back comes in finer and lighter than what you started with, and an occasional maintenance session keeps it that way. **What laser hair reduction is good at** - Underarms, which take about fifteen minutes and are the area people are gladdest they did - Bikini line and legs, where the time saved adds up fastest - Facial hair on the chin, upper lip and sideburn area - A back or a chest, where shaving is genuinely impractical - Reducing ingrown hairs and the irritation that comes with shaving coarse hair - Fitting into a normal day, because there is nothing to recover from You can start this any month you like, and people do. What changes month to month is how easy it is to keep the schedule, because the laser works by finding the pigment in your hair and untanned skin gives it the clearest run at it. So a little planning gets you a smoother course and a faster finish. The preparation is the whole of it: **skip the tanning, indoors and out, skip the sunless tanner, and wear broad-spectrum SPF 30 or higher daily.** [2] Easy to do in any season on the Central Coast, and easiest of all in the months your legs and underarms are covered anyway. WhenWhat is happeningSeptember to NovemberThe smoothest run at it. Summer color has faded and the areas being treated are covered anyway, so nothing interrupts the schedule.Through the winterSessions spaced weeks apart, catching different growth cycles. This is the stretch that does the work.SpringLater sessions land. You are already noticeably ahead of where you were.SummerThe point of the whole exercise. Sunscreen daily, and hold off on new sessions if you have caught sun.Any month you likePlenty of people start in spring or summer and do beautifully. It just takes a little more care with sunscreen between sessions, and we will build the schedule around your plans. The practical version: whenever you start, the sooner you start the sooner you are finished with it. Tell us what is on your calendar and we will space the sessions around it. These are our own patients, photographed at our San Luis Obispo office and published with their consent. Individual results vary. There are more in the practice's private gallery, and we are happy to show you cases similar to yours at your consultation. ![Man with a hairless chest](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-icon-laser-hair-reduction.webp) Laser hair reduction is sold almost everywhere now, and the machines are broadly similar. What differs is who chooses the settings. Here that happens inside a board-certified dermatology practice, where your skin tone and your hair color are assessed properly and the settings are built around them rather than around an average of everyone who walked in that week. That is what gets you a better result in fewer sessions. Deeper skin tones can be treated very effectively, and advances in the technology have made that possible in experienced hands. [1] Lighter, gray and red hair give the laser less pigment to work with, and you will hear an honest read on that at your consultation, along with what will get you where you want to go. **Laser hair reduction is probably a good fit if:** - You have dark hair you are tired of managing, anywhere on the face or body - You want the time back more than you want a cosmetic change - You can commit to a series spaced over months rather than one appointment - You can stay out of the sun and off self-tanner while you are having it - You would rather have your settings chosen by a dermatology practice than by a franchise **We will steer you somewhere else if:** - Your hair is very light, gray, white or red, where a different approach will serve you better - You are tanned right now, fresh or from a bottle, which needs to fade first [2] - You are taking or recently finished isotretinoin, or another medicine that changes how your skin reacts to light [2] - There is an active skin infection or broken skin in the area - You are pregnant Not sure which of these you are? That is what the consultation is for. Hair color is the one thing worth checking before you plan a course around it. Expect the treated area to look a little pink and feel warm, like mild sunburn, for a few hours. A cold compress goes on before you leave. There is no real downtime and most people go straight back to whatever they were doing. Over the following week or two, treated hairs work their way out on their own, which can look like regrowth and is not. **Afterward, do** - Let the treated hairs shed on their own over the next week or two - Shave between sessions if you want to, because shaving leaves the root alone - Wear broad-spectrum sunscreen, SPF 30 or higher, on treated skin every day [2] - Keep your sessions on schedule, because the spacing is set by the growth cycle **Afterward, don't** - Wax, pluck or thread between sessions, because those remove the exact thing the laser is aiming at - Tan, use a tanning bed, or use a sunless tanner at any point during your course [2] - Take a very hot shower, sit in a sauna or work out hard for the rest of the day - Assume patchy regrowth means it failed, because different follicles wake up at different times Call us about anything severe, worsening or surprising: blistering, a burn, real pain, signs of infection, or any lightening or darkening of the skin. We would far rather hear from you early. One concern, treated properly. Pick it to see how we approach it. Laser hair reduction is priced by the area and by the number of sessions, and because it is always a series, the number that matters is the course rather than the visit. A small area like an upper lip and a large one like a full leg are not remotely the same appointment, and areas are often bundled when they are treated together. You get the cost of the whole course at your consultation, along with a realistic session count for your hair and your skin, rather than a per-session price that adds up quietly across a year. **Q: How long will it last?** Most patients stay hair free for months or even years. [1] Anything that comes back is finer and lighter than it was, and an occasional maintenance session keeps it where you want it. **Q: How many sessions will I need?** A series. The usual range is two to six, and hair grows in shifts, so each session catches follicles the last one could not. [1] You get your number after your hair and skin have been looked at. **Q: Does it hurt?** A rubber band snapping, with a chilled tip cooling the skin before and after every pulse. Coarser hair and bonier areas are sharper. It is quick, and we offer Nitronox if procedures are hard for you. **Q: Can I have it if my skin is darker?** Yes. Deeper skin tones can be treated very effectively, and advances in the technology have made this possible in experienced hands. [1] Your settings get built around your skin, which is exactly what a dermatology practice is set up to do. **Q: Will it work on gray, blonde or red hair?** Less well, because the laser finds hair by its pigment and there is less of it to find. If that is your hair, we will give you a straight read at the consultation and talk through what will actually get you the result you want. **Q: Can I shave between sessions?** Yes, and you should if you want to. Shaving cuts the hair and leaves the root where the laser needs it. Waxing, plucking and threading remove that root, which is exactly what you do not want between sessions. 1. American Academy of Dermatology Association. "Laser hair removal: FAQs." States that "most patients need 2 to 6 laser treatments," that "you can expect a 10% to 25% reduction in hair after the first treatment," that "most patients remain hair free for months or even years" but "some of the hair regrows" and is "finer and lighter in color," that maintenance treatments may be needed, that the treatment "works best for patients with light-colored skin and dark-colored hair" while advances now allow treatment of light hair and dark skin, that it "generally does not require any real downtime," and to "choose a board-certified dermatologist to perform laser treatments." [https://www.aad.org/public/cosmetic/hair-removal/laser-hair-removal-faqs](https://www.aad.org/public/cosmetic/hair-removal/laser-hair-removal-faqs) · Medical Organization 2. American Academy of Dermatology Association. "Laser hair removal: Preparation." "Do not tan (outdoors and indoors)," "Do not use sunless tanners," apply sunscreen "broad-spectrum, SPF 30+, and water-resistant" every day before going outdoors, and tell your dermatologist if you have taken isotretinoin or any other medicine. [https://www.aad.org/public/cosmetic/hair-removal/laser-hair-removal-preparation](https://www.aad.org/public/cosmetic/hair-removal/laser-hair-removal-preparation) · Medical Organization 3. U.S. Food and Drug Administration. 510(k) Premarket Notification K142376, Palomar Icon Aesthetic System, Cynosure, Inc., cleared 24 September 2014. Clears the 1064 laser and the Max IPL handpieces for hair removal, among other indications. [https://www.accessdata.fda.gov/cdrh_docs/pdf14/K142376.pdf](https://www.accessdata.fda.gov/cdrh_docs/pdf14/K142376.pdf) · Regulatory Content on this page is for educational purposes and is not a substitute for professional medical advice. ICON™ is a trademark of Cynosure Lutronic, Inc. This is hair reduction rather than permanent hair removal; some hair regrows and maintenance treatments may be needed. Redness, swelling and a warm sunburned feeling in the treated area are expected and settle within hours. Blistering, burns, scarring, and lightening or darkening of the skin are uncommon but possible, and the risk rises on skin that is tanned or sunburned at the time of treatment and on skin that carries more pigment. Very light, gray, white and red hair respond poorly. Tell us about any medicine that makes your skin sensitive to light and about isotretinoin taken now or in the past year. This treatment is not suitable during pregnancy or where there is an active infection or broken skin in the area. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### IPL Photofacial Two things make skin look weathered rather than older: brown patches where the sun has left pigment behind, and small red veins that have surfaced and stayed. Creams do not reach either of them. Light does, because both of them absorb it. A pulse of filtered light passes through the surface of your skin and is soaked up by the brown and the red specifically, leaving everything around them alone. What it hits breaks apart. Over the next week or two your body clears the debris, brown spots darken and flake away, and the redness fades. What is left is your own skin with the weathering taken off it. This is a course rather than a single visit. Most people book three to five sessions about a month apart, because each one takes a layer of the problem rather than all of it, and gradual is what keeps the result looking natural. **What IPL is good at** - Clearing sun spots and brown patches on the face, chest, shoulders and hands - Fading the general background redness that comes with rosacea - Clearing the small broken red veins that surface around the nose and cheeks - Lifting the brown patches of melasma, as one part of a plan built around it - Evening out overall tone so skin looks brighter rather than treated - Covering a large area in one visit rather than spot by spot - Being combined with resurfacing in the same appointment, which is what ThreeForMe does This is the part most pages in this market leave out, and it is the part that decides whether you get a good result or a problem. IPL works by being absorbed by pigment. That is the whole mechanism, and it is also the catch: a tan is pigment too. Treat skin that has been in the sun and the light goes into the tan rather than into the spot, which is how people end up with burns, blisters, or pale and dark patches that can take months to settle. The same logic applies to deeper skin tones, where more pigment sits throughout the skin and the settings have to account for it. Getting that judgment right is most of the outcome, and it is the reason this is a physician's decision rather than a setting someone picks off a chart. So we ask you to stay out of the sun and off sunbeds for two weeks before your appointment, and self-tanner counts as a tan. If you arrive with color, we will move you rather than treat you, which is not us being difficult. One more thing, and it is the reason a dermatology practice is the right place for this. Every pigmented mark is examined by a dermatologist before any light goes near it, by someone qualified to tell one kind of brown spot from another. That check costs you nothing and it is built into every appointment here. None of this is a reason to avoid IPL. It is the reason to have it done somewhere that assesses your skin before it turns the machine on. These are our own patients, photographed at our San Luis Obispo office and published with their consent. Individual results vary. There are more in the practice's private gallery, and we are happy to show you cases similar to yours at your consultation. Every med spa on this coast has a light device, and most of them will book you without ever looking at your skin properly. The device is not the difference. Knowing which mark on your face is a sun spot, which is a broken vessel, which is something that needs a biopsy rather than a treatment, and what your skin tone means for the settings, is the difference. That assessment is a dermatologist's job and it happens here before anything is scheduled. [Melasma](/conditions/melasma/) is the clearest example of why that matters. IPL can lift it and we do use it for melasma, but melasma is not a spot you clear and forget. It is a condition that keeps being switched back on by sun, heat and hormones, and light on its own tends to buy you a few good months before it returns. Visible light has been shown to worsen melasma, and more so on skin that carries more pigment. [4] So when melasma is what you have, IPL goes into a plan rather than being sold as the plan: prescription-strength topical treatment doing the steady work, [a daily sunscreen](/treatments/heliocare/) you actually wear, and light used to accelerate it. That is what the evidence supports and it is what we will recommend. [3] [5] A practice that sells you a course of IPL for melasma and nothing else has sold you a relapse. The same honesty applies elsewhere. If your redness is heavy vessels rather than background flush, [VBeam](/treatments/vbeam-photorejuvenation/) is the better instrument. Getting sent to the right treatment first time is cheaper than getting sold the wrong one. **IPL is probably a good fit if:** - You have brown spots, freckling or mottled sun damage on the face, chest, shoulders or hands - You have background facial redness or small broken veins around the nose and cheeks - You have melasma and want light as part of a plan that also includes topical treatment and daily sun protection - Your skin has not seen recent sun and you can keep it that way through the course - You can plan around a week or two of spots darkening and flaking - You would rather do a short course than one heavy treatment **We will steer you somewhere else if:** - You are tanned or sunburned right now, from the sun, a bed or a bottle - You want IPL alone for melasma, without the topical treatment and sun protection that hold it - You are pregnant, or taking anything that makes you more sensitive to light - You have recently finished a strong oral acne medication - You have a pigmented spot that has not been examined yet, which comes first Not sure which of those you are? That is exactly what the consultation is for, and it is why we look at your skin before booking this one. For the first day your skin feels warm and looks flushed, like mild sunburn. Then the treated spots go darker, sometimes noticeably darker, before turning crisp and flaking away over three to fourteen days. Redness fades more gradually. Plan the week if you have something on. **In the first week, do** - Wear broad spectrum SPF 30 or higher every day without exception [2] - Keep the area moisturized and let the spots flake off on their own - Cool the skin gently if it feels hot on the first day - Tell us if anything blisters or hurts rather than waiting **In the first week, don't** - Pick, scrub or exfoliate the darkened spots - Go back to retinoids or acids until we clear you - Sit in the sun, use a sunbed or apply self-tanner - Book a hot tub, sauna or heavy workout on the first day Call us about blistering, real pain or any sign of infection. We would far rather hear from you. IPL clears what the sun and time have left on the surface: pigment and small vessels. Pick a concern to see how we approach it. IPL is priced per session and per area, and most people are booking a course of three to five rather than a single visit. We quote you the whole course at your consultation rather than one number that grows once you have started. If a cheaper option or a different one would serve you better, that is the one you will be offered. **Q: Does it hurt?** Most people describe it as a warm rubber band flick, over in a fraction of a second and repeated across the area. It is uncomfortable rather than painful, and a full face takes under half an hour. **Q: Why do I have to stay out of the sun for two weeks first?** Because a tan is pigment, and pigment is what the light goes for. Treat tanned skin and the energy lands in the tan instead of the spot, which is how burns and blotchy patches happen. Self-tanner counts. Two weeks, no sun, no beds, no bottle. **Q: Does IPL work on melasma?** Yes, and we use it for melasma, as part of a plan rather than on its own. Melasma is a condition rather than a mark: sun, heat and hormones keep switching it back on, so light clears the pigment and then the pigment has every reason to return. Used inside a plan, with prescription-strength topical treatment doing the steady work and daily sun protection holding the line, it earns its place and gets you there faster. Used on its own, it usually buys a few good months. [4] [5] If melasma is what you have, come in for a plan rather than a course of light. **Q: Why do the spots darken before they clear?** Yes, and that is the treatment working. Treated spots usually darken for a few days, go crisp, then flake away over about two weeks. Do not pick them. **Q: How many sessions will I need?** Usually three to five, about four weeks apart, depending on how much sun damage there is and how your skin responds. You get the number and the price for the whole course before you book the first one. **Q: Will they come back?** The sun spots we clear are gone. New sun makes new spots, which is why daily sunscreen is the difference between a result that holds for years and one that needs redoing. Melasma is the exception and is answered above. [2] Offered in San Luis Obispo. Not yet available in Santa Maria. 1. Bjerring P, Christiansen K. "Intense pulsed light source for treatment of small melanocytic nevi and solar lentigines." *Journal of Cutaneous Laser Therapy.* 2000;2(4):177-181. Eighteen patients with solar lentigines received one treatment; average clearance 74.2% at two months, with pigment reduction in 96% of patients. Follow-up ran to two months only, so it supports no claim about how long the result lasts. Only the sun spot figure is used. PMID 11350673. https://pubmed.ncbi.nlm.nih.gov/11350673/ · Peer-Reviewed Study 2. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization 3. American Academy of Dermatology Association. "Skin conditions that lasers can treat." Laser and light treatments are listed as useful to "reduce melasma," alongside age spots, scars, spider veins and other concerns. [https://www.aad.org/public/diseases/a-z/skin-conditions-lasers-treat](https://www.aad.org/public/diseases/a-z/skin-conditions-lasers-treat) · Medical Organization 4. American Academy of Dermatology Association. "Melasma: Self-care." "Visible light has been shown to worsen melasma, especially for people with darker skin tones." Melasma "may go away on its own" but "for some people, it can last for years," and because sunlight triggers it, daily protection matters even on cloudy days. [https://www.aad.org/public/diseases/a-z/melasma-self-care](https://www.aad.org/public/diseases/a-z/melasma-self-care) · Medical Organization 5. American Academy of Dermatology Association. "Melasma: Diagnosis and treatment." A laser or light treatment "can improve results for patients who are already applying medication to their skin and protecting their skin from the sun," and should only be performed by a board-certified dermatologist. [https://www.aad.org/public/diseases/a-z/melasma-treatment](https://www.aad.org/public/diseases/a-z/melasma-treatment) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice. Mild redness and a warm, sunburned feeling for a day or two are expected, and treated spots commonly darken before flaking away over three to fourteen days. Blistering, burns, crusting, and lightening or darkening of the skin that can last months are recognized risks, and the risk is higher on tanned skin and on deeper skin tones. Melasma can recur after light-based treatment and can worsen without topical treatment and consistent sun protection. Machines of this class are cleared, not approved. This treatment is not suitable on skin that is tanned or sunburned, during pregnancy, alongside medications that increase sensitivity to sunlight, on or shortly after a strong oral acne medication, or where the skin is broken or infected. An unexamined pigmented spot is assessed by a dermatologist before any light-based treatment. Call us about blistering, real pain or signs of infection. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### JUVÉDERM® Fillers Hyaluronic acid is something your skin already makes, and less of it every year. A filler is a gel of it, placed where your face has lost its shape, and it works the moment it goes in. You look in the mirror in the chair, not in four months. The thing worth understanding before you book: **JUVÉDERM is not one product.** It is a family, and the members are built differently on purpose. Some are firm enough to rebuild a cheekbone. Some are soft enough to go under an eye without showing an edge. Using the firm one where the soft one belongs is how people end up looking lumpy or overfilled, and it is a choice made by whoever is holding the syringe. It is also reversible, which almost nothing else in aesthetics is. Hyaluronic acid fillers can be dissolved with an enzyme if you do not like the result or if anything needs correcting. That safety net is a real reason to start here rather than with something permanent. **What filler is good at** - Rebuilding cheeks that have flattened, which lifts everything below them - Softening the folds from nose to mouth without stuffing the fold itself - Adding definition to a jawline or projection to a chin, without surgery - Lips: more volume, better shape, or just the hydration back - Filling under-eye hollows that make you look exhausted - Being undone if you change your mind **H3: JUVÉDERM® VOLUMA® XC** The structural one. Placed deep in the cheek to rebuild volume that has gone, and also approved for chin augmentation and temple hollowing. It is the firmest of the group, which is why it goes where the face has lost its underlying shape rather than where it has lost a line. [1] **H3: JUVÉDERM® VOLUX® XC** For the jawline. A firm gel placed along the jaw to sharpen definition and improve its shape, which is the treatment people are asking for when they say they want a stronger profile without surgery. [1] **H3: JUVÉDERM® VOLLURE® XC** For moderate to severe wrinkles and folds, most often the nasolabial folds running from nose to mouth. Softer than the structural gels, because a fold moves every time you speak. [1] **H3: JUVÉDERM® VOLBELLA® XC** The delicate one. Approved for lip augmentation, for the fine vertical lines around the mouth, and for under-eye hollows: all the places where a firmer gel would announce itself. If you want your lips to look like lips rather than like lip filler, this is usually the conversation. [1] **H3: JUVÉDERM® Ultra XC and Ultra Plus XC** Ultra XC is used mainly for adding volume to thin lips. Ultra Plus XC is the heavier of the two, for moderate to severe facial wrinkles and folds. [1] SKINVIVE does something different from a filler. It is a series of tiny hyaluronic acid microdroplets placed just beneath the surface to improve the smoothness of your cheeks, working on skin quality rather than on shape or volume. It was the first injectable of its kind approved in the United States. [1] It answers a specific complaint: your face still has its structure, but your cheeks look dull, rough or crepey in photographs and no cream has touched it. Results last up to six months. [1] It sits comfortably alongside filler and neuromodulator treatment, and it is worth asking about even if you have already decided you do not want filler. These are our own patients, photographed at our offices and published with their consent. Individual results vary. There are more in the practice's private gallery, and we will show you cases close to yours at your consultation. ![Woman's full lips](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-juvederm-fillers.webp) The complications that matter with filler are not cosmetic. They are vascular, they are rare, and they happen when a gel goes somewhere it should not near a facial artery. That is a question of anatomy, of recognizing a problem early, and of having the means to act immediately. All three of those live inside a board-certified dermatology practice. It also means we will tell you when filler is the wrong answer. Lines carved by muscle movement need a [neuromodulator](/treatments/botox-cosmetic-xeomin/), not volume. Diffuse thinning across the whole midface often does better with a [collagen stimulator](/treatments/sculptra/) than with gel placed in one spot. And a face that genuinely needs lifting rather than filling needs a different conversation altogether, which you should have before you spend, not after. **Filler is probably a good fit if:** - Your face looks flatter or more tired than it used to and you cannot point at one line - You want a sharper jaw, a stronger chin or fuller lips without surgery - You want to see the result the same day - You accept that it is temporary and will need topping up - You want a plan built around your proportions rather than a fixed number of syringes **We will steer you somewhere else if:** - You have an infection or active inflammation in the area - You have one of the severe allergies named in the product labeling - You are pregnant or breastfeeding, where elective treatment is deferred - What you are describing is better answered by surgery, a neuromodulator or skin treatment Swelling and tenderness for a few days, and bruising is common, particularly around the lips and eyes. Lips swell more than anything else and more than people expect, so do not book them three days before a wedding. You may feel firmness or slight unevenness while everything settles. **For the first few days, do** - Use ice for swelling - Sleep with your head slightly raised - Give it two weeks before you judge the result **For the first few days, don't** - Massage or press the area unless we have told you to - Book a hard workout, a sauna or a long flight - Panic about asymmetry in week one Call us right away about severe or increasing pain, skin that turns white or dusky, or any change in your vision. These are rare and they are urgent, and they are the reason this belongs in a medical setting. Pick a concern to see how we approach it. Filler is priced per syringe, and how many you need depends on how much volume has gone and where. One syringe is roughly a teaspoon, which is less than most people picture, and a face that has been emptying for a decade is rarely a one-syringe conversation. You will be told how many syringes and what it costs before anything is opened. We would rather stage it across two visits than sell you a result you did not agree to. **Q: How long does it last?** It depends on the product and where it goes. Structural gels in the cheek last longest; lips are the shortest, because they move constantly. Your provider gives you the range for the product you are actually having, and areas that move more need topping up sooner. **Q: Will it look obvious?** Not if it is done in proportion and not all at once. Overfilled faces are the result of too much, placed too superficially, too often, and usually of chasing one feature rather than balancing a face. We stage treatment and review you between sessions for exactly that reason. **Q: Does it hurt?** Less than you would think. The gels contain lidocaine and we use numbing cream for delicate areas. Lips are the most sensitive spot and we treat them accordingly. **Q: Can it be undone?** Yes. Hyaluronic acid fillers can be dissolved with an enzyme, usually within a day or two of asking. That reversibility is one of the strongest arguments for starting with this class of filler rather than something permanent. **Q: How is it different from BOTOX?** They do opposite jobs. A neuromodulator relaxes a muscle that is pulling a line into your skin. Filler replaces volume that has gone. Lines that appear when you move need one; hollows that are there when you are still need the other. Most people over forty are having a conversation about both. **Q: What is SKINVIVE, and do I need it?** It is not filler. It is hyaluronic acid placed as tiny droplets near the surface to smooth the skin of your cheeks, lasting up to six months. [1] It is for someone whose face has kept its shape but whose skin looks dull or crepey, which is a different complaint from an empty cheek. 1. JUVÉDERM® Collection of Fillers, Indications and Important Safety Information, Allergan Aesthetics. Product-specific approved indications: VOLUMA XC for cheek augmentation, chin augmentation and temple hollowing in adults over 21; VOLUX XC for jawline definition in adults over 21; VOLBELLA XC for lip augmentation, perioral rhytids and infraorbital hollowing in adults over 21; VOLLURE XC and Ultra Plus XC for moderate to severe facial wrinkles and folds; Ultra XC for lip augmentation. SKINVIVE® by JUVÉDERM® is a hyaluronic acid microdroplet injectable indicated for improvement of skin smoothness of the cheeks in adults over 21, with results lasting up to six months. https://hcp.juvederm.com/ · Regulatory / Prescribing Information 2. U.S. Food and Drug Administration. "Dermal Fillers (Soft Tissue Fillers)." Approved uses, risks and potential complications of injectable dermal fillers. [https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/dermal-fillers-soft-tissue-fillers](https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/dermal-fillers-soft-tissue-fillers) · Regulatory Content on this page is for educational purposes and is not a substitute for professional medical advice. Dermal filler injection carries rare but serious risks including vascular occlusion and vision changes. JUVÉDERM® and SKINVIVE® are trademarks of Allergan Aesthetics. