Thank you for your question.
You submitted your question without a photo and you’re asking about comparing the benefits
of fractionated CO2 laser versus fractionated Erbium laser in terms of levels in depths
and numbers of treatments needed.
And basically the problems that you are concerned about have to do with pores, with under eye
wrinkling and of course collagen induction.
Well, I can completely understand why you are asking this question.
We live in a time where there are a lot of literal commoditization of these devices and
essentially, they all start to look the same and make the same claims.
I’ll share with you my approach in my practice to help guide you into what would be a strategy
that would be helpful in your quest to find the right answer for you.
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.
I have been using lasers since the very beginning of the use of fillers especially in facial
skin resurfacing beginning with the original CO2 lasers in the mid 90s.
And I have in my practice essentially every laser you can think of.
In fact, because we have two offices.
We have essentially two of every laser that are applicable for the type of practice I
have.
So I think that why it is becoming confusing is that there are certain principles that
are guiding principles in how we treat our patients that have to do with the effects
on the skin and that the lasers can be essentially tools.
Unfortunately, these things are, because the strategic approach to skin treatment is difficult
to convey, it’s often overshadowed by a new flashy name of a laser and that laser
gets airtime on different talk shows and everybody runs in that direction.
And another 6 months later, another laser shows up and everyone runs in that direction.
There are some basic principles to understand.
Whether it’s Erbium or CO2 laser laser, you are dealing with essentially different
levels of ablation which means removal of skin and different levels of thermal energy
delivery which means delivering heat in skin to induce a healing response that results
in more collagen and tightening of the skin.
Now, because of the advancement in the ability to tune lasers to do what you want in other
words, varying degrees of depth as well as varying degrees of heat delivery, depending
on the device you have, you can actually have comparable results between the two lasers.
The laser manufacturers have become extremely sophisticated with computerization and technology
so that you can get comparable results whether you use an Erbium fractional or CO2 fractional.
But when you get down to what you need, you have to think about what is a strategy.
There’s a basic straightforward rule.
The deeper you go, the more thermal energy you deliver, the longer it takes to heal.
A lot of times people are frustrated because they want to essentially get out of a laser
treatment the same thing that they want to get out of a surgical treatment.
So for example, if I take care of someone’s under eye bags, well this is a procedure where
once I take the bags out and improve the appearance, that can be stable for many years and it will
not need another surgery.
Skin is different.
Skin can benefit from an aggressive treatment but almost always, you have to think about
a maintenance strategy.
And one of the things I observe constantly are people bouncing from one medispa to a
medispa to a dermatologist to a plastic surgeon, to whoever, jumping from one treatment to
another.
My philosophy is straightforward.
You have to have a treatment plan.
You should have a strategy as to what to expect out of the treatments that are offered and
understand that whether you are dealing with aging, sun exposure or combination of both
as well as other environmental issues whether it’s smoking or other things that have to
do with genetics, you are dealing with skin that has to continuously be monitored.
Now when you talk about pores, for example, we use something called Q-switch laser where
there’s no down time.
We use this laser to treat pores and we’re able to get very nice results and the patients
don’t have to worry about being raw and having to wait for the healing process.
Now understand that pores do require continuous treatment.
You don’t just treat pores once and never treat them again.
It’s just a matter of treating, observing and treating and observing.
When it comes to other issues whether it’s wrinkling, wrinkling can also be treated not
just with laser devices.
We use something called platelet-rich plasma.
With platelet-rich plasma, we’re actually injecting below the skin and within the skin
and we’re stimulating collagen.
This platelet-rich plasma strategy is getting a lot more love these days because now the
dermatology and plastic surgery journals are actually publishing data supporting what we’ve
been saying for many years and we were not taken seriously.
Just through clinical experience that you’re inducing collagen, you’re inducing new blood
supply, you’re improving the fatty cell layer under the skin.
And so, you can actually balance how aggressive you are with the laser by using PRP in conjunction.
Other strategies also include such as microneedling.
Microneedling can also stimulate collagen.
So I think that you want to step away from comparing devices.
It’s very easy for anyone to buy a device.
Any physician can buy a device and depending on the state, you don’t even have to be
a physician to buy a device.
And what it takes is knowledge, experience and judgment.
As far as I’m concerned, the willingness to follow the patient not just for a series
of treatments but for years to really manage.
So what I would recommend is you find a doctor who is going to be with you for the long-term
and don’t expect that one particular treatment will have you covered for years.
You may get a significant improvement with one treatment but you will likely need some
kind of a maintenance plan.
So it does require investing time, resources, effort etc. in order to do that but I think
it’s important to be realistic by having an understanding that it’s the doctor who
is doing the procedures and is trying to help you and having that connection more than any
specific device.
So I hope that was helpful, I wish you the best of luck and thank you for your question.