Scar therapy consists of a wide variety of possible treatments from injections, lasers and light devices and surgical excision. There is no one type of scar treatment which is uniformly effective for all scars. There are simply too many types of scars and differing skin types and body locations for any uniform approach to improving the appearance of scars.

While scar revision by excision still remains a mainstay for many scar patients that I see, it is not effective for scars that involve large surface areas. Broad hypertrophic scars, particularly from burns and other forms of trauma, pose unique challenges for improvement. While in some cases complete excision and skin grafting may be useful, patients may either not want that approach or want to try non-surgical methods first.

One non-excisional treatment approach, and the only that I find effective for established scars, is that of combined laser resurfacing and topical steroids. When referring to laser resurfacing, I am not talking about a uniform ablative approach but specifically that of fractional CO2 ablation. This ablative CO2 laser creates channels from 400 to 600 microns or more deep into the dermis/scar. Such channels provide many points of entry for topical agents such as steroids. The early introduction of intradermal steroids helps to control the inflammation that the laser causes as well as suppresses collagen synthesis to reduce scar thickness  

This scar treatment approach can be done under either topical or local anesthetic. Usually topical is better because wide hypertrophic scars are typically hard to inject under and get good pain relief. Numerous topical anesthetic creams are available but ones that contain a combination of benzocaine, lidocaine and tetracaine penetrate and work the best. Once adequately anesthetized, the broad scar is treated by the fractional CO2 laser to create intradermal pores. Thereafter, the steroid triamcinolone acetonide suspension (kenalog) is applied over the laser-treated area. Different concentrations of the steroid can be used from prepared concentrates of 10, 20 and 40mg/cc. In some cases, intralesional steroid injections may be given as well if the scar is very thick. The topical steroid suspension is held into place over the scar treated area by a clear adhesive dressing for 24 hours.

Few wide hypertrophic scars respond well to a single treatment and a series of fractional laser resurfacing and topical steroids is needed to get the best result. Typically it requires three or four sessions spaced four to six weeks apart.

This combined laser and steroid treatment is fairly novel but makes biologic sense with its multimodality approach. The synergism of these two treatments  strives to create a flatter scar that is more supple, not necessarily complete scar removal. Breaking down existing scar tissue, without creating a lot more, is the only realistic goal for this type of hypertrophic scar.

Dr. Barry Eppley

Indianapolis, Indiana 

The use of lasers in facial rejuvenation has largely revolved around skin resurfacing or the reduction of wrinkles and the improvement in texture. When introduced nearly 20 years ago, the CO2 was the standard and produced a deep burn injury, some dramatic results and an associated significant recovery. Today’s skin resurfacing lasers use more superficial depths of penetration as well as newer fractional platforms. While fractional laser technologies are highly marketed and are often proclaimed to be better than traditional ablative lasers, those claims have never been substantiated.

 Traditional high energy CO₂ lasers treat 100% of the skin surface through a computer-generated pattern method. Fractional laser treatment means that just a fraction of the skin’surface is treated, in the range of 10% to 15% of the total surface and leaves normal skin next to small microscopic burn holes. Given that less of the skin surface is treated,  it is no surprise that recovery is quicker as less skin has been injured. This, however, does not mean that the result is better…as it is not. Less recovery is usually associated with  less of a result.

These more superficial and incomplete skin resurfacing lasers are good for two types of patients in my opinion. If you are younger and do not have a lot of skin damage or wrinkle problems, then this would be the better laser resurfacing approach. The other type of patient to benefit is at the opposite end of the spectrum, the patient who has a lot of skin damage but can not tolerate much recovery. This applies to many working women who do not have a lot of the time from work for recovery. One other benefit to these superficial microlaser and fractional laser treatments is that they can be performed in the office under just topical anesthesia. Because of their more superficial effects, a series or package of treatments is often needed to get the best long-term results.

When it comes to lasers you get what you pay for, not in terms of fee, but in terms of recovery time. There is no doubt that deeper laser resurfacing is harder on both the patient and the treating plastic surgeon. More wound care is needed until the skin is healed and the skin will remain red for weeks. There are also risks of permanent loss of skin pigment and burn injuries, particularly if done by someone with limited experience. As a result, many surgeons have abandoned these deeper laser treatments. However, I find I do them as much as ever. It is all about good patient selection and education. Many of the results seen can not be rivaled by more superficial laser treatments.

There are several things I have learned that can make a big difference in deeper laser resurfacing recovery. During the procedure, the skin debris left behind after the first pass should be left alone rather than removed. This helps to serve as a biologic dressing and the patient will not ooze as much serum in the first two or three days afterwards. I have also stopped using any external dressings and have my patients just use Aquaphor or even plain Vaseline. This makes it much easier for the patient. After five days it is a good time to employ some newer healing topical agents such as amino acid complexes, stem cell serums and oxygenated mists.  All of these help the skin increase the final rate of re-epithelialization, the last step in completing early healing.

One other good use of laser resurfacing is in the operating room to treat the facelift patient. Many limited or even full facelift patients have significant skin wrinkling and texture irregularities. The central face can be treated aggressively as would be done normally but the sides of the face where the skin flaps are undermined should be done with caution. This can be a great addition to the skin tightening from the facelift and help reduce a lot of fine wrinkles.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana   

Aging around the eyes, as evidenced by wrinkles and dark circles, will occur to some degree in everyone. It is a perpetual process that starts to become evident after the age of 35. While formal eyelid surgery (blepharoplasty) may ultimately be needed, some may desire to consider non-surgical treatment options. While there are thousands of eye creams and potions, none can really make a significant periorbital rejuvenation change.

Laser resurfacing is the bridge between creams and blepharoplasty surgery. Traditionally, laser skin treatments have been avoided on the eyelids because the skin is very thin and the risk of causing a burn injury is very real. But laser resurfacing has changed over the past ten years with the use of more accurate depth control and fractional spacing of the laser pulses. Both approaches produce less skin damage and can virtually eliminate any risk of burns and scarring.

While there are advocates for every type of laser resurfacing device out there, there is not solid scientific evidence that fractional laser treatment produces a better or longer-lasting result than traditional non-fractional ablation. Fractional laser is certainly more popular currently but optimal laser energies and devices remain in a state of perpetual development and evolution.

Non-surgical eyelifts are currently done in my practice using the Sciton microlaser peel. Typical treatment time is done in less than 10 minutes for both upper and lower eyelids. The laser is used to treat the entire upper and lower eyelids, going right up to the lashline.The eyelid skin is first treated by a topical anesthetic for 15 minutes and the eye is protected with a metal shield. The eyelid skin can be treated from a 4 to 15 micron depth. This results in some mild redness and swelling for several days. Whether it is two days (4 micron) or four or five days (15 micron) is depth dependent. How much downtime a patient can tolerate determines the best depth. Ideally, a series of laser treatments are done to get the best skin tightening and some wrinkle reduction. Treating a patient every 6 to 8 weeks over  a 6 month period for a total of four treatment sessions is our current protocol.

Laser resurfacing of the eyelids is not new and has even been given branding names by certain practices. It has been touted that it achieves significant skin tightening with results that are comparable to a surgical eyelid lift…without any risks. The minimal to no risk part is true but comparing it to what can be accomplished with a blepharoplasty is an overstatement. It is a good compliment for the younger patient who does not yet need surgery and works well in conjunction with Botox injections. For the older patient with more skin excess, it provides some improvement but should clearly be viewed as a bridge to blepharoplasty and not a replacement for it.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Indianapolis, Indiana

Wrinkles, tiny blood vessels and brown spots are very typical signs of aging and can add years to your facial appearance. While many feel that these are just the effects of aging, in reality they are the long-term effects of unseen sun damage from years ago.What may have been a love affair with the sun in our early years eventually appears as something we hate decades later.

Fortunately, there are numerous treatments to help treat these chronic signs of sun damage known as photoaging. Lasers, peels and light treatments, and many combinations thereof, can help offset the damaging effects of our lifelong exposure to ultraviolet light.

While there are many available skin treatments, their sheer number makes it very confusing to patients. Here is a brief overview:

PEELS. For patients with light skin damage and fine wrinkles, a chemical peel can be a great treatment. By removing several superficial layers of outer skin, one can smooth the skin and get rid of some brown spots. There are many types of peels but those that provide real therapeutic benefit are light TCA and the newer Vi peel. These peels are usually combined with a microdermabrasion which helps prep the skin to receive the peel. In general, peels help most with pigmented skin problems and less for significant wrinkle issues.

LIGHT and LASERS. Light treatments, known as IPL or BBL, are excellent for brown spots and telangectasias. They work by emitting a polychromatic light with multiple absorption targets. (melanin in brown spots and hemoglobin in telangectasias) Since they pass through the skin and only hit the target, there is no real downtime. Lasers work by burning off the top layers of skin. As of now, there are two fundamental laser skin resurfacing approaches, micropeeling and fractional. Micropeeling removes 100% of the outer surface at a set depth. Fractional punches holes in the skin but only treats about 10% of the surface area in a single treatment. When it comes to which is better for skin resurfacing, the jury is still out. Fractional is the newest laser toy so it receives a lot of press, but it is not magic and the choice between the two (or combination) is up to the practitioner’s experience.

COMBINATION APPROACHES. If a patient has significant wrinkles or skin texture problems, then I would recommend a laser resurfacing with the depth based on how much recovery they can allow. This is often combined with some Botox for muscle action decrease and injectable fillers for volume loss. If the photoaging damage is less, then BBL and chemical peels can suffice.

Many times, the combination of BBL for brown spots, laser resurfacing for wrinkles and texture and Skin Type (for tightening some loose skin) can be safely combined in a single treatment. While this will not create the same results as a facelift, for those with lesser amounts of skin laxity it can create a really significant improvement with much less recovery.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Indianapolis, Indiana

1.      What  can lasers do in plastic surgery that a scalpel can’t?

While many think of lasers like a ‘Star Wars’ saber that cuts through tissue, that is not how it is used in plastic surgery. Lasers are not used to cut tissue. While this sounds theoretically appealing, the effects of such heat on the skin cause exactly the opposite of any benefit…tissue burn and delayed healing. Such an effect is of limited use in cosmetic surgery.

The benefits of lasers in plastic surgery are focused on skin-related problems that are not readily treated by any form of conventional surgery. Cosmetic problems of the skin that can not be cut out without severe and undesireable scarring These include facial wrinkles and scars, excessive hair, unwanted tattoos, visible blood vessels, and brown discoloration.

Because of the greater attraction of heat to darker colors, extreme caution must be used in any type of laser treatment in patients of olive, suntanned, or black skin.

2.      How can lasers make my skin look better?

Laser skin resurfacing, commonly called a laser peel, removes the outer damaged layer of skin leaving the way for new cells to appear.  This removal and replacement of top surface skin cells can remove benign growths, reduce the appearance of wrinkles and minimize surface scars. The heat from the laser also has a contraction effect on the deeper collagen layers of the skin which can create some degree of skin tightening.

 The effectiveness of laser skin resurfacing is a function of its depth. Lasers today can be tuned to the depth of penetration or the amount of skin removal desired. From lighter laser skin peels (often call Erbium or microlaser peels) to deeper CO2 laser peels, the results and amount of recovery can be adjusted to each individual patient’s needs and desires. Because of the extended amount of recovery needed for deeper laser peels, a microlaser peeling approach has become popular. The tradeoff of this approach (healing in a week or less) is that a series of treatments are needed to create the best skin smoothing result.

The newest concept in laser skin resurfacing is that of a fractional approach. (e.g., Fraxel) Fractional means that only a fraction of the surface of our skin is actually treated by the laser. The laser burns less skin surface but goes deeper in the areas that are treated. By leaving small areas of untouched skin, healing is much quicker than it would be otherwise. Whether fractional laser resurfacing is better than non-fractional is a matter of debate. The newest lasers are incorporating both approaches in a single treatment.

Any method of laser skin resurfacing requires a good skin regimen for long-term maintenance of the results. This includes a combination of daily topical skin products combined with intermittent microdermabrasions and light chemical peels.

3.      How does laser hair removal work?

      Hair growth can be disabled or destroyed by specific long wavelengths of pulsed laser light. The laser is pulsed for only a fraction of a second so that the energy will be absorbed by the hair follicle but not long enough that too much heat is absorbed by the skin. The result is hair reduction or removal without burning the skin. This creates immediate results that will last far longer than shaving, tweezing, waxing, or chemical depilation, all of which are only very temporary.

