However CO2 laser resurfacing has several limitations including a prolonged and difficult recovery period, often lasting three weeks, prolonged facial redness that can last three months, hypo pigmentation or lightening of skin color, and the potential for infection which can lead to scarring.

During the past three years new technology called fractional laser resurfacing or fractional skin rejuvenation has been developed which has dramatically shortened recovery time and lessened the occurrence of complications.

With Fractional Skin Rejuvenation the laser beam is broken up or fractionated into many small micro beams which are separated so that when they strike the skin surface small areas of the skin between the beams are not hit by the laser and left intact. These small areas of untreated skin promote a much more rapid recovery and healing with less risk of complications. The small areas treated by the fractional micro beams, called micro treatment zones, cause sufficient laser injury to promote new collagen production and resultant facial skin rejuvenation.

The first fractional laser made by Reliant the Fraxel laser and subsequently Palomar Medical’s Lux1540 have produced excellent results treating acne scars and facial pigmentation and have improved skin texture and facial rejuvenation. They have not however achieved the same degree of wrinkle removal and skin tightening as the traditional ablative CO2 laser resurfacing technique.

To ablate means to “surgically remove”. The Fraxel and Lux1540 are non ablative lasers which mean that when the laser beam strikes the skin the skin is not removed immediately, rather the laser beam heats the skin to cause inflammation and new collagen production. The benefits of non ablative laser skin treatments are dramatically reduced recovery time, but the results in terms of wrinkle removal and skin tightening are much less dramatic.

The results achieved by ablative CO2 resurfacing are more significant because ablation removes damaged, aged skin as well as heating the deeper skin layers to promote new collagen production.

Recently several new micro fractional ablative lasers have been developed which have the benefits of fractional treatments, less down time and complications, as well as the benefits of ablative skin resurfacing, better wrinkle removal and facial rejuvenation. The diagram below shows how this new technology works in comparison to previous laser methods.

The first on the left is traditional CO2 and Erbium laser resurfacing. Next is the Lumenis CO2 ActiveFX which fractionally ablated the surface of the skin down to a depth of 70-100 microns. Next are the non ablative fractional technologies which heated but did not ablate the skin. More recently the Palomar Lux2940, the Sciton Profractional, the new Lumenis Bridge Therapy and Reliant’s FDDA or Repair lasers have all developed new ablative or microablative fractional laser systems that reach much deeper into the skin, 200 to 1000 microns, and can produce much more effective wrinkle removal, new collagen production and skin rejuvenation with significantly less down time and recovery than traditional CO2 ablative laser resurfacing.

The photo below shows the wrinkle removal results achieved with Palomar’s new Lux2940 micro fractional ablative laser with 4-6 days of down time and a week of redness as compared to 3 weeks of down time and 3 months of redness with a traditional CO2 laser resurfacing.

The new Fractional Skin Rejuvenation lasers are a very exciting advance in the field of non surgical facial rejuvenation and wrinkle removal. Many new applications are being developed which will likely improve our ability to rejuvenate the skin and possibly improve scars, stretch marks, and remove pigment.

Another very exciting aspect of Fractional Skin Rejuvenation is that unlike older ablative laser resurfacing techniques, the new Fractional Skin Rejuvenation lasers appear to be safe to use on darker skin for Asian Skin Rejuvenation and African American Skin Rejuvenation. This will make the latest skin rejuvenation techniques available to millions of people with dark skin who could not be safely treated with previous skin rejuvenation techniques.

The patient below was treated with the Lumenis ActiveFX fractional ablative CO2 laser by Dr Bosniak in NY:

To learn more about non surgical facial rejuvenation and Fractional Skin Rejuvenation, read Save Your Face or contact me.

Dr. Seckel

Concord, Massachusetts

Boston, Massachusetts

978-369-4499

Laser skin care is a descriptive term used to denote a very wide variety of laser skin treatments, most commonly wrinkle removal, that are available to treat a wide variety of skin conditions. The most common laser skin care procedure or laser skin treatment available today is laser hair removal but there are many other types of laser skin care or laser skin treatments available today. Laser skin rejuvenation is rapidly becoming the most common laser skin care procedure in use today. With regard to the issue of concern to you, wrinkles, fine lines, crow’s feet and facial pigment I group the laser skin care procedures under the broad category of laser skin rejuvenation.

Laser skin care or laser skin treatment for laser skin rejuvenation is used in several different ways to rejuvenate the face and facial skin. Broadly these laser skin care treatments can be classified as follows:

1. Laser Skin Exfoliation or Laser Skin Peel – Lasers can be used to peel or exfoliate the skin to remove dead skin and smooth wrinkles and fine lines. Once the dead skin and surface of the wrinkles are removed by the laser peel, you see new shiny skin on the surface of your face. The skin can form new cells daily and deep laser exfoliation or laser skin peel is a very effective way to stimulate the production of new facial skin cells. Laser skin care for exfoliation or laser peel usually requires some down time for redness and healing because laser skin peel is an ablative laser procedure which means the dead skin cells and wrinkles are ablated or removed so that new skin cells can grow over the facial skin, The first exfoliative laser skin care procedure was laser resurfacing, a very deep laser skin peel, but the recovery time was very long and the skin was lightened, so laser resurfacing is only done today for very deep wrinkles and acne scars. More modern laser skin care for wrinkles and fine lines involves the use of fractional laser resurfacing with de-powered lasers that do not cause as deep a laser peel. Modern laser skin care for wrinkles uses superficial laser skin peels with minimal down time for recovery, usually 4-6 days of redness. Examples of the new laser skin care systems are the ActiveFX laser skin peel with the Lumenis Ultrapulse Encore laser and the Microlaserpeel with the Sciton Erbium laser. Exfoliative laser skin care is used for treating acne scars as well as facial aging, fine lines and wrinkles and to remove pigment. Laser skin exfoliation is one of the most important laser skin care or laser skin treatments available today.

2. Laser Stimulation of New Collagen in The Deep Skin Layer, The Dermis – A major cause of wrinkles and acne scars is loss of collagen in the deep layer of the facial skin called the dermis. Sun damage kills the collagen in the dermis of the skin and when the collagen dies the skin loses volume and shrinks and the overlying outer surface of the skin you see wrinkles. This is similar to what happens to a nice plump plum which is dried in the sun, after the plum loses its inner water volume, the skin wrinkles and you have a prune. Laser skin care also describes laser skin treatments or procedures which can stimulate the production of new collagen to replace the damaged collagen and plump up the wrinkles and even acne scars in the skin. The laser skin peels do this by irritating the skin as the laser peel is done. The irritation causes inflammation of the skin and when the skin is inflamed the skin responds by forming new collagen. The newer laser skin care treatments are very effective at stimulation of new collagen formation even in the deeper portions of the dermis and are very effective at plumping acne scars and can improve wrinkles. Examples of laser skin care techniques for new collagen production for treatment of facial skin aging and acne scars are the fractional lasers the Lux1540 by Palomar, The fraxel by Reliant technology, and the ActiveFX laser skin peel by Lumenis.

3. Laser Removal of Pigment and Facial Skin Photo-damage – The aging effects of the sun, called Photo damage, are not only dry skin and wrinkles but also pigment, called brown spots, sun spots, age spots, and “liver spots”. Laser skin care procedures are very effective at removing pigment and photo-damage. The ablative laser skin care procedures such as the laser peel and laser resurfacing strip away the pigment, but only the superficial pigment. Newer Fractional laser skin care treatments go deeper and can remove deep pigment with even less recovery time than the laser resurfacing laser skin rejuvenation treatments. Microlaserpeel, and ActiveFX are the laser skin peel treatments, and the Lux1540 and Fraxel are the non-ablative fractional laser skin care treatments for pigment. Today laser skin care for pigment removal is more often done with newer IPL (Intense Pulsed Light) or photo facial treatments. IPL or photo facial uses light energy not laser energy to remove pigment, and is a more gentle treatment with no down time.

4. Laser Skin Tightening – Laser skin care can tighten sagging facial skin but only minimally. All of the lasers mentioned above do tighten skin a bit because when they stimulate new collagen production in the skin, the new collagen is tighter and the tighter collagen tightens the skin. This effect takes months after the laser skin care treatment and is not nearly as noticeable as a face lift. Newer and more effective skin tightening treatments are possible but not with laser skin care. The more effective skin tightening treatments are done with Infrared or Radiofrequency energy with machines called LuxIR, Titan, Aluma with Faces, Refirme, and Thermage.

5. Laser Removal of Broken Blood Vessels, Red Spots and Rosacea on the Face – Photo-aging and sun damage also cause broken blood vessels to appear on the face. Laser skin care can remove broken blood vessels on the face and legs. Both the 532 and 1064 Yag lasers are useful laser skin treatments for removal of broken blood vessels. However the newer IPL and Photo-facial treatments are very effective, produce less down time and are used more frequently today. The 1064 Yag laser is the choice for larger broken blood vessels and leg veins.

6. Laser Hair Removal – Laser hair removal is the most commonly performed laser skin care procedure done today. There are many different laser skin care treatments for laser hair removal but I prefer the diode laser-I believe it is safer for darker skin types.

7. Laser Tattoo Removal – Laser skin care for tattoo removal was one of the first applications of laser skin care. There are many different lasers for tattoo removal and different laser wavelengths are chosen for the specific color of the tattoo to be removed. Laser tattoo removal takes many treatments over a long period of time, but is preferable to surgery which can leave scars.

I am sure there are other laser treatments that can be classified as laser skin care or laser skin treatmentds but the above are the most widely available and useful laser skin care treatments available today. As you can see the applications are very different for each type of laser so it is very important that the type of laser skin care be customized to fit the facial skin problem that you are trying to correct.

The MOST IMPORTANT THING is that you seek consultation with a board certified Dermatologist or Plastic Surgeon who is knowledgeable and specializes in laser skin care. There are many doctors, spas, and medi spas and medical spas that offer laser skin care without a board certified laser specialist in house, available to evaluate you and choose the right laser treatment for your unique face and skin. This is dangerous and not good medical care. Laser skin care if not done correctly by certified medical specialists can damage your skin. The State Medical Boards and legislatures are trying to establish guidelines and licensing regulations in many states but at this time in many states anyone can buy a laser and open a spa and offer laser skin care. Protect yourself and insist on seeing a board certified doctor for evaluation and recommendation of the laser skin care procedure that is best for your unique face and skin.

For more information on laser skin care, laser peel, laser skin rejuvenation, and non-surgical facial rejuvenation read Save Your Face or contact me,

Sincerely,

Dr Seckel,

Boston, Massachusetts

I am surprised to hear of you difficulty following Fraxel laser treatments–Melasma has been the one condition that Fraxel laser skin rejuvenation has been most successful with. There is a reported 15% incidence of post-inflammatory hyperpigmentaion that is brown spots, after Fraxel, but that usually occurs on darker skin. Hopefully your Fraxel post-inflammatory hyperpigmentation will resolve in time.

My aestheticians all (5 of them) agree that the best treatment for pigment removal of melasma or post-inflammatory hyperpigmentation after Fraxel treatmentys is to start the Obagi (prescription) skin care program–a series of strong topical creams including Retin A and hydroquinone–it always makes the pigment better–if you stop the cream it comes back. Some knowledge is required-see if you can find a doctor familiar with the product usually a plastic surgeon or cosmetic dermatologist. I also do a series of microdermabrasions while on the Obagi program.

After the above and a waiting period of 3-6 months after Fraxel there are other options to try. A new laser by Palomar called the Lux1540 which is the Palomar answer or Fraxel type laser has had success with pigment removal. Another ablative fractionated laser similar to Fraxel, the new ablative fractional laser peel called the ActiveFX laser skin peel can help-but do a test area in a small spot of pigment first.

You should email Reliant Technologies they company that makes Fraxel about your experience with Fraxel treatment for melasma–they tout Fraxel as the best treatment for melasma.

The reports I have heard so far about Fraxel is that Fraxel works well foer pigment removal and acne scars. The 15% incidence of pigmentation following fraxel is known, and can be treated. I dont have a fraxel but if I did I would test a patch of hidden skin behind the ear first to see if pigmentaion was a problem after fraxel treatment.

For more information on pigment removal, lasers and non-surgical facial rejuvenation read Save Your Face or contact me.

Dr Seckel

978-369-4499

Boston, Massachusetts

Concord, Massaxchusetts

The profile plasma is also good-but new and I have had only a brief experience with it–to get a good result you will need a “high energy” treatment with the plasma machine which can give 10 days or more down time.

These new ablative laser skin peel treatments are effective for wrinkle removal but with much less downtime and fewer complications than traditional laser resurfacing. Laser skin rejuvenation technology has improved dramatically in the past two years.

For more information on laser skin rejuvenation and non-surgical facial rejuvenation read Save Your Face or contact me.

Dr Seckel

Boston, Massachusetts

It is customary for a nurse or aesthetician supervised by a physician on site to do Fraxel treatments.

However results using Fraxel for wrinkle removal and skin tightening have been sometimes disappointing and if wrinkle removal and skin tightening of loose or lax skin is your goal I would not rely on the Fraxel. Fraxel is most effective for pigment removal and acne scarring at this writing.

According to the people who have used Fraxel most-it is best for removal of sun damage pigment and acne scars.

For effective wrinkle removal I use the Lumenis Ultrapulse CO2
LYTE-ActiveFX laser skin peel-it is by far the most effective for
wrinkle removal in my hands-the machine is new but you can check lumenis.com for a doctor in your area who has it-downtime is 4-6 days usually.

For effective skin tightening there are several -Thermage, Titan, Aluma with Faces by Lumenis and Lux IR by Palomar-I use the Palomar LuxIR and have been very happy with skin tightening results. I also like the Aluma for skin tightening in the area around the eyes.

You will get some skin tightening with the ActiveFX laser skin peel-wait 3 months after your laser skin peel to see the effect.

The other tightening machines are very different and tighten the skin by deep heating with Radiofrequency or Infrared energy.

You may however be happy with the skin tightening you get from the ActiveFX laser skin peel-you may want to do 2-3 CO2 lyte peels over a year-the results should be excellent if the procedure is done correctly.

For more information on laser skin rejuvenation, wrinkle removal, skin tightening and non-surgical facial rejuvenation read Save Your Face or contact me.

Dr Seckel

Boston, Massachusetts

Studies report that 15% of patients receiving Fraxel laser skin rejuvenation treatments develope pigment on the face after treatment. I would gues that you are right, that the pigment on your face is secondary to the Fraxel laser skin rejuvenation-its called post inflammatory hyperpigmentation. Many people have written me complaining of this. The best treatment right now is hydroquinone 4% cream and a series (4-6) of microdermabrasion treatments for pigment removal.

After those treatments are done if you still need pigment removal then I would use IPL-Intense pulsed light treatments, also called photo facial treatments, to remove the residual pigment on your facial skin.

Fraxel laser skin rejuvenation is an ablative (micro treatment zones are micro ablated zones in my opinion) laser and when ablation is done on olive skin hyperpigmentation can result. You are correct. Let me know how you do.

For more information on pigment removal, laser skin rejuvenation and non-surgical facial rejuvenation read Save Your Face or contact me.

Dr Seckel

Boston, Massachusetts

Both the MicroLaserPeel®, done with the Sciton® Profile Erbium laser, and the Fraxel®, done with the Fraxel® laser by Reliant Technologies® are non-surgical facial rejuvenation laser skin treatments used to remove wrinkles, pigment and other facial aging changes on the surface of the facial skin. With repeated applications wrinkle removal and pigment removal are possible.

These laser skin rejuvenation techniques work by injuring the damaged skin cells so that they are removed and new healthy skin cells form. In addition the injury stimulates the deeper skin layer, the dermis, to form new collagen to replace the old age damaged and sun damaged collagen that is causing wrinkles.

The difference between the two technologies, both Erbium lasers, is that the MicroLaserPeel® is a uniform treatment-the entire skin surface is treated. The Fraxel® only treats small areas and leaves small adjacent areas untreated with the theory that there is less injury and quicker healing.

In fact the healing time for both procedures when used at effective settings is about the same. After the MicroLaserPeel® at 40 microns depth you will be pink for 4-6 days. After the Fraxel® laser most users report a bronze color for 10-14 days.

Fraxel® promotes their technique as non-ablative-meaning no skin removal, but many patients peel after Fraxel® so I would not agree with this statement as peeling to me indicates ablation.

Fraxel® also calls the Fraxel® treatment a no down time procedure but having your face peel and then have a bronze color is not no down time for many people.

They are both good effective laser skin rejuvenation treatments for superficial facial aging skin changes. Fraxel is proven to be effective for pigment removal, microlaserpeel may be better for wrinkle removal. The most important thing is finding an excellent board certified plastic surgeon or dermatologist who is experienced in laser skin treatments and trusting him/her to recommend the treatment they are comfortable with.

