IT'S THE DEAD OF WINTER and you're bundled head-to-toe in cozy, cold-weather gear. Under all those layers, how could anyone possibly see the sunspots on your arms and chest or the imperfections behind your knees? Dermatologists actually recommend treating leg veins, brown spots, and unwanted hair on the body in the winter—for a number of good reasons. Chief among them: vanity. Your favorite sweaters and opaque Wolfords conceal unattractive side effects (redness, bruising, swelling, and scabbing) from professional procedures. Plus, each of these complexion correctors demands sun avoidance before and after treatment to ensure the best results and to prevent complications like post-inflammatory hyperpigmentation or even permanent scarring. Finally, it can take months before you see the rewarding outcome. "If you begin vein treatments in June, summer may be over before you see the results," says Santa Monica, California—based dermatologist Dr. Ava Shamban. So start now, and you can bare flawless, rejuvenated skin on the first sunny day of spring.
SPIDER AND VARICOSE VEINS ($350—$1,000 PER TREATMENT)
THE TREATMENTS: Most visible leg veins are actually quite large and too deeply embedded in the skin for a laser to adequately penetrate, which is why sclerotherapy is the gold standard treatment. It involves injecting a concentrated saline or a detergent (a common practice and not as scary as it sounds) solution directly into the vessel to injure and destroy it. "The main difference between salt and detergent solutions is the pain factor," says Dr. Ellen Marmur, chief of Dermatologic & Cosmetic Surgery at The Mount Sinai Medical Center in New York City. Saline, although commonly used and very effective, tends to hurt—a lot. The latest FDA-approved sclerosant is Asclera (polidocanol), a detergent solution that's proved to be less painful during the injection. Once it's been obliterated, the body's inflammatory cells clear away the damaged goods so the vein eventually disappears.
WHY DO IT NOW?
DOWNTIME: "It's rare for someone's spider veins to go away after one procedure," says Dr. Tina Alster, director of the Washington Institute of Dermatologic Laser Surgery. "On average, it takes two to three treatments and one to three months for an area to heal before the residual blood vessels can be retreated." Total downtime: three to six months.
SIDE EFFECTS: After the initial redness, bruising and swelling abate in a few days, and a rusty-brown discoloration appears along the course of the vein that's been treated. "This is iron pigment from the blood, a positive sign that the vessel has collapsed and the blood is clotting and breaking down. It can last weeks to a year," Alster explains. (A pigment-specific laser can help clear discoloration faster.) As if a web of brown lines weren't reason enough to cover your legs for a few weeks, here's another: support hose. Pressure applied by wearing compression stockings for two to five days post-treatment helps accelerate the healing process. (Good news: Brands such as Ames Walker, Jobst, and Elly Carezza—all available online—make styles that look like your favorite opaque tights.)
SUN-RELATED COMPLICATIONS: "A suntan hides leg veins and makes it harder for the doctor to see the vessels that need to be injected," says Shamban.
BROWN SPOTS ($250—$1,500 PER TREATMENT)
THE TREATMENTS: "For getting rid of stubborn brown spots, lasers that pinpoint pigment spot by spot are by far the most effective," says Marmur. She recommends Q-switched lasers, which zone in on melanin, heat it up, and blow brown spots to smithereens. The explosive method causes the pigment to ultimately, but not instantly, disappear. A broadband light source (Intense Pulsed Light is one) or the new Fraxel dual laser is also used to address larger areas of diffuse sun damage.
WHY DO IT NOW?
DOWNTIME: "It takes one to three months to treat the spots," says Marmur. In most cases, it will take two to three sessions, spaced two to four weeks apart, to completely eradicate them. "A follow-up treatment has to wait until the area has healed so the doctor can see the faded spots that are left on the skin."
SIDE EFFECTS: A dermatologist always examines a brown spot for skin cancer before lasering it. Immediately after being zapped, the area of treatment turns ash white, then quickly becomes bruised and red. In a few days, a dark scab develops that will flake off in about a week. You're left with a light-pink patch that either disappears completely in a matter of weeks or becomes a faded version of the original spot, thus ready for a follow-up treatment.
SUN-RELATED COMPLICATIONS: Remember, they're called "sunspots" for a reason. "When a patient has her skin lasered to eliminate damage caused from frying it in the sun, it goes without saying that she'll be warned about going back into the sun," says Shamban. "You now have to be committed to practicing complete UV protection in order to prevent new brown spots from forming." You have to lose the tan before coming in for laser treatment, too. "Because it zeros in on darker pigment, the laser can burn and blister tanned skin," warns Marmur. "I tell patients to avoid the sun two weeks before any pigment-specific laser procedure, and two to four weeks after." People with naturally dark skin should be extra-cautious. "Using the wrong energy and wavelength can cause burning, discoloration, and scarring," says Alster.
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UNWANTED HAIR ($500-$1,000 PER TREATMENT)
THE TREATMENT: A pigment-specific laser zones in on its bull's-eye (in this case, dark hair inside the follicle) and destroys it with heat. Take note: White, blonde, and gray hair don't provide the necessary dark targets for the laser to hone in on.
WHY DO IT NOW?
DOWNTIME: Due to the hair's growth cycle, you can bank on a series of at least three consecutive monthly treatments. "Two-thirds of the follicles are in a resting phase, while one-third is growing," explains Marmur. "Only hair in the growing phase makes a good visible target, so a laser can wipe out just one-third of the population at one time."
SIDE EFFECTS: After treatment, the area becomes itchy, red, and bumpy (similar to a heat rash), and—get ready—tiny black hairs begin to emerge almost immediately. "These are the roots of the hairs just beneath the skin that are burning and lifting out of the follicles," explains Marmur. "It looks like stubble, and often people freak out because it seems that they've got more hair growing after treatment than they had before. The hairs will shed in a day or two, but for one to three days, the area can look worse than before."
SUN-RELATED COMPLICATIONS: For a few days after treatment, the inflamed skin is prone to hyperpigmentation and hypopigmentation (white spots). In fact, UV exposure before or after laser hair removal can be a recipe for a polka-dotted bikini line. Lasers that target pigment aren't selective, so they can burn darker skin along with the hair. "I won't treat a patient if he or she is tan," says Alster. "Tanned skin is inflamed from the sun and at greater risk for blistering and post-inflammatory hyperpigmentation."
Before getting lasered, lose the tan and avoid the sun two weeks before and up to four weeks after your treatment. lasers zero in on pigment and can burn and blister tanned skin.