One of the most important concepts in laser hair removal is that it requires multiple treatment sessions. This is because the laser works only on hairs that are in their active growth cycle. Since other hairs will enter their growth cycles at different times, additional treatments are needed. The number of sessions may be five to eight, spaced four to six weeks apart.

Because the laser treats many hairs at a time, facial areas (e.g., chin, lip,
cheek) can be treated in ten to fifteen minutes. Small body areas (e.g., underarms,
bikini line) take about  half an hour. Larger body areas (e.g., full back, chest,
full legs, both arms) usually an hour or more, depending upon the size
of the area and the density of the hair. No matter how it is marketed, laser hair removal is uncomfortable and topical anesthetics are always needed.

4.      How do lasers remove tattoos? How effective are they?

Because of differential color absorption, some tattoos are easier to remove than others. For example, black and blue pigments clear the easiest followed by red and greens. Light colors such as pink, orange, yellow and white are often very resistant.

It usually takes six or more treatments to remove a tattoo or reduce it to a shadow or smear. Complete removal cannot be guaranteed or predicted for any tattoo. There is definitely some discomfort associated with laser tattoo treatments and there is often some blistering that develops after a treatment. There is some risk of scarring due to the loss of skin pigment from the absorbed heat.

5.      Can I get rid of those tiny blood vessels on my nose and cheeks?

The laser wavelengths needed to treat red colors has been known for decades and served as the color basis for the initial introduction of the concept of laser photothermolysis. (treating color-specific targets) Red spots (angiomas) and small superficial blood vessels are ideal for laser treatments.

Angiomas are quick and easy to treat. The laser turns them initially black (coagulated) and the body simply absorbs them away after a few weeks. Telangectasias are different in that they have flow (you only see them because they have blood flow in them)and are located at different levels in the skin. They are more difficult to treat as it is a delicate balance between enough heat to clot the vessel off but not enough to burn the skin and create a scar. If they are not adequately coagulated, the clot breaks down later and they reappear as the flow returns. Facial telangectasias often require more than one treatment to get the best result.

6.      Will laser treatments help scars?

Scars from acne and injury are frequent patient requests for improvements. In some cases, laser treatments can provide scar improvement but it is highly dependent on the type of scar. Laser treatments are frequently given more credit for scar improvements than they often produce.

Deeper laser resurfacing can reduce the appearance of fine superficial acne scars but not deeper ice-pick or saucer-shaped acne scars. More superficial depth laser treatments rarely produce  any improvement. More than one laser treatment is usually needed.

Incisional and traumatic scars can be improved with laser resurfacing but only if the problem is one of irregular texture. Excisional treatments are more frequently used and are more effective for the problems of wide, depressed, or raised scars. Scars that are noticeable because of their persistent red color can be improved with red wavelength laser treatments.

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7.      What’s the difference between laser and light treatments?

While both use light as the treatment method, the type of light used is quite different…which also makes what they are effective for quite different also. A laser is high-energy focused light of a single wavelength. Light, or pulsed light treatments, are lower energy, non-focused light treatments. Known as IPL, BBL, and photofacials, they are very effective for brown spots on the face and hands and generalized redness and rosace. When used with other skin treatments, it can also provide for some minor skin texture improvement and tightening.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon,, Indiana

Indianapolis    

Anytime the word ‘laser’ is used in plastic surgery, it conjures up images of immediate and dramatic results for removing wrinkles and tightening skin. But the face is not a video game or a Photoshop program and it just isn’t that easy. And there are many types of lasers used which can have quite different effects.

One concept to understand is the difference between ablative and non-ablative laser therapies which are used to facial skin issues. The term, ablative, means removing and specifically refers to laser resurfacing for the treatment of sun-damaged and aging skin. This is also known  today as CO2 (carbon dioxide) and erbium skin resurfacing. Fundamentally, laser skin resurfacing is all about burning off the top layers of skin which results in less wrinkles and more youthful looking facial skin. The difference between CO2 and erbium is all about depth of the burn. The deeper you go, the better the results but the longer the recovery will be. For these reasons, this is why ablative laser treatments are also known as the ‘hot laser’ method.

