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Lasers and Lights--A Technological Revolution

By: Jeffrey Dover, MD, and Amy Kamin
Posted: June 6, 2008, from the January 2007 issue of Skin Inc. magazine.

page 5 of 6

Fractional resurfacing. Columns of epidermis and dermis are thermally damaged, leaving completely intact skin in between the treated columns. The healthy untreated skin is the source of rapid healing, accounting for redness and swelling for only three days after even an aggressive treatment. A series of six treatments is recommended every three to four weeks, which slowly improves both color and skin texture. The more treatments, the better the results. These devices are effective for mild to moderately deep wrinkles, as well as acne scarring. The treatment is slightly uncomfortable and produces redness and swelling for about three days after each treatment.

Plasma portrait. In plasma skin resurfacing, inert nitrogen gas is delivered to the skin. The plasma energy is absorbed within the skin. Depending on the energy used and the number of passes performed, the layer of altered skin slowly sheds over a period of three to seven days. With this highly versatile device, fine, moderate or severe wrinkles can be treated. The skin peels in a few days following the treatment, under which there is the new tissue formation of healthy new skin. Gentle treatments are very well-tolerated. More aggressive treatments require a topical anesthetic and occasionally oral medication.

Ablative devices

Er: YAG laser resurfacing. This laser wavelength is absorbed by water in skin, which produces removal of fine layers of the skin. The more tissue to be removed, the higher the energy used and the more passes done during the treatment. The treatment is painful, requiring topical anesthesia and occasionally some oral pain medication. The skin peels off over several days. Downtime is proportional to the depth of treatment, lasting from a few days to just more than a week. It is effective in treating mild to moderate sun-damaged skin.

CO2 laser. This pulsed laser, like the Er:YAG laser, is well-absorbed by water and vaporizes skin. Immediately after this gold standard for laser skin rejuvenation treatment, the skin is raw and during a period of seven to 10 days new skin is formed. While the posttreatment course is unpleasant and the procedure painful enough that it requires significant sedation and pain medication done by an expert, the results are dramatic. Fine to deep wrinkles improve as does skin color and overall texture.

Sagging

Until recently, the only treatment for a sagging face was a facelift, which involves cutting and removing excess skin at the edge of the face. Recent technological advances have brought about several exciting nonsurgical ways to tighten sagging facial skin. Each of these devices work by slowly and safely heating the dermis, producing shrinkage and tightening collagen. Results are modest and are not meant to replace a facelift. For the individual with mild to modest sagging, or for the person with sagging that would benefit from a surgical procedure but who is either not medically fit for such a procedure or who does not wish to have one of these techniques, they offer a very nice alternative.

Nonablative techniques