Which laser treatment is best for facial rejuvenation and skin tightening?

There are several different options available to treat the problems described.  There are treatments designed to resurface the top layer of the dermis  while accomplishing the skin tightening you are looking for. 

The Pearl Laser Resurfacing procedure combines the impact of resurfacing lasers with the gentleness and safety of non-invasive procedures to treat aging, sun damaged skin and acne marked skin.  Pearl reduces wrinkles, uneven texture and solar damage with fewer treatments and less overall recovery time than other technologies to provide a healthy, pearl-like glow.

During the Pearl procedure,  the top layer of skin is treated with pulses of light in a pre-selected pattern.  The laser simultaneously sends heat to the deeper layers of skin to provide longer-term benefits.  A natural protective dressing forms on the skin to minimize downtime during the resorative process.  On day 3 or 4 the natural dressing will peel or slough off, revealing new, healthy, vibrant skin underneath.

In a short time, patients will notice overall skin clarity, smoothness and softness- all from a short treatment with only 3-4 days of "social downtime".  Social Downtime means that while recovering from a procedure you may continue your normal daily activities.  However, you may not be able to attend important social events because your face will appear pink/red for a few days.

Pearl also compares favorably with other lasers and laser treatments.  Pearl offers the most effective treatment to address fine lines, uneven texture and discoloration without wound care and the lengthy downtime required with certain Erbium and CO2 laser procedures.  Compared to day's fractionated technoligies, Pearl offers noticeable results in  just one treatment versus 4-6 fractionated treatments.

Laser Skin Tightening : Over the last several years, one focus of aesthetic medical technology has been on a means for improving fine wrinkles and lines on the face without prolonged 'downtime'. This is often referred to as non-invasive collagen remodeling.

This has traditionally been accomplished with laser peels (carbon dioxide, erbium) or deep chemical peels (phenol, high-concentration TCA), which resurface the skin by creating a second-degree burn. The epidermis is essentially burned through and the dermis is injured, stimulating new collagen production. The problems with these aggressive peels are the following:

• an open, weeping facial wound (like a burn which has blistered) for several days, followed by crusting/scabbing
• a great deal of discomfort and itching
• a prolonged period (frequently several months) of erythema (facial redness) which must be concealed with make-up
• the possibility of hypo- or hyperpigmentation due to melanocyte injury or overstimulation
• a line of 'demarcation' between peeled and non-peeled skin
• the risk of scarring if the level of the peel is too deep
• the possibility of a 'waxy' or 'shiny' skin appearance with deep or repeated peels

The ideal method for improvement of facial wrinkles and lines, therefore, should stimulate new collagen production in the dermis without injuring the epidermis (which results in long downtimes and the possibility of pigmentation changes and scarring). Our goal is to improve the quality and tone of facial skin without (or with as little as possible) downtime. The skin care treatment of every client is individualized, as the needs of no two faces are exactly alike. Our highly-trained team of aesthetic professionals can determine which services are right for you.

Laser Skin Tightening can provide extremely dramatic facial and body skin tightening results without surgery.

Q: What is Laser Skin Tightening?

A: Laser Skin Tightening is a series of laser treatments, using the Candela GentleYAG laser, designed to stimulate dermal collagen production and regeneration of damaged skin cells. The single-wavelength light energy produced by the GentleYAG targets fibroblasts in the dermis, which produce new collagen in response to laser energy. Increased turnover of skin cells is also stimulated, helping to regenerate and replace damaged cells.

Q: Will I have to take time from work or my children to recover?

A: No. There is no downtime or external injury to the skin. A person can return to work or reapply makeup immediately following the procedure. The full face and neck can be treated in just one hour.

Q: How long will the results last?

A: The new dermal collagen that is produced becomes part of the structure of the treated skin, and thus Laser Skin Tightening can produce improvements in skin which lasts for years. GentleYAG skin tightening is so powerful that new collagen production can continue several months after the treatment. Most people report improvement immediately, with even more dramatic results weeks later. New collagen growth results in continued skin tightening and the development of a more youthful complexion with fewer lines, folds, and looseness of the skin. Continued exposure to the damaging ultraviolet rays of the sun will result in breakdown of both existing and new collagen over time, so it is very important to protect your results by limiting sun exposure, using a high-SPF sunblock, and maintaining a healthy and scientifically sound skin care regimen.