A CO2 laser treatment removes wrinkles and stimulates new skin formation with a tightening effect. But the procedure does have a significant amount of downtime. It works well but it goes deep. Think of your skin having a thickness of 1000 microns. (forget what a mcron is…focus just on the number) A CO2 laser treatment might remove as much as 300 to 400 microns of the upper skin. If your wrinkle goes that deep or less, it is gone, If it lies even deeper, it will only be partially removed. Conversely, an erbium laser treatment can remove anywhere from 4 to 100 microns, much less than CO2. Many wrinkles lie deeper than this and will only be softened as a result. The beauty of this lower level of ablation is that it can be adjusted based on what your wrinkle problem is and how much recovery you want. But it will require multiple treatments in most people to get the best result. So you can see that one treatment is not the same as the other. Because erbium offers a faster recovery and virtually no risk of adverse scarring,, many patients and doctors alike prefer this treatment

Conversely, non-ablative laser treatments do not involve the burning off of the outer skin layer. They do not remove skin but are used  to treat problems that lie in or below the skin, such as brown spots and red blood vessels. Because there is no burning involved, they are call ‘cold laser’ treatments even though they create heat during the treatment. Some evidence exists, and a lot of marketing, that these lasers can remove wrinkles and tighten skin. While in my Indianapolis plastic surgery experience, I have observed that is true, it is usually not up the level of most patient’s expectations. As a result, they often have to be combined with other types of cosmetic facial treatments (e.g., Botox, injectable fillers, microdermabrasion) to be visibly beneficial.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Energy technologies, such as laser and pulsed light, have been a big part of causing the tidal wave of non- to minimally invasive cosmetic treatments available today. When combined with Botox and injectable fillers, a wide range of cosmetic improvements of the skin are possible.

The most common skin problems that I see in my Indianapolis plastic surgery practice that people want treated are facial wrinkles and  telangiectasias and solar lentigines (brown spots)  of the face, body, and extremities. Other less common but not rare skin conditions to see are acne, rosacea, and melasma.

Facial telangiectasias and different forms of angiomas are not the easiest to treat in terms of getting a high elimination rate with one treatment. One has to have a lot of experience with the laser unit that you have to treat these dynamic vascular  problems. While there are many different laser manufacturers with different machines and settings, laser vascular treatments defy consistent results with just one wavelength, power level, depth of penetration, and thermal relaxation time. There is no one magical laser that simply works without experience and knowledge of what its effects are at different settings. While I use the Sciton laser, it has  taken me sometime before I have found a balance of settings that gives consistent results. It is easy to create hot spots or skin burns with an inexperienced treater of vascular lesions.

Solar lentignes or brown spots are the easiest of skin cosmetic problems to treat. Using the BBL pulsed light energy from Sciton, most true solar pigmentation problems can be reduced in one treatment with easy to find settings (joules and milliseconds) that will work. A near immediate darkening of the brown spot is a very favorable sign. It often takes two treatments to get the best reduction and complete elimination does occur in many cases.

There continues to be a high demand for facial skin resurfacing  with the patients demanding a quicker recovery from  the greater depth treatments that we did ten years ago. Patients seem very willing to accept a series of skin resurfacings if their recovery can be days and not weeks. Most skin resurfacing patients have brown spots and telangiectasias and resurfacing wavelengths will not get rid of most of them.  Laser vascular and BBL treatments are usually needed and a question  is whether they should be done at the same time. In many cases they can and the skin resurfacing phase follow the others when they are combined. When properly done, there should be no increased risk of injury or burns with combination laser or light energy therapies. Such an approach eliminates patients coming back for additional treatment sessions and more potential social downtime. When many different treatments are combined, I usually provide some oral sedation for a more comfortable experience.

When possible, one should also try to combine Botox and injectable fillers during the same treatment session as well. Since I use local anesthetic blocks for injecting around the mouth, this is an ideal time to do painless perioral laser resurfacing which often must be deeper than the rest of the face to get a good result.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Self-mutilation behavior is defined as the deliberate, repetitive, and non-lethal harming of one’s self. This could include a variety of harmful skin injuries including cutting, scratching, and burning, all of which leaves visible. In my Indianapolis plastic surgery practice over the years, I have seen all of these types of injuries due to the scars that they create.

