How To Plan Your Laser Treatments

I didn’t get a fractionated laser until earlier this year. A mom friend who gets them regularly to treat her melasma sent me a week long selfie series showing her metamorphosis from Freddy Krueger to fabulous and I was very there for it. Despite being familiar with the technology that’s been around now for a decade, I had only dabbled in radiofrequency treatments that targeted the deeper dermal layer, but never tried any lasers for skin resurfacing for fear it would wreak havoc on my freckly thin skin. Man was I wrong, after a week of pretty minor peeling and redness, I enjoyed an even, glowing complexion for months.  

The treatment responsible for my perfected skin was the Fraxel Restore Dual which is the machine you’re most likely to find in your derm’s office thanks to its versatility. It boasts two wavelengths, one that improves surface texture and a deeper wavelength that stimulates collagen rebuilding. It’s non-ablative meaning non-wound making and only treats a fraction of the skin at a time, about 25 percent, so the healing process is super quick. Notes Lisa Goodman, director of anti-aging clinic GoodSkin, “Newer lasers offer less downtime, less sun sensitivity, and overall less epidermal damage.”   

Super long downtimes and angry raw skin are more often outcomes from the aggressive ablative lasers like a CO2 or Erbium which removes the epidermis as well as a portion of the dermis to treat heavy duty wrinkles and scarring. When I hit 50, I may be ablating my way to my JLO glow, but for now I am adding a Fraxel Restore Dual treatment to my skin care routine.  

 But how exactly does my newfound love of Fraxel fit into my current regime that includes other beloved energy-based treatments? Lasers, radiofrequency and ultrasound have become as entrenched in our skincare regimes as masking or moisturizing. Ways to deliver this energy have become more sophisticated removing a lot of the risk and resulting in less complications. The dizzying array of options now tackle nearly every one of our aesthetic concerns including: pigment issues, acne, wrinkles, scarring and skin laxity among others.   

The movement towards gentler yet more frequent treatments however, demands thoughtful planning and a bit of experimenting. Says celebrity dermatologist, founder of PFRANK MD and my Fraxel guru, Dr. Paul Jarrod Frank, “The current and future of non-invasive cosmetic dermatology is in combining a lot of small things to get big results, so you can’t just go to someone that only offers one device.”

 Mixing and matching can feel overwhelming and while side effects like scarring, post-inflammatory hyperpigmentation, burns and compromised skin barrier are much less frequent, they can crop up with improper usage.  

We’ve approached some of our favorite skin pros to go over some safety protocols and ideal skin rejuvenating combinations to ensure we’re optimizing our heat-based treatments. Ok, who is ready to look like Jenny from the Block? 

Know the device and who is behind it  

There is currently no governing board for laser surgeons.  Be sure you go to a board certified dermatologist, plastic surgeon or an extensively-trained medical professional like a physician’s assistant or nurse. While lasers do have presets, providers choose the specific laser and the speed at which the light is directed at your skin based on your particular needs. Ultrasound methods like Ultera are particularly reliant on the skill of the administrator. Ultherapy requires the provider to read a sonogram and know where the heat needs to be delivered deep to the dermis. A misinterpretation of this information can lead to burns and welts (which isn’t very common) or just no results at all. The latter was a much more common side effect until recently.  

Ulthera recently released a new study that revealed their old protocols had client satisfaction rates of 30-40% while their latest protocols have satisfaction rates of 80-90% and it all largely has to do with the skill of the provider. Says Goodman,

“The new protocols are based upon reading the ultrasound at each specific area on the face and then adjusting the treatment based on visualization of the target connective tissue. This means that the depth of treatment may vary between each area and would need to be adjusted just so . This way the energy delivered is precise and also far less painful.”

There have also been some concerns raised about fat atrophy, a condition where the heat from the ultrasound device emulsifies fat because the handheld device is held too long on one particular area. Every expert I interviewed noted they have never come across it in their practice. Notes Dr. Matthew White, a renowned NYC plastic surgeon who has been key in developing safe and effective Ulthera protocols, “Collagen absorbs ultrasound energy, fat does not. We’ve done tests to see if it could shrink fat purposefully and it was not possible.”

Space out treatments

A skilled provider will not only know how to handle these powerful devices, but also be thoughtful about the timing of your procedures. There is a reason fall season is called laser season since it’s an ideal time to tackle the sun damage accumulated over the summer months and less UV exposure makes for a gentler environment for post-treated photosensitive skin.   

