Fractional Laser Rejuvenation

Fractional skin resurfacing targets a variable fraction of the skin’s surface area in any single session, leaving bridges of untreated tissue intact. This results in less downtime, faster healing, and the ability to treat the face, neck, chest, hands, and forearms, all with a better safety profile than previously available.

The benefits are fresher looking skin, improved tone and texture, diminished wrinkles, a reduction of brown spots and skin discoloration, and an improvement in acne and surgical scars.

Fraxel^® Restore Laser

The Fraxel Restore laser, our favorite, is a fractional Erbium-based, non-ablative laser that does not disrupt the skin’s surface. It is ideal for those who are unwilling or unable to have more than a few days of downtime. Makeup may be immediately applied after each treatment.

Fraxel Restore is our treatment of choice for dull, sallow, discolored, and sun-damaged skin. The benefits include improved skin tone, color, and texture. Administered in a series of sessions, Fraxel Restore is excellent for refreshing the face, neck, chest, hands, and arms, and can be used on skin of any color.

Age and liver spots, melasma (the “mask of pregnancy”), wrinkles around the eyes, acne scarring, surgical scarring, and stretch marks all are responsive to Fraxel treatments.

Simply put, Fraxel treatment promotes your skin’s own healing process and results in a natural rejuvenation that improves your appearance.

What is Fraxel Restore?

Fraxel Restore is an Erbium-based non-ablative laser that is safe for all skin types. Fraxel treatments can target between 5–50% of the skin surface, leaving the remaining 50–95% available to quickly heal the treated area. Since the Fraxel treatment is so precise, it is safe and effective on delicate skin areas like the face, neck, chest, and hands. You can expect two levels of results: immediate and progressive. Immediately after initial healing is complete, the surface of your skin will feel softer, look brighter, and the tone will start to become more even. Progressive results occur over the next three to six months as the deeper layers of the skin continue to heal.

How many treatments are necessary?

Depending on your skin, you can decide if you want fewer more aggressive treatments that result in more postoperative side effects (more days of social downtime), or less aggressive treatments that accomplish the same results with a few more treatment sessions and less pronounced side effects. For some skin types and skin conditions, gentle and/or fewer treatments are best. On average, three to five sessions spaced one month apart are necessary to achieve the best results.

What is special about Fraxel?

The technology behind Fraxel treatment is as revolutionary as the results it delivers. Unlike other laser treatments, Fraxel treatment is able to precisely treat thousands of microscopic areas of skin using pinpoint laser beams to penetrate the skin’s surface and eliminate old, damaged skin cells. Fraxel treatment stimulates the body’s own natural healing process, which then replaces damaged skin with fresh, glowing, healthy skin.

Fraxel laser has received FDA clearance for the following treatments:

• Wrinkles around the eyes (periorbital wrinkles)
• Age and sun spots (pigment lesions or liver spots)
• Brown spots of pregnancy (melasma)
• Acne scars and surgical scars
• Skin resurfacing, tone, and texture
• Fraxel can also help improve stretch marks

Does Fraxel hurt?

Topical anesthesia is applied before the procedure and cold air is directed across the skin during treatment to minimize discomfort. After treatment, most patients report a feeling similar to having too much sun. This sensation disappears in one to three hours.

What can I expect after treatment?

You will have some degree of redness and swelling, with the intensity and duration dependent on how aggressive the treatment was and your particular healing characteristics. Other temporary side effects may include minor itching, dry skin, peeling or flaking of skin, and a bronzed appearance. We will give you specific instructions about what to expect from your particular treatment and how to minimize the side effects.

How do I protect my new skin?

Always wear a sunscreen SPF 30 or higher and avoid direct sun exposure when you are healing and for at least three months after the last treatment. Further protect yourself by wearing a wide-brimmed hat if you expect to be in the sun.

How long do the benefits of Fraxel treatment last?

