Laser dermis resurfacing is not a brand new process. CO2 fractional laser laser ablation has existed for 25 years. Despite the fact that laser ablation had been fine for lines and wrinkles, acne scars, sun-damage or elastosis, there was clearly significant risk of bacterial infections, scarring damage and melanin modifications. The side-effects caused this kind of CO2 laser treatment to fall from with laser clinics and subjects as well.

The idea of fractionated laser technologies has been available since ‘04. Basically, Fraxel treatments is where a tiny part of your epidermis to be treated while the all of the intervening areas won’t be ablated. These untouched areas of dermis around the pinholes provides for rapid recuperation.

The minute Fraxel treatments ended up being combined with with a carbon dioxide laser, interest in the aesthetic marketplace catapulted. There are many explanations for this reaction:

1st, there is less recovery time.

Conventional CO2 laser ablation methods carried extended recovery times of around five weeks. Several clients can have erythema (redness) present for up to eight months.

With Fraxel CO2 solutions, your down time is anywhere from 3 to 6 days depending on the power applied. This kind of fast recovery delivers a superior degree of expediency for the ordinary client.

2. Less risk of secondary complications.

Utilizing old-school ablation laser procedures the risk of contamination, damage like hypertrophic scars and pigment variations of hypo or hyper pigmentation had been a lot more widespread even with veteran cosmetic dermatologists.

Due to the fact new fractional CO2 procedures leaves all of the surrounding skin in one piece, the dangers affiliated with this kind of procedure are significantly less.

3. Success.

Though much less of a impressive final result as compared to old-fashioned CO2 laser treatments, that lowered hazard and really good results help make fractionated laser treatments an attractive laser. In comparison to fraxel lasers, fraxel CO2 lasers deliver improved dermis tightening.

Fractional CO2 laser treatments could be repeated as well. For scarring damage, it generally calls for three procedures to decrease any the scar tissue.

There are various Fraxel CO2 lasers on the market:

1. Smart Skin by Cynosure. This unique laser runs to 30 W with a two millisecond period. There are numerous variables which can be picked so the procedure is customized for each and every person.

2. Active FX and Deep FX by Lumenis: This fractional skin is likewise common, yet there can be a couple different treatment sizes which need to be switched out during a treatment.

3. Fraxel Repair from Solta: This laser skin penetrates quite deeply. Make certain you look at an expert skin clinic, as the greatest rate of troubles are already associated using this laser because of the amount of penetration.

4. eCO by Lutronics. This laser skin will be attaining traction inside quite a number of medical offices and utilizes a disorder concept which can be good.

These might be the major fractional CO2 lasers that are typically though of as superior lasers which seem to be easy to use and demonstrate successes. Now there are additional lasers, even so, many can be lower powered and / or case studies tend to be lacking.

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3-D imaging has emerged as a modern method that helps cosmetic surgeons and patients visualize outcomes.  There is a high demand for a tool that allows people to see what they might look like after cosmetic surgery.  The old days of red and blue tinted glasses are gone, and the newest version of 3-D uses sophisticated computers to create lifelike images. Disney, Pixar, and Dreamworks have brought three-dimensional animated features to movie theatres, with blockbuster reviews. Patients are often surprised to find the same technology used in films like James Cameron’s Avatar in their cosmetic surgeon’s office.

Most commonly, 3-D simulations are used to imagine breast augmentation, nose reshaping, and chin sculpting.  Dr. Charles Mok at Allure Medical Spa has been using this tool for the past year and it has changed the way he does consultations with patients.  ”The 3-D simulator helps me to communicate in a specific way and set the patient’s expectations.  When they are realistic about what can be achieved with surgery, they are much happier after having a procedure,” says Dr. Mok. Michelle, mother of four, knew she wanted breast augmentation but was apprehensive about the size; using 3-D imaging we were able to show her what she could expect to look like.  ”After seeing what my outcome would look like and comparing three different sizes.”

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A few more reasons to kick the habit…

Smoking can make your teeth yellow, dull your skin, make your hair stink, and emphasize little lines around your mouth. But the drawbacks aren’t just an above-the-neck issue.

A University of Michigan study found smoking has an aging effect on every inch of skin. According to researchers, the total number of packs of cigarettes smoked per day and the total years a person has smoked is linked with the amount of skin damage a person experiences from head to toe.

