Medical Laser Blog - Fotona Straight Talk for the Physician

Laser Skin Resurfacing or Chemical Peel. Precision vs Guess.

It would be reasonable to ask “why do laser peels when you can do chemical peels for so cheap?” A big part of this is the tried and true answer of “you get what you pay for.” I tell patients a chemical peel is a little like using prunes as a laxitive. There’s an old commercial for kids and it goes something like this: “Is two enough? Is three too many? We just don’t know.” Well, it’s a bit like that with chemical peels. When you put the chemicals on the face there’s a timing element and the correct timing depends on the degree of hydration and the overall health of your skin.

With a laser, you take things down layer by layer, in a controlled fashion, to landmarks that you have pre-determined. If you want to stay within the curatenous layer, you simply ablate to a white color on the skin. If you want to get down into the living tissue (the upper papillary layer), you ablate until there’s a yellow color. And if you want to take it down to the papillary dermis, you ablate until you can see a fine, reticular mesh of capillaries and start to see some very fine punctate bleeding. If you want to go deeper than that, you start to see more and more bleeding. For every level, there are very definitive endpoints.

With a chemical peel, you place the chemical on the face and you wait. But how long do you wait? Do you wait 2 minutes, 5 minutes, 30 minutes? It depends on the preparation, it depends on the operator and so many other variables. There are fewer variables with a laser skin resurfacing. In my mind, a laser skin resurfacing is safer, and because you are getting to your pre-determined endpoint in terms of depth of the skin layers, it is more efficacious as well.

So the difference between a chemical peel and a laser skin resurfacing is a guess versus precision. It’s as simple as that.

What's Fractional Laser Skin Resurfacing Got to Do With Driveway Cracks?

Father’s Day is right around the corner and while many of us may not think about it, men want aesthetic services just as women do.  We see a lot of men in our medical laser practice, particularly men in the sales professions, wanting to look young, healthy and vital.  They do this with Botox, by getting a Fotona full or fractional laser skin resurfacing, re-volumizing injections…basically all the same procedures that women are interested in (just applied slightly differently).  

With Father’s Day coming up you might think about coming up with a promotion that reminds men that they fix the cracks in their driveways, kill the weeds in their lawns, repair the paint chips on their car and why aren’t they fixing the imperfections in their face?

When you present an issue to your audience, you need to use their own language.  Men understand maintenance and men understand health.  To promote your medical laser spa services to men, you really need to present from the perspective of a man’s point of view.  While he’s thinking about the chips on his car and the cracks in his driveway, etc., he may not be thinking about beauty and aesthetics and could use a friendly reminder!   You should also promote wellness.  Men work hard and workout hard, but wanting to look good includes healthy looking skin.  In addition to toning muscles, you can help him look healthy by taking the furrows out of his face.  

Promote your services to men…especially now around Father’s Day.  Speak the right language using the concepts of “maintenance” and “wellness.”

Better Laser Skin Resurfacing with the Fotona Erbium YAG

I saw a woman in the clinic the other day who had been treated with an IPL in another clinic for spots on the back of her hands.  Now, an IPL is a broadband light device that has a large spot size.  With the large spot size you’re not targeting specific spots on the hand, but rather you’re targeting all of the tissue and you’re hoping there’s a differential absorption of the IPL energy into the spot, causing the spot to super-heat and then slough off.  Unfortunately, because an IPL is broadband, it has very broad absorption in the skin.  And in the case of this lady, I think they treated her a little hot as well. When I saw her, she had certainly very inflamed-looking, swollen dorsum of the hand.  The pigments had sloughed, but they were showing a lot of erythematous change and eventually she developed post-inflammatory hyper-pigmentation of most of the back of her hand.  

We do laser skin resurfacing and thus treat spots on the hand a little bit differently.  We are able to use our Fotona Erbium YAG laser, which is an ablative laser.  We can use it in a very short pulse mode with moderately high energy so that we’re in a zone of ablation that we call cold ablation.  Basically that means that all of the heat from the ablation is contained within the tissue that is ablated away!  There is then very little heat left in the tissue.  We literally go over the spots like you’d use a pencil eraser and we erase the spots, taking them down layer by layer until they’re gone – not having to go any deeper than necessary.  We’ll typically then do a light skin resurfacing over the rest of the hand to even out the texture of the skin on the back of the hand, and from there, we let it heal.  We rarely, if ever, see post inflammatory hyper-pigmentation.  We don’t see burns or swelling or other side effects, except on the most rare of occasions.  We get great results with hand spots.

Fractional Laser Treatment is Just One Trick

So where does fractional resurfacing fit into your cosmetic laser treatment line-up?  Fractional resurfacing is just one trick in your bag.  Fractional treatments are used for decreasing downtime.  If you injure 10-20% of the skin with a tiny injury, it will tighten the skin and stimulate new collagen growth. Over time, with more and more fractional resurfacing, you’ll get more and more tightening and more and more improvements to the surface of the skin.  

So fractional resurfacing should really be positioned for that patient that does not have the luxury of significant downtime.  Maybe they’re interested in having their fractional treatment on Friday after work, with the intention that by Monday morning the redness is gone and they’re ready to go back to work.  On the other hand, if they’re looking for that wow treatment…that 10 years younger look in 10 days… then what they really need is full resurfacing. 

So rather than owning a one trick pony machine that only does one type of therapy, it’s better to have the treatment options at your disposal - to have a machine that is versatile enough to do fractional resurfacing when minimizing downtime is important to the patient, and to do full-on resurfacing when the wow factor in the shortest possible recovery time is required.  

When you think about it, if there are 3 days of downtime per fractional resurfacing treatment (which is probably conservative as there is likely a longer recovery in some cases), and you have to do 5 resurfacings, then 3x5 = 15 days of downtime.  If I do a papillary dermis peel with the erbium yag laser, using warm settings, or even fairly hot settings to achieve good collagen stimulation, the vast majority of the time patients can be in camouflage makeup and be back to work in 5 days.  In 7-10 days they are, in most cases, back to their baseline - of course with the exception of the improved tone, texture and tightness of their skin!

Collagen - The Protein of Youth and FRAC3®

It is collagen that keeps our skin tight and looking young.  We have potions and lotions with collagen in them that purport to increase collagen in your skin.  We even inject collagen to plump up our lips or to fill wrinkles.  The best collagen is your collagen.  Collagen is one of the proteins we make in response to injury.  That is the basis for most peels (chemical or laser) and for most non-ablative therapies to improve the texture and appearance of the skin.

Most of these therapies are bulk heating.  This would include IPL, ultrasound and most lasers.  Fotona has once again revolutionized the industry and collagen stimulation laser treatments with FRAC3®.

FRAC3® is a completely different technique.  It is the technique of delivering the laser beam with very high energy but very short bursts.  It results in a sub-surface, auto-selective process that targets skin imperfections within the collagen-producing layer of the skin.  The advantage here is that you are not causing wide area injury.  You are not causing injury to the more normal skin, but rather you are targeting the imperfections in the skin.  These imperfections are heated, resulting in the stimulation of collagen growth.  Collagen growth right where you need it…at the imperfections.

We have been using FRAC3® in much the same way you should be using a fitness center.  You don’t expect to get in shape in just one visit to the gym, nor should you expect your collagen to be built up in just one treatment.  FRAC3® will build your collagen over time and with no sign of treatment.  So it is the ideal “no down-time treatment” and a great maintenance treatment after more invasive therapies.

This link shows a woman who was in for laser hair removal.  We also noted texture and pigment changes.  We treated her with hair reduction settings and FRAC3® with the same Nd:YAG laser.  Note how the pigment, texture and hair have improved.
http://www.fotonamedicallasers.com/hair-rem-b-a02/

Why Nd:YAG for Laser Lipolysis?

The 1064 nm Nd:YAG lasers are the most widely used lasers for lipolysis, with the longest clinical record of safety and efficacy. The clinically observed minimal discomfort, exceptional long-term success and short recovery are attributed to this lasers ability to optimally target laser energy into fatty tissue, thereby limiting undesirable side effects.

In addition, the Nd:YAG 1064 nm laser systems have developed significantly since their introduction for laser lipolysis. For example, the latest Fotona XP-2 Focus has a 30W QCW mode power generating capacity, reaching higher procedure speeds and efficiency while operating at a fraction of its maximum capacity. This ensures system durability, essentially lowering running costs. In conjunction with the VSP (Variable Square Pulse) technology, a wide range of selectable pulse durations are now available in Nd:YAG lasers. This provides better procedure control and extreme versatility. The latest Nd:YAG laser devices can be used not only for laser lipolysis but also for endo and exo vascular procedures, FRAC3 skin rejuvenation, acne treatments, hair removal, and other procedures. The high performance and versatility of the latest technology solid crystal Nd:YAG 1064 nm laser systems, combined with their optimal efficacy and safety, make these lasers the medical devices of choice when compared with other wavelength devices for laser lipolysis.  Take a look at our white paper on laser lipolysis for more information.

Collagen Stimulation Laser...Like Taking Your Skin to the Gym

As we age, the skin becomes lax and the result is the primary sign of aging.  This laxity and the other signs of aging, such as variations in skin color, can be treated non-invasively and without downtime.  Due to the high power and extreme flexibility of the Fotona Nd:YAG platform, Fotona has been able to develop the FRAC3®.  It operates at very high peak powers between the so-called Q-Switch range and the Long Pulse range.  These conditions are only achievable with the sophisticated energy feedback control system of a Fotona unit.  Basically what happens is that very small imperfections within the skin are heated.  These imperfections are pigments, injured skin cells and other imperfections.  The result is stimulation of collagen remodeling and improved elasticity of the skin and improved color of the skin.  It is subsurface, auto-selective and non-ablative.  There is no downtime and patients will tell you that they feel the difference in only one treatment.  Pigments will require a series of treatments.  I think of this treatment like going to the gym for your skin.  You would not expect optimal results from a single trip to the gym.  In that same way, you can expect excellent results from FRAC3® as an ongoing maintenance therapy.