Question: I have heard of something called photo facial. What is this and what does it do?
Answer: A photo facial is an intense pulse light treatment that can be performed in a variety of ways. Most places perform a single pass of intense pulse light treatment and this light energy targets pigment and vascularity on the face, but can also be used on the body as well. It injures the pigmented and vascular structures and then the body slowly resorbs these structures and it essentially clears these abnormalities from the skin in a way that creates no downtime. Frequently, several episodes or treatments are necessary to create the desired effect. At Quintessa Medical Spa we perform a photo facial in a little bit of a different way in that we treat the face with several passes of this intense pulse light all at one time, creating a much more significant effect, which will greatly improve the result and decrease the number of episodes or treatments that are necessary.
Question: I have significant sun damage on my chest. What can be done to eliminate these fine lines and spots?
Answer: The discolorations in the decollete area or upper chest area can be treated with intense pulsed light or broadband light, and this does a very nice job of improving the discolorations but does very little for the wrinkling and surface irregularities. We are starting to use the Ultherapy device, which is an ultrasound-based technology for tissue tightening, in the decollete area and have seen some relatively impressive results. We tend to combine this treatment with ProFractional laser resurfacing by Sciton, which is an Erbium laser that can drill small tunnels in the skin, and these tunnels are small enough that these can be performed on the skin outside of the facial region without causing any scarring or unexpected side effects. The combination of these two treatments does cause some deeper new collagen deposition, and this in turn then tightens the skin and deeper tissues and improves the overall texture and wrinkling of this region.
As far as I know, virtually all photorejuvenation laser systems use some form of intense pulsed light. Intense pulsed light has been around for many years, but they have made some significant improvements in the technology, specifically the BBL System by Sciton, which stands for broadband light, seems to be distinctly superior over our previous technology of intense pulsed light in that it has a significant amount of “punch.” In essence, the broadband light seems to be much more efficient at treating vascular and pigmented lesions and we therefore tend to turn down the power setting quite a bit compared to our prior intense pulsed light technology. This allows us to treat in a much safer and more comfortable manner and yet we end up getting superior results when compared to intense pulsed light. We have had several employees that have extensive experience with intense pulsed light in the past and now have been trained on our new broadband light or BBL technology. These employees have been extremely impressed with the BBL therapy as it seems to provide a more efficacious treatment with less discomfort and less risk of any complications. At Quintessa Medical Spa we will frequently combine BBL technology with other laser systems such as the ProFractional laser and/or micro laser peels to not only rid our patients of unwanted pigment and vascularity, but also to improve their overall skin texture and provide for wrinkle reduction.
No, intense pulsed light treatments on the skin should not be able to damage silicone breast implants. First of all, the intense pulsed light is only going to penetrate a matter of a few millimeters and breast implants are classically placed much, much deeper than this and furthermore, the light energy itself really is not going to injure the breast implant, but I would caution that the heat generated by the intense pulsed light could theoretically affect the silicone capsule that the implant is made of. This would only be true if the implant was directly under the skin and I assume would then only be pertinent for individuals that has have a complete mastectomy with silicone implant reconstruction and in whom are extraordinarily thin with a very small amount of subcutaneous fat volume. Classically, when we perform intense pulsed light treatments on the chest area, these intense pulsed light treatments are only performed in the decolletage area, which would be above and between where the breast implants would be placed in the first place. I would therefore recommend that in patients that have had a full reconstruction with a breast implant that they avoid treatment directly overlying the implant itself to avoid any possibility of injury, even though that risk of injury would be incredibly low.
Historically speaking, IPL was less effective than other modalities such as the diode laser, specifically the LightSheer, or the Alexandrite laser that is essentially considered the gold standard in hair removal technology. Today, with the advent of broadband light by Sciton, which is a more advanced and more powerful form of intense pulsed light, laser hair removal can be accomplished quite successfully using this modality. At Quintessa Medial Spa we not only have the broadband light by Sciton, but we also have the new laser hair removal system by Lumenis called the Duet, which combines six diode laser heads in a single device in association with a suction that performs laser hair removal in one-sixth of the time and with virtually no discomfort and no need for messy gels. We are very excited about this new technology as I think it has taken another revolutionary step for hair reduction.
