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Laser Revision 

Non-ablative lasers point the way back to youthful skin

As we grow older, many of us begin to consider the multitude of treatments designed to combat the visible signs of aging associated with an increased loss of collagen, decreased elasticity and firmness and other environmental damage our skin experiences over the years. Some of us may be looking for prevention while others are looking for corrective treatments, which can be either surgical or non-surgical. But let's face it, most of us would probably like to avoid surgical treatments for as long as possible.

Lakeview dermatologist Dr. Mary Lupo says three primary types of non-surgical treatments for aging skin are available in the New Orleans area today: injectibles and fillers; creams and cosmeceuticals; and texture and resurfacing treatments, including lasers.

For those who are uncomfortable with the idea of a Botox injection or injectible fillers and likewise wish to avoid the inconvenience of peeling from retinol creams, lasers may be the most attractive non-surgical option for treating fine lines and wrinkles, broken blood vessels, brown spots, redness and other visible signs of aging.

There are two ways dermatologists approach treating the skin with lasers — ablative and non-ablative procedures. Unlike a deep chemical peel or dermabrasion or the ablative CO2 laser, non-ablative procedures generally don't damage the surface of the skin and require far less recovery time afterward.

While individual recovery times vary, non-ablative laser procedures usually involve little discomfort and have minimal side effects, which range from some swelling and redness to small purple bruises that may last anywhere from two to 10 days. Most non-ablative procedures allow you to apply cosmetics the same day.

These treatments "don't leave you with open, wounded, sore skin and at this point in time are far more popular than ablative procedures," says local dermatologist Dr. Patricia Farris. "Twenty years ago we did nothing but ablative procedures, but now we've got all of these non-ablative technologies. So people can come have a laser treatment, go out to dinner that night and be a little pink — but by and large don't look like they've had much done."

Dr. Elizabeth McBurney, a Slidell dermatologist specializing in laser treatments, explains that non-ablative lasers typically work in one of two ways: they penetrate the top layer of the skin and heat the dermis below through radiofrequency or infrared technology, which sets off a cascade of chemical reactions that stimulates new collagen formation deep below the skin's surface. This helps to tighten and firm the skin. Or, they stay closer to the surface of the skin to take care of more superficial problems such as fine lines, brown spots, sun freckles and broken blood vessels.

Local dermatologists agree that the rising popularity of these non-ablative laser procedures reflects consumers' desires to achieve maximum results for their money with the least amount of down time after treatment. They also agree that laser procedures are most effective as part of a well-maintained skin-care routine. Laser treatment results should be augmented by proper skin care, says Dr. McBurney, "The patient continues to age. This is just one part of the whole advice we give to the patients — they've got to use sunscreen regularly, avoid tanning booths and use topical creams with alpha hydroxy acids or anti-oxidants daily."

1. Fractional Resurfacing: LUX 1540 and Fraxel

On the market for about four years, this non-ablative procedure penetrates the skin in tiny cones or microthermal zones, creating little columns of laser light, which leave a lot of normal skin in between the affected areas. This stimulates the production of collagen in a way that doesn't destroy tissue or require stripping the entire top layer of the skin, as the older ablative CO2 lasers do.

"CO2 lasers removed the whole top layer of the skin, and that's still the gold standard. That's the way to go [to achieve maximum results], but the problem is, you have about two weeks of down time. And there aren't many people who are going to take that much time in their life. Their schedules just don't permit it," explains Dr. Elizabeth McBurney. Fractional resurfacing provides an alternative for achieving the benefits of this type of skin rejuvenation without the down time or the higher risk of infection, and has been shown to have long-term results.

"Seems like with fractional technology we're now looking at three and four years out on some people and they're doing very well. If they use a good regimen and avoid the sun, the results can be fairly long lasting. And by long lasting, I'm talking several years. And so it makes it quite worthwhile."

Best For: Fraxel and LUX 1540 are good for all skin types, generally require only topical anesthetics and work best for treating brown spots, fine lines and acne scars.

Cost: Depending on the area treated, the cost is typically around $800 per treatment.

# OF TREATMENTS: 3-5 monthly treatments.

ADVANTAGE: Offers the benefits of CO2 lasers in resurfacing the skin without damaging, risk of infection or changes in pigmentation that accompany stripping the skin completely.

DISADVANTAGE: Will not improve red spots.

