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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If there is one, which laser treatment is most effective for reducing the appearance of large sebaceous filaments on the nose? Salicylic acid has not worked for me at all.
Overgrown old glands (sebaceous gland hyperplasia) can be scarlessly removed with lasers that target oil. This treatment works for 99% of facial overgrown oil glands and the results are permanent. It takes about 3-4 sequential treatments every 3-4 weeks.
An oily face (seborrhea) can be reduced with photodynamic therapy, lasers, as well as oral medications. Photodynamic therapy has the least amount of side effects. Each treatment takes about an hour in the office, of which half is spent waiting for the skin to absorb the medicine until light activation of the medicine can begin. Three treatments 4 weeks or longer apart are typically very effective. The Aviclear laser for acne also takes 3 treatments and treatment time is an hour each time. Oral medication is only used with severe seborrhea because the medicine does not permanently destroy glands and needs to be taken daily to exert its effect.
The contents of oil glands which can sometimes push out in filaments (threads) when we stretch the skin over our nose, will reduce with periodic extractions, e.g. during a custom facial, weekly use of low percentage exfoliating pads (such as our Brilliance in a Pad), salicylic acid peels every 6-12 weeks. Unfortunately, we cannot get rid of them.
Hi, which of these lasers is good to treat pigmentation and/or acne on African Amy’s kin (Fitzpatrick 4-5)? Thank you!
Post inflammatory hyperpigmentation (PIH) often occurs as a result of acne breakouts. Acne should be controlled as quickly as possible to prevent post inflammatory changes. In most individuals, acne control can be achieved by 3-6 months after treatment start. We only use lasers for acne treatment when there are contraindications or side effects to first or second line treatments. Laser are not usually able to provide sustained control/prevention of acne.
PIH can be treated while acne is brought under control. Topicals, including peels, work best, and there are excellent choices for skin of all ethnicities. Lasers can sometimes support treatment of PIH. There are a number of different lasers that are safe on African American skin of the lighter type (Fitzpatrick IV or V) and our office operates them.
I strongly recommend that you are evaluated by a dermatologist for acne and PIH treatment.
Hello,
I was wondering if you have any treatment available for ichthyosis vulgaris on the legs?
Thanks!
Ichthyosis vulgaris is not yet curable. Treatment includes daily application of urea or other humectants and possible retinoids if you have a strong expression orn your face (rare in ichthyosis vulgaris). Eucerin brought a new product to the market earlier this year that combines urea with ceramides (Roughness Relief). I would strongly encourage that you try it.
Hi,
Does your office perform subcision for acne scars? TCA cross? OR punch excisions? Thanks
We perform all of these.
i have ugly syringoma under my left eye. my derm told me laser is the best choice for removal but no promises they get it all, and theres a strong chance it could return. Do you treat this condition? If so do you have a different price for under the eyes only? Please Please advise
Excision is the best option as it removes the syringomas through tiny slits. The minute scars under the eyes heal usually very well. I do not know of anyone in our area who performs this procedure but would be happy to provide a recommendation for someone in the Boston area. A CO2 laser treatment is an option. You stated all pitfalls correctly. The procedure might not work on all and syringomas could recur. In our office, the fee is $1000 for the CO2 laser treatment for syringoms on the eyelids.
What is the best method/option for improving frown lines?
When the frown lines are just starting to be noticeable, neuromodulators like Botox, Dysport or Xeomin can often fully treat them and prevent further crunching of the muscles that contribute. In someone who had frown lines for years, neuromodulators will prevent them from becoming deeper and will often soften them. The results usually get better with repeated injections every 4-=6 months but very deep lines can never be fully corrected with neuromodulators. Off-label use of a very fine filler might be an option in the right person.
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.
I was wondering if you do Microneedling and how much it is a session
Microneedling is usually available in spas.
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, 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.