A growing number of people are interested in laser treatments to remove unwanted hair, wrinkles, scars, brown spots, stretch marks and other skin imperfections. Cosmetic laser skin treatments is one of the fastest growing and most lucrative areas of dermatology. In many states, most treatments are barely regulated and offered in both doctors’ offices and day spas.

Are you considering cosmetic laser treatment or surgery? How well-trained is your doctor and are procedures in day spas safe?

Join Dr. Eliot Battle of Cultura Cosmetic Dermatology, Plastic Surgery & Laser Center to discuss the pros and cons of cosmetic laser skin treatments.

Send your questions now or during the discussion.

Battle is a cosmetic dermatologist who specializes in cosmetic laser surgery. He is considered one of the world's top specialist for cosmetic laser therapy and his laser research at Harvard pioneered the safe and effective use of lasers on darker ethnic skin. He completed his dermatology residency and M.D. degree from Howard University and his laser fellowship from the Department of Dermatology at Harvard Medical School. Battle has published and lectured nationally and internationally on a variety of cutaneous laser surgery topics. He has been featured in numerous magazines and TV shows including TIME, Good Morning America, ABC's 20-20 and Primetime. He is a member of the American Society of Laser Medicine & Surgery, American Society of Dermatologic Surgery, International Society of Laser Medicine & Surgery, Brazilian Society of Laser Medicine & Surgery, European Society of Laser Aesthetic Surgery, American Academy of Dermatology and the National Medical Association.

Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.

washingtonpost.com: Good morning, we would like to welcome Dr. Eliot Battle to our discussion on laser treatments to remove anything from unwanted hair to wrinkles and skin imperfections. Dr. Battle, please describe three areas to look for when considering laser treatments.

Dr. Eliot Battle: The most important areas to look for when considering laser treatments is:
1. Make sure you are being treated by a experienced laser physician or under the direct supervision of the ONSITE physician.
2. Make sure the facility has numerous lasers so they can streamline the treatment to your skin color, tan level, and treatment need.
3. It is preferably to be screened prior to treatment and treated by a dermatologist or plastic surgeon to make sure that you don't have any suspicious looking moles that the laser might change the appearance of. For example, hair lasers can change the appearance of pre-cancerous and cancerous moles.

Potomac, Md.: Does laser surgery really remove wrinkles? How does it do that? Isn't the skin underneath just as loose as the skin on top? What do you think of those face muscle toning things they sell on TV? Does "exercising" your face muscles reduce wrinkles? Thanks.

Dr. Eliot Battle: There are lasers on the market that can make your cells that make collagen in the dermis thicker. This increase volume in the dermis (the foundation of the skin) will apply pressure from inside out and can smooth out wrinkles and acne scars.

Most face muscle toning machines do not work. Exercising your face muscles does not work to reduce wrinkles but exercising your face muscles for laughter is a great habit to start.

Detroit, MI: Dear Doctor, I'm a fair skinned male who is interested in get laser treatments to remove
hair and smooth skin. Can lasers effectively stop hair from growing out of one's ears without damage to one's hearing? And, I have several severe acne (pits) scars on my nose. How would lasers work to remove somwthing pitted?

Dr. Eliot Battle: If treated by an expert you can have the hair on your ears treated. Make sure you go to someone with experience in doing this.

There are many ways to treat acne scars. They can be treated with lasers to induce more collagen growth. As you increase the collagen you are applying pressure from the inside towards the outside. It's like blowing up a balloon. As you increase the volume you smooth out the surface.

Washington DC: Dear Dr Battle,
I am a 24 yr. old woman. I have no wrinkles around my eyes, but I do have 2 significant creases on my forehead. They seem to be getting worse as the years go on. Would botox therapy provide relief? These aren't wrinkles that any cream can fix. What are my options?

Thanks!

Dr. Eliot Battle: There are great new lasers that can improve wrinkles on the forehead. Botox stops the ability to create new wrinkles and soften the appearance of exsisting ones. Lasers can assist in filling in the wrinkles that exist. You need to make sure that the expert who treats you have the new generation of lasers that can safely treat the skin. At our facility we have 5 different lasers that can treat wrinkles so dependent on the type of wrinkle and your skin color we would choose the best option for you. Make sure who ever you go to has multiple laser options for the procedure you want.

Springfield Virginia: What steps have been taken to make sure that nobody else dies from anaphylactic shock, as my sons' friend (Jonathan Briese) did during a hair removal treatment?

It really scares me to think that people who aren't trained in rescusitation are performing these proceedures.

