Tuesday, April 21, 2009

Fractional CO2 article from Vogue Magazine

Another great article. You can find it in Vogue April 2009. Silk Touch offers treatments using the Smartxide DOT Therapy and we also offer Affirm skin tightening treatments.

Easy Does It

In the past, laser resurfacing has been epically harsh or barely noticeable.

Catherine Piercy reports on the breakthrough that’s finally getting it right.

It’s a bright winter morning when I arrive at dermatologist Deborah Sarnoff, M.D.’s Park Avenue laser center for a sneak peek at the Next Big Thing in dermatology. My mind is racing with visions of the latest high-tech wizardry; 3-D laser light goggles, wrinkle-obliterating bodysuits, skin-searing wands. You know.

So imagine my surprise when Sarnoff swings open the door to a pristine white treatment room and reveals…an eggplant, perched in a reclining chair atop its own paper surgical gown.

“I know, I know, “she says with a laugh. “But you’ve got to see this.”

And then, like the Jetsons—esque hostess of some far-out futuristic culinary show, she aims a nearby laser head at that dark, ripe flesh, and fires, searing a square grid of tiny, tightly packed pink dots onto its surface (and filling the air with the scent of cooked eggplant).

What Sarnoff has just demonstrated is fractional carbon dioxide resurfacing, and it may be the biggest breakthrough in laser skin care in nearly a decade. The spot eradicating, line-smoothing results, swears Sarnoff, are good enough “to turn a prune-face” back into a taut, juicy plum, and they has the most conservative dermatologists feeling giddy with excitement.


If the new class of fractional carbon dioxide lasers sounds vaguely familiar, that’s because their name, like the technology behind them, merges the best of two well-established lasers—the mighty CO2 and its gentler cousin, fractionalized therapy—into a single power tool.

Searing through the uppermost layers of the skin in a single uniform sheet—delivering in effect, a second-degree burn to the face—the original CO2 lasers, with their 10,600-nanometer beams, seemed a godsend when they debuted in the early nineties. Dermatologists hailed their ability to diminish severe sun damage and dramatically tighten skin in just one treatment, but they now acknowledge that their reputation is a “blowtorches” was no coincidence. “Do you have three weeks to hide from your friends, family, co-workers?” asks David Goldberg, M.D., a clinical professor of dermatology at New York’s Mount Sinai School of Medicine, of the CO2’s downtime, which included two weeks of raw oozing, “weeping” skin and up to six months of lingering redness.

The kinder fractional procedures of recent years—lasers like Fraxel and Affirm—delivered their weaker 1,550 nm of erbium energy in a series of micropixels (rather than a single beam), projected on the skin as a checkerboard grid. By poking selective holes in the skin’s surface, they left what Sarnoff calls “a tiny island of healthy skin behind” for every dot they vaporized. The result: pinkish skin that healed in up to two days and a noticeable improvement in fine lines and sun spots (after three to five $1500 treatments). The concentration of Fraxel was genius, that it redefined the way doctors ______about deliver____ laser light, “says Manhattan dermatologist Alexiades, M.D.
But for women with deeper wrinkles, severe sun damage, and limited reserves of time and patience, “the results were mediocre at best.”

Combine the principles of each—a friendlier, fractionalized delivery system with all the strength, depth, and reach of the original CO2—and you’ve got the new fractional CO2. While the chief function of any laser is to temporarily wound the skin, triggering the production of fresh new collagen fibers as it vaporizes old, damaged tissue, none of these new hired guns which go by the brand names of Fractioanl Re:pair (from Reliant Technologies, UltraPulse ActiveFX (Lumenis) and SmartXide DOT Therapy (Deka)—inflict anything close to the harrowing collateral damage of their prehistoric predecessors. “In most cases, we’re talking about four to seven days of what looks like a very bad sunburn,” says Goldberg. “And don’t forget, it’s usually a one-shot deal.”


