Lasers, lasers everywhere….
Lasers are ubiquitous in aesthetic medicine. Other than Botox and fillers, no one technology is used more often. The only problem is that there are a bewildering array of lasers available and an even more bewildering barrage of advertising to go with them. The truth does set you free, but finding it on the Internet can be challenging.
The word laser itself evokes images of 1960s science fiction where a giant beam is used to destroy the earth (Dr. Evil in the movie Austin Powers comes to mind). Since the inception of lasers in medicine, there has always been some degree of optimism or even wishful thinking about them. Until recently, the results have been somewhat disappointing. Laser is an acronym for “light amplification by stimulated emission of radiation.” Light of a given wavelength is excited and then focused into a very concentrated beam. Different wavelengths are attracted to different molecules in our bodies such as water, blood, fat, collagen, etc. It is this interaction that bears fruit for medical applications. In aesthetic medicine, people are interested in ways to rejuvenate or resurrect the skin. We are all looking for ways to stop time and avoid surgery.
The art of facial resurfacing has come a long way. As a medical art, it began with French aestheticians who used phenol to smooth wrinkles and tighten skin. Plastic surgeons got a hold of this technology and refined it further. The only problem was significant downtime and significant complications such as scarring and pigment changes, things that could radically alter someone’s appearance.
Next came CO2 lasers which had a 10,600 nm wavelength. CO2 is attracted to water among other things, and water is a big part of the skin. It was, and, is a powerful device. Unfortunately, CO2 had many of the same problems as Phenol, including significant downtime, with raw, wounded skin for weeks to months. During the late 1990s, engineers started fiddling with fractionation, or breaking up, the actual laser beams into little spots to speed healing time. Early devices of this type were “non-ablative” in that they did not damage the skin surface. They penetrated into the deeper skin layers. The only problem was that the clinical results were typically mediocre and required multiple treatments.
More recently, fractionation has been applied to “ablative” lasers that treat both superficial and deep skin layers. Fraxel, an Erbium laser, came first. It was then followed by fractionated CO2 devices. Fraxel was relatively effective but was painful and often needed multiple treatments (5-6) to see an effect. Now, CO2 devices are available that are more powerful, safely deliver more energy, and require fewer treatments.
The best of these devices (in my opinion), and the one used at The Refine Institute is the DOT laser. The actual beam is not only fractionated but has also been engineered to have an inverted dumbbell shape that delivers maximum energy to the deeper skin layers while leaving a small footprint above. The heat in the deeper layers is critical in that heat stimulates new collagen formation (neocollagenesis). This process leads to skin tightening and “rejuvenation.” The skin surface is also addressed. Brown spots, pores, and fine wrinkles are removed partly through vaporization. Typically, 1 treatment is all that is necessary for younger patients (40s), while older patients with deeper wrinkles and more skin laxity require 2-3 treatments. I also use this device for people with bad acne scarring.
The DOT laser can also be safely used on the eyelid skin, creating a surrogate for surgical blepharoplasty in the right patient. Downtime is relatively minor for most patients (5-7 days). The first few days, the treated area becomes red with variable amounts of swelling. The skin then will become very dry and scaly as the treatment DOTS begin to shed. While healing, moisturizer and sunscreen are essential.
Lasers will continue to evolve. One key take home concept is that lasers, like fat grafting, rejuvenate the skin by stimulating it rather than cutting it out surgically. You want to take your skin back in time or preserve it, not cut it out like a cancer. Skin rejuvenation is a process and requires general maintenance, much like Botox and fillers. Stimulating your skin every few years with a treatment like the DOT laser is, in my mind, preferable to waiting to the last minute and getting the facelift that so many are trying to avoid.
Andrew J.L. Gear, MD
The Refine Institute
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