How does skin aging caused by the sun manifest itself?
Skin ageing caused by exposure to sunlight and the passage of time manifests itself with different characteristic signs: skin atrophy (loss of thickness and smoothness), telangiectasias (capillaries), lentigines (brown spots) and hypomelanosis (white spots). The simultaneous coexistence of all these signs is called “poikiloderma”, and is especially common in the neck and décolleté area in people who have lived in sunny areas (in this area it is called Civatte’s poikiloderma).
How is solar skin ageing treated?
One of the most frequent therapeutic challenges in skin rejuvenation is the treatment of potachyloderma, because it requires improving or reversing different skin disorders: vascular, pigmentary and skin atrophy. Until now, it was treated almost exclusively with vascular laser (pulsed dye) in combination with laser for hyperpigmentation (Alexandrite Q-switched), or with isolated pulsed light (which treats both vascular and pigmentary disorders). However, although this therapy offered positive results, it did not produce a marked improvement in hypopigmented areas or atrophy, so the appearance at the end of the therapy was sub-optimal.
Which therapeutic technique offers the best results?
Currently, the combination of lighting devices that allow all the skin signs of aging to be treated simultaneously has been described. Intense pulsed light has its therapeutic targets in melanin and hemoglobin, making it an optimal treatment to eliminate lentigines and telangiectasias. On the other hand, the non-ablative fractional laser of erbium manages to heat the dermis and stimulate the endogenous synthesis of collagen, increasing the thickness of the skin and eliminating the most superficial wrinkles.
How is the treatment of skin aging due to the Sun performed with a combination of lasers?
In the same session it is possible to apply the two lighting systems to achieve the sum of both effects. The treatment session lasts a few minutes, depending on the extension of the area to be treated. It does not cause remarkable pain and it is not necessary to use any anaesthetic. After the session, the lentigines will remain erythematous (red) for a few hours and in the following days they darken until they detach. The area treated with the non-ablative fractional laser remains erythematous for a period of approximately 2 – 5 hours. The patient can lead a normal life immediately after the session, with the only care being to apply SPF50 sunscreen for the following month.
Does combining two lasers really increase the effectiveness of the treatment?
Yes. In comparative studies between intense pulsed light, non-ablative fractional laser or the two, an increase in response has been observed when both therapies are added. The degree of patient satisfaction is high and 76% of them report an excellent result in a single session according to the publication by Kearney et al. The results obtained are superior with the simultaneous combination of pulsed light and non-ablative laser than if only pulsed light, non-ablative laser or if both therapies are separated for a few days. The simultaneous combination obtains better results in the reduction of telangiectasias, pigmentation disorders and skin texture than using treatments alone.
Is combined treatment less tolerated than using only one of the two devices?
No. In the comparative studies, the discomfort caused to patients was minimal, either using both lighting systems or with only one.
Does combining two lasers cause more injury to the skin and will more wounds form?
No. With pulsed light treatment, the lentigines will remain darker for a period of 7 – 10 days and will eventually flake. The non-ablative fractional laser only causes redness (erythema) lasting a few hours, so it does not pose any additional risk in terms of forming wounds. It should also be noted that the non-ablative laser is commonly used for the treatment of side effects caused by laser therapies, which reduces the risk of forming hypopigmented scars with pulsed light used in isolation.
Comparative studies of combination therapy or the use of isolated pulsed light/non-ablative laser have not shown a higher associated complication rate.
Can this treatment be combined with other techniques such as peelings, hyaluronic acid fillers and/or botulinum toxin?
Yes. There is no problem with using them together, although it is recommended not to perform other procedures in the same area in a single session.
What are the advantages of the combined use of pulsed light and non-ablative fractional laser for the treatment of skin ageing compared to their isolated use?
A higher degree of improvement (synergism of actions), in fewer treatment sessions to reach that result and without greater risk of complications.
Does using two lasers instead of one make the cost too expensive?
No. Although no cost/benefit studies have been conducted, it is likely that in fact the combination of both lasers reduces the total cost of the treatment, as fewer sessions are needed to reach the same point or even higher.
REFERENCES
· Kearney C, Brew D. Single-session combination treatment with intense pulsed light and nonablative fractional photothermolysis: a split-face study. Dermatol Surg. 2012 Jul; 38(7 Pt 1):1002-9.
· Chan CS, Saedi N, Mickle C, Dover JS. Combined treatment for facial rejuvenation using an optimized pulsed light source followed by a fractional non-ablative laser. Lasers Surg Med. 2013 Sep; 45(7):405-9.