Skin Resurfacing - Patients ask, Dr. Ringpfeil answers
Please feel free to use the blog below to share information about Skin Resurfacing or to ask Dr. Franziska Ringpfeil a question that might be of interest to others.
Philadelphia and Mainline Center of Dermatology and Cosmetic Surgery
Skin Resurfacing
Are you confused by all the different options you hear about making your skin look younger? Non-surgical skin rejuvenation, laser skin resurfacing, wrinkle treatment, fillers, face lift, and skin tightening are common approaches for improving the look of your skin. Among these options, laser skin resurfacing is the most effective, non or semi-invasive surgical approach to achieve drastic results. A multitude of technologies for skin resurfacing is currently available. They include carbon dioxide lasers, erbium lasers, plasma and radiofrequency devices delivering their results in a fractional, ablative or non-ablative manner. This review will help you understand the different skin resurfacing options and determine which one fits you best. You will learn about the different treatments, looking side by side at each attribute of skin resurfacing - expected results, social downtime, number of treatments needed, time results last, and cost.
Treatment Options
| CO2 Laser | ActiveFX(TM) | Icon 1540 non-ablative fractionated laser |
Fractional Lasers |
TCA Peel | Glycolic Peel |
|
|---|---|---|---|---|---|---|
| Results | ++++ | +++ | +++ | ++ | ++ | + |
| Social downtime | 5-14 days | 3-5 days | 1-4 days | 1-6 days | 5-7 days | None |
| # Treatments | 1 | 1-2 | 2-4 | 4-8 | 1 | 6-8 |
| Lasting results | 10 years | 10 years | 5 Years | Unknown | 1-2 years | 1 Year |
| Avg. total cost | $3000 | $3000-$4500 | $1000-$4000 | $4000-$7000 | $500 | $700 |
- Skin Resurfacing - Introduction
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Maintaining beauty and a youthful appearance date back several thousand years to the ancient Egyptian. However, the advances in technology have never before awarded such a choice of modalities. Non-surgical skin rejuvenation, laser skin resurfacing, wrinkle treatment, fillers, face lift, and skin tightening are common approaches for improving the look of your skin. Particularly, the introduction of a multitude of skin resurfacing devices has caused a lot of confusion amongst consumers. Among these options, laser skin resurfacing is the most effective non or semi-invasive surgical approach to achieve drastic results.
First of all you must know that every new resurfacing laser or device is measured against the industry's most powerful machine for the past 40 years, the carbon dioxide (CO2) laser. It was invented in 1964 and has been the most widely used laser in medicine. In the area of dermatology, its use has been predominantly for facial resurfacing. It often achieves desired results in a single treatment, works on fine and intermediate lines and acne scars, maximally tightens the skin and delivers results that last a number of years. Its drawback is a long, 10-14 day social downtime, making it less desirable for any working person. To overcome this handicap and minimize healing time, many devices that do not injure the uppermost layers of the skin (non-ablative) have recently been developed by the aesthetic industry. The single most important advance was the creation of fractional technology. Leaving small islands of normal skin behind, the skin regenerates much faster than with the traditional full ablation of skin.
You will learn about the current industry recognized ablative and non-ablative strategies that rejuvenate your skin and about the benefits and downsides of each of these techniques.
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- Fractionated Ablative Lasers -- Carbon Dioxide Laser - CO2 Laser
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As an ablative laser, it vaporizes the tissue and is able to eradicate fine and intermediate lines, smoothes overall skin texture and acne scars, eradicates uneven pigmentation as well as tightens the skin. It lets you appear about 10 years younger and often replaces the need for a face lift unless skin sagging is severe. Preparation and postoperative care most closely resembles a full fletched surgical procedure, however, CO2 laser resurfacing can be performed under local anesthesia. The price you pay for the results is one to two weeks of social downtime while the skin reepithelializes. In addition, the resurfaced skin may appear pinkish for several months thereafter.
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- Fractional CO2 Laser - ActiveFX(TM), DeepFX(TM), Fraxel re:pair(TM), Mosaic eCO2
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Since the beginning of 2007, refined systems with partial degrees of ablation that leave small islands of normal skin from which the skin can regenerate much faster, have revolutionized the resurfacing market. Amongst these, the combination of DeepFx and ActiveFx, manufactured by the leader in CO2 technology (Lumenis) give results that most closely compare to the traditional laser resurfacing. This new technology offers faster healing times with still excellent results. In the meantime, a number of laser companies have now developed their own permutations of a fractionated CO2 laser and names include Fraxel re:Pair, Slim MIxto/SX, Exelo 2, Mosaic.
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- Erbium YAG Lasers
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The traditional erbium laser has produced results that were absolutely comparable to the CO2 laser yet it fell out of favor because of significant post operative bleeding. As with the fractional method developed for the CO2 laser, today's erbium laser treatments are almost exclusively fractionated and may also be called pixelated. Names that you may read about are Pearl, Pixel, ProFractional and Starlux 2940. However, with the exception of the Pearl, these do not deliver results that mirror the original. While downtime is typically limited to 1-4 days, the downfall of most of the fractionated erbium technology is the very superficial nature of the resurfacing results, being excellent at improving sun damage, and skin texture, but will target only the finest lines. They are considered more like an aggressive peel. Several treatments are often necessary to achieve such results. These fractionated lasers do not significantly contribute to skin tightening, removal of wrinkles, let alone acne scars.