Don’t believe the marketing hype. For laser skin rejuvenation treatments to be effective they must be done at a deep enough level that you will have some down time afterward. However, the down time is minimal-less than a week which is a great improvement over the older CO2 laser resurfacing which required a 3 week down time and left you pink for 4-6 weeks. These new laser skin rejuvenation technologies are a definite improvement.

Just don’t plan to go to a cocktail party the night after you have one of these procedures done.

The MicroLaserPeel® may need to be repeated 1 or 2 times for best effect. The Fraxel® requires 4-5 treatments according to published guidelines (I have not used the machine).

I use the MicroLaserPeel® and have had excellent results. There is another new laser skin peel technique called the activeFX laser skin peel which is also excellent with minimal down time.

For more information on laser skin rejuvenation and non-surgical facial rejuvenation read Save Your Face or contact me.

Thank you,

Dr Seckel

Boston, Massachusetts

Thank you for the kind words about Save Your Face.

You certainly can have laser resurfacing or laser skin rejuvenation a second time if the skin is healthy and has plenty of oil glands and hair follicles to provide cells to heal the skin surface after the laser peel or laser resurfacing.

However there are many new non-surgical facial skin rejuvenation technologies today that may also be helpful for acne and oily skin and skin contour irregularities.

Retin A is great for helping with acne control. I would also suggest microdermabrasion and possibly brevoxyl washes.

Several new laser skin rejuvenation technologies including Clearlight, Smoothbeam and others can also help with acne control and wrinkle and fine line removal. IPL or photo facial when used with Levulon, a technique called photodynamic therapy is also an excellent laser treatment for acne.

Microlaserpeel with the Erbium laser provide excellent skin exfoliation and can remove wrinkles and requires less down time than the laser resurfacing you probably had 6 years ago. The activeFX laser skin peel is a newer gentleer CO2 laser peel that is also excellent.

I would suggest that you have an evaluation with a good board certified plastic surgeon or dermatologist skin care specialist who is experienced with lasers and facial rejuvenation to make a plan. Also check the archives to the right of the screen under the heading 6-step facial rejuvenation program.

For more information on laser skin peels, laser skin rejuvenation and non-surgical facial rejuvenation read Save Your Face or contact me.

Dr. Seckel

Boston, Massachusetts

There is no hard published scientific data on the combination of laser skin care or laser skin rejuvenation treatments and concurrent soft tissue filler injections.

I am comfortable in doing a laser skin rejuvenation procedure like a Microlaserpeel® on a patient about 6 weeks after Restylane® soft tissue filler injection and I would be comfortable after a 6 week wait, to do a Fraxel® laser skin rejuvenation procedure.

However it is important that you consult with a board certified physician who is experienced in laser skin rejuvenation procedures and soft tissue filler injections and follow his/her advice.

Thank you for your question.

For more information on fillers, laser skin care, and non-surgical facial rejuvenation read Save Your Face or contact me.

Dr. Seckel

Boston, Massachusetts

I would not do laser skin rejuvenation or laser resurfacing a second time, your skin could become too white or hypo pigmented and you risk having a demarcation line at the neck where the skin that has not been lasered stands out.

The best skin cream for your situation for pigment removal and wrinkle removal is Epiquin® a retinol mixed with a bleach called hydroquinone (best for average or oily skin) or Glyquin®, a combination of Vitamins A, C, E, Glycolic Acid and Hydroquinone (best for dry sensitive skin).

The best treatment for pigment removal today is IPL or Photo facial skin rejuvenation which is a no down time non-surgical facial skin rejuvenation procedure which can help with wrinkle removal and pigment removal. I would seek consultation with a very experienced board certified doctor who is experienced with IPL (called Intense Pulsed light) and Photo facial. Since you have had a laser skin rejuvenation peel I would proceed cautiously with IPL and photo facial only if your skin looks normal and has not been thinned by the laser skin rejuvenation or laser resurfacing.

For further information on laser peel, laser skin rejuvenation and laser resurfacing or non-surgical facial rejuvenation in general read Save Your Face or contact me.

Thank you,

Dr Seckel

Boston, Massachusetts