Wrinkle reduction is achieved using a number of modalities including chemical peels, fractional superficial lasers, fractional deeper lasers, radiofrequency devices, picosecond Nd:YAG lasers, Long-pulse (300 msec and 600 msec) Nd:YAG lasers and others. It is important for the surgeon to know the difference between static and dynamic wrinkles and wrinkles related to gravity vs underlying muscle movements. Furthermore, if the surgeon is familia with the cross-sectional anatomy of the face (and other parts of the body where wrinkles occur), then he/she can choose the best combinations of treatments to give you superb results.
What kind of fractional lasers are there?
There are two types of fractional lasers:
- The more gentle and more superficial erbium fractional lasers
- The more aggressive fractionated CO2 lasers
In general, the erbium lasers treat more superficial changes and are better for younger patients (under 50), mild to moderate acne scarring, and fine wrinkles. The CO2 systems are better for older patients, deeper wrinkles, some skin tightening, deeper acne scarring, and other scars. The fractional CO2 lasers can treat more deeply, but they also can require more downtime than the erbium lasers.
What are fractional erbium lasers best for?
These erbium glass fractional lasers treat the following:
- Sun damage, fine wrinkles, and aging on the face, neck, chest and hands but also on the arms, legs, and back;
- Certain cases of melasma;
- Certain kinds of acne scarring and surgical scars;
- To improve the crepiness and fine lines around the eye and on the eyelids.
- To improve skin texture and tone.
- To reduce precancerous lesions by replacing sun damaged skin with new skin.
These fractional lasers are generally NOT good for redness, but work somewhat on brown pigment and the above issues. A series of treatments (generally 3-5) are performed, usually one every 3-8 weeks. The benefits of fractional laser treatments are achieved with little discomfort and minimal risk.
How does fractional Erbium resurfacing work?
The erbium laser creates tiny “microthermal” zones (think pixels) deep into the skin which the skin repairs by pushing out the old sun damaged skin (the tiny pixels) and replacing it with new skin. Each treatment replaces about 15-20% of the sun damaged, scarred or wrinkled skin. It triggers the body’s natural healing process accelerating the production of collagen and new, healthy skin cells. 1,000-2,000 microthermal zones per are created each centimeter squared. The depth of penetration of the erbium lasers is less than that of the CO2 lasers.
Can I do the Erbium treatment with other cosmetic treatments?
We often perform erbium laser treatments in combination with botox and fillers (Restylane, Juvederm, Radiesse, etc).
How long do the effects of an Erbium treatment last?
That depends on how well you protect your skin from the sun and your genetic aging process. If you apply sunscreen and wear sun protective clothing, your skin will look good longer than if you are tanning, including tanning booths, or spend a lot of time outdoors. If you are careful with your skin, your skin may continue to look good with annual maintenance treatments.
How long does the Erbium laser take to work? When will I see results?
Many people notice results within a week after their first treatment. Their skin feels smoother, looks less blotchy, and has a glow to it. The results depend on what your issue is that you want treated. If you are doing a series, you may need to wait the full length of the series, which can be 5-6 months, to see the complete and best results. Usually, collagen will continue to develop even up to 3-6 months after your last treatment.
How are Erbium laser treatments performed?
You need to arrive about 1 hour before your treatment. You or a technician will cleanse the treatment area and then apply a numbing cream to the area to be treated. Then you just relax, read, or listen to music, while the numbing cream takes effect. Many patients like to put the anesthetic cream on the face before they leave home so they are ready to be treated by the time they arrive to the clinic.
After about 45 minutes, the numbing cream will be removed. No gel is needed for treatment with the newer Erbium lasers. The skin is cooled using the amazing Zimmer cooler and the laser treatment is commenced.
The level of discomfort is about a 3 out of 10. At the end of the treatment, the face is cleansed and a moisturizer is applied. Plan on being in the office for 1 ½ hours total. Most people drive to and from their own Erbium laser appointments.
What is the process for Erbium eyelid treatment?
Patients should try to arrive with a clean face, including all eye cosmetics, and you should inform your clinician if you have any permanent makeup before beginning the treatment. Numbing eye drops are placed in the eye to aid in the insertion of a contact lens-like eye shield to protect the eye. The shield fits comfortably within the eye.
The eye treatment is then performed on the upper and lower eyelids. Erbium eyelid treatment may be performed at the same time as Erbium face treatment. Remember, it is normal like all areas treated with the Fraxel, to some swelling and redness for 2-3 days after the treatment.
What do I do prior to my Erbium laser treatment?
- Stop use of Accutane 6-12 months before any treatments
1-2 Week Before Treatment:
- Buy several bags of ice packs/frozen peas
- Buy Cetaphil or another gentle cleanser
- Stop use of Asprin, Advil and Aleve if possible. Tylenol is ok.
- Stop use of all Retinols/Retin-A
- Stop Renova, Tazorac, “anti-aging” products
- Stop use of all glycolic acid treatments
- Avoid sun exposure 2 weeks prior to your treatment (use sunscreeb)
- Stop minocycline, doxycycline and tetracycline
- Stop waxing
- Stop abrasive scrubs and microdermabrasion treatments
- Call your doctor if you have a history of cold sores- you may need a prescription for Valtrex or Famvir to begin the day before your treatment.
Day of Treatment:
- Eat a meal 1-2 hours before your treatment – this prevents feeling jittery with the numbing cream
- No caffeine for 4 hours before your treatment
- Wear comfortable/ washable sweats or clothes
- Arrive with no make-up or eye contacts
- Bring a wide brimmed hat to your appointment to wear after your treatment.
- Are you pregnant or breast feeding? If so, you are not a candidate at this time
- Tendency to hyperpigment? We will start you on a hydroquinone bleaching cream about four weeks prior to your treatment.
What will I look like right after the treatment and what is the healing time?
- During the first 24 hours after treatment, your skin may feel as though it is sunburned. Ice packs or frozen peas are used 5-10 minutes per hour for the first 5-6 hours after the treatment.
- Please apply a moisturizer (see the section on “which moisturizer should I use after laser treatments” for suggestions) four times a day to the treated skin, and more often if the skin feels dry.
- Your skin will look very red immediately after the treatment and will fade over the next 1-3 days. Usually you can go back to normal activities including work, with make-up, within 1-3 days (we will estimate for you). Occasionally, the redness may take longer to resolve. Make-up can be worn to reduce the red. Rarely, bruising may develop, which can take up to two weeks to resolve. Allow 2-3 weeks for weddings, reunions, family pictures, etc just to be safe.
- Within a few days after each treatment, a “bronzed” look to the skin is common, which can last 1-2 weeks. Your skin may flake and exfoliate a little. Use a moisturizer three to four times a day to the lasered areas: this will help reduce the appearance of dry flakes. Remember, it will take several treatments to obtain optimal results.
Instructions for care after Erbium laser treatment.
- Ice for ten to fifteen minutes every hour for the next 5 – 6 hours to reduce swelling. Use a bag of frozen peas covered with a thin clean cloth/towel.
- Avoid scratching or rubbing the treated skin – do not put adhesive dressings over treated areas.
- Men may shave 1-2 days post-treatment but be gentle. Best to use an electric razor for the first few days!
- Avoid all saunas and hot tubs. Showers can be taken, but avoid hot water and direct shower spray to treatment area for 3 days following treatment. You may, however, shower and get the face and treated areas wet the day after the treatment.
- Avoid strenuous exercise for 48-72 hours (this includes all yoga, especially the upside down, inside out Bridge-Lion pose.
- Avoid alcoholic beverages for 24-48 hours.
- Sleep with 1-2 extra pillows at night to keep head raised for the two nights.
- Avoid direct sunlight for a minimum of 4 weeks after your treatment and wear a sun block with 10% zinc or titanium for the next 4 weeks. If actively outdoors, you should reapply your sunscreen every 2-4 hours and wear a wide-brimmed hat
- Do not use any retinoid, Retin-A or glycolic products for 1-2 weeks following the procedure. Do not use any non-prescription creams without checking with us first.
- Refrain from any chemical peel treatments or microdermabrasion (or deep facials!) for 4 weeks post-procedure.
Can I go back to work and activities immediately?
No, you will need to take the rest of that day off to ice and care for the treated area. You can go back to all of your activities, including exercise when your doctor approves it, usually 1-7 days after your laser treatment. Swimming in a chlorinated pool is not advised for 1-3 weeks. You may exercise outside with a full brimmed hat and with a high-quality sunscreen with 10% zinc or titanium.
How many treatments will I need?
Three to five treatments, approximately 3-8 weeks apart. An estimate should be given to you at your consultation. The number depends on the extent of your sun damage, acne scarring or wrinkles. Gradual improvement occurs with each treatment. However, with Erbium lasers, depending upon what is being treated, each treatment should give you a substantial improvement in appearance.
Are there any reasons not to be treated with Erbium lasers?
Reasons not to do a fractional Erbium laser treatment may include use of medications that increase photosensitivity, use of anticoagulants, history of bleeding disorders, and pregnancy.
Are there any medical or cosmetic side effects with Erbium laser treatment?
The main side effects are temporary swelling, redness, an accentuation of the brown spots, crusting, and an occasional bruise or small superficial blister (like a sunburn blister).
What about all these different names of lasers people try to sell me like Fraxel, Thermage, etc?
Please don’t fall for false and exaggerated claims. A Rolls Royce drives as well as a Bentley and an Aston Martin is as beautiful as a Ferrari. It is the engine that is really important, and so it is with lasers. Every ablative laser (besides the plasma machines which are covered on a different page) will be a type of Erbium laser or a Carbon dioxide (CO2) laser. Of course, many different companies make these lasers (even though the engine of these lasers is often manufactured in Israel, Italy or the United States and rebadged and sold as different machines.
Properly used, a knowledgeable and proficient surgeon can make each of these lasers perform like a Rolls Royce, or a Bentley or an Aston Martin or a Ferrari. It is the results that count. Don’t worship false gods (mixing metaphors).
Always review before-and-after photographs of patients treated for the same condition as you (by your surgeon!), or talk to other patients who have had treatments. Medicine and surgery are best practiced with a thorough knowledge of anatomy, physiology, pathophysiology, knowledge of different wavelengths of lasers and the effects and side-effects of the same. And experience!
How does the Erbium laser work for acne scars?
Many of the original studies with this laser were done on patients with acne scarring. It works well for acne scarring as long as the scarring is mild or moderate. If the scarring is deep or there is a skin sagging associated with the scars, a fractional CO2 laser is generally a better choice.
How does the Erbium laser work for sagging skin?
This laser does NOT work well for sagging skin.
How does the Erbium laser work for wrinkles?
The Erbium laser has a modest but noticeable effect on wrinkles that are mild to moderate. It’s not the best choice for deep wrinkles and wrinkles associated with volume loss and sagging. For wrinkles, younger patients more in the 30-50 range will generally get the best results with this laser. It still has a very positive effect on sun damage and texture changes due to sun damage if a 3-5 treatment series is performed.
Picosecond Nd:YAG Lasers
These are the latest addition to the devices we can use to improve skin wrinkles, lines, “pillow lines), etc. The advantage of the picosecond Nd:YAG lasers is that there is a sequential tightening of the wrinkles and skin with little to no downtime and these are therefore becoming very popular with our professional and other busy patients. Come and see what we can do!