Evolutions Medical Spa Event Recap: “Brighten Up” with FotoFacials, Laser Facials, Peels and More

Santa Barbara cosmetic surgeon Dr. Terry Perkins – and founder of Evolutions Medical Spa – never ceases to amaze us with the knowledge he holds about the skin and skin care. Last night he shared with a captive audience how to get on the path to clear, bright skin. Here is the recap from the “Brighten Up” educational event at Evolutions.

What stands in the way of luminous skin? For many of us, it is an issue of pigmentation. Pigmentation, also referred to as age spots, “liver” spots, freckles, is caused by melanin.  Melanin is produced as a protection to the skin in response to sun exposure (a sun “tan” is actually a skin injury), trauma, or inflammation. Melanin can also be influenced by hormones, birth control pills, and pregnancy. Appearance problems occur when melanocytes are over stimulated such as post-inflammatory hyperpigmentation (from pimples) or melasma, which is a broad patch of pigmentation that can occur in the epidermal or dermal layers of the skin.

How do we get rid of pigmentation? Below are the options that Dr. Perkins outlined for us:


While Evolutions offers a variety of services that are effective in the treatment of pigmentation problems, Dr. Perkins stressed that it is also important to practice diligent home care to prevent or lighten pigmentation. The #1 recommendation from Dr. Perkins is to wear your sunscreen daily! The fact is that more than half of UV exposure is “incidental” exposure such as sitting near a window, driving in your car, walking outside to chat with your neighbor, you get the picture! UVA actually goes through glass, so you aren’t protected in your car or at your window office.

Evolutions offers a variety of bleaching agents and hydroquinone (which stops the formation of pigment from being formed). Some product recommendations:

  • Obagi Clear and C-Rx Night: a product with hydroquinone as an active ingredient that helps to fade unwanted pigment
  • Revale Illuminating Serum: has the highest potency of antioxidants – good anti-oxidation helps skin repair
  • Nia24: helps skin repair at the DNA level which normalizes pigmentation
  • Retinoids (“Retin A”, “Tretinoin”): help normalize cell differentiation
  • Combination Prescription Products (“Firm and Fade”): offered exclusively at Evolutions that combines Retin-A, hydroquinone, and a low potency steroid (used to calm down inflammation)

In addition to using a brightening/lightening product, you may want to add in a product that encourages cell turnover. Products that contain alpha-hydroxy acids, amino fruit acids, and retinoids are all good choices.


Vibraderm is done using abrasive aluminum paddles that provide a gentle abrasion. It is faster than microdermabrasion and does not have a vacuum component (which can cause broken capillaries).  This physical exfoliation is used to treat superficial pigment problems with no downtime. It will improve the penetration of products / peels and is great as a stand alone service or in conjunction with a peel or facial.


This “Gold Standard” treatment of pigmentation uses Intense Pulsed Light / Radiofrequency to target pigment and “red” areas. A FotoFacial works deeper than most chemical peels and can significantly improve your skin texture by reducing redness, age spots, sun damage, spider veins, fine lines (although not a treatment for wrinkles) and large pores. We offer the FotoFacial in a series or in combination with other treatments (FotoPeel, FotoPeel Plus, and FotoFacial Genesis Packages), depending on an individual’s needs.


Chemical peels are a “controlled” injury to the skin that causes a deep, even exfoliation. At Evolutions we offer different depths of peels (from light to medium to deep).

  • AFA Peels: the alpha-hydroxy peel is a “light” peel for those who want the benefits of a peels without a large amount of actual peeling. This peel can be done alone or in a series of five (recommended).
  • Alpha Beta Peel: this is the most popular peel at Evolutions. It is a medium-depth physical exfoliation and works well to get rid of superficial sun damage and is a great choice for clients who want to see results in 4-5 days.
  • Obagi Blue Peel: this is the deepest peel offered. It will significantly improve your complexion. You will have firmer, clearer, smoother, healthier skin.