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- Non Ablative Fractional Lasers
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Protecting the epidermis, the upper most layer of our skin, and thereby minimizing social downtime, non-ablative lasers deliver energy in the lower layers of skin, ideally only causing swelling which is socially much more tolerable than oozing. Amongst the non-ablative lasers, FRAXEL is the most marketed. Other brands include Affirm, StarLux-Lux, Mosaic.
Using a wave length lower than that of a CO2 laser, these lasers drive energy into the skin, stimulating collagen production and thereby tightening skin. Results after a single treatment are minimal and it can easily take 4-8 treatments to observe an effect. While its effects on wrinkles and lines after 4-8 treatments is fairly close to the results of a single CO2 laser treatment, it does not seem to deliver on scars as well. In addition, the Fraxel has been FDA approved for the treatment of melasma, also known as the mask of pregnancy, which shows as symmetric pigmentation on the face as a result of sun exposure with increased estrogen levels.
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- Non-laser Fractionated Resurfacing Devices
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Plasma and radiofrequency devices belong to this category. Because of the more convincing results, plasma technology will be discussed here. The plasma device is not based on laser principle. Plasma is pushed into the skin to induce partial ablation of the epidermis and renewal of collagen beneath the surface of the skin. Treatments can be delivered in 1-2 aggressive sessions, results mimicking nearly those of fractionated CO2 laser resurfacing. When energy levels are minimized to allow for as a little as a few-hour lasting redness, several treatments will be needed for an effect. With the latter technique however, results tend to be much less dramatic. Having gained FDA approval in the second half of 2007, the technology is fairly new and long term results are not known yet.
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- Skin Resurfacing - Summary
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In sum, many exciting technologies are available nowadays. The general rule of little downtime little results still applies. Non-ablative technology seldom achieves noticeable results in a single treatment and the overall outcome even after several treatments is often below expectations. Ablative devices appear to deliver best, require only a small number of treatments results and social downtime can effectively be lowered by the uses of fractional technology. Ultimately, your goals, your ability to tolerate social downtime and your wallet will steer you and your treating physician to a resurfacing plan that is tailored to you.
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Hi Dr. Ringpfiel – What would you recommend to reduce pore size? There’s a lot of otc cosmetic type options to reduce the “appearance” of pores but I want them smaller for real!! Help please 🙂
Unfortunately, there is no great option yet to minimizes enlarged pores.
Daily use of a glycolic acid/hydroxyl acid topical helps plump up skin cells and visually reduces the size of pores by a little bit. Several photodynamic therapy treatments or a CO2 laser resurfacing treatment also reduce pore size by a little. Both have significant downtime. For the little reduction in pore size, the amount of downtime and the cost associated with the treatments must be considered.
http://www.realself.com/question/my-acne-severe
Is my acne scars are Severe ??what treatment should i undergo and how much reduction can i expect.
You have ice pick and box scars on your cheeks form past severe acne. It is possible to improve these scars up to 50% after several treatments with a deep reaching fractional CO2 laser (Deep FX) or FRAXEL.
These ice pick and box scars are not too deep and i am a dark skinned person comes under category 4 medium coloured…….is co2 laser is a good idea??
As I mentioned, only DeepFX (safe for all skin colors) and FRAXEL.
are these impossible to go away with peels??they are not too much deep…….
Many scars can significantly improve with treatment. At this time, only wounds that are created before we are born do not result in permanent scars. When we sustain any type of trauma, including acne or certain types of infections, the body repairs this with a scar and a scar does not fully “go away” with even the best treatment available to date. Your skin texture can nicely improve with peels and you can maintain the results by repeating peels regularly. I suggest you allow your dermatologist to evaluate you properly (not only by photograph) and talk to you about your specific needs.
Is derma rolling good option?? What isthe difference between derma rolling and dermabrasion are both same?
Dermabrasion removes tiny layers of skin to adjust the surrounding skin to the base of the scars. It is safe for fair skinned individuals and contraindicated on darker skin. When appropriate, dermabrasion is now mostly performed with a CO2 laser instead of a traditional hand held mirodermabrader. It is still used for certain types of scars. Acne scars are not usually treated in this ablative fashion anymore as technology has advanced. Dermarolling is safe on all skin colors. A roller pierces the skin with very fine needles to stimulate repair from underneath the skin. You can do it at home or find a salon which performs this service, in case the discomfort it too difficult to tolerate on your own. It takes many treatments to yield the success.
Is there a limit to the number of sessions of non ablative laser resurfacing (for example palomar 1540) one can get to treat acne scars? Should the patient continue with the non ablative laser sessions as long as there is improvement seen? Is it safe to take like 20 or more sessions scheduled over 3 years with a good healing time between the sessions? thanks so much
I am unaware of limitations. Treatments may continue as long as improvement is noted and proper healing is allowed.
