There are several aspects to this question. Considering Botox, because it prevents muscle contraction the treated muscles will become weak and diminish in size. However, because facial muscles are in constant demand, if Botox is not continued the weakened muscle will have a lot of opportunities to exercise and it will eventually return to normal function. Having said that, you have permanently altered the time course of the wrinkles caused by that muscle. If you do Botox for 10 years, your wrinkles should take 10 years to catch up when you stop Botox treatments. As for fillers, there is evidence that some fillers trigger collagen production, resulting in a partial permanent correction after repeated treatments. I would hope you don’t develop scar tissue, that would be a complication!
IPL is broad band light, with filters used to concentrate energy in certain visible light wavelengths, as well as some infrared. As such it can be tuned so that the energy is best absorbed by certain targets, called chromophores. You can target red, you can target brown and you can compensate to a certain degree for different natural skin tones, target sizes and target depth. As such it is true that it is best for redness, spider veins, and certain brown pigmented lesions. However, there is a an effect on fibroblasts in the papillary dermis. These cells produce and degrade collagen, so we have documented that fine lines around the eyes will respond to IPL treatment. In general, we would not recommend IPL as the primary treatment if that is the only goal of treatment, but if you also have redness and brown spots to go along with your fine lines, which pretty much everyone does, then IPL is a good option. We presented this data at the American Society of Laser Medicine and Surgery nearly 20 years ago.
This is an excellent question. It sounds like you are looking for a primarily epidermal response, since post-inflammatory hyperpigmentation is due to over-active epidermal melanocytes (pigment producing cells). Having said that, some epidermal pigment can end up in the superficial dermis, a process called pigment incontinence. That is why pigment lightening procedures that target just the epidermis, like hydroquinone or chemical peels, sometimes fail. The Fraxel laser will treat both the epidermis and dermis, so that increases your chance of a successful outcome. On the other hand, if you treat too frequently you can stimulate those pesky melanocytes to produce more pigment again, so the pigment recurs. A good rule of thumb is to wait until any redness and swelling from the previous procedure is completely gone before retreating; in general we recommend 4 weeks between treatments. Also, if there are also any textural changes from your acne, you want to keep producing new dermal collagen for as long as possible to achieve the best improvement. That is another reason to wait 4 weeks or longer to allow the benefits to accumulate before retreating. That will save you money. Also, it is critical that you stay out of the sun during your treatments to avoid complications. In terms of laser setup, for epidermal improvement a high density of microthermal zones works best, with a correspondingly low treatment fluence to avoid complications. Good luck!