This newest laser is used for our newest service – tattoo removal. It delivers laser energy so rapidly that it breaks up pigment without excessive heating of the surrounding tissue.  Currently we are testing how effectively it can treat stubborn brown pigmentation. Stay tuned at a later date for more information on the Q-Switched Laser!


This unique fractional resurfacing device uses radiofrequency energy instead of light to safely treat all skin types. Sublative Rejuvenation is used to treat wrinkles, pigment, acne scarring, skin laxity, tone and texture. There is less downtime and discomfort than older fractional laser devises (i.e. the Fraxel) and it can be combined with other light-based treatments (such as the FotoFacial RF or Total Tightening) for customizable treatment options.


This surgical procedure done by Dr. Perkins at Cosmetic Surgery Center in Santa Barbara (near Cottage Hospital) combines a deep peel with dermabrasion (not microdermabrasion). It treats wrinkles, sun damage, and pigment. You will be very impressed with the results. For more information, contact Cosmetic Surgery Center at 805.563.0000.


The best way to treat sun damage is to prevent it by using your sunscreen daily (on your face, neck, and decolletage). When pigment issues arise, there are a number of treatment options available at Evolutions and “at home”. Pigmentation can be treated on all areas of the body.

At Evolutions we always offer a complimentary consultation. If you are interested in one of our medical spa services, or simply looking for a new home care routine, call us at 805.687.0212 to make an appointment (or book online).

Evolutions Medical Spa’s Event Recap: All About Acne Management and Treatment

Evolutions Medical Spa Santa Barbara hosts events to educate clients and guests on select topics. The Evolutions Educational Event held this past Wednesday was titled “From Red to Ready” and addressed how it is possible to get rid of acne and rosacea! Since so much information was offered, this post is dedicated to acne.

Cosmetic surgeon Dr. Terry Perkins gave a very informative presentation including a better understanding of acne and , more importantly, tips on prevention and treatment!

If you are battling acne (and, surprisingly, acne can be a lifelong occurrence, not just part of the teen years), and you’d like a complimentary consultation with Dr. Perkins, please call Evolutions at 805.687.0212.

Acne Facts
  • Acne is one of the most common of all skin problems
  • Acne affects over 70 million people and 90% of all teens
  • Acne is an ongoing condition, often characterized by periodic flare-ups
  • It most commonly affects the face, upper chest and back

For most people it is a matter of “controlling” acne instead of curing it.

Types of Acne

  • Comedonal Acne: this type of acne usually consists of plugged pores with not a lot of bacterial activity, often seen as small bumps under the skin.
  • Papulopustular Acne: this type of acne has more bacterial activity and appears more as pimples with a whitehead and red surrounding area.
  • Cystic Acne: this type of acne is more deeply rooted, with the acne appearing as large bumps (like a marble under the skin) with, or without, whiteheads and may need to be treated systemically (with oral antibiotics or Accutane).

What Causes Acne?

  • Increased sebum or oil production – usually related to hormones
  • Obstruction of the pore
  • P. Acnes bacteria begin to grow in the sebum
  • Inflammation occurs when the sebum escapes into the surrounding skin

Treating Acne
Treating acne is an ongoing process because there is no “cure” your goal is to “control” what is going on. There are three overall goals:

  1. Prevent the blocking of the pores. Opening pores helps the skin function better. Keep the pores open through exfoliation, which promotes skin turnover. Use of retinoids (like Retin-A) and exfoliation through products are recommended for at-home skin care. It is also recommended to seek periodic professional treatments such as a chemical peel or Vibradermabrasion (a more physical way to open up the surface) to expedite exfoliation of the top layers of skin.
  2. Minimize inflammation. Salicyclic acid liquefies the sebum and helps to quiet the skin. A low percentage of salicyclic acid is okay to use on a regular basis and can help minimize the inflammation of acne.
  3. Prevent Scarring. Acne scarring or pitting remains long after the acne is gone which is why it is a good idea to learn how to get your acne under control.