In the past, several studies had been done to measure the premature skin-aging affects of smoking, but they were focused mainly on the face. This is the first study of its kind to show that cigarettes can actually cause your entire body’s skin to wrinkle, yellow and become coarse.

Although there are treatments to help undo these unattractive effects, your appearance, and more importantly, your health, will be better if you simply stop smoking or never start.

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Active FX laser skin resurfacing is gaining popularity at medical spas, laser centers and skin clinics. It’s main competitors are Thermage, Fraxel, and other skin tightening or laser skin resurfacing treatments.

Here’s an overview of Active FX and some links to more information.

The goal of laser skin resurfacing is simple: replace damaged skin with new, fresh skin. Techniques for skin resurfacing have made enormous advances, allowing nearly everyone to achieve close to flawless complexions. Many systems allow for light, moderate or deep laser resurfacing. The primary targets of laser skin resurfacing include:

• Fine lines and wrinkles of the face, especially around the upper lip, cheeks and forehead
• Loose eyelid skin
• Crow’s feet around the eyes
• Pucker marks (smoker’s lines) and frown lines
• Brown spots and splotchy, uneven skin tone
• Scars, especially acne scars
• Loose skin around the neck and jowls

How it Works

One of the standard laser resurfacing systems, the UltraPulse® CO2 laser delivers thousands of tiny laser pulses in a pattern over the skin. Each pulse heats a column of tissue eliminating pigment discolorations at the surface and creating a zone of heating deep in the tissue. Unique to the UltraPulse Encore, these zones of heating shrink collagen and tighten the skin immediately*. The CO2 laser also offers the benefits of heating deeper layers of skin tissue, thereby stimulating collagen remodeling, tightening* the skin further. Patients can select from a range of treatments depending on the needs of your skin and lifestyle.

What is ActiveFX “fractional” laser resurfacing?

ActiveFX is a fractional laser procedure performed in a single treatment with minimal patient downtime. During the procedure, a high-energy beam of laser light is used to smooth out lines, wrinkles and scars, remove brown spots and other irregularities, and tighten the skin. It also stimulates formation of new underlying collagen to continue improvement over time. With fractional laser treatment, only a fraction of the skin’s surface is treated by the laser, leaving small “bridges” of untouched skin. This technique makes the healing process much faster and enables you to get back to normal activities sooner.

Is ActiveFX right for you?

Treated areas should be washed twice a day with cool water and a mild soap. Use our lotion twice daily to treated areas for 3 to 5 days or until healing is complete. Treated areas should be protected from direct exposure to sunlight. Sunscreen with SPF greater than 15 should be used at all times on the treated areas.

ActiveFX is ideal for you if you:

• Have a busy lifestyle or cannot be away from work for a long time
• Want noticeable results with minimal downtime
• Want to treat dyschromia, fine lines, wrinkles and skin laxity

What you can expect from ActiveFX

Most physicians perform the procedure in the office with a topical anesthetic cream that is applied 30-40 minutes before the ActiveFX procedure begins. There is little to no pain associated with the procedure – most patients say they feel warmth similar to sunburn. You can drive yourself home after the procedure. With a gentle washing and moisturizing regimen, your photodamaged skin will begin to flake off within 2 days. After about 3-5 days, your doctor will probably let you wear make-up. Pinkness should be gone in about a week.

ActiveFX benefits

ActiveFX treatment produces a dramatic effect on the skin:

• Causes immediate skin tightening
• Reduces wrinkles and fine lines, and softens deeper frown lines
• Noticeably improves skin tone and texture
• Stimulates new collagen formation and plumps the skin

The results of ActiveFX laser treatment are long-term and, with proper sun protection, can persist for many years. Most effects of treatment become visible right away, whereas others – such as new collagen formation, which leads to continued inner tightening – build up gradually and become more evident over time. Therefore, most people look even better 3-5 months after the procedure.

Additional Information on ActiveFX

http://www.aesthetic.lumenis.com/wt/page/activefx

http://www.lumenis.com/wt/page/pr_1170434066

Redness after IPL & Laser Treatments: DeepFX & ActiveFX

Reliant UltraPulse Fractional CO2 Laser

For Physicians using Active FX: Medical Spa MDs Physician user groups.

