Dallas —Patients who have realistic expectations when seeking treatment of mild to moderate photodamaged skin will be happy with the gradual improvements of nonablative laser treatments.
The Vbeam (Candela) and V-Star (Cynosure) pulsed dye lasers and the KTP (Nd:YAG) laser are also used for nonablative treatments. In addition to unwanted blood vessels and brown spots, Dr. Bernstein nonablatively treats fine lines and wrinkles, enlarged pores and sagging skin."All but sagging skin are addressed well by lasers normally used for treating veins," says Dr. Bernstein, who practices at the Laser Surgery and Cosmetic Dermatology Centers, Inc., in Marlton, N.J., and is a clinical associate professor at the University of Pennsylvania. "What is nice about the vascular lasers is that the radiation is absorbed by melanin and blood vessels, and that helps not only blood vessels and pigment, but also enlarged pores and fine lines and wrinkles."
Dr. Bernstein uses the Smoothbeam, an infrared laser, to treat acne scarring, because infrared wavelengths are absorbed mostly by water, not by blood and melanin. He uses topical anesthesia (lidocaine cream) only with Smoothbeam treatments.
"The Smoothbeam — and also the CoolTouch (New Star Lasers) — heat the dermis, and I've had results with acne scarring that exceeded my expectations dramatically," he says. "In my opinion, these lasers are the treatment of choice over carbon dioxide for acne scarring. I also use the infrared laser for fine lines and wrinkles where there is not a strong vascular component."
For photoaging and acne scarring, Dr. Bernstein gives four treatments at one-month intervals so patients can go back to work immediately.
For patients with average brown spots, fine lines and wrinkles, veins and enlarged pores, Dr. Bernstein uses combinations of lasers. He treats the vascular areas with a vascular laser and the more wrinkled, less red areas with the infrared laser.
The perfect patients for nonablative treatments have mild-to-moderate photodamage, according to Dr. Bernstein. "The key is setting realistic expectations," he adds. "I tell patients I can 'improve,' not 'remove,' their fine lines, wrinkles and acne scars."
If the physician suspects that a patient has unrealistic expectations, Dr. Bernstein recommends treating a "test spot" and allowing the patient to see the result. "Let them know the change is subtle and requires a number of treatments. That makes for the happiest patients," he says.