The photo above shows the result of a full face CO2 Laser Resurfacing for wrinkle removal done 10 years ago using the Ultrapulse CO2 laser, a revolutionary advance in 1995. While the wrinkle removal results were stunning, CO2 laser resurfacing created a “burn wound” that took months of recovery and after a year often left the skin white or hypo pigmented. Because of the prolonged recovery, the need for general anesthesia, and other side effects most people today do not choose to have this effective wrinkle removing procedure.

Over the past three years the concept of Fractional Skin Rejuvenation or fractional laser skin resurfacing has evolved. With Fractional Skin Rejuvenation the laser beam, an erbium 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. (See Figure Below) The small areas treated by the fractional micro beams, called micro treatment zones, cause sufficient laser injury to promote new collagen production to replace collagen damaged by aging and sun exposure. Damage to collagen in the skin is a cause of skin wrinkles. The new collagen produced by the laser injury “plumps” skin wrinkles. The intact skin between the micro treatment zones allows for much more rapid healing-3-4 days as opposed to 2-3 weeks for the older CO2, and enough pigment cells are left intact that hypo pigmentation does not occur.

The diagram above shows the progression of laser skin rejuvenation technology from the older CO2 on the left to the newest fractional ablative lasers which have just come out. The Fraxel laser and the Lux 1540 are depicted in the 3^rd illustration under Non ablative fractional laser resurfacing.

Fractional Non Ablative Laser Resurfacing

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 the Fraxel and Lux 1540 non ablative laser skin treatments are dramatically reduced recovery time, but the results in terms of wrinkle removal and skin tightening are less dramatic than with ablative lasers.

However, the new fractional lasers like Fraxel and the Lux 1540 are able to penetrate much deeper than traditional non fractional ablative lasers and we are discovering that deeper penetration of the laser produces a much more dramatic stimulation of new collagen formation which translates into a plumping effect on the skin. This is particularly useful in treating depressed acne scars. Another diagram which helps explain this is the diagrammatic representation of the Lux 1540 below.

In summary, the benefits of fractional non ablative laser skin treatments are:

1. Less down time- only pink skin for 1-2 days and a day or so of bronzing that can be covered with make up
2. Better new collagen production in the deeper skin layers causing skin plumping especially of acne scars
3. Fewer complications like hyper pigmentation (although with Fraxel there is a 15% incidence of hyper pigmentation (darkening of treated areas) especially in dark skinned people, but it is temporary.
4. Improvement in skin texture and possibly enlarged pores
5. Improvement in wrinkles (See Photos below of Lux 1540 Results)

Above-Before and after Lux1540 treatment-Photos courtesy of Palomar and Dr Dwight Scarborough

The Future-Fractional Ablative Laser Resurfacing

Recently several new 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. Fractional ablative lasers are depicted in the last or 4^th picture in the first comparative fractional laser diagram above.

The fractional ablative lasers remove the tissue in the micro treatment zone rather than just heating it as is done with Fraxel and the Lux 1540. The benefit of ablation is that more sun damaged, wrinkled skin is removed than with Fraxel or the Lux 1540 and better wrinkle removal and skin surface smoothing and textural improvement is achieved. This however comes at the price of some recovery time, redness and pinkness for 4-6 days. The fractional ablative lasers however require much less recovery time than the traditional non fractional erbium and CO2 ablative lasers which required weeks of recovery. Reliant, the company that makes Fraxel has released a new CO2 fractional laser called the Repair, Lumenis has released a CO2 fractional ablative laser for Bridge Therapy, and Palomar has released the Lux 2940, an Erbium fractional ablative laser.

Impressive wrinkle removal and improvement in skin texture is achieved with the Lux 2940 fractional ablative laser (see Photo Below).

The first non ablative fractional laser on the market was the Fraxel. The Fraxel has been improved and many new improved fractional devices have been released since Fraxel appeared on the market three years ago. The field of laser skin rejuvenation is advancing rapidly and new technological breakthroughs occur frequently. The benefit to you is that better wrinkle removal results are possible with less down time and fewer potential side effects. The applications of fractional laser technology are expanding to other fields like skin tightening and eventually to fat and cellulite removal.

For further information on the skin rejuvenation and facial aging read Save Your Face or contact me. In my practice I use the new Lux 1540 Fractional Non ablative erbium laser for skin rejuvenation.

Be sure to sign up fro my free email newsletter to keep up on new developments.

Dr Seckel
978-369-4499

Concord, Massachusetts

Boston, Massachusetts

The most common laser skin treatment or laser skin care procedure available today is laser hair removal but there are many other types of laser skin treatments available today. Laser skin rejuvenation is rapidly becoming the most common laser skin treatments 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 treatments 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 Lux 2940 Micro ablative Erbium Laser by Palomar, the ActiveFX laser skin peel with the Lumenis Ultrapulse Encore laser, the Fraxel repair system and the Microlaserpeel and Profractional 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,

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 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 techniques 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 Skin Treatment 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 becau7se 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 LuxIRDeep, Titan, Aluma with Faces, Refirme, and Thermage.

5. Laser skin treatment for 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 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 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 skin treatments, laser peel, laser skin rejuvenation, and non-surgical facial rejuvenation read Save Your Face or contact me,

Sincerely,

Dr Seckel,

Boston, Massachusetts

Concord, Massachusetts

978-369-4499

The most common laser skin treatment or laser skin care procedure available today is laser hair removal but there are many other types of laser skin treatments available today. Laser skin rejuvenation is rapidly becoming the most common laser skin treatments 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 treatments 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 new fractional laser resurfacing using the Lux1540 and Fraxel non-ablative lasers and the newer Lux2940 fractional erbium and Fraxel Repair CO2 lasers. Exfoliative laser skin care is used for treating acne scars as well as facial aging, fine lines and wrinkles and to remove pigment.

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 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 techniques 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.

Above-Before and after Lux1540 skin plumping treatment for acne scars

3. Laser Skin Treatment 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.

Above-Before and after Lux Green IPL treatments remove pigment for Decolletage

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 becau7se 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.

Before and after LuxIR Deep skin tightening of neck

5. Laser skin treatment for 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 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.

Above-Before and after leg vein removal with Lux 1064 Laser

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.

Above- Before and after hair removal with the LuxRed IPL

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 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 skin treatments, laser peel, laser skin rejuvenation, and non-surgical facial rejuvenation read Save Your Face or contact me,

Sincerely,

Dr Seckel,

978-369-4499

Boston, Massachusetts

Concord, Massachusetts

Laser resurfacing is a technique which removes wrinkles and brown spots, and tightens the skin. (See Chapter 8 High Tech facial Rejuvenation, and Chapter 9-What can Plastic Surgery Do For You in my book “Save Your Face”).

Originally laser facial skin rejuvenation was done with the CO2 laser and more recently with the Erbium laser. These lasers are used to strip the outer aged, damaged skin layers off of the face and following a period of healing, the results are frequently spectacular, with new fresh youthful tightened skin free of pigment and age spots.

Laser Resurfacing-Contact Dr Seckel

The problem with laser resurfacing is that it is a surgical procedure and there is significant down time or recovery time. There is an initial 8-10 day period during which the skin is raw and “oozing” fluid until new skin covers the surface of the face. Following this healing period, the skin is very pink for three to six weeks requiring the patient to wear make up. Although the results are beautiful many patients cannot take 2-3 weeks out of their life to have this procedure done.

The traditional laser resurfacing is called an ablative procedure meaning the old skin is ablated or removed so that new skin will grow back on to the face. Because of the down time associated with traditional ablative resurfacing scientists have developed “non-ablative” lasers which attempt to rejuvenate the skin without removing or ablating the outer layer.

IPL(Photofacial) , Cool touch®, Gentlewaves®, Titan®, Thermage®, LuxIR, and laser photo-rejuvenation are some examples of non-ablative facial skin rejuvenation therapies which you may have heard of.

The problem with older non-ablative skin therapies is that the results or benefit, if any, are very minimal and only occur after many treatments over a period of 6 or 7 months. Improvements of 20% in wrinkling after 6 or 7 months and thousands of dollars are hard to justify in my opinion.

All resurfacing techniques work by injuring the skin and causing the skin to form new collagen to replace the old damaged collagen in the skin. This process is technically called selective photothermolysis (see Chapter 8-High Tech Facial Rejuvenation in Save Your Face for a thorough discussion). Laser resurfacing with the CO2 and Erbium do this in a very dramatic way all at once. The non-ablative therapies do it slowly over time but not nearly as effectively.

Fraxel®, a laser, and the new Lux 1540 by Palomar use a new approach called fractional photothermolysis (FP), also called fractional skin rejuvenation. Fraxel® and the Lux 1540 are non ablative lasers,  the laser beam is broken up into tiny beams which are spread apart so that not all areas of the skin are treated. Rather tiny “cells” of skin called microscopic treatment zones or MTZ are heated but not ablated beneath the skin leaving the surrounding skin intact.

The result is that the skin is inflamed so that new collagen will form but much of the skin stays in place-so the face is not left raw and recovery time is shorter.

Down time is less than that with traditional laser resurfacing. However multiple treatments  are required to get a result. So expect that after each treatment you will be red and may have bronzing and some flaking skin for several days.

Early results with Fraxel and the Lux 1540 are impressive and similar to what is achieved with the Sciton®Erbium Microlaser peel (see chapter 7-Save Your Face).

Photos courtesy of Palomar and Dr Dwight Scarborough-Lux 1540

Fraxel® is a very exciting new concept in laser technology by Dr. Rox Anderson in Boston, who is the brilliant scientist who first conceived the theory of photothermolysis and started the whole laser facial rejuvenation field.

Fraxel® and the Lux 1540 are certainly more effective than the “non-ablative” therapies available today. The benefit to the patient will be similar to that of the Microlaserpeel performed with the Sciton® Erbium laser which I use.

Just don’t plan on going to a social event the evening after having this procedure done. If you want honest unbiased information about the confusing array of facial rejuvenation treatments and wrinkle cures offered today please read my new book Save Your Face, it will make sense of all the conflicting information you read.

Contact me for more information on any of the procedures mentioned above.

Dr. Seckel

Boston, Massachusetts