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
Indianapolis, Indiana