Diet, exercise and healthier living may make us feel younger but too often our skin tells the true tale of our age, despite our best efforts to mitigate the damage to our skin that can make us look much older over time. Aging skin, with its “loose” feel, sagging, fine lines, enlarged pores, sallow complexion, and creases — is caused by many factors, including too much sun with too little sunscreen, wind, cold and pollution, plus cigarette smoke, stress, poor nutrition, facial contortions, and alcohol, among other things.
While many people still opt for invasive techniques like surgical face lifts, aggressive resurfacing, or deep chemical peels to combat the signs of aging skin, many are now turning to minimally invasive procedures to rejuvenate facial skin and take years off that image in the mirror. According to the American Society of Plastic Surgeons, minimally invasive cosmetic procedures for the face increased considerably in 2010, with laser skin resurfacing treatments increasing by one-third over the prior year.
One key reason that the number of these procedures has increased so dramatically is the development of high-energy, extremely accurate lasers which have enhanced the ability of physicians to improve sun-damaged skin, scars, wrinkles, brown spots and other conditions with minimal to no downtime.
New laser skin resurfacing techniques can take years off your appearance and you can see a significant improvement in the look and feel of your skin. You will see fewer wrinkles. Laser skin rejuvenation can be done in one to just a few treatments, depending on the technology, and patients are able to return quickly to their normal activities.
1. Fractional Non-ablative Lasers. This multiple treatment approach requires no preparation for the patients, who simply get a topical anesthetic and feel light pressure during this safe and gradual laser procedure that stimulates the body to replace aged and photo-damaged skin. It also shrinks the pores and is the first and only laser approved for treatment of the discoloration of melasma. It can be used throughout the body. Although there is some redness, most go right back to work.
2. Fractional Ablative Lasers. These are less aggressive than CO2 resurfacing and result in much less patient down-time. The physician tailors the skin resurfacing procedure to each person’s unique needs. The technology can be used on light, medium and deep settings depending on the amount of improvement and the number of days for complete rehabilitation along with the number of treatments desired. It does not have the previous CO2′s high risk of discoloration, long healing times and prolonged erythema. It still offers some skin tightening benefits which increases with a second or third treatment. The results can be quite dramatic.
3. Erbium Lasers. One of the latest tools available for the treatment of wrinkles, acne scars, aged and sun-damaged skin, the Erbium is a cool light laser that resurfaces the skin. This method results in less post-procedure redness, less swelling and faster healing time and much less risk of side effect than with other strong laser skin resurfacing methods. The Erbium laser can be used on the face, neck, chest and hands. You can expect up to a several days of down-time from this procedure depending on the depth of the peel. People say how smooth and fresh their skin looks and feels.
Using one or more of these new laser skin rejuvenation methods, healthy, active adults can now look as young as they feel.
Effectively treating vascular and pigmented lesions — from common facial telangiectasias to more challenging hemangiomas — relies on identifying the appropriate tools and then honing one’s technique to achieve the best results. However, more often than not, patients want to make the most of their sessions by undergoing concomitant facial resurfacing to improve wrinkles and texture changes related to repeated sun exposure, according to William F. Groff, D.O., who practices alongside aesthetic laser pioneer, Richard Fitzpatrick, M.D., at the La Jolla Cosmetic Surgery Centre, in La Jolla, Calif. In these cases, Dr. Groff tells Cosmetic Surgery Times, a combination of two or more lasers is often the best approach. Here, Dr. Groff offers tips and perspective on wrinkle and vascular and pigmented lesion treatment strategies that result in patients whose post-procedure appearance is ultimately the best form of marketing.
RESULTS DELIVERED The most common facial lesions that patients request treatment for are wrinkles, telangiectasias and solar lentigines according to Dr. Groff, who adds that these are followed in frequency by rosacea, melasma, cherry angiomas and spider angiomas.