Tips on the Treatment of Acne

  • Good hygiene: keep the skin clean. Dr. Perkins does not recommend washing the face more than two times per day. Washing the face more than that may cause an increase in oil production. Use a gentle foaming cleanser. The face wash does not need to be harsh or it may “strip” your skin – again causing increased oil production – especially if you are using other products such as salicyclic acid or retinoids. The Clarisonic skin care brush is highly recommended by Dr. Perkins. He touts this as the “best cleaning device” because the ultrasonic waves penetrate below the surface for a deep, yet gentle, cleanse.
  • Don’t “pick” and “pop”: this may increase the life of the pimple, making it larger or redder and /or increase your chances of scarring.
  • No oil based cosmetics: many store make-up brands are petroleum based, which is like putting putty in your pores. Over time, this clogs pores. Mineral make-up is more quieting to the skin.
  • Don’t go to sleep with make-up on: give your face a rest!
  • “Good” diet: consuming foods with a high iodine content (salt) tends to foster breakouts. In addition, a skin supplement that has worked for some Evolutions clients are the VitaMedica “Clear Skin Treatment”.
  • Stress management: Learn to manage your stress. Outbreaks can definitely be stress (and hormone) related.

How You Can Treat Your Acne

Treatment of acne can be done in many ways, from at-home topical treatments to professional treatments to oral medication. How acne is treated typically depends on your specific case of acne and it is recommended that you get a professional opinion on how to best proceed in managing your acne.

Topical Acne Treatments

  • Retinoids (Retin-A), exfoliants (AFA Exfoliating Gel), and amino fruit acids can be used topically to treat acne.
  • Although glycolic acid is very popular and found in many store products, it can be the most irritating of the alpha hyrdoxy acids and Dr. Perkins prefers mandelic acid (available at Evolutions) which is less irritating and has an anti-bacterial function to decrease the P. Acnes bacteria.

Oral / Systemic Therapy

  • Oral treatments include antibiotics and Accutane. Dr. Perkins prefers to try to treat the acne topically before prescribing an oral treatment.

Professional Procedures

  • Acne Facials professionally cleanse, exfoliate and extract keeping the pores open and the skin functioning normally.
  • Vibradermabrasion is a physical exfoliation that is similar to microdermabrasion without the suction. It has been found that the suction in microdermabrasion may affect the tiny blood vessels in the face, making the skin appear redder. Vibraderm is similar to “buffing” the skin, is comfortable, and the whole face can be done in 10 to 15 minutes as opposed to a 35 to 40 minute session of microdermabrasion.
  • AFA/Clay Mask Peel is an advanced amino fruit acid mask which exfoliates and opens up the pores. It is less irritating than alpha hydroxy acids.
  • Multiwave LED (Light Emitting Diode) therapy works in which energy is delivered to the skin and absorbed by the cells for therapeutic benefits through a process called “photo-stimulation.” The “blue” light kills the P. Acnes bacteria while the “red” light calms the skin and gets rid of inflammation. The Multiwave LED therapy can be done alone or often is part of a facial at Evolutions.
  • Levulan is similar to the oral drug Accutane, but is a topical treatment. Levulan causes the sebaceous cells to sink and people have seen dramatic changes in their skin from one treatment or through a series (which is often three treatments).
  • Cyst Injections are a topical way to treat cystic acne. Antibiotics are injected under the cystic acne to help bring done the bacterial infection.
  • Isolaz Deep Pore Therapy combines a vacuum with a light treatment. The vacuum purifies the pores from the inside out and the blue light kills the bacteria. A great treatment for persistent papulopustular acne.

There is no “magic bullet” that cures acne. It is important to create and execute a comprehensive “attack plan” that combines good home care with appropriate professional services. Generally it takes a few weeks (a “turnover cycle”) to start seeing results of a treatment, so patience is necessary.