Dr. Eliot Battle: This reinforces the need to go to a Physician office to get these treatments. I'm amazed that people continue to go to these "laser centers" that non-physicians do the treatments without a physician on site. Physicans are trained in life support and emergency procedures. The terrible event that you mentioned is the only case in the country of this and the death was not because of the laser but because of the improper anesthetic that was used.

Arlington, VA: How long has laser hair removal been around and how well does it work on thick hair? Also, typically, how many treatments are required for complete removal?

Dr. Eliot Battle: I spent the last 3 years at Harvard Medical School's Wellman Laboratory of Photomedicine where hair removal with lasers was invented. We are now seeing patients who were treated 7 years ago who still have permanent hair removal. The darker the hair, the thicker the hair the better results we get. You usually need 3-5 treatments approx. 1 month apart to get the results you want. Again, you need to combine the right laser with a laser expert to get excellent results. At our center we have 5 different hair removal lasers so dependent upon your skin color, tan level, hair thickness and color I would choose the best laser for you. Going to a facility with only one laser for hair (and since these lasers cost approx $100,000 each - most facilities can only afford one) probably means you won't get the optimal results. Chose your experts wisely!

McPherson Square, Washington, D.C.: Hello, I am seriously considering having laser resurfacing to help make my acne less noticeable. What are some of the qualifications that I should look for in a doctor? Specifically, since this seems be becoming all the rage recently, how long does it take a doctor to become proficient at these types of procedures?

Thank you!

Dr. Eliot Battle: Great question:
You need to make sure that you are going to a physican who is both trained in skin (dermatology or plastic surgery) and who has extenive laser training (preferably at least a year fellowship doing nothing but cosmetic laser treatments.) As one of the laser experts I trained for over 3 years at Harvard under the renown Dr. Rox Anderson ( the inventor of the theory that is the foundation of all cosmetic lasers). You also need to make sure the center has multiple lasers that can treat your condition to make sure it is best for your skin type. There are many options to treat acne scars, make sure you investigate all of them.

Alexandria, Va.: I have discolored skin due on the back of my neck (looks like my neck is always dirty). I also have darkened skin around my ankles. Is there a procedure that will help this?

Dr. Eliot Battle: There are many ways to lighten darken skin including the use of lasers. You need to be evaluated by a dermatologist with laser expertise so you can be presented all the various options (bleaching, dermabrasion, chemical, lasers, etc.)

washingtonpost.com: To read more about laser treatments, please read the article Cosmetic Lasers: Facing Up the Risk

New York, N.Y.: I have dark spots on my legs and I have been getting laser treatment. Can I go in the sun after a treatment? Will my skin be thin and weak after completing laser treatment?

Dr. Eliot Battle: I'm not sure what type of laser procedure you had but the reason we ask patients to avoid the sun is that sun-tanned skin is more difficult to treat. We now have wonderful hair removal lasers that can treat all skin colors, even the darkest ethnic populations. My research at Harvard helped to pioneer the safe use of lasers on all skin colors and ethnic populations. The knowledge we gained from the research helped us to create lasers that are safer for tanned skin also. Again, choose your expert wisely. After most laser treatments (with the exception of laser resurfacing) your skin is unchanged. Idealy, within hours after being treated no one should be able to see any changes in your skin. The new generation of lasers can safely treat any skin color and ethnicity without side effects or temporary changes in skin color.

Arlington, Va: I did laser once and then i ran out of funds. After doing it once and stop I noticed the hairs grow back faster. is it in my head?

Dr. Eliot Battle: Hairs do not grow back faster even if you stop hair removal treatments before you were finished with series of treatments. Laser treatments can coordinate the growth of you hair (hair growth is in 3 stages - growing, resting and expelling ) such that all hairs can be in the growing stage, instead of spread out in 3 stages. So perhaps what you notices was the sychronization of your hairs all growing at the same time.

Washington, D.C.: How much should facial hair removal (lip, chin) cost, total?

Dr. Eliot Battle: This is one of my big concerns. I feel that patients are being over charged for treatments. We are physicians and should be charging a price that is fair, not "what we can get". Because most of the laser centers are set up by business-people to solely make a profit, then there concern is with profit and not patient satisfaction and fair pricing. When I bought my center (elan -
Washington, DC) my first speach to my staff was that this is a physician practice and our first rule is to do no harm. Harm can be done to the "wallat" by overcharging. A fair price for hair removal on the upper lip or chin is approx. $150 per treatment.

Springfield,VA: Can more hair grow if treated once or twice?

