The Facial Laser

Fibre optics with laser; strand of optical glass , close-up

Kim Steele

 Lasers are buzzwords in the aesthetic industry. While they have their place in skin rejuvenation, it pays to choose wisely, according to the medical experts. “Lasers are fancy flashlights,” says Dr. Michael Nayak of Nayak Plastic Surgery. “We shine them on skin and they can effectively treat many issues. Skin is complicated: It has many structures living in it. Lasers can effectively kill the parts we don’t like.” He says different lasers have different functions and can be either ablative (causing raw skin), or non-ablative, which require much less downtime, but are somewhat limited in what they can achieve.

    Nayak uses non-ablative lasers to target red or purple blood vessels, unwanted hair, or pigment spots. Ablative lasers can be used to resurface the skin as a whole, to remove surface imperfections and strengthen the skin as it heals. “A third and more controversial approach is using non-ablative lasers to target fine lines and wrinkles,” Nayak reports. “They are touted as being able to stir up the healing response without surface injury.”   

    Ablative lasers can be further divided into ‘full-field,’ which treat the entire surface at one time, or ‘fractionated,’ which treat a percentage of the surface, “to jumpstart the healing process,” he explains.  

    Dr. Amy Miller of St. Louis Skin is elated with fractionated, or pixilated, lasers. “With the old CO2 laser resurfacing, you had to go to the operating room because it removed all the epidermis and some of the dermis,” she explains. “Your face was bandaged and took six weeks to heal, with redness persisting for months. The pixilated CO2 laser allows aggressive resurfacing with downtime of a week or less because it drills only micro holes into the skin surface. The pixilated laser can greatly improve fine lines and wrinkles, and even acne scars, because the depth of treatment stimulates collagen formation.”

    Another laser Miller uses is the LightSheer DUET, a suction laser hair removal system. She says that suction applied as the laser treats the areas makes the treatment feel like warmth, rather than pain, and is very fast. Another non-ablative laser for reducing redness, rosacea, sun spots and spider veins is the Q-Switch. Miller employs it to remove tattoos and melasma, a tan discoloration.

        Dr. Brock Ridenour of Ridenour Plastic Surgery says in the last five years, he has seen the development of more than 30 fractionated laser devices, with more on the way. He says that with the old full-face laser resurfacing, there was a 20 percent complication rate involving loss of pigment or scarring, but fractionated lasers have eliminated those issues. “Fractionated lasers have about 70 percent of the clinical outcome of full-face treatments, but have the advantages of more natural results and a reasonable healing time,” Ridenour says. “Another plus is that fractionated technology can be applied to different wavelengths. I use one superficially for hyperpigmentation, another a little deeper for large pores and fine wrinkles, and another still deeper for older, sun-damaged skin with more substantial wrinkles.”

    Another type of laser, the Vbeam pulsed dye laser, treats redness and broken blood vessels and speeds bruise resolution by half. Ridenour also uses a new generation of radiofrequency Thermage, a device that stimulates collagen production by heating the skin to a precise temperature. While not strictly a laser device, the system has some of the same effects, with more precision and less pain than earlier versions, he says.