Active FX: Physician User Group ~ Medical Spa MD

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In principle, there's no difference in clinical outcomes bet the Thermage TC and the Thermage NXT. However practically speaking there is because of the shorter lapse time between pulses on the Thermage NXT machine that one can get better results from it than from the Thermage TC.

The effective clinical targets are to heat collagen containing dermal layer to 56-60 degree celsius AND to maintain such temp range for 1-2 mins (though my goal is 2-3 mins long). Therefore the more rapid pulse firing of the NXT device would make it easier for the treater to "get there and stay there" more efficiently. Personally, I don't have such problem using the TC device (by the way, I have both devices). When using the TC device, you want to make smaller sections on the face or abdomen or wherever then start and finish one section at a time. Make sure that within each section that any treated 3cm square per pulse is "re-pulsed" within 30-60seconds, this will ensure that any heated square will be effectively brought to the correct temp range and maintained there for those 2 mins.

One more thing you asked was about the Alma Accent, it is of the "same" monopolar RF platform technically speaking combined with bipolar RF. The difference which I see is with Thermage tips you know for sure they deliver the RF at consistent depth (2.4 mm or 4.3mm depending on the tips STC or DC). With the Alma Accent, I don't think the company has been able to provide the exact information on this thu I heard the depth was about 2.4 also but not any deeper.

More discussions about Thermage and Fraxel at Medical Spa MD.

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Within the last few years the technologies around cosmetic Fractional Skin Rejuvenation or Fractional Laser Skin Resurfacing has changed to eliminate many of the older technologies shortcomings. The erbium laser used in the Starlux is divided or ‘fractionated’ into many tiny micro-beams which treats only a portion of the skin (think tiny pin pricks) and leaves the surrounding skin intact and greatly improves the healing time.

These ‘fractionated’ treatment areas are referred to as micro-treatment zones and cause just enough injury to the layers of the dermis to trigger new collagen production and stimulate the replacement of collagen damaged by aging and sun exposure. This production of new collagen ‘fills in’ or ‘plumps’ the underlying dermal tissues and smoothes wrinkles. The surrounding, untreated skin speeds the healing process to a mere 3-4 days. Since most of the pigment cells remain intact, hypo pigmentation is effectively prevented.

Starlux 1540: Palomars New Fractional Non-Ablative Laser Resurfacing Technology

The Fraxel and Starlux 1540 are non-ablative lasers that don’t actually vaporize or remove the skin. Instead, the laser instantly heats the skin, stimulating new collagen growth.

Results for skin laxity and wrinkle smoothing are less dramatic than with ablative lasers, but the benefit of reduced recovery time and reduced side effects are mean that non ablative laser treatments are often the patients first choice.

Starlux Fractional Ablative Laser Resurfacing In The Near Future

Starlux 2940 fractional ablative lasers now provide the benefits of fractional treatments (less down time and reduced complications) with ablative skin resurfacings benefits (better wrinkle removal and facial rejuvenation) offering patients the best of both worlds.

These newer fractional ablative lasers remove tissue in the micro treatment zone instead of just heating the dermis like the old Fraxel or Starlux 1540.

The benefit of this new form of fractional laser ablation is that more wrinkled, sun damaged skin is removed than with the older laser technologies, and a better cosmetic result is attained. There is some increase in recovery time with redness and pink skin for around 5-6 days. The Starlux fractional ablative lasers still require much less recovery time than the old non fractional erbium and CO2 ablative lasers which actually burned off the top layers of the dermis.

Competing Fractional Laser Technologies

Reliant (the company that makes Fraxel) has launched a new CO2 fractional laser called Repair

Lumenis: CO2 fractional ablative lasers; ActiveFX & DeepFx

Palomar: Starlux 2940 Erbium fractional ablative skin resurfacing laser. Author Resource:- Medical Spa MD is a cosmetic medical community of Plastic Surgeons, Cosmetic Dermatologists, and Aesthetic Physicians with more than 3,500 physician members. Medical Spa MD offers wholesale Botox online and provides information on nonsurgical cosmetic medical technologies and treatments.

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Medical Spa MD is now publishing training manuals and books for laser clinics, plastic surgery centers and dermatology clinics.

These medical spa training eBooks are designed specifically for medical estheticians, cosmetic laser and IPL technicians and front desk staff, to provide a consistent environment for new hires and keep the staff informed the latest cosmetic treatments.

