Lazer Treatment - Best New Technology
Doctor Answers 7
Conservative CO2, plus fractionated laser for areas other than the face
As a patient, you may hear that the CO2 laser causes whiteness, that it causes a prolonged healing time and that the fractionated CO2 laser systems give similar results with no down time or minimal down time, and therefore fractionated laser is superior to the "old" CO2 laser. You will get white from the "old CO2 laser".
These statements are false. Here is why.
Fractionated laser with the CO2 laser works by giving small pulses of light to the skin, causing injury to the epidermal layer and the dermal layer. The "claim to fame" for the fractionated lasers is that they leave bridges of uninjured epithelium between areas of injured tissue. This enables the face to "reepithelialize" quicker. The reason is that the face reepithelializes by the epithel ial cells replicating and migrating from islands of uninjured tissue. Therefore to form a shield of epithelial cells, this occurs more quickly with the fractionated laser system. The advantage is quicker healing. The disadvantage is that all those bridges that didn't get lasered don't get tightened either. There can be a patchy appearance to the face since the face was not uniformly blanketed. I see many patients who were unhappy with their fractionated lasers because the results were not what they expected and they still had 4-5 days of down time. So they had the treatments repeated again and again, incurring additional down times and additional expense.
When the CO2 laser is used on common density settings, the tissues are largely "blanketed" by CO2, and the epithelial cells residing in the pilosebaceous units and hair follicles etc. perform the same reepithelialization function, just more slowly. A tug of war begins. If epithelization can occur within a reasonable amount of time, say less than a week, scarring almost never occurs in the face. We know this from decades of burn research, and the study of laser injury is burn biology. For an explanation of the boiology behind burn injury, you may wish to read my chapter in "Current Medical Diagnosis and Treatment, Burn Therapy 2009"
The CO2 can be set to many different settings, let's just say low medium and high for the sake of explanation. The high setting occurs when 3 or 4 passes are done on the face. The injury is relatively deep. Lots of the dermis is injured. The results are fantastic. However characteristic loss of pigment occurs as the pigment elements are progressively wiped out the deeper the laser goes. And there may be long term pigment cell death as well (apoptosis). This is the laser settings that most of the panelists are referring to. We never laser this deep, because of the undesired effects.
However, the CO2 laser can be "turned down" to 1 or 2 passes on more conservative settings. The time to reepithelialization averages 5-6 days. Almost never is it more than 7 days. This also means that the redness and depigmentation (and risk of scarring) is also greatly reduced. Our incidence of "milkbeard" deformity and scarring with our current conservative CO2 system is zero. And our patients generally have a single treatment and are back in public feeling comfortable within 7-10 days, often sooner. We tell them in advance some wrinkles will be left behind, and the reasons why aggressive laser resurfacing would not make them look better.
The benefits of fractionated laser seem to be on areas other than on the face. CO2 is not commonly performed in darkly skinned patients, the hands, chest, decollete, where fractionated laser may be safer.
Latest trends in lasers
Undoubtedly, the latest and really exciting trend in skin laser treatment is the development of fractional laser technology, in particular fractional CO2 resurfacing. CO2 lasers have been around for a long time and have proved to be a fantastic tool for facial skin resurfacing - removing lines, wrinkles, pigmentation, and skin tightening. Unfortunately, sometimes patients took months to recover, and sometimes removing too much pigment left obvious "laser stigmata".
The new technology has allowed us to maintain the efficacy of the CO2 laser and minimize the downtime and the risks. It is becoming the new gold standard in the skin resurfacing. Among the many new lasers, Active/Deep FX by Lumenis is one of the most powerful and safest machines. The combination treatment allows us to choose the precise settings for each patient to successfully treat lines, wrinkles, sun damage, pigmentation, old scarring and acne scars. It improves skin texture and tone, and dramatically rejuvenates the appearance. The downtime for this treatment is about a week, and it is quite worth the results that the patients get.
The latest trend in laser treatment is fractionation of the laser beam, which delivers the laser on the skin in a pixel-like fashion allowing for minimal downtime, rapid healing, and now with CO2 fractionation, maximum results. Fraxel re: pair has been the leader in developing this technology.
Good luck, and be well.
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We have recently added one of the newest and most exciting lasers that is on the market. Pearl Laser by Cutera. The Pearl laser is excellent for treating modest sun damage including dark spots, freckles, delicate wrinkling and large pore size.
I have found that the Pearl Laser (unlike the Fraxel) is less painful during the treatment process. The Pearl Laser on a scale of 1 to 10 is about a 2 to 3 for the majority of my patients.
A full Pearl Laser treatment for the face takes only 15 to 20 minutes. However, we do have the patient arrive 45 minutes before the treatment to have a topical numbing cream applied to the area being lasered. Patients are red for about four days. After the fourth day usually you will peel for about a 24 hour period. After you have peeled you are free to apply regular moisturizer and makeup.
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