Combining Laser Therapies for Optimal Outcomes in Treating the Aging Face and Acne Scars

Aging and sun damage of the skin results in skin laxity, rhytides, texture irregularities, dyspigmentation, and vascular changes. Many different laser devices are frequently used to correct these changes from age and photodamage. This article describes the author’s experience in combining laser technologies (different wavelengths and applications) in one treatment session to achieve better outcomes with fewer visits for the patient.

•

Different lasers can be combined safely and effectively in same treatment session.
•

Choice of lasers depends on skin type of patient, degree of sun damage, and goals of treatment.
•

Frequently used combinations include the combination of vascular lasers with lasers to target pigment and the combination of one or both of these with fractional nonablative lasers.
•

Laser treatments can be combined with fractional ablative lasers but with greater caution due to the amount of heat delivered to skin during fractional ablation.
•

Combinations of lasers can achieve better outcomes in fewer sessions and lead to greater patient satisfaction.

Key Points

Video of Surgical Technique for fractional ablative laser treatment in combination with punch excisions and the CROSS technique and suturing of the surgical defects at http://www.facialplastic.theclinics.com/ .

Cosmetic surgeons have an ever-expanding variety of devices and products to improve the appearance of aging skin and improve the changes from facial aging. Several neuromuscular relaxers are now used to treat and prevent facial lines that occur from the action of muscle movement. A variety of dermal fillers are used to fill lines and restore facial volume. Radiofrequency (RF) and ultrasound energy devices are used to tighten skin and stimulate collagen production in the skin.

Numerous light-based and energy-based devices can target the visible changes of aging and sun damage on the skin. There are ablative and nonablative lasers in the infrared spectrum that improve the appearance of wrinkles, skin texture, and acne scars. Lasers devices that have wavelengths in the visible light spectrum can specifically target melanin or hemoglobin to treat the dyspigmentation and vascular changes that occur with photoaging. Broad-spectrum intense pulsed light (IPL) devices have the ability to target pigment, erythema, and telangiectasia via a variety of wavelengths.

Several devices have combination therapies built in. RF energy has been combined with IPL and diode laser in several devices. The goal of the combination of technology is to achieve skin tightening and improvement in the visible changes of sun damage in the skin or enhancement of the improvement seen with the light-based device alone. Sadick and colleagues reported significant overall skin improvement (75.3%) and significant patient satisfaction (92%) using a novel device called electro-optical synergy that combines RF and IPL energy in a single pulse. In 2006, Alexiades-Armenakas evaluated the sequential combination use of two devices that combined bipolar RF with light-based energy. One device combined RF with diode laser and the other device combined RF with IPL. Blinded physician evaluation of improvement per category (rhytides, laxity, elastosis, dyschromia, erythema-telangiectasia, keratoses, and texture) after each treatment was mild (average improvement of 10.9% per treatment), but overall patient satisfaction was significantly higher (71.4%). Patient satisfaction was attributed to the use of a combination device that combined three nonablative technologies.

Studies evaluating combination laser treatment

Several studies have evaluated the combinations of different lasers in the same session for the cosmetic enhancement of facial skin. Berlin and colleagues reported successful combination of very light erbium followed sequentially by IPL. Twelve of 15 patients finished the study and reported mild erythema lasting up to 1 week and mild scaling for 3 to 4 days after the treatment. Overall satisfaction at 3-month follow-up was 63%. A study by Lee compared the efficacy of the 532-nm, ms potassium titanyl phosphate alone and the 1064-nm, ms neodymium (Nd:YAG) alone, as well as in combination, for the treatment of skin changes from photoaging. The combination of the two wavelengths gave slightly greater results than either alone. A similar study by Tan and colleagues was a split-face study that showed slightly greater improvement in the side that had received combination treatment of 532 nm and 1064 nm wavelengths. Studies by Goldman and Manuskiatti and by Goldman and colleagues have shown benefit in sequential use of ablative erbium immediately after ablative CO ₂laser in resurfacing to improve healing times and outcomes.

Combination of q-switched lasers (532 followed by 1064 nm) was shown to be significantly more effective in the treatment of Hori nevus than 1064 nm alone. A higher incidence of postinflammatory hyperpigmentation was seen on the combination laser side but all resolved in 2 months. Trelles and colleagues reported better results in leg vein treatment (blue veins and veins >1 mm responded best) using a laser that combined a pulsed dye and Nd:YAG laser sequentially in the same pulse. The sequential pulsed dye 1064 nm Nd:YAG laser has also been reported to be an effective and safe treatment for venous malformation.

Only gold members can continue reading. Log In or Register to continue