It's part of an evolving plan to be able to monetize the huge community of plastic surgeons, dermatologists, laser clinics and medical spas that are part of the community at Medical Spa MD. There are more than 4,000 physician members running laser clinics, medical spas, and skin clinics, and around a million and a half targeted page views, most of which are from physicians (although non-physician numbers are growing).

Medical Spa MD is a community that was started a few years ago and I think it demonstrates how effective you can be if you have information that is not generally available, and know how to build and motivate an online community. Medical Spa MD will never make me rich, but it's an asset that accrues increasing value over time and more than pays for itself with new opportunities.

Medical Spa RX is the sister site to Medical Spa MD and allows these same dermatologists, plastic surgeons and laser clinics to buy wholesale Botox, Juvederm, Restylane and Dysport from Canada and distribute it world wide.

But perhaps the greatest value of Medical Spa MD is simply the trust and goodwill we've grown among physicians. Medical Spa MD's influence and reach is very long, as attested to the numerous leagal threats, phone calls from lawyers, and cease and desist letters we've received.

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Facelifts have become a common cosmetic surgery for men and women. But surgery patients face a number of unwanted effects. Scarring, extensive recovery time, that artificial "stretched" look, and a permanent result that may be unwanted.

Fortunately, newly developed medical alternatives offer results to people wanting look younger without going under the knife.

As a leader in non-invasive cosmetic medicine, many medical spas, laser clinics and skin clinics now specialize in innovative new medical treatments for a youthful lift without the messy and painful recovery. Some medical spas have developed a unique non-surgical facelift for patients looking to gain the dramatic results of a surgical facelift but avoid a surgical facelift. Non-surgical facelifts include Thermage or Fraxel Skin Tightening followed by their signature Surface Point Lift as the non-invasive, yet exceptionally effective substitute for any surgical facelift. (Botox is also used.)

Thermage is an FDA approved radio-frequency technology that has been proven to tighten and contour the skin and its many underlying tissues without surgery. The treatment has the added benefit of stimulating the growth of new collagen throughout the skin. But there's a caveat. Thermage results are highly dependant upon the way the treatment is administered. Surface has developed specialized protocols that produce results that attract patients from other areas of the country who are looking to achieve maxim results.

Nonsurgical facelifts can be just as spectacular.

Point Lifts were created by specialists in non-surgical cosmetic medicine to replace the traditional invasive facelift. It can also be used for brows, jaw lines, necks, breasts, and even the derriere. They're perfect for the patient who does not want to undergo the harsh effects of a traditional surgical facelift including the associated, frustrating recovery period. Point Lifts are a physician procedure that "lifts" the treatment area in exactly the same was as surgical lifts, only there's no surgery.

The procedure involves placing a small, special suture under the skin through a tiny needle hole, leaving the skin to smooth with its own tension. The theme here is "No cutting. No stretching. No Stitches. No scars!" Most importantly, Point Lifts will not leave the face with that "stretched look" of traditional surgical lifts. Patients can resume their normal activities immediately with only minimal discomfort. Best of all, Point Lifts are completely reversible. Most people never knew they could have a fresh, younger lift without the troubles of surgery.

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Thermage is FDA approved for tightening and thickening skin without surgery. This non-invasive choice is particularly attractive for patients who don’t want to undergo the more drastic effects of a traditional surgical facelift and its associated recovery period.

Thermage uses a radiofrequency (RF) technology to heat the deep layers of the skin while protecting the skin’s outer layers with a cooling cryogen spray. This deep heating promotes immediate collagen contraction beneath the skins surface and generates new collagen growth over time.

Thermage: Key Points

• Thermage is approved by the FDA for skin tightening and collagen growth.
• Thermage provides an alternative to traditional surgical face lifts.
• Thermage not only treats existing conditions, but is also a preventative treatment for future problems including wrinkles, loose skin and collagen loss.
• Thermage can treat any area of the body but is most commonly used on the face, around the eyes and forehead, cheeks and jowls, and the neck. Results actually increase over time. With maximum results usually achieved up to 6 months after the treatment.
• Thermage “Vectoring” can be used for more specific results. Vectoring uses a second, double row of pulses to tighten skin along specific lines or “vectors”. In this way we can perform eyelifts, neck lifts, bags around the eyes, crows feet, or any part of the face where loose skin is unwanted.

