New directions in aesthetic treatments include fractional resurfacing, both nonablative and semi-ablative, and a host of other new devices, according to an expert.
"The history of skin resurfacing began with ablative resurfacing, which could improve the skin surface and tighten skin, followed by nonablative lasers, and now devices that provide skin tightening and others that give fractional, nonablative treatments," says Melanie C. Grossman, M.D., a New York-based dermatologist in private practice.
Furthermore, she says the spectrum of fractional devices is growing.
"There are now fractional ablative devices available, and more types of devices for skin tightening both on and off the face," she tells Dermatology Times.
Traditional CO2 lasers required a single treatment and produced "great results," along with downtime and the potential for adverse events, such as pigmentary changes and scarring, Dr. Grossman says.
Newer nonablative fractional tools for skin resurfacing include the Fraxel (Reliant Technologies), the Lux1540 Fractional Handpiece (Palomar) and the Affirm (Cynosure). These devices operate at 1,550, 1,540 and 1,440 nm, respectively, she says.
"The Fraxel was the first to market. Initially, it was used with a dye and was slow and painful, but it showed some improvement in texture and surface pigment," Dr. Grossman says.
The Lux1540 uses pulsed, rather than scanned, microbeams, along with contact cooling, to address issues such as facial wrinkling and postsurgical scars, she says. The Affirm, on the other hand, uses Combined Apex Pulse (CAP) technology along with a diffractive lens to produce zones of high and low energy to minimize tissue trauma, Dr. Grossman adds.
"There are two types of treatments that are a little more aggressive than these fractional, nonablative treatments," she says.
One is a fractional ablative laser being developed by Reliant; the others are low-energy CO2 and erbium lasers that provide low-density, nonsequential, nonablative scanned treatments, Dr. Grossman says.
All these technologies "seek to do more than nonablative and fractional treatments, but less than ablative treatments."
Although low-energy ablative treatments represent the latest wave in skin resurfacing, "They're not really new. Some of these technologies have been developed in the past and are seeing a resurgence" in response to patients' desire for minimal downtime and discomfort, Dr. Grossman says.
TIGHTENING THE SKIN
As for skin tightening, she says monopolar RF (ThermaCool™, Thermage®) has proven to be effective.
"What's new with this device is that the manufacturer has introduced various types of tips with new protocols. And they now are talking about doing Thermage® around the eye and all over the body," Dr. Grossman adds.
Regarding technologies that combine broadband and pulsed light (Titan, Cutera), she says, "Research that's been done over the past several years shows that this device does work for skin tightening."
In contrast, she says the Aluma (Lumenis Inc.) uses a combination of vacuum suction and RF energy.
"It's FDA-cleared to treat wrinkles but is also being used for skin tightening and laxity on and off the face," including the neck and arms, Dr. Grossman notes.