Thank you for your question!
You submitted a question without a photo but your description is certainly very helpful.
You describe yourself as being 39, you have some light freckles, some discolorations.
You are using Tazorac.
It seems that your focus is on the large pores and you state that you’re having difficulty
trusting doctors in your area.
And you are asking about IPL versus laser therapy.
And what you want is tight skin.
You want the pores to look better and you want the deep wrinkles to look better.
You’re 39 and again, you’re Caucasian with blue eyes.
Well, I can give you some guidance as to how we make assessments with our patients about
the best option for them for a result that is very much in line with what you are looking
for.
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 for over 20 years and I have been using laser and the latest
non-surgical devices since the mid-90s starting with the original CO2 lasers which were fully
ablative and fully aggressive.
So I think that what your goal ultimately is not necessarily tight skin but smooth skin.
What I help my patients try to understand is they often feel like their skin needs to
be tight and they pull their skin.
And whether they need a facelift or whether they want something to make their skin tighter,
they feel like pulling would be the ideal.
But ultimately, having improvement of skin pores and wrinkles is essentially what everybody
wants.
Now the challenge is, how do we do that in the modern world and at the same time, not
having a long downtime?
Well, first of all, a proper skin assessment has to do be done with a good physical examination
plus in the context of a good medical history.
We have to ask how deep are those wrinkles.
You may feel that they’re deep but they may be from a medical perspective, not so
deep.
In terms of pores, you can be sure that most doctors are hesitant to guarantee significant
improvement in pores because of the nature of some people’s skin having large pores.
Now, I’ll go with the most aggressive which is probably which is probably the most effective
but may not be something that you can tolerate with time and the healing process.
The most aggressive would be something like a fully ablative CO2 laser.
Why?
Because you you are ablating the top layer of skin going down to the level where the
pores will be almost flushed and smooth.
You got generation of thermal energy which causes tightening of the skin and you’ll
have a new layer of skin that will look smoother.
What’s the downside?
The downside is that it takes a long time to heal.
And based on that prolonged healing process, the technology has advanced to try to balance.
And so, with that thought in mind, we have fractionated technology.
Now, fractionated technology can be anything from the most superficial fractional Erbium
laser to a much deeper fractional CO2 laser or even what’s called a long pulse Erbium
laser which can be equivalent, for intents and purposes, like a CO2 laser.
We offer those things to our patients.
We also offer ND:Yag, non-ablative technology for dermal remodeling.
So what are the advantages and disadvantages?
Well, with a fractional laser technology, you will heal faster but you may not get the
same result as an ablative technology.
With a non-ablative technology, there’s no real downtime but it does take some consistency
in order to see if you can achieve the best result.
We sometimes often combine these technologies with regenerative technology such as the use
of platelet-rich plasma (PRP).
So platelet-rich plasma helps to induce collagen, induce vascularity, improve skin quality and
wrinkles.
In a way, it’s almost like it’s a painter having a lot of different paints.
We have a lot of tools in our disposal.
In our practice, we have everything.
As a surgeon, I am able to offer non-surgical solutions.
I don’t really have a bias but I do try to figure out what each patient can tolerate
and what their expectations are.
It’s so important to have good thorough consultation to get these expectations understood
as well as the process understood.
A lot of times people bounce from doctor to doctor.
Sometimes they shop price because they learn about a technology and then some doctors somewhere
offers a deep discount to bring people in the door but they get disappointed because
they didn’t get the results they wanted.
So it’s very important to have a real connection with a good doctor you feel comfortable with
who can offer you an array of solutions and feel comfortable with that doctor’s experience
and knowledge and understanding of what is achievable.
It’s very important because if you don’t get what you want, then you would be out the
cost and the time and you will be dissatisfied.
So meet with doctors and maybe it’s necessary for you to travel outside of your area in
order to feel comfortable but learn about these options.
Everything has pluses and minuses.
There’s no one perfect solution.
If there was one perfect solution, we’d all use that one perfect solution.
This is an art especially cosmetic dermatology.
It’s very much an art.
And figuring out not only what’s optimal from the initial impression but seeing how
you do with the treatment and how you are managed.
So I hope that was helpful, I wish you the best of luck and thank you for your question!