Over the past 6 years much has been learned about the effects of the KTP and Erbium:YAG lasers to rejuvenate our wrinkled skin. Previously in this column in an article called "Facial Skin Resurfacing", I alluded to these newer devices which go below the skin surface leaving the epidermis intact and not wounded. It seems that these new devices approximately two each year have passed FDA approval since then and are being heavily marketed. The major differences in results are that the skin surface is not removed or modified, therefore the down time for epithelial regrowth is not a factor. The down time is reduced from 2 weeks or 2 months to 2 days or none. What is really happening when you are treated with these lower frequency lasers or radio-frequency devices?  The experimental thought is that by heating or wounding the upper surface of the dermis, 100-500 microns below the surface, healing takes place with the contraction or shortening of existing collagen fibers, and the development of new collagen for up to 6-8 months. The problem is, "Can this change, if it does take place with any consistency, cause the epidermis to flatten and appear younger?"  While patient satisfaction appears very high after spending all that money, independent observation of the disappearance of wrinkles lists improvement at mild to moderate in 20-50% of patients. What is consistent is that an increasing number of treatments on a monthly basis gives better, but not permanent results. These are broad generalizations, but the TV demo says we can do a full face with one treatment and it will improve over a 6 month period.  Sure! Maybe! And everybody observing the swelling and redness immediately after the treatment says, "I want one."  These devices are being used for fine wrinkles, brow lifts, crows feet and full face treatments. They cannot begin to touch the deep wrinkles or nose to lip folds.

So we must understand that these new devices do not have a long history of use and are purposely lowering our expectations of what can be achieved with the promise of lower risk and less down time. The candidates at this time appear to be younger people, age 30-50 years with fine wrinkles, increased vanity and lots of money at $2,000 per treatment. Now as that market expands so will our understanding of the machines� potential. The treatments are either proceeded with a local anesthetic gel or a simultaneous cooling of the skin using a cryogen cooling spray to prevent surface injury. There is intermittent mild burning pain with the delivery of the laser energy, but not enough to require pain medication. As with previous Laser skin resurfacing, patients who have been on retinoic acids are not candidates until 1 year after completion. Following treatment ice packs and topical steroids are applied to the skin to reduce redness and swelling. Most people leave the doctor and just go about their business.

The newest entry into this field is the radio-frequency device, Therma Cool TC introduced by Thermage. This has been undergoing testing at Stanford but I have not seen the published results of a 40 patient group. In this device a spray intermittently cools the electrode and indirectly the skin. I tried to compare the before and after photos, but in each case the after photos were brighter than the before photos. Without accompanying biopsy results in each patient, we cannot know if collagen was actually increased. So the results cannot be evaluated at this time.  Since the skin is actually heated to high temperature, 167 F  degrees for 2.5 seconds, there have been superficial burns with blistering in a very small, 5-6%, percent of patients. Beauty is in the eye of the beholder and whether these theoretical collagen changes will take place in your face you will never know unless biopsies are performed concomittantly and then it is no longer noninvasive. All papers on this subject end with this thought . "The development of non-ablative rejuvenation of human skin is at an early stage. The narrow "therapeutic window" of laser-induced dermal heating and epidermal cooling must still be optimized so that effective treatments can be obtained routinely. Clinical verification of effective treatment parameters will be obtained through further human studies. Most importantly, understanding the relationship between dermal thermal injury and synthesis of new collagen is paramount."
 1. Nelson, J.S. in Seminars in Cutaneous Medicine and Surgery, December 2002.