From Spring-Summer 2007
It’s a high-tech world, right down to skincare. Lasers are now widely marketed as cure-alls, promising to zap away flaws from spider veins to sun damage to cellulite. We consulted with some of the city’s experts to confirm the truths and dispel the myths.
In this primer, we provide the highlights for treating a variety of skin problems. However, there are many types of lasers in the marketplace and just as many brands. Each facility has its own arsenal of devices based on the practitioner’s personal preferences. And, as with any kind of technology, upgrades and improvements are occurring all the time. Therefore, it’s imperative to visit a reputable doctor or registered nurse (see “Where To Go for Laser Treatment” at bottom of page) to determine which type of treatment is right for you. In addition, it is equally important that these treatments are performed by highly trained and experienced technicians to avoid the risk of burns, scarring, and other side effects.
To that we say, happy zapping.
PIGMENT PROBLEMS AND SUN DAMAGE
We’ve all paid the price for sun worship, but those brown spots and sun damage can be corrected. Intense Pulsed Light (IPL), often called Fotofacial, is a popular treatment that, although not a true laser, is often categorized as such. The difference is that the IPL device emits a broad spectrum of light that affects more areas, but with less specificity. A laser emits a specific wavelength of light directed at a particular target. The IPL can treat several skin imperfections, such as red and brown blotches, facial redness, and dilated red blood vessels. It can also be used to send acne into remission. “With the IPL, different filters are used depending on the condition to be treated, such as spots, rosea, or small vessels,” says Ellen Turner, M.D., of DermLaser Institute of Dallas. “The treatment also improves the whole face by rejuvenating the skin, improving texture, tone, and alleviating other skin problems.”
KTP or VersaPulse lasers send an intense pulse of light that breaks up and removes the unwanted or damaged cells without harming the surrounding healthy cells. They can be used to treat pigmentation spots, broken blood vessels, rosea, red dots, freckles, and more. If an even deeper-reaching laser treatment is needed, Nd:YAG lasers, which emit a higher wavelength than the KTP and VersaPulse, may be used to combat these same skin problems.
In addition, Fraxel lasers (discussed in more detail in the resurfacing section) can treat similar discoloration, as well as improve the skin condition in general.
SPIDER VEINS, BROKEN BLOOD VESSELS, SUPERFICIAL RED BIRTHMARKS, PORT WINE STAINS, AND ACNE ROSEA
Some doctors’ offices and laser centers use an IPL device to treat vascular (red) lesions. However, specialized vascular lasers emit wavelengths specifically designed to treat these lesions. Vascular lasers target the hemoglobin molecule in the blood, making them highly effective for eliminating spider veins, broken blood vessels, superficial red birthmarks, port wine stains, venous malformations, and acne rosea.
KTP and Nd:YAG vascular lasers are often used to treat spider veins, leg veins, broken blood vessels, rosea, and other vascularity problems of the face, including broken blood vessels around the nose and cheeks. A stronger vascular laser is usually needed for treatment of port wine birth marks, superficial hemangiomas, venous malformations, as well as red raised scars and post surgery scars. For these problems, many practitioners turn to Pulsed Dye Lasers, but they can cause bruising, which requires some downtime for recovery.
Who doesn’t want to look 10 years younger? The goal of resurfacing is to alleviate wrinkles, diffused pigmentation, acne scars, and blemishes. In the ’90s, an aggressive carbon dioxide laser (CO2) was the cure, which had a blowtorch-like effect on the skin. Top layers of skin were removed, followed by a two-week recovery of crusting and oozing. The end result was healed skin that was dramatically improved, in terms of color and wrinkles. In addition to the long recovery time, the downside of the fierce CO2 laser was the risk of scarring and changes in pigment. These days, doctors tend to use the CO2 laser less aggressively.
Improved technology has brought new options for resurfacing. One is the Erbium laser. Like the CO2, this laser removes skin down to a deep layer, which then heals over a period of five to seven days, resulting in improved, healthier skin.
