No Such Thing as the "Best Laser"

There continues to be a lot of controversy and discussions revolving around what laser device is best for certain conditions.  Let’s tackle Acne scars and brown spots for a start, as these represent a majority of the laser interest.  Even with the advancements in laser technology, there has yet to be a device produced that has become the staple laser for the treatment of these conditions.  There are however, numerous lasers that can produce great results when in the right hands.

It is always important to emphasize the impact that a bad, good and great laser specialist makes on your outcome.  You cannot expect Porsche performance from a Kia and therefore, should not expect exceptional results from a mediocre physician or laser specialist.  I only mention Laser specialist in the same sentence because I personally employed a Dermatology Physician Assistant that was better with lasers than 99%(not exaggerating) of the physicians in our city.  It is always a safer option to start with a cosmetic dermatologist or plastic surgeon, but there are non physician providers that do a great job with lasers.

Physicians that claim to have the latest and greatest technology does not guarantee that your results will be positive.  The latest and greatest technology may actually be bad when in the wrong hands.  The technology can give the physician a level of confidence that they should only have after years of experience.  Most skilled laser specialists will be interested in the research and will probably have published articles and done their own clinical studies.  I have yet to meet a Dermatologist or Plastic Surgeon who is one of the best in their field and have not published articles or performed their own laser studies.  This can be used as an indicator when deciding on your next laser specialist.

One of the greatest minds in laser and cosmetic dermatology, Dr. Victor Ross from Scripps Clinic in San Diego, had a few things to say regarding this in a recent article published in Cosmetic Dermatology Times.  He was quick to point out that there is not an ’easy’ button when it comes to selecting the right laser and light-based treatments.  “We’re all looking for the easy button. Everyone wants maximal results with minimal downtime, cost and pain,”

Unfortunately, he says that there is no system that satisfies all these requirements. Therefore, Dr. Ross states that a major key to a successful aesthetic laser practice, is in matching the treatment to the indication — factoring in patients’ needs, as well as the physician’s experience level and preferences.  Dr. Ross did mention the fractional laser technology saying, “The hottest new item in facial rejuvenation in the past couple years is nonablative fractional remodeling, with the key to its popularity being the fact that because this technology is nonablative, many patients who weren’t candidates for more traditional co2 resurfacing can undergo some form of facial rejuvenation, including scar remodeling,”

When the procedure is properly managed, he adds, “Downtime and pain are fairly minimal.”

However, he says, “You can probably do more with one treatment using ablative fractional technology versus a nonablative technology, which almost always requires multiple treatments.”

Regarding ablative technologies, Dr. Ross says they remain important, but they’re harder to use than nonablative modalities and cause downtime most patients find intolerable. (Further indicating how important it is to select your laser specialist wisely)

“What nearly killed conventional CO₂ laser resurfacing years ago was delayed hypopigmentation,” which typically occurred because physicians performed multiple passes, failed to use feathering techniques or treated darker-skinned patients the same way they treated light-skinned patients, he says.

Although fractional technologies have eliminated many of these problems, he notes that because CO₂ treatment parameters have been significantly modified over the past 10 to 15 years, “There’s still a role for conventional CO₂ resurfacing.”

Conversely, he says skin tightening devices are less valuable to him, “But not because they’re bad technologies.” Rather, he says that products such as the Titan (Cutera), Polaris (Syneron) and ThermaCool (Thermage) face a tremendously difficult challenge.

“We’re trying to heat the skin from the surface confluently while preserving the epidermis” and creating skin tightening underneath. Under these conditions, “The best we can hope for is very modest, gentle skin tightening in most patients.”

According, Dr. Ross says that if patients are expecting surgery-like results from tightening technologies, “They’re going to be disappointed.”