Combined therapies produce 'total care'

San Diego - While the viability of the Nd:YAG laser has made nonablative resurfacing a real alternative for many cosmetic surgeons, physicians today are realizing the necessity of supplementing this treatment with a variety of other devices to address diverse conditions.

"When we doctors were using this nonablative method, we realized we were forgetting the outside layers of the skin, which is the first thing that we see in someone when we are observing them. That's the reason we need to combine several devices, and several wavelengths. No one wavelength can give the solution to everything, which is the moral today. We can combine methods to get to total care concept of skin rejuvenation," says Mario Trelles, M.D., Ph.D., assistant professor at universities in Europe, including Spain.

The effectiveness of laser use in ablative skin resurfacing was partially offset by the treatment's side effects.

Among the drawbacks of ablative resurfacing are the associated downtime, the persistent erythema, and the risk of complications and side effects. "At the moment, in our clinic, we tell our patients erythema is part of the game. It's not a bad symptom, but it should be handled correctly. Erythema represents, as we have published, an increase in vascular activity, in blood vessels feeding into the territory that we have treated. We don't want to decrease the erythema because it's a representation that the tissues are getting the necessary blood," he says.

Along with erythema, there is a certain period of downtime.

Nonablative choices Among the methods that can be used to accomplish a nonablative resurfacing technique are electrosurgery using radiofrequency.

"This could be in two different directions - monopolar or bipolar radiofrequency," Dr. Trelles says. "The monopolar method involves injecting electricity into the body in order to stimulate, to irritate the tissue. In case of bipolar radiofrequency, the distinction is that you don't inject the electrical energy, but you make the electricity pass from one electrode to another, from one pole to another. You can more specifically control the action of the electrical energy, and direct this energy deeper into the skin to stimulate not only the collagen but also, for example, the fat tissue. Because of the profoundness of the action, you can actually tighten the tissue," he says.

While the older methods of nonablative resurfacing, such as use of the Nd:YAG, remain viable, other devices may offer distinct advantages. "The Nd:YAG still keeps going strong in the market. But now being realized by the manufacturer that it's necessary to add some visible light to create a better condition, such as blanching of the skin," Dr. Trelles says.

Benefits of IPL option "Nowadays, we have a whole range of devices which are available, such as intense pulsed light sources," Dr. Trelles continues.

"IPL is not a laser. They can reach several targets, located at the surface of the skin and in the dermis. Nowadays we're going back to the basics, and we realize that by using a specific wavelength involving pure color of light, we can get to stimulate the tissue. The skin looks much more luminous. When using red light of 633 nm for example, new devices of this wavelength are easier to handle. It was difficult to treat big areas, but the use of LED is very promising because they are very narrow, and specific in color, mimicking the light of lasers, but that permit the treatment of larger areas," he says.

"I do believe that in the near future we will see that this light will be helping a lot of doctors. There are certain pigments which we put on the skin when we want to cure superficial cancers of the skin, and when we irradiate it with LED, a toxic situation will develop in the cancer and you clean the tissue," he says.

Disclosure: Dr. Trelles reports no financial interest regarding this article.