Skin & Laser

There are 3 different types of light devices that are used today by the cosmetic laser surgeon:

LASER is an acronym that stands for:

    Light Amplification by the Stimulated Emission of Radiation

What is really crucial to understand is that each laser emits a unique wavelength of light. Traditionally, the primary targets for cosmetic lasers have been either water, hemoglobin (blood) or melanin (pigment). Lasers used for the treatment of acne use a unique target related to the bacteria that causes acne. There is much work being done today on lasers that can be used to reduce fat which is the primary target.

The laser surgeon may not be able to manipulate the wavelength of the light emitted by the laser, but he can control the power (also called fluence) and duration of each pulse of laser light (the pulse width).

INTENSE PULSE LIGHT devices differ from lasers in that they emit a band of light instead of a single wavelength of light. This band of light includes all the wavelengths within the limits of the band. As with lasers, the surgeon is able to control the power and pulse width of the band of light.

LIGHT EMITTING DIODES (LED) are a new class of light devices that use a low level of light to modulate activities within cells and can be used to decrease pigment (brown and red), reduce inflammation, soften wrinkles, and increase collagen. Other uses for LEDs include improving acne; investigations are underway to see if it is possible to stimulate the growth of hair on the balding scalp.

Aesthetic lasers can be used to complement plastic surgery procedures and help the patient achieve a more natural and youthful appearance by improving the appearance of the skin of the face and neck. This is achieved by:

More than a decade ago, cosmetic laser surgeons used a CO2 laser to improve the appearance of a patient’s face. This type of treatment is called ablative resurfacing because all of the epidermis (outermost layer of the skin) was removed. The deeper layer of the skin is called the dermis. During deep ablative resurfacing, the upper part of the dermis might also be removed. It is a procedure that is used to achieve results that in the past could only be done with deep dermabrasion or chemical peels.

These lasers were excellent devices in both eliminating wrinkles and tightening skin. Today, the results obtained with the CO2 laser represent the gold standard by which the results of all other lasers are measured. Unfortunately, these lasers were also associated with a long period of healing and redness, as well as with a high incidence of changes in the pigmentation of the skin.

Another type of laser also used for ablative resurfacing was the erbium laser. Lasers operating at this wavelength of light were good for eliminating wrinkles; however, they did not achieve the skin tightening seen with the CO2 Laser. In addition, they could not be used for deeper wrinkles because they are not hemostatic; that is, they were associated with bleeding from the skin.

The current generation of the lasers employed for skin resurfacing use a type of technology known as FRACTIONAL RESURFACING. In fractional resurfacing, the skin is not treated evenly over its entire surface; instead, it is done in a polka dot fashion. The affected areas are treated in deep columns that go down much deeper into the skin than was possible when all the skin was treated. In fact, these columns may extend up to 4 times as deeper than traditional ablative resurfacing. This is possible because the skin in between each “polka dot” is untreated and enables rapid healing of the skin.

There are two types of fractional resurfacing:

  1. Non-Ablative
  2. Ablative

As previously described, the epidermis is intact after treatment with non-ablative lasers and is removed after treatment with ablative lasers. After a non-ablative fractional laser treatment, the epidermis is intact and there are columns of coagulated or treated tissue below the epidermis that is surrounded by normal tissue. After an ablative fractional laser treatment, the epidermis and the entire column of tissue are removed.

Fractionally non-ablative lasers can be used to improve brown pigmentation of the skin and to improve the texture of the skin, as well as the appearance of scars.

Fractionally ablative lasers are used to not only improve pigmentation, but to also reduce the appearance of wrinkles and to achieve skin tightening.



Lasers In Our Practice


The lasers, intense pulse light devices, and light emitting diodes in our practice used to improve the appearance of the aging face and neck include the:

  1. Gemini
  2. Aura
  3. CoolTouch
  4. Lux G
  5. Lux 1540
  6. Lux 2950
  7. Venus
  8. LuxIR
  9. Medlite IV
  10. Gentlewaves

The following is a list of some of the changes seen in the aging face and the lasers that are used to treat them:

  1. Brown spots – Lux1540(fractionally nonablative), Gemini, KTP, LuxG, MedliteIV, Gentlewaves
  2. Capillaries and Rosacea - Gemini, KTP, LuxG, MedliteIV, Gentlewaves
  3. Skin Texture – Lux1540, Gemini, LuxG, Medlite IV, Gentlewaves
  4. Wrinkles and Acne Scarring – Lux 2940 (fractionally ablative), Venus, CoolTouch, Active and Deep FX C02 Fractional Laser
  5. Skin Tightening – LuxIR. Early investigative results are hopeful that the fractional CO2 laser may also achieve tightening of the skin. In addition, work is now being done on the use of the Lasers to achieve skin tightening during laser lipolysis (liposuction).

