Ipl or laser for skin tightening?

Question

I need help, I have hard time trusting doc in my area. What is the best treatment for tight,low pores,skin treatment? I do have mild discoloration but if I had a choice I'd want tight, poreless skin,deep wrinkles gone. Is there hope? I use tazorac and it's helpful and worse. Should I keep using, pores seem bigger? I want porcelain skin.Any advice vast improvements? I want tight skin. BTW I'm 39/ white. Light freckles, blue eyes.It's not saggy but,tightness is priority. TY

Jason Emer, MD · Answer

I suggest posting photos for further treatment advise. Lasers, microneedling, ultherapy/thermage and skin care can improve skin elasticity, pore size, and wrinkles.  Deep peels and fillers can also give improvement.  IPL has no effect on skin tightening.  Please see an expert for a combination approach.  Best, Dr. Emer

Amiya Prasad, MD · Answer

Thank you for your question. You submitted a question without a photo but your description is very helpful. You say you’re 39, Caucasian with blue eyes, have some light freckles, some discolorations, and currently using Tazorac. Your focus seems to be on large pores, and you state difficulty in trusting doctors in your area. You ask about IPL versus laser therapy to tighten skin. You want the pores and deep wrinkles to look better.

I can give you some guidance with how we assess our patients about the best option and result, which is very much in line with what you are looking for. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice for over 20 years and I have been using laser and the latest non-surgical devices since the mid-90s, starting with the original CO2 lasers which were fully ablative and aggressive.

I think your goal is not necessarily tight skin, but smooth skin. What I help my patients understand is they often feel like their skin needs to be tight, so they pull their skin. Whether they need a facelift or something to make their skin tighter, they feel like pulling would be the ideal. Having improvement of skin pores and wrinkles are what everybody wants, but the challenge is to do that in the modern world without long downtime.

First, a proper skin assessment, and a physical examination have to be done with context of a good medical history. We have to asses the depth of the wrinkles because you may feel they’re deep, but from a medical perspective they may not be so deep. With pores, most doctors are hesitant to guarantee significant improvement in because of the nature of some people’s skin is having large pores.

The most aggressive treatment which is probably the most effective, is fully ablative CO2 laser, but it may not be something you can tolerate with time and the healing process. This laser ablates the top layer of skin going down to the level where the pores will be almost flushed and smooth. Generation of thermal energy causes tightening of the skin, and you’ll have a new layer of skin that will look smoother. The downside is that it takes a long time to heal.

Based on that prolonged healing process, the technology has advanced to be more balanced, so we have fractionated technology. Fractionated technology can be anything from the most superficial fractional Erbium laser to a much deeper fractional CO2 laser, or even a long pulse Erbium laser which can be equivalent, for intents and purposes, to a CO2 laser. We offer those things to our patients. We also offer ND:Yag, non-ablative technology for dermal remodeling.

So what are the advantages and disadvantages? With a fractional laser technology you will heal faster, but you may not get the same result as an ablative technology. With non-ablative technology, there’s no real downtime but it does take some consistency to achieve the best result. We often combine these technologies with regenerative technology such as the use of platelet-rich plasma (PRP).to induce collagen, vascularity, improve skin quality, and improve wrinkles.

In a way, it’s almost like a painter having a lot of different paints - we have a lot of tools at our disposal. In our practice, we have everything - as a surgeon, I am able to offer non-surgical solutions. I don’t really have a bias, but I do try to figure out what each patient can tolerate, and what their expectations are. It’s important to have good, thorough consultation so these expectations and the process are understood. Often, people bounce from doctor to doctor, or shop price because they learn about a technology, with some doctors offering a deep discount to bring people in the door, but they get disappointed because they didn’t get the results they wanted.

It’s very important to have a real connection with a good doctor you feel comfortable with, and who can offer an array of solutions. You need to feel comfortable with the doctor’s experience, knowledge, and understanding of what is achievable. It’s very important because if you don’t get what you want, then you would be out the cost and time, and you will be dissatisfied.

Meet with doctors, and maybe it’s necessary for you to travel outside of your area to feel comfortable, but learn about these options. Everything has pluses and minuses, so there’s no one perfect solution. If there was one perfect solution, we’d all use that one perfect solution - this is an art, especially cosmetic dermatology.  Figure out not only what’s optimal from the initial impression, but see how you do with the treatment and how you are managed. I hope that was helpful, I wish you the best of luck and thank you for your question.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question canabis. Enlarged pores and loose skin are common concerns for many people. One of the most important things is being able to trust your doctor because that is the backbone of the doctor-patient relationship. If that is lacking it is important to find someone that you trust. I'm not sure if I understand if the tazorac is helpful or making you skin worse. There are various treatments to address enlarged pores including chemical peels, laser peels, laser skin tightening, IPL, radiofrequency, fractional lasers, and ultrasound. Please speak with a trusted doctor for specific recommendations. Good luck!

Grant Stevens, MD · Answer

If you tolerate your Tazorac nightly, continue the use of it!  It is a great anti aging skincare product.  Also consider the use of Sunscreen daily.  In my office we offer the new Sciton BBL.  There is a series called Forever Young BBL.  I would highly recommend this type of treatment for overall skin health.  Hope this helps.

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