Dr. Eliot Battle: If you are treated with insuffient energy that is well below what is appropriate, then it can actually cause hair stimulation. This is one of the problems in going to a now expert or a spa. They usually have purchase inexpensive lasers or light devices that only produce low energy. These low energy devices can produce temporary hair removal but not permanent reduction. They also can stimulate hair to grow more. Again choose your expert wisely (have you noticed a re-ocurring theme yet :-)

georgetown: What is typical cost for hair removal in large areas legs/back?

Dr. Eliot Battle: Again, I feel patients are being over charged for these procedures. I can't tell you what prices other facilities charge, even with technicians and non experts doing the treatments but on average they are charging $1500 per treatment. At my center we charge less than half of that for treatment of the back or legs. Treating these areas take a long time so that is why the price is so high but still I feel a fair price is around $700.

Germantown MD: Good Morning. I am a great candidate for laser hair removal. Light skin, dark hair. I have undergone 5 treaments over 2.5 years for about $5K. Other than the discomfort during the procedure (and it does hurt, don't let anyone fool you), I experienced no other negative effects. The hair is less, but not gone by any means. I have two questions

1. Are the laser getting better and providing better hair removal results? I just can't see spending another 5K to get the results I currently have.

2. Why is pricing so hard to get over the phone? I have to switch providers because my provider (Plastic Surgeon) is getting out of the laser hair removal service. Price is an important point and should be for everyone, since it really IS NOT PERMANENT, why does it have to be such a mystery. "You must get a consultation", which costs, just to get pricing. It's worse than buying a car.

Dr. Eliot Battle: I'm sorry for your experience. There are over 100 different types of lasers. A doctor who bought a laser 5 years ago is probably still using it and still paying for it. He can't afford to by a new generation laser so he will probably still be treating patients with a less that ideal device. The new generation of hair removal lasers are wonderful and we get excellent results. On average, after 3-5 treatments you can expect over 80% of your hair to be PERMANENTLY reduced. I wouldn't trust any office that wouldn't provide me with pricing over the phone. We do. As I said and will keep on saying, pick your laser expert wisely. I was on ABC primetime last Thursday and reviewed video tapes when they went undercover to these "hair removal centers". I was shocked and amazed at what I saw and heard. It was worse than buying a car. I was embarrassed for my profession.

Philadelphia, PA: Dr. Battle,

I am a female with some hair growing on my breasts. It's not too furry, but thick and dark enough to bother me. Would laser hair removal in any way increase my risk of breast cancer or future ability to breast feed? Thanks!

Dr. Eliot Battle: No hair removal lasers are completlely safe in terms of underlying tissue. We are using wavelengths of light from the visible and near-infrared light spectrum that are harmless to cellular structure. They also would not effect breast feeding, now or in the future. The only side effects you can get is to the skin when treating someone with the wrong laser and/or the wrong parameters. If this is done the you can get blistering, discoloration and scarring. The darker your skin is the greater at risk you are for unwanted side effects. We have lasers that can treat any skin color so anyone regardless of skin color or ethnicity is now is a good candidate for treatment.

Bethesda, Md.: How does laser treatment differ from Botox in removing wrinkles?

Dr. Eliot Battle: Botox stops your ability to make wrinkles of facial expression and lasers help to fill in the static wrinkles that you have. It's like water dripping on a cement floor. Over enough time the water can make a hole in the flow. Botox stops the water from dripping (stops the ability to make wrinkles) but you still have a hole in the floor. Lasers help to fill in the hole (static wrinkles).

Foggy Bottom, Washington, DC: Can laser treatments cause the skin to become more elastic than normal or cause wrinkling? After treatment are you more susceptible to the damage that can be caused by exposure to sunlight?

Dr. Eliot Battle: Again it is hard for me to answer this general question. Lasers are used to remove hair, veins, wrinkles, scars, tattoos, birthmarks, freckles, etc. Each of these require a different type of laser and procedure. Some of these procedures can cause the skin to be more fragile and susceptible to damage (from trauma or sunlight).

Arlington, Va.: Hello,

I have couperosis and my cheeks get red very easily with temperature changes or spicy food, etc. I have had this problem since I was a child and would love to have a more even skin tone. I avoid the sun, do not drink alcohol and try to stay away from hot foods. My cousins and my sister have the same problem so it must be genetic. My grandfather had asthma and I was told it can be related. Is there any good laser treatment that can help reduce the redness? Thanks for replying to this question.

