Laser, light, RF technologies team up

Sacramento, Calif. - As the array of ablative, nonablative and other options for facial rejuvenation continues to expand, doctors say the key to achieving optimal results is in knowing when to use which technology.

He is a San Francisco-based, board-certified cosmetic surgeon in private practice, as well as assistant clinical professor of dermatology at the University of California, Davis, Medical Center, and president-elect of the American Society of Cosmetic Dermatology and Aesthetic Surgery (ASCDAS).

For example, ablative procedures (i.e., those that compromise the epidermis) are very effective for deep damage, such as deep perioral or periorbital rhytids, he says.

Risks, recovery time

Although ablative resurfacing remains the gold standard for such problems, fewer physicians are performing ablative resurfacing due to its risks and recovery time.

"Part of the reason also is that the media and less-than-ethical people are promoting the notion that nonablative and ablative procedures achieve equivalent results," Dr. Narurkar adds. "Very often, patients are being talked into procedures that may not achieve the appropriate results, so they come in with expectations that are far beyond what the technology can deliver."

Dr. Narurkar advises physicians to be clear with patients about the limitations of nonablative or fractional technologies.

He says, "I often talk about the phenomenon known as target-specific rejuvenation. If a patient possesses a lot of broken blood vessels and solar lentigines and one uses a nonablative source such as intense pulsed light (IPL) or a vascular and a pigmented laser, the patient will get a dramatic improvement in skin color and texture. A secondary effect is the stimulation of collagen. But these procedures should not be promoted as tissue-tightening or wrinkle-reduction (treatments). Their primary target is pigment in vessels."

Fractional resurfacing, nonablative technologies

As for fractional resurfacing, Dr. Narurkar adds, "The consensus is that fractional resurfacing is intermediary between ablative and nonablative technologies. I don't believe it will address deep rhytids as a CO₂ or erbium: YAG will. But it does a pretty good job of addressing texture and pigment. In addition, it may hold the potential for treating certain pigmentary disorders such as melasma, which are very difficult to treat with traditional technologies. However, we still need to study its long-term efficacy."

Nonablative technologies, on the other hand, fall into three basic categories:

Nonablative resurfacing options provide the widest variation in results, Dr. Narurkar cautions.

"Any wavelength, all the way from 500 nm to the infrared spectrum, can stimulate collagen," he says. "But what does that mean to the patient? To what degree does one get collagen contraction?"

Remodeling technologies

Among tissue remodeling technologies, unipolar RF devices have undergone the most extensive research.