Q: Are there other skin tightening laser systems?

A: Other laser systems have been developed that are designed to stimulate dermal collagen production (Titan, Fraxel, etc); however none have been demonstrated to be as effective as the Candela GentleYAG. The GentleYAG has more watts of power than any other skin tightening laser, and is therefore more effective in generating new collagen. The Laser Skin Tightening treatment protocols which we use were developed here at Michael Law MD, PA / Blue Water Spa, and have been adopted by medical offices and medical spas around the country and around the world.

Another unique feature of the GentleYAG is the Dynamic Cooling Device (DCDT) which sprays a cooling agent on the skin before every laser pulse. The DCDT protects the outer skin layers during laser treatment and reduces discomfort. No topical numbing agents are required.
Q: Is Laser Skin Tightening effective for both the face and body?

A: Yes. LST can be used to treat any part of the body that may benefit from softer, smoother skin quality, wrinkle reduction, improvement of pore size and texture, or elimination of acne scars. The GentleYAG can provide beautiful firm skin on the face, neck, chest, upper arms, legs and other body areas with no downtime and without the need for potentially dangerous numbing creams.

Q: How many treatments would I have to have?

A: Clinical studies suggest that 4-6 treatments spaced 2 to 4 weeks apart in most cases will produce a significant increase in dermal collagen, remodeling of dermal matrix components, and a resulting improvement in overall skin tone and vitality.

Facial rejuvenation via skin resurfacing has been available in many forms over the years.  The original cosmetic treatments consisted of chemical peels (believed to have been used by the Ancient Egyptians) and dermabrasion.  These modalities work very well but are not without risk.

The next generation of resurfacing was achieved with abalative lasers, the earliest of which was the CO2, and later erbium modalities.  The extended downtimes of lasers and risk (most particularly CO2) has lead to a decline in usage, despite potentially great results.  Since then, newer fractionated and non-ablative lasers have also been introduced and ceratinly have both positive and negative features.

For the last two years in my practice, I have incorporated a newer, non-laser modality for facial rejuvenation and skin tightening known as Nitrogen Plasma Skin Regeneration (PSR), made by Rhytec.  The PSR can be used in both a low energy (PSR-1) or high energy treatment (PSR-3). 

The principle of how it works is based on excitation of Nitrogen gas, which forms an ionized form of Ntrogen known as plasma (similar to the principle in "Plasma" TV sets). The energy is then released on the skin, causing a controlled area of injury on the skin.  The skin is left on as a biological layer for 3-5 days, and then peels away.  An initial rejuvenative result is obtained, followed by further skin tightening over the course of the next year (caused by increased collagen deposition and remodelling). 

The benefit of the PSR is less redness, less downtime, less risk of scarring, and less risk of hypopigmentation than with conventional lasers such as the CO2.  A PSR will achieve 70-80% of the wrinkle reduction and skin tightening result of the CO2, depending on the skin type and the extent of skin damage.

Patients must consider the combination of results, downtime, and risks when assessing facial resurfacing. There are many modalities available, many of which work well.  Understanding the potential upsides and downsides is essential to being happy with the ultimate outcome.

My recommendation is to ask yourself few questions before deciding what type of laser to use.

• How much improvment would I be happy with? As we age it is not only skin that relaxes, rather underlying fat and muscle. The best lasers, radiofrequency, and light technologies cannot effect underlying tissues in any significant manner. To my experience, these technologies can give 50% improvement at best. If you have to stand in front of the miror and pull on your face or neck to get your satisfied result then lasers might not be the way to go. You need to lift the loose fat and muscles through lift procedures.

• How many times do I want to do this? The final result from the best lasers, radiofrequency, and light technologies are usually noticable when done multiple times.

• Do I want immediate results or can I wait? The final result from the best lasers, radiofrequency, and light technologies are not usually noticable immediately. You have to be patient. If you want immediate result then surgery might be a better option for you.

• How much downtime can I afford? Lasers have the advantage of having less downtime per each procedure when compared to surgical procedures. However, when you sum up all the downtimes from multiple laser treatments then they may come equal to the surgical procedures.