It depends upon your particular condition and how you care for your skin. Once your skin is restored, continue to protect it as described above. For condition such as melasma, it is very important to avoid direct sun exposure. We will give you specific advice based on your individual needs.

What treatments can Fraxel be combine with?

Fraxel can be combined with Botox^® Cosmetic and Dysport™ to reduce frown lines, forehead wrinkles, and upper lip lines. It can also be combined with dermal fillers such as Restylane^®, Juvederm^®, and Radiesse^® to plump and refill, add facial fullness, soften deeper lines, and enhance lips; and Sculptra^® Aesthetic or fat transfer to restore facial volume and fullness.

Pulsed Dye Laser

What is a Pulsed Dye Laser?

Pulsed Dye Lasers deliver an intense but gentle burst of light into selectively targeted areas of the skin. The light is absorbed by specific blood vessels or melanin pigmented areas in the dermis depending on the condition being treated. Factors such as the age, color and type of lesions, as well as the location on the body, all determine whether lesions can be removed.

What is the procedure for being treated with a Pulse Dye Laser?

Dr. Binstock will ensure you are as comfortable as possible; most patients are reclined or lying down depending on the area being treated. Both the patient and Dr. Binstock will be wearing protective eyewear. When treatment begins, the laser will be calibrated and parameters will be set based on the specific condition being treated, each condition and each individual is unique and these settings maximize the results you will see following treatment.

Are there any requirements for treatment – how do I know if I qualify for treatment?

The only requirement is that you have a desire to improve the condition of your skin. Most patients who receive cosmetic laser treatment opt for procedures to correct skin conditions not out of medical necessity, but because they are interested in improving the appearance of their skin without invasive surgery that would cause downtime away from daily activities. From total facial rejuvenation which involves the reduction and removal of red and brown pigmented lesions with a general firming of the skin, to the removal of sun-spot damage, patients should discuss with their practitioner which treatments are right for them.

Does it hurt?

No anesthetics are required, but they may be used. The feeling most patients report is a warming or tingling sensation during treatment. The skin being treated is additionally protected by Candela’s dynamic cooling method, DCD, which delivers a cooling mist on to the skin before the laser pulse is emitted. This cooling mist increases comfort during treatment, as well as protects the skin to minimize side effects like redness.

Is PDL Treatment safe?

Yes. In fact, treatment is so safe that it has been successfully used since the 1989‘s for the treatment of port wine stain birthmarks in infants and young children. During treatment, the epidermis is protected by Candela’s exclusive dynamic cooling method, DCD, which sprays a cooling mist onto the targeted area of skin before each laser pulse, maximizing comfort and protecting the skin during treatment.

Are the results of Pulse Dye Laser Treatment Permanent?

Permanency of results depend on many factors, like the condition being treated, or lifestyle of the patient. For example, if a patient has sun spots removed, and continues to spend time in the sun without adequate skin protection, it is likely that the sun spots will return. Talk to Dr. Binstock about your goals and expectations for treatment.

What are the Side Effects of Treatment?

Some patents experience redness or mild swelling in the treated area immediately following treatment, this usually goes away in a few hours. Occasionally purpura, a laser bruise, may occur. Purpura is transient and usually disappears in three to five days.

Are there any special precautions I need to take before or after treatment?

It is recommended to avoid sun exposure before and throughout treatment to maximize results. A sunblock of SPF 30 or higher should be worn daily during this time. Post treatment care guidelines depend on the condition treated, and should be discussed with your practitioner.

Is Pulse Dye Laser Treatment covered by insurance?

Insurance companies do not offer reimbursement for cosmetic and aesthetic procedures.

How much does Pulse Dye Laser Treatment Cost?

Cost depends on the size of the area being treated as well as the condition being treated, talk with Dr. Binstock to learn more about treatment fees.

*Content and images for this Pulse Dyed Laser section provided by Candela.

