|
Fine
Lines and Sun-Damaged Skin Respond to Laser Threapy
Fine lines and sun-damaged skin are common problems for patients
who come to
our Center. The treatment for this type of condition is resurfacing,
but
what type of resurfacing is best? For quite some time, the use
of lasers
has replaced the older technique of chemical peel. There is
no question
that the old deep chemical peel produced by the use of phenol
compounds was
effective in reducing facial lines. Unfortunately, the price
was rather
steep with prolonged recovery, a relatively high risk of skin
of lightning
and the possibility of scarring. Patients are sometimes confused
in
thinking that the use of lasers provides for more effective elimination
of
lines'. Actually, the advantage of lasers primarily involves
the potential
for greater safety rather than greater effectiveness. The problem
is
deciding which type of laser to use.
The earliest surgical lasers utilized carbon dioxide as a
medium for
producing heat. The heat, which is intensely focused, was used
as a cutting
device. Indeed lasers still are commonly used as surgical cutting
tools.
Their advantage lies in precision and lack of bleeding. At our
Center,
laser cutting is commonly used in nasal and eyelid surgery as
well as in the
deeper layers of facelift surgery dissection.
The idea of using laser energy for skin resurfacing is not new
but
difficulties arose in attempting to create an even pattern of
applying the
laser energy to the skin. This obstacle was overcome by the
development of
computer-driven pattern generators.
As laser skin resurfacing became more popular, the companies
that made these
machines began to heavily market them. One of the most popular
marketing
techniques was to hire consulting doctors who were provided with
machines
and in return were expected to present glowing reports of effectiveness
at
medical meetings. In an effort to gain competitive edge companies
developed
different types of lasers that purportedly were more effective
with less
risk. Again, they depended on physician consultants to promote
the
advantages of these newer machines. Another popular marketing
technique
involves the use of the lay press. Magazines are always looking
for
"cutting edge" articles, and nothing seems more attractive
these days than
lasers.
Certainly the final answer is not yet in. However, we remain
convinced that
the choice of laser is far less important than the skill and
experience
applied to the technique. As in every operation, there is a
fine balance
between the effectiveness and risk. There is no escaping the
fact that if
the surgeon is overly aggressive in applying laser energy to
the skin,
regardless of the type of laser, the risk of complications increases.
We continue to believe that a conservative approach utilizing
the carbon
dioxide laser offers patients a high degree of effectiveness
with low risk.
We do not believe that it is wise to attempt to eliminate all
of the
offending lines. We have also found that by adopting this conservative
approach we can safely combined laser resurfacing with facelift
surgery. By
combining these two modalities, we can effectively take up the
slack
produced by aging and reduce the lines that have resulted from
long-term
skin damage with one operative session. This combination of
face lifting
and laser resurfacing has become increasingly common in our practice
over
the past few years.
Lasers will continue to play an important role in facial cosmetic
surgery.
Certainly there will be improvements in technology, but until
such
improvements are substantiated, we will continue to depend on
our long-term
experience with the carbon dioxide laser.
|
