Practical Applications for Medical and Aesthetic Treatment of Skin of Color With a New 650-Microsecond Laser

April 2019 | Volume 18 | Issue 4 | Supplement Individual Articles | 138 | Copyright © April 2019


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Dr. Campbell-Chambers: We include a retinoid, and in the morning either a benzyl peroxide cleanser or clindamycin product. Also, we have a steroid combination with fucidin cream as well, to calm down the bumps, then monthly treatments. I recommend breaking off medications for about three days and then resuming a few days after the laser. I did a small study a few years ago and we found that quality of life improved after laser treatments.Dr. Henry: I often use it for PFB, even right after injecting, and I don't stop the tretinoin except in the darkest of skin. I haven’t had much difficulty. You get improvement without using energies strong enough to remove hair. Patients like being able to regrow hair. I haven't had any side effects from this.Dr. Roberts: For PFB, what percentage are women versus men? Dr. Campbell-Chambers: Probably about 70% women. I treat men for PFB, but for those that go with the laser, more women for some reason.Dr. Burgess: Probably 95% of my patients with facial hair are female. Men usually want to keep their hair, so I always ask first. Some men want to shave every morning, ingrown hairs or not, others will never grow a beard because of their career.Dr. Roberts: I see about 50-50. Men tend to want the option of growing hair, so I use lower settings for PFB, level two to three oftentimes decreases the keratinization, gets PFB to a level of acceptability in their eyes.Dr. Roberts: On a related note, the number one litigated and number one cause of laser complications nationally, usually with scars and hypopigmentation resulting from treatments, is laser hair removal, so let’s discuss the safety profile techniques and why the 650-microsecond 1064nm Nd:YAG laser is great for this. Dr. Burgess: I’ve seen many of the hair removal disasters in our community, so I’ve used this device for PIH due to trauma or laser burns from hair removal. This device works very well in combination with chemical peels. If patients are gun shy because of a previous bad experience, we do a test spot, and when they see the difference or correction, it builds trust, which is so important in correction of the skin.Dr. Chilukuri: I do very little laser hair removal patients but in my experience the device is powerful and safe to use on all skin types but takes a lot longer than our diode laser.Dr. Campbell-Chambers: It’s my go-to SOC for hair removal. Safety can make or break your practice. The safety profile and efficacy with this laser, especially with ancillary staff users, has positioned it well. For patients who've had traditional lasers versus this, they attest to the higher comfort level. Expectations management is important because patients want to see no hair. We advise an average of six treatments, approximately once a month, plus maintenance afterward. With hair, heat can build up so we must be conservative with the number of passes, and so forth, but we know that rapid pulses limit the time for energy to diffuse into surrounding areas and damage the epidermis.Dr. Burgess: I also find it very helpful with fine vellus hair on the face in post-menopausal women.Dr. Roberts: I love this laser for facial hair. In post-menopausal woman, all skin types, it's a hit. In my type IIIs and IVs, just one treatment and they notice a big change. And I see a lot of teenage girls with hairiness based on ethnicity, so I am very enthusiastic about this laser for that group.

Skin Rejuvenation and Photodamage

Dr. Roberts: What about photodamage and skin rejuvenation? Dr. Chilukuri: We're using the device in combinations as well as a last-minute fine tuning for events. But we're also using it long term to heat skin with multiple passes for skin types I through III, especially on the anterior neck. The lateral neck I can tighten with a variety of things, whether we're putting in PLLA or PDO threads, or building along the jaw line using PLLA, calcium hydroxlapatite, or HA fillers, but the anterior portion of the neck has been a challenge. I've learned to be patient. We’ll do three treatments at two-week intervals, wait three months, then do that again. When I combine it with something where I can penetrate even deeper, like fractional 1540 XD handpiece, we're starting to hit some home runs there. I’ll use the 1540 nm Erbium Glass and then follow it with the Aerolase, and where I'm seeing even better results is with RF-plus-ultrasound to deeply penetrate with heat, and then utilize the Aerolase laser immediately after in the same treatment session, with the goal of raising temperature in the superficial skin to the neighborhood of 40°C, with good long-term results.Dr. Burgess: I have gotten great results, in fact one patient with a lot of photodamage on her neck and décolleté saw what a great job this laser was doing on her face and wanted to try neck and chest. In two treatments you could see a difference, same frequency as for the face, which was about every three weeks. I’m not combining treatments; therefore, I’m excited to try some of the things Dr. Chilukuri is doing.Dr. Roberts: It does such a great job on the anterior neck. Sometimes on the face, people aren't as excited, but always on the neck, first treatment, everyone notices a difference. I combine it with RF and I'm getting amazing results. Because people ask