Lasers, fillers provide gentler facial rejuvenation

Key Points

"We now look at the whole patient, and the individual issues that she has, and then combine anti-aging treatments, including fractional devices, nonablative lasers, Botox (onabotulinumtoxinA, Allergan) and fillers, together to get the most optimal results in the shortest amount of time," says Suzanne Kilmer, M.D., founding director of the Laser & Skin Surgery Center of Northern California, Sacramento.

This approach differs from the anti-aging treatments of the past, which consisted of tightening and bleaching the face.

An easier way

Today, Dr. Kilmer says, a gentler, multistep approach is used.

"First, for anything that is movement-related or for an area we want to relax, we use botulinum toxins to relax the areas ahead of time, so they are not moving and not creating tension or wrinkles when we proceed with the laser procedures. These laser procedures will be tightening up or evening out the skin's color and textures.

"As a result, there is not as much force against what the laser is doing. Then we put volume back in, because a lot of the wrinkling that we used to think was just saggy skin is from volume loss," says Dr. Kilmer, who is also associate clinical professor at the University of California, Davis.

Multistep treatment

The fractional laser pokes thousands of tiny holes, helps with collagen remodeling and new collagen stimulation, and also is used to even out skin tones and colors.

Other lasers can be used prior to and in combination with the fractional laser. In some ways, these lasers do a more specific job better, Dr. Kilmer says.

"For example, if a patient has several brown spots that have been there for a long time, they can be treated more effectively with a Q-switched laser or a KTP laser on the same day that the fractional laser is used.

In addition, if the patient has sebaceous hyperplasia or nevi or lumps and bumps that need to be smoothed, that also can be done prior to fractional laser treatment.

"Patients will have the same downtime with the combination treatments, and, if anything, they heal faster with the fractional lasers than they would if they had the one procedure alone," Dr. Kilmer says. "The fractional lasers actually stimulate collagen remodeling and wound healing; therefore, things tend to heal up faster if you do a combination treatment."