• How much money can I afford? Lasers have the advantage of being less expensive per each procedure when compared to surgical procedures. However, when you sum up all the fees for multiple laser treatments then they may come equal to surgical procedures.

• How long do I want my result to last? The result from the best lasers, radiofrequency, and light technologies usually last much shorter to their surgical counterparts. You have to be ready to redo them much sooner than you expect.

Hi L,

Fractionated CO2 lasers are the best current choice, and will likely be the best facial rejuvenating and moderate skin tightening technology.  Fraxel re:pair laser treatment is a much more aggresive, and deeper treatment than the superficial Active FX. 

When Deep FX is added to Active FX, then the combination treatment results in very impressive skin tightening and rejuvenation.  Both Fraxel repair laser treatment and the combined Active/Deep FX treatment give excellent results. The price point for the two technologies should be very close.  Good luck and be well.

Dr. P

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.

3D Titan treatments plus Active-FX gives awesome results.

The Titan is specifically designed to tighten skin. Combining other lasers that remove pigment and smooth wrinkles not only rejuvenates the look of the skin but enhances the Titan results. Adding Active-FX is the final key to rejuvenation as it resurfaces to clear and smooth skin.

Active FX utilizes CO2 and is effective for overall skin rejuvenation. Active FX and other skin lasers help more with the quality of the skin than wrinkle reduction. It is very effective for reducing or eliminating the brown spots caused by sun damage.

Active FX also improves the tone and texture of the skin reducing pore size and plumping the skin through collagen stimulation. The collagen remodeling can continue to improve for 4-6 months after one treatment. Most often, only one treatment is required.

Active FX and Fraxel are limited as to what they can do for wrinkles. There is mild improvement to wrinkles but for those who wish wrinkle improvement the treatment would need to be deeper or more aggressive using the Max FX which increases the risk of hypopigmentation. This deeper treatment would result in longer down time as much as 3-4 weeks with the skin staying red longer.

There are different Fraxel treatments ranging from the original Fraxel (now called Fraxel Restore the treatment you had) which require 3-5 treatments 2-4 weeks apart to a newer CO2 Fraxel called Fraxel Repair. In choosing which treatment to have, make sure that you are comparing Active FX to other CO2 lasers such as the Fraxel Repair. Then, the decision regarding which one to use becomes based on your level of confidence in your provider after your consultation.

You should be fully informed about the specifics of your treatment and the expected downtime, as this will vary based on the settings used for your treatment. The settings for each patient's Active FX treatment depends on several factors including, but not limited to, the individual patient's skin type, areas of concern, and amount of downtime they are willing to have. We also use the Aluma to help tighten loose skin on the face and body. It uses radiofrequency, has no downtime and is not painful. It can be done alone or as a maintenance program 6 months to a year after the Active FX. To find a provider you can access information from www.surgery.org

I am a big fan of Fraxel Re:store because of the nice improvement with little social downtime, but it requires 4-6 sessions.

Fractional carbon dioxide lasers, such as Active FX, Deep FX, Juvia and Fraxel Re:pair, give faster results because they require fewer sessions. But the downtime can be a week, and even longer, with aggressive settings.

Carbon dioxide lasers also cause more coagulation, which contracts skin more and will likely result in more tightening. Sometimes, I combine Fraxel Re:store with Sculptra, Radiesse or hyaluronic acid filler to get the lift faster with a less aggressive laser for those who can't get a week off of work.

I have also added Titan along the jawline in some patients for added contraction. Titan and fillers have the benefit of "no downtime." In the end, there are options for every patient's unique needs, goals and timeline. Just see an experienced, board-certified dermatologist or plastic surgeon to get sound advice and guidance.

CO2 is the best and gold standard. However, due to complications, such as hypopigmentation, scarring etc. today, many offices do not perform traditional CO2. It has been replaced with "fractional" CO2 laser. (See Active / Deep FX) You are only treating a "fraction" of the skin instead of 100% of the skin. There has not been the same types of complications with these devices.

Fractional CO2 devices/procedures: Active and Deep FX made by Lumenis. Ask your physician which option may be best and why.

Best wishes,
- Dr. Kenneth Han