Had to post
Fractional laser is NOT the best way to improve skin texture!
+2
I risk the disagreement of many of my colleagues who have and use fractional lasers in their practices, but I would be able to submit evidence that this is indeed a correct statement. First, I will state that there is nothing WRONG with fractional lasers or resurfacing--they do make nice changes in wrinkled or scarred skin and are generally appreciated by patients who have these¦ Show more
This is particularly true for patient such as you who have relatively "mild" textural changes (often described as "big pores") and want smoothing, when fractional lasers, by their design, treats the target skin in tiny polka dots that can actually lead to little improvement and sometimes even more textural irregularities!
I have taught laser surgery, including resurfacing, for over twenty years, nationally and internationally (Korea, Canada, Caribbean), and have performed thousands of laser cases in my practice. (I am in private practice, do not have academic affiliation, publish sparingly, but have taught nearly a hundred laser courses and thousands of physicians of various specialties over these years). Now, just the facts, Ma'am.
Ablative CO2 laser resurfacing came first, gave great (dramatic) results, but fell somewhat out of favor as hypopigmentation (skin color lightening) occurred a year or so after treatment. Wrinkles, spots, and sun damage still gone, but line of demarcation where treatment stopped, and lighter skin color where treatment was done. Bummer!
Ablative Erbium-YAG laser resurfacing came next, but treated much more superficial layers, so skin healed faster, with less redness, but with less dramatic changes. If the doctor promoted this as "better than CO2" and charged as much, patients were unhappy, but not because the laser had a "problem" other than milder results. Bad doctor "marketing!"
By the time that third-generation combination CO2/erbium-YAG lasers came along about ten years ago, the herd of dermatologists, plastic surgeons, and other laser doctors had moved on to the "non-ablative" lasers or therapies such as Thermage, N-lite, Cool-touch, Smoothbeam, and many others. These all "worked" to varying degrees, but usually with very minimal results. Prices dropped, and so did most of the hype, and "the herd" of doctors that need the "latest and the greatest" moved on to Fractional lasers.
Fractional lasers started with Erbium wavelengths, and treated the skin in tiny polka-dots. Bridges of intact skin were left untreated, which is said to promote faster healing and less down-time (partially true). Actually, less skin treated = less result, which required multiple treatments, which = more procedures, more healing and MORE cumulative downtime. Oh, and the total cost adds up to a tidy sum usually! The results are real, but with superficial layer and polka-dot treatment came mild results (and sometimes textural changes). More, give us more!
The next fractional lasers returned to CO2 wavelengths, which penetrate deeper, and still treated skin in tiny polka-dots. Fortunately, unless the energy was turned up too much, or the polka-dot density too tight, hypopigmentation changes were limited, and the results were indeed better. Still only in the fraction of the skin treated, still requiring more than one treatment for results that could approach that of well-performed third-generation combination CO2/Erbium-YAG fully-ablative (read "smooth") resurfacing (which very few doctors even had then, or have today), and still adding up to a tidy sum for only "fractional" results. BTW, it still takes a week to heal fractional laser treatments, and if you add up the time for multiple procedures, doctor's visits, and cost, HOW can this be "LESS DOWNTIME"?
So at the risk of being contrarian, I would submit that a properly-performed ablative CO2/Erbium-YAG full-face laser resurfacing remains the BEST one-time laser resurfacing procedure available. For textural issues such as yours, it is preferential! With proper skin care, I routinely have patients healed in 7-10 days, and with minimal (truly) redness easily covered with standard make-up. I even purchased a second CO2/Erbium-YAG laser for parts--they are no longer available. But the marketplace delivers what the public (and their doctors) demand. I know from all the courses I have taught over the years, that many, if not most, of the doctors that use lasers don't even understand the basic laser biophysics of how laser energy interacts with tissues--they just want to know "what is the basic setting, where is the trigger, and how much can I charge?"
So instead of searching for a fractional laser surgeon to treat your skin, I would suggest a fully ablative Erbium-YAG (superficial) laser resurfacing to improve your skin texture, or if you really want more aggressive improvement (your skin does not look as if it needs it), then combination CO2/Erbium-YAG ablative resurfacing would be my recommendation (if you can find someone who still has that kind of laser). Otherwise, you may be just as pleased with a full face chemical peel (TCA). Please see several laser experts before you decide. Best wishes!
