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.
As I continue to review the Medline English literature and recent international conferences regarding Fractional photothermolysis (FP) technology, applications, and indications, it becomes more obvious that this relatively new modality is one of the most significant milestones in laser technology and skin resurfacing.
Successful conditions treated with non-ablative fractional lasers reported in the literature include acne scarring; dyschromia and fine wrinkling of photoaging on the face, chest, neck, and hands; melasma; poikiloderma of Civatte; nevus of Ota; scars; minocycline hyperpigmentation; telangiectatic matting; residual hemangioma; granuloma annulare; colloid milium; and disseminated superficial actinic porokeratosis.
An advance in 2007 was the introduction of ablative FP (AFP), which results in significantly greater improvement in skin laxity and textural abnormalities. There is no doubt that AFP has demonstrated significantly greater improvement than non-ablative FP in reducing acne scarring and skin redundancy and laxity associated with photoaging.
Through the induction of microthermal zones of injury, FP technology stimulates a robust and rapid wound healing response resulting in improvement in a diversity of aesthetic, inflammatory, and preneoplastic skin disorders.
Further investigation into the technology and diverse array of cutaneous conditions that can benefit from FP will continue and bring additional data to use in determining treatment parameters and identifying new apppliations.
The concept of non-ablative fractional photothermolysis was introduced to the market in 2003 as an answer to the need for effective, yet low risk, skin resurfacing techniques. Unlike conventional ablative (CO2 and Erbium) and non-ablative lasers, fractional ablative and non-ablative photothermolysis treats only a fraction of the skin, leaving up to a maximum of 95% of the skin uninvolved. The undamaged surrounding tissue allows for a reservoir of viable tissue, permitting rapid epidermal repair.
Non-ablative fractional photothermolysis is currently approved by the US Food and Drug Administration (FDA) for the treatment of pigmented lesions, periorbital rhytides, skin resurfacing, melasma and soft tissue coagulation, acne and surgical scars, and actinic keratoses. However, its off-label use is clearly more extended. Many practitioners would agree that this first wave of fractional lasers has delivered very limited clinical efficacy.
In 2007 the concept was further developed, and ablative fractional photothermolysis was introduced, using an erbium yttrium aluminium garnet (Er:YAG) or carbon dioxide (CO2) laser. These devices are FDA cleared to treat wrinkles, rhytides, furrows, fine lines, textural irregularities, pigmented lesions and vascular dyschromia. (more…)
Doctors Arielle N. B. Kauvar from New York Laser & Skin Care and E. Victor Ross, M.D., director of laser and cosmetic dermatology, Scripps Clinic, San Diego, provided a quick overview of different aesthetic lasers for medical practice in this article published by Modern Medicine yesterday.
The overview is a good basic briefing on most of the laser modalities, applications and what different types of lasers have to offer. Dr. Ross is one of the veterans of the laser medicine and I like his comment on his personal favorite lasers: ”If my clinic were burning and I only had time to save two lasers, I’d save my KTP laser and my CO2 laser. They do very different things, but they’re the yin and yang that allow me to cover the widest range of indications with the fewest lasers”.
There is, however, a tremendous shift towards non-invasive and affordable treatments in the last few years. The trend is also fueled by bad economy, which caused a significant drop in more expensive invasive procedures. These days most of aesthetic physicians should consider rushing in to save their YAGs if the practice were burning.
