New technology offers options for skin resurfacing and tightening, tattoo removal

Anne M. Chapas, MD, (left) discusses dermatologic devices as Jennifer L. MacGregor, MD, listens.

Anne M. Chapas, MD, (left) discusses dermatologic devices as Jennifer L. MacGregor, MD, listens.

Advances in technology in the last 15 years have created a variety of options for skin resurfacing and rejuvenation, tattoo removal, skin tightening, and body contouring, which were covered Saturday in “The Science Behind New Devices in Dermatology.”

“From 2000 forward, we have had tons of technologies that we are constantly bombarded with,” said Anne M. Chapas, MD, Union Square Laser Dermatology, New York. “We are looking at radio frequency, cryolipolysis, ultrasound, microwave, and fractional lasers that are being brought to market. It is no wonder we are all saying ‘What works, what doesn’t work, and what is the evidence that it works?’”

Dr. Chapas discussed the science of lasers and their history, emphasizing that dermatologists “are in the best position to be translational scientists.” She explained the interaction between lasers and tissue during treatment.

“The interaction is determined by the quality of the laser light and the physical parameters of the biological object,” she said. “The degree of the effect depends on the properties of the tissue, which are determined by its structure, water content, blood circulation, absorption, and scattering of the light, reflection, thermal conductivity, heat capacity, and density.”

The most established method of skin resurfacing is ablative resurfacing, which has evolved from continuous-wave CO2 lasers to pulsed and scanned resurfacing. Ablative resurfacing vaporizes or removes damaged tissue and stimulates neocollagenesis.

Studies suggest that vitamin C and growth factors may shorten the inflammatory stage, increase collagen production following treatment, and reduce recovery time, Dr. Chapas said.

Platelet-rich plasma also can help reduce recovery time, and evidence gathered in studies shows that they also may affect collagen production, she said.

An option to these treatments is less invasive non-ablative fractional resurfacing, which does not vaporize the skin, with collagen remodeling taking place over 3-6 months.

Multiple devices can be used for non-ablative skin rejuvenation, and many of these devices may enable aged skin to produce cytokine levels typical of younger skin profiles. Also, the response to these procedures may be reduced in aged skin and not as relevant in younger patients, Dr. Chapas said.

Pigment lasers

An area of growth is pigmented lasers, and the gold standard is Q-switched lasers that often are used to remove tattoos, Dr. Chapas said. They use high temperatures for a short time to disrupt ink particles.

The major advance in this area is the development of picosecond pulse lasers, versus older nanosecond pulse lasers. The rapid delivery of laser energy in picosecond lasers shatters pigment fragments into smaller particles, but there is still debate about which is better.

“The consensus is that the picosecond lasers are faster at clearing tattoos,” Dr. Chapas said.

Skin tightening and body contouring

Jennifer L. MacGregor, MD, also of Union Square Laser Dermatology, discussed the science behind skin tightening and body contouring devices and procedures that are growing in popularity.

A 2014 consumer survey of 8,315 people showed that 50 percent are considering a cosmetic procedure and that skin tightening and body contouring are tops concerns. Several technologies have been developed in light of this demand.

For non-ablative skin tightening, radiofrequency and ultrasound are most frequently used. For contouring, cryolipolysis, ultrasound, radiofrequency, infrared laser, low-level laser therapy, and combination devices are used.

In radiofrequency, monopolar and multipolar electrodes are used. Monopolar radiofrequency uses a treatment tip that creates an electric field in the tissue that leads to collagen contraction and a wound-healing response, with durable results, Dr. MacGregor said. Multipolar radiofrequency limits the depth of penetration, but requires multiple sessions to achieve results. Ultrasound uses short, low-energy pulses delivered to a specific skin depth.

The limitations of these non-invasive tightening procedures is that patients will not see dramatic results. They also often need skin surface smoothing and restoration, she said.

For body contouring, cryolipolysis is a relatively new concept that uses cooling to trigger death of fat cells. Ultrasound creates waves that cause cavitation in the fat. Radiofrequency uses short-wave diathermy for deep-heating of tissue, and is useful for larger areas, such as the abdomen, buttocks, and posterior thighs.

In the end, none of these devices cause weight loss or dramatic results, Dr. MacGregor said, adding “Dermatologists must scrutinize data to separate fact from fiction.”

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