Laser Skin Resurfacing in Caucasian and Ethnic Patients
The role and place of laser skin resurfacing is rapidly evolving in the field of facial plastics. Used alone, the laser has enjoyed success in the treatment of facial scars, skin lesions, and rhytids. Dr. Jose Barrera, MD is a certified laser surgeon and has been named a Top Doctor in Laser Resurfacing by his patients and Realself.com. Dr. Barrera has treated patients of different ethnic backgrounds including Caucasians, Hispanics, African-Americans, and Asians with success. Dr. Barrera has laser skin resurfacing expertise using the Lumenis Ultrapulse CO2 Fractional Laser and the Syneron Candela CO2RE Fractional CO2 Resurfacing systems, ResurFX Erbium Glass laser for wrinkles and scar treatment, Nd:Yag laser for leg veins and vascular lesions, and Intense Pulse Light (IPL) for treating rosacea, redness, brown spots, and age spots. Learn more about aesthetic skin conditions which are treated by laser at Aesthetipedia Home Page.
Follow our patient during her recovery after Laser Skin Resurfacing.
There is a growing trend in the use of lasers for laser skin resurfacing. With improved technology, patients are able to confront dermatologic concerns in an office-based setting and with outpatient procedures. Conditions such as photoaging, acne vulgaris, freckles, unwanted hair, rosacea, fine lines and wrinkles, broken facial capillaries, leg veins, birth marks, scars, age spots and sun spots (dyschromia) can be treated with laser skin resurfacing. Fractional CO2 laser resurfacing and non-ablative ResurFX photofractional lasers improve skin texture, abnormal color, and facial scars.
Understanding Your Skin Type
Skin types and colors vary depending on ethnicity, sun exposure, and aging. The Fitzpatrick scale devides skin types into six categories, I through VI, with I being the most fair, and VI being the most dark. Type I patients always burn while Type VI never burn. The color of skin is dependent on the number, density, size, and activity of melanosomes as darker skin has a higher number of larger melanosomes. Additionally, darker skin types, Fitzpatrick V and VI, have thicker and more compact skin layers with thicker collagen bundles, which increase the epidermal barrier and reduce skin sensitivity. This barrier delays skin damage from the environment and ultraviolet radiation and aging in darker phototypes when compared to lighter skin types. Due to these histologic differences, darker skin is at increased risk for injury due to incidental laser absorption by melanin, problems with post-inflammatory hyperpigmentation, and decrease of melanin production leading to hypopigmentation.
How Does Laser Skin Resurfacing Work?
While there are many of types of lasers, the fundamental principle of laser skin resurfacing is the same: all lasers treat the skin by targeting a specific chromophore. A chromophore is an endogenous molecule that has a unique absorption spectrum and peak absorption wavelength. The main chromphores of the skin are hemoglobin, melanin, and water. Lasers are designed at a specific wavelength for a particular chromophore to cause targeted heat and thermal damage that promotes new collagen formation and skin tightening. Most lasers use water in the dermal layer as the target chromophore. Melanin has a broad absorption spectrum (from 250nm to 1200nm) and will compete to absorb laser light of short wavelengths. The selection of a laser with a longer wavelength can reduce the risk of dyspigmentation in darker skin types. Other variables important to lasers include the thermal relaxation time, pulse duration, and energy fluence. The thermal relaxation time is the time required for a tissue to cool to half the temperature to which it was heated. Heating the tissue for time longer than the thermal relaxation time can cause thermal damage to surrounding tissue. In darker skinned individuals, it is important to select a pulse duration longer than the thermal relaxation time without changing the energy, so that the same amount of energy is delivered over a longer time period, minimizing damage to surrounding structures. The energy fluence is the Joules per square centimeter of energy absorbed by the target. The laser fluence may be decreased to protect the epidermis and surrounding tissues and multiple treatments may be needed to achieve the desired effect. In order to reduce laser complications in patients with darker phototypes, it is important to select lasers with longer wavelengths, longer pulse durations, and to cool the skin before and after the procedure to avoid further heat damage.