|YAG 1064 nm Lasers||Intense Pulsed Light (IPL) Devices|
|Applications||Hair Removal, Photorejuvenation, Skin Tightening, Active Acne treatment, Telangiectasias (spider veins), Rosacea, Sun & Age Spots, Pseudofolliculitis Barbae.||Hair Removal, Photorejuvenation, Sun & Age Spots, Rosacea.|
|Efficacy||High power to dermis: more energy to follicles, vessels, collagen, sebaceous glands.||High power absorption in epidermis: less energy to deep dermal structures.|
|Comfort||Less painful due to shorter pulse durations.||Very painful due to tendency to super heat epidermal melanin. Skin cooling gels or equipment needed.|
|Risk of Side Effects||Safe on all Skin Types.||Higher risk of burning skin; not recommended for use on skin types 4-6 or tanned skin because of pigmentary risk.|
|Consumables||Few or none.||Frequent head replacements (on average after 30,000 pulses), filters and gels – annual cost $5,000-$10,000.|
A White Paper by David J. Friedman, MD
I recently completed a clinical study of laser hair removal using the LightPod Neo, a 1064nm Nd:YAG laser from Aerolase. I was requested to conduct this study because I have a well established cosmetic dermatology practice in which I perform the laser treatments myself, and hair removal is a key area of my laser dermatology expertise.
I became intrigued by this laser’s unique 0.65msec pulse duration, which is below the skin’s thermal relaxation time; this unique feature negates the need for skin cooling during treatment that is common with other systems, and it allows for treatment that is virtually pain-free on any skin type. But the main question in my mind at the outset had to do with clinical efficacy: would this device have the capability of delivering long-term results?
The parameters of the study, conducted during the Winter of 2006/2007, were as follows:
Patients were treated without any form of cooling or application of gels or anesthetics, either before, during or after treatment, regardless of skin type. The laser delivered fluences that were appropriate for hair removal, causing hairs to singe and creating perifollicular edema as expected; transient erythema was observed in just a few instances and patients reported that the treatment pain ranged from painless to tolerable. Patients were treated monthly for a total # of treatment sessions ranging from 3 to 7, and they were followed to assess long-term results. The majority of patients reported >75% clearance; those treated 5 to 7 times reported 82% clearance on average and as high as 93%. These assessments were made, on average, 8.3 months after the patients’ final treatment sessions.
This study demonstrates that, from the standpoint of clinical efficacy, the Neo has the ability to perform hair removal in a similar fashion to Nd:YAG 1064nm lasers that employ substantially longer pulse durations. This is true not only in terms of % hair clearance for a given number of treatment sessions but, of particular importance, in terms of long-term results. When combined with the other advantages of the 0.65msec pulse duration mentioned above – no skin cooling with virtually no treatment pain and the ability to safely treat any skin type – this makes the Neo a unique addition to the field of Nd:YAG lasers from a clinical performance standpoint.
The physical characteristics of the LightPod Neo laser are also very unique.
Due to its air-cooled emitter design, it is a compact and portable device, in marked contrast to large conventional water-cooled laser systems. The Neo design has eliminated the water circulating system as well as fiber optic cables common in other systems, which results in a highly affordable device that is essentially maintenance-free.
In summary, the LightPod Neo offers a new and unique set of capabilities to laser hair removal, enabling it to be a foundation laser for a hair removal practice focusing on higher-profit facial, axilla and bikini treatment areas or an extension of an existing practice into treatment of darker skin types, pain-free performance and/or any practice where the laser’s compact size, portability or lack of required maintenance are deemed beneficial.
A new research in the U.K. reveals that 10 per cent of women are now choosing at-home alternatives over visits to aesthetic medical clinics.
Many beauty professionals are reporting a new trend – correcting mistakes made by women who wrongly imagine they can effectively de-wrinkle their face or laser-remove hair in their own bathrooms.
Americans have access to many devices, which can be useful for daily skin care. However, before pulling out their credit card consumers need to do their own research. A word of advice from LaserOffers.com:
Most importantly, consumers should not fall into grandiose claims manufacturers make. If you cannot understand the technical specifications (few device manufacturers actually provide them) – consult with a medical professional who has reviewed the device.
LaserOffers provides such reviews and recommendations on carefully selected devices for home use. These devices should not be used instead of aesthetic treatments by medical professionals, but rather in addition to doctor recommended procedures and, ideally, after they have been cleared for your use at home by the doctor.