The innovations don’t stop there. Like the keypad on your gym’s elliptical machine, the fractional CO2 allows derms to tailor the intensity of its pitch pattern—the distance between each little dot as well as its depth—with the push of a button. Sarnoff might set the device “closer together for a more aggressive treatment around the mouth or crow’s fee,” farther part “on sensitive areas like the jawline.”

When I drop by dermatologist Frederric Brandt, M.D.’s Manhattan office, he shows me the Lumenis ActiveFX”s newly customized handpiece. As I peer at its lens, he flips through an assortment of tiny dancing geometric CO2 light patterns—circles, parallelograms, hexagons, and triangles—that, when projected onto the skin, access “the hard-to reach angles around the nose or mouth.” Putting an end to a “40-year old face floating above a 50-year-old chest,” the new CO2s also treat “ the neck, forearms, and tops of the hands”—fragile areas that were prone to scarring and discoloration under the reign of the old CO2.

To combat the first signs of aging, dermatologists like Manhattan’s Patricia Wexler, M.D., are sticking with gentler resurfacers, like the original Fraxel (now called Fraxel Re:store). However, there are instances where Wexler feels the potency of fractional carbon dioxide is appropriate for younger skin—for example, to treat acne scars in patients as young as their 20s.

Roy Geronemus, M.D., a dermatologist in New York, is using his Fraxel Re:pair to diminish telltale plastic-surgery scars around the face and breasts, and is even using it around some patients’ eyes as a substitute for surgery. One look at the before and after pictures he recently presented at the American Society for Dermatologic Surgery conference in Orlando, and I can see why: Droopy corners, hooded eyelids, and stubborn crow’s feet virtually disappear after a single blast. At approximately $2,000 a session, “it’s a fraction of what you’d pay for an eye-lift,” he says. (A full face may cost upwards of $4,000.)

New York plastic surgeon Sam S. Rizk, M.D. sends patients for fractional CO2 as a skin-tightening “complement” to the muscle-lifting effects of his endoscopic face- and neck-lifts.

In some cases—lip and forehead lines, cracks at the corner of the mouth—Wexler is using fractional CO2 in place of fillers like Cosmoderm. As she points out, “you don’t have to come back every eight weeks to have it touched up.” The new CO2’s effects last, by most estimates, between five and eight years.


Like ay emerging technology, the first generation of fractional CO2s are works in progress. Lasers, says Goldberg, “are like laptops—your new model is constantly being updated.” If the old CO2 was the truck-size monitor on your first Macintosh, the fractional CO2 is your new MacBook Air: fabulous but soon to be tweaked in exciting new ways.

Though they remain unsuitable for darker skins, which may be prone to heat-related scarring, the new CO2s have slightly more range than their predecessors, extending from fair to light-olive and, in some cases, light Hispanic and Asian skin tones. As for hypopigmentation (small, permanently colorless patches of skin that appeared in patients up to a year after the old CO2 procedures were performed), “fractional technology seems to have virtually eliminated the risk,” says Alexiades, who is currently conducting the FDA trials for Deka’s DOT Therapy device. “But it’s still early, and there may be limits to how close together each little dot can be placed without causing a similar effect.”

Not unlike the feeling one might experience while looking at Sunday Afternoon on the Island of La Grande Jatte, Georges Seurat’s pointillist painting from 1884, with its tiny pixilated dots and early Neo-Impressionist overtones, the significance of the new CO2 seems greater than the sum of its own parts. “Ten years ago, I couldn’t have guessed that we’d be delivering carbon-dioxide laser light without the downtime or the risks,” says Goldberg. “Just imagine what’s next.”

A cure for cellulite?

I spotted this article and wanted to share it with our clients. Our Affirm laser helps with cellulite, stimulating collagen production within the skin. Fat transfer can also be done by Dr. Kerr.

A Possible Cure for Unsightly Cellulite?

