- Today we've got an interesting,
split face trial for you to watch, on freckle removal.
Using two lasers, one on each half of the face.
And we're going to put them head to head
and see which one does better.
Firstly, freckles are a form of pigmentation
that most commonly occurs on fair skinned people.
They are little matchstick size,
discreet pigment spots on the face, or the body.
People often wanna remove them for cosmetic purposes.
It's usually the case that people with freckles
don't want to have freckles,
and the people who don't have freckles don't mind them.
But for those who have freckles,
it can often be a big concern for them,
and it's something they often want to remove
for quite a number of years.
So, freckles being a form of pigmentation
that sits fairly close to the skin's surface,
can be removed in a couple of ways.
So the first method is
resurfacing or removal of the top layers of the skin.
And these lasers are less specific to pigment,
but are able to sort of remove that top layer of the skin,
and remove the problems in that top layer.
For example, the freckles that you want to get rid of.
The other way of removing freckles is to use a laser
which is specifically attracted to melanin,
or the pigment found in freckles.
These lasers tend to be attracted to melanin
over other parts of the skin,
such as water, or the blood vessels, for example.
So, in today's trial,
we'll be taking one laser from each of these groups,
and trialing them on the left and right side of the face.
So, the first laser we'll be using will be the Fraxel laser,
which is a resurfacing laser.
The Fraxel laser is attracted to water in the skin,
and what it does, it actually heats up
little channels of water in the skin in a fractional manner.
So not every part of the skin is treated,
but enough of the skin is treated to remove the freckles.
The next type of laser we'll trial,
on the other side of the face, is a Q-Switched Nd:YAG laser.
We have a new laser called a PiQo4 laser,
and this is one of the most powerful lasers
on the market, at the moment.
It can be used also for tattoo removal.
But in this case, we'll be using it for freckle removal.
These Q-Switched Nd:YAG lasers
are able to specifically target melanin,
or the pigment in freckles, over other parts of the skin.
And they basically break down the pigment,
and allow the body's immune system to take it away.
So a completely different method of removing freckles.
And we're gonna put these two lasers together,
and see which one does the best job.
In terms of ethical considerations, you might wonder,
what if the result is different on both sides?
So what we plan to do after obtaining results,
is actually switch the lasers over,
and then reverse the treatment around,
so that the patient actually gets
the same treatment on both sides, in the end.
So the criteria we'll be using
for determining which is the best laser in this case,
will be, a few things.
So firstly, we wanna look at the patient experience.
What sort of pain they've experienced with each laser,
which one is more uncomfortable?
Both will be uncomfortable,
and they'll feel a hot and prickly sensation,
but there may be one
which is a bit more uncomfortable than another.
The next criteria we'll apply is the ease of use
for the operator.
This will include things like
determining the right setting for the laser,
the ease of which we can get a nice, uniform result,
and how the operator feels when using the laser.
The recovery is another criteria we'll be using,
so we'll track Stephanie's recovery over the week,
and we'll see, from her perspective,
which side was easier to recover from,
and what the social downtime of each side was.
And finally, we're gonna be looking at the outcome.
With one treatment that we do, we're gonna see
which one removes freckles to a greater degree.
Which one gives you the greater degree of fading.
We've taken some photos of Stephanie,
using cross polarized photography.
Normally reflections in the flesh,
you lose a bit of the appearance of the freckles,
you can't see them very well.
So using cross polarized photography,
we can actually see the freckles clearer,
and actually make a better determination
of which lasers work better.
So we're gonna do the 1927 nanometer Fraxel
on the right side,
and on the left side we're gonna use the new PiQo4 laser.
So we'll start with the Fraxel laser.
She's had numbing cream on for almost an hour now,
and you can see her skin is a bit red as of result,
so normally she doesn't look as red as this.
But it works very effectively in reducing any discomfort.
The other thing we'll be using to help discomfort,
and also helps a bit of recovery is this Zimmer cooler.
So this blows cold air from this machine,
it's like a refrigerator air source.
It blows into this tube
over the surface of where the laser fires.
So it comes out through this hole there.
So basically, it cools the skin as the laser's being fired,
which helps a lot with discomfort,
and helps also a lot with the recovery process,
particularly if you're doing it with the top laser skin.
