Noninvasive Techniques for Management of Aging Skin

Dr. Larrabee and Dr. Henderson agreed that they do not use dermabrasion as much as in the past, but said that it is useful for scars, pitted skin from acne, and after Mohs reconstructive surgery. It is rare for anyone to perform a full-face dermabrasion, Dr. Larrabee said.

In addition to being safer than dermabrasion, laser treatment allows more precision and is more predictable for skin resurfacing. This treatment is suitable for all patients who want skin resurfacing. You can precisely set the depth of the laser to address pigment changes, severe wrinkles, or a combination of the two, Dr. Henderson said. You can tailor it to what the patient wants to achieve.

Contraindications to laser resurfacing include dark skin, keloid or hypertrophic scarring, and use of Accutane™ within the past year. In Dr. Larrabee’s opinion, laser should not be used to tighten neck skin. He said that sagging neck tissue should be treated with a face lift, not a laser.

All patients who undergo laser surgery should be pretreated with an antiviral agent to prevent oral herpes reactivation. The skin should also be pretreated with a bleaching agent plus Retin-A to reduce pigment problems and speed healing, Dr. Henderson added.

Dr. Carruthers said that two forms of the Ultra Pulse Encore™ pixilated carbon dioxide laser are useful for cosmetic procedures to tighten baggy lower eyelids; unlike Dr. Larrabee, she uses this type of laser for loose skin on the face or neck. The Deep Fx laser head of the Ultra Pulse Encore is used to tighten tissue and has an advantage over older lasers because of pixilation, which spares more normal tissue and speeds healing. At the most, five to seven days of rest are needed to recover from skin-tightening procedures. The Active Function utilizes the same pixilation and is carbon dioxide-directed; this is used for more superficial procedures, like a deeper intense pulse light, Dr. Carruthers said.

Recovery time following laser resurfacing depends on the depth of the treatment. A minimum of five to six days is needed; for deeper procedures, it takes about 10 days to recover and skin redness may persist for a few weeks to a few months.

Laser resurfacing is usually accomplished in one session. The cost varies according to the depth of surgery and the type of anesthesia required, and can range from $2000 to $3000 for a full-face treatment to up to $5000 for skin that has more sun damage.

Thermage and Titan

Thermage is also used to tighten skin on the face and the neck. The first type of thermage to become available used radio frequency as an energy source. More recently, Titan™, a technique that utilizes infrared laser, has become available. In addition to uses on the face, it is promoted for use on the stomach and thighs.