February 9, 2009

Findings from a new study published in the November/December 2008 issue of Aesthetic Surgery Journal suggest that a combination treatment using laser energy and fat transplantation shows promise in significantly improving cellulite. Cellulite is a common condition that gives the appearance of lumpiness and dimpling across the skin and is most prevalent in the thigh, hip, and buttock areas. Currently some treatments may provide temporary improvement in the dimpled appearance of cellulite, but to date there is no proven, permanent “cure” for cellulite. “Cellulite is caused by bands of fibrous tissue that connect the muscle to the skin,” says Alan Gold, MD, President of the American Society for Aesthetic Plastic Surgery (ASAPS). “If these bands are tight and the fat between the muscle and the skin bulges out between them, there will be dimpling over each of those bands. There is nothing otherwise special or unique about the fat itself in those areas.” Almost all women (and some men) have cellulite, stemming from genetic predisposition, hormonal changes and weight gain.

The treatment presented in the ASJ study first uses 1064-nm Nd:YAG laser energy conducted underneath the skin to stimulate collagen formation, skin tightening and, on a deeper level, to reduce fatty tissue. Laser treatment is followed by injections of the patient’s own fat to fill in the depressed areas. Along with visible improvement, there are very few adverse effects, most of which are mild and temporary.

“The search for the cause of cellulite and effective treatments is ongoing, however, the combination of a minimally-invasive pulsed laser treatment and autologous fat transplantation represents a viable option for women who have severe cases of cellulite,” says Robert Gotkin, MD, a plastic surgeon in New York, NY and one of the authors of the study. “All treatments have limitations and since cellulite is a chronic condition, the patient must understand that there are no miracle procedures and multiple treatments may be necessary.”

The doctors treated 52 women between the ages of 18-47 with severe cases of cellulite who had not undergone previous surgical treatments such as lipoplasty or subcision (cutting scar tissue just below the surface of the skin). After the laser tightening and fat injections, patients received a massage to evenly distribute the fat and returned the next day for physiotherapeutic postoperative treatments. The follow-up period ranged from a year to almost 3 years, and nearly 85% of the patients rated their results as “good” or “excellent”.

Various methods of treating cellulite have been proposed including:

  • Liposuction
  • Fat Injections
  • Lower Body Lift
  • Endermologie
  • Injection lipolysis
  • Herbal and dietary supplements
  • Creams and lotions

While some of these procedures, such as fat injections and lower body lift, have been shown to be beneficial in appropriately selected patients, others such as injection lipolysis and lotions do not have any scientific data supporting their efficacy. Liposuction, while highly effective in reducing fat deposits and improving contour, sometimes makes cellulite appear worse.

Nd:YAG laser lipolysis and autologous fat transplantation are proven procedures for various aesthetic conditions, and, the use of these same modalities for cellulite treatment, may offer both a safe and effective new alternative. “Although there is currently no ‘cure’ for cellulite, this study provides hope for people who have the most severe cases,” says Foad Nahai, MD, Editor in Chief of ASJ.

About ASJ
Aesthetic Surgery Journal, owned by the American Society for Aesthetic Plastic Surgery and published by Elsevier Science, is a peer-reviewed international journal focusing on clinical and scientific developments in cosmetic surgery and cosmetic medicine. The Journal has subscribers in more than 80 countries. Besides its affiliation with ASAPS, the leading organization of board-certified plastic surgeons who specialize in aesthetic surgery, ASJ is also the official English-language journal of plastic surgery societies in Brazil, Israel, Mexico, Japan, Korea, Thailand, Costa Rica, Colombia, India and The Netherlands, and it is the official journal of the Rhinoplasty Society. ASJ’s Editorial Board includes plastic surgeons and Interspecialty Editors representing anesthesiology, dermatology, ophthalmology, otolaryngology and clinical psychology. For information on the Journal, as well as subscriber and pay-per-view access to the Journal’s full text and graphics, go to www.aestheticsurgeryjournal.com.

The American Society for Aesthetic Plastic Surgery, the leading organization of board-certified plastic surgeons specializing in cosmetic plastic surgery, includes Active-Member plastic surgeons certified by the American Board of Plastic Surgery or the Royal College of Physicians and Surgeons of Canada, as well as International Active Members who hold equivalent credentials in their own countries. For information, visit www.surgery.org.

Written by admin · Filed Under Medical Spa News