Yes, Asian patients can indeed have intense pulsed light treatments. Obviously the device is set with a different filter and different energy settings to take into account the significant increased pigmentation that is in Asian skin. We further tend to take significant precautions with Asian skin to prevent postinflammatory hyperpigmentation as it is extremely common in this skin type. These precautions include very consistent use of a sunblock as well as consistent use of a hydroquinone product and frequently the additional use of a Retin-A type product as well. We want to be very careful that these products do not cause any irritation to the skin as the irritation can also contribute to postinflammatory hyperpigmentation; however, when this is performed properly in conjunction with the intense pulsed light, we can successfully treat very difficult skin conditions such as melasma even in Asian patients. They are counseled that even very brief amounts of sun exposure can cause the abnormal pigmentation to recur.
Absolutely, the skin will still tan after intense pulsed light. If a patient is having intense pulsed light treatments due to pigmentary issues, I obviously would then highly recommend that they not try to tan as the pigmentary issues will just recur and worsen. If patients are having intense pulsed light treatments for vascular lesions, I also again would recommend that they try to avoid the sun, but if they did end up getting sun exposure, they should tan in a natural way without any difficulties or influence from the IPL treatment. We all know the damaging effects of the sun’s rays and I counsel all of my patients to wear sunblock on a daily basis and should they desire any sort of improved or darker color to their skin that they consider some high end bronzing agents as the newer products that are available including the products that we have at Quintessa Medical Spa can provide a very natural appearing tan-like quality to the skin without the damaging effects that come with the actual exposure to the sun.
Though we are not usually using settings with enough power to actually burn the hair off the face when performing photofacials, it is theoretically possible to do so due to the fact that the intense pulsed light is absorbed by the melanin, which is within the hair shafts. This is not usually within the fine hairs of the face as these typically do not have any significant amount of melanin within them, but if someone has darker or coarser hair, the photofacial can certainly injure this hair. The settings on the intense pulsed light machine are different and the filters are also different when we are doing a photofacial versus an intense pulsed light hair removal treatment, so to answer your question, classically intense pulsed light will not burn the hair off of somebody’s face during a photofacial treatment.
Depending on the patient’s skin type and problems, I would most likely recommend the Obagi Skin Care System as this is one of the more aggressive approaches for skin rejuvenation and maintenance. I would have the patient on the Clear, which has hydroquinone in it. I would also recommend the use of Retin-A on a daily basis of tolerated. It is recommended that the patient discontinue the Retin-A and hydroquinone two to three days before the intense pulse light treatment and then they can resume it the day after the treatment again. Obviously a very good sunblock on a daily basis is expected of patients so that their skin can be rejuvenated to the highest degree and they will maintain this rejuvenation with the help of the sunblock.
There are several modalities to consider when treating dark spots after a TCA burn. These are due to postinflammatory hyperpigmentation and this type of pigmentation can be very difficult to completely eradicate; however, with multimodality treatment, we can very successfully improve the appearance of these types of lesions. Treatment includes regular and judicious use of sunblock. Do not confuse sunblock with sunscreens. Sunblock would have titanium dioxide and/or zinc oxide in the ingredients and this would be a sunblock preventing any significant UV from damaging or causing further pigmentation to the skin. This is by far and away the most important step in a treatment regimen for postinflammatory hyperpigmentation. Other additional treatment options would include hydroquinone applied at least daily if the skin is able to tolerate it. If hydroquinone tends to irritate the skin, this can further produce postinflammatory hyperpigmentation and I would therefore place the patient on Tri-Luma, which has hydroquinone and Retin-A as well as a steroid to reduce the inflammatory reaction. Broadband light or intense pulse light can also be used on postinflammatory hyperpigmentation, but must be used in combination with the aforementioned treatments to prevent further pigmentation from the injury. Ultimately these areas will greatly improve over time, but there really is no quick fix for postinflammatory hyperpigmentation and most patients will take at least several months to show significant improvement and possibly six months or even longer for resolution of these lesions.