Best fractional CO2 laser for 45yr old fair skin w/ fine lines @ eyes, upper lip, and age spots/ mildly sun damaged skin?

Question

What’s the best fractional CO2 laser resurfacing for 45 year old fair skinned person looking to reduce/eliminate fine lines around eyes, “smoker lines” on upper lip (not a smoker), and some age spots/sun damaged skin. Also would like to know if any of the lasers address creepy upper eye lid skin? And is their risk of a line around the face/edge where laser was used vs not used. Downtime is not really a factor, just want the best result in a one time procedure. Thanks!

Paul Lanfranchi, DO, FAOCOO · Answer

Thank you for your inquiry.  The "ideal" patient for a fractional CO2 laser is a patient who has fair skin like yourself.  From a technology standpoint, most fractional CO2 lasers to the same thing...they basically punch out microscopic holes in the skin.  Of course the depth and distance of these holes can be adjusted based on the settings of the laser.  Thin and crinkled skin under the eye certainly can be corrected with most fractional lasers.In my experience, probably the MOST important factor in laser treatments has to do with the individual actually operating the machine.  From personal experience, I used to not like my fractional laser (for the first 6 months) simply because I could not give a substantial result with a single treatment.  However over time, one learns how to make adjustments and vary techniques in order to get fantastic results.  Certainly you would want to seek a practitioner who has lots of experience with THAT particular laser (perhaps years even).  Another consideration/question would be to ask how they protect the actual eyes of the patient during the treatment, especially if they are going close to the eyelashes and lid.  Some docs use corneal shields (metal discs placed over the cornea with local anesthesia drops), while others use a metal hand-held shield to protect the eye and lashes.

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Shobhan Manoharan, MBBS, FACD · Answer

Thanks for the question. There is number of excellent CO2 devices on the market and it often comes down to not only the device in particular but also the level of experience and expertise of the practitioner.

My favourite CO2 device at the moment is the Lumenis Ultra Pulse CO2 which is an outstanding device in terms of addressing surface concerns (pigment, sunspots, textural change) as well as deep concerns (deeper wrinkles, collagen remodelling and scarring) but as I mentioned the key is to understand the level of training and experience that your practitioner has.

By using CO2 laser in experienced hands and being able to treat by cosmetic units and blending techniques we should be able to address all the concerns that you mentioned in your question and minimise your chance of demarcation lines.

Amy Y. Paul, DO, FAAD · Answer

Thanks for your question.  In general, CO2 lasers are similar, and there is not really one leading machine out there.  What really matters is the physician doing the treatment for you. In our practice, I love the CO2 laser, and it is the only of of my many lasers that I personally perform myself.  You can have a risk of a line of demarcation if the physician does not blend the edges with artistry.  You can treat pretty close to the eyes, but make sure you have the regulation eye shields in place. My excellent Certified Laser Specialist with 15 years of experience does all of our other laser work, but I feel strongly that my experience and interaction with the patient during the CO2 treatment and afterwards are very important.  I like to know exactly what settings I am using and can use my years of experience to fine-tune the laser treatment depending on the patient's goals and problem areas.  I would encourage you to consult with a board certified dermatologist you trust and who has excellent before and after photos.  CO2 laser can be an aggressive tool with a risk of burning and scarring if not done properly, so make sure you are feeling comfortable with your decision.  Best of luck!

Laura Riehm, MD · Answer

Thanks for your question.  Apparently, you put no value on technique or experience.  It's like asking what's the best car?  Who is going to drive it?  On road or off?  Are you going for speed or comfort?You need to find a physician with lots of experience and up to date equipment.  If you go for the newest, best laser, they don't have the experience to know what works well and what doesn't.  When a physician gets training for a newly purchased laser, they are only instructed to use the settings/technique approved by the FDA.  It takes experience to formulate protocols that work for your patients.Look for a physician in your area with excellent reviews and experience  with patients in your demographic.  Best of luck.

Davin Lim, MBBS, FACD - Account Suspended · Answer

Really depends on the clinical picture as well as the application of lasers. In the context of your description lasers like the Ultapulse, Mixto, and many others can treat your concerns. As eluded by others, its the expertise of the Specialist that makes the big difference. In CA, Dr Sue Kilmer, Dr Chris Zachary and Dr Jason Emer can help you with your questions and procedure. All the best, Dr Davin S. Lim. Brisbane.  Australia.

Best fractional CO2 laser for 45yr old fair skin w/ fine lines @ eyes, upper lip, and age spots/ mildly sun damaged skin?

Answers (6)

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