According to Subhas Gupta, M.D., Ph.D., chief of plastic surgery at the Loma Linda University School of Medicine, his technique, which he's dubbed the Loma Linda PhotoPeel, combines elements of several successful skin management regimens to provide a gentler, noninvasive means by which to improve skin appearance.
"Over time, the effects of the sun, age and hormones begin to appear," he tells Cosmetic Surgery Times. "The first signs of aging are fine lines forming around the eyes and lips, and then the collagen and elastin balance changes and deeper lines and grooves form in our brow, next to the nose and down to the corners of our mouth. Surface irregularities such as pigment discolorations, redness and enlarged pores may also occur."In an effort to improve on other traditional therapies, Dr. Gupta developed the Loma Linda PhotoPeel process and has shared it in seminars and clinics around the country.
"The process consists of a preparation phase that lasts four to 12 weeks, then the PhotoPeel procedure, post-procedure protocol for two weeks and then a maintenance program," Dr. Gupta explains. "Photodynamic therapy is performed with a topical application of aminolevulinic acid (ALA), and specific wavelengths of intense light delivered to the skin through very specific filters. Once delivered, the targeted tissue absorbs the light's energy and, combined with the topical applications of ALA, restores a smoother, more youthful appearance to skin by treating redness, flushing, pigmentary problems, scars and wrinkles."
Prior to light-energy treatment, patients receiving the topical application of ALA are asked to rest for about an hour of incubation after the cream is applied.
Some patients may experience a mild discomfort as the light energy is administered. Treatments are spaced at three- to five-week intervals. The number of treatments and treatment time and intervals may vary with severity of the condition.
Dr. Gupta reports that post-procedure pain is minimal to nonexistent.
"The skin may appear flushed, brown spots may be darker and tiny veins may be more visible or gray in color, but this will decrease over the next 48 hours or so," he says. "Normal activities can be resumed immediately after the treatment."
Following the PhotoPeel, the treated areas can appear red and swollen with some peeling for up to seven days. Some patients have an exuberant response to treatment, and experience marked redness of their skin. Temporary swelling of the lips and around the eyes can occur, but lasts only a few days. Over a week or so, darker pigmented patches can become temporarily darker, but will peel off to reveal lighter skin.
"After each session, the patient will experience some improvement in skin tone and texture, and there will be a decrease in overall redness and flushing in rosacea patients," Dr. Gupta says. "Sunspots will fade, pore sizes will shrink and fine lines and wrinkles will gradually decrease in size as the new collagen forms within the dermis. These improvements will continue to increase with each treatment."
The key to this combination therapy is dermal collagen stimulation without ablating the entire epidermis, he says, adding that the PhotoPeel magnifies the effect of a standard photofacial due to the photosensitizing ALA.
As for treatment protocol, Dr. Gupta recommends: