The Latest Advances in Cosmetic Laser Treatments
Lawrence Janowski, MD
The field of cosmetic laser skin rejuvenation continues to advance rapidly, with many new devices entering the market as well as enhancements of older devices. How does a consumer make sense of all this technology? It can be difficult, with literally hundreds of devices flooding the market. Treatments for the removal of hair, veins, brown spots, wrinkles, and even loose skin abound.
To make things a bit easier, the removal of hair and veins is fairly standardized at this point, and most devices will do a good job. The differences between manufacturers are minor, despite what they would have you believe. The most exciting developments nowadays revolve around facial rejuvenation, which will be the focus of this article.
By facial rejuvenation, also called laser resurfacing, I mean the improvement of the texture, color and laxity on the face. Textural improvement means smoother skin with fewer lines, wrinkles and scars. Color improvement means a reduction in pigmentation related to sun exposure, aging or genetics. Laxity is loose skin, and to a small degree, resurfacing lasers can have a positive effect on this as well.
The most remarkable development in the last few years in the area of facial rejuvenation has been the emergence of fractional carbon dioxide (CO2) lasers. As a class, these are far and away the most effective resurfacing devices. There are probably a dozen manufacturers of these machines, and likely more to follow. To understand their current dominance in the field of laser aesthetics, one must look at the history of cosmetic lasers.
Carbon dioxide lasers are not new. They have been used both to treat medical skin conditions and for rejuvenation for about 20 years. They are ablative lasers, which means they can destroy tissue, albeit in a very controlled fashion. Years ago, this ablative power was a double-edged sword. It was clear that no other laser could accomplish what a CO2 laser could. By ablating the epidermis, it created a very smooth and younger looking skin upon healing. It accomplished this through collagen regeneration, otherwise known as collagen remodeling. This means, that once the old tissue was destroyed, new collagen grew in its place, but this new collagen grew in a much more organized fashion, creating a smooth appearance. The downside: Tremendous recovery time, typically several weeks to several months.
This was unacceptable to most people, despite the fact that results were outstanding. The idea of looking like a Martian for several weeks with effectively no epidermis was hard to sell. The brave few who were willing to go through such a recovery did benefit from the rejuvenating effects of CO2. For everyone else, a host of alternatives became available as the demand for these services grew: Nd:Yag lasers, Erbium lasers, and many others. But nothing quite matched CO2 in terms of results.
The next wave of rejuvenating lasers came about 5 years ago with the introduction of fractional technology. The concept was simple but brilliant: Reduce recovery by fractionating the laser beam. That is, instead of a full beam on the face, the beam would be broken up on its way out of the laser into small dots. This left healthy tissue between the dots that would assist in healing in the ablated zones of tissue. This created a revolution in laser rejuvenation practically overnight and every major manufacturer got on board.
It wasn’t long before two logical concepts were put together, just like a Reese’s Peanut Butter Sandwich. Merge the power of CO2 with the convenience and tolerability of fractional technology. Fractional CO2 was born. Now we have the best of both worlds: The strongest and most effective rejuvenating wavelength with a much more tolerable recovery, typically 3-5 days of a sunburn-like appearance followed by 3-5 days of peeling. The masses were pleased, and the manufacturers responded with a host of new generation devices.
Now this begs the question “which fractional CO2 device is best?”. This indeed is a difficult question to answer at this point. For the most part, these devices will give you excellent results which include a smoother complexion, even tone and color to the skin, fewer lines and wrinkles and some modest tightening. For acne scar sufferers, this offers the only hope of softening those scars. Having worked with this technology myself, I am in general very pleased with the results. As with all laser devices, one must operate with caution and use the technology safely and properly. That being said, these are incredibly safe procedures and complications are quite rare. Is laser resurfacing right for you? A consultation with a qualified and experienced cosmetic physician can help you answer that question.
Dr. Lawrence Janowski is medical director for New Image Laser and Skin in Broomfield.
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