What can I do about skin damage and volume loss from laser treatment there
is no question that laser technology has had a significant impact on the
aesthetic field the ability to use lasers to target specific areas of the
skin has made a range of lasers indispensable in my practice over the
past several years there has been a proliferation of cleverly named devices
marketed directly to consumers using phrases such as erase the wrinkles and
no more turkey neck these lasers are promotive miracles only dreamed of in
science fiction it’s important to understand some of the science of how
lasers interact with your skin and why questions are continuously being raised
about the unintended consequences of laser treatment
one such unintended consequence is the frequent reporting by people who’ve
undergone treatment with lasers and comparable technology for the purpose of
skin lifting or tightening although intended to non surgically lift and
tighten the skin lasers and related thermal energy devices are being blamed
for skin becoming thinner and facial fat loss described as Halloween I’ll discuss
how I approach the issues which motivate people to seek these non-surgical
heating devices as well as how I help people who come to my practice with
undesirable skin changes after they’ve had laser and thermal energy treatment
I’m Dr. Amiya Prasad I’m a Board-certified cosmetic surgeon and
Fellowship-trained oculofacial plastic and reconstructive surgeon I’ve been
practice in Manhattan and Long Island for over 20 years I routinely performed
both surgeon and non-surgical procedures for facial
aging I also routinely perform eyelid surgery facelifts and facial implant
surgery non-surgical procedures are something I
do every day in my practice such as the placement of hyaluronic acid fillers
botulinum toxin lasers and radio frequency treatment as well as
regenerative medical procedures using PRP and a seller matrix for skin quality
improvement as well as the treatment of hair loss before discussing my
therapeutic strategy for patients who come in with the depletion of collagen
and facial volume loss after laser and thermal energy treatment I think it’s
important to look at some assumptions about what happens to your appearance
with aging particularly in your 40s and 50s the first is the assumption that
your skin is loose and it needs to be tightened I have found that this
assumption is the biggest driver for the marketing of creams lasers and thermal
energy devices although there is some degree of skin laxity consistent with
age-related changes the more significant reason for the perception of skin laxity
is bone volume loss when you understand that bone volume loss is responsible for
supporting the skin it makes complete sense that the skin appears loose with
bone volume depletion the second assumption is that new devices are
better at treating the skin conditions than existing technologies this is not
true lasers and other technologies are tools a highly experienced specialty
trained physician is the most qualified to develop a treatment strategy for you
no device can replace that much of the industry focuses on messaging claims to
consumers about their device which are reinforced by
paid medical consultant endorsements they don’t allow for enough time for
there to be a more organic experience from doctors without bias to share their
first-hand knowledge through marketing the focus is about the device not the
professional by creating demand through name recognition of their devices these
companies have been very successful in selling or leasing devices and the
associated disposables to a range of practitioners these practitioners are
often more interested in transactions than they are long-term management or
the long-term consequences of their treatment the third assumption is that
the practitioner performing the laser or thermal energy device is as qualified as
a specially trained doctor to perform a procedure although the more modern laser
devices often have touchscreens to reduce the risk of incorrect settings
being used the devices aren’t a replacement for a proper history and
physical examination by a physician in New York State there is no licensure for
the use of lasers and thermal energy devices the fourth assumption is that
the skin can produce unlimited amounts of collagen and that collagen
stimulation can only occur by aggressive heat delivery to the skin so that new
collagen produced will lift the skin and make the skin more youthful let’s look
at what happens as a consequence of these assumptions consumers go to a
practitioner for the latest greatest laser or non-surgical lifting device the
practitioner who is paying a monthly lease for this device performs a
procedure the qualifications of this practitioner are assumed based on them
wearing medical attire like a doctor as weeks and months go by after the
procedure the patient experiences skin thinning and feels that they look worse
after the treatment the practitioner then offers a different
device treatment or performs a more aggressive treatment often applying a
higher temperature for a longer period of time now the skin looks even worse
and the patient is distraught about their appearance when a patient in this
situation comes to see me I evaluate their appearance with the same a
systematic approach I do with any facial aging examination I look from the inside
outward this means evaluation of the bone structure followed by the soft
tissue and fatty tissue layer below the skin and then the skin itself I
frequently observed that the patient’s bone structure has significant
deficiencies consistent with facial aging this means that from the outset
the decision to pursue skin heating was not addressing the most significant
basis for the appearance of skin laxity to address volume deficiency from bone
loss I perform a technique called structural volumizing where I use the
principles derived from facial implant surgery to place long lasting hyaluronic
acid fillers such as Juvederm Ultra Plus and Juvederm Voluma at the bone level
