Updates in laser therapy

Several experts shared their techniques for working with lasers to treat photoaging, wrinkles, laser dermabrasion and other therapeutic approaches during the 2013 Vegas Cosmetic Surgery and Aesthetic Dermatology meeting in Las Vegas.

David J. Goldberg, M.D., J.D., director of the Skin Laser & Surgery Specialists of New York and New Jersey, offered results of an interesting split-face comparison between fractional Er:YAG and fractional CO₂ lasers. He pointed to the results of several studies that ultimately supported his conclusion that all of the fractional ablative lasers are effective.

Results indicated statistical improvement in photoaging in all patients. No device was statistically significantly superior to another, he found. And, no statistically significant differences were found in the pain scores among the devices. And histologically, there were also no differences.

“The bottom line is it’s your experience and comfort with using the system,” Dr. Goldberg says. “So when people come to your office and try to sell you these systems, the reality is that the good systems all work and it’s simply a matter of getting comfortable and that leads to good results.”

John Fezza, M.D., who practices in Sarasota, Fla., discussed his technique for laserbrasion, which he described as the combination of the heavy ablative CO₂ laser augmented with dermasanding. He finds that in his practice, this technique is a safe and effective way to treat heavy perioral wrinkles and he shared case studies that demonstrated the quality of results he feels are typical in his practice.

“Treatment of wrinkles with laser resurfacing alone, I think for moderate wrinkles does a pretty good job, it reduces the lines and it works well,” Dr. Fezza says. He finds about a 70 percent wrinkle reduction around the perioral area in patients with moderate wrinkles when treated with laser alone.

However, Dr. Fezza notes that many of the patients he treats have a disproportional amount of heavy wrinkles around the perioroal area, and these are challenging to treat because they’re deeper set and more resilient to other skin tightening modalities, he said.

He shared his technique for laserbrasion, which includes:

• 20 ccs of tumescent around the lips to plump them out to deliver anesthetic. This stretches the wrinkles, effaces the deep lines and, he feels, allows better penetration of either the laser or the sander.

• Two to three passes of CO₂ laser, after which he cleans the area and reevaluates

• If the patient is still in need of wrinkle reduction, he proceeds to dermasanding. He uses Frigiderm on the upper lip to tighten and freeze them and then proceeds.

Dr. Fezza displayed images typical of the results he’s seen demonstrating that at day one, there’s some crusting around the lips, by day five the patient’s skin is nearly epitheliazed, and by day nine the skin is fully epitheliazed, but may have some redness. By day 14, that redness has faded.

Dr. Fezza notes about a 90 percent wrinkle reduction with this technique and says the results he gets have augmented his practice.

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