Treating the skin texture. Skin tightening

 

The emergence of the fractional technology has redefined aesthetic medicine. We will not use the overused term of revolution, but this is what it is all about: a radical change in the management of cases.

The resurfacing concept is not new, and several types of medical lasers exist already. Each of them has different characteristics and effects. They are all called ablative lasers: their action consists in ablating part of the skin surface, so that a new skin layer is reformed.

The CO2 laser

It is the oldest laser dedicated to resurfacing. The CO2 laser has been one of the first gas lasers on the market and its special affinity with water has made it popular in medical cabinets. The energy output of this type of laser allows it to release large amounts of energy, in other words, to erode very large skin layers at each passage.

Its use implies surgical type precautions, general anaesthesia, and a 3-week social eviction at least – the patient being quite disfigured. The infectious complications are – undoubtedly - frequent in spite of all the precautions.

Until recently, the disadvantages of the treatment were outweighed by the skin “shortening” effect of the scars induced by the CO2 laser lesions, providing a very interesting “lifting” effect.

It was at the time the only way to act on the deep dermis to stimulate the production of collagen, while removing the outer skin layer affected by the sun.

This type of laser is not used anymore because of its numerous side effects and a complicated installation. Its use in aesthetics has become much less common.

The erbium laser

The erbium has nothing to do with botanic and is thus not spelled with an “h”. It is a rare earth element (lanthanide), named by its discoverer, Gustav Mosander, in the 1860s near Ytterby in Sweden. This type of laser has very close affinity with tissue water, and vaporizes it almost instantly.

The depth of the abrasion is less important than with the CO2 laser, but impressive.

The Erbium is used in the treatment of deep fine lines, acne scars or “sun wrinkles” around the mouth.

This flexibility is a major asset, and the treatment is brought progressively rather than massively as with the CO2 laser. A recent study shows that the effects of the new generation erbium lasers can be compared to those of a CO2 laser, with fewer complications.

Some fractional technology erbiums can guarantee very satisfying results on very thin skin areas that could not be treated otherwise, such as the neck or the hands. It corresponds to a simple laser peel with no effects under the skin surface.

Indeed, the disadvantage of the erbium peel is that it only treats the skin surface. It provides a shiny complexion which does not – alas - last very long. Moreover, it cannot act on collagen neither.

The laser peel has however the advantage of being based on a physical effect and of replacing chemical peels, the innocuousness of which are more and more questioned…

Flash Lamps

If you have read our laser hair removal guide, you might think we are against the use of flash lamps. But we were referring to flash lamps used for hair removal: a few effects will be observed on the thickest hair, as well as many hazards and dangers. We thus strongly recommend not using this device.

But the flash lamp is perfect in the domain of rejuvenation, as it consists in burning the skin. Physicians use the most advanced devices to manage to burn the skin “just as needed”. We must admit that this handful of colleagues obtain very good results.

As far as we are concerned, we believe that the gap between the therapeutic effect and the sometimes severe complications is too small for us to use this kind of device.

 

 

The MULTIPLEX FRACTIONAL technology

 

Birth of a new technology

It is precisely because of the damages induced by CO2 lasers that the idea of the FRAXEL was born. In theory, the innovation is brilliant. Indeed, instead of affecting the whole skin surface in one move, there are thousands of impacts, a bit like a matrix, leaving several areas of healthy skin that will help in the healing process

Instead of one big session, there are 4 to 5 sessions, and at the end of the treatment, the entire dermis and epidermis are affected. As we are always looking for novelty, we have worked with one of the first Fraxel lasers imported in Europe. The complex and expensive technology did not always provide very satisfying results.

 

 

Like all good ideas, this idea has been copied and improved by other manufacturers. We are now equipped with the CYNOSURE AFFIRM MULTIPLEX laser, which responds to all our demands and seems to be one of the best devices available on the market

This video, more explicit than a long speech, is 5-minutes long and describes the different properties of the laser. We thus recommend you to look at it

This laser uses two Nd-Yag wavelengths.

The first one, at 1320 nm, is very well absorbed by deep tissues. The beam is decomposed in thousands of spots following the now completely handled fractional technology, now available at very reasonable costs. The heat modifies the tissue collagen and forces the cells to make some more.

The second, at 1440 nm, is strongly absorbed by the skin. The heat destroys pigmentation marks and induces skin peel.

After the session, the skin is very red and hot and must be cooled with cold applications. It is important to keep away from the sun during the treatment so as to avoid complications such as burns, possible with any kind of laser.

 

 

Results and indications

The treatment is almost painless. However, skin redness in the 3 hours following the treatment can be compared to severe sunburns. Prickling and heat sensations have also been reported.

The results are remarkable, as each session completes and amplifies the effects of the previous session. The skin is rejuvenated, tightened and lifted.

Wrinkles are reduced (most of all the numerous little wrinkles that are too thin to react to injection treatments), and open pores are tightened.

Moreover, the treatment erases scars and chloasma marks. We are currently conducting promising intensive tests in the domain of the treatment of stretch marks. The results of this study will be available as soon as mid 2009.

This type of laser is appropriate for all skin types, in men and women of course. One other big improvement is that all face and body parts can be treated, notably the neck, the neckline and the hands.

An average of 4 to 5 sessions is amply sufficient to obtain satisfying results on the complexion and on the quality of tissues both refirmed and retightened. Remember sun exposure is completely contraindicated during the 3 months following the session.

The session

The AFFIRM MULTIPLEX laser targets the tissue water. We thus prepare the session by cooling the skin intensely and by drying it out thoroughly.

However we recommend solar eviction during 4 to 6 months to avoid pigmentation disorders.

Perioral wrinkles are a typical indication for Fraxel-type lasers. Injections alone did not bring satisfying results: the dermal filler induced a thickening of the upper lip. A few sessions of fraxel resurfacing laser erase such folds durably (during several years). Then the only thing left to do on this patient will be to inject hyaluronic acid into the bitterness fold.

The laser is composed of many parameters concerning the power impact and the depth of action. The physician will choose those who suit the best your skin type. It is only after months of practice that a practitioner will be able to adjust the power correctly according to the phototype and to each wavelength of the multiplex fraxel laser.

The treatment is not very painful or completely painless, a cold air anaesthesia at -60°C is used, just like in laser hair removal.

An occlusive bandage such as Cicalfate will be applied immediately after the treatment, and renewed during three days. After the session, redness appears on the treated area during one day approximately. It is easy to hide with a bit of make-up.

On the left, aspect of the face 3 hours after a session. One laser shot will suffice on this light skin. Approximately 12 hours after the session, rednesses have disappeared, but prickling sensations can be felt.

 

A new « skin » will thus be reconstituted from the annexes of the epidermis and the new collagen secreted by the dermis. We recommend you to undergo 5 sessions to reach optimal results you will be satisfied with for years.