“Facial telangiectasias, cherry angiomas and spider angiomas are fairly easy to treat if you have the right tools,” says Dr. Groff. They can all be treated very safely and effectively with pulsed dye lasers (PDLs) in just one or two sessions. “PDL has a long track record and is certainly considered the gold standard, so if the practitioner wants to treat both vascular and pigmented lesions, the PDL is one unit that can be counted on to deliver reliable, predictable and safe results. We have about 20 lasers in our practice and the PDL is probably the safest. The chance of having a problem or complication is extremely rare.”
Dr. Groff’s technique for facial telangiectasias comprises the use of a Candela V-beam Perfecta PDL, using the 10 mm spot size with 7.5 to 10 J/cm2. “I would usually use a 6, 10 or 20 ms pulse duration [depending on the size of the vessels], and it could take anywhere from one to three sessions at the most,” he explains. Larger vessels require treatment with longer pulse durations. David J. Goldberg, M.D., J.D., adds that, “A variety of other lasers and light sources can also be successfully and safely used to treat such vascular lesions. Among the more popular wavelengths besides the 595 PDL are the 532, 940, 980 and 1064 nm wavelengths.” Dr. Goldberg is director of Skin Laser & Surgery Specialists of NY/NJ, and clinical professor of dermatology/director of laser research at the Mount Sinai School of Medicine in NYC.
There is a high demand for facial laser resurfacing in Dr. Groff’s practice and almost every person who comes in for resurfacing has brown spots and telangiectasias. “But no matter what kind of fractional resurfacing device you use, most telangiectasias and some brown spots remain.” To get the best results, Dr. Groff recommends using a combination of lasers. “There’s not one box that does it all and does it all the best,” he says.
For a patient who has facial telangiectasias, solar lentigines and wrinkles, Dr. Groff recommends using the PDL to remove the capillaries, the PDL or Q-switched alexandrite to remove the lentigines, then immediately treating with fractional CO2 resurfacing all in one session. “The results are much better than if you use any of these technologies alone,” he says. “Dr. Fitzpatrick and I have been doing these combination treatments for years, and we’ve never had any complications from combining lasers in one session. Our results are excellent and patients appreciate not having to come back for separate treatments, which would incur more social downtime. There’s a synergistic effect where the results are much better when these treatments are done at the same time, in comparison to doing them separately,” he adds.
Taking the synergistic effect one step further, Dr. Groff recommends pretreating with BOTOX around the glabella, the forehead and the crow’s feet area one to two weeks before performing fractional resurfacing. “If you do this, those muscles are relaxed so they’re not contracting and etching lines into freshly resurfaced skin,” he explains.
STACKING TREATMENTS In the majority of these cases, patients who are seeking resurfacing and treatment for telangiectasias also want to be rid of the vertical upper lip “smokers’ lines” that are commonplace among women over the age of 40. “The gold standard for erasing these lines is still traditional multiple pass CO2 laser resurfacing in combination with erbium laser resurfacing. So even though fractionated CO2 will soften the lines, if the patient wants those lines to be gone you still need multiple pass CO2 and erbium laser resurfacing,” he explains. “In our practice, if we’re going to resurface a woman’s facial skin, we’ll use a fractional CO2 over the entire face with the exception of the upper lip where we’ll perform traditional multiple pass CO2 and erbium resurfacing in addition to using the PDL and the Q-switched alexandrite laser to address the telangiectasias and brown spots, respectively. We use these lasers back to back in the same treatment session. That’s really the way to get the best results,” Dr. Groff says. With regard to these challenging upper lip lines, Dr. Goldberg adds that, “Although fractional nonablative lasers do not typically lead to improvement of upper lip lines, many clinicians have also seen great results from ablative fractional lasers emitting 2790, 2940 and 10,600 nm wavelengths.”