Thermage: Key Benefits

• Thermage tightens skin and stimulates new collagen growth.
• Thermage can be performed in 2-3 hours under local anesthetic.
• Thermage actually “tightens” skin rather than stretching skin.
• The results look completely natural
• The cost is less than traditional, surgical facelifts
• The results are very long lasting or permanent.
• Additional treatments can maximize the effects or just maintain results.

Thermage: Benefits in comparison to traditional surgical face lifts

• No cutting. No stretching. No stitches. No scars.
• Thermage requires no physical recovery time.
• The skin is tightened rather than stretched, eliminating the pulled look that can happen with traditional face lifts.
• The chance of complications or infection is almost nil.
• Thermage can be combined with other treatments like filler injections and Pointé Lifts for more dramatic effects.

Possible Complications with Thermage Treatments:

Thermage complications are very rare. The device contains three computers that constantly monitor the amount of energy being delivered. However, as with any medical treatment there exists the possibility of other results, including:

• Burns; in clinical trials for Thermage less than 1% of patients received any burns. (There were only two that healed completely and without complication). At Surface, we have never seen a burn.
• The effect is less dramatic than the client wants: However, Thermage can be used as a treatment more than once. Results can be improved or enhanced with additional treatments like Botox or Surface Pointé Lifts.

NOTE: Thermage has received mixed reviews from both patients and physicians. In our opinion this is because of the way that Thermage has been marketed to physicians as an "add-on" to their practice. Thermage results are highly dependant upon the treatment you receive. While Thermage is now widely available, our recommendation is that you only have a Thermage treatment from a physician who specializes in non-surgical cosmetic medicine and has a laser clinic, skin clinic, or laser treatment center with experience with this treatment.

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Laser Hair Removal Clinic Procedures

Generally, most IPL treatments technically operate the same way when performing a hair removal procedure. The parameters on the cosmetic laser or IPL (joules, milliseconds, pulse, etc.) should be set according to the skin analysis and history performed on the patient.

It is important to instruct clients not to wear dark clothing near the area to be treated as the pigment in the clothing could potentially be absorbed by the Intense Pulsed Light Device (IPL) or cosmetic laser light and can result in a burn. The patient should be instructed to refrain from using any body washes, lotions, cosmetics, or any skin medications the day of the treatment.

Some patients may prefer to have a topical anesthetic applied prior to the procedure. If any residue of the anesthetic remains, it should be wiped clean from the skin. Often a cooling gel or other cooling apparatus is applied to the skin.

A spot test should be performed on the intended treatment area. (Small white sheets of paper with perforated holes are often available for spot testing patients.) In the spot test procedure, the test paper is placed over the area to be treated and one firing of the laser or IPL device is applied over the hole in the paper. After waiting 10 to 15 minutes, the area is checked for unusual redness swelling, bruising, or any other undesirable responses. If the area emits a slight reddish hue with no other abnormalities, the device settings are optimal.

Some cosmetic lasers or IPLs require a second pass over the treatment area with different settings.

Hair Removal Clinic: Post Treatment

After a aesthetic laser or IPL hair removal treatment he patient may experience a mild burning sensation and redness following the hair removal procedure. This is can be expected and can be relieved by applying ice packs and an oral anti-inflammatory or pain medication if warranted by the physician. Exposure to ultraviolet light (sun, tanning beds/booths) should be avoided. A sunscreen with an SPF 20 UVA and UVB protection should be applied to the skin prior to leaving the office.

In the case of burning or blistering a topical antibiotic medication should be applied and the skin clinics physician should be consulted.

Unfortunately, some patients may experience temporary pigment changes such as lightening or darkening of the skin.

Laser hair removal clinic patient education: The patient should be made aware that an actively growing hair is the only follicle which will respond to IPL treatments. In the weeks following the procedure, the portion of the hair which remains under the skin (after shaving prior to the procedure) will be be expelled. The patient will begin to see these hairs protrude from the follicles which may be misinterpreted as hair regrowth. This is especially more noticeable in areas of the body which has thicker or more coarse hair such as the armpits and genitals.

Laser hair removal patients should also be informed that no laser or IPL device can destroy all of the hair follicles… especially after only one procedure. Some hairs are in their dormant state and can’t be treated, some have been placed into a prolonged dormant state due to the procedure effects, and others have been transformed into vellus hairs (light, fine hairs). Several treatments are required at monthly intervals for an optimal outcome. A maintenance procedure performed at yearly intervals is recommended for permanent hair removal.

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The true work horse of a medical spa, this Palomar Starlux was purchased in 2006 for $150,000, but you can save more than 70%!

This IPL Starlux Includes:

Palomar Starlux 300 Series II IPL
Palomar IPL stand
Power supply
IPL / Laser Glasses
Chlller Fluid
Original paperwork, instructions and DVDs

4 HandPieces (Each of these retails for $7,000 – $10,000)

RED LuxR pulse count: 91,682
PURPLE LuxV pulse count: 2,593
GREEN LuxG pulse count 58,726
YELLOW LuxY pulse count 39,444

FREE Shipping: Up to $300

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Skin laser clinics are medical businesses that provide non-surgical cosmetic treatments and include laser clinics, medical spas and other medical centers that are operated with some form of physician oversight and differ from day spas in that offer medical treatments.

Skin & laser clinics usually offer very high end skin care.

The use of nonsurgical technology also differentiates medspas and laser clinics from traditional plastic surgery. Laser hair removal, IPL and laser treatments, Fraxel, Thermage, Botox, Restylane and other popular cosmetic treatments are usually offered.

With the addition of nonsurgical technology solutions that don’t require surgery, cosmetic medicine is now being offered in a growing number of general medical practices.

Medspas, skin clinics and laser centers usually have blogs as part of their web sites and use it as a means of communication with existing patients and patient marketing.

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Bikini line laser hair removal can be classified in four types that has variable names depending on the skin clinic visited.

• American bikini line is removal of hair at the top of the thighs and under the navel when wearing a bikini. It is also known as a basic bikini wax.
• French bikini linie leaves a vertical strip in front (a landing strip), two to three finger-widths in length just above the vulva. It is also known as a partial Brazilian. Hair of the peri-anal area and labia may be removed. Removal of hair from these areas is also known as the Playboy wax or G-waxing.
• Brazilian laser hair removal refers to a removal of everything, front to back, while sometimes leaving a thin strip of hair on the pubis. An extreme form of bikini line laser hair removal, it involves complete removal of hair from the buttocks and adjacent to the anus, perineum and vulva (labia majora and mons pubis). Waxes that remove all of the pubic hair are known as a full Brazilian wax, full Bikini wax, Hollywood wax or the Sphinx.

Further subgroups for laser hair removal around the bikini line:

• The Bikini Line: This is the least extreme form. All pubic hair covered by the bikini is left in place. Only straggling hairs on either side are removed, so that none are visible when a bikini with high-cut sides is being worn.
• The Full Bikini: Only a small amount of hair is left, on the Mount of Venus (the mons pubis)
• The European: All pubic hair is removed ‘except for a small patch on the mound’.
• The Triangle: All pubic hair is removed except for a sharply trimmed triangle with the central, lower point aimed at the top of the genitals. It has been described as ‘an arrowhead pointing the way to pleasure’.
• The Moustache: Everything is removed except for a wide, rectangular patch just above the hood at the top of the genital slit. This is sometimes called ‘The Hitler’s Moustache’, sometimes ‘Chaplin’s Moustache’.
• The Heart: The main pubic tuft is shaped into a heart symbol and may be dyed pink. This is a popular style for St. Valentine’s Day, presented as an erotic surprise to a sexual partner.
• The Landing Strip: The central hair is trimmed into a narrow vertical strip and all other pubic hair is removed. This has become popular with models who must wear clothes or swimsuits of an extreme narrowness in the crotch region.
• The Playboy Strip: Everything is removed except for a long, narrow rectangle.
• The Brazilian: This is the most famous bikini line hair removal but there is some confusion about its exact form. To some it is the same as the Landing Strip, leaving only a ‘vertical stripe of hair’. To still others it signifies the removal of all pubic hair.
• The Sphynx: This is unambiguously the ‘everything off’ style, leaving a completely hairless pubic region. The name is derived from that of a naked breed of cat from Canada. The smooth-skinned, hairless Sphynx Cat was a genetic oddity discovered in Toronto in 1966. Some skin clinics refer to ‘the Sphynx’ as ‘the Hollywood’.

Bikini Line Laser Hair Removal is a post from: Skin Clinic MD

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