As with all other aspects of cosmetic medicine, we are always trying to balance safety with efficacy. We want a treatment that will solve the problem but that has minimal side effects or complications.
The best laser treatment for facial rejuvenation and skin tightening from the standpoint of effectiveness is old fashioned CO2 laser resurfacing. Unfortunately, it is also the riskiest and has the most downtime. Think Samantha in Sex And The City. Slightly less effective, but much safer and with less downtime, is fractionated CO2 laser resurfacing like Active and Deep FX and Fraxel Re:pair. Less effective still, but also safe, are the other Fraxel treatments like Re:store.
I am personally familiar with Active FX and can comment only on its use. I have not used any other fractionated CO2 lasers.
The recommended treatment and the intensity of the fractionated CO2 laser settings are determined by the nature and the severity of the patient's area of cosmetic concern and the patient's tolerance for downtime and risk. In this case, downtime means several days of redness and the need for vaseline like skin treatments followed by several more days of redness that can be covered with makeup. A patient with fine to moderate wrinkles around the eyes and/or mouth may benefit from Active FX with energy and intensity settings keyed to the extent of the wrinkles and the patient's willingness to spend 3 to 5 days with a red face. For more severe wrinkles in a patient who is willing to have a red face for a week, more aggressive settings and multiple passes over the problem areas may be indicated.
The most important aspect of this is that the treatment be customized for the individual patient with his or her goals and tolerance for downtime and risk as the guideposts.
Combining this with fillers to replace lost volume and a nueromodulator like Botox will also improve the overall results.
The eye, hand and brain of the operator need to be connected.
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