New laser treatment delivers swift makeover

As 78 million "baby boomers" near retirement age, years of sun, wind, smoke, alcohol, the environment and hormones are all beginning to show.

But with the fast pace of today's society, an aging society now wants that fresh look without spending weeks of recovery.

"People want to look better, but they don't want to give up any time," said Susan Weinkle, a Bradenton dermatologist.

A new generation of laser treatment - scalpel-less or non-ablative skin lasers - can now meet that time demand. Dubbed "lunchtime facials," these laser treatment procedures, alone or combined with cosmetic tissue fillers, can erase wrinkles, blemishes and acne scars and repair sun-damaged skin - all within minutes a day or during a "lunch hour."

Reality TV shows like "Extreme Makeover" and "The Swan" have brought the desire for the perfect face and body into everyone's living room. Cosmetic procedures have already increased 465 percent since 1997, and there was a 44 percent increase in the total number of cosmetic procedures from 2003 to 2004.

"It is a service that is demanded by the public," said Dr. Inda Mowett of the Aesthetic and Wellness Center in Bradenton, a clinic that offers cosmetic skin treatments.

Last year, about 11.9 million cosmetic procedures were performed with people spending just under $12.5 billion on facelifts, tummy tucks and Botox injections, according to the American Society of Aesthetic Plastic Surgery, or ASAPS.

From surgery to lasers

For a number of years, plastic surgeons have used surgery to correct what age and the environment has done to the skin. At first it was just treating fine lines, but as time continued marching on, the collagen beneath the skin began to break down, and deeper wrinkles started to appear.

Lasers were first developed in 1964 for industrial use before they graduated to doctors' offices, according to the American Society for Laser Medicine and Surgery Inc. in Wausau, Wis. Laser stands for Light Amplification by the Stimulated Emission of Radiation, and it works by producing an intense beam of light traveling in one direction.

In the early 1980s, lasers were first developed for surgery. The pulsed-dye laser was approved by the FDA in 1988. It revolutionized the treatment of port wine stains and birthmarks.

Today, lasers used for skin procedures (laser treatment) are divided into two categories: ablative, or wounding, and non-ablative, or non-wounding.

Traditionally, rejuvenation of sun-damaged, aging skin involved ablation of the skin surface. In the past, doctors have used facelift surgery or an ablative laser to combat deep wrinkles. Ablative lasers, such as carbon-dioxide lasers, use short bursts of high-energy laser light to vaporize skin tissue, one layer at a time, leaving fresh skin underneath.

Depending on the size of the area being treated, a laser treatment session can last anywhere from a few minutes to a couple of hours. But the downside to ablative laser treatments is the use of an anesthesia during the laser treatment and the healing time afterward.

"It can take care of deeper wrinkles, but where there's a lot of gain, there's also a lot of risk," said Weinkle.

The ablative laser process leaves the skin red like a sunburn, and pain and swelling can last anywhere from 10 days to two weeks. And as the skin heals, it becomes crusty. The results from an ablative skin resurfacing treatment won't be seen for months, or until the skin heals.

"People don't want to sit at home with a red peeling face," said Weinkle. "It's a lot to give up."

Plus, ablative skin lasers are only good for lighter skin and not for darker skin tones because it can cause pigmentation changes.

New lasers work wonders

The American Society for Plastic Surgeons said lasers should not be considered a "magic wand." Traditional cosmetic surgery with a scalpel still provides the best results.

But newer laser treatment technology has revolutionized cosmetic surgery in the past decade. A new group of non-ablative skin lasers developed within the last five years work beneath the surface skin layer utilizing short pulses of light to reduce wrinkles and sun damage, freckles and irregular pigmentation, as well as redness and dilated capillaries commonly associated with rosacea. They build new collagen while improving skin tone, texture, fine lines and scars.

Some of the first of the non-ablative generation of lasers included the Cool Touch I, Cool Touch II, the Medlite and the N-Lite. Thermage utilizes a radio frequency instead of laser energy to heat the dermis (the inner layer of skin) while cooling and protecting the epidermis (the outer layer). It has become popular in Singapore, and in 2003 the skin rejuvenation technique was featured on "The Oprah Winfrey Show."

Thermage requires no incisions or recovery time and takes an hour or less to perform, leaving patients to resume normal activities. Thermage is said to deliver a very uniform volume of heating under the skin to bring about collagen contraction and then regeneration for months afterwards.

Results can be seen in two to six months after a single treatment session. They can last 18 months or longer depending on a patient's rate of aging, according to the Thermage Co., which developed the technology in 1995.

