It's becoming easier to save face

New skin-treatment machines are less invasive than chemicals and lasers but aren't yet as effective

October 11, 2007|By Colin Stewart | Colin Stewart,McClatchy-Tribune

Like teachers erasing a blackboard to get a clean slate, dermatologists can wipe away skin defects on patients' faces by destroying a layer of old cells.

The process lets patients start fresh with newly grown skin cells, but only after enduring a week - or more - with a raw, swollen, oozing face.

Whether the old cells are wiped out by chemicals, by friction or by a laser, it's strong medicine that makes doctors and patients squirm. So for years, doctors and medical-device makers have been seeking less-drastic remedies for acne scars, wrinkles and discoloration - mostly with mixed results.

Now, experts are cautiously optimistic that some newer skin-treatment machines - devices that peel away skin cells via radio-frequency waves, electrical charges, intense pulses of nonlaser light and less-invasive lasers - may provide an easier answer.

The new techniques used in skin removal have been only partially successful.

"We're trying devices that are not quite as scary to patients, or to us, but the results are not as good," says Dr. Mark Rubin, assistant clinical professor of dermatology at University of California, San Diego.

In contrast to the broad impact of older devices such as carbon-dioxide lasers, most of the new treatments spur new cell growth by destroying old cells selectively. Others, such as photofacial machines, use heat or light to stimulate the skin without destroying cells.

"Skin resurfacing [with full-face carbon-dioxide lasers] is clinically proven to increase collagen," which gives the new skin a more youthful appearance, says Dr. E. Victor Ross, director of the Laser and Cosmetic Dermatology Unit at Scripps Clinic in San Diego.

"Nobody has yet achieved results like that" with photofacial devices, he says, adding that fractional lasers also fall short, but not by as much.

Ross says fractional lasers, such as the Affirm system from Cynosure of Westford, Mass., are promising.

Instead of flooding the skin with laser light, they are computer-controlled to create a pattern of hundreds of microscopic holes, which the body repairs with new skin cells.

Newport Beach, Calif., dermatologist Dore Gilbert is similarly impressed by two new fractional lasers, the Fraxel from Reliant Technologies of Mountain View, Calif., and the ActiveFX from Lumenis of Santa Clara, Calif.

"They offer patients an opportunity for resurfacing your skin with minimal, or practically no, downtime," he says. "ActiveFX, which is a [fractional] carbon-dioxide laser, is particularly helpful around the eyes and around the mouth. The Fraxel laser is very useful in treating the cheeks and the rest of the face, acne scarring and photo damage."

Both lasers remove the top layer of the skin, but they treat only about 20 percent of the skin at a time, boring tiny holes at regular intervals.

"That spares the skin around the treated area, so patients actually heal in 24 hours," Gilbert says. In contrast, "the old way of doing a carbon-dioxide laser [left patients] wiped out for seven to 14 days."

Gilbert and others favor Intense Pulsed Light systems, which beam nonlaser light at wavelengths that are absorbed and turned into heat by unwanted melanin pigments and the hemoglobin contained in unwanted blood vessels.

Gilbert is much happier with IPL treatments than with the carbon-dioxide lasers he formerly used.

"It's hard to go to Nordstrom and sell shoes all day long if you have a black-and-blue face" from a laser treatment, he says. "That's why IPL has been so successful, because our patients, especially our female patients, can have an IPL treatment, go down to the girls' room, put on their makeup, and they're gone, out playing tennis."

Nancy Klemm, 43, of Corona del Mar, Calif., says her photofacial at Gilbert's office "completely eliminated all the freckles on my chest."

"Klemm noticed that the skin on her neck was sagging, so she moved on to a skin-tightening treatment called Thermage.

"Dr. Gilbert recommended Thermage and said it works on some patients, not on others," Klemm says. "For me, it absolutely did tighten the skin around my neck."

It and a competitor, ReFirme from Syneron, are two radio-frequency devices that some dermatologists say can reduce wrinkles and tighten loose skin in some people.

ReFirme does not require patients to be sedated, unlike Thermage. The device, which is used with the Elos system, emits both electrical energy and radio-frequency waves that heat deep layers of the skin. Like Thermage, it can tighten the skin overall and reduce shallow wrinkles by stimulating growth of collagen.

"ReFirme is not a face-lift," says Dr. Vince Afsahi, a University of Southern California dermatology instructor. "If the patient is 75 years old, a smoker, with centimeters of lax skin, this is not the procedure for him or her.

"But there are numerous patients who are middle-aged, in very good shape, nonsmokers, who take care of themselves who have modest expectations. They do quite well with this procedure."

Thermage is increasingly popular though patients typically need to be sedated and under local anesthesia during a treatment.

Still, Gilbert says patients should expect only "modest improvements" from Thermage.

"In consultations with patients, I tell them there's a chance they may not see any change at all," he says.

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