Thank you for your question.
You've submitted a question where you're asking, which is better, Pellevé for Thermage?
And you described in your question that you've undergone skin pinch procedure which is still
not satisfied with the appearance of your under eye wrinkles.
And that you don’t want to have the intensity of a laser and the prolonged healing time.
And so next – so you're asking for what is the best option that doesn’t – that
meets your requirements.
Well I can certainly give you my perspective and tell you how I manage my patients in my
practice.
I'm a board certified cosmetic surgeon and fellowship trained oculoplastic or oculofacial
plastic surgeon practicing in Manhattan and Long Island for over 20 years.
And I've been performing CO2 lasers since the mid-90s, since the introduction.
And certainly a have a lot of experience with thermal devices that with the goal of helping
people improve their appearance of fine line and wrinkles for over 20 years.
So let’s start just with the issue that you're wrestling with at this point.
You're clearly after undergoing a skin pinch removal.
You're no longer dealing with extra skin or redundant skin.
You're dealing with skin quality issue.
So the thin quality of the skin.
Now it’s important to understand that the eyelid skin is only half a millimeter in thickness.
That means you can only do so much to it.
The skin is so thin it’s actually, practically transparent when you realize what half a millimeter
is.
That being said, what is the principle that’s being used when you apply heat to skin?
Well the principle is, the skin will cause something – will result – will respond
by what’s called collagen contraction or tightening and you'll get some stimulation
of more collagen that provides support.
But I would – I would say that when you think about eyelid skin you have to think
of the amount of the percentage of skin that is affected from the thermal energy and what
kind of a percentage is affected by anything that you do superficially.
Now there’s a point to that.
The concern that you have about the prolonged downtime with CO2 lasers is something that
I've wrestled it for a long time.
So years ago, I started combining CO2 laser with platelet-rich plasma.
Platelet-rich plasma is derived from your own blood and it’s a concentration of the
growth and healing factors that are used in wound healing.
So when you think about it, injecting platelet-rich plasma under the skin potentially can improve
the skin quality and reduce the need for delivery of high doses of thermal energy.
And in clinical practice, that’s turned out to be very much the case.
So in our practice, we actually combine not full ablative CO2 which we don’t do that
often but fractional CO2 laser.
Fractional CO2 laser means less – there are fewer areas of ablation and which means
there’s quicker healing but still you deliver the columns of thermal energy to get contraction.
Combine them with platelet-rich plasma, the skin quality not only improves but the healing
appears to improve as well.
Bottom line is our patients look pretty good in about a week and they are able to look
even better as time goes on and they get a more definitive result.
There’s a lot of popularity right now of non-surgical thermal devices.
And slowly the pendulum is swinging the other way as I had predicted years and years ago
with the first thermal device introduction is that people overheating the skin.
The technology, the practitioner with the intent of tightening the skin is actually
overheating skin resulting in tissue breakdown.
So I would say that if your skin type is of a lighter skin type, you're better off with
that strategy with the CO2 laser and PRP.
And if you have a darker skin type, like when we see patients who have fine lines and wrinkles
and their skin is – has more melanin, then actually we’ll combine PRP with Pellevé.
The reason I use Pellevé and I chose Pellevé as the one thermal energy device that’s
not ablative is that I felt I had a lot more control, that I can gradually elevate the
heat to a point where I can feel like I know how much heat I'm delivering and how much
benefit I’ll get.
I can – I can customize it and be conservative.
A lot of thermal energy devices like lasers will promote their ability to deliver high
energy.
And of course in a world where you think more is better, people will always think more energy
equals better results.
But it’s skating a very, very fine line and once you cross that line you get breakdown.
And so now you now hear more and more about complications of thermal energy devices which
deliver a lot of heat.
And you're getting – and we’re seeing patients, we are helping them to rehabilitate
their skin by using platelet-rich plasma and other modalities to stimulate and restore
with regenerative medical technology that is some of the health of their skin because
they have been literally overcooked.
And unfortunately when you had delivered too much heat, not necessarily eyelid skin which
doesn’t have much of anything resembling a fat under the skin.
In fact, it doesn’t seem to have any of a fatty cell layer.
But in other areas of the face, when you deliver thermal energy with a very high level, you're
literally cooking the fat and you – and that fat is very important for the health
of the skin.
So in my practice it’s become routine to use PRP at the time we do laser and then if
we want to further enhance and improve the results, we can inject PRP again.
PRP is something that’s sustainable.
You can’t keep sustainably reheating the skin.
This is a very common problem again with thermal energy devices.
And not that thermal energy itself has value in treating skin but the judgment, and the
amount, and the dose has to be the right amount and not too much.
So I would suggest you explore this idea and accept a certain amount of downtime to get
that improvement.
Because when I was mentioning about ablation, you know, with the fractional CO2 laser, with
people of lighter skin color, just taking off that limited amount of the top layer skin
allows fresh new skin to come in that automatically looks better.
You know, before there was CO2 lasers, there was chemical peels.
And there’s still chemical peels.
And chemical peels benefit the skin by taking off the top layer and allowing a new layer
of fresh, better quality skin to come in.
That principle remains the same.
And with a non-ablative devices, you don’t get that benefit.
You can get improvement from a deeper level, at the dermis level.
But at the epidermis which is – it’s overlooked and you may get some limitations for that
respect.
Of course there are alternatives.
You can retinols and other things like that.
So explore these options and I hope that this was of value to you.
So once again, I hope that was helpful and thank you for your question.