CoolTouch^® Laser

We have found the benefits of Fraxel Restore treatments  to be consistently superior to those attained by CoolTouch, and now recommend Fraxel Restore treatments for fine lines, acne scars, in addition to skin surface rejuvenation for sun damage and aging.

Intense Pulsed Light (IPL)

What is IPL for skin rejuvenation?

IPL is not a laser, but a spectrum of wavelengths of light. IPL effectively treats facial redness, flushing, dilated blood vessels, liver spots, brown skin discoloration (but not melesma, which is treated with Fraxel Restore Laser), and sun damage occurring over the face, neck, chest, and hands. IPL usually requires a series of three to five sessions and does not improve wrinkles or tighten  skin. Our AURORA-ELOS™ IPL system combines broadband intense pulsed light technology (i.e., a spectrum of multiple wavelengths of intense light) with the energy of radiofrequency (RF) waves into a single pulse. This system is  approved for the treatment of all skin types, and has been proven safe when used by a qualified operator.

In contrast to laser technology, where a single wavelength of light is utilized to treat a specific problem, IPL is based on a spectrum of multiple wavelengths of pulsed light. The AURORA-ELOS system is the only one to combine IPL with the energy of radiofrequency waves, taking advantage of the greater synergistic effect of both modalities.

How  are Fotofacial treatments  preformed?

Fotofacial treatments are a series of AURORA-ELOS sessions, where following the application of topical anesthetic to the areas selected to be treated, a cooling  gel is applied and the combination IPL/RF fotofacial beam is applied to the face, neck, chest, hands, or arms. Each session takes about 30 minutes and facial redness, dilated blood vessels, liver spots, skin tone, and texture incrementally improve with each treatment.

After each treatment, you will be able to apply makeup and return to normal activities. These treatments are low risk and associated with few complications and usually little downtime.

How long will the Fotofacial benefits last?

As most patients desire to maintain the benefits achieved through the series of fotofacial treatments, a periodic maintenance treatment is recommended every four to six months to keep your skin looking its best as aging continues.

What are the potential side effects?

Potential side effects are generally temporary. There may be redness or swelling at the treatment site. This usually disappears within a day. Occasionally, changes of pigmentation can be observed; this typically resolves in several weeks.  Rarely, there may be permanent changes of skin pigmentation. Seldom-seen side effects include blistering, bruising, or infection. Rarely, there may be permanent side effects such as skin discoloration and scarring.

Photodynamic Therapy (PDT)

Photodynamic therapy uses the interaction of ultraviolet light and the topical photosensitizer Levulin^®. Treatment of actinic keratosis and precancers is FDA-approved when used in association with a special ultraviolet BLU-U light and usually takes two to three sessions for best benefit.

BLU-U light alone is an effective FDA-approved non-drug treatment for moderate acne that is safe, painless, and effective.

When Levulin is combined with IPL, there will also be improvement of brown spots, red spots, rosecea, and acne, in addition to actinic keratosis. The number of sessions vs traditional IPL treatments is reduced. This use is off-label (not FDA-approved), and not covered by insurance.

What is photodynamic therapy? 

PDT is the interaction of ultraviolet light with the topical photosensitizing agent Levulan (delta-aminolevulinic acid or ALA). ALA is first applied to the skin and is activated when exposed to an appropriate ultraviolet light source, either BLU-U or IPL.

PDT using ALA and BLU-U light is an approved treatment for precancerous skin lesions known as actinic keratosis, which appear on sun-exposed skin. In contrast, PHOTODYNAMIC SKIN REJUVENATION is a cosmetic procedure that uses ALA and IPL to reduce sun damage, facial vessels, and liver spots, as well as actinic keratosis. Both of these treatments are also effective in treating acne and rosacea.

How much benefit can I expect?

Most patients see a 40–70% improvement after two to three PDT sessions.

How is the treatment performed?