“The Erbium laser involves less residual heating of the skin than the CO2 laser,” says A. Jay Burns, M.D., a plastic surgeon affiliated with EpiCentre Dallas and UT Southwestern. “The Erbium laser can be used more aggressively, with better results, while minimizing but not eliminating complications.”
Lori Stetler, M.D., P.A., of Dallas Center for Dermatology and Aesthetics, uses a modern-day carbon dioxide laser or an Erbium laser for resurfacing, depending on the patient’s needs. Dr. Stetler explains that the Erbium laser does not penetrate as deep as the CO2, which means that recovery time is faster, but the Erbium is not as effective on wrinkles as the deeper CO2.
In recent years, the Fraxel laser has received a lot of attention in the dermatology and plastic surgery communities. Fraxel and others like it use a “fractional” approach to resurfacing, which means it spares injuring some of the skin. The laser creates a checkerboard of tiny, deep columns known as microthermal treatment zones, while leaving neighboring skin untouched. About 20 percent of the skin is resurfaced at a time, and the skin heals much faster; new, healthy tissue replaces skin imperfections. Patients experience little to no downtime—usually three to five days of redness and swelling after each treatment.
Originally, a few sessions of Fraxel was hyped to yield the same result as one CO2 treatment. However, Fraxel has proved to be less effective on wrinkles. Nonetheless, it is effective for treating diffused pigmentation, sun damage, and acne scarring, and it can also alleviate some fine lines and wrinkles. Liz Newman, R.N., of EpiCentre touts another benefit of Fraxel: antiaging. “Like Retin A, it reaches the dermal layer of the skin and stimulates collagen, which tightens the skin. It is a great preventive measure to slow down the aging process.” In addition, the FDA has approved Fraxel for treating a pre-cancerous skin condition known as actinic keratosis.
COLLAGEN STIMULATION AND SKIN TIGHTENING
As we age, our skin loses elasticity and starts to sag. Thankfully, there are ways to counteract the forces of Mother Nature. Some of these treatments have been marketed as “nonsurgical facelifts,” but Dr. Turner warns that even the best results of these lasers cannot compare with the results of a surgical facelift.
To treat sagging skin, Turner prefers the Sciton Profile laser, which heats up collagen bundles. As they cool they contract, which helps tighten the skin. Other collagen-stimulating lasers such as the CoolTouch, Polaris, and SmoothBeam use a similar method of heat to tighten skin.
“My patients have seen a visible amount of tightening, especially in the neck and lower face,” Turner says. “It is not the same as a facelift, so patients looking for that kind of result are not candidates for this treatment. Some patients in their 40s and 50s have the treatment as a preventive measure years before they would need a facelift, which is a good idea.” Typically, patients undergo three treatments, with a month between each. There is zero downtime, and improved, tightened skin appears in three to six months.
The Fraxel laser (discussed in the resurfacing section) also thickens and tightens the skin, in addition to treating pigmentation and other woes. Another treatment for tightening the skin is Thermage, which isn’t a true laser; rather, it uses radiofrequency to affect the skin. Thermage cools the top layer of the skin while delivering heat to the bottom layer. “The result is the tightening of existing collagen and the production of more collagen,” Dr. Stetler says. Proponents of Thermage claim that the process tightens the skin and improves facial contour, thus getting rid of wrinkles with no downtime. Critics point out that results among patients are often very inconsistent.
Laser hair removal has become so popular that even salons and day spas offer it. But although laser hair removal is often referred to as “permanent,” the more accurate term may be “hair reduction.” Unwanted hair can be dramatically reduced through a series of lasers treatments, but after the series, most patients need occasional touch-ups.
Many hair removal centers use an IPL device, but IPL is less effective than a laser with a wavelength that specifically targets the melanin pigment in the hair, which then disables the hair follicle. Because melanin is present not just in the hair, but also in tanned skin and darker skin tones, only select hair reduction lasers can be used on these patients. For example, the Alexandrite laser is ideal for a patient with dark hair and light skin. For patients with dark or tanned skin, the Nd:YAG laser may be a better choice.