I don’t pretend as a plastic surgeon to understand the why of this behavior. But I have only seen it in children, teenagers, and young adults. I suspect that it is done as an effort to feel something or satisfy some deep-seated loneliness or isolation. In a world full of broken homes, declining morals, and near unlimited access to destructive past times,  our youth are becoming desensitized. Perhaps this desensitization leaves a longing for some that needs to be filled.

Self-mutilation leaves scars most commonly on the arms. While the original behavior may or may not have been done to attract attention, patients that are recovering or have recovered do their best to disguise these scars. They do so by wearing clothes that conceal the scars or tell cover up stories that explain their injuries from a different cause. They seek plastic surgery consultation to see what can be done to remove or improve their scars to the point that they don’t look like obvious self-mutilation injuries.

Invariably, the scar pattern is a series of scattered linear scars in a random array on an arm location  (usually) where repetitive cutting or scratching was done. These scars are often flat or only slightly raised because their original depth was not full-thickness. They are numerous and no single scar revision on any of them will change their obvious self-mutilation look.

One has to look at them as a unit area rather than as single scars. Two approaches that I have found helpful are laser resurfacing, either moderate or deep. The objective is different with the depth of laser skin injury. Moderate depth resurfacing (200 to 300 microns) is helpful if the scars are very superficial and the goal is to lessen their appearance without creating additional scars from a burn injury. Deep laser resurfacing (> 300 to 400 microns) is done to create a near full-thickness injury with the objective of having the involved area becoming a more confluent scar. That would create a scarred area that would be easier to explain as a burn injury.

There is always the option of excising the area and replacing it with a split-thickness or full-thickness skin graft. And this is certainly a ‘salvage’ position if the laser treatment did not create the result that the patient wanted. But I find creating a deeper burn with a resultant more confluent scar easier. Such laser treatments can be done in the office under local anesthesia unlike skin grafting.

Disguising self-mutilation scars is an uncommon plastic surgery problem.The goal is to either reduce their appearance by softening them or creating a more confluent scar that looks like it came from a more common and less embarrassing source of injury.

 Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

As one ages, the texture of the facial skin changes in many unfavorable ways. Wrinkles develop, skin texture becomes more irregular, brown discolorations may appear, and in some areas the skin actually thins as well. Many skin rejuvenation methods exist but none have been more effective than that of laser skin resurfacing technology. Injuring the outer skin layers by laser light, burning it if you will, allows new collagen to form underneath and new epithelial growth on the outside.

Once healed after laser treatments, the skin’s texture and appearance is improved.  The recovery time and how much improvement of the skin is seen  depends on how deep the skin injury was.  Deeper treatments remove more epithelium and stimulate the collagen layers better….but recovery time is also linked to depth of treatment.

In days gone past, deep laser resurfacing was an operating room experience due to the depth of injury. While the skin results were often spectacular, so was the pain and recovery time. Patients no longer want that experience and the concept of less invasive skin treatments done as a series over time have become a better lifestyle choice. This has been coined Microlaser Peeling (MLP)  and looks at a series of 4 to 6 treatments done months apart to get the final result….with recovery time of days rather than weeks. MLP burns off top layers of skin whose depth is controlled by the operator based on what the patient can tolerate with a topical anesthetic and how much recovery time the patient finds acceptable.

A newer approach to laser skin rejuvenation has been the modification known as fractional treatments or Fraxel. (the first company that introduced this technology) In this laser skin approach, the entire surface of skin is not burned off. Rather a  portion or ‘fraction’ of the skin area is treated rather than 100% of it. This fraction is usually about 11% to 16% of the skin in the path of the laser beam. But the depth of each hole that is burned into the skin is deeper, reaching deeper skin areas with the theroretical potential of greater collagen production. (skin thickening effect) So  less skin surface injured results in less of a burn injury and less recovery. Fractional laser treatments also require a series of treatments to get the full effect.

The question is…..is MLP or Fractional laser treatment better?  The question is a good one as the recovery from either one is a little different but so is the skin injury as well. In reality, despite marketing claims, no real scientific studies have been done to compare the two. Both produce results but whether one is really a significant improvement over the other (gets better skin rejuvenation) is more anectodal than proven fact. To those doctors who have taken on the great expense of the Fraxel, they no doubt are great believers.

