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Combining Laser Treatments and Esthetics

By: Terri Wojak
Posted: May 26, 2010, from the June 2010 issue of Skin Inc. magazine.

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CO2 ablative laser treatments improve wrinkles and fine lines by heating the water content in the skin to the boiling point, thereby vaporizing the skin cells. This laser treatment results in a controlled burn, which is limited to the outer layers of the skin. When this reaction occurs, it is called “ablative” because the outer layers of the skin are being destroyed, or ablated. If the treatment is aggressive, the underlying skin is left raw, uncovered and unprotected. The skin typically becomes red and weepy following the procedure, and full skin regeneration can take up to six months, depending on the procedure. As the wound heals, new skin regenerates by collagen formation and is laid down in a more orderly fashion. There is a thickening of the dermis and the epidermis, excess dead skin cells are removed and pigmentation spots greatly improve.

One of the biggest breakthroughs in facial rejuvenation treatments during the past few years has been the addition of fractionated laser resurfacing. This technology allows for the deep penetration of energy that changes the structure of collagen and stimulates a wound response. During these treatments, the laser beam is fractionated by a special microlens so that it is evenly distributed from the handpiece to the skin. Islands of untreated, intact skin are targeted evenly throughout the treatment field; this results in rapid re-epithelialization and healing. Fractionated lasers are quickly replacing the use of nonfractionated ablative lasers due to the decreased possibility of side effects, increased healing times and better results.

The esthetician’s role. The esthetician’s role is involved and intense with ablative and fractionated patients. The patient must be educated about the importance of keeping the skin moist, and avoiding sun exposure and smoking, or they can have serious side effects including hyperpigmentation and even scarring. It also is important to counsel patients and prepare them for the intense treatment they are about to undergo. Before the treatment, the esthetician can prepare the skin with microdermabrasion treatments and superficial peels. A series of three treatments could be performed at two-week intervals starting eight weeks before the scheduled laser appointment. Understanding the post-treatment protocols is also necessary, as is identifying any concerns so that a physician or nurse can be notified of potential adverse effects. During the ensuing six-month healing time, the skin will need attentive care. Most patients will be excited and interested to learn how to take proper care of their newly rejuvenated skin, and they will be motivated to work with the esthetician to keep it in a healthy state.

Ablative erbium: YAG laser resurfacing

For those who want an improvement but do not want the significant amount of downtime or risk that comes with CO2 laser therapy, there is another option; the ablative erbium YAG (Er:YAG) laser. One of the greatest benefits of the erbium laser is that it allows the strength of the treatment to be adjusted from a mild resurfacing to a deeper treatment, based on the patient’s desire. The Er:YAG laser has a shorter wavelength (2940 nm) than the CO2 laser, and it produces energy in the mid-infrared invisible light spectrum. The Er:YAG laser does not burn the skin like the CO2 laser does, and because of this, the amount of pain and the number of adverse effects experienced by the patient are greatly reduced, while the degree of precision and control is significantly enhanced. The healing process lasts from three to seven days, depending on the depth of the treatment.

The esthetician’s role. Similar to the esthetician’s role in CO2 laser resurfacing, in Er:YAG laser treatment, the esthetician is involved both before and after the treatment. Before it takes place, the esthetician can prep the skin with superficial peels and microdermabrasion treatments. These should be performed at least two weeks before the laser treatment. During the first week after the laser treatment, the esthetician should guide the patient on the proper after-care products, including the importance of wearing sunscreen. Care must be taken with patients who have oily or acne-prone skin to avoid irritation and future breakouts. Many patients undergoing Er:YAG laser treatments become regular clients of the esthetician because their skin is in better condition, and they will require continued help to care for it.

Nonablative fractionated