with Structural Volumizing of the cheekbones jaw angle jawline and chin the
improvements on the facial proportions result in a more youthful appearance
this is far more effective than what they went through with the high-priced
skin heating device the benefits of Structural Volumizing are appreciated
immediately as opposed to waiting to see if the skin is somehow lifted without
surgery after being treated with the miracle machine of the week I do value
the technology of thermal energy for fat reduction and skin tightening and use it
in my practice I use it as a tool for specific situations where I
feel it is the optimal choice what the patient needs for example if you have
some fat that creates the appearance of a jowl and you have good skin elasticity
I perform a jowl lift procedure non-surgically with a long pulsed 1064
YAG laser which I own I actually own all my lasers because I’m confident of their
value from my patients for years to come not because they’re the hot device of
the week moving outward towards the skin are the layers of the fact below the
scanner there is a difference between reducing areas of fat accumulation and
reducing large areas of fat under the facial skin when you look at someone
who’s younger their skin has this soft quality part of which is from a healthy
layer of what is often referred to as baby fat by delivering excess heat deep
below the skin these practitioners are literally destroying the fat the fat
layers under the skin are important not only as a cushion but also for their
blood supply and biochemical interactions with the skin if you look
at someone who is in their 70s or older you can appreciate how thin their skin
appears which is significantly attributed to diminished fat layers so
essentially these devices are being used in a way where the skin aging is
actually being accelerated I help my patients who come to me with this
condition using regenerative technology such as the use of platelet-rich plasma
or PRP PRP is a concentration of the wound healing cells and growth factors
in the plasma which are needed when you have an injury like a cut this treatment
has a beneficial effect on the surviving fat cells and can be performed over
several sessions I also use a material called acellular or extracellular matrix
which recruits your body stem cells for the purpose of healing i’ve uses
material in conjunction with PRP since 2011 for a
non-surgical hair loss treatment system I developed called trichostem hair
regeneration patients come from around the world for this treatment hair is a
skin appendage I’ve observed that the quality of hair appears to improve when
the quality of the skin is improved using this technology the objective is
to maximally improve the viable remaining fatty tissue to help the skin
become healthier and more vibrant this now brings us to the skin composed of
the dermis and the epidermis the dermis is the foundation for the epidermis it’s
well established that there is a loss of dermis related to aging and
environmental exposures such as excess sun or UV light it’s also well
established that controlled injury can induce a repair response that can
improve the integrity of the dermis the problem occurs when the dermis is
injured beyond its capacity to generate enough collagen which results in
weakening of the dermis from collagen loss this is particularly difficult to
manage I’ve been told by patients who experience thermal energy induced
collagen loss that they were subsequently recommended to undergo
additional injury based procedures with an expectation that collagen production
will occur I disagree with this strategy collagen is a protein and can be thought
of as support cables the cells that make collagen are called fibroblasts after
such a significant injury to the dermis how can a practitioner be sure that
there are adequate fibroblasts with the capacity to produce the amount of
college needed in my mind the skin needs rehabilitation before being challenged
with another injury it’s like having a muscle injury and getting rehabilitation
for healing before being challenged with weight training
my strategy for rehabilitation on the dermis is to use PRP and hyaluronic acid
and use a micro infusion device to deliver this combination directly
through the dermis with virtually no trauma the hyaluronic acid provides a
scaffold for the collagen produced by the fibroblasts to strengthen the dermis
and enhance the healing process this has been established in studies for wound
healing and conditions where bone was exposed and effectively treated with PRP
and hyaluronic acid combination as far as the epidermis and any other issues of
pigmentation I usually make a decision based on my assessment of the skins
current state I would consider low-energy non ablative laser targeted
for pigmentation as well as conservative epidermal therapies such as hydro facial
it’s more important than ever for people to think twice before getting caught up
in the hype surrounding aesthetic technology in my practice I spend a lot
of time with my patients educating them about the risks and benefits of
aesthetic medical products and procedures which are being marketed to
them my role has become to be the primary care doctor for beauty many
people are being harmed by trusting their appearance to businesses who are
only interested in short term high profit marketers don’t want you as a
consumer to consult with a physician who will put things into perspective for you
that rather entice you and direct you to practitioners who are using their
products an ounce of prevention is worth more than a pound of cure as I stated
earlier it’s important to rethink the assumptions you have about facial aging
and the state of the aesthetic industry so you don’t make a wrong decision
companies and unethical petitioners are trying very hard to
commoditize aesthetic procedures and shout loudly over the voice of honest
and ethical doctors the practitioner is much more important for your appearance
than any product or device I hope you found this information helpful thank you
for your question