 Most importantly, either laser technology  is an improvement over nothing being used. But the most important issue, in my opinion, is that any laser skin rejuvenation treatment(s) should be part of an overall skin care approach. Used with the laser could be intense pulsed light therapy as well as time-proven maintenance techniques such as microdermabrasion and chemical peels. Skin care and its improvement is like your lawn…..one cutting will only look good for a very short period of time.

Rather than just signing up for a laser series, go to a place where they will sit down with you, make a diagnosis with computerized imaging, and lay out a long-term comprehensive skin treatment plan.  Your skin didn’t get to look this way overnight and it won’t get better overnight either….unless you opt for a deep laser peel.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis  

The nice warm weather of the summer and the beauty of seeing the sun repeatedly over clear skies has made for a fun and productive season…and put a tan and a glow to that face. But with that good summer look lies some damage from the sun underneath. The suncreen you used (hopefully) and a hat were helpful but it can’t repair the ongoing damage to your skin cells from the UV rays that made it through or the damage that was there beforehand. To get skin healthier and looking better from sun damage requires the process of exfoliation. Whether this exfoliative process is superfical or deep will determine, how much recovery, cost, and the amount of improvement seen.

Medical facials are a good and pleasurable way to help nourish sun damaged skin. Light chemical peels and nourishing facial agents help infuse the skin with cell-boosting vitamins and minerals that will soften and hydrate dry facial skin. You will need a series of treatments in order to reap any long-term benefits but these need to be be repeated every few weeks as they are more about stimulation than exfoliation. Usually a facial is best combined with microdermabrasion or other skin resurfacing procedures (see below) for a more comprehensive treatment that gets a better result.

 
Microdermabrasion, a procedure which almost everyone has heard of, is a superficial exfoliating treatment that can help buff away dead skin cells and give your skin an immediate brighter gklow. It is usually combined with a light chemical peel to get a better result.Microdermabrasion can help brighten up a dull complexion and also boosts collagen production deep within the skin’s layers. You’ll see immediate results, and a noticeable difference in the texture and tone of your skin after a few days. Because it does not go very deep, it will not correct deeper wrinkles or heavily damaged skin. I like to think of microdermabrasion as a ‘maintenance’ treatment rather than a truly therapeutic one, meaning it is a good to other more aggressive treatments but do not expect miracles from it. Medical microdermabrasion treatments usually cost in the range of $125 - $175.

Resurfacing of your skin with the use of the laser is the most aggressive and successful approach to skin rejuvenation. By burning off the top layers, the outer layer of damaged skin is partially removed and the skin must heal by producing new skin cells. The result is a smoother, more youthful appearance and the elimination of sun damaged skin spots or patches of pigmented skin. The key to laser resurfacing, and the real progress made in this technology, is that you can control the depth of the exfoliation or burn. Measured in microns (typical facial skin is around 1000 microns thick), lasers can be adjusted to burn off as little as 6 to 100s of microns. Superficial laser resurfacing is around 6 to 20 microns, medium-depth laser resurfacing is 20 - 75 microns, and deep laser resurfacing is anything over 100 up to 200 or 300 microns. Superificial and medium-depth laser resurfacing can be done in the office under topical anesthesia and heals well in a week or less at a cost of $500 - $2000 for a full face treatment. Best results are obtained with a series of treatments over time. Deep laser resurfacing requires an anesthetic, usually a general, and takes weeks to heal and will run in the $3000 to $4000 range. Which method you would choose depends on the time you have for recovery, your budget, and how fast you want to get the best result.

Photofacials are a well known skin treatment method that is poorly understood. It is not laser therapy but a high-intensity light treatment. Some know it as IPL (intense pulsed light). We use a higher intensity treatment known as BBL or broad-band light. It’s single best benefit is in helping reduce sunspots, freckles, and superficial pigment changes. It is very effective for facial, neck, chest, and hand age spots and pigmented sun damage. It is not an exfoliative treatment, jut think of it as most effective for helping even skin tone. It is an adjunctve treatment to skin resurfacing and chemical peels, not a substitute.

A variety of good after-the-summer facial treatments are available that can clear up summer sun damage and provide protection during the colder winter months. Meet with a plastic surgeon who works closely with a medical aesthetician to get the best treatment program for your skin.

Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis