Thank you for your question.
You’re asking a question without submitting any photos.
And you’re asking what is the best laser that does not cause facial fat loss.
And in the details of your question, you describe situations where you see great before and
after pictures where deep wrinkles are very well improved and at the same time, you are
concerned about so many issues surrounding patients who you describe with significant
fat loss.
So you’re asking what’s the best laser for improving wrinkles and not getting fat
loss.
Well, I can certainly share with you my approach to patients who ask exactly the same question
in my practice every day.
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.
Helping people look their best at every age is the core of my practice.
And I have been using lasers and other technologies since the very beginning since the mid 90s
when the first CO2 lasers were introduced.
So this type of question essentially reveals an understandable confusion that comes from
conflicting messages from different interests basically essentially saturating your perception
of what is the latest greatest amazing technology that basically eliminates all of the other
previous latest greatest technologies.
And the answer to this question really lies in defining the problem and this is something
that essentially everyone overlooks.
When the typical person looks at themselves, they look at the lines and wrinkles.
It is not by any error that the cosmetics industry, the beauty industry where creams
are a multibillion dollar industry.
It’s because people want to naturally treat what they see.
When you come for a consultation, when I evaluate a patient with a similar concern, I begin
every consultation first about the basic details of the major concerns and then I take pictures.
And when I take these pictures, I review these pictures with my patient.
This is an opportunity to essentially educate.
And I would ask you to consider what is more of methodical and systematic approach and
that’s the point of having a consultation with a physician who isn't just trying to
promote a particular device.
Every device on the market has a certain benefit otherwise the device wouldn't be on the market.
Choosing the device for the right reasons in the right patient, that takes judgement.
So when you think about facial aging, since you are concerned about wrinkles and lines,
you have to consider all the elements of facial aging.
And so when I look at a patient, instead of thinking of an approach working from the outside
in, I think of an approach working from the inside out and there’s one major basis for
this and that’s the foundation of facial aging and volume loss.
There are two things that happen with facial aging: one is volume loss and that includes
bone, muscle, fat, soft tissue and there’s sagging and descent or laxity.
Let’s assume that you’re not quite ready for a facelift but you want to deal with a
lot of lines, wrinkles and hollows.
Well, at the foundation, it’s bone loss that has the greatest impact on facial appearance.
So for example, if someone is bothered by the lines, wrinkles and hollowing, well if
we restored volume at the bone level, then a lot of that volume would actually help correct
or improve significantly a lot of this concern of the appearance of the skin.
And essentially, when you lose volume, the skin folds and wrinkles and goes in.
Now there’s a difference and there’s also the issue of texture but that’s something
we’ll address later.
In our practice, we do something called Structural Volumizing.
So for patients who have a desire to see improvement, what I may do is first offer a procedure using
injectable fillers at the bone level and at Structural Volumizing that means I’m addressing
the underlying issue whether it’s at the cheekbone, the jawline, the jaw angle or the
chin.
Those are the areas that are the foundation of supporting the face.
Now going from the inside out, you then look at what’s going on under the skin.
So below the skin is a layer of soft tissue or fat which makes up a large percentage.
You expressed a concern about people complaining about losing fat.
Facial fat volume or fullness is a very important part of a youthful appearance but there’s
a fine line.
You don't want to overdo any kind of volume but you want to create that support so now
we’re going from the bone level to the soft tissue level.
Now that's a place where a lot of things can be of value.
Anything from soft tissue fillers such as in the hyaluronic acid family, platelet-rich
plasma to stimulate the fat under the skin can have a very nice effect on improving skin
quality as well as improving the lines and essentially thinking of modalities that can
help improve the health and quality under the skin.
Then we get to the skin level.
And on the face basically looking at skin that’s about 2 millimeters in thickness,
now this is where the industry is quite wide and varied in the approach.
Everything from lasers of different types, different levels, ablative, non-ablative,
microneedles, there are a lot of options.
So when you think about choosing an option, you also have to factor in what are the elements
that you are really looking to improve and how much downtime are you willing to experience.
I can tell you from the mid 90s moving forward that the biggest challenge with laser treatment
was not necessarily the quality of the outcome but it was also the extent of the healing
time.
And I can tell you that in the modern day, prolonged healing process is something that
some people simply cannot handle in their lives.
So a lot of strategies that we employ involve a dual modality of doing something at the
dermis level with various laser devices as well as at the epidermal level.
Again, with laser devices as well as something as straightforward as water based microdermabrasion
like Hydrafacial.
So there is certainly no single answer to the question of what’s the best laser.
You really have to allow for the judgement of the doctor and you and doctor having a
synergy and understanding of a plan.
A lot of times, people look at their friends and will naturally make assumptions that such
and such strategy worked for their friend, why wouldn't it work for them.
And I always say, essentially look at not just what you may appear like on the outside
but look at the issues from the inside out.
And then with a systematic approach, you can then choose what you are interested in pursuing.
A lot of people come to us who have been disappointed with the latest and greatest device because
they expected a lot more as a standalone can deliver.
Very often, it’s a combination approach that gets the best outcome.
So what you need is of course a treatment plan.
And so meet with qualified, experienced doctors who perform these types of procedures who
have extensive experience and get a sense of their strategy.
Hopefully you’ll be able to screen out any significant biases towards pushing a certain
device over everything else.
And if someone says this is the best device ever, well that’s concerning because these
devices are generally speaking are very useful but they have to be used correctly.
So I hope that was helpful, I wish you the best of luck and thank you for your question.