Classes Of Lasers Used For Laser Skin Resurfacing
The major classes of lasers include ablative and nonablative lasers in both nonfractionated and fractionated varieties as well as radiofrequency resurfacing. Ablative lasers are more aggressive and function similar to a skin peel with prolonged recovery time with a higher adverse event profile. Nonablative lasers preserve the epidermis and target the dermal tissues to promote collagen formation. These nonablative treatments are milder and reduce the adverse event profile and recovery time. Fractionated lasers are designed to target microscopic treatment zones (MTZs) to create columns of thermal injury with surrounding normal skin. This promotes healing and improves skin texture compared to nonfractionated lasers without the high side effect profile of ablative lasers. Dr. Jose Barrera, MD, uses the Lumenis Ultrapulse and Syneron Candela CO2RE Fractional Laser Skin Resurfacing Systems. Laser skin resurfacing effectively treats the skin’s surface, middle, and deep dermal levels improving skin tone and texture, sun-damaged skin, age spots, and scars. Radiofrequency resurfacing is a nonablative technique that uses a low temperature to penetrate dermal tissues and promote collagen healing. Fractionated bi-polar radio frequency (RF) precisely directs matrix treatments to produce collagen, reduce acne scars, improve mild to moderate wrinkles, and superficial skin discolation. Dr. Barrera utilizes the Sublative RF laser system to improve virtually all skin types. Ablative lasers target water molecules in the epidermis, causing vaporization of skin cells and retraction of the dermis with collagen formation. There are several options for laser therapy and it is important to determine the expectations of your patient while balancing the risks and benefits associated with laser therapy in patient-specific phototypes.
Treatment Goals For Laser Skin Resurfacing
Laser skin resurfacing may be considered for a variety of indications and the goals of the treatment should reflect the patient presentations.
1. Fine Lines and Wrinkles
There is an increased desire in all patients to achieve more youthful and refreshed facial skin. Over time, facial skin experiences photodamage, soft tissue volume loss, lines and rhytides, abnormal pigmentation, and irregular textures. Fine Lines and Wrinkles can be improved with a Liquid Facelift San Antonio using a combination of Fractional Laser Skin Resurfacing and Dermal Fillers. Learn more about treating Fine Lines and Wrinkles.
2. Dyschromia (Brown Spots, Age Spots, Sun Spots)
The primary concerns of patients may vary depending on ethnicity and skin type. In one study, Hispanic patients presented with primary complaints of acne vulgaris, eczema, contact dermatitis, photoaging, facial melasma, and hyperpigmentation. In another setting, an African-American population complained of acne vulgaris, dyschromia, contact dermatitis, alopecia, and seborrhea dermatitis. Asian patients typically present with pigmentary disorders, facial melasma, freckles, lentigines and dyschromia. Dyschromia is a common presentation of darker skinned patients and it is important to distinguish between melasma and postinflammatory hyperpigmentation when considering laser skin resurfacing.
3. Laser hair removal
The use of lasers for hair removal relies on melanin absorption within the hair follicle. Laser hair removal may be complicated in patients with darker skin due to disruption of melanin and subsequent risk for hypopigmentation at the site of hair removal. With this in mind, longer wavelength lasers (1064-nm Nd:YAG) with lower fluences and post-procedural cooling may be used successfully in darker skin types for the treatment of hypertrichosis and pseudofolliculitis barbae. Intense Pulse Light and Diode Lasers can also be used to remove unwanted hair. The Lumenis IPL and Lumenis Light Sheer are laser systems which can provide benefit in hair removal.
4. Keloids and hypertrophic scarring
Keloids and hypertrophic scarring are very common patient complaints in the African American and darker skinned population. Laser skin resurfacing of thickened scars may be considered in combination with topical kenalog or intralesional steroid injections as well as 5-flurouracil treatments for scar remodeling. These effects may facilitate intralesional steroid or 5-FU injections.