Turning Back the Clock – For Women Only!


It is no secret that women have it harder.  First, we get monthly periods well before we need them. Then, we go through pregnancy with its hormone spikes, body stretching, and delivering an entire human being out of a tiny opening.  Just as we are trying to bounce back, menopause strikes to slow us down. The body region hit the hardest is, of course, the female genitourinary system.

Women experience vaginal itching, dryness, irritation, poor lubrication, pain during intercourse, urinary incontinence, and stretching of tissues.  This complex of symptoms is now called the Genitourinary Syndrome of Menopause (GSM). However, many of these same issues can occur before menopause due to childbirth, breast feeding, or after cancer treatment.

Vaginal health has a tremendous impact on quality of life – physically, psychologically, and sexually.  It can affect comfort, confidence, and romantic relationships.

Treatment options have traditionally been limited to hormone therapies and invasive surgical procedures, both of which carry undesirable risks and side effects. In recent years, minimally invasive laser treatments previously used to treat various gynecologic diseases have been found to also be effective for vaginal rejuvenation.

The most exciting device in this arena is the Juliet by Cutera.  Juliet is an erbium laser that takes 20 minutes to revitalize both the internal and external vaginal tissue.  The process involves 2 passes: The first delivers micro columns of laser energy that stimulate regeneration of collagen and elastin, strengthening the structure of the inner vaginal wall.  The second pass delivers gentle heat to improve vaginal tone and flexibility. There is minimal discomfort and little downtime. A series of 3 treatments at 4 week intervals with yearly touch ups is recommended.

Various studies published in medical journals have shown significant improvement in symptoms of GSM and suggest that vaginal erbium laser may be a safe and effective treatment for this indication. Women who have had Juliet treatments report life changing improvements in lubrication, sexual discomfort, vaginal firmness and tone, leakage of urine when sneezing/ coughing or laughing, labial tightening, and external skin appearance.

With Juliet, women now have an alternative to taking hormones or having surgery when it comes to turning back the vaginal clock! And, don’t worry – nobody has to know about it!

Nobody Has To Know


Nobody likes to talk about it but our vaginas are never the same after childbirth.  Then, the natural aging process and hormonal shifts associated with menopause further take a toll.  The result is a decline in vaginal health and appearance with symptoms like decreased lubrication, discomfort during intercourse, stress incontinence and labial laxity.    


Fortunately, technology is now on our side.  The Juliet laser is a revolutionary, non-invasive device designed to functionally and cosmetically restore vaginal health. It works by delivering gentle laser energy to the vaginal wall to stimulate new collagen, remodel tissue and restore flexibility/shape.  During the treatment, a probe is inserted into the vaginal canal and two passes of energy are delivered to the vaginal wall. The first pass uses ablation to create micro channels causing immediate contraction while the second pass uses coagulation to deliver thermal energy to stimulate collagen production and revitalization.  


The procedure takes approximately 20 minutes and is comfortable throughout. Each treatment uses a disposable hand piece with a rotating optic for hygiene and cleanliness. There is minimal downtime, with most patients reporting complete recovery within days.  The Juliet has been approved for sale in 35 countries. Numerous studies published in peer-reviewed journals have demonstrated its safety and efficacy. Notably, the Juliet was not among the devices cited by the recent FDA warning against competing devices for vaginal rejuvenation.


Benefits of a Juliet treatment can be noticeable soon after the first treatment and continue for several months after. Three monthly treatments are recommended with a maintenance treatment done once a year thereafter.   


Please contact our office to learn more! Nobody has to know!

Post Acne Scarring can be Fixed!


Long term cystic acne can result in both pigmentary and textural scarring.  While most pigmentary scarring will fade over time, textural scarring can be permanent. For many patients, the long term uneven appearance of the skin is just as distressing as the acne breakouts themselves.

Textural acne scarring occurs when inflammation recurs repeatedly in the same areas causing breakdown of the collagen and elastin in the skin.  Most commonly, textural scarring is atrophic or indented.  There are three types of atrophic scarring – ice pick, boxcar and rolling scars.

  • Ice pick: V shaped – which can be very narrow types of scar but extend deep into the dermis (<2mm)
  • Boxcar: U shaped – can be superficial or deep in the dermis (2-4mm)
  • Rolling: appears larger but very superficial


Fortunately, there are various resurfacing procedures available to improve the appearance of textural scarring in all skin types.  Skin resurfacing can be done with laser energy or manually with micro-needling.   The concept is similar – the scarring is broken down incrementally in microscopic columns which then stimulates the body’s natural healing response to regenerate the tissue in a more organized fashion.

Fractional lasers can help remove surface imperfections and significantly reduce the appearance of scarring. There are two general types of fractional laser resurfacing, ablative and non-ablative.  Ablative lasers work by vaporizing the outer layers of skin while non-ablative lasers work beneath the surface of the skin by heating tissue.  Ablative lasers are generally more effective but require more downtime and have a higher risk of side effects.  Non-ablative lasers have less downtime and less risk, but require a series of treatments.

Micro-needling with PRP (platelet rich plasma) is a revolutionary resurfacing procedure that uses an electric pen with multiple tiny needles on the tip. This device goes over the skin surface causing micro-pores/channels which stimulate the skin to regenerate collagen/elastin. PRP is a clear, gold fluid extracted from the patient’s blood with a special centrifuge.  A high concentration of activated platelets in the PRP release growth factors that recruit and increase the proliferation of the reparative (healing) cells of the body.  PRP can be applied to the skin and driven into the scarred area using the microneedling pen.  The needling itself breaks up the scarring while the PRP naturally augments the healing response.  There is minimal downtime and risk of side effects.  Most patients require a series of treatments for best results.

Spring Street Dermatology offers fractional ablative resurfacing, two types of non-ablative resurfacing and microneedling with PRP to address textural acne scarring.   A treatment plan, using one or multiple modalities, is formed by taking into consideration patients’ goals, skin type and depth of scarring. The final step in the long battle with acne is to improve the leftover scarring – fortunately there are various effective procedures that can help!