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### Nitronox™ Some people put off a treatment for years, not because of the cost or the recovery, but because of the twenty minutes in the chair. Nitronox exists for exactly that. You breathe it through a mask during the treatment you are already having. Within a minute or two the edge comes off, both the discomfort and the nerves that make the discomfort worse. You do not go under. You stay awake, you know where you are, you can talk to us the whole time and you can tell us to stop. When the treatment finishes you stop breathing it and it is gone within five to ten minutes. It is not an anesthetic and it does not replace numbing cream, which still goes on where it is needed. It takes a treatment you have been dreading and makes it something you get through without dreading the next one. **What Nitronox is good for** - Getting through a treatment you have been putting off because of nerves - Taking the edge off microneedling, which people find sharper than they expect - Making filler injections easier if needles are the part you hate - Scalp injections), which are more sensitive than face work - Longer sessions of laser hair reduction where the discomfort adds up - Anyone whose blood pressure goes up the moment they sit in a treatment chair Nobody books Nitronox. People book a treatment and then ask whether there is anything for the part they are worried about. Here is where it comes up most. If this is the treatmentWhat people sayWhy Nitronox helpsMicroneedlingSharper than expected, especially around the forehead and upper lipNumbing cream handles the surface; this handles the rest and the anticipationFiller injectionsIt is not the pain, it is the needleTakes the edge off the anticipation, which is usually the real problemScalp injections)The scalp is more sensitive than the faceMakes a longer scalp session comfortable enough to keep going with the courseLaser hair reductionFine for two minutes, less fine for twentyThe discomfort is cumulative, and this stops it buildingAnything, for someone who dreads appointmentsI have been putting this off for two yearsFear of the chair is a real reason people go untreated, and it is a solvable one If any of those sound like you, mention it when you book rather than the day of your appointment. It is easier to have it ready than to arrange it while you are sitting there. ![woman with blonde hair](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-nitronox.webp) Plenty of people have been meaning to deal with something for years and have not, because of twenty minutes they do not want to sit through. That is a real reason and we treat it as one. Offering this at all is a decision about how we would like appointments here to go. Two honest things about it. It is not enough for everyone, and some people find it takes the edge off rather than removes it, which is exactly why you stay awake and in charge and can stop at any point. And it is not right for everybody: pregnancy, certain vitamin and breathing problems, recent eye surgery and a short list of other situations rule it out, which is why we ask about your history first rather than handing you a mask. If it is not the right call for you, we will say so and we will find another way to make your appointment bearable. **Nitronox is probably a good fit if:** - You have been putting off a treatment because of nerves rather than cost - Needles or the sound of a device bother you more than the actual sensation does - You want to stay awake, aware and able to talk to us throughout - You want something that is gone by the time you walk out - You have a longer session booked and the discomfort tends to build **We will steer you somewhere else if:** - You are pregnant, or think you might be - You have low vitamin B12 or a known problem processing it - You have a breathing problem, a blocked nose or sinuses, or a middle-ear problem - You have had recent eye surgery where gas was placed in the eye - You have a blocked bowel or trapped gas after abdominal surgery - Your medication list includes something that does not sit well with it, which is why we ask Tell us your full medical history and everything you take before your appointment. That conversation is the whole screening, and it takes two minutes. Most people feel warm, floaty and noticeably less bothered, and then feel completely normal within five to ten minutes of the mask coming off. Some people feel briefly lightheaded, a little queasy, tingly in the hands, or get a short headache. All of it usually settles within minutes of stopping. **Do** - Tell us your full medical history and medication list before the appointment - Eat lightly beforehand rather than arriving on an empty stomach - Tell us right away if you feel queasy, so we can stop - Sit for a few minutes afterward if you would rather not get straight up **Don't** - Assume it replaces numbing cream, because it does not and you still get both - Stay quiet about feeling odd, at any point - Book it as a treatment on its own, because it is added to something else - Skip mentioning a supplement or medication because it seemed irrelevant Tell us about anything that does not settle within a few minutes of stopping. We would far rather hear from you. Nitronox carries its own charge on top of the treatment you are having, because it is an added service rather than part of the price of the procedure. We tell you the amount when you book so it is not a surprise at checkout. If cost is the reason you are hesitating, say so. Numbing cream, a slower pace and a shorter session are all free, and sometimes they are enough. **Q: Will I be asleep?** No. This is not sedation and it is not general anesthetic. You stay awake, you know where you are, you can talk to us and you can ask us to stop. That is the point of it rather than a limitation. **Q: Is it the same gas the dentist uses?** Yes, the same idea. If you have had it at a dental appointment you already know what to expect, and if you have not, the description most people give is warm, light and much less bothered. **Q: Does it get rid of the pain completely?** Not always, and we would rather say so. For most people it takes the edge off enough to get comfortably through a treatment they were dreading. Numbing cream still goes on where it is needed, and if it is not doing enough for you, we can stop and rethink the plan rather than push on. **Q: How long until it wears off?** Five to ten minutes after you stop breathing it. It does not hang around for the rest of the day, which is the main reason people choose it over anything stronger. **Q: Can I have it with any treatment?** It is most often added to microneedling, injections, scalp treatments and longer laser sessions. Ask when you book and we will tell you whether it makes sense for what you have scheduled. **Q: Does it cost extra?** Yes. It is a separate charge on top of the treatment, and we tell you what it is when you book rather than at checkout. Offered in San Luis Obispo. Not yet available in Santa Maria. Content on this page is for educational purposes and is not a substitute for professional medical advice. Nitronox™ is a trademark of its owner. This is a comfort option added to another treatment and is not a standalone service, and it carries a separate cost. It is not sedation and not general anesthesia. Lightheadedness, nausea, tingling and a brief headache are the commonly reported effects and usually settle within minutes of stopping. It is generally avoided during pregnancy, in people with low vitamin B12 or a known problem processing it, with breathing problems, with middle ear or sinus blockage, after recent eye surgery where gas was placed in the eye, with a blocked bowel or trapped gas after abdominal surgery, and alongside certain medications. Tell us your full medical history and medication list before your appointment. Individual experiences vary. ### Nutrafol® Thinning hair is one of the few things people will spend real money on before asking anybody what is causing it. The shelf is enormous, almost none of it has been studied, and the marketing is aimed squarely at how much you want it to work. Nutrafol is a daily capsule you swallow rather than something you rub into your scalp, and what sets it apart from most of that shelf is that somebody ran a proper study on it. Seventy women, six months, half on the supplement and half on a look-alike capsule with nothing in it, and nobody knowing which until the end. The group taking Nutrafol was shedding about a third less by the end of it. [1] Here is the part a checkout screen will not tell you: it is a supplement, not a drug, and the company that makes it paid for that study. Both of those are true and neither one makes it useless. It means Nutrafol belongs in a plan built by somebody who looked at your scalp first, alongside whatever else that exam turns up, rather than being the thing you try because it came up in an ad. **Where Nutrafol fits** - Diffuse thinning where the whole head has less density rather than one receding area - Shedding that started after a pregnancy, an illness, a stressful year or a big weight change - The thinning that arrives with the years around menopause - People who want to start with something that does not need a prescription - As one part of a plan rather than the whole plan, which is how it is usually used here - People who will actually take it daily for six months, because that is the only way it gets a fair test Almost everybody who searches for a hair supplement skips this part, and it is the part that decides whether anything you buy is going to work. These are the common reasons hair thins, and they look identical in a mirror. **Genetics.** The pattern kind, which shows up as a widening part or receding temples and runs in families. It is progressive, it responds best to treatment started early, and a supplement is not the main tool for it. **A shock to the system.** A pregnancy, an illness, surgery, a very stressful stretch, a rapid weight change. Hair sheds all at once a few months after the event, which is why the timing never seems to match. This kind usually recovers, and the main job is supporting it while it does and not panicking. **Hormonal change.** The years around menopause are the common one. Density drops gradually across the whole head rather than in a pattern. **Something in your bloodwork.** Thyroid and iron are the two usual suspects. Both are common, both are treatable, and no supplement on any shelf fixes either of them. This is the reason we sometimes test before we recommend anything. **The scalp itself.** Inflammation, flaking and seborrheic dermatitis make an unhappy environment for hair to grow in. Treat the scalp and the hair often improves without anything else changing. **Medication.** More common than people expect, and worth going through your list properly. Most people have more than one of these running at once. Working out which ones you have is a twenty-minute exam and some questions, and it is what turns a bottle of anything into an actual plan. ![Man checking for hair loss](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-nutrafol.webp) Hair and scalp are dermatology. One visit with a board-certified dermatologist can look at your scalp properly, order blood work if your history calls for it, talk through prescription options, and reach for a supplement only if a supplement is genuinely the right answer. A checkout screen does none of that, and neither does a med spa selling one device. It also means being told when this is not the answer. [Thinning hair](/conditions/hair-loss/) has a lot of causes and Nutrafol is one option among several, including [PRF made from your own blood](/treatments/platelet-rich-fibrin-prf/)) and, where the scalp itself is the problem, [a scalp treatment](/treatments/hydrascalp/). At our San Luis Obispo office those are all in the same building, which means nobody here has to sell you the only thing on the shelf. **Nutrafol is probably worth trying if:** - Your hair is thinning across the whole head rather than receding in a pattern - The shedding started a few months after a pregnancy, an illness or a hard year - You are in the years around menopause and your density has dropped - You want to start with something that does not need a prescription - You will genuinely take it every day for six months **We will suggest something else if:** - Your history or exam points at your thyroid, your iron or a medication, which need addressing first - Your scalp is inflamed or flaking, where treating the scalp comes before anything you swallow - You are looking for a result in a month, which no product in this category can give you - You are pregnant or breastfeeding, when this is a conversation to have with your physician first Not sure which of these you are? Almost nobody is from a mirror. That is the exam, and it is what makes the difference between a plan and a purchase. There is no recovery and nothing to plan around. You take the capsules daily and nothing visible happens for about three months, which is the hardest part and the reason most people quit before they have given it a fair run. **While you are taking it, do** - Take it every day, because an inconsistent six months is not a six-month trial - Photograph your part line on day one, in the same light, and again monthly - Tell us about every other medication and supplement you take - Come back at three and six months so somebody other than you assesses it **While you are taking it, don't** - Judge it at eight weeks - Add three other supplements at the same time, because then you will not know what did what - Assume it replaces treatment for a cause we have identified - Start it in pregnancy or while breastfeeding without speaking to your physician first Tell us about any digestive upset, which is the most commonly reported complaint with supplements of this kind, or anything else that does not seem right. We would far rather hear from you. Hair and scalp are dermatology, and the supplement is the last decision rather than the first. Pick a concern to see how we approach it. Nutrafol is priced per bottle and you can buy it without an appointment. What it is worth paying for first is the exam, because the same money spent on the wrong product for six months is the actual expense here. We do not recommend a supplement to make a sale. If your exam points at something else, that is what you will hear, and it is frequently what happens. **Q: Does it actually work?** There is a real study behind it, which is rare in this category. Seventy women took part over six months. Some got Nutrafol, some got a look-alike capsule with nothing in it, and nobody knew which until the end. The Nutrafol group was shedding about a third less by the end. Two things belong next to that: the company that makes Nutrafol paid for the study, and the women joined because they felt their hair was thinning rather than because a doctor had pinned down a cause. It is genuine evidence. It is not a drug trial. [1] **Q: Is it a drug?** No. It is a supplement, so no prescription is needed and it is not held to the standard a prescription medication is held to. Knowing which of the two you are buying is the useful thing here. **Q: How long before I see anything?** Three months at the very earliest and six months for a fair verdict. Anything promising you a result in a month is selling you something. **Q: Is it better than minoxidil?** Nobody can honestly tell you that, because the study compared Nutrafol against a dummy capsule rather than against minoxidil. They are different animals. One is a supplement, the other is a medication you put on your scalp with decades of use behind it. For some people the answer is one, for some the other, and for plenty of people it is both. **Q: Which formula would I take?** That comes out of the exam. There are separate products for women, for women in menopause, and for men, because what drives thinning is different in each. **Q: Should I get blood work first?** Possibly, and that is exactly the conversation to have here rather than at a checkout. Thyroid and iron are the usual suspects. If something in your history points that way, we test before we recommend a bottle of anything. 1. Ablon G, Kogan S. "A Six-Month, Randomized, Double-Blind, Placebo-Controlled Study Evaluating the Safety and Efficacy of a Nutraceutical Supplement for Promoting Hair Growth in Women With Self-Perceived Thinning Hair." *Journal of Drugs in Dermatology.* 2021;20(1):55-61. Supports the shedding figure: 70 women over six months, about a third less shedding in the group taking the supplement than in the group taking a look-alike capsule. Funded by the manufacturer of Nutrafol, which the page discloses. Participants joined on their own sense that their hair was thinning rather than on a confirmed cause, and shedding was not the study's main measure. PMID 33400421. https://pubmed.ncbi.nlm.nih.gov/33400421/ · Peer-Reviewed Study Content on this page is for educational purposes and is not a substitute for professional medical advice. Nutrafol® is a registered trademark of its owner. This is a dietary supplement and is not intended to diagnose, treat, cure or prevent any disease. Dietary supplements are not approved by the FDA before sale. The study cited on this page was funded by the product's manufacturer. Mild digestive upset is the most commonly reported complaint with supplements of this kind. Tell us about every medication and supplement you take before starting, and speak with your physician first if you are pregnant or breastfeeding. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### PDRN Booster PDRN stands for polydeoxyribonucleotide. It is a fragment of DNA, usually derived from salmon, and it is the active ingredient behind the treatments you have seen described as salmon DNA facials. It is used here as a **topical booster**, added to a treatment rather than sold as a product to take home. It goes on during a session and is driven in through channels opened by a device. **Benefits:** - Adds a hydration and skin-conditioning step to a treatment you are already having - Pairs naturally with nano-infusion, which exists to solve the delivery problem described below - No needles and no additional recovery beyond whatever the base treatment involves - Suits sensitive skin, since nothing is injected and nothing is heated Almost every page selling PDRN skips the only question that decides whether it works. Here it is. **Skin is built to keep large molecules out.** The working rule in dermatology is that molecules much above 500 daltons do not cross intact skin. [1] PDRN fragments are enormously larger than that, measured in the tens to hundreds of kilodaltons. [1] Which means a PDRN serum applied to intact skin, at home or in a treatment room, is very unlikely to reach the layer where it would do anything. That is not a criticism of the ingredient. It is arithmetic about the barrier. **So delivery is the entire question.** Applied through the temporary channels that nano-infusion or microneedling creates, the molecule has a route in that it does not otherwise have. Applied to intact skin, it mostly sits on top. **And the injectable version is not available here.** In Korea and elsewhere, PDRN is injected. **Injectable PDRN is not FDA-approved for cosmetic use in the United States.** [1] If you have read about Rejuran or similar treatments and are looking for them locally, that is the reason you are not finding them at a US practice offering them straightforwardly. We would rather tell you that than let you assume a topical is the same thing. Base treatmentWhy it suitsNano-infusionBuilt for delivery. The obvious pairing, and the one most sessions useRF microneedlingDeeper channels, more downtime, and a structural treatment in its own rightAfter a peel or resurfacingAs a conditioning step once the skin barrier has recovered Nano-infusion and RF microneedling are San Luis Obispo and Santa Maria treatments. Ask which base treatments are available at your office. PDRN is having a moment, and moments produce a lot of confident marketing. What you should want from a practice is a straight answer about what an ingredient can and cannot do, and whether the version being sold to you is the version the research was done on. That is why this page tells you the molecule is too large to cross intact skin, and that the injected form is not available in the United States. Neither fact helps sell it. Both are true, and you can only make a decision with them in front of you. If a booster is not worth it for what you are trying to change, we will say so at [a consultation](/treatments/skin-care-consultations/) and put the money somewhere it does more. **A good fit if:** - You are already having nano-infusion or microneedling and want to get more out of the session - Your skin is dry, stressed or reactive and you want a conditioning step - You have read about salmon DNA treatments and want a straight account of what is available here **Worth a conversation first if:** - You are specifically looking for the injectable version, which is not available in the US - You have a fish or seafood allergy, which is worth raising before anything derived from salmon goes on your skin - You want structural change, since a booster is not the treatment that delivers that The booster adds no recovery of its own. Whatever the base treatment involves is what you plan around: nothing for nano-infusion, a couple of days for microneedling. Skin is briefly more absorbent after either, so keep the rest of the day simple and use sun protection. Tell us about any fish or shellfish allergy before treatment. Reactions are uncommon and the ingredient is highly purified, but it is derived from salmon and you should be asked. A PDRN booster is used here alongside treatments for these concerns. Pick one to see how we approach it. PDRN is priced as a booster added to a base treatment, not as an appointment of its own. You are paying for the session plus the booster, and we will quote both so you can see what the addition actually costs. Whether it is worth adding depends on what you are treating. For some concerns the money does more in the base treatment or in what you use at home, and we will tell you when that is the case. **Q: Is this the salmon DNA treatment I have seen online?** It is the same ingredient. What you have most likely seen is the injected version, which is widely used in Korea. Injectable PDRN is not FDA-approved for cosmetic use in the United States. [1] What we offer is a topical booster delivered through a device. **Q: Does topical PDRN actually work?** It depends entirely on delivery. The molecule is far too large to cross intact skin, so a serum applied to an unbroken surface is unlikely to reach anything. [1] Applied through channels opened by nano-infusion or microneedling, it has a route in. That is why we only offer it as part of a treatment rather than as a product to take home. **Q: Is it safe if I am allergic to fish?** Raise it before treatment. The ingredient is highly purified and reactions are uncommon, but it is salmon-derived and that is a conversation worth having first. **Q: Can I just buy a PDRN serum instead?** You can, and it will sit on your skin. Topical PDRN is sold legally in the United States as a cosmetic. [1] Whether it does anything is the delivery question above. **Q: Which treatment should I add it to?** Nano-infusion is the natural pairing and involves no recovery. If you are already having microneedling, it can go on then instead. 1. Dermatology Times. "Social Media Mythbusters: PDRN Serums." On the United States regulatory position, that injectable PDRN is not FDA-approved for cosmetic use while topical PDRN is legally sold in the US as a cosmetic product, and on the penetration barrier, that molecules larger than approximately 500 daltons are unlikely to penetrate intact human skin while PDRN fragments range from 50 to 1,500 kilodaltons. [https://www.dermatologytimes.com/view/social-media-mythbusters-pdrn-serums](https://www.dermatologytimes.com/view/social-media-mythbusters-pdrn-serums) · Trade Publication Content on this page is for educational purposes and is not a substitute for professional medical advice. This is a topical cosmetic booster applied during a treatment. Nothing is injected. Injectable PDRN is not FDA-approved for cosmetic use in the United States and is not offered here. The booster is not intended to diagnose, treat, cure or prevent any condition. It adds no recovery of its own beyond the base treatment it is applied with. A reaction to the serum is uncommon but possible. Tell us about any fish or shellfish allergy before treatment, because the ingredient is salmon-derived. This booster is not applied where there is an active infection or broken skin in the area. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### Pendulum® Probiotics Pendulum is a gut and metabolic supplement. That is what it was built for, that is what the company's own research looks at, and that is the honest frame for anyone buying it in a dermatology office. What makes it worth stocking is what is inside it. Nearly every probiotic on a drugstore shelf is built from the same short list of bacteria, and the reason is not that those are the ones your gut needs most. It is that they are the ones that survive being grown, dried and packed. Pendulum's headline organism lives deep in the oxygen-free part of your large intestine, in the slippery lining that sits between your gut wall and everything passing through it. Air kills it. Getting it into a capsule alive is a manufacturing problem before it is a health one, which is why almost nobody sells it. That is a real difference and we are happy to explain it. It is also not a skin treatment, and you will not find a sentence on this page pretending otherwise. **What it is good for** - Supporting the gut lining, which is what the headline organism does where it lives - Gut and metabolic health, which is what the products were formulated around - People who already take a probiotic and want one built on something other than the usual short list - Anyone who would rather buy a supplement from a practice that will tell them where the evidence stops - Taking on its own terms, alongside your dermatology plan rather than instead of any part of it Search "probiotics and skin" and you will find dermatology practices publishing articles that say probiotics reduce acne severity, rebuild your skin barrier and reverse premature aging. Several of them run the identical article, word for word, with no citations under any of it. It is good marketing. It is not something a board-certified dermatology practice should put its name to. Here is what is actually true. There is real research into the connection between the gut and the skin, some of it promising, and it is nowhere near settled. Strain matters, dose matters, and the condition matters, and a finding about one bacterium in one study does not transfer to the bottle in your hand. No probiotic treats acne, rosacea, eczema or psoriasis the way the actual treatments for those conditions do. So we carry Pendulum for what it is: a well-made supplement for gut and metabolic health, from a company that solved a hard manufacturing problem, sold by people who will answer a straight question with a straight answer. If you want it, we will get it to you. If you are hoping it will do something we do not believe it does, we will say so first, and then we will show you the thing that actually works on the problem you came in with. There is a version of this page that says probiotics clear acne and heal eczema. Plenty of practices run it, some word for word from the same syndicated article. You will not find it here, because a dermatology practice trades on being believed and we intend to keep that. What we will do instead is stock a product that is genuinely hard to make, tell you what it was built for, and be clear about which parts of the story are settled and which are still being researched. You can ask that question at our San Luis Obispo office and get an answer that is not a sales pitch, in the same visit as [the products we carry](/treatments/skin-care-products/) for your skin and whatever we are already treating. **Pendulum is probably a good fit if:** - You are interested in gut and metabolic health for its own sake - You already take a probiotic and want one built on something other than the usual short list - You want to buy a supplement from somewhere that will tell you where the evidence stops - You can take a capsule daily and stay with it long enough to judge it **We will steer you somewhere else if:** - You are hoping it will clear a skin condition, which is a job for your treatment plan - Your immune system is compromised, or you are pregnant or breastfeeding, without your physician's sign-off - You are medically complex enough that any new supplement should go past your treating clinician first - What is actually bothering you is hair thinning, where a different product has the research behind it Not sure which of those you are? Ask us at your next visit. This is a conversation, not a checkout. Most people take it and notice nothing except, after a while, better digestive comfort. Some people get gas, bloating or a change in bowel habits in the first several days while things settle. Take it with food, give it a fair run, and tell us if something does not settle. **Do** - Take one capsule daily with food, as the label directs - Store it the way the label says, which for live cultures is not optional - Keep taking your prescribed treatment exactly as prescribed - Give it long enough to judge before you decide either way **Don't** - Swap out anything in your medical plan for a supplement - Assume every probiotic on a shelf is interchangeable with this one - Start it without checking first if you are immunocompromised, pregnant or breastfeeding - Push through gut symptoms that are worsening rather than settling Call us about anything severe, worsening or simply not what we described. We would far rather hear from you. Pendulum is priced per product and per subscription by the manufacturer, and what you pay depends on which formulation makes sense for you. We will tell you the price before you commit to anything, and we will tell you if the answer is that you do not need it. If a cheaper option would serve you better, that is what you will hear. **Q: Will a probiotic clear my skin?** The gut and skin connection is a real and active area of research, and it is not settled. For acne, rosacea, eczema or psoriasis, the treatments built for those conditions are what will move your skin, and that is what your plan here is for. **Q: What makes this different from a drugstore probiotic?** What is in it. Most shelf probiotics use the same short list of bacteria, mainly because those are the ones that grow easily and survive being packed into a capsule. The organism this product is built around is neither, and keeping it alive in a capsule is the hard part. **Q: What is that bacterium called?** It lives in the slippery mucus lining of your gut, cannot tolerate oxygen, and goes by the name Akkermansia muciniphila. You will see it written that way on the box and in the research. It is the reason the product exists rather than a marketing flourish. **Q: What is it actually made for?** Gut and metabolic health. That is what the products are formulated around and what the company's own research looks at. **Q: Can I take it alongside my treatment?** Usually yes, if nothing in your history makes a live-culture supplement unsuitable. It sits alongside your plan rather than replacing anything in it. **Q: Is it safe?** For most people, supplements like this are well tolerated. If your immune system is compromised, or you are pregnant or breastfeeding, talk with your physician before starting any live-culture product. Dietary supplements are not reviewed by the FDA before they go on sale, which is a good reason to buy them somewhere that will give you a straight answer about whether you need one. 1. Pendulum Therapeutics. "100 Million AFUs in Akkermansia: Why We Don't Measure CFUs." Active Fluorescent Units measured by flow cytometry, which distinguishes live, dead and active cells; 100 million AFU per serving of Pendulum Akkermansia. [https://pendulumlife.com/blogs/news/100-million-afus-in-akkermansia-why-we-don-t-measure-cfus](https://pendulumlife.com/blogs/news/100-million-afus-in-akkermansia-why-we-don-t-measure-cfus) · Manufacturer 2. Coastal Dermatology + Aesthetics. Pendulum® Probiotics. Manufacturer's stated timing: digestive comfort within the first few weeks, broader benefits building over about 90 days; one capsule daily with food. https://coastaldermaesthetics.com/treatments/pendulum-probiotics/ · Practice / Manufacturer 3. U.S. Food and Drug Administration. "Dietary Supplements." Supplements are not approved by FDA before marketing, and a product marketed to treat, prevent or cure a disease is regulated as a drug. [https://www.fda.gov/food/dietary-supplements](https://www.fda.gov/food/dietary-supplements) · Regulatory 4. National Center for Complementary and Integrative Health. "Probiotics: What You Need To Know." Effects are strain specific and cannot be generalized from one product or organism to another; evidence varies by condition. [https://www.nccih.nih.gov/health/probiotics-what-you-need-to-know](https://www.nccih.nih.gov/health/probiotics-what-you-need-to-know) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice. Pendulum® is a registered trademark of Pendulum Therapeutics, Inc. This is a dietary supplement and is not intended to diagnose, treat, cure or prevent any disease. Dietary supplements are not approved by the FDA before sale. Live-culture supplements are not suitable for everyone: talk with your physician first if your immune system is compromised, if you have a serious illness, or if you are pregnant or breastfeeding. Mild gas, bloating or digestive upset in the first days is the most commonly reported complaint. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### Photodynamic Therapy [Actinic keratoses](/conditions/actinic-keratosis/) are the rough, scaly patches that show up on the parts of you that have taken the most sun: the forehead, the nose, the tops of the ears, the scalp if your hair has thinned, the backs of the hands. They are precancerous, which means some of them go on to become a squamous cell carcinoma if they are left alone. [2] More than 40 million Americans develop them each year. [2] The usual approach is to freeze the ones you can see, one at a time. That works well when there are a few. When [years of sun](/conditions/sun-damage/) have left a whole region of skin damaged, freezing spot by spot becomes a game of catch-up, because for every patch you can feel there are usually others that have not surfaced yet. Photodynamic therapy treats the region instead. A solution is applied across the whole area and absorbed preferentially by the damaged cells. A blue light then activates it, and those cells clear as your skin heals over the following one to two weeks. You come out with new skin across the area rather than a handful of treated spots and the same problem underneath. **What photodynamic therapy is used for** - Actinic keratoses on the face and scalp, treated as a whole area at once - Sun-damaged regions where new rough patches keep appearing - Scalps where thinning hair has left skin exposed for years - People who would rather have two appointments than a standing series of freezing visits - Reducing the risk that a precancerous growth becomes a skin cancer [1] This is the part worth understanding before you choose between treatments, because it is the whole reason photodynamic therapy exists alongside freezing. Sun damage does not arrive one spot at a time. It accumulates across a region over years, and the rough patch you can feel today is simply the one that surfaced first. Dermatologists call treating the whole region **field treatment**, as opposed to **lesion-directed treatment**, which handles the individual growths you can see. Freezing, spot by spotPhotodynamic therapy, whole areaWhat it treatsThe growths you and your dermatologist can see and feelThe visible growths and the surrounding damaged skin they came fromBest whenYou have a small number of scattered patchesA whole region keeps producing new onesAppointmentQuick, often part of a routine visitAround two hours, most of it waitingAfterwardSmall blisters or scabs on each treated spot48 hours indoors, then redness and peeling across the areaHow oftenRepeated whenever new patches appearUsually two treatments, a few weeks apart Neither one is better in the abstract. If you have three patches, freezing them is quick and sensible. If you have been back three times in two years and there are always more, treating the field is usually what breaks the cycle. Your dermatologist will tell you which situation you are in, and it is a straightforward conversation. ![Smiling woman outside](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-photodynamic-therapy.webp) Before any treatment is planned, the area is examined by a board-certified dermatologist. Rough, scaly patches are usually actinic keratoses, and sometimes they are something that needs a different answer entirely. Telling those apart is the work, and it is why this is done in a dermatology practice rather than anywhere a light can be plugged in. It also means the treatment sits inside a longer view of your skin. Anyone with enough sun damage to need field treatment is someone whose skin is worth watching over time, so photodynamic therapy is usually one part of a plan that includes [a skin cancer check](/treatments/skin-cancer-diagnosis/) and [daily sun protection](/treatments/heliocare/). That plan is what keeps you ahead of it. **Photodynamic therapy is often the right choice if:** - You have several actinic keratoses across one region rather than one or two isolated patches - New rough patches keep appearing in the same area after freezing - Your scalp or face has taken decades of sun and the damage is widespread - You can arrange to stay indoors for the 48 hours afterward [1] **Your dermatologist may suggest something else if:** - You have only a few isolated patches, where freezing is quicker and simpler - You are taking a medication that makes your skin unusually sensitive to light - You have a condition that makes light-sensitive treatment unsuitable - The 48 hours indoors will not fit the next few weeks, in which case it is worth waiting for a week that suits All of this is settled at your appointment, after your skin has been examined. There is nothing you need to work out in advance. The 48 hours after treatment matter more here than the treatment itself. Your skin stays highly sensitive to light during that window, including daylight through a window or on an overcast day, so you stay indoors and away from bright indoor light. [1] After that, expect redness, some swelling and peeling across the treated area for several days, similar to a strong sunburn, as the treated cells clear and new skin comes through. **In the first 48 hours, do** - Stay indoors and out of daylight completely, including on cloudy days [1] - Keep the treated area covered if you have to go outside at all - Use a gentle cleanser and whatever ointment we send you home with - Plan the treatment for a stretch when two days indoors is easy **In the following week, do** - Let any flaking and peeling come away on its own - Wear broad-spectrum sunscreen, SPF 30 or higher, every day from then on [3] - Keep your follow-up appointment, because the second treatment is part of the plan - Tell us about anything that does not match what we described Call us about anything severe, worsening or unexpected: significant pain, blistering, spreading redness, or signs of infection. We would far rather hear from you early. Sun-damaged and precancerous skin, treated across the whole area. Pick a concern to see how we approach it. Photodynamic therapy is a medical treatment rather than a cosmetic one, so the cost depends on the area treated and the number of sessions, and it is handled differently from the aesthetic services on this site. Our office will go through what applies to you before anything is scheduled. If freezing a few patches would serve you just as well, that is what will be recommended, and it is the less involved appointment of the two. **Q: Why does the appointment take two hours?** Most of it is waiting. The solution needs around 60 to 90 minutes on your skin before the light, so it can concentrate in the cells being treated. [1] The light itself is a fraction of that. Bring a book. **Q: Does it hurt?** Most people describe a stinging, burning or prickling sensation during the light portion, strongest in the first few minutes and easing after that. It is manageable, we can cool the area as we go, and it stops when the light does. **Q: Why do I have to stay indoors for two days?** Because the solution leaves your skin very sensitive to light for about 48 hours, and daylight during that window can cause a strong reaction, even on a cloudy day. [1] It is the one instruction that really matters, and planning the treatment for a quiet couple of days makes it easy. **Q: How many treatments will I need?** Most patients need two, with the second given a few weeks after the first. [1] Your dermatologist will confirm what your skin needs after examining the area. **Q: Will the patches come back?** New actinic keratoses can appear in sun-damaged skin over time, which is why this is usually paired with regular skin checks and daily sun protection. Treating the field puts you well ahead of where you were, and keeping up with checks is what holds that position. **Q: Do I need a referral?** Yes. Photodynamic therapy is medical dermatology, and the practice is currently accepting new medical patients by referral from your primary care physician. Once you have that, call the office and we will get you booked. Both offices offer photodynamic therapy. San Luis Obispo uses blue light and Santa Maria uses red light. 1. American Academy of Dermatology Association. "Actinic keratosis: Diagnosis and treatment." States that treatment can "reduce your risk of developing skin cancer," that during photodynamic therapy "a solution that makes your skin extremely sensitive to light is applied to the area with AKs. You'll sit in the office with this on your skin for about 60 to 90 minutes. Afterward, you'll be treated with either a blue or red light," that "for 48 hours after treatment, you'll need to avoid the outdoors during daylight. The UV light, even on a cloudy or snowy day, can cause a serious skin reaction," and that "most patients with AKs need 2 PDT treatments, with the second treatment given 3 weeks after the first." [https://www.aad.org/public/diseases/skin-cancer/actinic-keratosis-treatment](https://www.aad.org/public/diseases/skin-cancer/actinic-keratosis-treatment) · Medical Organization 2. American Academy of Dermatology Association. "Actinic keratosis: Overview." Describes an actinic keratosis as "a precancerous skin growth caused by the sun or indoor tanning," states that "more than 40 million Americans develop actinic keratoses each year," and that "some AKs and actinic cheilitis turn into a type of skin cancer called squamous cell carcinoma." [https://www.aad.org/public/diseases/skin-cancer/actinic-keratosis-overview](https://www.aad.org/public/diseases/skin-cancer/actinic-keratosis-overview) · Medical Organization 3. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice. Redness, swelling, stinging during treatment, and peeling across the treated area for several days are expected. Treated skin is highly sensitive to light for approximately 48 hours after treatment and must be kept out of daylight during that period. Blistering, infection, and temporary lightening or darkening of the skin are uncommon but possible. Tell us about any medication that makes your skin sensitive to light. This treatment is not suitable during pregnancy or where there is a known sensitivity to the medication used. Individual results may vary. ### Platelet-Rich Fibrin (PRF) Your blood carries the platelets and growth factors your body reaches for whenever it has to rebuild tissue. PRF concentrates them and puts them exactly where you want the rebuilding to happen: a thinning patch of scalp, the tired hollow under an eye, skin across the cheeks that has lost its freshness. For thinning hair, PRF goes into the scalp to wake up follicles that have gone quiet and thicken the hairs still growing. This is the use with the strongest evidence behind it, and for a lot of people it is the first thing that has moved at all after years of shampoos and supplements. Under the eyes and across the cheeks, where this practice uses it most, PRF improves the quality of the skin itself. The area looks fresher and better rested. Because it is working with your own tissue rather than adding volume, it does not read as done. Nothing synthetic goes in at any stage, which is why reactions are rare and why people who have held off on injectables tend to start here. **What PRF is good at** - Thickening thinning hair and waking up follicles that have gone quiet - Improving the tired, crepey skin under the eyes where most treatments are too aggressive - Freshening overall skin quality across the cheeks and midface - Working alongside filler rather than instead of it, because the two do different jobs - Suiting people who want nothing synthetic in their face - Giving a result that reads as rested rather than as treated Almost every practice on the Central Coast offering something made from your own blood is offering PRP. It is worth knowing what the difference actually is, because it is not marketing. PRP is spun fast, with an additive that stops it clotting so it stays liquid. Injected, it releases everything it has more or less at once. PRF is spun slower with nothing added at all, so it sets into a soft gel. That gel stays where it is put and feeds the tissue around it over the following days. Slower delivery, longer contact, nothing in it but you. That difference shows up in the research. A 2026 multicenter trial put the two head to head in women with pattern hair thinning and found the fibrin group grew about a quarter more hairs in the treated area, close to double the increase in the group treated with PRP, with the lowest rate of side effects of any group in the trial. [1] None of which makes PRP a bad treatment. It makes PRF the one we chose, and it means that when you compare us to a practice down the road, you are not comparing the same thing. ![Woman holding a cup of tea](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-platelet-rich-fibrin-prf.webp) Something made from your own blood is available in a lot of places now. What is not available in a lot of places is a board-certified dermatology practice deciding whether it is the right call for you in the first place. [Thinning hair](/conditions/hair-loss/) has a dozen possible causes, and the plan works far better when we know which one is yours. Sometimes that means PRF on its own. Sometimes it means PRF alongside [a daily supplement](/treatments/nutrafol/) or a prescription. You get a plan rather than a product. [2] Technique is where the result lives. Placement, depth and timing separate a treatment that shows from one that does not, and our San Luis Obispo office does this every week on scalps and on faces. We will also tell you when PRF is not the answer: if a follicle has been gone for years there is nothing left to wake up, and if what you have lost is volume rather than quality, [filler](/treatments/juvederm-fillers/) is the honest recommendation and you will hear it. **PRF is probably a good fit if:** - Your hair is thinning or your part is widening and you want to act while there is something to work with - The area under your eyes looks tired no matter how much you sleep - You want nothing synthetic put into your face - You would rather build a result over three months than chase a quick one - You have held off on injectables and want somewhere sensible to start **We will steer you somewhere else if:** - You have a blood or platelet disorder, or take medication affecting clotting - Your hair loss has a cause that needs treating first, which is what the consultation finds - What you have lost is volume rather than skin quality - The skin in the treatment area is infected or inflamed right now Not sure which of those you are? That is what the consultation is for, and it is why we do not sell this over the phone. Expect some swelling, tenderness and possibly a little bruising at the injection sites. Under the eyes, swelling is most noticeable for the first day or two and then settles. Scalp treatment can leave the area tender to the touch for a day. Nobody needs time off for this. **In the first day or two, do** - Keep the treated area clean and leave it alone - Sleep with your head slightly raised after under-eye treatment - Drink water and eat normally after the draw, the same as any blood test - Wear sunscreen once the skin is comfortable **In the first day or two, don't** - Rub, massage or press the treated area - Do heavy exercise, sit in a sauna or overheat - Wash your hair with anything harsh after scalp treatment - Expect to see anything yet Contact us right away about increasing pain, skin that turns white or dusky, any change in vision, or signs of infection. We would far rather hear from you. PRF works by giving your own tissue something to build with. Pick a concern to see how we approach it. PRF is priced per session and most plans are a short series rather than a single visit, spaced several weeks apart. Scalp plans and face plans are priced differently because they take different amounts of time and product. You get the whole course quoted at your consultation rather than one number that grows later. We do not discount our way into a treatment. If a cheaper option or a different one would serve you better, that is the one you will be offered. **Q: What is the difference between PRF and PRP?** How it is spun, and what that gets you. PRP is spun fast with an additive that keeps it liquid, so it releases everything at once. PRF is spun slower with nothing added, so it sets into a gel that stays put and feeds your tissue over several days. That slower release is the point, and it is why we use PRF. **Q: Does it really work for hair?** It has the best evidence of anything in this category. In a 2026 multicenter trial of women with pattern thinning, the fibrin group grew about a quarter more hairs in the treated area over six months, close to double the PRP group. [1] It works best while follicles are thinning rather than long gone, which is a good reason to come in sooner rather than later. **Q: Is anything synthetic added?** Nothing. Your blood, spun, returned. That is the whole ingredient list, and it is why allergic reactions are so rare. **Q: Does it hurt?** A blood draw, then injections. The scalp is more sensitive than the face. Numbing cream comes standard, and laughing gas is there if you would rather be somewhere else for ten minutes. **Q: How many visits, and how soon will I see it?** A series spaced six to eight weeks apart, with the real change showing at three to four months as your body builds new tissue. You get your plan, including how many, before you book the first one. **Q: Can I have it with filler?** Often the best results use both. Filler restores fullness and PRF improves the quality of the skin sitting over it, so the two do different jobs and work well together. It also sits alongside our other collagen-building options. Offered in San Luis Obispo. Not yet available in Santa Maria. 1. Li M, Bai Y, Ye Z, Zhang D, He Z, Ge Z, Tan A, Han Y, Chen A, Wang W, Zhuo F. "Comparative efficacy and safety of platelet-rich plasma (PRP), injectable platelet-rich fibrin (i-PRF) and concentrated growth factors (CGF) for female pattern hair loss (FPHL): a prospective multicenter randomized clinical trial." *The Journal of Dermatological Treatment.* 2026;37(1):2659498. Total hair count rose in all groups; i-PRF about 26.5% and CGF about 27%, against about 14.5% with PRP. The i-PRF group had the lowest adverse event rate. PMID 42041234. doi:10.1080/09546634.2026.2659498. https://pubmed.ncbi.nlm.nih.gov/42041234/ · Peer-Reviewed Randomized Trial 2. American Academy of Dermatology Association. "Hair loss: Diagnosis and treatment." Hair loss has multiple causes and treatment depends on which one is present, which is why diagnosis comes before treatment. [https://www.aad.org/public/diseases/hair-loss/treatment/diagnosis-treat](https://www.aad.org/public/diseases/hair-loss/treatment/diagnosis-treat) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice. Bruising, swelling, tenderness and temporary firmness at the injection sites are common and settle on their own; swelling is most noticeable under the eyes for the first day or two. As with any injection there is a small risk of infection, and any injectable placed in the face carries a rare risk of injury to a blood vessel. Contact us right away about increasing pain, skin that turns white or dusky, any change in vision, or signs of infection. PRF is not suitable for people with a blood or platelet disorder, people taking medication that affects clotting, or where the skin in the treatment area is infected or inflamed. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### Potenza® RF Microneedling Potenza rebuilds your skin from underneath. Ultrafine needles open microscopic channels and carry radiofrequency energy down to the layer where collagen actually lives, and your body answers by making more of it. Over the following weeks acne scars soften and shallow out, rough texture smooths, loose skin firms up, and fine lines fill in from below rather than being covered over. This is not a facial. A facial polishes the skin you already have and you look better that afternoon. Potenza changes the structure underneath, which is why it keeps improving for weeks after you leave and why the result stays. Nothing about it is preset. How deep the needles go, how much energy they carry and how many passes you get are chosen for your skin at your appointment. That is what lets it be used safely on every skin tone, and it is what lets it reach scarring that no cream, peel or facial will ever get to. **What Potenza is good at** - Softening pitted acne scars that have outlasted every product you have tried - Smoothing rough, uneven texture and enlarged-looking pores - Firming skin that has started to loosen along the jaw, neck and chest - Filling fine lines from underneath instead of covering them - Working safely on every skin tone, including deeper tones that rule out some lasers - Treating more than one of those in the same appointment, rather than one concern per visit We are one of the only providers in our area that uses groundbreaking Potenza® Fusion tip technology, which delivers a topical treatment into the channels while your skin is being tightened through soft tissue coagulation. Here is why that matters. Every serum you have ever bought has to fight its way through an intact skin barrier, and most of it never gets there. The Fusion tip puts the product in while the channels are still open, so it reaches the depth it was designed for instead of sitting on top and drying off. These are our own patients, photographed at our San Luis Obispo office and published with their consent. Individual results vary. There are more in the practice's private gallery, and we are happy to show you cases similar to yours at your consultation. ![MIddle age woman holding a cup of coffee in her living room](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-potenza-rf-microneedling.webp) The needle depth, the mode and the energy are not preset, and they are the whole treatment. Chosen well they soften a scar that has been there fifteen years. Chosen badly on the wrong skin, energy treatments leave dark marks instead of fixing them. Potenza can be used on every skin tone. That is not the same sentence as "at these settings, on your skin," and the second one takes a physician. You will also be told when something else is the better answer. Potenza is superb on scarring and texture and it is not a volume treatment, so if what is actually bothering you is a face that has emptied out, we will say so. A [chemical peel](/treatments/chemical-peels/) treats the surface layer Potenza passes straight through, and the two are often sequenced together rather than chosen between. **Potenza is probably a good fit if:** - You have acne scars, rough texture or enlarged-looking pores that have not budged with skincare - Your skin is starting to lose its firmness and you are not ready for anything surgical - You can take two to five days of looking flushed - You would rather build a result over three months than chase a quick one **We will steer you somewhere else if:** - You have active acne or broken skin in the area right now, which needs settling first - You have a condition or medication that slows healing - You have an implanted device that rules out radiofrequency - You have a tan, fresh or from a bottle, and it needs to fade first Not sure which of these you are? That is what the consultation is for, and it is the reason we do not sell this over the phone. For the first few days you will look like you caught too much sun. Expect redness, some swelling, a few pinpoint dots where the needles went, and skin that feels tight and dry. It settles on its own. Most people are comfortable in public by day three and fully back to normal within a week. **In the first week, do** - Wash with a gentle cleanser and keep moisturizer on - Wear sunscreen every day without exception - Follow whatever topical plan your provider sends you home with - Leave your skin alone while it heals **In the first week, don't** - Pick at anything that flakes or crusts - Go back to retinoids or acids until we clear you - Work out, sit in a sauna or overheat if we have told you to wait - Let healing skin see direct sun Call us about anything severe, worsening, or simply not what we described: significant pain, blistering, signs of infection, or any reaction that does not match what we discussed before your treatment. We would far rather hear from you. Potenza works on the layer where scars, laxity and lines actually sit. Pick a concern to see how we approach it. Potenza is priced per session, and what you pay depends on how much area is being treated and how many sessions your skin needs. Most people are planning a short course rather than a single visit, so we quote you the whole plan at your consultation rather than one number that changes later. We do not discount our way into a treatment. If a cheaper option would serve you better, that is the one you will be offered. **Q: How much downtime is there really?** Two to five days of looking flushed and a little swollen, closer to a strong sunburn than to a wound. Plan it around your week. Most people book it so the worst of it lands on a weekend. **Q: Does it hurt?** You will feel prickling and warmth. We numb you first, and we offer Nitronox® if procedures are hard for you. Nobody grits their teeth through this. **Q: How many sessions will I need?** Usually a short course rather than one visit, because each session adds another round of collagen. Your provider gives you the number after looking at your skin, and you will know it before you commit to anything. **Q: When will I actually see a result?** The redness is gone in days. The change you came for arrives over four to twelve weeks and keeps developing after that. Take a photo on day one, because the improvement is gradual enough that you will not notice it happening. **Q: Can I have it with darker skin?** Yes. Potenza is designed for every skin type, and RF microneedling is generally kinder to deeper skin tones than resurfacing lasers because it does not strip the surface. The settings still matter, which is why a dermatologist chooses them. **Q: How is this different from a HydraFacial?** A HydraFacial cleans and hydrates the surface, takes half an hour and has no recovery. Potenza works underneath and rebuilds. One is upkeep, the other is renovation, and plenty of people do both. 1. Cynosure Lutronic. Potenza RF microneedling system. Four treatment modes: monopolar or bipolar delivery at 1 MHz or 2 MHz; monopolar for deep heating across a wider area, bipolar for concentrated superficial delivery. https://www.dermatologytimes.com/view/cynosure-announces-launch-of-potenza-rf-microneedling-device · Manufacturer / Trade Press 2. Niaz G, Ajeebi Y, Alshamrani HM, Khalmurad M, Lee K. "Fractional Radiofrequency Microneedling as a Monotherapy in Acne Scar Management: A Systematic Review of Current Evidence." *Clinical, Cosmetic and Investigational Dermatology.* 2025;18:19-29. Sixteen studies, 481 patients. PMID 39781098. https://pubmed.ncbi.nlm.nih.gov/39781098/ · Peer-Reviewed Systematic Review 3. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization 4. U.S. Food and Drug Administration. 510(k) Premarket Notification K192545, Potenza, cleared 20 February 2020. [https://www.accessdata.fda.gov/cdrh_docs/pdf19/K192545.pdf](https://www.accessdata.fda.gov/cdrh_docs/pdf19/K192545.pdf) · Regulatory Content on this page is for educational purposes and is not a substitute for professional medical advice. Potenza® is a trademark of Cynosure Lutronic, Inc. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### Préime NanoTap™ Nano-Infusion Your skin's outermost layer exists to keep things out, and it is very good at it. That is the reason a serum can be excellent and still do almost nothing: the molecules that matter are simply too large to cross an intact surface. Nano-infusion changes the delivery rather than the product. Very fine, non-invasive tips tap the surface to open temporary micro-channels, and the actives go in through those channels while they are open. Nothing punctures the skin. The channels close on their own. **Benefits:** - Gets more out of the medical-grade products you are already using - No needles, no bleeding, no recovery, so it fits either side of a working day - Gentle enough for sensitive skin and for areas where needling is not appropriate - Immediately smoother, more even-looking skin - Pairs with a PDRN booster, which is a large molecule that needs the help The two get sold as though they were the same thing at different intensities. They are not, and being clear about it is the only way you can judge whether this is the right treatment for you. Nano-infusionMicroneedlingDoes it break the skinNo. The tips work at the surfaceYes. Needles pass into the skinWhat it is forGetting product in, and immediate surface smoothnessRebuilding structure underneathRegulated as a medical deviceNoYes. Cleared for specific uses [1]DowntimeNoneTwo to three daysWhat it will not doChange scarring or skin structureFix a poor product routine **Because it does not penetrate living skin, nano-infusion is not a medical device and it is not cleared to treat scars, wrinkles, or anything structural.** [1] Any page telling you a nano-needling facial builds collagen or removes acne scars is describing a different treatment. That is not a criticism of it. It is a very good version of what it actually is: a delivery treatment and a same-day skin-appearance treatment, with none of the recovery that structural work requires. If what you need is structural, [microneedling](/treatments/potenza-rf-microneedling/) is the honest answer and we will say so at [a consultation](/treatments/skin-care-consultations/). SituationWhy it works hereBefore an eventImmediate surface smoothness with nothing to recover fromSensitive or reactive skinNo puncture, so no inflammatory response to manageAround the eyesDelicate skin where needling depth is limited or inappropriateBetween deeper treatmentsKeeps skin in good condition without adding downtimeGetting more from good productsThe actives you already own, actually absorbed The device is the least interesting part of this treatment. What decides whether it does anything is what goes into the channels, and that is a clinical judgment about your skin rather than a menu choice. At Coastal, that judgment comes from a dermatology practice that also treats the conditions behind the concern. If your pigment is melasma rather than sun damage, the actives change, because treating melasma like sun damage makes melasma worse. If what you actually need is structural, we will tell you that instead of selling you a course of facials. **A good fit if:** - You want visibly better skin for an event and cannot take any downtime - Your skin is sensitive, reactive, or too thin for needling in the areas that bother you - You have invested in good products and suspect they are not getting anywhere - You want maintenance between deeper treatments **Worth a conversation first if:** - Acne scarring or genuine laxity is your main concern, because this will not address either - You have active infection, open breakouts or inflamed skin in the treatment area - You have been promised collagen building by another provider and want to know what is real Most people leave slightly flushed and are back to normal within an hour or two. Makeup the same day is fine. There is no aftercare regimen to follow. Skin is briefly more absorbent than usual, which is the point, so avoid applying anything harsh for the rest of the day and use sun protection as you would anyway. Adverse effects are uncommon and mild. Tell us if you have reacted to a skincare active before, since the treatment increases how much of it reaches your skin. Nano-infusion is used here for these concerns. Pick one to see how we approach it. Nano-infusion is priced per session, and the actives used are part of that price. Because the result is largely about what goes in, the plan is quoted against what you are trying to change rather than as a flat facial price. Most people use it as maintenance rather than as a course, so we will tell you honestly whether a package makes sense for you or whether occasional sessions are better value. **Q: Is this microneedling?