Photorejuvenation is one of the newest entries on the list of words that have been invented to describe new technological applications. It refers to light-based treatments designed to improve the appearance of the skin. There are two types of light technology, lasers and intensed pulsed light (IPL) sources. Lasers emit tremendously magnified light in a single or narrow band wavelength, and different lasers do different things to skin. Intense pulsed light (IPL) is also magnified light but uses a much broader portion of the spectrum. IPL is promoted for many of the same indications as are lasers. IPL is also used to treat sun damage and skin cancers as part of a process called photodynamic therapy. Magnified light sources are frequently used in the treatment of both cosmetic and medical skin conditions. Photorejuvenation technology has been further classified into two categories according to the goals of treatment. Some machines are designed to treat skin discoloration; others are engineered to target skin structures in an effort to improve skin texture. Very broadly, this translates to mean that various light sources are used to treat brown spots, red spots, and wrinkles. Every laser or light source has its advantages and disadvantages things it does well and things it does poorly.
Laser and light treatments are considered ablative or nonablative, depending on how much damage the skin sustains during treatment. Ablative treatments are those causing significant burns that require long healing times; these carry more risks, yet generally yield better and longer lasting results. Most ablative lasers can be “dialed down” to nonablative settings, but results are less impressive. Ablative laser resurfacing can be performed with numerous lasers, including a specialized carbon dioxide (CO2) laser, an erbium: YAG laser, and several new lasers such as the Fraxel. The first surge of interest in laser resurfacing occurred a decade ago when the specialized CO2 lasers came on the market. However, it soon became evident that high doses of laser energy were required for good effect and that those high energy levels were yielding a significant rate of complications such as permanent skin pigment alterations and scarring. Even so, some surgeons prefer ablative lasers for treating wrinkles around the mouth and eyelids.
Fraxel is the proprietary name of a laser manufactured by Reliant Technologies that uses a mechanism of action dubbed fractional photothermolysis. The advantage of this partic ular laser technology is reported to be its ability to treat many of the manifestations of photoaging, including wrinkles, fine lines, and pigment irregularities, better than nonablative laser treatments but without the prolonged healing time of ablative treatments. To date very few studies on the effectiveness of fractional photothermolysis technology have been completed, so although the concept is promising, the value of this type of laser is too early to call. So far it appears that multiple treatments at significant cost will be required for visible effect. If this laser proves successful, we can look forward to a fl urry of “fractionating” and “fractional” technologies that may or may not have equivalent benefits.
Recovery after ablative laser resurfacing can be quite prolonged, much like that after a phenol peel. Depending on the technique used, skin healing may take weeks, during which time the patient may experience significant pain and swelling. The skin will remain red for weeks, pink for even longer. Some physicians cover the treated skin with dressings for much of the healing phase; others require the patient to apply thick layers of ointment regularly.
The pendulum swings back and forth between chemical peels and laser treatments as the preferred method of skin rejuvenation. An individual provider’s recommendation will be driven by his or her experience, comfort level, and available technology.
The bottom line: The usefulness of laser rejuvenation/resurfacing depends mainly on the willingness of the patient to accept the significant downtime and risks that accompany ablative treatments. Lesser procedures have significantly lower cost/benefit ratios.
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