ALA is applied to the skin followed by a topical anesthetic to reduce the mild discomfort of the procedure. IPL or BLU-U is then administered over the entire area. Additional treatments are spaced at one month intervals.

For those seeking further rejuvenation of sun damage and/or sun spots as well as reduction of rosacea, redness, and blood vessels, adding ALA to fotofacial treatments often enhances the benefit and reduces the number of sessions at the same time.

PDT with BLU-U is easier for patients with multiple actinic keratoses than repeated treatments with liquid nitrogen or topically applied agents such as Efudex^® or Aldara^®. The risk of scaring is reduced as compared to liquid nitrogen or surgery. The treatment is usually well tolerated with minimal discomfort.

What are the disadvantages?

Following PDT, the treated area(s) can appear red, with some swelling, and may peel, and occasional crust. This rarely lasts longer than a week. In addition, a very small percentage of patients may experience swelling of the skin lasting a week or so, or experience significant redness that is prominent the first week.

All will noticed that their sun spots and actinic keratosis darken and eventually peel off, leaving normal-appearing skin. Repeated treatments may be necessary for more sever sun damage.

PDT requires the avoidance of direct light sources for forty hours after the application of the ALA. You will be required to leave the office after treatment with a broad-brimmed cap and scarf covering your face, as sunscreens are not sufficient to protect you. Exposure to additional light during the first 40 hours will result in an exaggerated severe reaction with possible blistering.

Portrait^® Plasma Skin Resurfacing (PSR)

Portrait Plasma Skin Resurfacing is an ablative treatment using nitrogen-based plasma energy, not laser (light) energy, that results in benefits similar to a UltraPulse CO2 treatment. PSR improves skin texture, tone, and pigmentation, reduces wrinkles, and can result in some skin tightening. This is a one treatment one week downtime procedure that affords significant benefit, and with side effects less severe than traditional UltraPulse CO2 laser.

PSR is a dramatically different treatment that utilizes a nitrogen plasma field to transfer energy to the skin surface in a controlled manner. This encourages uniform regeneration of your skin and stimulates new collagen formation. This is an ablative treatment, i.e., the surface of the skin is disrupted. Portrait leaves a layer of treated skin left in place, which helps promote faster healing, as opposed to CO2 laser, which does not.

What are the benefits of Portrait?

The benefits of this procedure are a marked improvement in skin texture and tone and improvement in surface discoloration and wrinkles, along with some skin tightening to yield a more vibrant, youthful appearance. For as long as six months after treatment, your skin’s condition will continue to improve as new collagen is laid down. Portrait is safe and effective and gives you results similar to, but with less downtime, than traditional full-face CO2 resurfacing.

What is the procedure like and how long does it take?

A topical anesthetic is applied to the skin an hour before the procedure and generally supplemented with nerve blocks to ensure complete comfort. The treatment typically takes forty-five minutes. Usually, one session is all that is needed. Occasionally, a second session to touch up limited areas may be beneficial.

What should I expect after treatment?

The treated area will be swollen and bronzed with some redness, which resolves over the course of seven to nine days. After the bronzing is shed, there is residual pinkness which can last a few weeks.

Is Portrait safe?

Portrait has an excellent safety profile with less downtime, less residual redness, and no long-term permanent decrease of pigmentation when compared to traditional CO2 laser skin resurfacing. As with any skin surface procedure, there is always a risk of healing lighter or darker, and of infection or scarring.

Can Portrait be combined with other treatments?

Portrait can be combined with Botox Cosmetic or Dyspor to reduce frown lines, forehead wrinkles, and upper lip lines. It can also be combined with dermal fillers such as Restylane, Juvederm, and Radiesse to plump and refill, add facial fullness, and soften deeper lines, and Sculptra Aesthetic or fat transfer to restore facial volume and fullness.

**Benefits depicted are actual and not retouched. Patient results may vary. Each set of photos reflects the benefit realized by the person in that set of photos, and not necessarily the viewers final results.