Hi,
I have large pores all over my face and ice pick and boxcar scars on my cheeks. I had one fractionated CO2 laser treatment and one Fraxel treatment after that. In addition to multiple skin peels and microdermabrasion treatments over the years. What else is out there for me to try. I hate my skin texture and scars and I feel the laser treatments didn’t do a thing. Thanks
Nicole
I am surprised to hear that you noticed no improvement after the laser treatments. We usually expect to see some improvement after 2-3 treatments depending on the severity of acne scars. 50% improvement in depth of acne scars is seen after about 6 treatments. The treatments that permanently remodel scars are CO2 laser, Picosure laser, and even FRAXEL or other non-ablative lasers in the 1540 nm wavelength range. Most of the time we mix or match our aproach because a scar changes after several treatments and we always customize the treatment to the scar. Among the treatments you have listed, both fractionated CO2 as well as FRAXEL provide results that are permanent whereas microdermabrasion and peels are temporarily improving texture. Large pores respond quite well to photodynamic therapy and fractionated CO2. There are differences in the power of fractionated CO2 laser treatments and I am unable to comment specifically why you failed to improve without knowing which model your laser surgeon (hopefully a dermatologist or plastic surgeon) used.
Which of these skin resurfacing lasers does your practice actually have? I love your website and the fact that you take time to answer questions is a great resource. But I think it would be improved and provide patients and prospective patients a better service if you also separately identify which devices the practice has and what specific treatments are available.
You raised an excellent point. In addition to all lasers listed in the skin resurfacing table, we use an Erbium pixel laser for resurfacing (more superficial than fractionated CO2 and therefore lesser downtime), the Picosure laser with focus lens array to generate new elastin and collagen inside the skin and Infini high intensity radiofrequency to rebuild fresh collagen and tighten the skin from within. Our CO2 laser is the industry gold standard, Lumenis Ultrapulse Encore, against which all other CO2 lasers are usually compared. It features ActiveFX, DeepFX and MaxFX. In contrast to other CO2 lasers that are listed below the table it has the broadest range of operation. We have this large number of lasers and devices to customize treatment to expectations, skin color and downtime that can be afforded.
I, too, have had 3 treatments of laser therapy on my calves after a bad bout of sun poisoning left my thighs and calves covered in freckles I did not previously have. I feel the treatment did absolutely nothing. I was devastated because through my own personal research and through what I was told, I really believed this would be the answer. Is there anything stronger or better for removing/fading freckles than laser? The front of my legs seem to be bleached a permanent whiter tone than the backs and they no longer tan the way they used to; the freckles just get darker.
It is often extremely challenging to remove innumerable sun freckles on legs. While I am unable to answer why your laser treatment did not work because you did not provide the specific laser information, our practice does not usually rely only on lasers for sun induced pigmentation on the legs. In case of many sun psots, the legs just do not respond the same as the face, chest, arms or neck. Combination treatments include Melanage peel, photodynamic therapy, alexandrite laser, erbium and even light fractionated CO2 laser. Innumerable sun spots on legs will remain a challenge and might require more resources than one is ready to put forth. It becomes even more problematic once some of these sun spots develop texture. Unless resources do not play a role and it is of utmost importance to remove the sun spots, we often discourage treatment. Please schedule a complimentary consultation with our aestheticians to learn if you are a candidate for removal.
Would it be more cost effective to just do the calves of my legs and not the thighs? I know a consultation can better answer these questions, but just to get a rough idea, would this likely be more affordable?
I do not feel competent, based on the information I have, to provide and answer. I must encourage you to have a consultation. Unless examination by the aesthetician reveals that you have more than sun spots (solar lentigos), you should be able to get all your questions answered during a complimentary consultation with any of our aetstheticians.
I’m in my late forties and I’m finding that my lipstick bleeds. I look as if I’m an older women whose applied it below the lip, wiped it off and it’s left a stain. When I look closely in the mirror I see fine vertical lines. I assume this is the cause of the bleeding lipstick. What filler would you recommend and is there a way to test for an allergy first?
Lipstick bleed can be corrected with filler placement in the vermillion border of the lip. My preferred fillers for this area are Belotero Balance and Restylane Silk. Both are very fine and provide excellent results for lip contouring and the very fine vertical lip lines. Both are made of hyaluronic acid which is identical to the hyaluronic acid in our body. Unlike the former collagen based fillers, none of hyaluronic acid based fillers contain animal derived proteins and therefore an allergy test is not needed. However, a history of many different allergies is a contraindication to receive any filler.
I was wondering if you do Microneedling and how much it is a session
Microneedling is usually available in spas.
Hello,
My sister (who lives in California) recently had a laser treatment referred to as “BBL”. The results are astounding, and I wondered if you have a Broad Band Light laser and what you think about the treatment. Thank you!
BBL refers to a platform with multiple wavelength that the laser company Sciton brought to the market a couple of years ago. Several other companies have the same platforms, e.g. M22 by Lumenis or Icon by Cynosure. We have decided to go with the platform by the market leader Cynosure and have operated the Icon since the beginning of 2017. I totally agree with the phenomenal results that these types of platforms deliver. You can call the office to set up a consultation with Marina or Dana.