Patient Resources – Laser Resurfacing

RealSelf.com Answers from Dr. Verebelyi

• Which laser skin treatment is best for acne scars?
  There are so many entities out there claiming efficacy for treating acne scarring that it can become very confusing. These range from non ablative light based therapies such as Nd:YAG and Pulsed Dye Laser to fully ablative CO2 resurfacing. As with most things the treatments that offer the best range of results, side effect profile and downtime tend to be the patient favorites. In our experience non-ablative lasers will max out at about 30-40 percent improvement with a minimum of five treatments. The best results usually require more like 8-10 treatments. Most patients favor these procedures for treatment of enlarged pores or fine lines and not acne scars. On the other end, CO2 laser is the gold standard for results. There are a few downsides to full CO2 resurfacing. These include downtime, which can last several weeks with the possibility of having several months of residual redness. Discomfort and swelling may also last several weeks. Long term side effects such has permanent hypopigmentation (lightening of the skin) and scaring have been significantly reduced but still occur. Due mostly to the significant downtime, full CO2 resurfacing tends to not be the treatment of choice. For most patients the best options are the fractionated lasers. These include things like Active FX, Deep FX and Fraxel re:pair (ablative CO2). When treating with a fractionated laser, there are patches of skin that are not affected by the laser. The amount of skin treated vs. untreated can be controlled by your provider. These patches of untreated skin drastically reduce both side effects and downtime. Even though these procedures have mostly eliminated hypopigmenation and scaring they still produce about 80-90% of the effects that are achieved with full CO2. I am not as much of a fan of the Fraxel re:store (non-ablative Erbium) because, although it has been proven to improve acne scars, it takes a minimum of 5 treatments and produces less results than 1 -2 treatments of the fractionated CO2 devices (Active FX, Deep FX and Fraxel re: pair). Between the Active FX, Deep FX and Fraxel re:pair, I like the combination of Active FX and Deep FX better because the technology is less provider dependent and the manufacturer has been making CO2 lasers for skin since 1990. No matter what your providers tells you expect 2-3 treatment with a minimum of 90 days between treatments for the best results.
• How can I treat deep smile lines?
  Smile lines or peri-oral lines are some of the most challenging to treat on the face. There are several options depending on the amount of result you want, the money you want to spend and downtime you are undergo. Lasers Probably the most effective treatment is CO2 laser. The fractionated version (Active FX and Deep FX) are a nice combination of very good results while limiting downtime. This procedure uses a laser to remove the damaged skin and heat to stimulate skin repair and new collagen growth. Procedures run around $3000-$4500, count on downtime of about 1-2 weeks but the results will be very good for a single treatment and will likely last several years. Dermal Fillers Another option is a filler like Juvederm. Depending on the amount of Juvederm is needed, you may spend anywhere from $500-$1500. If injections are done with proper anesthesia, they are almost completely painless. Swelling will likely last from a few days up to a week and results will last about 6-9 month.
• What’s the best treatment for eye wrinkles?
  Aging, environmental exposure and muscles that fold the skin around the eyes hundreds of times a day provide a triple threat to the tissue around the eyes. The results are wrinkles, textural changes, laxity and discoloration. In order to get the best results in this area you need to treat both the skin and the underlying muscle. I start my patients with Botox. This quick, effective and safe procedure treats the muscle under the skin and keeps it from folding the overlying skin. This prevents further damage, gives an immediate decrease in the lines and provides a slight raise in the lateral height of the eyebrow all without making the face look altered or frozen. Next I turn to resurfacing in order to address the wrinkles, pigmentation, texture and laxity of the skin around the eyes. We have used Titan, Laser Genesis, IPL, chemical peels, Fraxel and many other modalities all with modest results. The combination of the Active FX with Deep FX (i.e. Total FX) is the only procedure outside of full CO2 resurfacing that I have seen consistently excellent results for fine, moderate and even deep lines. Downtime should range from about 5 day to 2 weeks depending on how aggressively your provider performs the treatment.