SKIN RESURFACING

What is it for:

Aged and sun damaged skin can make you look older than you really are. The youthful bounce and shine of your younger years may also be lost as a result of collagen and elastin depletion and lack of regeneration. In many women the onset of peri-menopause and menopause are the time markers that make you sit up and notice the effects of gravity. What is present in terms of collagen and elastin become stretched, wavy, and thin. Smooth and silky gives way to wrinkled and rough. In many others the damaged skin is a result of acne or trauma with resultant pitting and discoloration of skin. Scars become prominent and seem never to be overcome.

What are the tools:

New technologies now available to heal the damaged skin focus on lasers, radiowaves, electroporation and other modalities. The most commonly used lasers for skin resurfacing and regeneration are the CO2 and Erbium lasers. These lasers are capable of peeling away the top layers of skin all the way down to the bottom layers of skin. They can be very superficial or very deep in use depending on the patient’s goals and downtime availability. The standard CO2 laser, used for decades by plastic surgeon, cosmetic surgeons, dermatologists, and gynecologists is excellent in making a rough and rugged and pigmented skin become smooth, radiant, and almost scar free. It can actually shrink the skin and give a tightening effect. The only downside of the CO2 laser is the very long recovery of weeks to months as the skin basically healed from a first or second-degree laser burn. Hypopigmentation occurred in some leaving an unsightly pale area of skin showing. In darker skinned individuals this effect can be quite striking and distressing. Even more distressing perhaps is the possibility of the skin turning darker. More modern Erbium lasers became available that gave similar effects with only a few days of downtime and less chance of pigment issues. It was also a great deal more comfortable to recover from as compared to the CO2 laser. The Erbium laser soon became the standard until modern variations of the CO2 lasers were made.

What are the most current technologies:

The technological leap in lasers occurred when Palomar Medical near MIT in Cambridge, Massachusetts, discovered and patented Fractional Technology. In the past, both the CO2 and Erbium lasers would have the effect of “removing asphalt from a highway.” Replacing this “asphalt” took a long time to heal and it hurt. Fractional Technology is more akin to placing potholes on the highway and not removing all of the surface asphalt. Fractional resurfacing was born when advances in science allowed thousands of little “potholes” to be placed on the skin with more rapid healing because potholes were faster to fix than an entire highway to rebuild. Fractional holes were spaced in such a way that there was abundant normal skin in between that was not damaged or potholed. Healing time was turned from weeks to months to just a handful of days. It was also found that Fractional treatments resulted in less pigment issues and less pain but with similar smooth results available to the patient. Now there are both Fractional CO2 and Erbium lasers manufactured worldwide. The most common wavelengths used are 1540nm and 2940nm. The 1540nm wavelength has been marketed as “Fraxel.” We offer both wavelengths in our laser center. Both lasers can give that quick “lunchtime” treatment but the difference is that the 2940 can be turned up to a very aggressive level compared to the 1540. Both lasers need topical anesthesia in the form of a cream with the 2940 causing a bit more discomfort. Today’s modern laser center uses dual wavelengths stacked on top of the other to give a deeper tightening and a more superficial smoothing effect at the same time. Dramatic reduction in wrinkles, scars, and brown discoloration is the end result. When used in conjunction with the Pelleve Radiofrequency skin tightening treatments, you can literally remove decades off the aging skin and achieve outstanding results. It is like a facelift without a knife. A facelift using light energy and sound waves.

Summary of Technology:

What is the difference in using the 1540 versus the 2940 Erbium laser? They are equal in total cost but vary in number of treatments and tolerability. Let us give some examples:

  1. Fractional 1540: Great for scars, acne scars, brown pigment, melasma, fine lines and wrinkles. It is the only FDA approved laser for stretch marks and striae. Need topical anesthetic, feels like little rubber band snaps. No bleeding and no weeping of skin. Needs 2 to 4 treatments spaced a month apart. 1 to 3 day downtime as the skin gets swollen and pink/red. Not generally used as a “Lunchtime Peel” but can be. Does not give immediate glow to the skin. Gives a skin tightening effect.


  2. Fractional 2940: Great for brown pigments and smoothing out skin. Great for fine lines AND deep wrinkles. Great for acne as a finishing touch after 1540 treatments are done. Need topical anesthetic, feels hotter, skin may bleed as it ablates and exposes some of the small capillaries underneath. Skin gets weepy. Need only one treatment with a 10-day downtime. Can accommodate a “Lunchtime Peel” or “Arctic Peel” with minimal discomfort and immediate glow of the skin. Gives a skin tightening effect.


  3. Fractional CO2: Great for scars, acne scars, brown pigment, superficial and deep lines. Gives a skin tightening effect. Need topical anesthesia, is a hot treatment, significant rubber band snap sensation. Can be used in low settings as a “Lunchtime Peel.” Need only one treatment with a 10-day and longer downtime.
  4. Stacked Fractional 1540/2940 Treatments: Aggressively attacks all the skin levels to achieve maximum skin smoothness and pigment control. All of the above descriptions on these wavelengths apply.
  5. Ellman radio wave instruments (Pelleve and Surgitron/SurgiMax): This is another way of resurfacing skin. It is not a laser but a device that uses two wavelengths considered “cool” due to its placement on the spectrum charts. “Cool” is a misnomer because the treatments are hot but the tip is immediately cool to touch when the power is turned off unlike standard cautery or laser fiber tips what remain quite hot and can burn down to the bone if allowed. The treatments require anesthesia and can be used in any part of the body. It is our primary tool for resurfacing labial revisions. It is extremely precise with lateral heat spread measured in nanometers. It can be used in small areas of the body including the face for skin tags, keloids, and moles. It generally leaves a minimal scar for those lesions. It is not used for full-face resurfacing.
Which resurfacing tool is best for you?
It will all depend on how you answer these questions:
  1. How much downtime can you dedicate?
  2. Do you have deep or superficial furrows/wrinkles?
  3. Do you have pigment issues you need addressed?
  4. Do you want a single treatment or a series of treatments? Single treatments cause more discomfort and need a longer recovery.
  5. How much discomfort can you put up with?
  6. Will you stay out of the sun?
  7. Will you use quality post-treatment skin care products to maintain your investment?
How much does it cost?

It depends what part of the body is treated and how many treatments are needed and which technologies you want used. Single treatments of the 2940nm are approximately $2,500 and up for the face. The 1540nm treatment needs anywhere from 2 to 4 monthly sessions at about $800 - 1,200 per session. Stacked Fractional Treatments employing both wavelengths are discounted to about $3,000 per treatment. This is about a $700 savings. Adding Pelleve to the face is about $800 - 1000 per treatment and two treatments are recommended a month apart. Eyes and mouth regions sometimes need an additional Pelleve treatment at a discounted fee. When compared to face lift prices these treatments are a bargain.

We will discuss these fully with you at the time of your consultation so that we can set out a reasonable and efficient plan of action that gives you the maximum results for the minimum spending and discomfort. Dr. Alinsod performs all the aggressive resurfacing treatments and has over 20 years of experience in this field.







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TREATMENTS




Fractional 1540


Fractional 2940