For pigmented lesions, Dr. Groff opts for Candela’s TriVantage, a Q-switched alexandrite laser, which delivers energy through a fiber optic cable, giving it a homogeneous result with less variation from pulse to pulse. “We consider this laser the workhorse of our practice. It’s fast and extremely effective,” he says. The TriVantage offers Q-switched 1064 nm and 532 nm wavelengths, as well as a 755 nm wavelength, so, in addition to treating pigmented lesions, it is also effective for tattoo removal of many colors. “Previously removing multicolor tattoos meant using multiple lasers, but with the TRiVantage we’re able to remove all colors except for white, yellow and fluorescents,” he says.
CO2 and Erbium laser skin resurfacing is a very efficient procedure to remove wrinkles, acne scars, blemishes, growths, and sun-damaged skin blemishes. The laser allows the body to produce new collagen and generate new skin. The result is usually “years younger” skin. Improvement continues as the aged and sun-damaged deep collagen areas continue to regenerate and repair for three to six months after treatment.
How long will the improvement last?
No one can say for sure, but many laser physicians believe that you can expect the results to last for several years. How long may depend on your unique skin type and upon your post-treatment skin care. Think of the laser as “turning back the clock” so to speak, so that your skin again resembles its fresher appearance of years past. Your new skin remains dynamic and alive and it should take many years before your skin appearance manages to catch up with where it was before your treatment. Much depends on how carefully you protect your new skin from damaging sun-exposure. You have a second chance at slowing down the sunlight-related aging process. (more…)
Still horrified by laser blasting of facial wrinkles followed by months of redness? This is so 90s!
New generation of aesthetic lasers is safer and more selective in treating just what the doctors says you need: wrinkles, age spots, broken capillaries, saggy skin, etc. The result? Faster healing, so you can get back in makeup and return to work with smoother skin in as little as 24-48 hours. Well… it depends. Here is a brief guide to different laser treatments so you can better understand your options.
This is the skin-wounding original 1990s procedure.
Used for: hard-core lines and acne scars; can also tighten loose skin but is safe only for fair skin types only.
How it works: By blasting and burning away the skin’s top layer, this aggressive single treatment bulldozes wrinkles and everything else in it path.
How it feels: you should not feel anything during the procedure since it is performed under general anesthesia. Recovery time: you are a burn victim for several days with open wounds, which ooze and bleed, followed by 7-10 days of rawness while your obliterated epidermis regenerates, and pinkness for 4-5 months.
Price: $4,000 to $8,000
Efficacy/Results: Excellent (if done right) but in a few months after the treatment.
Used for: fine to deep wrinkles and acne scars; can also tighten loose skin, doctor must be cautious with darker skin types.
How it works: By evaporizing layers of epidermis (the skin’s top layer).
How it feels: This proceudre is performed under a topical or local anesthesia and you may experience some burning discomfort. Recovery time: depending on the depth of resurfacing, you will feel from slight to mild oozing for 2-5 days, followed by 7-20 days of pinkness, which can be covered by make-up.
Price: $1,500 to $3,000
Efficacy/Results: Good to excellent depending on the depth of resurfacing.
Types of lasers used: either CO2 or Erbium (Er:YAG).
Used for: Smoothing fine-to-deep lines and evening out brown spots in a single treatment. Can also help tighten lax skin and remove some small spider veins.
How it works: The laser beam strikes the skin in thousands of tiny spots, destroying tissue a millimeter deep in those microscopic spots only (think perforated paper). Surrounding skin remains intact, allowing for faster recovery than the original ablative devices but more intense results than the nonablative fractional laser. The hole-punching fires up the body’s wound-healing response, which generates collagen and smooths wrinkles. It’s ablative and therefore riskier for patients of color, but can be executed successfully at a doctor’s office.
How it feels: Typicaly performed with local anesthesia similar to what you’d get in a dentist’s office. After 15 minutes of post-treatment discomfort and an application of ice packs, pain is minimal. For 24 to 36 hours, skin oozes, bleeds and peels, followed by five days of crustiness. Once crust peels, new, pink skin emerges and makeup can be worn; complete healing within two weeks.
Price: $1,500 to $5,000
Efficacy/Results: Average to good.