But beware of asking for what you "think" you need--you may well end up with more textural irregularities than you started with! Enough said, my soapbox is sagging! Caveat emptor!
Web reference: http://www.mpsmn.com/laser-and-skin-procedures
+1
There are certainly risks with Laser Resurfacing and thus a properly trained physician
Interesting. I have read that post by the same doctor on other threads at Realself and they actually had a few replies from doctors recommending fractional co2. The thread you linked only has one reply and the one doctor isn't recommending fractional co2. Appears to be a copy+paste reply. He obviously believes in traditional Co2 laser. Keep n mind, some fractional co2 lasers, like Active FX and MixTo, are capable of 100% ablation. With that said, I don't understand this doctor's point. Perhaps, he is unwillingly to invest in modern technology...
I did copy/paste however if you click on the show more link it will take you to the realself site where the original question was asked.
I do find this interesting in some respects. I have read many complaints about worse skin texture after lasers and most seem to go the fractional way however I also know that with traditional co2 laser hypopigmentation is probably more common than not. My mom has had the gold standard co2 laser for skin tightness and she is perm. as white as a ghost. Okay for her because she is normally pale.
Anyways after so many complaints of worse texture after laser I cant say that this dr. is completely wrong.
I did copy/paste however if you click on the show more link it will take you to the realself site where the original question was asked.
I do find this interesting in some respects. I have read many complaints about worse skin texture after lasers and most seem to go the fractional way however I also know that with traditional co2 laser hypopigmentation is probably more common than not. My mom has had the gold standard co2 laser for skin tightness and she is perm. as white as a ghost. Okay for her because she is normally pale.
Anyways after so many complaints of worse texture after laser I cant say that this dr. is completely wrong.
How was the recovery for your mom? Is she happy with it overall?
My mom isn't dealing with scarring or textural or pigment issues. But yes the co2 laser did give her results making her skin look more vibrant and tighter. She had about 1 1/2 weeks of real downtime. She was a mess and no way could go out in public without scaring children for the 1st week but after that for about 1 month she was pink like a mild sunburn and 3 months later she is normal looking again.
The thing is that if you aren't the fairest of fair the traditional co2 laser will make your skin tone look odd and you will probably be void of pigment.
I did copy/paste however if you click on the show more link it will take you to the realself site where the original question was asked.
I do find this interesting in some respects. I have read many complaints about worse skin texture after lasers and most seem to go the fractional way however I also know that with traditional co2 laser hypopigmentation is probably more common than not. My mom has had the gold standard co2 laser for skin tightness and she is perm. as white as a ghost. Okay for her because she is normally pale.
Anyways after so many complaints of worse texture after laser I cant say that this dr. is completely wrong.
Sorry for the confusion. I know you copy and pasted. I have also read this comment by the same doctor on other threads at Realself. He seems to copy and paste that response to people asking about Fractional Co2. I just thought that was interesting.
I would think traditional co2 laser has more risks of complications than fractional as it is 100% ablative.
This is my problem with lasers. You're basically creating wounds in the skin and hoping that it heals in a way that the skin has a better texture than before. Except that the body's response to trauma can't always be predicted, which is why some people have a negative reaction to lasers, like fat loss, loss of collagen, poor skin texture, etc. We also create minor trauma to the skin with peels and dermarolling, which is on a much smaller scale than lasers, but more trauma=a greater risk of complications. Yes, fractional lasers create smaller wounds, but the risk of complications also decreases.
Having had fully ablative CO2 I will suggest it from time to time for those with milder scaring. The patient he was addressing may well have been just such a patient. For people with deeper scaring I believe Fractionalized Ablative CO2 is the only answer, and this involves a process of multiple treatments.
Well...let me play devil's advocate to my own post. I feel kind of bad because I'm seriously considering getting a Mixto laser treatment in the coming months, despite the risks.
I've heard a lot of reviews on this board claiming that fractional laser did very little, and more ablative lasers providing better results.