Dr. Eliot Battle: There are wonderful new lasers that treat vascular induced lasers on the cheeks. We have a laser here that is great to even out the complexion of the face. These treatments are also wonderful for patients who have rosacea, broken capillaries, dark spots from trauma and solar damages, etc. Again.....chose your experts wisely.

Phila., Pa. : What kind of treatment is most appropriate for lines beneath the eyes and "cross-hatched" fine wrinkles?

Dr. Eliot Battle: There are excellent new lasers that can reduce the wrinkles and lines beneath the eyes. These treatments are safe and you can expect that no one will know you have received a treatment within hours of the procedure. It will take a series of treatments (3-5) a month a part to get the results you are looking for.

Cincinnati, Ohio: Hi. Can laser treatment be effective for sun damaged skin?

Dr. Eliot Battle: Laser treatments are actually one of the best treatments for sun damaged skin. They are used to take away the discoloration that the sun has created. They can also remove the broken capillaries and blood vessels that sun damage can cause.

Alexandria, Va.: Is there any over-the-counter lotion, cream, whatever(!) that will help prevent new eczema from starting and help treat existing eczema?

Any other anti-eczema tips? Thanks!

Dr. Eliot Battle: Eczema is best treated preventively rather that once you get it. You really need a prescription strength steriod cream but you can use over the counter hydrocortisone cream to get some relief. Ways to help eczema is to use hypoallogenic washing detergents. Do not use bleach or fabric softners. Bath in luke warm, not hot water and keep your skin constantly moisturized. You need to make an appointment with a dermatologist who can further instruct you.

Washington, DC: Hello. I am getting laser hair removal tomorrow on my back. It is in a doctor's office (Clinic For Laser Hair Removal) but it is done by a technician (she has done this procedure for at least 3 years). I have been there for a consultation and the person has helped me to answer my questions and concerns. Is there anything I should look for at the office that might make me shy away? Are there any repercussion if they "mess up" or do the procedure incorrectly. Thank you.

Dr. Eliot Battle: I'm still not comfortable with technicians doing the treatments. For as much as you are paying I feel you deserve to be treated by either a nurse or a physician. You need to make sure that they have multiple hair removal lasers in their facility (and most don't) to ensure that you are getting the optimal results. The repercussion are numerous and include ineffective results, blistering, discoloration and scarring. Again...choose your eperts wisely.

Washington, DC: About 3 years ago my physician told me that lasers for hair removal were not safe or effective for people of color. Is that true? Also, I recently saw you on Dateline, and based on that show, I would like to know what should I do to ensure I receive safe and effective laser treatment?

Dr. Eliot Battle: I have lasers that can treat any skin color or ethnicity. It is much more difficult to treat people of color (Italians, Latinos, African-Americans, Asians, Indians, etc.) because the pigment in the skin wants to absorb the laser light which can produce the side effects. From my reseach at Harvard we have developed wonderful new lasers that can treat all skin colors safely. But even with these lasers you still need to be an expert. You need to make sure that the center has not only one of these very new lasers but as important that they have a VERY HIGH level of laser expertise. We have 3 hair removal lasers in our office that can treat patients with darker skin. I would choose one of these depending upon how dark your skin is, how tanned your skin is and what type of hair do you have (thick, thin, light or dark.) This is why it is crucial to go to a center that has multiple lasers that can be used on the procedure you need.

Columbia Missouri: I live in Missouri, how can I find a dermatologist who can address dark skin?

Dr. Eliot Battle: Excellent Question:
The dermatologist needs to have experience through residency and private practice in treating darker skin types. Expertise is learned through acadmeic experience and clinical experience. Combining this with laser expertise makes it even that much more difficult. The chance of finding this combined expertise is hard and with the inexpensive cost for airfare and transportation it might be worth while to consider to travel to the expert when you find them. I'm in Washington, DC, a wonderful city to visit :-)

Foggy Bottom, Washington, DC: Where do you see dermatological laser technology heading in the next 5-10 years?

Dr. Eliot Battle: The field is exciting. At Harvard we are working on lasers that can remove acne, melasma and even fat. Lasers will be getting more inexpensive and I hope that the physicians will pass on these savings to others.

More importantly, I feel that there will be very strong regulations regarding who can use lasers and treat patients. In 26 states, including MD and Virginia, almost anyone can purchase a laser and treat patients. Soon these procedures will be limited to treatment from physicians and appropriately trained laser nurses. It scares me when I see all the ads for laser treatment from centers that don't have the appropriately trained practitioners.

wdc: How prevalent is laser surgery on ethnic skin? Last time I spoke with my dermatologist, he said no one could remove my birth marks because I had very dark Indian skin and the treatments were geared toward Caucasians.