Non-ablative simply means that your skin will not actually be resurfaced, i.e. top layer of the skin, aka epidermis, will remain intact.
Used for: Smoothing fine-to-moderate lines, evening out brown/age spots, and improving overall texture and glow.
Downtime: typically none, but the skin may be red for a couple of days.
How it works: The laser penetrates deep into the skin, heats and provides controlled thermal injury to the connective tissue, which stimulates collagen production. No oozing no raw skin. It’s typically performed over a course of three to five 25-minute treatments, one to two months apart. This procedure is safe for darker skin types.
How it feels: like the heat is building up in your skin, but no pins and needles. May feel like a bad sunburn for a few minutes after the procedure is over; afterward, skin is pink and sandpapery for three to five days but can be camouflaged with concealer.
Price: $600 to $1200 per treatment depending on the actual laser modality and doctor.
Efficacy/Results: Average to good depending on a number of treatments.
Used for: Eliminating brown spots and other sun-induced discoloration and spot-treating broken capillaries. No effect on wrinkles.
How it works: IPL devices are not lasers, unlike lasers they emit a broad spectrum of light. Short pulses of bright white light pinpoint brown pigment cells and redness, which are damaged when they absorb the light and the heat it creates. Safe for most skin types, but a doctor may dial down intensity for darker skin tones to avoid slim risk of de-pigmentation.
How it feels: Like a sunburn. Patients experience slight swelling and pinkness the day of the procedure, but there’s no downtime, which is why it’s often categorized as a “lunchtime” treatment.
Price: $400 to $600 per treatment.
Efficacy/Results: Average and multiple treatments are required.
Dyschromias, in particular hyperpigmentation, are major issues of concern for people of color. Pigmentary disorders such as melasma and postinflammatory hyperpigmentation can cause psychological and emotional distress and pose a negative impact on a person’s health-related quality of life.
The precise etiology of these conditions is unknown. Therapies for melasma and postinflammatory hyperpigmentation target various points during the cycle of melanin production and degradation. Therapies for these conditions include topical agents and resurfacing procedures. Hydroquinone remains the gold standard of topical agents. Other efficacious agents include kojic acid, azelaic acid, mequinol, and retinoids. Cosmeceutical agents include licorice, arbutin, soy, N-acetyl glucosamine, and niacinamide.
Laser resurfacing procedures are the safest and most efficacious options to treat melasma and hyperpigmentation on the skin of color. These procedures are best used in combination with topical bleaching agents. Given the propensity of darker skin to hyperpigment, resurfacing procedures should be used with care and caution. Maximal results are best achieved with repetitive, superficial, resurfacing modalities.
In addition, ultraviolet protective measures such as broad-spectrum sunscreens are fundamental to the successful management of these conditions.
A disappointing conclusion was made from a recent study:
Treatment of Melasma Using Variable Square Pulse Er: YAG Laser Resurfacing
Authors: WANITPHAKDEEDECHA, RUNGSIMA1; MANUSKIATTI, WORAPHONG1; SIRIPHUKPONG, SUJITTRA1; CHEN, T. MINSUE2
Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; 2: Department of Dermatology, MD Anderson Cancer Center, University of Texas, Houston, Texas
Source: Dermatologic Surgery, Volume 35, Number 3, March 2009 , pp. 475-482(8)
Twenty Thai women with epidermal-type melasma were treated with two passes of variable square pulsed (VSP) Er:YAG laser resurfacing using a 7-mm spot size, pulse duration of 300 μs, and a fluence of 0.4 J/cm2. Two treatments were given 1 month apart. Visual analog scale (VAS), Melasma Area and Severity Index (MASI) score and melanin index (MI) were measured at baseline and 1, 2, and 4 months after treatment.
There was a significant improvement in VAS from baseline at 1-, 2-, and 4-month follow-up visits (p<.001). Significant improvement in MASI score at the 2-month visit from baseline (p=.004) was also observed. The average MI measured using melanin reflectance spectrometry measurements corresponded to MASI score rating.
