Many of the older, time-tested techniques — including the use of peels to combat the signs of aging — still hold their own in the ever-changing aesthetic medicine market.
"You do not always have to get the latest and the greatest, because it may not be," says Tina S. Alster, M.D., director, Washington Institute of Dermatologic Laser Surgery, and clinical professor of dermatology, Georgetown University Medical Center, Washington. "Even though technologies have evolved, physicians need to find out what works best in their hands and for their patients, and not just jump to the newest technology."Chemical peels have come a long way since their first historic mention in ancient Egypt, and though they are still available today, their ideal use depends on the cosmetic indication.
According to Dr. Alster, medium-strength peels such as Vitalize Peel (SkinMedica) or a low-strength TCA peel are still the treatment of choice for facial dyspigmentation, blotchiness and melasma when compared to any of the currently available laser devices. For these indications, the effect of glycolic peels may be too superficial and phenol peels, too deep, the latter often being associated with adverse events such as hypopigmentation.
In addition to medium peels, Dr. Alster says intense pulsed light (IPL) devices also work well for dyspigmentation, redness and for evening-out skin coloration. When addressing wrinkling, atrophic scarring and skin tightening, however, these modalities are less than optimal, and laser sources are the treatment of choice.
LASER ADVANCEMENTS The advent of ablative lasers in the mid-1990s was a milestone in cosmetic dermatology. These devices deviated from continuous wave systems and were considered high-tech at the time, and though they were effective, they also were associated with long healing times and a host of side effects.
Further technological advances soon led to nonablative systems such as the Smoothbeam (Candela) and CoolTouch (CoolTouch Inc.) laser systems, among many others. Unlike ablative devices, these nonablative devices were designed to heat the dermis without destroying the epidermis and to provide for progressive collagen remodeling.
The process is slow, however, and requires many treatment sessions to achieve the desired aesthetic outcome, adding a level of frustration for patients who demand quicker results. The latest cutting-edge devices are based on fractionated technology, and fall into the "nonablative" and "ablative" categories.
"With the advent of lasers used for skin rejuvenation, the pendulum swung widely between ablative and nonablative devices, but it now appears to have settled in the intermediate phase with fractionated technologies. This new technology marries the excellent safety profile of nonablative devices with the superior clinical results seen with ablative systems," Dr. Alster says.