Thank you for your question.
You’re 45-years-old.
You submitted several photos and you state that you are dealing with essentially discolorations
and acne scars that is reducing the quality and appearance of your skin.
And you’re trying to decide whether laser versus peels will help you get younger looking
skin.
And you state that there are so many options out there.
You want to know which is the best option.
Well, I can certainly share with you how I discuss these exact same concerns 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 achieve younger looking skin is a critical part of our daily practice whether
a patient comes in for a surgical procedure or specifically for skin issues.
We have a system that we use to apply what is essentially one or two or maybe more of
the many options that you are referring to.
It’s understandable why there’s such confusion.
There are so many procedures that essentially say the same thing: improve the appearance
of the discoloration, improve collagen, increase collagen, reduce wrinkles.
And so you certainly have a very valid request.
So to begin with, we start by first doing an evaluation.
And what I find is that you want to really come up with a treatment plan.
When it comes to skin, it’s not usually a single one-off process where we do one thing
and then you’re done.
Now this is of course in comparison to surgical procedures.
For example, if someone comes with under eye bags, well there’s a surgical solution.
We do something called transconjunctival blepharoplasty and we reduce the fat pockets and it works
out well.
It’s the same thing for upper eyelid surgery or facelifts.
When it comes to skin, there is often the difference between what the patient sees which
are irregularities and discolorations but what’s going on underneath.
And what I am referring to is volume loss from bone loss, volume loss from fat loss
as well as what defines healthy looking skin.
For decades now and I’ve been using lasers for patients since the mid 90s and certainly,
there was the always the gold standard of peels.
The challenge we always have to wrestle with is how much can we do with minimal downtime.
Essentially, we learned from the years of doing ablative procedures which is CO2 laser
or Erbium laser that was fully ablative that the healing process is often something that
requires so much additional time for the patient to be away from work and other obligations
that we’ve learned to figure out ways to mitigate that even though those are very effective
treatments and sometimes the best option.
So when it comes to skin quality, I often recommend a regular treatment using something
called PRP or platelet-rich plasma.
This is derived from your own blood.
And essentially, the goal of stimulating collagen and improving skin that we would do with laser,
I do with your own natural healing and growth factors which is, as I said, derived from
your own blood.
Now that’s like the foundational approach to help the skin improve and glow.
I would say that in comparison to peels, I would say that there is a certain advantage
to certain ablative and also certain non-ablative technologies.
Discolorations have a lot of success using something called a Q-switch laser for pigmentations
and using different wavelengths to treat these different pigmentations whether it’s something
called laser toning or specific reduction of brown spots.
Now there’s also overlap.
These treatments also have an indirect effect on the acne scars.
We also have strategies using lasers for acne scars.
Acne scars are also very often well served by treatments such as microneedling as well
as injectable hyaluronic acid fillers.
So, although it’s very tempting to say ,well what’s the one thing I can do to make everything
go away or improve.
It really is more about having a treatment plan.
And this is where selecting a physician who can work with you and really define for you
what your options are, what are the predictable results that would be expected and what kind
of timeframe would that entail and of course, what kind of expense.
We see in our practice that these variables often help patients develop a prioritization
scale for themselves as well as it also has to work with the person’s schedule.
So a lot of our procedures are minimally invasive and are done over the course of time with
the expectation that over the course of, let’s say, 3 to 6 treatments of a given laser treatment
which doesn't require any downtime will eventually lead to an improvement or combining these
with PRP.
One of the things that I really try to leverage when I try to help my patients with skin is
the synergistic effect.
So PRP combined with hyaluronic acid, combined with laser can really make a much greater
impact.
Basically, the take home message is, the whole is greater than the sum of the parts.
So it goes back to strategy.
Too many people bounce around from different entities whether it’s a medispa or somebody
offering some kind of a discount for a laser treatment and they keep bouncing around and
they never get a satisfactory outcome and they’re often frustrated because they hoped
that what was presented to them as a single device, single solution.
And just name the year and you can name the device that was hot for that year until a
new device was hot the next year.
So it’s more about a treatment plan and a strategy that it is about a single option.
So find a doctor you’re comfortable with and then start getting to the process of helping
your skin look better.
So I hope that was helpful, I wish you the best of luck and thank you for your question.