Thermage only requires one treatment as opposed to three or four treatments from non-ablative lasers. The downside to Thermage is the cost. Prices start around $850 for a single treatment.

Treating people of color

The newest non-ablative laser gaining popularity has been the Aramis, manufactured by a French company called Quantel Medical. A 14-month evaluation published in a 2002 edition of the American Journal of Dermatologic Surgery discovered Aramis laser treatment revealed a major improvement in wrinkles and an increase in skin thickness. Also, recent studies found it to be the most effective and pain-free of all of the newer lasers.

The Aramis can be used on any skin type while many lasers cannot. Some laser treatment were found inappropriate for use on patients with darker skin because of the abundance of melanin found in skin of color. When darker-skinned patients are treated with some lasers, their natural skin melanin would compete with the laser light, according to Dr. Eliot F. Battle, an assistant dermatology professor at Howard University Hospital and co-founder of Cultura Cosmetic Medical Spa in Washington, D.C. He is a leading pioneer in advancing laser treatment technologies for treating people of color.

"As a result, the laser's energy would be absorbed too quickly, greatly increasing the risk of side effects such as serious blisters, loss of pigmentation and scarring," Battle said.

Aramis patients suffer no side effects and feel no pain, said Bradenton's Mowett, who uses an Aramis laser in her clinic since. Some of her patients have said the laser is relaxing and one patient even fell asleep during a treatment, she said.

The only visible effect is a mild redness or swelling that disappears within minutes.

"They leave here and don't even know they have had a laser treatment," Mowett said.

An average of four laser treatments in one-month intervals is recommended for best results, she said. The laser treatments take only about 30 minutes and can be done in a lunch hour, hence the name "lunchtime facial." Make-up can be applied immediately following the procedure.

It also can be used in sensitive areas like around the mouth and eyes.

"We can do the laser treatment on the entire face, but most of the time people have particular concerns," she said.

Patients will start noting gradual changes to the skin after the second or third treatment. Full results from a series of Aramis laser treatments can be seen in about six months, Mowett said.

"It's going to give you more tone and firm the epidermis," said Mowett, who treats about 15 to 20 patients a month with the Aramis laser.

Although most laser skin resurfacing treatments cost more than $2,000, according to the ASAPS, Aramis laser treatment start at about $350 per full face session.

Lasers battle acne

Local plastic surgeon Enrique Fernandez of Bradenton Plastic Surgery said he doesn't believe the non-ablative lasers are advanced enough to provide people with satisfying results.

"It has its place, but I find that many patients can achieve the same results from a chemical peel or a home-based skin care program," he said.

Besides fighting wrinkles, the non-ablative lasers are fast becoming the hottest new acne fighting tool. The Aramis and the Smoothbeam were approved last year by the federal Food and Drug Administration to treat acne. A doctor using the Aramis stumbled across its acne-fighting ability while treating wrinkles.

Using the non-ablative laser for acne, it alters the size and function of the overactive sebaceous gland. It also uses its heat to kill bacteria, paving the way for clearer skin. Also, by being able to build collagen at the same time, it helps acne scarring.

More than 80 percent of the world's population are affected by acne at some point in their lives, said the American Academy of Dermatology. "We've been able to see good results, even with severe cases," Weinkle said.

Other effective acne laser treatment include mid-infrared laser therapy, broadband blue light, intense pulsed light treatments and laser-assisted photodynamic therapy.

Other wrinkle treatments

Laser treatment and surgeries aren't the only method of fighting wrinkles. Dermabrasion and fillers can provide more immediate visible results while waiting months for the outcome of a laser treatment.

"What's nice is we have all these fillers and the explosion of the laser treatment," Weinkle said. "The cupboard is overflowing."

Dermabrasion uses gentle, abrasive crystals combined with an air stream to gently remove the upper layer of skin cells. Removal of the skin brings the under layer of skin to the surface, minimizing fine age lines and wrinkles and encouraging cell rejuvenation.

The process is entirely painless and non-invasive, usually taking less than 30 minutes for a complete facial treatment. The only side affect is a little redness caused by the abrasion process.

Costs can range anywhere from $100 to a few hundred dollars for repeated dermabrasions.

Last year, more than 3.6 million Americans used injectable soft tissue fillers such as Botox, Restylane, Radiesse, Sculptra, Hylaform and Captique to fight the signs of aging, according to the ASPS. Radiesse, Sculptra, Hylaform and Captique are a few of the newest to hit the market.