VSP Er:YAG laser resurfacing effectively but temporarily improved epidermal-type melasma. Recurrence was observed after the treatment was discontinued.
We continue the coverage of the laser skin resurfacing as new data comes in and novel techniques are revealed in this rapidly growing field of cosmetic surgery.
Laser resurfacing, and in particular mild or gentle laser peel, is soaring in popularity as men and women seek quality clinics to get their wrinkles smoothed out. Over the past three years, the number of procedures has increased 456 percent among men and 215 percent among women, according to the statistical report recently published by the American Academy of Cosmetic Surgery. Publications by similar national groups confirm the dramatic growth in the number of procedures and physicians’ fees.
Laser resurfacing is performed by laser beam pulses from a carbon dioxide (CO2) or erbium (Er:YAG) laser to vaporize water molecules from the skin. The controlled damage stimulates the regrowth of new healthy skin tissue, which helps minimize wrinkles and lines. In the last couple of years fractional lasers, which produce microscopic beams in a pre-set pattern, have been upgraded by using the ablative CO2 or Er:YAG wavelengths to join the ranks of skin resurfacing lasers.
Laser peels produce very good aesthetic results at an affordable price, and seem to be more recession proof than most cosmetic surgery procedures.
Wrinkles and sagging skin are caused by a structural breakdown of connective tissue made up of proteins within the epidermis and dermis. These proteins, of which collagen is the main one, are produced from cells called fibroblasts. A fibroblast is a type of cell that synthesizes the extracellular matrix and collagen (and fibrin), the structural framework (stroma) for skin tissue.
Fibroblasts and fibrocytes are two states of the same cells, the former being the activated state, the latter the less active state, concerned with maintenance. Currently, there is a tendency to call both forms fibroblasts. The main function of fibroblasts is to maintain the structural integrity of connective tissues.
As skin ages, fibroblasts collapse and there is an increase in the production of collagenase, which breaks down collagen. For example, people in their 80s have four times more broken collagen than people in their 20s. This “dissolving” of the skin can be interrupted, or else the aging skin is just going downhill.
Our understanding of possible ways and means of the “interruption” is improving quite rapidly. Laser treatments effectively counteract the breakdown of fibroblasts by stimulating the growth of new collagen and subsequently the connective tissue.
Recent studies show that some cosmetic surgeries, such as silicone injections to the face and liposuction to remove fat (and lots of other stuff), may provide acceptable short-lived results but could be destructive and ultimately far less effective than most people expect. Bad side effects are not uncommon.
More and more studies suggest that laser skin resurfacing is the most effective, safe and long-term “interruption”. Voorhees and colleagues, in reviewing dozens of studies done since the early 1990s, found three types of treatments to be effective: topical retinoic acid, laser resurfacing and injections of cross-linked hyaluronic acid. “These treatments all improve the skin’s appearance — and its ability to resist bruises and tears — by stimulating new collagen,” the researchers wrote in the Archives of Dermatology. The work was funded by the university and the National Institutes of Health. “We have shown that if you make more collagen go in, it provides an environment in which fibroblasts recover and make more collagen,” Voorhees said.
As it is the case with all aesthetic treatments, comfort, safety and effectiveness are determined by the provider, not the technology. Recent advances in aesthetic lasers have made them safe and very effective. The operator is ultimately responsible for the rest.
In conclusion, here is what the FDA has to say about laser resurfacing of wrinkles:
“Several manufacturers have received FDA clearance to claim treatment of wrinkles, while others may claim skin resurfacing. Patients have reported reddening of the skin, which lasted from one to four months. Pain was mild and could be treated with over-the-counter analgesics. Consumers should bear in mind that skin abrasion, whether achieved by lasers, chemicals or abrasive materials, means removing one or more layers of skin, which can be painful and could cause redness, swelling or scarring, depending on how each person heals.”