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Dr. Barry Eppley

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Posts Tagged ‘pulsed light treatments’

Common Questions about Skin Rejuvenation

Sunday, February 7th, 2010

1.      What is the best approach to make my skin look better?


To make your skin look and feel more healthy and attractive, one must reduce or prevent wrinkles, sun spots and loose skin, improve skin texture and color, and remove blotches or damaged blood vessels.


Such total skin rejuvenation requires a program approach. Skin care is very similar to exercise and dieting…there is not one single thing that makes the big difference. It is a combination of different methods over the long-term which attains improved and better looking skin. One needs to avoid the idea that a single product applied daily is what works the best.


A comprehensive skin care program includes a daily topical regimen (at-home products), periodic exfoliative maintenance and refreshening (microdermabrasion and superficial chemical peels) and therapeutic laser and light treatments if needed. (deeper wrinkles, brown spots, and red lesions and vessels) Putting a individualized program together with the right products and types of treatments requires a skin care professional. (aesthetician) The skin care world is full of thousands of products and treatments. Knowing which is best for you requires a professional guide.

2.      How does microdermabrasion work?


The concept of microdermabrasion (often referred to as getting a  microderm) is to remove the most outer layer of the skin. (known as the stratum corneum which is dead skin cells) This is done by light abrasion usually using a wand with a roughened surface. It is not a painful procedure and requires no anesthetic. It is done either as a stand alone procedure but more commonly, and effectively, as part of a comprehensive facial treatment procedure.


Besides being a refreshening skin procedure, removal of the outer skin cells allows applied topical products, like light chemical peels, to penetrate deeper for more of an effect. It is part of a periodic maintenance facial skin treatment which is done every six to twelve weeks. Microdermabrasion is often touted has having benefits for scars and other superficial skin lesions but this is not true. It simply doesn’t go deep enough or remove enough skin layers to have any significant effect on these problems.There is no evidence that it can stimulate collagen formation either so it does not have a ‘rejuvenative’ effect on skin. Microdermabrasion can also be used as part of a treatment program for acne but chemical peels are usually more effective and less irritating. Because it is a superficial exfoliation treatment, there is no recovery needed.


Microdermabrasion should not be confused with dermabrasion, a much deeper form of skin removal. This requires some form of anesthesia, is effective for deeper scarring and wrinkles and requires a recovery period.


3.      How effective are IPL (photofacials) and what skin problems are they good for?


Light-based treatments are non-invasive procedures that are known by a variety of names, most popularly IPL or intense-pulsed light or BBL. (broad- based light) Unlike focused wavelength light (lasers), IPL treatments use non-focused broad-spectrum light targeting red and brown pigment which commonly develops from sun-damaged and aged skin. These treatments can leave skin with a more even colored complexion.  They are a safe and effective method to improve the signs of aging from the face, neck, chest, arms and hands.


Pulsed-light treatments have been credited for improving fine wrinkles and skin texture but theses effects are minor and not their primary benefits. One newer use for pulsed light is to help tighten skin. Without damaging the skin’s surface, pulsed light can safely heat the inner layer – dermis – of the skin, inducing the formation of collagen causing some mild skin contraction.


4.      What is a good skin product?


The plethora of over-the-counter skin care products is overwhelming and certainly confusing. Yet there are some significant similarities amongst many of them. The majority of them are basically moisturizers with additional components of sunscreen and botanicals. The moisturizer component (petrolatum, dimethicone and/or glycerin) acts both as a humidifier for the skin as well as a delivery vehicle for the other active agents.


The botanicals, such as soy, silymarin, curcumin, green tea and retinol  provide antioxidant properties that may help in the reduction of facial lines and wrinkles. The botanicals have tremendous marketing appeal but they are not the most important component of the skin care preparation.


Whether the product is an anti-aging night cream or a facial foundation, find one that does not irritate your skin and contains sunscreen protection and some antioxidant agent.


Prescription skin care products have significant proven potency, particularly in wrinkle treatment and prevention and in skin lightening. (bleaching) Vitamin A (Retin-A) and hydroquinone and kojic acid are well known for their effectiveness. A prescription product used with a moisturizing over-the-counter cream can be a very useful combination.


5.      How do lasers help reduce wrinkles and improve skin texture?


Removing layers of the skin, like sanding wood, can help get a  more even and smooth skin surface. Lasers do this by literally burning off the outer layers. Unlike microdermabrasion, lasers go much deeper being capable of removing up to one-third of the skin’s thickness. This is known as deep or CO2 laser resurfacing and requires some form of anesthesia. The effects of the heat of the laser on the dermis can also cause some skin tightening. It will usually take a week for the skin to heal after this laser treatment.


To decrease the recovery and make it an office-based procedure without anesthesia (topical is still needed), the concept of microlaser or erbium peeling has become popular. Going less deep than the CO2 laser, this treatment requires a series of laser peels done every six to eight weeks. They require just a few days to heal and, when done over time, can create a skin result that may approximate a single deep laser peel in some cases.


A newer variation of laser skin treatments is that of fractional skin resurfacing. It strives to decrease the time it takes for the skin to heal after a treatment but to stimulate the deeper collagen layers of the skin. Fractional laser does this by only treating a small percent of the skin’s surface but goes much deeper. By cutting deeper holes in the skin that are spaced out (like aerating a lawn), less skin surface is treated but those areas that are have deeper channels cut into them.


Laser skin resurfacing today can be done at different depths which can be tailored for the patient’s lifestyle. Significant wrinkle reduction and skin texture improvement can be achieved by computer-controlled skin layer removal.


6.      What role does chemical peels have in improving skin?


Chemical peels have a long history of use as a skin improvement treatment. They work by the acid acting with the top layer of the skin, ultimately resulting in it being sloughed off. The acid penetrates into the skin until it is neutralized. This controls its depth of penetration.


Chemical peels come in three basic types based on how deep they penetrate, superficial, medium, and deep. Salicyclic lactic, and glycolic acids are superficial, trichloroacetic acid (TCA) is medium, and phenol is deep. They are differing concentrations of each. Superficial peels are part of most aesthetic facial and at-home treatments, require no anesthetic and heal in a day. Medium-depth TCA peels are done by physicians, require at least a topical anesthetic, and heal in less than a week. Phenol is a deep chemical peel that has largely been replaced by CO2 laser resurfacing.


How deep a chemical peel goes is affected by a variety of factors other than the concentration of the acid. Chemical peeling is very much an art form that requires a lot of experience to get consistent and safe results. Medium and deep depth chemical peels should only be done by an experienced physician.


7.      Which is better for improving wrinkles, chemical peels or laser resurfacing?


Both can significantly improve wrinkles and the quality of facial skin depending upon the type and concentration of the chemical peel and the depth of laser resurfacing. In well-trained and experienced hands, both treatment methods are effective. Laser resurfacing is better for the treatment of scarring and skin irregularities.  


Barry L. Eppley, M.D., D.M.D.

Indianapolis, Indiana

Common Questions about Laser Treatments in Plastic Surgery

Monday, January 25th, 2010

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?

      The principle of all laser treatments is based on the absorption of light. The target is the metal oxide pigments which have been implanted in the skin. As the tattoo pigment absorbs the light, the heat causes the metal pigments to shatter into smaller pieces. This ‘smashing of the boulder with a hammer’ creates smaller metal fragments which can then be dispersed through the skin and carried away by scavenger cells.

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.


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

Indianapolis, Indiana    

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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