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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.

Ablative Carbon Dioxide (CO2) Resurfacing

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.

Ablative  Erbium Laser Resurfacing

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.

Ablative Fractional 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.

Nonablative Fractional Resurfacing

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.

Intense Pulsed Light (IPL)

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.

Plastic Surgery Is Not Forever

There is an excellent story with recommendations for a few typical plastic surgeries in Great Britain published today in MailOnline.

Anastasia Stephens, 37, a writer and holisitic health expert in London, underwent a surgical procedure to remove hereditary eye-bags that made her look haggard, even after a good night’s sleep. After the cosmetic surgeon had scraped out two bags of fat from beneath each eye, she couldn’t have been happier.

Ten years later, her eyes had prematurely aged. Having the fat removed had loosened the skin under them, and over time, this has wrinkled more than it would have, and in an unnatural way. Lots of lines developed directly under each lower eyelid where the bags used to be.

She recently discovered that a few affordable laser procedures could tighten the skin under her eyes and reduce the wrinkles. She saw the effect after the third treatment and was relieved completely as she realised that her condition can be safely treated without the knife, and the results would last for many years to come.

Aloette Perfect Lift Plus

Aloette is a new anti-aging product that contains natural skin moisturizing agents. Clinical testing has shown that this herbal blend decreased fine lines and wrinkles while increasing skin firmness.

Aloette Perfect Lift Plus

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  • Filed under: LT | skin tightening
  • We have rediscovered an interesting article published by Cosmetic Surgery Times in July 2008.

    Mark Solomon, M.D., F.A.C.S., of Bala Cynwyd, PA, a clinical associate professor of surgery, Drexel University College of Medicine, Philadelphia, and medical director for LaserTight, explains that the Bleph Makeover procedure takes a different approach to lower lid blepharoplasty.

    This is a simple office procedure performed under local anesthesia, minimum of downtime and a lasting effect with the results comparable to transconjunctival blepharoplasty. It needs to prove the test of time, and it’s not for every patient. The new device is made by EyeTight (LaserTight LLC; Philadelphia, PA), and it is FDA cleared for use in lower lid blepharoplasty.

    “Unlike Fraxel or CO2, both of which are surface treatments, for instance, the EyeTight procedure is under the surface,” Dr. Solomon says. “We use local anesthesia, it’s performed in the office in about 15 minutes, and the patient is on his or her way with minimal downtime.” Using a 980 nm laser energy delivered through a 20-gauge EyeTight endoprobe, a puncture is made, the probe is inserted, and the fat bags under the skin are vaporized. The probe, about the size of a typical catheter, is removed, and the procedure is done. “The skin then shrinks, because the fat underlying it is gone — so the skin shrinks secondarily,” Dr. Solomon explains. comment

    We have checked the EyeTight website today and were quite disappointed to see that there is no further information about this laser and the Bleph Makeover. The current trend in laser technology development is to make versatile devices to provide multiple procedures. Devices for niche applications, especially the ones that can be done by other devices or by hand, typically have hard time surviving the test of time and market competition. We will keep track of this laser and additional data and peer reviewed studies, whic may come out in the future.

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  • Filed under: Device Review, LT | skin tightening, New Lasers
  • Fractional skin resurfacing technologies like Fraxel, Lumenis ActiveFX, DeepFX, Palomar Starlux 1540 and Starlux 2940, and are quickly becoming familiar to many cosmetic, dermatology, plastic surgery and medical spa practices.

    The history of laser skin resurfacing goes back to 1995, when the first full face CO2 laser resurfacing for wrinkle removal was performed. The procedure was a revolution in facial laser surgery. A flock of lasers were developed primarily for plastic surgeons. The procedure was done under general anesthesia and created a burn wound, which took 7-10 months to heal. The hypo pigmentation that followed for about another 10-12 months was normal and fairly well accepted for a few years due to lack of other options.

    The next advance in laser skin resurfacing was the development of Erbium (Er:YAG) lasers. They became available to plastic and dermatology surgeons around the year 2000. These were, and continue to be very effective for the resurfacing. Erbium lasers are a lot safer and cause a significantly reduced downtime for the patient. At about the same time fewer patients wanted to have a full face resurfaced as a nicely done areas around the eyes and mouth created a very comparable overall aesthetic result with even faster healing and shorter downtime. A mild laser peel will give most patients an excellent result with about one week of “take it easy” time.

    Fractional laserswere introduced to the aesthetic market in 2002-2003 with a big bang and glitzy and very effective promotions by Reliant, which pioneered the fractional photothermolysis. The idea was to bring about a laser that would be non-ablative,  but as effective as the ablative lasers (the CO2 and Erbium) before it.

    Fraxel laser by Reliant was the first non-ablative fractional laser for the cosmetic medical market and it gave birth to the first generation of non-ablative fractional lasers. While there were a lot of hype about these non-ablative fractional lasers, the clinical fact is that they had categorically fallen short of the goal of ‘profound results with zero downtime.’ As we have seen with these devices, patients had to tolerate painful treatment in multiple sessions while still enduring disruption of the epidermis and thus multiple episodes of downtime, before the final outcome, which also failed to meet expectations. Fraxel has been upgraded and improved by a number of other competing fractional laser skin resurfacing technologies such as the Lumenis DeepFX and ActiveFX, Palomar Starlux 1540, and Starlux 2940. The newest fractional skin resurfacing technologies employ the use of erbium lasers and may be non-ablative (Fraxel re:fine, Fraxel re:store, Palomar Starlux 1540) or ablative (the newest generation of fractional lasers). The laser beam is ‘fractionated’ into tiny micro-lasers, treating only a small portion of the skin (MTZ – microthermal zone, or sometimes called microscopic treatment zones) and leaving surrounding skin tissue undamaged. The goal is to speed up the healing.   These MTZs cause enough injury to the dermis to trigger new collagen production and stimulate the replacement of collagen damaged by aging and sun exposure. This production of new collagen ‘fills in’ or ‘plumps’ the underlying dermal tissues and smoothes wrinkles. The surrounding, untreated skin speeds the healing process to a mere 3-4 days. Since most of the pigment cells remain intact, hypo pigmentation is effectively prevented. The Fraxel re:fine, Fraxel re:store and Palomar Starlux 1540 are non-ablative lasers that don’t actually vaporize or remove the skin. Instead, the laser instantly heats MTZs, causes the thermal damage, which stimulates new collagen growth during the healing process. Results for wrinkle removal and skin tightening are less dramatic than with any ablative lasers, but some patients may appreciate the benefit of reduced recovery time and fewer side effects.

    Fractional Ablative Laser Resurfacing

    The newest generation of fractional lasers (Starlux 2940, Lumenis ActiveFX and DeepFx systems and Fraxel re:pair) use the ablative skin resurfacing, i.e. CO2 10600 nm or Erbium 2940 nm. They are designed to offer the best of both worlds: fractional treatments with less downtime and reduced complications and ablative laser skin resurfacing for better wrinkle removal and facial rejuvenation. These lasers actually remove tissue in the micro treatment zones, providing much better cosmetic result for patients with heavily wrinkled and sun damaged skin. These lasers provide “rapid remodeling from the inside out”: the fractional treatment results in both rapid reepitheliazation of the epidermis as well as collagen remodeling to depths of 1.6 mm. The skin heals much faster than if the entire area were treated at once, because the treatment uses the body’s natural healing process to create new, healthy tissue that replaces skin imperfections – such as wrinkles, melasma, dyschromia, actinic ketatosis, pigmented lesions, acne scars and surgical scars.

    Actifirm Post Laser Gel combines skin-soothers like Aloe and Chamomile with a Mushroom-derived, exfoliating enzyme, Mucor Miehi Extract, to inhibit pain and inflammation, while helping renew your skin to its freshest form. You’ll be looking your best in no time.

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    Fractional treatment works on and off the face, including delicate areas like the neck, chest and hands. This is a huge advantage over previous generations of ablative lasers, which required a truly skilled hand to work on these areas.

    There is some increase in recovery time:  clinical downtime of 2-3 days (reepitheliazation of epidermis) and 5-7 days of social downtime (time for patients to resume regular activities). Thus the overall downtime is comparable to the downtime after a traditional non-fractional erbium ablative laser treatment. comment

    Leaving the laser skin resurfacing by pulsed non-fractionated CO2 lasers in the past (where it belongs now), most experts agree that the newest generation of fractional lasers, which uses ablative technologies (Erbium or CO2), have approached the clinical efficacy achieved by traditional Erbium resurfacing. The pain for the patient, downtime and potential side effects are comparable. It is up to the physician to define what patient will benefit more from the subtle difference between these lasers. In time when value and ROI are particularly important, the cost of acquisition of either type of the ablative laser will be the best helpers to the physician.

    J Cosmet Laser Ther. 2008 Jun;10(2):67-71

    Authors: Carniol PJ, Dzopa N, Fernandes N, Carniol ET, Renzi AS

    BACKGROUND/OBJECTIVES: To determine the efficacy of the 1100-1800 nm infrared device for facial and cervical skin tightening.

    METHODS: Ten female patients, with a mean age of 56.5 years, received two treatments 1 month apart with a chilled tip infrared device (Titan; Cutera, Brisbane, CA, USA). Individuals were examined and photographed prior to treatment and at 1 and 3 months post-treatment. Three treatment-independent evaluators compared the photographs and graded them on a standardized scale applied to seven regions subdividing the face and neck. After evaluating the photographs, the difference in pretreatment and post-treatment scores was expressed as a percentage. The patients also rated their results.

    RESULTS/CONCLUSION: The greatest tightening was achieved over the malar region, the upper neck and the body of the mandible. In these areas the average tightening was 10%, 10%, and 12% respectively. The patients reported a 32% improvement in the appearance of their cheeks and a 20% visible improvement in their necks. Overall, they were pleased with the result of this non-surgical skin tightening.

    PMID: 18569258 [PubMed - indexed for MEDLINE]

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  • Filed under: Device Review, LT | skin tightening
  • Prolonged exposure to UV-radiation induces photo-aging and a variety of visible skin changes such as lentigines, actinic keratoses and solar elastosis. Laser skin resurfacing using ablative lasers (CO(2) or Erbium:YAG) is a popular procedure to reduce these marks and improve the aesthetic appearance of photoaged facial skin . Skin resurfacing is defined as an ablation of the epidermis (the upper layers of facial skin).

    The use of pulsed or scanning Carbon Dioxide, and pulsed Erbium-YAG lasers allows the programmable and reproducible photocoagulation of thin layers of the epidermis and superficial dermis. Thermal damage depends on the type of laser and is greater with CO(2) lasers. The degree of neocollagenesis is proportional to the thermal damage and is better with CO(2) lasers. Their main indication is the correction of photoaged facial skin but they can also be used for corrective dermatology, e.g. for scars and genodermatosis.

    Ablative laser resurfacing is the most effective treatment for many conditions of the photoaged skin. Results are highly satisfactory but the technique is invasive, edema and prolonged erythema are commonand, and the patient experiences a social hindrance of about 7 to 10 days (“downtime”). Possible side effects are hyperpigmentation, hypopigmentation and, at worst, scarring.

    A new concept of laser called fractional photothermolysis has been designed to create microscopic thermal wounds to achieve skin rejuvenation without significant side-effects. The fractional techniques such as the 1,550 nm erbium fiber laser (Fraxel Laser , Reliant Technologies) are used to treat non-adjacent microzones without ablation of the epidermis. Around 25 p. 100 of the affected region is treated per session without ablation of the epidermis. Each fraction is only mini-invasive and is performed under local anesthesia. Social hindrance is reduced. Fractional laser was an attempt to bridge the gap between the ablative and nonablative laser modalities to treat the epidermal and dermal signs of skin aging. By targeting water as its chromophore, the laser induces a dense array of microscopic, columnar thermal zones of tissue injury that do not perforate or impair the function of the epidermis. The significant skin remodeling that ensues can be used to treat, with limited downtime, epidermal pigmentation, melasma, and rhytides, as well as textural abnormalities that include acne-related and surgical scars. comment

    Nonetheless, the results are inferior to those obtained with ablative lasers, especially regarding deep wrinkles. The treatment is costly and four sessions are usually required to treat the whole affected area. 

    Skin Ablation by Aesthetic Lasers

    Ablative treatments smooth roughened skin, periorbital rhytids, remove pigmented lesions and minimise acne scarring. Dr Peter Crouch discusses the latest advances and the tried-and-tested methods

    Until the development of laser skin resurfacing in the 1980s, mechanical abrasion and chemical peeling agents were the mainstay of treatments targeting acne scarring, wrinkles and tired, aged skin. Controlled ablation promised the prospect of restoring a more youthful, radiant appearance. Non-ablative remodelling of existing tissue is only one method of stimulating positive change and is the key strategy with IPL and radiofrequency treatments and has been outlined in previous articles in this series. The approach with most non-ablative treatments is to provide a controlled thermal stimulus sufficient to denature and contract collagen while avoiding surrounding tissue damage. Most non-ablative procedures utilise thermal (heat) energy for immediate tissue contraction (short-lasting), followed over the next few months by collagen remodelling and regeneration (longer-lasting).

    Ablation literally means destruction, and there are several approaches for removing unwanted tissue and to promote increased tissue turnover as part of healing. Depending on the depth of ablation, skin resurfacing, smoothing of periorbital rhytids, removal of pigmented lesions and minimisation of acne scarring are all possible outcomes of expertly delivered skin ablation. In the months following ablative treatment, the body’s natural healing processes produce new replacement tissue, resulting in healthier, more even, smoother skin and a more youthful appearance.

    The ideal tissue-ablation device would cause little pain and discomfort, have little or no downtime, be affordable, show demonstrable results after each session and cause no unwanted side-effects. As tissue ablation can effectively remove unwanted targets and the ablation is more related to tissue water content and is relatively more indiscriminate, ablative techniques rely more on targeting precisely where the treatment beam ablates rather than using the wavelength of the treatment beam to discern one target from another based on pigmentation—that is, a specific chromophore, or the presence of, for example, haemoglobin. Because the wavelengths often used for ablation specifically target tissue water, the fluence often determines, fairly precisely, the exact depth of ablation.

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