We're just wiping some of the numbing jell
off the right side before we start.
How do you feel about your freckles, Steph?
- Um, nobody likes their freckles.
I don't really like them.
I usually wear two layers of makeup to hide them.
- I'll put them on.
Lay back.
(machine hissing)
What we're doing, we do eight passes of this laser
to achieve the required
sort of density of dots that it lays.
So what it's doing now it's actually laying down lots
and lots of little dots of laser energy into the skin.
The laser's actually attracted to the water in the skin.
What it does, it heats these columns of skin,
and these columns of skin gradually
sort of exfoliate themselves out,
including the freckled part.
So in terms of pain,
how would you rate this at the moment?
- I would say about a three out of 10,
however in the hairline there was not much numbing cream,
so it's a little bit more prickly.
- Yeah.
- But it's bearable.
- Bearable? - Yeah.
- In terms of using this, it's extremely easy.
And you don't have to worry about how even you are,
because the method in which the person applies the laser
is really effective and it's almost foolproof.
Unlike the other lasers this won't really affect any moles.
It's not specifically targeted to moles or your pigment,
so I can roll over these moles without any issue.
So in total on this side of the face,
I've been treating Steph for about nine, 10 minutes
and she's tolerating it well.
It's good that the laser's fairly speedy,
and it's not gonna take hours to do it.
I think people's tolerance to discomfort
decreases the longer you go.
So basic for me to use, fairly quick and effective.
Okay, that's one side done.
We've got the PiQo laser here, the PiQo4 laser,
which is a new Q-switched Nd:YAG laser.
It's actually attracted to the melanin
or the pigment in the skin quite hardly.
It doesn't go very deeply in the skin,
but we actually don't need to go very deep,
because it is a freckle, which is quite superficial.
One advantage of having a lot of power in this laser is
that we use larger laser spot sizes,
so you need a very powerful laser to achieve that.
With this laser it's not as simple to set,
so we're actually gonna do some test patches,
and look for some specific in-points on Stephanie's skin
to see if we have enough energy or not,
and the in-points we're looking for specifically
is the frosting or whitening of the freckle,
which will usually last around 10 minutes or so,
and then we know we've hit the right in-point.
One little test patch on one of Steph's freckles.
One, two, three.
We didn't get a lot of reaction there.
How did that feel in terms of pain?
- I couldn't feel it.
- Couldn't feel anything?
Ready? - Uh-huh.
- Yeah, a little bit of mild frosting there.
Yeah, that's about right.
So we have a mild degree of frosting in here,
and that will slowly disappear,
and that's a sign that we've reached the right in-point
for this sort of laser.
All right, we're gonna start treatment on the face.
(machine stirring)
You can see some little bits of frosting appearing there.
How painful is that?
- Um, it's just more shocky.
- More shocky?
- Like you did before.
(upbeat music)
(machine hissing)
- Almost done.
A very quick treatment.
So we're just fresh from finishing the laser,
and you can see the difference between both sides.
All the freckles have darkened up.
The Fraxel side's had a bit longer to recover.
Got a little bit of redness throughout
which is expected.
On the PiQo4 side, there's some broken blood vessels here,
where the laser's been so quick
that it's actually disrupted some blood vessels here,
which is quite normal.
And we'll see how she recovers over the next few days.
We'll keep progress check.
(upbeat music)
- It's about eight hours since I've had the treatment.
The Fraxel treatment on this side.
And the PiQo laser on this side.
I'm quite puffy but it's not very sore at all.
I am rough on the Fraxel side,
but still smooth on the PiQo side.
- So it's day two post your procedure,
how are you feeling?
- So yesterday was quite comfortable.
Still a little bit of warmth on the Fraxel side,
but no real other discomfort.
Today the Fraxel side is still a little bit warm,
a fair bit more swollen,
and starting to feel tired and cracky,
particularly around the mouth.
The PiQo side feels comfortable,
I don't feel like I'm swollen,
although I think there might be a little bit of
residual swelling going on.
And other than that everything's going well.
Getting a few strange looks when I'm down the street though.
Feeling much better than yesterday.
The swelling and discoloration on my lower face
has gone down on the Fraxel side.
It's starting to become a little bit flaky,
and the tightness is reducing.
I think that's due to the swelling reducing.
