Thank you for your question. You are 54-years-old and you want to improve the crow's feet lines
and you are deciding between two options that were presented to you. One is doing microneedling
with platelet-rich plasma (PRP), separated 3 sessions, 4 weeks apart or non-ablative
treatment with the laser that will be also be separated 3 sessions, 4 weeks apart. You
are asking what would you recommend and you say you don’t have any down time and so
certainly that is a very important distinction in making a decision about a procedure.
So to give you a little bit of my background, I’m a board certified cosmetic surgeon and
a fellowship trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan
and Long Island for over 20 years and I specialize in helping people look young and particularly
around the eyes. So I think that you have a certain sense of intent and goals before
just making this decision and you do have more than two options in terms of your conditions
that need to be met.
So having undergone ablative procedure 5 years ago, I can understand why you want to go through
time it takes for the ablative procedure to heal. Example, a CO2 laser where the top layers
of skin are removed and the underlying skin comes in smoother and tighter but it is very
important to understand that at your stage of life and having already had laser and your
skin is fairly thin. And so when you think of crow’s feet lines, you also you have
to understand there is a role of neurotoxin in this whole equation. Many years ago, I
actually published an article where I recommended the combination of the use of Botox™ to
relax muscle with laser to help improve the results so that that the muscle won’t contract
and cause wrinkling on the skin while the lasered skin was healing. The same applies
for both non-ablative treatments as well as partially ablative treatments such as microneedling.
I think that in your situation, another option I would consider, something I would do like
patients for yourself in my practice is a I would do combination of Botox™ and I would
actually inject platelet-rich plasma (PRP) into the crow’s feet lines rather than doing
a micro needling which can certainly have value. But when you are dealing skin that
is half a millimeter in thickness, you are going to get some bleeding. You are going
to get some bruising. And as far as non-ablative concern in our practice, we use a radio frequency
technology called Pelleve but if we are going to use that radiofrequency technology, I’ll
often combine that with Botox™ and platelet-rich plasma (PRP) injection.
So I think you are in the right track but I think you have more than two options. You
also have to define what will be the success and it is very hard to actually eliminate
crow’s feet lines as long as you are smiling. As long you are moving, even with Botox™,
you can still get activity from just a passive movement of the cheek when you smile.
So in terms of your questions, I think that if you really want to have no evidence to
any type of intervention, well you are probably better with a non-ablative treatment because
you are not going to be violating the skin which means you may not get the kind of result
you are looking for. I think that you have a lot of other ways to look at this beyond
just those two options and I don’t mean to intend to confuse you but I think that
to answer your question, I think that the non-ablative option is probably best but be
careful of the amount of energy that is being delivered and discuss with the doctor the
potential for the skin to get thinner.
As of late, there have been lot of thermal devices and people are being very aggressive
with the amount of heat that is being delivered. And I’m helping a lot of patients who come
to me from around the world to deal with crappy quality of their skin from aggressive use
of thermal energy devices whether around the eyes or the rest of the face. People are noticing
that they’re actually getting volume loss of fat and their skin looks thinner after
aggressive heating so there is a balancing act. So platelet-rich plasma (PRP) has a lot
of value in helping build the collagen in the skin without ablation with minimum trauma.
So I hope that was helpful, I wish you the best of luck and thank you for your question!