Fernandez said doctors can enhance facial features and repair some cosmetic problems with tissue fillers.

"You often can do things that are not a full facelift," said Fernandez.

A few injections of Botox or similar tissue filler can produce dramatic improvements in frown lines, forehead furrows, crow's feet and fine lip lines. Botox also works fast, with no recovery time. Most people return directly to normal activities following treatment.

Botox can last up to four months, but must be repeated at three- to six-month intervals for best results. The drawback is the cost. Botox can cost as little as $350 for a series of injections to more than a $1,000 to treat multiple skin areas, according to Botox Cosmetic.

Regardless of whether using fillers, dermabrasion or laser treatment to achieve that perfect appearance, doctors say consumers need to be wary of "spas or salons" offering bargain or sale cosmetic treatments, or clinics that do not have a physician on staff.

Consumers should consult their local medical association or get a referral from another physician to a board-certified dermatologist or plastic surgeon when considering cosmetic or laser procedures.

Naive consumers can easily "overlook the serious nature of cosmetic surgical procedures," said Dr. Rod Rohrich, president of the American Society of Plastic Surgeons. With every cosmetic procedure, there are risks as well as benefits.

"Even with those laser treatment, you need to find someone who is appropriately trained," Weinkle said.

Dermatologic do's and don'ts

Here is a list of do's and don'ts for choosing a cosmetic surgeon, provided by the American Society of Dermatologic Surgery and developed by Dr. Rhoda Narins, president of the ASDS.

Do's

• Do choose a location carefully: Beware of locations outside of a physician's office such as a clinic, salon, mall, someone's home or a hotel room. These locations usually have no emergency care facilities in place should something go wrong.

• Do make sure the doctor is on site: Most cosmetic procedures should be performed by a physician who is board certified in dermatology or another specialty with equivalent training and experience. Make sure that the supervising physician is on-site and immediately available to respond to any questions or problems that may occur while the procedure is being performed.

• Do check credentials: Don't be misguided by diplomas hanging on the walls. Check with your state medical board to see if any complaints have been filed against this person.

• Do discuss pain management options to avoid the risks associated with general anesthesia.

• Don't rely on price: If you are receiving a procedure that costs significantly less than usual, you can assume you are not receiving the best treatment.

• Don't be afraid to ask questions: Ask is the treatment right for you? Is this laser, device or technique appropriate for your skin type? Has the physician performed this procedure before on the part of the body you're having it done? Ask them to review your medical history.

• Don't go through with a procedure if they can't prove a trained physician is accessible.

• Don't be afraid to walk away: If it doesn't feel right then find a more reputable location/office.

The American Society of Plastic Surgeons offers these guidelines to anyone thinking of cosmetic procedures:

• Check board certification: Determine if your physician is certified by a board approved by The American Board of Medical Specialties.

• Ensure safe facilities: Everyone who chooses cosmetic plastic surgery has the right to a safe procedure. Injectables should be administered in a setting with appropriate medical personnel and necessary equipment to observe patients and manage potential complications, as well as provide for the disposal of medical waste as required by Occupational Safety and Health Administration regulations. ASPS require all members who perform surgery under anesthesia to do so in an accredited facility.

• Require a medical evaluation: When considering a cosmetic plastic surgery procedure, consult with a physician for an evaluation, as well as a full medical history, to determine what is most appropriate.

• Be informed: Speak with friends and family about the procedure as well as with a physician. When a treatment decision is made cooperatively between the physician and patient, the physician should explain the risks, benefits, alternatives, and reasoning for the proposed treatment, after which an informed consent document should be signed by the patient.

• Look for specialty group affiliation: Membership in the ASPS ensures that not only is the plastic surgeon certified by the American Board of Plastic Surgery, but that the plastic surgeon regularly attends continuing medical education courses and adheres to a strict code of ethics.

• Finally, ask questions.

There were 190,000 more minimally invasive procedures such as non-ablative laser treatment, dermabrasion and cosmetic fillers in 2004 than 2003.

Last year 994,758 people used Botox. Botox injections increased 184 percent from 1992 to 2004.

76,905 people got facelift surgery in 2004. Facelifts only increased 5 percent from 2002 to 2004.

WELL SAID

"With cosmetic and reconstructive plastic surgery reaching nearly 14.8 million procedures in 2004, the public's interest in plastic surgery shows no signs of slowing down." - Dr. Scott Spear, president of the American Society of Plastic Surgeons.

New laser treatment delivers swift makeover" to "Acne And Wrinkle Treatments Guide" Home