Archive for the ‘Skin’ Category


Wednesday, March 19th, 2014


There has been a dramatic proliferation of “fractionated” lasers being marketed for improvement in skin quality. Overall, they are not cost effective.

In order to understand the issues, a little biology lesson is needed.

The skin surface cells are in a layer called epidermis. These flat, layered cells are responsible for dryness, sun damage changes ( actinic keratoses) and pigment irregularity ( “age spots’ or solar lentigines).

Procedural correction of the skin surface has traditionally been accomplised by one of three methods: chemical peels, lasers, or dermabrasion. All these methods create removal of the entire epidermis, followed by reparative healing. The advantage of these methods is effective correction. The disadvantage is potential removal of all skin pigment cells ( melanocytes), leaving white, unpigmented skin.

Enter the concept of “fractionation” of lasers…The idea being to drill a grid of injury columns into the skin while leaving the tissue between columns undisturbed. The process is similar to aerating a golf green or yard. The advantage is sparing of pigment cells. The disadvantage is that only part of the skin surface is treated.

For skin problems involving abnormal pigment or sun damage the problem is uniform. Therefore, “fractionated” treatments would only partially remove the problems. Simpler, cheaper methods such as chemical peels are more practical and more effective.


Non-surgical Skin Tightening…Really?

Monday, April 4th, 2011


The American Society for Laser Medicine & Surgery (ASLMS) just concluded its annual meeting in Grapevine, Texas. The ASLMS is the nation’s largest organization of clinicians and scientists who perform laser procedures.

Here are highlights from the meeting…

The concept of non-surgical skin tightening, particularly in the face, neck, and abdomen is always a hot topic. The principle is heating dermal layer of the skin to 55-65 degrees centigrade creating contraction of collagen.The exhibit hall was bursting with technology claiming to tighten skin. The media is excited with testimonials. Good business for doctors, but is does it really work?

Thermage TM attempts to tighten skin by using focussed radiofrequency waves to heat the dermis. The technology has been around for nearly ten years. It never really caught on because the treatments were very painful, and the benefits were limited. Solta, the company who bought Thermage, has modified the machine so that treatments are less painful. However, the results are minimal and inconsistent.

UltheraTM attempts to heat the dermis to create tightening using focussed ultrasound waves. The technology is elegant and interesting. However, the treatment parameters of depth and density, have not been established. As with many new technologies, they are marketed before the exact effective guidelines have been established. No doubt, a few patients have shown noticeable, though modest benefits – mainly in the neck. I would say Ulthera is worth watching in development, but not ready for routine use.

The problem with all this skin tightening technology is that basic studies of effect have not been completed. How much can you burn dermis without scarring? How little can you burn dermis and still get benefit? How long does initial dermal contraction last? How consistently do you get a result worth the cost?

Until these technologies have been in use long enough to either become standardized or discarded for the next “new treatment”, I would say watch and wait. There still is no minimal procedure with maximum result in skin tightening!