How to look your best, on the best day of your life

From: Khalil A. Khatri, MDMelissa McCartney, PA-C Skin and Laser Surgery Center of New EnglandNashua, NH

Whether your big day is over a year away or in just a few months, there are steps you can take to look your best and improve the appearance of your skin. The options are wide and adaptable to your time constraints and budget and can range from non-invasive creams and peels to more involved laser and surgical treatments.

Before you take steps on your own you should see a qualified dermatologist. You want the best person, not the cheapest "doc in the box" to treat you. After all, this is your time to shine! Make an appointment for a consultation so your skin is examined in the right atmosphere, right light by the right doctor.

The most basic preventive measure that all brides should follow is using a sunscreen and a topical retinol daily. Whether it is July or February your skin is exposed to the damaging ultra-violet rays of the sun which can cause and worsen fine lines and sun spots. The daily use of a moisturizer with sunscreen will help for years to come. Nightly application of a retinol cream will freshen and give a "glow" to the skin. Retinols work by exfoliating the most superficial layer of skin which helps improve the appearance of sunspots and uneven pigmentation as well as fine lines and wrinkles. These are treatments that you can do yourself. An additional option for overall improvement in skin tone and texture is the use of chemical peels. Chemical peels range in strength; some brides may desire a more gentle series of superficial salicylic acid peels with no down-time whereas women with more extensive sun damage may prefer a deep trichloroacetic acid (TCA) peel. Salicylic acid peels are done every 2 weeks and six peels are recommended but not required, for best results. A TCA peel is typically done just once but the recovery time is about 5-7 days. Peels require time to improve the skin so it is best to have them done at least several months before your wedding to allow for optimal healing time.

When people think of wrinkles they often think of Botox. Botox is safe, highly effective, and wonderful at improving the appearance of fine and deeper lines. It takes a few hours to a few days to work and lasts 3-4 months. It is also great for prevention of wrinkle progression. The wedding planning process can be a stressful one and having Botox done at regular intervals, can prevent those "worry lines" from sticking and becoming deeper wrinkles. Another common use for Botox is the treatment of excessive sweating. This embarrassing problem is the last thing a bride should have to worry about on her big day. One treatment of Botox in the underarms, for instance, can keep the area relatively dry for 4-6 months. A bride should plan on having Botox treatment done at least a month before the wedding in order to allow enough time for the Botox to take effect. Another issue that women often complain of is the "parentheses" around the mouth that can develop as early as the mid-20's. Fillers are an easy solution to this problem and should be done at least 2-4 weeks before the wedding to allow time for any resultant inflammation or irritation to subside. Some common fillers in use are Restylane, JuverDerm, etc.

The use of lasers is very popular for skin rejuvenation. With ever-evolving laser technology, there are a large number of lasers that can be used to improve skin color and texture. It is recommended to see a doctor who has specific training is use of all lasers. There are lasers that are used for specific conditions and one should find a doctor who knows which lasers would be most effective for each desired outcome. One should avoid places that use one "magic" laser for everything, especially right before the most important day of your life.

Lasers vary in their potential for improvement. A quick fractional non-ablative laser treatment with little or no downtime, can give a fresh glow to skin. Whereas, a fractional ablative laser treatment will improve skin texture significantly but requires numbing cream and about 4 days downtime. A full ablative laser skin resurfacing gives the best improvement in skin texture, wrinkles and acne scars but needs injection of local anesthetic and a week of downtime. There are specific lasers that can be used to remove brown spots. These treatments are quick with little or no down time but it takes 6 weeks to see results. All laser procedures should be performed several weeks/months before the event. Same is true regarding laser hair removal, which may be desirable before the honeymoon!

If you are a bride-to-be who experiences frequent or even just occasional acne break outs, it is best to get to the dermatologist as soon as possible to allow for adequate treatment time. Acne can often leave behind red marks and whether you have residual redness from acne, red rosey cheeks from Rosacea, or just an apparent broken blood vessel, pulse dye laser (PDL) is an excellent treatment option (see figure 4). Most people usually require 2-3 treatments for best results and brides should plan on starting the treatment process at least several months before the wedding. Unsightly leg veins can also be treated with lasers and Sclerotherapy.

Most wedding gowns expose the back and "bra bulges" can be embarrassing. "Laser- Lipo" is a very safe way to remove them but needs about 3-6 months to see the best results (see figure 6). Some people get lose skin around eyes that makes them look old and tired. A combination of surgery to remove excess skin and fat, and laser resurfacing can give a young and a vibrant look.

As evident from the above discussion there is no shortage of treatment options for brides hoping to improve upon their appearance in time for their big day. These procedures can also make the mother of the bride and others look their best too!

If any of the above procedures interest you please come by and see us at the Skin and Laser Surgery Center of New England. We have over 20 different lasers that can be used for various different conditions. We also house the New England Institute of Laser Research where we develop new laser technologies for future use. This is the only laser center with a large number of lasers and its own laser research center. We would be delighted to help prepare you and your family members for your big day. You can reach us at 603-886-5506 and learn more at www.skinlaseronline.com.

Procedure	What it Treats	Numbers of Treatments Required	Associated Down Time	Length of time to allow before wedding
Chemical Peels: a) Salicylic Acid b) Trichloroacetic Acid	Sun damage, fine lines and wrinkles, uneven pigmentation	a) 6 recommended for optimal results b) 1	none 5-7 days	At least 3-6 months for both
Botox	a) wrinkles and wrinkle prevention b) excessive sweating	1 every 3-6 months for both	none	1 month
Fillers (i.e. Restylane, Juvederm)	Facial “parentheses”	Varies filler to filler	none	2 -4 weeks
Non-ablative Fractional Resurfacing	Gives an overall fresh glow to skin	3 for best results	None -2 days	3-6 months
Ablative Fractional Resurfacing	Skin tone and texture	1	4 days	3-6 months
Ablative Resurfacing	Skin tone, texture, wrinkles and acne scars	1	1 week	3 -6 months
Laser Tattoo Removal	Sun spots (brown spots)	1	None – few days	6 weeks +
Pulse Dye Laser	Red spots, broken blood vessels, rosacea	1-3	None-1 week	3-6 months
Sclerotherapy	Leg veins	1-3 on average	None	3-6 months +
Laser Lipo	Unsightly bulges	1	None	3-6 months
Laser Hair Removal	Dark hair	5-7 on average	None	6 months or more for best results