No need to lament an ill-advised youthful indiscretion. Unwanted tattoos and permanent cosmetics can usually be removed by a series of laser treatments. While some clinics use an IPL device, lasers such as the Q-switched YAG are more specifically designed for tattoo removal. This laser uses a technology called “Q switching,” delivering energy in very short bursts. Each burst of energy is absorbed by the pigment in the tattoo, which causes the pigment to fragment into tiny particles that the body subsequently removes naturally. The removal process takes several treatments, preferably spaced out every six to eight weeks. Results vary depending on the color of the ink, i.e., darker tones tend to respond better than lighter ones.
First they promised the fountain of youth and an end to shaving. Now lasers may be fat busters, too. These new devices are the latest noninvasive techniques for eliminating excess fat, cellulite, and stretch marks. However, such lasers are in the early stages of development, and most are not yet available.
The technology for fat reduction is the most promising. UltraShape, the first noninvasive alternative to liposuction, could be available in the United States as early as next year. EpiCentre is one of two locations in the United States chosen to test the UltraShape device.
“UltraShape uses focused, external ultrasound energy to destroy fat cells below the skin,” says plastic surgeon John L. Burns, M.D., who is also affiliated with EpiCentre. “Each treatment is safe, painless, and requires no downtime. One can expect a modest, one- to two-centimeter reduction in fat with each treatment.” These results are impressive and show clear changes, but, as Dr. Burns points out, they don’t compare to results from traditional liposuction.
Currently some clinics offer a cellulite treatment called Velasmooth. This device is not a laser and is designed to improve the appearance of cellulite through a combination of infrared light, suction massage, and radiofrequency. Many doctors say that Velasmooth actually causes swelling of the area being treated, which may give the illusion of cellulite reduction. According to Burns, a nonsurgical device offering consistent long-term cellulite reduction does not exist, though research is ongoing. Our fingers are crossed.
Where To Go for Laser Treatment
Baylor Tom Landry Health & Wellness Center
411 N. Washington St., Ste. 5000
Laser hair removal (for package of six): bikini, $1,350; underarms, $810; partial back, $1,620; prices per treatment also available Fotofacial: $550 each or $2,500 for a package of six Face veins: generally $225 for initial treatment and $150 follow-ups Fraxel: $1,000 per treatment for first three, then $500 each Tattoo removal: small, $250 initial treatment and $150 each thereafter; medium, $450 initial treatment and $250 thereafter; large, $650 first treatment and $350 thereafter
Dallas Center for Dermatology and Aesthetics
Dr. Lori Stetler
8201 Preston Rd., Ste. 350
Laser hair removal (for package of five): bikini, $1,350; underarms, $1,800; legs and back depend on patient Fotofacial: $550 per treatment Veins: $300 per treatment Thermage: $4,000 per treatment for full face and eyes Tattoo removal: depends on size and color Resurfacing with CO2 laser: $4,500 plus hospital and anesthesia costs (approx. $5,800)
DermLaser Institute of Dallas
Dr. Ellen Turner
8222 Douglas Ave., Ste. 950
Laser hair removal (for package of four): bikini, $750; underarms, $450; lower legs, $900; back (men), $1,050 Fotofacial: $300 per treatment Resurfacing: $175-$450, depending on depth Vein removal: $250 per 15 minutes Skin tightening (each treatment): full face, $800; partial face, $600; neck, $800; abdominal, $1,000; discounts apply to packages of three
Park Cities Aesthetics
Dr. Connie Casad
7777 Forest Ln., Ste. C202
Laser hair removal: bikini, $100 per session; underarms, $100 per session; lower legs, $350 per session; upper legs, $500 per session; back, $450 per session Fotofacial: $300 per treatment Skin tightening: $300 each Pixel fractional resurfacing (similar to Fraxel): $500 per treatment