Dear Dr. Seckel: I am nearing 40. A year and a half ago at the ripe old age of 38 I had a mini face-lift to tighten my skin that was beginning to sag prematurely. I also had a fat transfer to soften my nasal-labial folds. Well, unfortunately the results don’t seem to be lasting. My skin is once again beginning to sag and the lines are back. To make matters worse I have rosacea and a tendency for hyper pigmentation. This past August and again 6 weeks later I had the Sciton Erbium Contour peel (12microns and 20 microns respectively). Although I saw firmer skin immediately following, the results were only temporary and after the second peel my rosacea seemed worse. Help! In your opinion is the Sciton or Cutera’s Titan better for tightening? I thought I might try a combination of Laser Genesis for my rosacea and then may be one Titan treatment in between. I would appreciate your views. Thank you! Meg, Northport, NY.
Dear Meg,
You obviously are well read and up to date on Facial Rejuvenation Techniques and laser skin rejuvenation. The conclusion you have reached yourself would be my recommendation: LaserGenesis®, followed by Titan®.
The Titan is specifically for skin tightening, using infrared energy to heat the deep collagen in the skin and cause tightening. The Sciton Contour Laser® is more for exfoliation and treating surface wrinkles. Any secondary skin tightening is much less than with the Titan® and is a function of new collagen formation in response to skin irritation caused by the laser peel.
Your Microlaserpeels® were very superficial and not deep enough to cause skin tightening. When I do Microlaserpeel® I usually go at least 40 Microns and sometimes 80-this does leave you red for 4-5 days but you have to go this deep in my opinion to get effective wrinkle removal and skin tightening. Even at these depths of Microlaserpeel® I recommend a series of 3 treatments spaced 3 months apart. Skin tightening is still only moderate with these superficial laser peels. A deep laser resurfacing to a depth of 400 microns will cause significant skin tightening but the recovery time is unacceptable for most people.
You are correct about laser resurfacing or Microlaserpeel® worsening Rosacea. That is why I always recommend Microlaserpeel® or exfoliation as the FIRST STEP in any facial rejuvenation program (see 6-step facial rejuvenation program in Save Your Face-my book available on this website). Any redness, vessels or Rosacea may then be treated with the Laser Genesis® in step 2. Actually Titan® skin tightening is step 6 in my program.
I would guess that you will need 5-6 Laser Genesis® treatments to really stimulate new collagen for wrinkle removal and remove the red and rosacea. Most people need 3 Titan® skin tightening treatments to get the result they want.
You really are taking good care of yourself and I am sure continuing to look young for many years will reward your efforts.
I strongly recommend you read my book Save Your Face. I wrote the book just for people like you-the informed consumer. I specifically recommend that you read Chapter 6-Dr Seckel’s 6-step facial rejuvenation program. It gives you a comprehensive view of non-surgical rejuvenation and how to achieve it in a proper step-wise fashion. You have a good start.
I am sorry your fat grafting did not last. See if the Titan® treatments help-the nasal-labial fold is caused by loose skin sagging over the insertion of the smile muscle. Fillers like Restylane®, Radiesse®, etc., can help but they are expensive and temporary, so I would hold off for now.
Be sure that you take the necessary diet, supplement, and lifestyle steps along with all of the above options. These are very important! Don’t spend all the money you are spending and not take the most basic healthy steps.
For further information on laser skin rejuvenation visit my Boston Plastic Surgery Practice, read Save Your Face or contact me.
Good Luck.
Boston, Massachusetts
Peabody, Massachusetts