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.

ActiveFX^TM Fractional CO2 Laser

For those who want more immediate benefits and are able to have more than a week of downtime, the UltraPulse Active FX, a fractional CO2 ablative laser that disrupts the skin’s surface, may be the answer. Active FX results in faster improvement of texture, lines, and wrinkles, including some skin tightening, but necessitates more than a week of downtime, with oozing, crusting, surface discoloration, and swelling occurring.

Fractional CO2 laser resurfacing delivers thousands of tiny laser pulses in a random pattern to treat a variable portion of the skin surface. Each pulse heats a very small column of tissue, eliminating pigment discoloration at the surface while creating a zone of deep dermal healing in the targeted tissue. These heat zones heat-shrink collagen immediately and stimulate new collagen and collagen remodeling. You can select from a range of treatments depending upon your lifestyle and ability to tolerate downtime.

What is ActiveFX Fractional Laser Resurfacing?

ActiveFX fractional laser skin resurfacing is a CO2 ablative laser procedure usually performed as a single treatment with moderate patient downtime. During the procedure, a high-energy beam of CO2 laser is used to smooth out wrinkles and scars, remove brown spots and other skin irregularities, and stimulate the formation of new collagen that continues over time. With fractional laser resurfacing, only a fraction of the skin surface is treated, which leaves small bridges of untouched skin for faster healing than traditional CO2.

Is the ActiveFX right for me?

The ActiveFX is ideal if you can:

• Be away from work for a week or longer, and
• Desire noticeable results regarding skin discoloration, fine lines, wrinkles, and skin laxity, and/or wish to improve the appearance of scars, deep lines, and wrinkles

What can I expect after an FX treatment?

We performed the procedure in our office with a topical anesthetic cream that is supplemented by regional nerve blocks. There is little or no pain with the procedure. With gentle washing, your skin will begin to flake off after five days and you will be able to wear makeup seven days after the procedure.

VersaPulse^® Aesthetic Laser (VPL)

VersaPulse Aesthetic Laser is a unit composed of four separate lasers in one box. The lasers produce beams (highly concentrated single wavelengths of light); different types of lasers produce different wavelengths or colors of light. A particular wavelength of light is engineered to be absorbed by a particular skin pigment. For example, hemoglobin, found in red blood cells, absorbs the energy of yellow-green light  (532 nm) to heat and seal blood vessel from within, thus eliminating unwanted vessels. Another wavelength of light is effective in removing melanin or brown spots from the skin, as its energy is absorbed by melanin particles within skin cells, which in turn reduces the number of cells causing the skin discoloration. The VersaPulse laser similarly enables us to treat the full spectrum of tattoo pigments, with each color pigment absorbing and being disrupted by the energy of one of the four laser wavelengths specific to its absorption profile.

CoolTouch^® Laser

CoolTouch laser is a nonablative, no downtime laser that improves acne scarring, acne, and fine lines in a series of treatments. The laser stimulates new collagen formation. It is absorbed deeply into the skin and not absorbed by surface skin, so vessels and pigment discoloration are not improved by this procedure.

What is CoolTouch laser skin rejuvenation?

The CoolTouch laser system is FDA-approved for the permanent reduction of wrinkles, acne scars, and acne. This noninvasive procedure stimulates smoother skin by using an infrared YAG laser with a protecting coolant spray to rejuvenate the skin’s surface and collagen tissues. The most important part is that the surface is left intact, i.e., there is no long recovery, just younger-looking skin.

What are the benefits of this treatment?

A series of six CoolTouch treatments can be performed on any facial area:  around the eyes, mouth, cheeks, neck, and/or chin with minimal discomfort to effect a 35–50% average improvement in fine lines and a 50–70% improvement in broad, flat acne scars. A topical anesthetic is used before each treatment.

How long does the treatment take?

CoolTouch treatment is quick and easy, taking between fifteen to thirty minutes. You can reapply your makeup and carry on your day. There may be a few hours of redness and swelling.

What are the side effects of this treatment?

A topical anesthetic is applied before treatment. Redness and swelling typically  last a few hours. As with any skin surface treatment, there is a small risk of blistering and scarring. Cold sore (herpes) reactivation is a risk; please be sure to tell us if you have this condition.

What other treatments can be combined with CoolTouch to enhance benefits?

Versapulse Aesthetic laser can be used to treat dilated facial veins and liver spots, as CoolTouch does not affect the surface of the skin. Intense Pulsed Light can be used to treat pink and red faces and liver spots. Dermal fillers like Restylane and Juvederm are used to restore fullness and fill deeper lines and folds. Botox Cosmetic and Dysport, both muscle relaxers, soften frown lines, forehead wrinkles, and upper lip lines.

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 is IPL Hair Removal?

IPL hair removal was one of the first effective treatments for reducing and removing hair, and has been proven safe when performed by qualified operators. The AURORA-ELOS IPL system combines broadband light technology (a spectrum of multiple wavelengths of intense light) with the energy of radiofrequency waves into a single pulse. This hair removal system is approval for treatment of all colors of hair including red, blonde, white, and grey, as well as all skin types, unlike other laser hair removal systems.

How are Hair Removal treatments performed?

A topical anesthetic is applied before the treatment. The treatment works best when the hairs are present in the follicle, so waxing and plucking should be avoided six weeks before treatment (it is okay to shave). IPL light energy interacts with the pigment in the hair follicle causing injury to the cells which grow the hair. These treatments are best administered to untanned skin as the pigment in the tan acts to absorb the energy meant for the hair follicle deeper in the skin. A series of treatments are needed, and with each subsequent treatment the hair follicle is further damaged, producing hairs that are lighter and smaller in diameter. Facial areas, the bikini line, and axilla can easily be treated in ten-minute sessions.

What Hair Removal benefit can I expect?

We expect on average a 50–70% reduction in hair after three to five monthly visits. It is important to remember that at any point in time, 20–30% of hair follicles are resting, i.e. not growing, and thus are not affected by the treatment. Additional treatments are often required for lighter hair color. This hair removal system results in a long-term reduction in hair growth. You are not a candidate for this treatment if you have medical conditions or are receiving medications which make you sensitive to sunlight, or if you are pregnant, or prone to keloids or skin discoloration.

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.

MaxFX^TM CO2 UltraPulse Laser

What is MaxFX Ultrapulse CO2?

The time-honored CO2 laser skin rejuvenation procedure is the MaxFX, the original UltraPulse skin resurfacing procedure which ablates or removes 100% of the skin surface. This results in the most benefit from one session with a marked improvement of wrinkles, skin discoloration, texture, and tone, along with some skin tightening. This ablative treatment eliminates the skin surface causing significant oozing, crusting, discoloration, and swelling. Healing takes nine to twelve days. This treatment may result in prolonged redness that lasts for months and occasionally a delayed permanent decrease in skin pigmentation.

**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.