In terms of frequency there are no real hard and fast rules since skin type and patient concerns dictate the treatment. Skin resurfacing treatments like fractionated lasers initially require a series of three to four treatments spaced one month apart, but for upkeep one yearly suffices. Deep collagen remodeling treatments like Ultherapy can be performed one to two times a year. Maintenance treatments like light fractionated lasers for photo damage like a Clear and Brilliant or photo-facials like a Broad Band Light treatment that use light energy to target superficial imperfections can be done every three months although monthly is beneficial and won’t be damaging.

Find your power couple

While timing your treatments properly is important, considering which modalities best complement your favorite heat-based treatments can make a huge impact. For instance the smooth results from your yearly fractional laser treatment like a Halo Pro or Fraxel can be maintained throughout the year with a few Broad Band Light facials in the winter and spring. Dr. Frank loves pairing Fraxels with Ultherapy and/or micro-needling. He notes, “Ultherapy once a year and Fraxel once a year is a great combo! Fraxel cleans the window and washes the shingles of the house. Ultherapy strengthens the infrastructure.”

Ultherapy and certain fillers could prove to be a collagen-inducing super team as well. Dr. White recommends doing the ultrasound treatment first followed by Sculptra fillers on the same day. Sculptra is a specific type of filler that relies on the body’s own natural inflammatory process to work, so if you jump start the inflammation with ultherapy, the Sculptra really gets going more quickly. Explains Dr. White,

“Sculptra is like vicryl suture particles that you mix up in solution. You use it everywhere, even the face sometimes. It’s a dissolvable suture. The Scupltura gets injected, and then special cells called mast cells migrate into the area and act like little pac men and eat it up. After they ingest the particles, they send a shower of signals (cytokines) to their buddies (the fibroblasts) to start making brand new baby collagen.”

If you regularly get fillers, this strategy might be worth implementing to get the most bang for your buck. 

Don’t forget the boring stuff like medications and skin conditions

No amount of power pairing and planning will work if you aren’t totally transparent with your provider about medical history and current course of medications and supplements. Such emphasis is placed on skin revitalization that many neglect conditions that could be aggravated by heat therapies. Says Dr. Melissa Kanchanapoomi Levin, NYC dermatologist and founder of Entiere Dermatology, “Maintenance and control of underlying inflammatory facial conditions are just as important as the “anti-aging” component. A holistic medical and cosmetic approach is the most ideal.”

Acne medications that contain isotretinoin (i.e., Accutane) can lead to delayed healing or scarring from laser resurfacing, while common over-the-counter products like aspirin can increase the risk of post-procedure bleeding. Ezcema isn’t a condition that most lasers can treat although some dermatologist do treat it with gentle UVB light therapy. I am prone to a small patch of rosacea along my nose and the series of Fraxel treatments I did aggravated the patch slightly . Those who suffer from more intense rosacea benefit from the tried and tested pulse dye lasers that target swollen blood vessels like the Vbeam. Goodman has seen great results with microneedling with radiofrequency for those that have rosacea coupled with acne since the sebaceous glands are heated during the process and are induced to shrink. Notes Goodman,

“Clients with rosacea need to be treated on appropriate settings for their condition and follow good post care as regardless of the laser they will be more prone to swelling, edema and redness.”

Consider Skin Tone

Those with darker complexions also have to approach laser therapy with caution since they are at a greater risk for post-inflammatory hyperpigmentation. Dermatologists have made great strides in understanding how to best approach these skin types. Pulse dye lasers like a Vbeam are great options for redness issues as long as the settings are dialed down and recent versions of the Pico Sure, like the PicoSure Focus targets brown spots and increases collagen with gentle pressure wave technology that relies on super fast pulses rather than heat. This sort of laser is ideal for darker skin tones more sensitive to light since the technology relies less on heating up the skin. Dr. Levin still performs fractionated laser treatments on Asian and black skin but takes precautionary measures such as a course of hydroquinone one week before and one week after to relax pigment cells and make them less reactive to heat.   

 Give it a break and focus on products. 

If you do notice persistent redness and tightness this could be a sign of over doing it more specifically a sign of compromised skin barrier function.  Take a break and give your skin some TLC. Notes celebrity esthetician Joanna Vargas, “Not all skin types can handle so much laser. Signs like overly sensitive skin, redness and a waxy yellowish appearance are key signs of over doing it.”  

Joanna loves LED light therapy to help skin recover. While it does use light energy to boost collagen and promote healing, it does so at a very low dose and so it is impossible to overdue.  Growth factors in skin care form, like those found in the cult-favorite Augustinus Bader are great as are anti-inflammatolry niacinamide, vitamin c and moisturizers with ceramides.

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An industry veteran with over fifteen years experience, I cover prestige beauty, wellness, men’s grooming and style. As a communications specialist and brand consultant ...