The PiQo side is still quite smooth,
and there's not a lot of swelling going on,
there's no tenderness or heat.
Still a little bit of swelling on the Fraxel laser side.
I can say that my skin is starting to flake up
which is an expected outcome with the procedure.
There hasn't been much change over the past few days
until this morning when I was washing my face,
and you can see part of the scalping has come off
and revealed the fresh skin underneath.
It's still got a little bit happening in these areas here,
and a bit of congestion here where my face
keeps getting stuck to my pillow when I sleep.
Otherwise this side is feeling quite comfortable
aside from this patch.
The PiQo side is still smooth,
not really had any change to the area,
and the pigmentation has not flaked up yet.
In the two weeks following the procedure,
I experience quite a bit of different downtime
on each side of my face.
Not only did I look funny to people I passed in the shops,
and had a lot of people staring at me,
my right side, which was the Fraxel,
was very rough and it felt dry and tight.
The PiQo side it felt smooth,
although it was a lot more dotty,
and very obvious that I'd had a procedure done.
At about one week the right side of my face
completely shed,
so I had a lot of skin peeling off
and with that my pigmentation came away.
I had a very slow fading of pigmentation to my freckles
on the left side with the PiQo.
There was never any crusting or shedding
of the skin on my left PiQo side.
Comfort-wise during the two weeks of healing,
the PiQo side was a lot more comfortable.
It was a lot easier for me to apply sunscreen
and to wash my face.
Whereas the Fraxel side felt a bit more tender,
it was a bit rougher,
so I had to be a bit more cautious of the way
I was washing my skin and applying my sunscreen.
Other than that it was quite easy to maintain.
There was no real pain associated
once the heat had left the skin.
- A really good result on both sides.
I think the clear winner in this case is the Fraxel,
but with some pros and cons.
She definitely had much greater time recovering
from the Fraxel.
It took a lot longer,
and I think she had some scabs on one side as well,
which doesn't usually occur,
but it likely would be more with Fraxel
than the PiQo4 laser.
One more advantage of using the Fraxel laser was
that I think there was some improvements
in overall skin quality on that side, as well.
It does remove a bit of skin
when you do the treatment,
so you do get some exfoliation
and some renewed skin renewal.
So that's one thing you do get,
but at the expense of being a little bit pink
and having a bit more downtime for a couple of weeks.
- It was a lot smoother, after the shedding had occurred.
So overall I felt a lot smoother, brighter,
and pigmentation free from the Fraxel treatment.
- Recovery time was quite big with Fraxel,
whereas the PiQo4 laser,
although the scabs did take a little bit
of time to drop off,
or I should say the brown spots
took a little bit of time to come off.
The downtime was very manageable for her
and overall was much easier.
In terms of outcome, the Fraxel wins,
but in terms of recovery, you do pay the price.
And other thing that I'd like to mention is
that the settings that we used also make a difference.
Now on the Fraxel we had the settings up fairly high,
almost to the top end of the Fraxel.
So it doesn't go a lot higher than that,
that's almost the top setting.
Whereas the PiQo4 laser was running at virtually
at the bottom end of the settings,
so there's a lot more headroom in terms of settings
with the PiQo4, and I think we could have achieved a much
sort of greater pigment reduction
or freckle reduction
with the PiQo4 laser had we turned it up.
In terms of consistency and ease of use,
the Fraxel laser is a very easy set-up.
Pretty much you dial up the settings
as long as the patient has fair skin,
that would be the right settings.
Whereas PiQo4 laser takes a bit more filling
around to get the exact settings.
In terms of evenness of result,
Fraxel would certainly win there
because it's a scanning hand piece
so you can scan over the whole face,
not miss any spots.
Now missing spots can be a bit of an issue
as the PiQo4 laser has a circular spot size.
So you would literally have to be very consistent
and not miss any spots,
so that's one of the downsides of using the PiQo4 laser.
In conclusion, both excellent treatments for freckles.
It really would depend on the person,
what downtime they can afford,
what their skin goals are,
as to which one they pick,
but certainly both were effective treatments
for freckle removal.
- If I was to have it again, although the two weeks
following was a little bit more uncomfortable
with regards to the texture of my skin
and the dryness with the Fraxel,
I would have a Fraxel treatment to remove my pigmentation.