Thank you for your question.
You submitted a question without any photos which means of course that I don’t have
any details and specifics of your situation.
But you’re asking basically how does a fractional laser effectively treat sun damaged skin?
And of course, the further follow-up questions within in your submitted question are about
the effectiveness as well as the other options in case it doesn’t work out the way you
like such as microneedling and PRP.
This is very understandable where the confusion comes from about dealing with sun damaged
skin so I’ll try to help you by giving you a global understanding of how I counsel my
patients who come this type of issue.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
We have many solutions in our practice everything from skin products to minimally invasive technologies
including lasers of different kinds, radiofrequency technology, PRP, etc., as well as full surface
surgical solutions.
So we deal with a lot of situations which fall under the umbrella of sun damaged skin.
So let’s start with defining what is sun damaged skin?
Sun damaged skin usually refers to problems with discolorations.
So when people spend a certain amount of time in the sun whether it’s intentionally such
as for tanning or secondarily or incidentally just by living in a place where sun exposure
is intense and unavoidable.
The smoothness, the continuity and tone of the skin becomes affected by discoloration.
The other part of sun damaged skin is about loss of skin quality which means the development
of wrinkles, the loss of the luster of the skin as well as the breakdown of collagen
within the skin which also results in the increase in appearance of vessels.
So we’ll start with just basically dealing with trying to get luster and treating discoloration.
When we talk about where we have come from the first lasers that we were using back in
the mid-90s, the original CO2 laser, basically the idea was to resurface the skin, take off
the top layer of skin and let new skin come through.
Now of course, that was already being done for decades with chemical peels.
And the chemical peels were basically graded as light, medium or deep chemical peels, glycolic
acids to TCA peels to phenol peels.
So what was the difference with lasers?
Well, lasers gave us a certain amount of flexibility when it came to being able to control depth
in different areas.
Certainly, you can do that with chemical peels but there was a certain control that was achievable
with lasers which was very nice as well as the selectiveness of the use of these lasers
and certain target structures.
In addition, lasers generate thermal energy which causes a little tightening effect.
So move the clock forward and what was the challenge back then just going back to the
original CO2 lasers?
It was healing time.
Basically, we were treating patients essentially who are having second degree burns and doing
very burn focused wound healing strategies to help people heal and that became problematic.
Move the clock forward, different lasers such as the Erbium laser came along and then fractional
laser came along, fractional Erbium, fractional CO2 with a wide range of flexibility.
What you are effectively doing with a fractional laser is you are reducing the amount of injury
to the skin therefore allowing faster healing, making it controllable.
You can also go from very light to medium to deep as well as those different depths;
you can also go into different levels of heat.
So there’s a wide range and it gives us a lot of flexibility.
Now the concept of course is to try to even out the skin.
And when you are trying to even out the skin even the skin is not very thick, you are looking
at 3 millimeters of thickness, you want to balance out the relative amount of discomfort,
the time it takes to heal and the recovery and being able to get back to normal life
sooner rather than later.
So in addition to the fractional technology, we also have non-ablative laser technology
such as a Q-switch laser that is able to treat pigment very effectively without taking off
the top layers of skin.
So certainly, there are a lot of ways to help people with sun damaged skin.
But it’s very important to understand that treating skin and a very well-known dermatologist
stated this, he said that, “Essentially, you never cure anything in dermatology.
You make things better.”
And the point of saying something like that, it really brings home the critical aspect
of treatment when it comes to treating skin that is affected by the sun.
It’s more about management and not just a single procedure.
So in the modern world, what we have done is integrated combination therapies.
So when it comes to lasers, what I would do is combine something like a fractional laser
with something called PRP or platelet-rich plasma.
Platelet-rich plasma is derived from your blood, it’s a concentration of wound healing
growth factors and it does a lot of things that we try to do in lasers like stimulating
collagen, improving the quality of the skin, stimulating the fat cells under the skin which
you can’t do with laser and you get healthier looking skin.
And so, I developed in my practice a style which is more about minimizing the invasiveness
of the laser but creating a synergistic approach to helping people with sun damaged skin which
is about a management or treatment plan.
So with that comes a very important guidance in terms of the use of sunblock, the use of
different types of therapeutic topicals and having patients come for regular follow-ups.
And again, the fractional laser technology, the Q-switch technology, PRP and skin products,
essentially, we’re able to make a significant difference in improvement and we’re able
to document that.
Every patient’s situation has to be customized.
The relatively young male with let’s say brown skin or type four skin versus the middle
aged to older female with type one to two skin, lighter skin types, blue eyes, light
skin, we’re going to treat it very differently.
So you can’t necessarily apply the same strategy to everyone.
You actually have to customize it.
A lot of times, what I let patients try to understand is in cosmetic dermatologic treatment,
you also treat and you observe and you see how patients respond.
And microneedling is not to be overlooked and you mentioned that in your question.
Microneedling also has a valuable potential benefit particularly when combined with PRP
when it comes to fine wrinkles around the eyes or just generalized improvement in the
skin whether it’s the neck skin or facial skin.
So I think that you just need to meet with doctors and get some ideas about what the
strategy is.
But understand it’s more about a longer term treatment plan than it is about a single
device or transaction.
In the modern world of medispas and strip mall centers of skin treatment, there are
lot of people offering packages and things to try to get people in the door and just
do a one-off treatment.
Eventually, patients keep bouncing from place to place looking for solutions.
So meet with doctors and get the feel of whether or not the interaction with the doctor is
more about a long-term strategy and a long-term relationship rather than a one-off transactional
relationship.
So I hope that was helpful, I wish you the best of luck and thank you for your question.