2. Intense Pulsed Light and Vascular Lasers

Sometimes referred to as photofacials, intense pulsed light (IPL) and vascular lasers have been on the market for roughly 15 years and remain some of the most commonly used and versatile lasers for treating surface skin problems.

"I always explain IPL to people like this: it's like if you took all the lasers in the world and smashed them into one box," says Dr. Farris.

IPL provides a wide range of wavelengths that can be adjusted for each individual. "Using a series of filters, we can select out which wavelengths to use," says Farris. "The reason it's so popular with dermatologists is because we can use IPL to treat so many different things. We used to have to buy a different device for every single thing we did. Now we can use this device to treat a number of things and clear the surface of the skin."

BEST FOR: IPL and vascular lasers work best for lighter skin, require topical anesthetics and are typically used to treat superficial signs of aging such as brown spots, sun freckles, broken blood vessels and other pigment problems and fine lines.

COST: Prices vary depending on location and size of the area treated, and range from $300 for the back of the hands up to $1,500 if you include arms, face, neck and chest.

# OF TREATMENTS: Typically 3-5 treatments done in three- to four-week intervals. A one-treatment touch-up may be recommended every six months.

ADVANTAGE: They've been on the market for years and are considered one of the safest, most commonly used type of non-ablative procedures. It is likely that you will see visible improvement more quickly with IPL than with other non-ablative lasers meant to stimulate collagen production.

DISADVANTAGE: Will not do anything for sagging skin. 3. YAG: CoolTouch and Candela CoolTouch is used for improving the surface texture of the skin and has been on the market for eight to 10 years. CoolTouch applies a coolant to the surface of the skin to freeze it before using the laser to penetrate below. This protects the surface of the skin from damage, while the laser remains higher in the dermis than other deep-tissue lasers. Likewise, the Candela YAG laser used by Dr. Dung Tran of Laser Concepts in Metairie also uses a protecting cooling mist. This laser is best used to treat spider veins, broken blood vessels and fine lines in the face (in addition to other functions such as hair removal) while improving surface texture. But as Dr. Tran points out, the light in a laser is attracted to pigmentation, so the darker your veins, the more improvement you'll see.

COST: $250-500 per treatment

# OF TREATMENTS: 3-5 monthly are recommended

ADVANTAGE: CoolTouch works well even when active acne is still present, while also improving surface appearance of existing scars.

DISADVANTAGE: Improves the surface of the skin but does not tighten it.

4. Titan

Through the use of radiofrequency to heat the deep tissues of the skin, this device works to tighten and tone sagging skin by promoting collagen production. It has been on the market for about six years and is best used for laxity, lines and wrinkles, as it can go deeper than a laser like CoolTouch. However, as Dr. Mary Lupo points out, Titan is not a substitute for surgical facelifts.

Dr. Lupo recommends a regimen that includes the use of both Titan and a treatment like IPL or Fraxel that targets surface skin problems such as brown or red spots that Titan will not solve. She points out that skin care — prevention, correction and maintenance — is a very dynamic process. If started early and maintained regularly, it may eliminate the need for surgical treatments later on.

Likewise, local dermatologist Dr. Nia Terezakis prefers to use a laser similar to Titan in combination with retinols or injectibles to enhance the laser treatment and prolong its effects: "There is no 100 percent treatment with any one modality. It's a combination of what you use rather than any one thing that's going to make people the happiest over time."

Using a laser with a retinol also helps to jump-start the retinoid treatment, as the laser makes it easier for the cream to penetrate the skin.

BEST FOR: Titan is good for all skin types but may require more treatments for darker skin. It usually requires only topical anesthesia.

COST: $300-2000 per treatment, depending on size of area treated

# OF TREATMENTS: 3-5 treatments are best in four- to six-week intervals

ADVANTAGE: Compared to similar lasers, such as the Thermage, Titan produces the least discomfort, and unlike Thermage, does not typically require local anesthesia. It can be used to correct laxity in areas such as the elbows, knees and abdomen. It also penetrates more deeply than a laser like CoolTouch.

DISADVANTAGE: Won't do anything for brown or red spots and may take up to six months of treatments to see full results.

As several dermatologists point out, many of these laser technologies are still evolving alongside other non-surgical options. With newer devices like Titan and Fraxel offering a wider range of possibilities for treating the skin, and older devices like IPL becoming more versatile and familiar as they remain on the market — non-ablative anti-aging procedures are now more affordable and efficient, with less and less recovery time and discomfort involved.

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