Dr. Eliot Battle: Because of the research I was involved in at Harvard over the last 3 years we now have created lasers that can treat all skin colors and ethnicities. Your dermatologist concern was just but slightly un-true. I and other laser experts can safely and effectively treat and remove your birthmark. Lasers were origially used only for the lightest Caucasians but times have finally changed.

Silver Spring, Md.: My dermatologist says NOTHING can remove stretch marks. Can laser treatments remove stretch marks on the hips and upper thighs?

Dr. Eliot Battle: We are doing research and actually seeing good results with lasers to improve the appearance of stretch marks. These "scars" create quite a challenge but I am optimistic at the results we are seeing. We are building on the success of stretch mark treatments in Brazil. They have been doing some exciting techniques and procedures for many years.

McLean:: Is laser treatment helpful for reducing redness from rosacea?

Dr. Eliot Battle: There are wonderful new lasers and light sources on the market that are great at treating rosacea. They target the redness and blood vessels. Again...choose your expert wisely.

Arlington, VA: What is the typical cost to have laser treatment done for facial acne scars? Does insurance typically cover it? I'm young and not wealthy but would like to look into it...

Dr. Eliot Battle: Unfortunately cosmetic laser procedures are not covered by insurance. I've been petitioning to the Insurance industry for them to re-visit their position. Depending upon the area to be treated on the face for acne scars, treatments cost from $150 to $500 per treatment and it usually takes 3 treatments a month apart.

Rockville, MD: Dr. Eliot,

At what age should one start having his/her fine lines removed? Where is your center?

Dr. Eliot Battle: My center is in the friendship heights area of Washington, DC (adjacent to Chevy Chase, MD) and is called Cultura (formly elan of Chevy Chase). We are located at 5301 Wisconsin Ave. Washington, DC Our phone number is (202) 237-9292. Lasers are used to treat excisting wrinkles and fine lines and can also be used to prevent wrinkles from forming. Patients as young as 18 are requesting treatments and as old as 85.

Southern Maryland: Hi, thank you for taking my question. After 2 pregnancies, I have numerous spider veins in my legs which I would like to have treated. When they were above my knees it didn't bother me too much but now they are also below my knees and very noticeable. Can you tell me how effective the procedure is to remove them, how long it takes, and whether there are any side effects? Also, how to find an expert in this area. Thank you so much!

Dr. Eliot Battle: The gold standard to treat leg veins is sclerotherapy but new lasers are now very effective also. We can remove 50-75% of leg veins after one to two treatments but sometimes it takes more. The main side effect you can unfortunately get is darkening of the area for weeks to months.

Washington, D.C.: Can laser treaments remove nose hair (the hairs that grow out of the nostril)? How painful is it?

Dr. Eliot Battle: Yes laser treatments can remove nose hair but this is a more difficult procedure and again you need to choose your expert wisely. We have many forms of anethesia to improve tolerance (creams, ice, etc.). You will feel anything from nothing, to rubber band snapping, or fine needles. It is not painful, just uncomfortable.

LaserBoy: I had serious acne when I was younger which left me with pockmarks. I am comfortable with myself, thankfully, but someone did mention that laser treatment might be a way of removing them. I checked it out with a local dermatologist in D.C., and she said it costs about $100 for laser treatment the size of a pencil eraser.

I didn't find the price abhorrent as much as laughable. Is this a reasonable and customary rate for the D.C. area? In your opinion, what should a treatment cost, and how large (pencil eraser-size seems much too small)?

thanks

Dr. Eliot Battle: To treat your entire face would be $500 per treatment and to treat your cheeks would be approx. $150-200 per treatment. The size of the laser tip varies with which laser we use.

Centreville, Va.: Dr. Battle, what safety precautions should one take when contemplating laser surgery? What are the health risks?

Dr. Eliot Battle: The major contraindications are recent accutane therapy and if you are on any medications that are increase your sensitivity to sunlight (e.g. tetracycline). Again, choose your expert wisely.

Minneapolis, Minn.: I have mild facial and eyelid rosacea and have noticed ads for laser treatments for this condition. Could you tell me more about this?

Dr. Eliot Battle: Rosacea is one of the many dermatological conditions that lasers can effectively treat. They target the redness (blood vessels) that are created by rosacea.

washingtonpost.com: washingtonpost.com: Unfortunately that is all the time we have for today. We would like to thank Dr. Eliot Battle for being here. If you would like to read any more about laser treatments, please read Cosmetic Lasers: Facing Up to the Risk.

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