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 call 978-369-4499.

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Dr. Seckel

Concord, Massachusetts

Boston, Massachusetts

978-369-4499

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 skin rejuvenation and facial aging read Save Your Face.

Dr. Seckel

Concord, Massachusetts

Boston, Massachusetts

Before and After Photo Facelift-notice full cheek after

A startling 12.4 million cosmetic plastic surgery operations were performed in this country last year and estimates are that nearly half of them were to correct facial aging and this does not include the millions of non-surgical facial rejuvenation procedures.

As the baby boomers reach their 50′s everyone wants to look younger but no one wants to have surgery. Most people do not want to have surgery especially if it is not for serious medical reasons.

However, revolutionary advances in technology have made it possible for many people to reverse facial skin aging changes using new non-surgical skin rejuvenation techniques without having to undergo plastic surgery.

On Wednesday, September 28, 2005, I spoke on a panel entitled Non-surgical Facial Rejuvenation at the meeting of the American Society of Plastic Surgeons in Chicago, Illinois. My topic was Botox, the soft tissue fillers including Restylane and Radiesse and the many skin peels used for exfoliation to remove wrinkles and signs of facial aging. I came away from that meeting very excited and enthused about all the wonderful new non-surgical facial rejuvenation therapies that are safe and effective for patients today.

Before and after Botox to remove Crow's Feet

Before and after Lip Filler Injection Restylane

There are so many new skin rejuvenation, wrinkle removing and skin tightening non-surgical facial rejuvention options available that the patient must understand exactly what facial aging change it is that they want to correct. Usually the patient just feels that their face looks older but cannot pinpoint exactly which facial aging change is causing concern. It is important to seek consultation with an experienced board certified Plastic Surgeon or Dermatologist who understands all the options so that the correct option is chosen for your very unique face. I advise you to avoid doctors who only do one or two facial rejuvenation procedures and tend to push patients to have the procedure that he/she performs rather than customizing the procedure to the patient’s needs.

The 6 Step Skin Rejuvenation Program™ consists of:

Step 1-Exfoliation-topical cremes, microdermabrasion, superficial skin peels with various fruit and salicylic acids to produce exfoliation to freshen the skin and give it a youthful glow and remove wrinkles. These treatments also stimulate the skin to form new collagen to replace the old damaged aged collagen, and help rejuvenate and tighten the facial skin.

Step 2- Stimulation of new collagen production- Controlled inflammation of the deep skin layer called the dermis causes the dermal skin cells called fibroblasts to manufacture new collagen to replace the collagen lost by sun damage and aging. Topical RetinA and the deep exfoliative process in step 1 start this process. Newer technological interventions like the Lux1540, Fraxel, Lux294o, Sciton Profractional, and Lumenis bridge therapy are powerful stimulators of new collagen production.

Step 3-Remove pigment and red spots-In addition to exfoliation new light and laser therapies such as IPL, Photo facial, Lux1540 and Fraxel® can be used to remove brown spots, pignent, broken blood vessels called telangiectasias, and rosacea from the facial skin. Pigment and blood vessels are a classic sign of facial aging and the non-surgical removal of these skin discolorations provides noticeable facial rejuvenation. These high tech yherapies can also remove wrinkles.

Step 4-Remove lines of facial expression wrinkles- Botox can be used to relax the muscles of facial expression and remove crow’s feet, worry lines, frown lines, and bunny lines and dynamic wrinkles, all of which are very early signs of facial aging. Botox® effectively removes these lines in most people for 6 to 9 months after a simple nearly painless injection.

Step 5-Fill deep facial lines called the nasolabial fold lines and marionette lines make the face look tired and old and coupled with the frown lines often make people look angry. Deep facial lines are deeper than wrinkles, and I do not use fillers for wrinkle removal. New soft tissue fillers can soften the nasal labial fold lines and marionette lines when they are injected into the skin beneath the aging lines. Commonly used soft tissue fillers are Restylane, Radiesse, Zyderm, Zyplast, Juvaderm, Sculptra®, Fascian®, Cymetra®, and Isolagen®. Each of these fillers has different characteristics and are better for some facial aging changes than others.

Step 6-Skin Tightening. The final facial aging change to treat is loose sagging skin. While the plastic surgical operation called a facelift is still the “gold standard” for facial rejuvenation, several new technologies are evolving which can tighten aged facial skin. LuxIR and Titan®, devices using infrared waves, and Aluma and Thermage® which use radiofrequency waves, are all being used to heat the collagen in the deep layers of the skin called the dermis causing the collagen to shorten and tighten the skin. While these technologies are new and only about 30% effective and require multiple treatments, they will most certainly be improved in the future and effective skin tightening of aging facial skin will be possible. Some wrinkle removal is seen following successful skin tightening.

Non-surgical facial rejuvenation is here and is getting more effective as new products come out every month. One of my common expressions whenever I speak about the new non-surgical options for facial rejuvination is “Plastic Surgery is becoming non surgeical,” and try to encourage my fellow plastic surgeons to embrace the new technology. I still believe that an experienced board certified plastic surgeon is the best doctor to provide the non-surgical facial rejuvenation procedures to patients because these doctors are the facial aging experts and they have the ability to do what is necessary for the patient. Contact me for more information on any of the above procedures.

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 ActiveFX with the Lumenis Ultrapulse Encore laser and the Microlaserpeel with the Sciton Erbium laser, and the Lux2940 Fractional Erbium Laser by Palomar. 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 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 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 ask a question,

Sincerely,

Dr. Seckel