In general, lasers that remodel collagen and stimulate collagen production throughout the dermis of the skin improve the appearance of wrinkles, texture, and crepe-iness. This is because the first two relate to weakening or irregular conformations of the dermal collagen, while the latter is a result of thinning of the dermal collagen. Remodeled and new collagen normalizes this layer so that it is more organized, more even in distribution, and deeper in depth.
There is a surprising misconception that lasers take off the top layers of skin, leaving it white, and/or shiny/thinned. This is not the case. I suspect this mistaken patient belief relates to older methods of rejuvenation like dermabrasion, deep chemical peels, and old-fashioned lasers, all of which did remove surface layers of skin and carried a risk of removing all normal pigment cells called melanocytes. (Today, I still see patients in the office who were treated in the 80s, 90s, and early 2000s with these older methods, and some do have these unusual signs of treatment.)
Fortunately, rejuvenating lasers today generally penetrate the surface skin, stimulating the collagen from within and below which triggers its production, rather than simply shearing off the surface. Areas of untreated skin separate this because resurfacing lasers today are fractional—meaning that the laser beam is delivered in a pixelated manner, touching the skin in tiny dots. This leaves behind healthy pigment producing cells (melanocytes) and other normal skin cells unaffected by the treatment that rapidly heal the skin and markedly diminish the risk of abnormal pigmentation.
The most commonly used lasers for these strategies are fractional resurfacing lasers. The most popular ones are those with limited downtime (generally from a few hours of pink and dryness to 4-5 days of pink and dryness). My currently used strategies include the non-ablative (non-wounding) Clear and Brilliant lasers and Fraxel Restore dual lasers. Not only do these lasers stimulate the collagen, they also allow for a surface exfoliation of the skin, which sheds abnormal browning and dullness to the skin. Consequently, the skin looks brighter.
The stronger lasers are ablative (meaning they superficially wound the skin), leaving the skin with redness and scabs for about a week, followed by 3-4 weeks of pink skin. The later 3-4 weeks can generally be masked with makeup, since the skin has healed. These stronger versions are usually reserved for more substantial signs of aging, uneven texture, deep wrinkling, or scars—often acne scars. My preferred ablative fractional laser is Fraxel Repair.
More good news about these therapies: I was part of a clinical trial published in 2012 that demonstrated the likelihood that these newer fractional laser treatments promote not just more beautiful skin, but healthier skin as well, by supporting the elimination of pre-cancerous skin changes known as actinic keratosis. These pre-cancers have the potential to turn into squamous cell carcinomas.
Finally, there is a very new method of collagen stimulation that benefits wrinkles, texture, and crepi-ness. It’s so new I imagine most people are not yet familiar with it: picosecond laser technology. It first appeared after the FDA approval for picosecond laser treatment of pigment, most notably tattoos. (It is called the Cynosure PicoSure laser, and the one I use in my office.) When I say picosecond technology, what I’m referring to is the rate at which laser energy is delivered to the skin. In this case, a beam of light at certain energy is delivered within a picosecond, an extraordinarily rapid rate. I participated in clinical trials that studied the effects of these picosecond lasers when passing through a specialized diffractive lens. The lens ultimately delivered areas of peak energy and low energy, almost like a fractional laser, but there was always some low level of energy touching the surface of the skin. There are a number of theories as to why this laser technology helps remodel and produce collagen. One of the most interesting to me is that the rapid delivery of laser light might stimulate a vibration throughout the surface of the skin, triggering the collagen response. I have since been a part of publications and lectures describing the clinical trials we performed. What makes this science all the more interesting—and desirable for our patients—is the limited downtime. Usually the skin is just a bit pink for a few hours after treatment (as you can see in the image above).
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