** No. The tips do not puncture the skin. Microneedling passes needles into the skin to rebuild structure underneath, and it is regulated as a medical device for exactly that reason. [1] Nano-infusion works at the surface and is a delivery treatment. **Q: Will it build collagen or fix my acne scars?** No, and any page telling you it will is describing something else. If scarring or laxity is what you want changed, microneedling is the honest answer. **Q: Does it hurt?** No, and no numbing is needed. Most people describe it as light tapping. **Q: How soon can I wear makeup?** The same day. There is no recovery to work around. **Q: How often should I have it?** It is a maintenance treatment, so most people use it monthly or before something they want to look well for. There is no course you have to commit to. **Q: What actually goes in?** That depends on what you are treating, and it is chosen at the appointment. A PDRN booster is one option and is a good example of why delivery matters, since it is far too large a molecule to cross intact skin on its own. 1. U.S. Food and Drug Administration. "Microneedling Devices." On the distinction between products that penetrate living skin and are regulated as medical devices, and products that do not penetrate living skin and may only claim to facilitate exfoliation or improve the appearance of skin. [https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/microneedling-devices](https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/microneedling-devices) · Regulatory Content on this page is for educational purposes and is not a substitute for professional medical advice. Préime® and NanoTap® are registered trademarks of their owner. This is a cosmetic surface treatment. The device does not penetrate living skin, is not a medical device, and is not intended to diagnose, treat, cure or prevent any condition. Mild flushing that settles within an hour or two is expected. Irritation or a reaction to a product applied during the session is uncommon but possible. Tell us about any sensitivity or allergy to skincare ingredients, and tell us if you are pregnant so that product choice can be adjusted. This treatment is not suitable where there is an active infection, active inflammatory acne or broken skin in the area. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### RHA® Dermal Filler RHA filler replaces what has gone from the areas that move. Smile lines that used to appear only when you smiled and now stay put. Lines around the mouth that got there from thousands of everyday expressions rather than from age alone. Cheeks that have quietly flattened and taken the rest of the face down with them. What separates this family from the rest is how it behaves when you stop sitting still. RHA gels are made to stretch and recover, so the correction is there when your face is at rest and still there when you are mid-sentence. That is the whole reason the collection exists, and it is why its approved uses are written around dynamic wrinkles and folds rather than static ones. [1] You see the change the day you have it. Some of what you see on day one is swelling, so the honest answer is that you will know your real result at about two weeks, which is when we look at it again and decide whether anything more is needed. **What RHA is good at** - Softening smile lines and the folds from nose to mouth without freezing the expression that made them - Treating the lines around the mouth, the hardest area in the face to make look natural - Adding lip volume with a gel that still moves when you talk - Rebuilding cheek and midface support that has quietly flattened - Holding correction in areas that move constantly, where firmer fillers announce themselves - Being fully reversible, so nothing you decide today is permanent We carry more than one family of filler because no single gel is right everywhere on the face. Here is roughly how the decision goes. **RHA** is the answer where movement is the problem. Around the mouth, in the smile lines, in a lower face that creases constantly. Its whole design is about surviving expression. **[JUVÉDERM](/treatments/juvederm-fillers/)** covers a wider range of jobs, including areas that need firm structure and hold, like a jawline or a chin that needs projection. Different gels in that family behave very differently from one another. **[Belotero](/treatments/belotero-balance/)** is the softest of the three and goes shallowest, which is why it gets used on fine etched lines that a thicker gel would sit under and shadow. **[Sculptra](/treatments/sculptra/)** is not really the same category. It is not filling anything; it prompts your own collagen over several months, which suits broad hollowing rather than a specific line. If what is actually bothering you is muscle movement rather than lost volume, none of these is the answer and a [neuromodulator](/treatments/botox-cosmetic-xeomin/) is. We will say so. ![Smiling woman in a car](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-rha-dermal-filler.webp) The area around the mouth is the hardest region in the face to treat well. Everything there moves constantly, and a gel that is too firm for it announces itself the second you speak. That is the exact problem the RHA Collection was made for, and it is why its approvals are written around dynamic wrinkles rather than static ones. [1] Choosing the product is still the easy part. The hard part is deciding whether filler is the right answer at all. Some of what people bring us is muscle activity and needs a [neuromodulator](/treatments/botox-cosmetic-xeomin/). Some is surface texture and needs resurfacing. Some is skin that has genuinely loosened, and filler will make that heavier rather than better. We would rather tell you filler is the wrong tool than sell you a syringe of it, which is also why the consultation is a dermatologist's assessment and not a sales appointment. **RHA is probably a good fit if:** - Your smile lines or the lines around your mouth are what you notice first in photographs - You have had filler before that looked fine at rest and stiff when you talked - You want more in your lips without it being obvious that you did - Your cheeks have flattened and the rest of your face has followed - You want something you can undo if you change your mind **We will steer you somewhere else if:** - You have an infection or a breakout in the area right now, which needs to clear first - You have a relevant severe allergy, which we will go through with you - You are pregnant or breastfeeding, when we defer elective treatment - What is bothering you is loose skin or muscle movement, where filler is the wrong tool Not sure which of these you are? That is what the consultation is for, and it is the reason we do not quote a syringe count over the phone. Expect some swelling, possibly a bruise, and an area that feels firm or slightly uneven for the first week or so. Lips swell more than anywhere else and they swell fast, so if you have treated your lips, the first 48 hours are not the result. Most of it settles within a week and the rest by about two. **In the first week, do** - Follow the instructions your injector gives you, which are specific to what you had - Use a cool compress if we told you to - Sleep with your head slightly elevated for the first couple of nights - Come back for your follow-up, which is when we assess the real result **In the first week, don't** - Massage or press the area unless we specifically asked you to - Judge the result while you are still swollen, or chase a small asymmetry on day three - Book a facial, a peel or a laser in the same two weeks - Ignore anything that feels wrong, which is the one instruction that actually matters Call us about anything severe, worsening, or simply not what we described: significant or increasing pain, skin that changes color or goes pale or dusky, any change in your vision, or signs of infection. Do not wait to see whether it settles. We would far rather hear from you. RHA is chosen for areas that move, and for volume that needs to look like it belongs there. Pick a concern to see how we approach it. Filler is priced by the syringe, and how many you need depends on the area and how much correction you are after. Lips take less than a midface rebuild. We give you the number for your plan at your consultation, before you commit to anything, and we would rather stage a plan across two appointments than talk you into more product than you came for. We also do not treat off a promotional price. If a smaller correction is the right one, that is the one you will be offered. **Q: What makes RHA different from other hyaluronic acid fillers?** The way it is manufactured keeps the hyaluronic acid chains longer and less modified, which produces a gel that stretches and recovers more readily when the tissue around it moves. That is why the collection's approvals are written specifically around dynamic wrinkles and folds. In practice it means the correction is still there, and still looks like you, when your face is doing something. [1] **Q: Which RHA product would I have?** It follows the area. RHA Redensity is approved for moderate to severe dynamic perioral lines. RHA 2 and RHA 3 are approved for dynamic facial wrinkles and folds such as the nasolabial folds, and RHA 3 is also approved for lip augmentation. RHA Dynamic Volume, previously called RHA 4, covers those folds plus cheek augmentation and age-related midface contour deficiencies. All are for adults 22 and older. [1][2] **Q: How long will it last?** It depends on the product and, more than most people expect, on where it goes. A filler placed in the constantly moving area around the mouth breaks down faster than the same gel placed deep on a cheekbone. We give you the expected range for your specific treatment before you decide, rather than one number for the whole collection. **Q: Does it hurt?** Less than you are imagining. The RHA Collection comes in formulations containing a local anesthetic, so the area numbs as we work, and we numb the surface beforehand as well. That is routine for lips and for perioral work. **Q: Can it be dissolved?** Yes. RHA products are hyaluronic acid, and hyaluronic acid fillers can be dissolved by a qualified medical professional when that is the right call. The FDA notes that fillers not made from materials such as hyaluronic acid can be difficult or impossible to remove. [3] That reversibility is a real safety margin, and it is a large part of why hyaluronic acid is the default for most of the face. **Q: Is RHA better than JUVÉDERM?** Neither is better in the abstract, and any practice telling you otherwise is selling its inventory. They handle differently and they are approved for different jobs, so they are better at different things. The right question is which gel suits the layer, the movement and the correction in front of us, and that is a decision made with your face in the room. 1. The Teoxane RHA® Collection, Indications and Important Safety Information, Revance Aesthetics. Product-specific approved indications for RHA Redensity, RHA 2, RHA 3 and RHA Dynamic Volume in adults 22 or older. https://rha.revanceaesthetics.com/ · Regulatory / Prescribing Information 2. Revance and Teoxane. "FDA Approval of RHA® Dynamic Volume for Midface Contour Deficiencies," January 13, 2026. Approved for cheek augmentation and correction of age-related midface contour deficiencies in adults aged 22 years or older. [https://www.prnewswire.com/news-releases/revance-and-teoxane-announce-the-fda-approval-of-rha-dynamic-volume-for-midface-contour-deficiencies-302658756.html](https://www.prnewswire.com/news-releases/revance-and-teoxane-announce-the-fda-approval-of-rha-dynamic-volume-for-midface-contour-deficiencies-302658756.html) · Manufacturer Announcement 3. U.S. Food and Drug Administration. "Dermal Fillers (Soft Tissue Fillers)." Notes that filler effect duration depends on the material and the area injected, and that it may be difficult or impossible to remove filler material that is not made of materials such as hyaluronic acid. [https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/dermal-fillers-soft-tissue-fillers](https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/dermal-fillers-soft-tissue-fillers) · Regulatory Content on this page is for educational purposes and is not a substitute for professional medical advice. RHA® is a registered trademark of Teoxane SA. Individual results may vary. Common effects after filler include swelling, bruising, tenderness and temporary firmness or asymmetry. Serious complications are uncommon but can occur; call the practice immediately about increasing pain, skin color change or any change in vision. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### SculpSure® Body Contouring Almost everyone who books this has already put in the work. The diet changed, the exercise is real, and for a lot of people now a GLP-1 has done its part too. And there is still [a pocket that will not move](/conditions/stubborn-fat/): the lower belly, the sides, the back of the bra line, under the chin. Where your body stores fat is mostly down to your genes, and effort does not reliably change that. That last stubborn pocket is exactly what this is built for. Flat paddles are held against the area for about twenty five minutes. The laser passes through your skin and warms the fat underneath until those cells cannot survive, while the surface stays cool the entire time. Your body then clears them out over the following weeks, using the same drainage system it uses for anything else it no longer needs. The fat cells treated in that area are gone for good. What you do afterward keeps the shape you paid for, the same way it keeps any result. **What SculpSure is good at** - The lower belly pocket that survived every change you made - Love handles along the waist, which is the single most requested area - The roll at the back of the bra line, which almost nothing else reaches - Inner and outer thighs, where saddlebag fullness sits - Under the chin, where the applicator also affects the look of lax tissue - Fitting into a lunch break, because there is nothing to recover from This changes the shape of one area, and shape is something a tape measure and a camera can see clearly. Five minutes of setup before your first session and you will have proof of every bit of it. People who do this are the happiest patients we have. WhenWhat to doBefore your first sessionPhotograph the area from the front and the side, standing relaxed, in the same light and the same clothes. Put a tape measure around the widest point and write the number down. Weigh yourself once and then leave the scale alone.Weeks 1 to 5Nothing to do. Your body is still clearing the treated cells, so leave the tape measure in the drawer and let it work.Week 6First real check. Same photo, same light, same clothes, same tape measure, same spot. This is usually where people first notice their waistband.Week 12 after your last sessionThe real answer. Compare the photos side by side rather than trusting your memory of what you looked like.Any timeA pair of pants you already own is the honest instrument. The outcome is pants that feel a little looser and a belly that looks a little flatter, and most people notice it there first. [2] Do all of that and you will see the whole result rather than half of it. It takes five minutes and it is the single best thing you can do to enjoy what you bought. These are our own patients, photographed at our San Luis Obispo office and published with their consent. Individual results vary. There are more in the practice's private gallery, and we are happy to show you cases similar to yours at your consultation. ![](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-sculpsure-body-contouring.webp) The people who love this treatment have one thing in common: one specific pocket, on a body already close to where they want it. Working out whether that is you takes about five minutes at a consultation, and it is the most useful five minutes in the whole process, because it is what makes the difference between a good result and a fine one. The device's own FDA clearance is specific about who it is built for: non-invasive fat reduction on the body in people with a body mass index of 30 or less, and up to 49 for under the chin. [3] Almost nobody in this market publishes that, and knowing it up front is why our patients get the result the device was designed to give. **SculpSure is probably a good fit if:** - You are near a stable weight and have one defined pocket that has not responded to anything - Your body mass index is 30 or less, which is what the clearance covers for body areas [3] - You want to change a shape rather than a number - You cannot take time off, or do not want to - You are prepared to judge it at twelve weeks rather than twelve days **We will steer you somewhere else if:** - Weight loss is still the main goal, in which case there is a better order to do things in - What is bothering you is loose skin rather than fat. Loose skin is treated first, because fat reduction gives a better result afterward [2] - There is broken skin, an active skin problem or a recent surgery site in the area - You are pregnant or nursing Not sure which of these you are? That is exactly what the consultation is for, and five minutes there tells you more than an hour of reading will. Most people feel a bit tender, firm or full in the treated area for a few days, and occasionally for a couple of weeks. Some people feel nothing at all. There is no recovery to plan, no compression to wear and no activity to avoid. You can go back to the gym that afternoon if you want to. **Afterward, do** - Carry on with your normal routine, workouts included - Drink water and keep moving, because your body is clearing the treated cells - Massage the area gently if it feels firm, which some people find helps - Give it the full twelve weeks before you decide what you think **Afterward, don't** - Weigh yourself looking for an answer, because the scale does not measure shape - Panic if the area feels lumpy or firm for a while, which is normal and settles - Book a second session on the same area before six weeks, because you cannot yet see what the first one did - Change your diet drastically at the same time, because then you will never know what worked Call us about anything severe, worsening or surprising: real pain, a burn, a firm lump that is not settling, or any reaction that does not match what we described. We would far rather hear from you early. One pocket at a time, on somebody already close to the shape they want. Pick a concern to see how we approach it. SculpSure is priced by the area and by how many sessions that area needs, and most people need more than one to get where they want to be. Flanks are usually treated as a pair, so they are quoted as a pair. You get the cost of the whole plan at your consultation rather than a per-session number that quietly multiplies. If a different treatment would get you closer to what you actually want, that is the one you will be offered. We would rather send you to the right thing than sell you the nearest thing. **Q: Is this a substitute for losing weight?** No, and it works best when it is not asked to be. This targets the fat in one specific pocket, which is why it suits people who are already near the shape they want and have one area that never responded. If weight loss is still the main goal, we will tell you what order to do things in. **Q: Does it hurt?** Most people describe cycles of deep warmth with cooling in between. It is comfortable enough that people read or answer email through it, and we turn it down if it gets too warm. **Q: How long until I see something?** Around six weeks for the first real difference, and about twelve weeks after your last session for the full one. [1] Nothing looks different in the first couple of weeks, which is exactly what should happen. **Q: How many sessions will I need?** Most people need more than one on a given area, and the number depends on the area and how much there is. You get that number after your skin and the pocket have actually been looked at, not over the phone. **Q: Is it permanent?** The treated fat cells are gone for good. Your body does not grow them back. Holding the shape from there is down to what you do afterward, the same as any result. **Q: Is this liposuction?** No. Liposuction is surgery, takes away considerably more in one procedure, and comes with anesthetic and a real recovery. This does not break the skin, takes away less, works gradually, and has no downtime. Different treatments for different situations, and we will say which one you are. 1. Cynosure Lutronic. "SculpSure body contouring." Manufacturer's US product page. States 25 minutes per treatment, that "studies have shown up to 24% of fat cells can be destroyed in the treated area," that most patients require a series of treatments, results as early as six weeks and optimal results usually seen 12 weeks after the final treatment, and describes SculpSure as "the world's first FDA-cleared **laser** device for non-invasive lipolysis of the abdomen, flanks, back, inner thighs, outer thighs and submental area." [https://www.cynosure.com/product/sculpsure/](https://www.cynosure.com/product/sculpsure/) · Manufacturer 2. American Academy of Dermatology Association. "Non-invasive fat removal: What can you expect?" States that good candidates "have a small bulge of fat that remains despite diet and exercise and their weight falls within the normal range for their height," that results are subtle, that "your pants will feel a little looser or your belly a little flatter," that most people see the full effect between 3 and 6 months after the last treatment, and that where there is also loose skin "your dermatologist may recommend treating this first." [https://www.aad.org/public/cosmetic/fat-removal/non-invasive-what-to-expect](https://www.aad.org/public/cosmetic/fat-removal/non-invasive-what-to-expect) · Medical Organization 3. U.S. Food and Drug Administration. 510(k) Premarket Notification K182741, SculpSure, Cynosure, Inc., cleared 3 January 2019. "Intended for non-invasive lipolysis of the abdomen, flanks, back, and thighs in individuals with a Body Mass Index (BMI) of 30 or less. In addition, the device is intended for non-invasive lipolysis of the submental area in individuals with a BMI of 49 or less... When using the petite mask for non-invasive lipolysis of the submental area, the device can also affect the appearance of lax tissue in the submental area." [https://www.accessdata.fda.gov/cdrh_docs/pdf18/K182741.pdf](https://www.accessdata.fda.gov/cdrh_docs/pdf18/K182741.pdf) · Regulatory Content on this page is for educational purposes and is not a substitute for professional medical advice. SculpSure® is a registered trademark of Cynosure Lutronic, Inc. Tenderness, firmness, mild swelling or a full feeling in the treated area are common and can last from a few days up to a couple of weeks. Firm lumps under the skin and burns are uncommon but possible. This treatment is not suitable during pregnancy, or where there is an active skin problem, broken skin or a recent surgery site in the area. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### Sculptra® There is a kind of aging that has nothing to do with lines. The face has not wrinkled so much as emptied. The cheeks have flattened, the temples have gone in, the light no longer catches where it used to, and the whole thing reads as tired rather than as older. Filling one spot does not fix that, because nothing in particular is wrong. Everything is a little less. Sculptra addresses it differently from everything else we inject. It is not a filler and it does not occupy space. It is poly-L-lactic acid, and what it does is set off the process by which your own skin builds collagen. Over the following months your face rebuilds its own support, so the volume you end up with is tissue you grew rather than gel someone placed. That is also why it looks the way it does. Nobody can point at what you had done, because there is no discrete thing to point at. Your face has simply come back up. The trade is patience: this treatment does not reward anyone who wants to look different by Friday. **What Sculptra is good at** - Broad, diffuse flattening across the cheeks and midface, where a single syringe of filler would look like a single syringe of filler - Temples that have hollowed and made the whole upper face read as drawn - Restoring support under the smile lines and marionette lines rather than filling the crease itself - A change nobody can identify, which is what most people actually want and rarely ask for - Results that held for up to 25 months after the last session for some people in the trial [3] - Building your own tissue rather than adding a product to it Sculptra rewards patience more than any other treatment we offer, and knowing the timeline in advance is what makes it so satisfying. Here is exactly how it unfolds. **The day of.** You look fuller leaving than you did arriving. Enjoy it, and do not get attached to it, because it is fluid from the injection and it is not your result. **Week one.** That fullness goes and your face looks the way it did before you came in. This is the part nobody prepares people for, and it is completely normal. Nothing has failed. **Weeks two to six.** Not much visible. Underneath, the process that builds collagen is running. This is where the treatment is actually working and where it looks like it is not. **Month two onward.** The change starts arriving, and it arrives slowly enough that you will notice it in photographs before you notice it in the mirror. Take a picture on day one. You will want it. **Month three to six.** The result you came for, built out across however many sessions your plan called for. This is where it gets judged, and where the people around you start saying you look well. Your sessions sit inside that: typically three of them, three to four weeks apart, so the injecting is done inside the first couple of months and the rest of the timeline is your own tissue doing the work. [3] Here is the thing about Sculptra that determines who should be injecting it. Hyaluronic acid filler can be dissolved. Poly-L-lactic acid cannot. There is no enzyme for it. Whatever goes in is going to run its course, which means the decisions made at your appointment about how much and where are decisions you live with rather than decisions you revise. That is why we treat conservatively and build across a series rather than aiming for the whole correction in one sitting, and why candidacy gets assessed properly before anyone picks up a syringe. It is also why we will tell you when Sculptra is the wrong answer. It is superb at broad [facial volume loss](/conditions/facial-volume-loss/) and early [sagging skin](/conditions/sagging-skin/), and it is genuinely poor at chasing one specific line, which a [hyaluronic acid filler](/treatments/juvederm-fillers/) does better in a single visit. If you want a result before an event next month, this is not your treatment and we would rather say so now than take your deposit. **Sculptra is probably a good fit if:** - Your face has flattened generally rather than developed one hollow you can point at - You want a change nobody can identify as a treatment - You are willing to wait several months for the result and to come back for the sessions - Your temples or cheeks have gone in and made you look tired regardless of how you feel - You would rather build your own tissue than top up a gel every year **We will steer you somewhere else if:** - You want to look different for something happening in the next few weeks - What you have is one defined line or one specific hollow, where filler does it better - You have an infection or an active breakout in the area, which needs to clear first - You are pregnant or breastfeeding, when we defer elective treatment - Your medical history makes you a poor candidate, which is part of the labeled indication and something we go through properly Not sure which of these you are? That is the consultation, and it is a dermatologist's assessment rather than a sales appointment. Expect some swelling, possibly a bruise, and tenderness at the injection sites for a few days. You may be able to feel a little firmness under the skin early on, which is normal and settles. The main thing to expect is what does not happen: the fullness you leave with goes away, and the real change has not started yet. **In the first weeks, do** - Follow the massage instructions you are given, exactly and for as long as we say - Come to your planned sessions, because the series is the treatment - Keep your usual skin care and sun protection going - Tell us about any firmness or lump you can feel, promptly rather than at your next visit **In the first weeks, don't** - Treat the immediate fullness as your result, or panic when it goes - Massage differently from the way you were shown, or skip it because you forgot - Judge the treatment at two weeks, or at six - Assume this can be dissolved like a hyaluronic acid filler, because it cannot Call us about anything severe, worsening, or simply not what we described: significant pain, blistering, signs of infection, any change in vision, or any reaction that does not match what we discussed. We would far rather hear from you. Sculptra is the answer when the problem is everywhere and nowhere in particular. Pick a concern to see how we approach it. Sculptra is priced per vial, and what you pay depends on how much volume has been lost and how many sessions your plan calls for. Because this is a course rather than a visit, we quote you the whole plan at your consultation instead of one number that grows later. We stage your plan across sessions with less product in each, building gradually to the result rather than rushing it. With a collagen stimulator, that measured approach is exactly what produces the natural look people come here for. **Q: Is Sculptra a filler?** Not in the usual sense. A hyaluronic acid filler occupies space the moment it goes in. Sculptra is poly-L-lactic acid, usually shortened to PLLA, and it prompts your own collagen production instead. The volume you end up with is tissue you built, which is why it arrives gradually and why it behaves differently as it goes. **Q: When will I see results?** Weeks to months, not days. There is a whole section above on what the timeline actually looks like, and it is worth reading before you book. The short version: the fullness on day one is fluid, the real change starts around month two, and you judge it at three to six months. **Q: How many sessions will I need?** Galderma's own patient guidance is one to four sessions, typically three, scheduled three to four weeks apart. That is the real range and we would rather you had it before you walk in than after. Where you land inside it depends on how much volume has gone and how you respond to the first session, and we set your spacing from that rather than from a calendar. You get your number at consultation, before you commit to anything. [3] **Q: Can it be reversed?** No. There is no enzyme for poly-L-lactic acid the way there is for hyaluronic acid. That is the single most important practical difference between this and the fillers, and it is why we dose conservatively and build up across sessions rather than aiming for the full correction at once. **Q: What is it approved for?** Sculptra is indicated for use in people with healthy immune systems for correction of shallow to deep nasolabial fold contour deficiencies, fine lines and wrinkles in the cheek region, and other facial wrinkles. The immune-system wording is part of the labeled indication, which is why your medical history is a real part of candidacy here rather than a formality. [1][2] **Q: What about lumps?** Firmness you can feel is the thing people ask about most. The risk is reduced by correct dilution, correct depth, even distribution and conservative dosing, which is most of what technique means with this product, and by following the massage instructions you are given. Tell us promptly about anything you can feel rather than waiting for your next appointment. Early is easier. 