Are you dealing with hyperpigmentation or textural concerns or are you looking for total skin rejuvenation? We talked to Molly Orden, PA-C, about finding the right treatments for specific skin concerns.
For Hyperpigmentation Concerns
"The other things that we use for hyperpigmentation would be chemical peels. I do like to pepper in chemical peels depending on your concern or level of downtime. The light chemical peels are great to do intermittently throughout the year because they have no downtime and are going to help keep your skin nice and bright and fresh. People who do have downtime can do something like a VI Peel in the winter. I usually don’t do a ton of VI Peels just because I think that the energy based devices are going to be even more effective but I will do maybe a BBL Moxi laser on somebody and they come back four weeks later and we can throw on a chemical peel or we can do microneedling. I do like to mix modalities especially because hyperpigmentation can be complex and inhibiting melanin production by way of different modalities is super beneficial.”
“In the winter, I love to do more skin-based treatments like lasers, BBL & Moxi, microneedling radiofrequency, CO2 laser, microneedling with PR, chemical peels like the VI Peel or like a triple bright peel TCA. I’m doing those treatments much more frequently in the fall and winter."
For Textural Concerns
“These can be varied but in terms of textural-like acne scars, a lot of acne scars are really helped with microneedling. The mechanical trauma to the scar itself is extremely helpful in helping to improve it."
"I do a lot of subcision with my acne scars and you can inject PRP into them and then of course lasers like the CO2 laser are very helpful for that. Again, chemical peels are also very beneficial for this type of concern, helping get all of the junk out of the pores is very effective. What's really nice about something like a VI Peel or really any chemical peel for that matter is that you can put it on top of active acne. So if someone is dealing with active acne, you wouldn't necessarily want to do a microneedling treatment but you could do a chemical peel to get all the junk out and have them come back 4 or 5 weeks later and then start a microneedling series which is really helpful.”
For Anti-Aging Concerns
“I love to do lasers, microneedling with radiofrequency, microneedling, CO2 laser, BBL Moxi treatments are fantastic as well as incorporating Scultpra, fillers, things like that. Basically anything that is going to help stimulate collagen, I’m a big fan of that for anti-aging.
Sometimes microneedling can be overshadowed by some of the other treatments but it’s one of the most effective things you can do to stimulate collagen. It’s fantastic, it works and is low to no downtime. It’s also a very cost effective treatment.”
For Overall Rejuvenation
“For overall rejuvenation, I recommend a mix of all the above! I frequently combine all of these things not just for myself but also for my patients.
If I have a bride, I will do a smattering of all the things that I’ve mentioned. I like to do a BBL Moxi as soon as possible to see how they heal from it (everyone typically heals well but I like to say that I don’t want to experiment with my brides right before their wedding so typically what we’ll do is do one in the winter. For instance, I just built out a bridal game plan for someone the other day. She's going to come in in February for her first BBL Moxi. She doesn't have a lot to treat, she just wants to rejuvenate her skin. So we’ll do that and then we’ll do it a month before the wedding in August. That way we’ll know how her skin responds and reacts to it during the winter! Then after the summer we’ll do a nice refresh and clean up and then in between that time before her bachelorette party and her bridal shower, we’ll do a light peel and an Aquagold treatment. Then this summer we’ll do a little microneedling to keep the skin looking refreshed and amazing.
For someone who needs a little bit more tightening, maybe older and have some early jowling, we’ll do a series of microneedling radiofrequency and then BBL & Moxi laser to take care of some vessels and redness around the nose and help resurface the skin and give you a nice glow. It really does make it look like you have a “Paris” filter in real life! Throw in some light peels here and there. These light peels are great (mandelic acid peels) because they take five minutes and they can be done right after a botox treatment which is great because it helps to give you the ultimate glow. I have some clients that do this combo of light peel and wrinkle reducer treatment three or four times a year.”
Who Are The Best Candidates For The Following Treatments?
Microneedling: “Microneedling is great for pretty much everyone. I love it for people who have acne scars, who are younger, and who maybe don’t have a lot of downtime available.”
Chemical peel: “Chemical peels are great for everyone. I perform them all the time! They are great before an event and great to get a nice glow on. Also great if you have active acne because you can't do microneedling on active acne.”
CO2 Laser: “CO2 laser is amazing though it’s not something I'm going to perform on everyone. It's not something for darker skin tones and it's also not going to be the first laser I’d recommend starting out with. Typically, I would rather have someone do the BBL Moxi first and then try the CO2 laser. It is a fractionated laser so it only treats a fraction of the skin just like many other lasers so the downtime isn't crazy unlike lasers past.”
Moxi Laser: “BBL + Moxi is usually my first choice for laser newbies. The Moxi laser is amazing because it's great for everyone no matter the skin type, tone, etc.—the Moxi laser is right for you! It's safe for those with melasma, and it’s safe if you're a Fitzpatrick 6. I’ve performed it on people with both light and dark skin tones as well as melasma and it just looks so great. I love it and adore it!”
BBL vs IPL: “They are similar but not the same! One stands for Broadband Light and one stands for Intense Pulsed Light. The benefit of BBL is that it's safer to treat those that have dark skin tones (I have treated Fitzgerald 4 and Fitzgerald 5 with BBL). I'm safely able to treat them with BBL whereas with IPL, I would not be able to treat them safely—part of it is due to the technology and other part is how targeted I'm able to make the treatment. BBL has certain attachments that are much smaller than certain attachments on the IPL so I can target the energy right in the spot that I need it as well as use certain settings just to make the machine a lot safer. So I really love the BBL!”
Microneedling + Radiofrequency: “That is also amazing treatment and is right for many people but not all. You can do it on darker skin tones and you can do it on those who have melasma but I want the melasma to be under control and to be pre-treated so that the heat doesn't trigger anything. So with my melasma patients, I'd start them off with using certain products a few weeks prior like hydroquinone or azelaic acid—something that's going to inhibit melanin production—before I do the microneedling radiofrequency. Also, in regards to darker skin tones, I'm not going to do it on someone that's really dark. You can use microneedling radiofrequency on Fitzgerald 4 and 5’s but I’d never use it on Fitzgerald 6 as I would never want to cause any hyperpigmentation at all with the heat. For those people I will choose regular microneedling.
Neither microneedling nor microneedling with radiofrequency are appropriate for someone who has keloids, so it is important to screen for that. That being said, it’s also important to check and see what the patient thinks is a keloid on their body. Sometimes a patient will think it is a keloid but sometimes it's not, it's really a hypertrophic scar and those are different so it’s important to take a look at that.”
About Molly Orden, PA-C
Molly Orden, PA-C is a board certified and state licensed Physician Assistant who specializes in both general and cosmetic Dermatology. Molly received her Bachelor’s degree in Psychology from the University Of Miami where she received the prestigious academic Dickinson Scholarship, which is reserved for top-performing students. She then completed her Master’s Degree in Physician Assistant Studies at Nova Southeastern University. Molly is a member of the American Academy of Physician Assistants and the Society of Dermatology Physician Assistants.
To book an appointment with Molly at JECT at their Upper East Side or West Village location, visit their website for more information. Follow Molly on Instagram to stay up to date with her favorite treatments, products, skin tips and more!