What would be the best for me: Halo laser or multiple micro-needling and IPL photo facials or blue light and levulan? (Photo)

Of the options you listed the halo laser treatment would be best combined with continued use of topical retin-A. With a history of AKs and that type of discoloration you’d get even better results from a fractionated CO2 treatment. Good luck! 

Great question! You have multiple treatment options, each of which have their strengths and what would be best if you consider treating your skin like you think of exercise of getting your teeth cleaned. There is an initial phase of getting it where you want it, and then regular (usually light) maintenance to mitigate the day to day changes of aging. This is especially delicate skin of the neck and chest.Let's address the AK's first as they are the most pressing health issue. If your insurance covers it, you might want to start with the Levulan and the clean that up and do more aesthetic treatments on your own dime. Solid research out this year (Derm Surg 6/2019, Ortiz et al) found Halo actually cleared up on average 90% of AK's missed by Levulan, liquid nitrogen and 5-FU.Once you get the AK's, reassess your most pressing concerns. A series of BBL's are best for color. Offices push MN b/c it's close to free revenue for them, but you will get more out of one BBL than a series of MN. Halo accelerates improvement in fine lines, wrinkles and texture and combines weil with BBL. Find a laser doc you like and trust and they'll help guide you! 

Dear DRT RDH, It’s great that you are really focused on turning around what is either pretty significant sun damage or a genetic predisposition to advanced aging. For most of us, it’s a combination. It is unfortunate that so many people wait and don’t get proactive early in their life like you are.  It sounds like you are off to a good start and I also assume you are very compliant with sun protection as well. The only thing that stands out is that your expectations that one treatment a year is going to make a significant change. IPL‘s or broadband light treatments really should be considered as an ongoing series. It may take up to Five or more treatments to really target the pigment. Ongoing treatments of about three a year will not only be great maintenance, but can also change genetic expression of that skin, waking up genes that are more active when patients are young. You do have to be careful in the neck and chest area because it’s extremely easy to get burned. The skin is much less resilient than the skin on your face. Low level treatments when there’s a lot of pigment is best. Combining this with micro needling is an excellent idea to speed results. Microneedling with  Radio frequency can be more aggressive with texture improvement.While intense pulsed light targets the pigment more, lasers will focus more on texture. Halo is a really nice combination of an ablative and non-ablative laser with easy healing. These too should be  considered best done in a series. The results of a non-ablative laser are significantly less aggressive than a laser that has more downtime like pro fractional, microLaser peel, and resurfacing.  Instead of just picking one of these options I would think of your choices as ongoing skin care, based on what you can afford financially and also from downtime perspective. Combinations of these choices are probably the best of all worlds. It takes a long time to get the skin damage, and it takes a while to repair it as well. Think of this as not a one stop shop treatments; but lifestyle changes and ongoing care that will continue to improve and  maintain your skin over your lifetime. Good luck,

thank you for your question, it’s a common one in my practice. The way I generally answer this issue is by using a combination treatment. I think levulan is a great way to start as it can be insurance covered and directly address the ak issue. I follow that with halo or halo/bbl. Dr Ortiz recently published a paper showing halo improves close to 90% of ak in the treated field. I choose halo/bbl if there is a lot of brown spots. Moreover resurfacing improves your pigmentation issues from freezing lesions previously. Good luck, hope this helps.