1. Galderma. "Galderma Receives FDA Approval for Sculptra® for Cheek Wrinkles," April 26, 2023. Sculptra (injectable poly-L-lactic acid) is indicated for use in people with healthy immune systems for the correction of shallow to deep nasolabial fold contour deficiencies, fine lines and wrinkles in the cheek region, and other facial wrinkles. [https://www.galderma.com/news/galderma-receives-fda-approval-sculptrar-cheek-wrinkles-0](https://www.galderma.com/news/galderma-receives-fda-approval-sculptrar-cheek-wrinkles-0) · Manufacturer Announcement 2. U.S. Food and Drug Administration. "Dermal Fillers (Soft Tissue Fillers)." Approved uses, risks and potential complications of injectable dermal fillers, including products that work by stimulating collagen production. [https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/dermal-fillers-soft-tissue-fillers](https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/dermal-fillers-soft-tissue-fillers) · Regulatory 3. Galderma. *Patient's Guide to Treatment with SCULPTRA®.* Manufacturer patient brochure. States that a treatment regimen consists of up to four injection sessions scheduled three to four weeks apart, that one to four sessions may be needed and typically three, and that in a U.S. clinical study results for some subjects lasted up to 25 months after the last treatment session. [https://www.galderma.com/us/sites/default/files/2021-12/Patient_Brochure_Sculptra_US_1.pdf](https://www.galderma.com/us/sites/default/files/2021-12/Patient_Brochure_Sculptra_US_1.pdf) · Manufacturer Patient Information Content on this page is for educational purposes and is not a substitute for professional medical advice. Sculptra® is a registered trademark of Galderma. Individual results may vary. Common effects after treatment include swelling, bruising, tenderness and temporary firmness that can be felt under the skin. Delayed nodules are uncommon but possible. Poly-L-lactic acid cannot be dissolved. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### Skin Cancer Diagnosis A full skin exam is exactly what it sounds like: a board-certified dermatologist looks over your skin, systematically, including the places you cannot easily see yourself. The scalp, behind the ears, the back, between the toes. It takes about ten minutes, there is nothing to prepare, and there is no downtime because nothing is done to you. What the dermatologist is looking for is the pattern rather than the spot. Most people have moles, marks and growths, and the overwhelming majority are harmless. What matters is which ones look different from the rest of yours, and that comparison is what training and a dermatoscope are for. [Rough, scaly patches](/conditions/actinic-keratosis/) get noted at the same time, since those are precancerous and easy to treat early. If a spot needs a definite answer, the answer comes from a laboratory rather than from an opinion. A small sample is taken under local anesthetic, usually at the same appointment, and sent for examination under a microscope. That is what a biopsy is, and it is a short and ordinary part of the day. **What the appointment covers** - A full skin check, including the areas you cannot see yourself - A mole that has changed in size, shape or color - A spot that itches, bleeds, or has not healed - Precancerous patches, which can be treated before they become anything - A biopsy at the same visit where one is needed, rather than a second appointment You see your own skin every day and a dermatologist sees it twice a year at most, which makes you the most useful person in this process. Five letters describe what is worth a closer look, and they are easy to remember once you have read them once. [1] What it meansA for Asymmetry"One half of the spot is unlike the other half."B for Border"The spot has an irregular, scalloped, or poorly defined border."C for Color"The spot has varying colors from one area to the next, such as shades of tan, brown or black, or areas of white, red, or blue."D for Diameter"While melanomas are usually greater than 6 millimeters, or about the size of a pencil eraser, when diagnosed, they can be smaller."E for Evolving"The spot looks different from the rest or is changing in size, shape, or color." Make an appointment if you notice any new spots on your skin, spots that are different from the others, or spots that are changing, itching or bleeding. [1] A good habit is a proper look at your own skin every month or so, in a well-lit room with a hand mirror for your back, and a photograph of anything you want to compare later. None of this is a substitute for the exam, and it is not a test you can fail. It is simply how the two of you cover more ground together. ![Man's back being checked for skin cancer](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-skin-cancer-diagnosis.webp) Anyone can look at a mole. What takes training is knowing how that mole compares to the several dozen others on your body, which ones have changed since last year, and which of the harmless-looking ones is worth a closer look. That judgment is what a board-certified dermatologist brings, and it is the whole value of the appointment. It also means the answer does not stop at the exam. If something needs a definite answer, the biopsy happens here, usually the same day. If a result comes back needing treatment, [what happens next](/treatments/cancer-surgery-mohs-referrals/) is planned by the same practice, including coordinating a Mohs surgeon where that is the better route. You are not handed a phone number and left to organize it. **Worth booking an appointment if:** - You have noticed a new spot, or one that looks different from the rest of yours - A spot is changing in size, shape or color, or is itching or bleeding [1] - Something has not healed after a few weeks - You have never had a full skin exam and have spent years in Central Coast sun - You have had a skin cancer before, or someone in your family has **Also worth knowing:** - How often you should be checked depends on your own risk, and your dermatologist will tell you what interval suits you [2] - You can bring a list, or photographs on your phone, of anything you have been watching - If you can, come without makeup and without nail polish, so your face and nails can be seen properly If you are not sure whether something is worth an appointment, book it. That is precisely what the ten minutes is for. A skin exam on its own needs no aftercare at all, because nothing has been done to your skin. Where a biopsy has been taken, expect a small wound with a dressing over it, a little tenderness for a day or two, and healing over one to two weeks depending on the size and site. **In the first week, do** - Keep the site clean and covered, following the instructions you are given - Use the ointment we send you home with - Let any scab come away on its own - Wear broad-spectrum sunscreen, SPF 30 or higher, over the healed area [3] **In the first week, don't** - Soak the site in a bath, pool or hot tub until it has healed - Pick at the dressing or the scab - Skip your result call, or assume that no news is good news Call us about anything that does not match what we described: spreading redness, increasing pain, bleeding that does not settle, or any sign of infection. We would far rather hear from you early. Moles, growths and sun-damaged skin, examined properly. Pick a concern to see how we approach it. A skin examination and any biopsy taken from it are medical care rather than a cosmetic service, and they are handled differently from the aesthetic treatments on this site. Our office will go through what applies to you when you book. Laboratory fees for a biopsy are billed separately by the laboratory that examines the sample, and we will tell you when a sample is being sent. **Q: How often should I have a skin check?** It depends on your own risk: your history, your family history, how much sun you have had and how many moles you have. The interval for a full-body exam is set by those risk factors rather than by a single rule. [2] Your dermatologist will tell you what suits you at your first visit. **Q: What actually happens at the appointment?** You change into a gown, and a dermatologist works through your skin methodically, head to toe, using a dermatoscope for a closer look at anything worth it. It takes about ten minutes. Nothing is done to your skin unless something needs a sample taken. **Q: Does a biopsy hurt?** The area is numbed first, so you feel the anesthetic going in and pressure after that. It takes a few minutes and leaves a small wound that heals over one to two weeks. **Q: How long do results take?** Pathology timing varies by laboratory. We will tell you what to expect when the sample is sent, and we call you with the result either way rather than only if there is something to report. **Q: What should I be looking for myself?** The ABCDEs above are the short version, and the simplest rule underneath them is that anything new, changing, itching or bleeding is worth an appointment. [1] **Q: Do I need a referral?** Yes. Skin cancer diagnosis is medical dermatology, and the practice is currently accepting new medical patients by referral from your primary care physician. Once you have that, call the office and we will get you in. 1. American Academy of Dermatology Association. "What to look for: ABCDEs of melanoma." Sets out Asymmetry, Border, Color, Diameter and Evolving as quoted, advises consulting a dermatologist immediately where a mole shows these features, and recommends an appointment for "any new spots on your skin, spots that are different from others, or spots that are changing, itching or bleeding." [https://www.aad.org/public/diseases/skin-cancer/find/at-risk/abcdes](https://www.aad.org/public/diseases/skin-cancer/find/at-risk/abcdes) · Medical Organization 2. American Academy of Dermatology Association. "How to check your skin for skin cancer." States that "found early and properly treated, skin cancer is highly treatable," that performing skin self-exams "can be lifesaving," that anyone who finds "a spot on your skin that's growing, bleeding, or changing" should see a board-certified dermatologist, and that the frequency of full-body skin exams by a dermatologist is determined by individual risk factors. [https://www.aad.org/public/diseases/skin-cancer/find/know-how](https://www.aad.org/public/diseases/skin-cancer/find/know-how) · Medical Organization 3. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. A skin examination is not a guarantee that a skin cancer will be found, and any spot that changes between appointments should be reported rather than waited on. Where a biopsy is taken, tenderness, a small wound and a scar at the site are expected. Bleeding, infection and delayed healing are uncommon but possible. Tell us about any bleeding disorder, any blood-thinning medication, and any history of thick or raised scars. Individual results may vary. ### Skin Cancer Surgery & Mohs Referrals [The biopsy that confirmed it](/treatments/skin-cancer-diagnosis/) also told us a great deal: what type of cancer it is, how it behaves, and how it sits in the skin. That is what decides the treatment, along with how large it is and where on the body it is. There is no single answer, and the plan is explained to you before anything is scheduled. Many basal cell and squamous cell cancers are treated here, surgically, under local anesthetic. The cancer is removed along with a margin of healthy skin around it, the wound is closed, and the tissue that came out is examined to confirm the cancer was fully removed. It is a same-day appointment and you go home afterward. Some cancers are better treated by Mohs micrographic surgery, in which the surgeon removes a thin layer at a time and checks each one under a microscope during the appointment, continuing until no cancer cells remain. [1] It preserves more healthy skin and has a high cure rate, and it is usually the choice for cancers that are large or aggressive, that sit on the eyelid, nose or ear, or that have come back after earlier treatment. [1] We do not perform Mohs here. We identify when it is the right call and coordinate the referral. **What this covers** - Surgical removal of appropriate basal cell and squamous cell cancers, in office - Assessment of whether Mohs micrographic surgery is the better route - Coordinating the referral to a Mohs surgeon, and staying involved afterward - Treatment of precancerous patches found along the way - Ongoing skin surveillance once treatment is finished Plenty of practices treat everything they can in house. We would rather you had the operation that suits the cancer, and sometimes that means sending you to somebody else. Here is how that decision is actually made. In-office excisionMohs micrographic surgeryHow it worksThe cancer is removed with a margin around it, and the tissue is checked afterwardThin layers are removed and checked under a microscope during the appointment, until none remain [1]AppointmentOne visit, usually under an hourLonger, with waiting between layers while the tissue is examined [1]Healthy skinA standard margin is takenThe least amount of skin needed, which matters most on a face [1]Usually chosen forCancers on the trunk and limbs where a margin is easily sparedCancers that are large or aggressive, on the eyelid, nose or ear, or that have returned [1]Who performs itYour dermatologist, hereA fellowship-trained Mohs surgeon, most of whom are dermatologists [1] The referral is not a handoff. We arrange it, send the pathology across, and pick your care back up afterward, including the skin checks that follow. **The right operation matters more than where it happens**, and on a face that difference is measured in millimeters of skin you get to keep. ![Happy, healthy older man](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-cancer-surgery-mohs-referrals.webp) The decision that matters here is not how the surgery is done, it is which surgery you have. A practice that treats everything in house has an interest in one answer. We do not perform Mohs, which means the recommendation you get is based on the pathology in front of us rather than on what we happen to offer. It also means you are not left to organize it. We make the referral, send the pathology and imaging across, and take your care back once the site has healed, including the skin checks that follow for years afterward. Having had one skin cancer changes what a future check is looking for, and continuity is worth a great deal at that point. **You will leave the planning appointment knowing:** - What type of skin cancer it is, and what that means in ordinary language - Whether it is treated here or with a Mohs surgeon, and why that call was made - What the appointment itself involves and how long it takes - What the site is likely to look like while it heals, and afterward - What the follow-up schedule looks like **Worth telling us before surgery:** - Any blood-thinning medication you take, including aspirin - Any bleeding disorder - Any history of thick or raised scars - Any pacemaker or implanted device, which affects some instruments - Anything you are taking, including supplements bought without a prescription None of this needs sorting out in advance of booking. Bring it to the appointment and it will be worked through with you. Expect the site to be tender for several days, and remember that a healing wound looks nothing like the settled result. You will go home with a dressing, written instructions and a number to call. Stitches come out at 7 to 14 days depending on the site. **While it heals, do** - Follow the wound care instructions exactly, in the order you were given them - Keep the dressing dry and in place until you are told otherwise - Take it easy with anything that stretches the area, which is what keeps a scar narrow - Keep the healed site covered or under broad-spectrum sunscreen, SPF 30 or higher [2] - Keep your follow-up and your future skin checks **While it heals, don't** - Soak the site in a bath, pool or hot tub - Pick at a scab or pull at a stitch - Restart a blood thinner without being told to - Assume a change at the site months later is nothing, because it is worth a look Call us about anything that does not match what we described: bleeding that does not settle with pressure, increasing pain, spreading redness, or any sign of infection. We would far rather hear from you early, and there is always somebody to talk to. Confirmed skin cancers and the precancerous changes around them. Pick a concern to see how we approach it. Skin cancer surgery is medical care rather than a cosmetic service and is handled differently from the aesthetic treatments on this site. Our office will go through what applies to you before anything is scheduled. Where you are referred to a Mohs surgeon, that surgeon's practice handles its own side of it, and we will tell you what to expect before the referral is made rather than afterward. **Q: Will I be awake?** Yes. In-office skin cancer surgery is done under local anesthetic. The area is numbed, you feel pressure rather than pain, and you go home the same day. **Q: What is Mohs surgery, in plain language?** The surgeon removes a thin layer, examines it under a microscope while you wait, and repeats that until no cancer cells remain. [1] Because the cancer is mapped as it goes, the least possible amount of healthy skin is removed, which is why it is favored on faces. [1] **Q: Why do you refer Mohs out instead of doing it here?** Because Mohs is a distinct specialty with its own fellowship training, and it should be done by somebody who does it constantly. [1] We identify when it is the right operation and coordinate the referral, and your care comes back to us afterward. **Q: Will there be a scar?** Any surgery on skin leaves a mark. How noticeable it ends up depends on the size, the site and how the wound is closed, and you will get a realistic picture of that at your planning appointment rather than afterward. Mohs generally allows a smaller wound on the face because less healthy skin is taken. [1] **Q: What happens after treatment?** Ongoing skin checks. Having had one skin cancer is the strongest reason there is to keep being checked, and your dermatologist will set the interval that fits your history. **Q: Do I need a referral?** Yes. This is medical dermatology, and the practice is currently accepting new medical patients by referral from your primary care physician. If a biopsy done elsewhere has confirmed a skin cancer, tell us when you call and bring the pathology report. 1. American Academy of Dermatology Association. "What is Mohs surgery?" States that "during surgery, the surgeon can see where the cancer stops," describes the layer-by-layer removal and microscopic examination until no cancer cells are found, states that "Mohs has a high cure rate," that it allows the surgeon to "remove the least amount of skin needed," that it is recommended for basal cell or squamous cell carcinoma that is "aggressive or large," located on the eyelid, nose or ear, or that has recurred, and that "most Mohs surgeons are dermatologists who have completed extensive training in Mohs surgery." [https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma/mohs-surgery](https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma/mohs-surgery) · Medical Organization 2. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Treatment for a skin cancer depends on its type, size, location and pathology, and the approach described here may not apply to your case. Surgery on skin leaves a scar. Tenderness, swelling, bruising and a healing wound are expected. Bleeding, infection, delayed healing, thickened scarring and changes in sensation at the site are uncommon but possible, and a skin cancer can recur and require further treatment. Tell us about any blood-thinning medication, bleeding disorder, implanted device or history of thick or raised scars. Ongoing skin surveillance is recommended after treatment. Individual results may vary. ### Skin Care Consultations Most people arrive having read a lot and decided very little. They know the names of four treatments, they have seen contradictory things about all of them, and what they actually want is someone qualified to look at their face and say which one is the answer. That is the whole appointment. Thirty minutes, a real look at your skin, and a straight ranking: this first, then this, and this one you have been reading about is not going to do what you want. You get told what it costs before anything is booked, including how many sessions it realistically takes, so the number does not move later. Nothing gets sold in this room. Sometimes the answer is a treatment. Sometimes it is [skin care products](/treatments/skin-care-products/) and nothing else. Sometimes it is that the thing bothering you is medical rather than cosmetic and belongs in a different kind of appointment. All three of those are a good outcome for thirty minutes. **What you get out of it** - A dermatology provider's read on what is actually happening with your skin - A ranked plan rather than a menu, so you know what to do first - Honest limits: what a treatment will not do, before you have paid for it - A realistic session count and a cost estimate up front - The fee credited back toward whatever you go ahead with - A clear answer on whether what you have is cosmetic or medical This trips people up constantly, and booking the wrong one costs you a visit. Here is the difference in plain terms. What is going onThe appointmentReferralCostYou want to look less tired, softer lines, better skin quality, fewer brown spotsCosmetic consultationNot neededConsultation fee, credited toward treatmentA mole that has changed, a rash, acne that needs prescriptions, a growth you want checkedMedical dermatology visitThe practice is currently accepting new medical patients by referralBilled to your insurance, subject to your planHair loss or melasma, which can be eitherStart with a cosmetic consultationNot neededSame as aboveYou are not sure which one you haveCall us and describe itWe will tell you before you bookNothing to find out The short version: if the goal is how your skin looks, book the cosmetic consultation. If the goal is a diagnosis or a prescription, that is a medical visit and it runs through your insurance. If you genuinely do not know, call the office and describe it. Sorting that out on the phone takes two minutes and saves you a wasted appointment. A free consultation has to be paid for somehow, and it is usually paid for by what you get talked into during it. Ours is not free, and that is deliberate. It buys you thirty minutes of a board-certified dermatology practice's opinion with nothing riding on the answer. Which means you get the parts that lose us money. That a treatment you have read about will not do what you want. That your budget is better spent on products than on a device. That what is actually bothering you is medical, and belongs in a different appointment on your insurance rather than on our price list. Those are normal outcomes here, not failed appointments, and they are the reason people send their friends. **Book a consultation if:** - Something bothers you when you look in the mirror and you cannot name the treatment for it - You have shortlisted two or three treatments and want to know which one is right - You have been quoted elsewhere and want a dermatology practice's read before committing - You want to know the real cost and session count before you start, not after - You are not sure whether what you have is cosmetic or medical **Book something else if:** - You have a mole or growth that has changed, which is a medical visit and should be soon - You need a prescription refilled or a diagnosis, which insurance covers and this does not - You already know exactly what you want and have had it here before, in which case just book it Not sure which of those you are? Call the office and describe it. We will tell you which appointment you need before you pay for one. Nothing invasive happens at a consultation, so there is nothing to recover from. A little preparation makes the thirty minutes go a lot further. **Do** - Come with no makeup, or expect to take it off, because we need to see your skin - Bring the products you currently use, or photograph the labels - Bring your medication and supplement list, including anything over the counter - Bring photos of yourself from a few years ago if the change has been gradual - Write down what actually bothers you before you arrive **Don't** - Come straight from a beach day, because a fresh tan changes what we can recommend - Arrive expecting a treatment on the same day, though sometimes it is possible - Leave out a medication or supplement because it seemed irrelevant - Feel obliged to book anything the same day A consultation is an assessment. It does not commit you to a treatment and it does not guarantee that a particular treatment will be recommended. The cosmetic consultation is $125, paid when you book. It is credited toward your treatment, so if you go ahead with anything, you have effectively paid nothing for the assessment. What you get for it is a cost estimate on everything discussed, including how many sessions it realistically takes, before anything is scheduled. We do not quote a per-session price for a treatment that needs six of them. Medical dermatology visits are different and are billed through your insurance rather than at this fee. The comparison above explains which one you need. **Q: Do I need a referral?** Not for a cosmetic consultation. Book it yourself. Medical dermatology visits run differently and the practice is currently accepting new medical patients by referral, so if what you have is a rash, a growth or something that needs a prescription, ask about that when you call. **Q: Is the consultation fee on top of the treatment?** No. It is credited toward whatever you go ahead with. Pay it at booking, and it comes off your treatment cost. **Q: Will you try to sell me something?** No. Plenty of consultations here end with products and no procedure, or with us telling you the thing you came in for is not the right call. That is a normal outcome, not a failed appointment. **Q: What if I do not know what I want?** That is the most common reason people book. Describe what bothers you when you look in the mirror and we will work backward from there. Naming the treatment is our job. **Q: Can I have treatment on the same day?** Sometimes, depending on what it is and how the schedule looks. Ask when you book if that is what you are hoping for, and we will tell you whether it is realistic. **Q: Which office should I go to?** San Luis Obispo offers the full range. Santa Maria offers neuromodulators, fillers and dermatology consultations. If what you want is only available in San Luis Obispo we will tell you before you drive. Content on this page is for educational purposes and is not a substitute for professional medical advice. The $125 consultation fee, the thirty-minute length and the credit toward treatment are current practice policy and are subject to change. Referral requirements differ between cosmetic and medical dermatology visits, and coverage for a medical visit depends on your insurance. A consultation is an assessment and does not guarantee that any particular treatment will be recommended or that any particular result can be achieved. Individual results may vary. ### Skin Care Products A regimen is the only part of your skin care that works every single day. A peel is one afternoon. A laser is one appointment. The products you put on morning and night are touching your skin twice a day for the rest of the year, which is why the wrong ones do so much damage and the right ones do so much quietly. What we build is short. Cleanse, protect, and two or three actives chosen for the thing you actually want fixed, whether that is pigment that keeps coming back, acne that never fully clears, or skin that has thinned and roughened from twenty summers on this coast. Actives get introduced at a pace your skin can take, in an order that matters, because most people who quit retinol quit it in week two after using too much of it. The lines we carry are sold through practices instead of stores, which means higher concentrations of the ingredients that do the work and formulations built around getting them where they need to go. It also means someone who has looked at your skin decides what you use. That is the part that turns a shelf of products into a result. **What a built regimen is good at** - Holding the result of a peel, a facial or a laser between visits instead of letting it fade - Fading and then holding pigment, which is where the daily product does more work than any single treatment - Clearing the kind of acne that never quite responds to what you can buy at the counter - Rebuilding a barrier that has been stripped by too many strong products used at once - Supporting prescribed treatment for eczema, contact dermatitis, rosacea and psoriasis - Preparing skin so a procedure does more, and settles faster afterward **ZO® Skin Health.** The topical line most of our regimens are built from, developed by a dermatologist and sold through practices rather than over the counter. Cleansers, exfoliants, treatment serums, moisturizers, eye products and sunscreens, with actives like retinol, salicylic acid and benzoyl peroxide. There is a full [ZO Skin Health](/treatments/zo-skin-health/) page if you want the detail on the line itself. **Heliocare®.** Capsules that add [oral sun protection](/treatments/heliocare/) on top of your sunscreen, not instead of it. It suits people who are outdoors here most of the year and people working on pigment, where every stray hour of sun undoes a little of the progress. **Nutrafol®.** For thinning hair, [a daily supplement](/treatments/nutrafol/) taken by mouth. It sits alongside a real look at why the hair is thinning rather than standing in for one. **Pendulum® Probiotics.** A [gut health](/treatments/pendulum-probiotics/) supplement, which is an unusual thing to find in a dermatology practice. It is here because what happens in the gut shows up on the skin often enough to be worth addressing. **Collagen Boost.** The one thing here you do not take home. This is the [in-office collagen work](/treatments/collagen-boost/) side of the same goal, and a regimen is usually built to hold on to what it achieves. ![](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-skin-care-products.webp) A counter clerk never finds out whether the thing they sold you worked. We do, because you are coming back for a skin check or a treatment anyway, and the person who chose your regimen is going to be looking at your face. Our aesthetics team includes a licensed esthetician holding ZO Skin Health Expert certification with more than two decades in the field, and building regimens is a large part of what that role does. We are also straight with you about what a regimen is for. It is the foundation: it keeps your skin healthy, holds the results you have paid for, and makes every treatment you have here work better. Where a line or looseness needs a treatment, we will point you at the right one. A [chemical peel](/treatments/chemical-peels/) on skin prepared with the right actives behaves differently than a peel on skin that has not been prepared, and the regimen is what keeps the result once you leave. It is not the thing you do instead of treatment. It is the thing that makes treatment worth paying for. **A built regimen is probably a good fit if:** - You own a lot of products and are not sure which ones are doing anything - You are treating pigment, acne or sun damage and want the result to hold between appointments - You have tried retinol before and stopped because your skin could not take it - You are booked for a procedure and want to get more out of it - You have a skin condition your dermatologist is treating and want your daily routine to support it **We will change the plan if:** - You have reacted to an ingredient before, which narrows the field and is worth knowing up front - What you are describing needs a prescription rather than a product - You are pregnant or breastfeeding, when several common actives come out of the routine Not sure which of these you are? That is what the consultation is for. Buying the bottle is easy. Knowing which bottle is the whole job. Strong actives ask something of your skin in the first few weeks. Expect some dryness, a little flaking and a period where your skin feels more sensitive than usual. That settles as your skin adapts, and it is the reason we introduce things one at a time instead of handing you five products and wishing you luck. **In the first weeks, do** - Introduce one active at a time and give it a couple of weeks - Wear broad-spectrum sunscreen every day, especially while treating pigment - Follow the order and frequency we wrote down, not the one on the box - Tell us if irritation is not settling, so we can adjust rather than have you quit **In the first weeks, don't** - Layer several strong actives on the same night - Assume the most expensive product is the one your skin needs - Push through significant irritation, which sets you back rather than speeding you up - Skip sunscreen while you are treating pigment or sun damage Call us about anything severe, worsening, or simply not what we described: real pain, blistering, signs of infection, or a reaction that does not match what we told you to expect. We would far rather hear from you. A regimen is either supporting the treatment plan or working against it. Pick a concern to see how we approach it. Products are priced individually and you can buy them without an appointment. What we would rather sell you is the plan, because the same four products in the wrong order do a fraction of what they do in the right one. We build the shortest regimen that gets you the result. If two products are enough, you leave with two products. **Q: What does "medical-grade" actually mean?** It has no legal definition, so treat the phrase as a signal rather than a standard. In practice it means higher concentrations of the ingredients that do the work, formulations built around getting them into the skin rather than feeling nice, and distribution through a clinic so someone who has seen your skin decides what you use. That last part is the one that matters. **Q: Are these products FDA-approved?** No, and neither is any other skin care line, including the ones that say they are. The FDA does not approve cosmetics before they go on the market, apart from color additives. Cosmetics are FDA-regulated, which is a different thing: they have to be safe and truthfully labeled. Products containing drug actives, sunscreens in particular, are regulated separately as over-the-counter drugs. [1] **Q: Do I need a consultation to buy?** No. You can walk in and buy a product. The value is in the regimen rather than the bottle, though, and the consultation is what turns one into the other. **Q: Is it worth it over drugstore skin care?** For actives, usually yes, because concentration and formulation are most of the answer and that is where the difference sits. Tretinoin is the ingredient with the deepest evidence behind it for sun-damaged skin, and it is prescription. [2] For sunscreen, the honest answer is that the best one is the one you will actually put on every morning, whatever it costs. Broad-spectrum, SPF 30 or higher, water resistant. [3] **Q: How long before I see anything?** Hydration and texture change within a couple of weeks. Pigment takes two to three months, and acne often goes through a brief adjustment before it clears. Take a photo the day you start, because the change is gradual enough that you will not notice it happening. **Q: Can I use these alongside a HydraFacial or a peel?** Yes, and that is usually the point. A HydraFacial or a peel resets the surface and the regimen holds it between visits. Your provider will tell you what to pause immediately before and after, since retinol in particular comes out of the rotation for a few days. 1. U.S. Food and Drug Administration. "FDA Authority Over Cosmetics: How Cosmetics Are Not FDA-Approved, but Are FDA-Regulated." Cosmetic products and ingredients do not require FDA premarket approval, with the exception of color additives. [https://www.fda.gov/cosmetics/cosmetics-laws-regulations/fda-authority-over-cosmetics-how-cosmetics-are-not-fda-approved-are-fda-regulated](https://www.fda.gov/cosmetics/cosmetics-laws-regulations/fda-authority-over-cosmetics-how-cosmetics-are-not-fda-approved-are-fda-regulated) · Regulatory 2. Sitohang IBS, Makes WI, Sandora N, Suryanegara J. "Topical tretinoin for treating photoaging: A systematic review of randomized controlled trials." *International Journal of Women's Dermatology.* 2022;8(1):e003. Seven randomized controlled trials; the authors concluded topical tretinoin is safe and effective for long-term treatment of photoaging. PMID 35620028. https://pubmed.ncbi.nlm.nih.gov/35620028/ · Peer-Reviewed Systematic Review 3. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice. ZO® is a registered trademark of ZO Skin Health, Inc. Heliocare® is a registered trademark of Cantabria Labs. Nutrafol® is a registered trademark of Nutraceutical Wellness Inc. Pendulum® is a registered trademark of Pendulum Therapeutics, Inc. Individual results may vary. Some products may cause dryness, peeling or irritation, particularly when actives are introduced too quickly. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### Skin Tag Removal [Skin tags](/conditions/skin-tags/) are soft, harmless growths that form where skin has been rubbing against skin, jewelry or clothing for a while. [1] They turn up under the arms, on the neck, on the eyelids, under the breasts, in the groin, on the sides and the back. They are extremely common, and having them says nothing about your health beyond the fact that something has been rubbing. Most people have them removed because one keeps catching. On a necklace, a collar, a bra strap, a razor. Sometimes it is an eyelid tag that sits in the way. Sometimes it is simply that you would rather not have it. All of those are good enough reasons, and none of them needs justifying at the appointment. The removal itself is quick. A dermatologist looks at the growth first to confirm what it is, numbs the area, and takes it off, most often by snipping it, freezing it or treating it with a fine electrical tip. [1] Which method suits depends on the size and where it sits. The growth is gone immediately and the skin closes over the next few days. **What we treat this way** - Skin tags on the neck, underarms, eyelids, groin and under the breasts - Tags that catch on jewelry, collars, straps or a razor - Growths that have become irritated, sore or have bled - Several tags in one appointment, rather than one visit each - A mole or another growth that you want looked at properly while you are here Skin tags look like the simplest thing in the world to deal with yourself, and there is a whole shelf of products sold on that idea. Here is what the short visit gives you that the shelf does not. An in-office removalA kit bought onlineConfirming what it isA dermatologist examines the growth first, and sends tissue to a lab if there is any question [2]Nothing is examinedNumbingLocal anesthetic. You feel pressure, not the removalNoneScarringTechnique chosen to keep the mark to a minimum, which is a large part of the training [2]The FDA notes skin injuries and scarring among the risks [2]BleedingHandled in the room, in seconds [2]Yours to manageRegulatory standingA procedure performed by a board-certified dermatologistThe FDA states that none of these products has been approved for this use [2] Products sold for removing skin tags at home are not recommended. [1] The appointment is short, the growth is gone the same day, and somebody qualified has confirmed what it was. That is the whole difference, and it is why this is one of the most satisfying small visits we do. ![Skin tag on a woman's arm](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-skin-tag-removal.webp) Removing a skin tag is quick. Knowing it is a skin tag is the part that takes training. Most soft growths in a friction area are exactly what they appear to be, and every so often something that looks ordinary is worth a closer look or a trip to the lab. In a dermatology practice that check happens automatically, before anything is removed, and it costs you nothing but a moment. It also means anything else you have noticed can be dealt with in the same visit. People routinely come in for one tag and mention a mole they have been half-watching for a year. That is a good use of the appointment, and it is usually the more important conversation of the two. **This is usually straightforward if:** - You have one or more skin tags that catch, rub, or you would simply rather be without - A tag has become irritated, sore or has bled - One sits somewhere awkward, like an eyelid - You have several and would rather deal with them in one appointment **Worth mentioning at your appointment:** - Any growth that has changed in size, color or shape, which we will want to look at properly - Any bleeding disorder or blood-thinning medication you take - A history of thick or raised scars - Whether you are pregnant, since skin tags are common in pregnancy and often settle afterward None of this needs sorting out in advance. Bring it up when you come in and it will be handled. Very little. A small dressing goes on where one is needed, and the area is a little tender for a day or so. Small tags heal in a few days; larger ones can take a couple of weeks. Frozen tags usually darken and fall away on their own over a week or two, which is exactly what should happen. **Afterward, do** - Keep the area clean and covered until it has closed over - Use whatever ointment we send you home with - Let anything that scabs or darkens come away on its own - Wear sunscreen over a healing area, since new skin marks easily [3] **Afterward, don't** - Pick at a scab or pull at a tag that is separating - Soak the area in a bath, pool or hot tub until it has healed - Worry if a frozen tag takes a week or two to drop off Call us about anything that does not match what we described: spreading redness, increasing pain, or any sign of infection. We would far rather hear from you early. Small benign growths, checked and removed. Pick a concern to see how we approach it. The cost depends on how many growths are being removed and the method used, and it is quoted before anything is done. Removing several in one appointment is more economical than returning for each one, which is why we would rather see all of them at once. Because a skin tag can be removed for comfort or for appearance, how the visit is handled varies. Our office will go through what applies to you when you book. **Q: Does it hurt?** The area is numbed first, so the removal itself is pressure rather than pain. The anesthetic going in is the only part most people notice, and it is over in a second or two. **Q: Can I just remove it myself?** The products sold for this are not recommended, and the FDA has not approved any of them for removing growths at home. [1][2] The visit is short, it is numbed, and somebody confirms what the growth is first. The section above on what the appointment buys you lays out the difference. **Q: Will removing one make more grow?** No. Removing a skin tag does not cause new ones to form. Some people are simply prone to them and will develop more over time in the same friction areas, which is unrelated to having had one taken off. **Q: Can you take off several in one visit?** Yes, and it is usually the sensible way to do it. Tell us where they all are when you book so enough time is set aside. **Q: Will it leave a mark?** Usually very little, and minimizing that is a large part of what the training is for. [2] Larger growths and certain locations leave more than a small tag on the neck, and you will get a realistic picture before anything is done. **Q: What if it turns out not to be a skin tag?** Then it goes to a lab and you get a proper answer, which is the single best reason to have a growth removed in a dermatology practice rather than anywhere else. [2] It is a straightforward next step, not a cause for alarm. 1. American Academy of Dermatology Association. "Skin tags: Why they develop, and how to remove them." States that skin tags are "harmless growths that can appear anywhere on your skin," that they develop "where skin has been rubbing against skin, jewelry, or clothing for some time," lists cryosurgery, electrodesiccation and snipping as the removal methods a dermatologist uses, and states that "products that you can use at home to remove skin tags are not recommended." [https://www.aad.org/public/diseases/a-z/skin-tags](https://www.aad.org/public/diseases/a-z/skin-tags) · Medical Organization 2. American Academy of Dermatology Association. "5 reasons to see a dermatologist for mole, skin tag removal." Covers confirming what a growth is and sending tissue to a lab, infection control, minimizing scarring, and managing bleeding, and states that the FDA warns at-home removal products carry risks including skin injuries, infection and scarring, and that "none of the products sold for removing moles, skin tags, and other growths at home has received FDA approval." [https://www.aad.org/public/diseases/a-z/mole-skin-tag-removal](https://www.aad.org/public/diseases/a-z/mole-skin-tag-removal) · Medical Organization 3. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice. Skin tags are benign growths and removal is generally elective. Tenderness for a day or two, and a small scab or a treated growth that darkens and separates over one to two weeks, are expected. Bleeding, infection and scarring are uncommon but possible. Tell us about any bleeding disorder, any blood-thinning medication, and any history of thick or raised scars. Any growth that has changed in size, color or shape should be examined rather than simply removed. Individual results may vary. ### SkinPen® Microneedling Microneedling makes a controlled injury and then gets out of the way. Fine needles create thousands of tiny channels in the skin, each one too small to see and deep enough to matter. Your skin responds the way it responds to any injury, by making new collagen and elastin, and the rebuilding is what changes the surface. That is why it works on [acne scarring](/conditions/acne-acne-scarring/) when topical products do not. A scar is a depression in the structure underneath. You cannot fill it from above. You have to rebuild it from below. **Benefits:** - Softens the pitted, indented scars that stay long after the acne itself has gone - Smooths rough texture and refines the look of large pores - Firms crepey skin on the neck, an area that shows age before the face does - Works on all skin tones for facial acne scarring, which is not true of every resurfacing option - No incisions, no heat, and a recovery measured in days rather than weeks Most pages about microneedling say "FDA cleared" and stop there. The clearance is more specific than that, and the specifics are worth knowing before you book. SkinPen Precision is cleared for two things, and they are not scoped the same way. [1] Cleared forWhoImproving the appearance of facial acne scarsAdults aged 22 and over, all skin tonesImproving the appearance of wrinkles of the neckFitzpatrick skin types II to IV Two things follow from that table. **The acne scar clearance covers every skin tone.** That matters, because several other resurfacing options carry real risk of pigment change in deeper skin tones and are used cautiously or not at all. Microneedling is mechanical rather than thermal, which is why the clearance is not skin-type limited here. **The neck clearance is narrower**, covering Fitzpatrick II to IV. If you are outside that range and the neck is what you came for, that is a conversation to have at [a consultation](/treatments/skin-care-consultations/) rather than a reason to assume the answer is no. There are other ways to approach it. Anything beyond those two indications is off-label. That is ordinary and legal in medical practice, and you are entitled to know which side of the line your treatment sits on. Microneedling is widely available and very unevenly performed. What changes the result is not the device, it is the judgment behind the settings: how deep, how many passes, over which areas, and how many sessions before you have got what you are going to get. That judgment is dermatology. At Coastal, the plan is built by clinicians who see acne scarring every week and know what a given scar type will and will not respond to. If microneedling is not the right answer for your scars, we will say so and tell you what is, including [radiofrequency microneedling](/treatments/potenza-rf-microneedling/) at our San Luis Obispo office, which reaches deeper and adds heat. **A good fit if:** - You have pitted or indented acne scarring that has not responded to topical treatment - Your texture is rough or uneven and you want change without heat or downtime measured in weeks - You have a deeper skin tone and have been told other resurfacing carries pigment risk - You are willing to give it three sessions and several months before judging the result **Worth a conversation first if:** - You are still getting active breakouts, which we would usually settle first - You take isotretinoin now or finished recently - You have a history of keloid scarring - You are pregnant - The neck is your main concern and you are outside Fitzpatrick II to IV The first day looks like a moderate sunburn: pink, warm and tight. That settles over two to three days, and some people flake lightly around day three or four. Keep it simple while it heals. No makeup for twenty-four hours, no active ingredients such as retinoids or acids for about a week, and no sun on treated skin without protection. A gentle cleanser and the aftercare products we send you home with are enough. Serious problems are uncommon. Call us if you develop spreading redness, unusual pain or anything that looks like infection rather than healing. SkinPen is used here for these concerns. Pick one to see how we approach it. Microneedling is priced per session, and almost nobody has one session. Most acne scar plans run to three, and we quote the course rather than the single treatment so you can see the real number before you start. Neck and face are priced separately. If both are on the plan, we will tell you whether doing them together makes sense or whether staging them is better for your skin. If microneedling is not the right value for what you want changed, we will tell you that too, and point you at what is. **Q: How many sessions will I need?** Most acne scar plans run to three, spaced about a month apart. Deeper scarring sometimes takes more. You will get a number at your consultation rather than after you have started. **Q: Does it hurt?** Less than people expect. Topical numbing goes on first, and most people describe pressure and vibration rather than pain. The neck is usually the most sensitive area. **Q: Is it safe for deeper skin tones?** For facial acne scarring, yes, and the clearance covers all skin types. [1] Microneedling works mechanically rather than with heat, which is what makes it a safer option where thermal resurfacing carries pigment risk. **Q: How is this different from the RF microneedling you offer in San Luis Obispo?** Potenza adds radiofrequency energy at the needle tip, which reaches deeper and treats laxity as well as texture. SkinPen is mechanical only. Which one suits you depends on what you are treating and how much downtime you can take. **Q: When will I see something?** Skin looks better within a week or two from the initial swelling settling. The real change is collagen, and that builds over four to twelve weeks and keeps going after the course finishes. **Q: Can I have it if I am on isotretinoin?** Not while you are taking it, and we will want to know when you finished. Bring it up at your consultation. 1. U.S. Food and Drug Administration. 510(k) Premarket Notification K202243, SkinPen® Precision System, Crown Aesthetics. Indications for Use: "The SkinPen® Precision system is a microneedling device and accessories intended to be used as a treatment to improve the appearance of wrinkles of the neck for Fitzpatrick skin types II - IV and to improve the appearance of facial acne scars in adults with all Fitzpatrick skin types aged 22 years and older." [https://www.accessdata.fda.gov/cdrh_docs/pdf20/K202243.pdf](https://www.accessdata.fda.gov/cdrh_docs/pdf20/K202243.pdf) · Regulatory 2. U.S. Food and Drug Administration. "Microneedling Devices." On which microneedling products are regulated as medical devices because they penetrate living skin, and which are not. [https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/microneedling-devices](https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/microneedling-devices) · Regulatory Content on this page is for educational purposes and is not a substitute for professional medical advice. SkinPen® is a registered trademark of its owner. Redness resembling a mild sunburn for one to two days, mild swelling on the first day, and dryness or light flaking for a few days afterward are expected. Infection, prolonged redness, lasting light or dark patches, and raised scarring are uncommon but possible, and the risk rises on skin that is tanned or sunburned at the time of treatment. Tell us about a history of raised or thick scars, about cold sores, about anything affecting how your blood clots, and about isotretinoin taken now or in the past year. This treatment is not suitable during pregnancy or where there is an active infection, active inflammatory acne or broken skin in the area. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### Smartskin®+ Laser Skin Resurfacing Most treatments try to improve the skin you have. This one replaces part of it. The laser removes the damaged surface in thousands of microscopic columns and leaves untouched skin in between, and that untouched skin is what heals the rest. You get the result of taking a layer off without the recovery of taking the whole layer off at once. That is why it reaches things nothing else on this page can. Lines that are visible when your face is completely still. Scars you can feel with your fingertips. The rough, mottled surface that Central Coast sun leaves behind. Those are structural, they live below the reach of any cream or facial, and they need the surface rebuilt rather than polished. It is also the treatment that rewards careful matching the most. Depth and intensity are chosen for your skin at your consultation, which is what turns a powerful laser into the right one for your face. **What Smartskin®+ is good at** - Softening pitted acne scars you can feel in the texture of your skin - Smoothing etched lines that stay put when your face is not moving, including the vertical ones above the lip - Resurfacing the rough, uneven skin left by years of sun damage - Evening out mottled tone and the brown patching that comes with it - Firming skin that has lost its tone, gradually, over the months after you heal - Doing all of it in one appointment for most people, rather than a course of visits Here is exactly what the week looks like, so you can book it against your calendar with confidence. Most pages give you "several days" and leave you guessing. This is the day by day. WhenWhat is happeningThe appointmentYou are numbed beforehand. You feel heat and pressure rather than sharp pain. Most faces take 30 to 90 minutes.That eveningHot, tight and swollen, like a bad sunburn. Ointment goes on and stays on. Somebody else drives you home.Days 1 to 2Swelling is at its most noticeable, usually on the second morning, and the skin stays damp as it heals. Both are exactly what should be happening.Days 2 to 3The new surface closes over. The skin dries, turns a bronze color and feels tight.Days 3 to 5Peeling and flaking, heaviest around the mouth and cheeks. You leave it alone and let it come off on its own.Days 5 to 7New skin, pink and slightly shiny. Most people are comfortable in front of other people again around here. Makeup goes back on once we clear you.Weeks 2 to 6The pink fades gradually. Sunscreen every day is not a suggestion during this stretch.Months 2 to 6The quiet part. Collagen keeps forming and the firmness keeps improving long after you have stopped watching for it. Most people book it so the visible stretch lands over a weekend and a few days either side. Give it a quiet week and you will enjoy the whole thing a great deal more. These are our own patients, photographed at our San Luis Obispo office and published with their consent. Individual results vary. There are more in the practice's private gallery, and we are happy to show you cases similar to yours at your consultation. ![Happy woman with great skin](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-smartskin-laser-skin-resurfacing.webp) A CO2 laser is only as good as the plan behind it. How deep it goes, how much energy it carries and how many passes your skin gets are all decisions, and they are made here inside a board-certified dermatology practice, for your skin specifically. The same team then looks after your week of healing, which is the part that turns a strong treatment into a great result. It also means you get pointed at the right treatment rather than the nearest one. [RF microneedling](/treatments/potenza-rf-microneedling/) reaches a similar depth while leaving the surface in place and suits some skin better. [Brown spots and broken veins](/treatments/ipl-photofacial/) are a different job with a different tool. If your face has lost volume rather than surface quality, filler is the answer and we will say so. Getting that call right is why people come here for this one. **Smartskin®+ is probably a good fit if:** - You have etched lines or pitted scarring that skincare and lighter treatments have not moved - Years of sun have left your skin rough, uneven and mottled rather than just a little dull - You can give up a week, and you would rather do that once than spread it over six visits - You will follow wound care exactly and stay out of the sun while you heal **We will steer you somewhere else if:** - Your skin carries more pigment, where a surface-sparing treatment usually suits you better - You have a tan, fresh or from a bottle, which has to fade first - You have an active infection or a cold sore anywhere near the treatment area - You heal slowly, form thick scars, or have finished a strong acne pill recently - You are pregnant or nursing - A week away from other people is not something your life has room for right now Not sure which of these you are? That is exactly what the consultation is for, and it is why we look at your skin before booking this one. Your skin does its healing out in the open for about a week, and every stage of it is a sign the treatment is working. Redness and swelling first, peaking around the second morning, then crusting and peeling as the new surface comes through. Most people look themselves again in about a week, with a fading pinkness for another two to six. The day-by-day walkthrough above covers it. **In the first week, do** - Follow the wound care instructions exactly, in the order you were given them - Use only the ointment and cleanser we send you home with - Sleep with your head raised for the first couple of nights to take the swelling down - Start sunscreen the moment the new skin has closed over, and wear it daily from then on - Call us early about anything that looks like an infection **In the first week, don't** - Pick, scrub or help the peeling along - Use retinoids, acids, vitamin C or anything active until we clear you - Let healing skin see direct sun, including through a car window - Wear makeup before we tell you that you can - Assume a symptom will settle on its own because you read about it somewhere Call us about anything severe, worsening, or simply not what we described: significant pain, spreading redness, signs of infection, blistering, or any reaction that does not fit what we went through before your treatment. We would far rather hear from you early. This laser works on the structure of your skin rather than its surface. Pick a concern to see how we approach it. Smartskin+ is priced by the area treated and by how intensively your skin needs to be worked, and a full face costs more than a single scar or the skin around the mouth. Because most people need one treatment rather than a course, you will usually get one number rather than a plan that grows. You get that number at your consultation, after your skin has been looked at, and it holds. If a lighter treatment would serve you better, that is the one you will be offered. **Q: How much downtime is there really?** About a week before you look yourself again, and two to six weeks of fading pinkness after that. Swelling first, then crusting and peeling as the new skin comes through. Plan a quiet week and you will sail through it. **Q: Does it hurt?** You are numbed thoroughly beforehand, so the appointment itself is heat and pressure rather than sharp pain. Afterward, expect a hot sunburned feeling for several hours and then tightness and soreness rather than pain for the first few days. **Q: Can I have it if my skin is darker?** Often the better fit is RF microneedling, which reaches a similar depth while leaving the surface in place and suits skin with more pigment very well. Your consultation sorts out which of the two gets you the result you want. **Q: Will it help acne scarring?** It is one of the strongest options there is for scars you can feel in the texture of your skin, because it removes and rebuilds rather than polishing over the top. Pooled research across six studies and 467 patients found it ahead of the treatments it was compared with on smoothness. [2] Resurfacing is also what dermatologists use for acne scars. [3] How much you get back depends on the kind of scars you have and how deep they run. **Q: Do you use this laser for anything besides resurfacing?** Yes, aimed at one spot rather than spread across an area. Stubborn warts that have not cleared with freezing or over-the-counter treatment are the common one, and it is a recognized in-office option for warts that have not responded to anything else. [4] It is also used to remove and reshape the thickened nose tissue that advanced rosacea can build over years. [5] Both are a separate appointment with different aftercare. **Q: How is it different from Clear + Brilliant?** Depth, and what it costs you in recovery. Clear + Brilliant leaves the top layer of your skin in place and builds the change over a series of visits with a few days of recovery each time. This takes that layer off and does far more in one session, in exchange for a real week. One is maintenance for skin that is still in good shape. The other is repair for skin that is not. 1. Cynosure Lutronic. "Smartskin+ micro-ablative skin resurfacing." Manufacturer's US product page. Supports the fractional CO2 mechanism, re-epithelialization at day 2 to 3, and five to seven days of downtime. [https://www.cynosure.com/product/smartskin/](https://www.cynosure.com/product/smartskin/) · Manufacturer 2. Lin L, Liao G, Chen J, Chen X. "A systematic review and meta-analysis on the effects of the ultra-pulse CO2 fractional laser in the treatment of depressed acne scars." *Annals of Palliative Medicine.* 2022;11(2):743-755. Six studies, 467 patients; higher skin smoothness scores than comparators. PMID 35249351. https://pubmed.ncbi.nlm.nih.gov/35249351/ · Peer-Reviewed Meta-Analysis 3. American Academy of Dermatology Association. "Acne scars: Diagnosis and treatment." Supports laser resurfacing as a dermatologist-performed treatment for acne scars, and that healing skin produces collagen and elastin that diminish scarring. [https://www.aad.org/public/diseases/acne/derm-treat/scars/treatment](https://www.aad.org/public/diseases/acne/derm-treat/scars/treatment) · Medical Organization 4. American Academy of Dermatology Association. "Warts: Diagnosis and treatment." "A laser can effectively treat stubborn warts and may clear them quickly," recommended where other treatments have not worked. [https://www.aad.org/public/diseases/a-z/warts-treatment](https://www.aad.org/public/diseases/a-z/warts-treatment) · Medical Organization 5. American Academy of Dermatology Association. "Rosacea treatment: Thickening skin." Lists laser surgery, which "uses light to remove excess tissue and sculpt the area," among the procedures for thickened rosacea skin. [https://www.aad.org/public/diseases/rosacea/treatment/thickening](https://www.aad.org/public/diseases/rosacea/treatment/thickening) · Medical Organization 6. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice. Smartskin®+ is a registered trademark of Cynosure Lutronic, Inc. Redness, swelling and crusting are expected during healing, and pinkness can last for weeks. Infection, prolonged redness, dark marks left behind, loss of skin color and scarring are uncommon but possible, and the risk rises on skin that carries more pigment and on skin that is tanned or sunburned at the time of treatment. Cold sores can be triggered and antiviral medication is started beforehand where needed. This treatment is not suitable during pregnancy, while taking or recently finishing a strong acne pill, or where healing is impaired. New skin marks easily and must be kept out of the sun. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### TempSure® Envi Skin Tightening Firmness is collagen. Your body makes less of it every year, and it starts earlier than most people expect, which is why the edge of your jaw softened, why the skin under your chin started to crease, and why none of it happened on a day you could point to. TempSure Envi warms the layer just below the surface to the point where your skin treats it as something to repair. Repair means new collagen. It is your own tissue doing the work over the months that follow, which is why nothing much looks different when you walk out and why a good deal looks different by month six. It is comfortable enough that most people describe it as pleasant, there is nothing to recover from, and because it works with heat rather than color-seeking light, skin tone is far less of a limit here than it is on most of this site. **What TempSure Envi is good at** - Firming a jawline that has started to soften at the edges - Smoothing early crepey texture on the neck and under the chin - Softening fine lines without freezing anything - Treating the thin, papery skin around the eyes, gently - Working across skin tones that rule out some light-based treatments - Fitting into a normal week, because there is no recovery to plan around This is the mildest treatment on the tightening ladder and it is the one most often oversold. Nobody in this market will tell you where its ceiling is, so here it is. Stand in front of a mirror in daylight and find your row. What you seeWhat it meansWhat actually helpsThe edge of your jaw has softened a little. Nothing hangs.Early collagen lossThis. It is exactly what it was built for.Fine crepey texture on the neck or around the eyes, skin still snaps back when you pinch itSkin quality rather than laxityThis, and often alongside skincare and a neuromodulatorEtched lines and pitted texture as well as softeningStructural change under the surfaceRF microneedling, which reaches deeper because it goes through the surface rather than over itSkin that stays folded for a second after you pinch it, or a jowl you can lift with a fingerReal laxityA surgeon gets you there. We will tell you that at the consultation.A face that looks hollow rather than looseVolume loss, not laxityFiller or a collagen stimulator. Heat will not put back what is gone. Non-surgical firming gives modest lifting and tightening, and it does not give the results of a facelift, eyelid surgery or a neck lift. [1] That is not a reason to skip it. It is the reason to have it early, while it is still the right answer, rather than after it has stopped being one. These are our own patients, photographed at our San Luis Obispo office and published with their consent. Individual results vary. There are more in the practice's private gallery, and we are happy to show you cases similar to yours at your consultation. ![Middle-age woman with great skin](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-tempsure-envi-skin-tightening.webp) This gives you a real, gradual improvement in firmness, and surgery is a different operation with a different result. Knowing which side of that line you are on before you start is what makes the eight months worth it. It depends on how much [loose skin](/conditions/sagging-skin/) you actually have, and that takes a look in person rather than a phone call. It also means the right machine for the right area. This one was built for the face, and we run different machines for the body and for color. If what is really bothering you is [brown spots and red veins](/treatments/ipl-photofacial/) rather than firmness, no amount of warmth will move them, and you will hear that at the consultation rather than at the end of a course. **TempSure Envi is probably a good fit if:** - Your skin has started to loosen rather than already loosened - You want something gradual and natural rather than obvious - You cannot give up a week, or any days at all - Your skin tone rules out some light-based treatments - You are prepared to judge it at six months rather than six weeks **We will steer you somewhere else if:** - You have significant loose skin, where the honest answer is a surgeon - What you actually have is volume loss rather than laxity - You have a pacemaker, defibrillator or other implanted electronic device - You have metal implants or permanent filler in the area to be treated - The area is infected or inflamed right now - You are pregnant Not sure which of these you are? That is what the consultation is for, and the how-much-loose-skin check above is the same conversation in advance. There is genuinely very little to this one. Expect mild redness and a warm flush in the treated area, usually settling within hours. Most people go straight back to work, the gym or a dinner the same evening. Makeup goes back on whenever you want it. **Afterward, do** - Drink water and carry on with your day as normal - Keep up your usual skincare routine - Wear broad-spectrum sunscreen, SPF 30 or higher, every day, which is what protects the collagen you are paying to build [2] - Finish the course on schedule, because the four-week spacing is set by how fast skin rebuilds **Afterward, don't** - Expect to see something that evening, because there will not be anything to see - Judge the result before six months - Skip a session or stretch the interval out to suit a calendar - Assume more heat would work faster Call us about anything severe, worsening or surprising: blistering, a burn, real pain, or any reaction that does not match what we described. We would far rather hear from you early. This is for skin that has started to loosen rather than skin that already has. Pick a concern to see how we approach it. TempSure Envi is priced per session and by the area treated, and most people are planning a course of three or four rather than a single visit. You get the cost of the whole course at your consultation rather than a per-visit number that adds up quietly. If your laxity is past what this can do, we will tell you that before you pay for anything, and if a different treatment would serve you better, that is the one you will be offered. Selling a course that cannot reach your goal is not a business we want. **Q: Do I need time off?** No. Some people have mild redness where they were treated and it usually settles within hours. You go right back to your day. **Q: Does it hurt?** Most people call it warm and genuinely pleasant, a deep heat that builds and eases as the applicator moves. It is one of the most comfortable things we do. **Q: How many visits will I need, and how far apart?** Three or four, four weeks apart. The spacing is set by how fast your skin rebuilds rather than by what fits your calendar, so finishing the course on schedule matters more here than it sounds like it should. **Q: When will I see something?** Gradually, over the months after your course. Almost nothing has changed when you leave. The best results from radiofrequency tightening land at around six months, which is when to judge it. [1] **Q: How long does it last?** Two to three years with good skin care. [1] Your skin carries on aging underneath that, so most people come back for maintenance rather than starting over. **Q: Is this a facelift?** No, and nobody here will imply it is. It firms and softens early looseness gradually, without surgery. It does not remove loose skin and it does not lift anything into a new position. If you have real laxity we will tell you and point you toward a surgeon rather than sell you a course that cannot get you there. 1. American Academy of Dermatology Association. "Many ways to firm sagging skin." States that radiofrequency gives "modest lifting and tightening," with best results in about 6 months and results that "can last 2 to 3 years with the right skin care," performed by a board-certified dermatologist, and that non-surgical options "still cannot give you the results of a surgical procedure like a facelift, eyelid surgery, or neck lift." [https://www.aad.org/public/cosmetic/younger-looking/firm-sagging-skin](https://www.aad.org/public/cosmetic/younger-looking/firm-sagging-skin) · Medical Organization 2. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization 3. U.S. Food and Drug Administration. 510(k) Premarket Notification K212891, TempSure System, Cynosure, LLC, cleared 18 March 2022. The facial handpieces are cleared for "non-ablative treatment of mild to moderate facial wrinkles and rhytids." [https://www.accessdata.fda.gov/cdrh_docs/pdf21/K212891.pdf](https://www.accessdata.fda.gov/cdrh_docs/pdf21/K212891.pdf) · Regulatory Content on this page is for educational purposes and is not a substitute for professional medical advice. TempSure® is a registered trademark of Cynosure Lutronic, Inc. Devices of this class are cleared, not approved, and the clearance covers the non-ablative treatment of mild to moderate facial wrinkles. Mild redness and warmth in the treated area are common and usually settle within hours. Blistering and burns are uncommon but possible. This treatment is not suitable during pregnancy, or for people with a pacemaker, defibrillator or other implanted electronic device, or with metal implants or permanent filler in the area to be treated, or where the area is infected or inflamed. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### TempSure® Firm Body Tightening This works on the surface story of a body: firmer skin on the backs of the arms and the stomach, smoother texture and softer-looking dimpling across the thighs and buttocks, and the crepey quality that shows up on skin that used to be smooth. A massage head glides across the area delivering steady radiofrequency warmth, the tissue underneath firms up, and the surface is worked at the same time. It is also the most comfortable thing we do to a body. Almost everybody describes it the same way, as a hot stone massage that happens to be doing something useful. Five minutes an area, nothing to recover from, and you leave exactly as you arrived except warmer. That matters more than it sounds: [skin that has lost its firmness](/conditions/sagging-skin/) responds to steady, repeated treatment, and this is comfortable enough that people actually finish the course. It is built as a course of five to eight sessions, and people who like it keep coming back for the occasional top-up. That is the pattern with this one, and it is an easy one to live with: a twenty minute appointment a few times a year, no recovery to plan around, and skin that keeps looking the way you want it to. **What TempSure Firm is good at** - Softening the look of dimpling across the thighs and buttocks - Firming the backs of the upper arms, which almost nothing else comfortably reaches - Improving skin quality on a stomach after weight change - Smoothing crepey texture around the waist and flanks - Being pleasant enough that people finish the course instead of abandoning it - Working across skin tones and in any season, because heat does not care what color your skin is This is the single most misunderstood thing in aesthetics, and getting it right the first time is what saves people from paying for two courses. Cellulite is fat that causes the skin to dimple, and it differs from fat in a way that matters enormously: treatment that effectively removes fat often has no effect on cellulite. [1] Dimpling is not caused by having too much fat sitting there. It is caused by how the fat is tethered underneath, which is why thin people have it, why losing weight does not reliably clear it, and why a treatment that reduces a fat pocket can leave the dimpling exactly where it was. What is bothering youWhat it actually isWhat we would point you atA defined bulge you can hold, on a flat areaA defined pocket of fatThe laser that reduces a fat pocket, which is aimed at volume rather than dimpling.Dimpling and texture across the thighs or buttocksCelluliteThis. Comfortable, temporary, built as a course.Skin that has gone soft and crepey on a curved areaSkin quality and laxityThis, or the wrap that curves around an arm for hands-free sessions across a whole area.Skin that stays folded after you pinch itReal laxityA surgeon. We will say so. Being straight about this is the whole reason the section exists. Nobody in this market will tell you that the treatment they are selling for your fat will do nothing for your dimpling, and plenty of people find that out afterward. These are our own patients, photographed at our San Luis Obispo office and published with their consent. Individual results vary. There are more in the practice's private gallery, and we are happy to show you cases similar to yours at your consultation. ![Young woman sitting in bed](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-tempsure-firm-body-tightening.webp) Cellulite is the most oversold category in aesthetics, and that is exactly why we are specific about it. You will be told what this treatment does, how many sessions it takes, and what keeping it up looks like, before you book rather than after. What it gives you is smoother-looking skin across a whole area, treated comfortably, with nothing to recover from and a top-up now and then to hold it. For most people that trade is the right one, because a pleasant appointment they will actually keep beats a procedure they will never book. And if what is bothering you would be better served by something else, you will hear that at the consultation from people who can tell the difference. **TempSure Firm is probably a good fit if:** - Texture, dimpling or softness bothers you more than size does - You want something comfortable you can keep up rather than a one-time procedure - You are near a stable weight and looking to refine - You can commit to a course of five to eight rather than judging it after one - You like the idea of an easy appointment you come back to now and then **We will steer you somewhere else if:** - What you have is a defined pocket of fat, where a different treatment does more - You have real laxity, the kind that stays folded when you let go of a pinch - You are set on a one-time permanent fix for dimpling, which no treatment anywhere reliably delivers - You have a pacemaker, defibrillator or other implanted electronic device - You have metal implants or permanent filler in the area to be treated - The area is infected, inflamed or has a recent surgery site - You are pregnant Not sure which of these you are? That is what the consultation is for, and the section above is most of that conversation already. Almost nothing. The area is warm and slightly pink for a little while and then it is not. No compression, no restrictions, no recovery, and nothing anyone else will notice. People book it on a lunch break and go back to work. **Afterward, do** - Carry on with your day exactly as planned - Drink water and keep moving - Wear broad-spectrum sunscreen, SPF 30 or higher, on treated areas, which the practice recommends and which matters most on legs and arms that see sun [3] - Finish the course, because this one is built out of repetition **Afterward, don't** - Expect a visible change after one session - Stretch the course out so far that it stops being a course - Assume a hotter session would replace two normal ones - Judge dimpling by a photograph taken in different light from the first one Call us about anything severe, worsening or surprising: a burn, blistering, real pain, or any reaction that does not match what we described. We would far rather hear from you early. Skin quality and texture on the body, treated gently and repeatedly. Pick a concern to see how we approach it. TempSure Firm is priced by the area and by the number of sessions, and because a course runs to five to eight, the number that matters is the course rather than the visit. Paired areas, like both thighs or both arms, are quoted as a pair. You get the whole figure at your consultation. You will also know what keeping it up looks like before you start rather than after, so there are no surprises in the second year. If a different treatment gets you closer to what you actually want, that is the one you will be offered. **Q: What does it feel like?** A hot stone massage. That is not marketing language, it is what almost everybody says unprompted. The massage head glides, the warmth builds, and most people find it genuinely relaxing. **Q: How many sessions will I need?** Five to eight for a full course. It is built out of repetition rather than intensity, which is exactly the trade that makes it this comfortable and gives it no downtime. **Q: What will it do for my cellulite?** It softens how the dimpling looks across the treated area, and a top-up now and then holds it there. Radiofrequency reduces the appearance of cellulite for many patients over a course of treatments. [1] You will get a realistic picture of your own skin at the consultation. **Q: Is this the same as the fat treatment?** No, and the difference matters. Cellulite is not the same problem as a pocket of fat, and a treatment that reduces fat often does nothing for dimpling. [1] The section above sorts out which one you have. **Q: Can I have it if my skin is darker, or in summer?** Yes to both. This works with heat rather than color-seeking light, so skin tone is far less of a limit and there is no tanning season to plan around. You still get assessed first. **Q: How is it different from the face version?** Same idea, different tool and different target. The face version treats a jawline and fine lines with a handpiece built for it. This has a massage head built for larger areas of the body and works on texture, firmness and dimpling. 1. American Academy of Dermatology Association. "Cellulite treatments: What really works?" States that cellulite "is fat that causes the skin to dimple," that it "differs from fat" in that "treatment that can effectively remove fat often has no effect on cellulite," and that for radiofrequency "recent studies suggest some patients see a little less cellulite. This result, however, is short lived and several treatments are needed." Also notes that losing weight and building muscle can reduce how visible it is. [https://www.aad.org/public/cosmetic/fat-removal/cellulite-treatments-what-really-works](https://www.aad.org/public/cosmetic/fat-removal/cellulite-treatments-what-really-works) · Medical Organization 2. American Academy of Dermatology Association. "Many ways to firm sagging skin." States that non-surgical firming gives "modest lifting and tightening" and "still cannot give you the results of a surgical procedure like a facelift, eyelid surgery, or neck lift." [https://www.aad.org/public/cosmetic/younger-looking/firm-sagging-skin](https://www.aad.org/public/cosmetic/younger-looking/firm-sagging-skin) · Medical Organization 3. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization 4. U.S. Food and Drug Administration. 510(k) Premarket Notification K212891, TempSure System, Cynosure, LLC, cleared 18 March 2022. "The massage device is intended to provide a temporary reduction in the appearance of cellulite." [https://www.accessdata.fda.gov/cdrh_docs/pdf21/K212891.pdf](https://www.accessdata.fda.gov/cdrh_docs/pdf21/K212891.pdf) · Regulatory Content on this page is for educational purposes and is not a substitute for professional medical advice. TempSure® is a registered trademark of Cynosure Lutronic, Inc. Improvement in the appearance of cellulite is temporary and maintenance treatments are expected. Warmth and mild pinkness in the treated area are common and settle quickly. Burns and blistering are uncommon but possible. This treatment is not suitable during pregnancy, or for people with a pacemaker, defibrillator or other implanted electronic device, or with metal implants or permanent filler in the area to be treated, or where the area is infected, inflamed or has a recent surgery site. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### ThreeForMe™ Photorejuvenation Skin that has spent time on the Central Coast almost never has one problem. It has brown spots from the sun, red vessels that arrived quietly and never left, and a surface that has lost the smoothness it used to have. Treat those one at a time and you are booking three separate courses of treatment, paying for three, and recovering from three. ThreeForMe puts two passes into one appointment. First pulses of light, which the brown and the red both soak up and break down. Then a laser, which works on the lines and the texture that light cannot touch. Together they take on all three problems, in roughly the time one treatment normally takes. The reason this works is that the two passes cannot substitute for each other. Light goes after color and does close to nothing for texture. The laser goes after texture and does close to nothing for color. Running both is the only way one appointment fixes three things, and it is why this costs more than a single treatment and considerably less than paying for two courses side by side. **What ThreeForMe is good at** - Clearing age spots, freckling and the patchy color left by sun damage - Fading broken capillaries around the nose and cheeks, and the background flush of rosacea - Softening fine lines and rough, uneven texture - Treating the chest and the backs of the hands, which are the two areas people leave until last and the two that give them away - Handling color and texture in one appointment rather than choosing which one to fix first Most people booking this can name what bothers them but not what it is, and the two passes treat different things. Here is how to tell them apart in your own mirror, in daylight, with no makeup on. What you seeWhat it isWhich pass handles itIf it is your only problemFlat brown patches and freckling that got worse every summerSun-driven pigmentThe light passAn IPL photofacial alone is the shorter, cheaper appointmentFine red lines beside the nose, or a flush across both cheeks that never fully settlesWidened surface vessels, often rosaceaThe light passIPL alone, or a vascular laser if the vessels are individual and stubbornSkin that looks fine in a photo but rough and crepey up closeSurface texture and collagen lossThe laser passClear + Brilliant® alone, which is the gentler texture-only optionA raised, changing or new brown spotNot a cosmetic question yetNeither, until it has been examinedA dermatology appointment first, and this is the one that matters If you can only tick one row, book the single treatment. We will tell you that at your consultation and we would rather you heard it from us than found out afterward. If you ticked two or three, that is what this treatment is for, and stacking them into one appointment is genuinely cheaper and faster than running the courses separately. These are our own patients, photographed at our San Luis Obispo office and published with their consent. Individual results vary. There are more in the practice's private gallery, and we are happy to show you cases similar to yours at your consultation. ![Middle-age woman with great skin](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-threeforme-photorejuvenation.webp) Combining treatments saves you time. It does not make the decision simpler, it doubles it, because both passes carry their own settings and both have to be right for the same skin on the same day. Getting one right and the other wrong is not half a good result. That judgment sits inside a board-certified dermatology practice rather than beside one. It also means your brown spots get looked at before they get treated. Not every brown spot is sun damage, and a treatment that clears color can clear away the one thing a dermatologist needed to see. That is not a hypothetical on skin that has spent decades outdoors here. It is the single best argument for having this done where somebody can tell the difference. **ThreeForMe is probably a good fit if:** - You can tick two or three rows in the table above rather than one - Years outdoors have left you with color and texture problems at the same time - You would rather run one course of treatment than two or three - You can take a week or two of treated spots darkening before they flake away **We will steer you somewhere else if:** - Only one of the three actually bothers you, in which case the single treatment is cheaper and shorter - You have a tan, fresh or from a bottle, which needs two clear weeks to fade first - Your skin carries more pigment and the light half raises the risk of a lasting color change - You are taking something that makes your skin sensitive to light, or finished a strong acne pill in the past year - There is a brown spot in the area that has never been examined - You are pregnant Not sure which of these you are? That is what the consultation is for, and it is why we look at your skin before we tell you what it needs. Expect mild redness and swelling for a day or two, and a warm sunburned feeling the same day. Then the satisfying part: treated brown spots go noticeably darker, sometimes almost black, and then flake away over one to two weeks, taking the pigment with them. That darkening is the treatment working, and it is why you want a week or two between this and a big event. **In the first two weeks, do** - Let darkened spots flake off on their own, on their own schedule - Keep treated skin out of direct sun completely - Wear broad-spectrum sunscreen, SPF 30 or higher, every day from here on [3] - Use a gentle cleanser and keep moisturizer on **In the first two weeks, don't** - Pick, scrub or exfoliate anything that darkens or flakes - Go back to retinoids, acids or scrubs until we clear you - Book a beach day, a tanning bed or a self-tanner - Take a very hot shower, sit in a sauna or overheat in the first day or two Call us about anything severe, worsening or surprising: blistering, real pain, signs of infection, or anything that does not match what we described before your treatment. We would far rather hear from you early. This is the treatment for skin with more than one thing going on. Pick a concern to see how we approach it. ThreeForMe is priced per session and by the area treated, so a face is not the same number as a face, neck and chest. It costs more per visit than a single light treatment, because you are getting two passes rather than one, and it costs considerably less than running two courses of treatment side by side. That trade is the whole reason the treatment exists. Most people are planning a course of three to four, so you get the cost of the course at your consultation rather than a per-visit number that adds up later. If only one of the three problems is really yours, we will quote you the single treatment instead and it will be cheaper. **Q: What are the three?** Brown spots, red veins and fine lines. Pulses of light take care of the first two and a laser takes care of the third. One appointment, two passes, three problems. The live name never says it, so now it does. **Q: Is this just an IPL photofacial?** No, and that is the whole difference. An IPL photofacial is the brown-and-red half on its own. This adds a second pass with a laser for lines and texture. If brown and red are all you want treated, the standalone treatment is the shorter, cheaper appointment and we will say so. **Q: How many visits will I need?** A course of three to four is recommended. Each visit takes on all three problems, so you are finishing one course rather than running several. **Q: Does it hurt?** The light pass feels like a rubber band snapping against your skin. The laser pass is more of a prickly heat. Neither lasts long, and we offer Nitronox if you find procedures hard. **Q: How much downtime is there?** A day or two of redness and swelling, then treated spots that go noticeably darker and flake away over one to two weeks. That darkening is the point, not a problem. **Q: Can I have it if my skin is darker?** Sometimes, and sometimes the honest answer is no. The light half works by being absorbed by color, which raises the risk on skin that carries more of it, and a recent tan does the same thing to anyone. Two clear weeks with no sun, no tanning bed and no self-tanner before your appointment. Your assessment decides, and if the answer is no we will tell you what to have instead. 1. American Academy of Dermatology Association. "How dermatologists treat sun-damaged skin." Names intense pulsed light and laser resurfacing among the treatments dermatologists use for age spots and wrinkles, and states that without protection from UV rays patients "may develop side effects from treatment, fail to get the results you seek, continue to damage your skin." [https://www.aad.org/public/everyday-care/sun-protection/sun-damage-skin/wrinkles-sun-damage-can-be-treated](https://www.aad.org/public/everyday-care/sun-protection/sun-damage-skin/wrinkles-sun-damage-can-be-treated) · Medical Organization 2. U.S. Food and Drug Administration. 510(k) Premarket Notification K142376, Palomar Icon Aesthetic System, Cynosure, Inc., cleared 24 September 2014. Clears the 1540 fractional non-ablative handpiece for skin resurfacing and for melasma, striae and acne and surgical scars, and the Max IPL handpieces for benign pigmented lesions, port wine stains, hemangiomas, angiomas, telangiectasias, rosacea and inflammatory acne. [https://www.accessdata.fda.gov/cdrh_docs/pdf14/K142376.pdf](https://www.accessdata.fda.gov/cdrh_docs/pdf14/K142376.pdf) · Regulatory 3. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization 4. American Academy of Dermatology Association. "Lasers and lights: How well do they treat rosacea?" Reports most patients seeing a 50% to 75% reduction in visible blood vessels after 1 to 3 treatments, with results tending to last 3 to 5 years and new vessels able to form. [https://www.aad.org/public/diseases/rosacea/treatment/lasers-lights](https://www.aad.org/public/diseases/rosacea/treatment/lasers-lights) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice. ThreeForMe™ and Icon® are trademarks of Cynosure Lutronic, Inc. Mild redness and swelling, a warm sunburned feeling, and treated spots that darken and flake away over one to two weeks are expected. Blistering, burns, infection and lasting light or dark patches are uncommon but possible, and the risk rises on skin that is tanned or sunburned at the time of treatment and on skin that carries more pigment. Tell us about any medicine that makes your skin sensitive to light and about a strong acne pill taken now or in the past year. This treatment is not suitable during pregnancy, or where a spot in the area has never been examined. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### VBeam Photorejuvenation Redness is not a stain on the surface. It is blood, sitting in vessels that have widened and stayed that way, close enough to the surface that you can see them. That is why no cream has ever touched it and why covering it with makeup is the only thing that has ever worked. This laser is set to a color that blood absorbs strongly and that the rest of your skin barely notices. The energy lands inside the vessel, heats it, and seals it shut. Your body then spends the following weeks clearing the closed vessel away. The redness leaves because the thing making it is gone, not because something is sitting on top of it. It is precise enough to take a single broken capillary off the side of your nose and broad enough to bring down the general flush across both cheeks. It is also the laser used on red birthmarks, including in infants, which is a medical conversation with its own assessment. **What VBeam is good at** - Clearing the visible vessels and background flush of rosacea - Taking out fine red lines and veins around the nose, cheeks and chin - Fading the red marks left behind by acne after the acne itself has cleared - Softening red and raised scars, including surgical scars - Treating red birthmarks, port wine stains and angiomas, in adults and in children - Evening out the mottled redness on the neck and chest from years of sun Here is the thing no other page about this laser in our market will tell you. It can be run two ways, and the difference between them is the whole of your next two weeks. Gentler settingStronger settingWhat you look like afterwardPink and a little swollen, settling over 3 to 4 daysA bruise-like mark, fading over 1 to 2 weeksCovered by makeupYesYesHow much clears per visitLessMoreVisits you will needMoreFewerBest forA wedding in three weeks, a job that faces the public, a first treatmentStubborn vessels, getting it over with, a quiet stretch on your calendar Neither one is the wrong answer and neither one is a complication. The bruise-like mark is the treatment working visibly, and on some vessels it is the setting that actually clears them. What matters is that you know which one you are getting before you sit down, because a patient who bruises without warning reasonably believes something went wrong. We decide it with you at the consultation, against your calendar rather than against a protocol. If you have something in three weeks, say so and we will plan around it. ![Woman with great skin](https://coastaldermaesthetics.com/wp-content/uploads/2026/08/cd-vbeam-photorejuvenation.webp) Not everything red is a blood vessel, and not every red growth is harmless. A dermatology practice works out what a mark actually is before pointing a laser at it, and that matters more here than almost anywhere else, because the laser removes the mark along with the evidence a lab would need. Red birthmarks in infants are treated with this laser too, including [port wine stains](/conditions/vascular-anomalies/) and [infantile hemangiomas](/conditions/infantile-hemangiomas/), and that is a medical assessment before it is ever a cosmetic one. It also means your redness gets treated as the condition it belongs to. Rosacea is a long-term condition with a plan behind it, and the laser is one part of that plan rather than the whole of it. On the Central Coast, where a lifetime of sun sits on top of everything else, treating the vessels and ignoring the rosacea is exactly why some people find themselves back in a laser chair every single year. **VBeam is probably a good fit if:** - What bothers you is red rather than brown - You have visible vessels, a flush that will not settle, or a red mark you have stopped photographing yourself next to - You have rosacea that is managed and you want the visible part dealt with - You can give it two to four visits a few weeks apart rather than expecting one **We will steer you somewhere else if:** - Brown spots and sun damage are the bigger part of the problem, in which case IPL covers both at once - You have a tan, fresh or from a bottle, which needs to fade first - You are taking something that makes your skin sensitive to light - You have an active infection or broken skin in the area - You are pregnant Not sure which of these you are? That is what the consultation is for, and it is why a red mark gets looked at before anything is aimed at it. On the gentler setting, expect redness, some swelling and tenderness that settles over three to four days. Treated spots often go darker before they fade. On the stronger setting, expect a bruise-like mark that fades over one to two weeks. Makeup covers all of it, and you will know which one you are getting before you sit down. **In the first week, do** - Use a cold compress in the first few hours if you want to take the swelling down - Keep treated skin covered or out of the sun entirely - Wear broad-spectrum sunscreen, SPF 30 or higher, every day from here on [2] - Let anything that darkens or crusts come away on its own **In the first week, don't** - Pick or scrub anything that darkens or flakes - Go back to retinol, acids or scrubs until we clear you - Sit in a sauna, take a very hot shower or do a hard workout for a day or two - Book a beach day or anything that puts treated skin in direct sun Call us about anything severe, worsening or surprising: blistering, real pain, signs of infection, or anything that does not match what we told you to expect. We would far rather hear from you early. If the thing bothering you is red rather than brown, this is usually the right tool. Pick a concern to see how we approach it. VBeam is priced per session and by the size of the area, so a single broken capillary beside the nose and a full face of rosacea redness are not the same appointment or the same number. Most people are planning two to four visits, so you get the cost of the course at your consultation rather than one number that grows later. Some of what this laser treats is medical rather than cosmetic, particularly birthmarks and vascular lesions in children. Where that is the case we will tell you, because it changes how the visit is handled. If a cheaper or lighter option would serve you better, that is the one you will be offered. **Q: Will I bruise?** Only if we choose the setting that does. The stronger setting clears more per visit and usually leaves a bruise-like mark for one to two weeks. The gentler setting rarely marks you and needs more visits. We pick between them with you, against your calendar. The bruise-or-no-bruise section above lays out the trade in full. **Q: Does it hurt?** Most people describe a rubber band snapping against the skin, with a burst of cold right before it. The cold spray takes most of the sting out. It is quick, and the spots over bone are the sharpest. **Q: How many visits will I need?** Usually two to four, spaced a few weeks apart, depending on the area and how much there is to clear. Most patients lose half to three quarters of their visible vessels after one to three treatments, with visits three to four weeks apart. [1] **Q: Does it cure rosacea?** No, and anyone telling you otherwise is selling something. It treats the visible vessels and the background redness very well, which is usually the part you see in the mirror. Rosacea itself is a long-term condition with a plan, and this is one part of that plan. **Q: Will the vessels come back?** The ones we treat are gone, and results tend to hold for three to five years. New vessels can form, especially with rosacea and with more sun, which is why daily sunscreen matters more here than with most treatments. [1][2] **Q: Can this laser be used on a child's birthmark?** Yes, and it is one of the things this device is specifically cleared for. Its FDA clearance names a pediatric indication: cutaneous capillary malformations, also known as port wine stains, and infantile and congenital hemangiomas. [3] Treating a birthmark in a child is medical care rather than a cosmetic service and starts with a diagnosis, so the route in is an appointment rather than a laser booking. **Q: How is this different from IPL?** IPL is a broad band of light that goes after brown spots and red vessels at the same time, which makes it the better choice when you have both. This is tuned to one color, which makes it sharper on redness and on individual vessels and useless on brown spots. If red is your only problem, this is the better tool. 1. American Academy of Dermatology Association. "Lasers and lights: How well do they treat rosacea?" Reports that most patients see a 50% to 75% reduction in visible blood vessels after 1 to 3 treatments, that treatments are usually spaced 3 to 4 weeks apart, and that results tend to last 3 to 5 years, with treated vessels not reappearing but new ones able to form. [https://www.aad.org/public/diseases/rosacea/treatment/lasers-lights](https://www.aad.org/public/diseases/rosacea/treatment/lasers-lights) · Medical Organization 2. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization 3. U.S. Food and Drug Administration. 510(k) Premarket Notification K230990, Candela Vbeam Family of Pulsed Dye Lasers, Candela Corporation, cleared 1 June 2023. Cleared indications include facial and leg telangiectasia, rosacea, port wine stains, hemangiomas, angioma, spider angioma, warts, scars, striae, wrinkles, inflammatory acne vulgaris, and, in children, cutaneous capillary malformations and infantile hemangiomas. [https://www.accessdata.fda.gov/cdrh_docs/pdf23/K230990.pdf](https://www.accessdata.fda.gov/cdrh_docs/pdf23/K230990.pdf) · Regulatory Content on this page is for educational purposes and is not a substitute for professional medical advice. Vbeam® is a registered trademark of Candela Corporation. Redness, swelling and tenderness for three to four days are expected, and a bruise-like mark lasting one to two weeks is expected at the stronger settings. Blistering, crusting, infection and lasting light or dark patches are uncommon but possible, and the risk rises on skin that is tanned or sunburned at the time of treatment. Tell us about any medicine that makes your skin sensitive to light, about a strong acne pill taken now or in the past year, about anything affecting how your blood clots, and about a history of raised, thick scars. This treatment is not suitable during pregnancy or where there is an active infection or broken skin in the area. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ### ZO® Skin Health Most people who try ZO have already tried a lot of things. That is who this line is for. The products carry more of the working ingredient than what you can buy in a store, and they are formulated to get it into the skin rather than to feel pleasant on the way. If nothing has moved your acne, your brown patches or your texture, the honest reason is usually that nothing you have used was strong enough to. The trade is that stronger cuts both ways. Start a retinol wrong and you spend three weeks red and flaking and you quit, which is the story behind almost every abandoned bottle of the stuff. That is the entire reason this line is sold through practices. Someone decides which products, in which order, on which nights, and adjusts it when your skin objects. What it treats, it treats properly. [Acne](/conditions/acne-acne-scarring/) that keeps coming back in the same three places. [Melasma](/conditions/melasma/), where the daily product does more of the work than any single treatment does. [Sun damage](/conditions/sun-damage/) from a lifetime on this coast, which shows up as roughness and mottling long before it shows up as lines. **What a ZO routine is good at** - Acne that has not responded to anything from a counter, including the adult kind along the jaw - Brown patches and melasma, where consistency at home is what holds a result between treatments - The rough, mottled texture that years of Central Coast sun leaves behind - Getting the benefit of retinol without the three weeks of peeling that make people give up - Holding the result of a peel, a facial or a laser instead of watching it fade - Preparing your skin so a procedure does more and settles faster ZO is a large line and most of it is not for you. Here are the ingredient families that do the work, and what each one is for, so you can tell what you are being handed and why. **Retinol.** The one with the deepest evidence behind it. It speeds up cell turnover, which is why it improves texture, acne and sun damage all at once, and why it is also the one that makes your skin peel for a few weeks if you start it too fast. Almost every routine we build has one, at a strength chosen for your skin rather than the highest available. **Pigment ingredients.** For melasma and sun spots. These work slowly and they only hold if the sunscreen holds, which is why a pigment routine without daily sunscreen is money spent on nothing. **Exfoliating acids.** Salicylic and glycolic, for congestion, rough texture and clogged pores. They do not go on the same night as your retinol unless we specifically tell you they do. **Benzoyl peroxide.** For inflammatory acne, the red and painful kind rather than the bumpy kind. Effective, and it bleaches towels and pillowcases, which nobody tells you at a counter. **Barrier and hydration products.** The unglamorous half, and the half that decides whether you can tolerate everything above. Most people who cannot handle actives have a barrier problem, not an active problem. **Sunscreen.** Non-negotiable with any of the above, because every one of these ingredients makes your skin more sensitive to light. Broad spectrum, SPF 30 or higher, water resistant. [3] ![](https://coastaldermaesthetics.com/wp-content/uploads/2026/07/zo-skin-health.jpg) Stronger products need supervision, and that is not a sales line, it is the difference between the routine working and you giving up on it in a month. Yours is built by a licensed esthetician holding ZO Expert certification, inside a practice run by board-certified dermatologists, and the person who chose it is going to see your face again. A clerk behind a counter never finds out whether it worked. We are also straight with you about what a routine is for. It is the foundation: it keeps your skin healthy and makes every treatment you have here work better and last longer. Where a line or looseness needs a treatment, we will point you at the right one. [A chemical peel](/treatments/chemical-peels/) on properly prepared skin behaves differently from a peel on skin that has not been prepared, and at our San Luis Obispo office the person planning the peel and the person planning the routine are in the same building and often the same person. **A ZO routine is probably a good fit if:** - You have tried a lot of things from a counter and none of them moved anything - You are treating acne, melasma or sun damage and want the daily product pulling its weight - You have tried retinol before and stopped because your skin could not take it - You want somebody to tell you what to use on which night, in what order - You are booked for a peel, a laser or microneedling and want more out of it **We will change the plan if:** - You have reacted to an ingredient before, which narrows the field and is worth knowing up front - What you are describing needs a prescription rather than a product - You are pregnant or breastfeeding, when retinol comes out of the routine entirely - Your skin barrier is already damaged, in which case we repair that before adding anything strong Not sure which of these you are? That is the consultation. Buying the products is the easy part; knowing which ones and in what order is the whole job. **One new product at a time, on the schedule we give you.** Almost every bad story about a strong routine is a schedule problem rather than a product problem. **Expect an adjustment period, and do not panic in it.** Dryness, flaking and some redness in the first few weeks is normal when you start a retinol. ZO calls it retinization and you will hear the word at the counter. It settles. **Sunscreen every day, not most days.** These products make your skin more sensitive to sunlight, so without daily broad-spectrum sunscreen, SPF 30 or higher, the routine is working against itself. [3] **Do not use a retinol and an exfoliating acid on the same night** unless we have specifically told you to. **Pause around treatments.** Retinol usually comes out for a few days before and after a peel, a laser or microneedling. Ask for the window and we will give it to you in days rather than in vague terms. **Tell us if it stings.** Not everything that stings is wrong and not everything wrong stings. We would far rather adjust the plan than have you quietly stop. ZO is where the daily routine does real clinical work rather than sitting alongside it. Pick a concern to see how we approach it. Products are priced individually and you can restock without an appointment. A starting routine is usually three to five products rather than fifteen, and we would rather send you home with three you will finish than eight you will not. We build the shortest routine that gets you the result. If what you need is two things, you leave with two things. **Q: Is ZO approved by the FDA?** No, and neither is any other skin care line anywhere. United States law does not have the FDA approve cosmetics before they go on sale, apart from the colors used in them. Cosmetics are regulated, which is a different thing: they have to be safe and honestly labeled. Anything containing a drug ingredient, sunscreen especially, is handled separately. A brand telling you its cream is FDA approved is a reason to trust it less, not more. [2] **Q: Do I have to buy the whole system?** No. Some people are on three products and some on eight. A starting routine is usually three to five, and the right one is the one you will actually finish. **Q: Can I buy it without a consultation?** Yes. If you know what you are on and you are restocking, that is straightforward. The value is in the routine rather than the bottle, and a conversation is what turns one into the other. **Q: My skin went dry and flaky when I started. Is that normal?** Usually, yes. Dryness, flaking and a little redness over the first few weeks is the adjustment period when you begin a retinol. ZO calls it retinization. It settles. Starting too strong or too often is what turns it into something worse, which is exactly why you get a schedule rather than a bag. **Q: How is this different from a drugstore retinol?** Strength and formulation. More of the working ingredient does more, and it also irritates more if you start it wrong, which is the trade our supervision exists to manage. For sunscreen specifically, the best one is still the one you will actually put on every day. [3] **Q: Can I use it with a peel or a HydraFacial?** Yes, and that is usually the idea. A HydraFacial or a peel resets your skin and the routine holds it there between visits. Retinol comes out for a few days around a treatment, and we give you the exact window in days rather than leaving you to guess. 1. Weinstein GD, Nigra TP, Pochi PE, Savin RC, Allan A, Benik K, Jeffes E, Lufrano L, Thorne EG. Multicenter study of a prescription vitamin A cream applied to sun-damaged skin. *Archives of Dermatology.* 1991;127(5):659-665. Supports the tile: about 8 in 10 people using a prescription vitamin A cream saw their sun-damaged skin improve, against about 5 in 10 using the same cream without the active ingredient. The product studied was a prescription cream, not a ZO product. PMID 2024983. https://pubmed.ncbi.nlm.nih.gov/2024983/ · Peer-Reviewed Study 2. U.S. Food and Drug Administration. "FDA Authority Over Cosmetics: How Cosmetics Are Not FDA-Approved, but Are FDA-Regulated." Supports the first FAQ: cosmetics do not need FDA approval before sale, apart from the colors used in them. [https://www.fda.gov/cosmetics/cosmetics-laws-regulations/fda-authority-over-cosmetics-how-cosmetics-are-not-fda-approved-are-fda-regulated](https://www.fda.gov/cosmetics/cosmetics-laws-regulations/fda-authority-over-cosmetics-how-cosmetics-are-not-fda-approved-are-fda-regulated) · Regulatory 3. American Academy of Dermatology Association. "How to select a sunscreen." Supports the daily sunscreen guidance: broad spectrum, SPF 30 or higher, water resistant. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization Content on this page is for educational purposes and is not a substitute for professional medical advice. ZO® Skin Health is a registered trademark of ZO Skin Health, Inc. Cosmetics are regulated by the FDA but are not approved by it before sale, apart from color additives. Products containing retinol and exfoliating acids commonly cause dryness, flaking, redness and stinging, particularly in the first weeks of use, and they increase the skin's sensitivity to sunlight. Retinol is not used during pregnancy or breastfeeding. Stop and contact us if you develop severe irritation, swelling, blistering or a rash. Individual results may vary. Cosmetic consultations are $125, paid at booking and credited toward the cost of treatment. ## Providers ### Brady Van Beurden, PA-C Brady Van Beurden is a Dermatology Physician Assistant with a passion for helping others. She was born in Orange County and grew up in Texas. Brady relocated to San Luis Obispo in 2013 to attend Cal Poly, where she was awarded the Community Outreach Scholarship and graduated Magna Cum Laude with a Bachelor’s in Biological Sciences in 2017. After graduating from Cal Poly, Brady attended Baylor College of Medicine in the Texas Medical Center in Houston and obtained a Masters of Science in Physician Assistant Studies in 2020. She is a member of the California Dermatology Physician Assistant Society and the Society of Dermatology Physician Assistants, having advanced her specialized knowledge of dermatology through their Diplomate Fellowship program. Brady truly enjoys serving the Central Coast community. She believes that everybody deserves access to quality healthcare and volunteers her time regularly. She is a skilled educator and enjoys teaching patients about skin conditions and how to keep their skin healthy. When she is not at work, Brady spends quality time with her husband, dog, family, and friends. She loves to run and explore trails throughout the central coast. ### Crissa Thomas, Aesthetics Coordinator As our aesthetic coordinator and licensed esthetician, Crissa Thomas brings her 23 years of experience providing exceptional skincare and aesthetic services to our clients.  Mentored by a leader in the field, Diane Schumacher, Crissa has dedicated her career to continuing education and state of the art treatments.  With a caring touch, she offers a level of service and expertise that has earned the trust of her clients and colleagues alike.  Crissa now enters her journey into the medical aesthetic field, fueled by a passion to have a greater impact on her clients by improving skin health.  With her eye on earning her nursing degree, Crissa has been inspired by current and past mentors in the field of skincare by becoming a ZO® Skin Health Expert.  With absolute confidence in the ZO® Skin Health product line, Crissa provides the results and noticeable benefits clients are looking for.  It is her belief that when the skin is healthy, it looks beautiful and inspires confidence from within.  When not working, Crissa enjoys spending time with her husband, Randall, and her two beautiful kids. Together they enjoy traveling, hiking, and of course – beaches! ### Dr. Christine Kilcline **Dr. Christine Kilcline** is a native of Northern California. She spent much of her childhood vacations searching for seashells on the beaches of Morro Bay and is elated to now call the Central Coast her home.   Dr. Kilcline graduated from UC Davis, recognized as an Outstanding Senior by her peers and faculty followed by cum laude honors from Albany Medical College. She completed her post-graduate training at UCSF with residencies in Pediatrics and U.S. News and World Reports top rated UCSF Dermatology. Dr. Kilcline has completed clinical research trials for Psoriasis and Eczema as well as additional specialized training as a Pediatric Dermatologist at Rady Children’s Hospital in San Diego. She devoted time as a Volunteer Clinical Faculty member for the Department of Dermatology at UC Davis Medical Center and awarded Best Volunteer Clinical Faculty, and served as Treasurer and Vice President of the Northern California Dermatology Society. Now on the Central Coast for over 5 years, her prior experience combined includes 14 years in private practice.   Dr. Kilcline practices the comprehensive scope of dermatologic care. She specializes in complex medical and pediatric dermatology. As a board certified pediatric dermatologist, Dr. Kilcline understands the impact skin disease can have on the physical and social development for the child and the family unit. Dr. Kilcline is an accomplished dermatologic surgeon and brings an artistic, natural eye to her aesthetic practice as well. Her training in both San Francisco and San Diego allowed her to develop as a skilled dermatologic and laser surgeon for both children and adults. Tambien, Dra. Kilcline se habla espanol. When Dr. Kilcline is not at work, she can be found cheering on her kids soccer teams, enjoying her husband’s cooking, practicing yoga, learning to paddle board, cheering for the San Francisco Giants…and still searching for seashells. ### Dr. Joshua Spanogle Dr. Joshua Spanogle is a dermatologic surgeon specializing in Mohs surgery, laser surgery, and aesthetic medicine. In addition to being a Dermatologic Surgeon, Dr. Spanogle is the author of two novels. His literary works, “*Isolation Ward*” and “*Flawless*,” achieved global reach through translations into nine languages.  Additionally, both books garnered critical and commercial success, as evidenced by their inclusion in the San Francisco Chronicle and the Los Angeles Times bestsellers. Dr. Spanogle has performed over 15,000 surgeries and is an active member of the American College of Mohs Surgeons and the American Academy of Dermatology. In December 2021, Dr. Spanogle became one of the first dermatologists to achieve certification in Micrographic Dermatologic Surgery. ### Jessy Arthurs, PA Jessy Arthurs is a fellow of the American Academy of Physician Assistants and Board Certified by the National Commission on Certification of Physician Assistants. She attended San Diego State University where she obtained her Bachelor’s degree in psychology. After graduating, she discovered her passion for the medical field and went on to complete her medical training at the University of South Alabama and received her Master’s degree in Health Science and Physician Assistant Studies.  Jessy was born and raised in San Luis Obispo County and holds a passion for dermatology and has extensive experience in pediatrics. She is a member of the Society of Dermatology Physician Assistants and has completed the SDPA Diplomate Fellowship to advance her training. In her free time, she enjoys the lake (with lots of sunscreen of course), camping, fishing and hiking. Jessy lives in Atascadero with her husband Daniel, her son Stetson and border collie, Emily. She is so excited to be joining the skilled team at Coastal Dermatology + Aesthetics. ### Laura De La Cruz, NP **Laura De La Cruz** is a nurse practitioner specializing in dermatology and has been a nurse for well over a decade. Her education includes Chico State University in Chico, California, where she earned her Bachelors of Science in Nursing. After working as a nurse for several years she decided to return to school, at Sonoma State University, and get her Masters of Science in Nursing and become a Family Nurse Practitioner. She is passionate about dermatology and helping her patients get the happy, healthy skin that they deserve. You can see her for a variety of dermatological needs including medical, surgical and aesthetic dermatology. Originally from Chico, California, she is new to the central coast and is loving exploring all of the incredible places that the central coast offers. She enjoys the outdoors, collecting jewelry and other shiny things and hanging out with her husband and 3 kids. ### Natalie Robertson, PA-C Natalie Robertson was born in Minnesota but moved at an early age to Northern California. Natalie moved to San Luis Obispo in 2010 to attend Cal Poly and fell in love with the central coast. She graduated in 2014 with an undergraduate degree in Biological Sciences and a minor in Microbiology. Natalie attended Concordia University Wisconsin for her masters degree in Physician Assistant Studies, graduating in 2018. She couldn’t resist the temptation to return to the central coast and is so fortunate to call this amazing area home once again! Natalie is a member of the Society of Dermatology Physician Assistants and has advanced her specialized knowledge of the skin through their Diplomate Fellowship program. Outside of work Natalie loves exploring with family and friends all the central coast has to offer, including hiking and going to the beach. She also enjoys training for half marathons. ### Tressa Esty, PA-C **Tressa Esty** was born in Minnesota and spent over 10 years visiting the central coast before relocating here in 2012. She is so happy to be a resident of the Central Coast. Tressa Esty, MPAS, PA-C obtained her undergraduate degree in Biology from the College of Saint Scholastica in Duluth, MN. She received her Master’s degree in Physician Assistant Studies from Chatham University in Pittsburgh, PA and received her certification in 2006. She was also accepted into Albert Schweitzer fellowship for Humanitarian work in medicine. Since certification, she practiced in Minnesota initially in Plastic Surgery for about a year and then specializing in General, Surgical and Cosmetic Dermatology since 2006. Her passion remains in all aspects of Dermatology. Her practice approach is to treat patients as she would treat her family. She also is a clinical professor for PA students from Chatham University and Rocky Mountain University. When she is not practicing, she enjoys camping, hiking, walking the beach, along with cultural cooking. She loves spending time with her husband and five daughters. ## Articles ###  A Decade of Excellence: Celebrating 10 Years of Coastal Dermatology ### 3 Must-Have Products For The New Year ### 3 Treatments to Spring Into the Warmer Months Refreshed & Restored ### 4 Best Treatments To Pair With Microneedling ### 4 Common Skin Concerns In The Winter & How To Treat Them ### 4 Reasons To Try Laser Treatments This Fall  ### 4 Treatments To Try This Fall ### 4 Ways To Achieve Your Aesthetic Goals in 2023 ### 4 Ways To Help Prevent Skin Cancer ### 4 Ways To Improve Your 2023 ### 5 Myths About Aging Skin ### 5 Myths About SPF Debunked ### 5 Ways to Fall in Love with Your Skin: Valentine’s Day Treatment Guide ### Acne Awareness Month: What Sets Coastal Dermatology + Aesthetics Apart ### Adult Acne: Why It Happens in Your 30s, 40s, and Beyond (And What Actually Works) ### An Integrative Approach to Rosacea ### Beautiful at Rest, Flawless in Motion⁠ ### Beauty Beyond Products: A Deeper Look into Comprehensive Skin Care Solutions ### Botox & Filler: Your Most Asked Questions Answered ### Cleanse, Exfoliate and Protect Your Skin with the Award-Winning HydraFacial®️ ### Coastal Dermatology + Aesthetics: Celebrating 2024 and Looking Ahead to 2025 ### Countdown to the Holidays: How to Keep Your Skin Healthy and Glowing All Winter Long ### Decoding Rosacea ### Eczema in the Fall ### Effectively Treat Your Rosacea Today! ### Everything You Need To Know About Sun Damage ### From Professional Care to Personal Routine: Ensuring Lasting Skin Health ### Give Dad the Gift of Confidence with Nutrafol ### Go & Glow: Get The Ultimate A-list Treatment ### Heat Up 2021 With SculpSure & FlexSure® ### How To Care For Your Skin At Any Age  ### How To Combat Skin Laxity ### How To Make Your Botox & Filler Last Longer ### How To Stay Youthful as the Leaves Change ### Meet The Filler Revolutionizing The Beauty Industry ### Men’s Health Month: Why Men Need Skincare Too  ### Protect and Perfect Your Skin This Summer — All About Hyperpigmentation ### Protect Your Skin From The Summer Sun ### Psoriasis Awareness Month Is Here: Here’s What You Need To Know ### SPF 101: The Summer Guide to Sun Protection ### Spring Skincare Reset: 5 Expert Tips for a Healthy Glow ### Summer Skin Recovery: How to Repair and Replenish Your Skin After Sun-Soaked Days ### Sun Damage Is Cumulative: What Your Skin Remembers (and What You Can Do About It) ### Sun Smarts: How To Shield Your Skin from Harmful Rays and Reduce Your Risk of Skin Cancer ### The Benefits of Combining Collagen With BOTOX® ### The Best Body Contouring Treatments to Try  ### The Best Treatments To Pair Together ### The Connection Between Gut Health and Glowing Skin: Unveiling the Secret ### The Difference Between BOTOX® & Filler ### The Importance of Collagen  ### The Importance of Medical-Grade Skincare ### The Men’s Guide to Aesthetic Treatments: What You Need to Know ### The Most Innovative Medical and Aesthetic Treatments To Try in 2023 ### The Science Behind JUVÉDERM ### The Secrets To Having Healthy Skin At Any Age  ### The Truth About How Melanoma and Breast Cancer Are Related ### The Truth About Summer Sun Exposure: Debunking the Biggest UV Myths ### Top 5 Skincare Tips For Any Age  ### Treat Yourself This Valentine’s Day! ### Two Locations, One Mission: Your 2026 Holiday Glow Guide and Year-End Reflection ### Understanding Eczema: Tips for Managing Flare-Ups During Fall & Winter ### Understanding Preventive Skin Checks: What’s Covered, What’s Not, and Why ### Understanding Psoriasis: Causes, Triggers, and Treatment Options on the Central Coast ### Understanding the Connection Between Stress and Skin Health ### Valentine’s Day Self-Care Starts with Healthy Skin ### We’re All-In On ZO This Year: Here’s Why ### What You Need To Know About RHA® Filler ### Why Annual Skin Exams Matter: Early Detection Saves Lives ### Why Fall is the Best Season to Start Laser Hair Removal (and Other Laser Treatments) ### Why To Try RHA® Filler  ### Your 2026 Body and Skin Goals Start Now