Other aesthetic or cosmetic procedures commonly performed with lasers, both on and off the face and neck, are:

  1. Hair Removal
  2. Treatment of Spider and Varicose Veins of the Face and Legs
  3. Treatment of Brown Spots
  4. Removal of Tattoos
  5. Improvement of Scars
  6. Laser Assisted Liposuction

All of these laser procedures are discussed in greater detail on our sister website, www.lasersandplasticsurgery.com.




Plasma Skin Resurfacing


Plasma skin resurfacing is another device which can also be used for rejuvenation of not only the face and neck, but also the chest, arms, and hands. This treatment is considered non-ablative because the epidermis remains intact after the treatment. The changes seen with plasma include:

The plasma device, however, uses nitrogen gas instead of light. Plasma, a super-heated form of gas, is the fourth state of matter in addition to solid, liquid, and gas. During the patient’s treatment, the nitrogen plasma is formed in the hand piece of the device and directed onto the patient’s skin. When the nitrogen plasma comes in contact with the skin, the energy in the plasma is transmitted into the skin and nitrogen plasma becomes nitrogen gas again. The treatment with the plasma device is performed under a topical anesthesia only.

The heat energy of the nitrogen plasma forms a line of cleavage within the skin. As noted above, the epidermis remains intact until the skin heals below. The old epidermis then peels off 4-5 days after the treatment to reveal the new layer of epidermis. The results seen with the plasma device continue to get better over the next 6 to 12 months.

Plasma skin resurfacing can be done as a free-standing procedure and is often done in conjunction with a face lift.



BOTOX®


Frown lines between the eyebrows, wrinkles along the forehead, and crow's feet next to the eyes can be significantly lessened with BOTOX®. The treatment takes minutes and lasts months. It is an effective, low risk procedure that remarkably rejuvenates the aging face. Unlike the popular misconception, when performed properly, a frozen or unnatural look should not be the result of BOTOX® injections.

BOTOX® is best used to treat dynamic wrinkles (those as a result of the action of the underlying muscles), examples of which are noted above. BOTOX® treatments do not require an anesthetic to be performed and the results are seen 4-7 days after the injections.

It is our experience, that the duration of the effects of the injections is directly related to the number of units of BOTOX®. As there is a permitted variation by the manufacturer in the amount of sterile saline used to prepare BOTOX®, the number of units in a single syringe will vary by practice. In addition, the duration of the BOTOX® effects may vary depending on the site into which it is injected. For example, BOTOX® injections into the crow’s feet may last longer than those into the glabellar region. Following this protocol of my practice, we find that the results last up to 6 months after the first treatment with BOTOX®. After repeated injections, however, the results last longer and can extend up to 8 – 10 months or more.

Patients should avoid aspirin and the NSAIDs, such as Motrin, Advil, and Naprosyn for the week before the injection. It is alright, however, to use acetaminophen products such as Tylenol.



Filler Agents


Filler agents can be used to fill in wrinkles, scars, depressed areas, and to fill out thinning areas, such as the aging lip or cheeks. These agents can be divided into those agents that are:

Filler agents can also be classified by their origin:

It is our opinion that at the current time the ideal filler is one that would have the following characteristics:

Currently, the agent that is used most frequently in my practice is the hyaluronic gel Juvederm, which is manufactured by the Allergan Corporation. Juvederm is cross-linked hyaluronic acid, lasts up to 10 – 12 months, is lab derived, and feels very natural.

Juvederm injections are performed under a topical anesthetic. The entire procedure, including application of the anesthetic and injection, is performed in a 45-minute office visit. The results are almost immediate, although there is occasionally some swelling that can last overnight. Patients are advised to avoid aspirin or NSAIDs such as Motrin, Advil, and Naprosyn for a week prior to the treatment to avoid bruising.



Microdermabrasion


This is a gentle sanding procedure using salt. It is used for smoothing the outer layers of the skin and helping accelerate the removal of areas of hyperpigmentation. This is often used in conjunction with glycolic peels and non-ablative laser resurfacing procedures.



Glycolic Peels


These are gentle chemical peels used to help rejuvenate and maintain a youthful tone and texture to the skin.

For additional information on Laser Aesthetic Procedures, go to www.lasersandplasticsurgery.com.

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