Ideal SmartDot Laser Setting for Wrinkles?

I have just had a second SartDot Laser, this time it was more painful and pinpoint bleeding. Also my doctor said the protocols have changed and he had new gas put in. He said that was why it was getting a deeper depth and he did stacking 4 is that the dots been closer and the sound of the machine was different second time. Do you think this was a deeper treatment than my first even though I had more swelling first time. I really want to know what is best for wrinkles and what setting is best. 

Doctor Answers 3

What is the right laser setting?

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You have had the perspective of two procedures with the same machine, same doctor, and same target area, so your experience does have some value in anticipating potential outcomes. Your doctor also sounds as if he is honest and forthcoming about the reasons your experience was so different the second time around.

"New gas" means a rejuvenated laser tube for the resonating chamber, which in this case is a CO2-containing laser tube. This means a stronger beam for otherwise identical settings. However, most lasers have internal "check and balance" sensors that keep the actual energy output within specified tolerances of the front panel readings. So, all things otherwise being equal, the output should be very close for identical settings with an "old" tube and a refreshed, re-gassed laser tube.

So, the real difference here is the "new protocol." Some laser surgeons use "standard" settings suggested by the laser manufacturer, and these are usually quite conservative (read safe). Once more experience is gained, the laser operator utilizes tissue responses as the procedure is performed, and in cases such as yours, the very valuable experience gained by your first procedure. It sounds as if you had a more aggressive second laser procedure, and should expect a more dramatic result. Obviously, more agressive settings mean more dramatic results, but at the potential for longer healing and higher risk of scar formation. So everything is on a scale of judgement and experience.

By the way, this is not something you should worry about. Your laser surgeon's job is to convince you of his experience and capability, just as an expert race car driver is expected to make his own decisions about acceleration, braking, and speed. Each driver does this slightly differently, and only one driver wins the race, and many crash. But in this example, your laser settings are designed to give you the best result within the parameters of the operator's training and experience, and his desire to avoid complications in EVERY case, not just to barely scrape by and accept the occasional bad result--NOT acceptable.

It's not about the machine or the settings, it's about the skill and expertise of the operator!

Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

Dot Laser settings

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There is no best setting.  A nice advantage of the DOT laser is that it easily customized for each patient.  The DOTS can be moved closer together and depth adjusted.  The closer the dots and deeper the dotsgives a more aggressive treatment and usually better results , but also takes longer to heal and slightly increased the risks.  Also , the DOTS can be stacked or a second pass done to problem areas,which I frequenly do around the lip area.  It sounds like your second treatment was more aggressive, and I hope you see good results.  Lana Long, M.D.

Lana Long, MD
Cincinnati Dermatologic Surgeon

DOT CO2 laser

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It sounds like your second treatment was deeper but you should ask your doctor if you want to know for sure.  I often see pinpoint bleeding after a more aggressive treatment.  It is also common to see swelling for a couple of days, especially around the eyes.  There is no one best setting.  It all depends on your doctor's experience, the patient's degree of sun damage, and the patient's tolerance for downtime.  Usually when a patient is doing multiple treatments, it makes sense to be more aggressive with subsequent treatments if the first treatment was well tolerated.  Usually I am more aggressive in areas of deeper wrinkles such as around the mouth.  I use lower settings for the eyelids, where the skin is thin.  In my hands, DOT laser has been a very effective and safe treatment for sun damage and acne scars.  I have lectured and taught CO2 laser techniques to other physicians.

Richard Ort, MD
Lone Tree Dermatologic Surgeon
5.0 out of 5 stars 28 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.