I think combining techniques is a good solution. There are people on this board who combined subcision with Mixto or Repair and had truly fantastic, transformational results.
I have Fitzpatrick skin type IV so I need to be careful what I use on my skin. But I am seriously considering driving a ways to someone who specializes in Mixto laser. She described the results and it has reversed the signs of aging for a number of patients.
It's true that you'll probably need to repeat treatments, or combine treatments.
Any invasive procedure, even subcision, comes with risks.
Actually, the one laser treatment I had she spot-treated my deepest scars. A few months later (long enough for collagen to build) my coworkers were commenting on how much better my skin looked.
Well for my particular case I have enlarged pores/ scarred pores and boxcar scars. It seems like what the dr was saying in his answer was the fractional is good for scarring/wrinkles but can make texture worse. Now if my scarring looked better but the texture of my skin looked worse I still don't think I would be happy:(
Its really a hard decision for me because I have no clue what the outcome would be...
The textural difference would probably only be the orange peel texture; which I did not experience after my laser treatment. In any case, my skin actually looks healthier after laser than before. But it is your call, really.
Sleep and diet would probably play a bigger role in maintaining a healthy skin texture than lasers.
Yes but I already have an orange peel texture. I mean could that be made even worse?
My diet sucks, I do get good sleep,I use medical grade skincare products, but my large pores are heridetairy. Nothing is going to change that not even lasers.
Like Starlite said everyone will have a different outcome. I just have to decide if I am willing to take that chance........
LOL I just took the Fitzpatrick test and I am a 2-3. Definitely not brown skin, but I am definitely on the cusp between 2 and 3. Brown hair with hazel eyes, and I haven't had a burn since I was a kid.
I think Starlite makes a great point.
At this point not sure if I will pursue laser. I really do need to get some more insight. I know Dudley has had great success with Repair but I have a feeling that our skin type is very different.
I think the reason Co2 works for a minority and not most is that you don't know how deep your scar is. Ablative lasers only hit the top layer of skin, so of course if you have scars that reach into the dermis, like most scar sufferers or worse, the subcutaneous layer, you will not see any results.
Anyway, most drs. don't use it anymore for scarring now that fractionated lasers are on the market.
I'm starting to wonder if traditional CO2 is the way to go depending on the scarring you have. My scarring is more of a loss of elasticity, rather than actual pitting, so I'm wondering if it would work for me like it would for a person battling aging. The traditional CO2 has been around so much longer, and on Realself it has a much higher positive rating than the fractional lasers which you hear those horror stories about all the time. I'm not saying traditional is without risks, it obviously has high risks, but I think that for some people it might be better. I do agree though that fractional might be necessary to reach that deep scarring.
One thing that people often neglect in fractional laser resurfacing is the thermal zones created under deep skin. That is one effect which differentiates fractional ablative lasers from needling; it essentially dissociates a percentage of collagen fibers that holds down scar tissue, allowing new collagen to regenerate in its place, creating a filling effect much like a cutting out threads holding down a pocket. Sort of like miniscule subcisions done along your skin.
Traditional resurfacing eliminates the full surface, leaving less to no skin for scar remodeling, but perhaps it is better for surface/textural scarring, which alternative would be dermabrasion.
Different types of lasers confuse me so much and you all seem to know much more about it than I do. One thing you didn't mention was which laser is best for certain depths of scarring. My scarring is at the most moderate depth and only on my nose and I have no idea what kind of laser/how many treatments I would need. Could you please help? I'm afraid of going into a dermatologist and being duped into something really risky or way more expensive than I need.
One thing that people often neglect in fractional laser resurfacing is the thermal zones created under deep skin. That is one effect which differentiates fractional ablative lasers from needling; it essentially dissociates a percentage of collagen fibers that holds down scar tissue, allowing new collagen to regenerate in its place, creating a filling effect much like a cutting out threads holding down a pocket. Sort of like miniscule subcisions done along your skin.
Traditional resurfacing eliminates the full surface, leaving less to no skin for scar remodeling, but perhaps it is better for surface/textural scarring, which alternative would be dermabrasion.
In addition to this - depth is also very much a factor. Considering scars start at 500 microns -> 2000 microns.....
