The notion of beauty is defined in many ways with many different cultural accents. In Rome, beauty was relegated to women with full lips. In India, woman who are tall with lighter features are beautiful. In Africa, the swanlike neck was a sign of beauty. Even in cultural history, the image of beauty is constantly changing. Thirty years prior, beauty was in a curvaceous figure, whereas now, beauty of the body seems to arrive in the slender frame.
The one aspect that seems to be universal when describing beauty is a clear complexion. A face that doesn't have to resort to make-up to cover over complexionary nuisances such as pigmentation, ruddy or erythematous color and broken blood vessels in an enviable face.
In the previous post we discussed topical medications to help minimize pigmentation. While topicals take about 6-12 weeks to show the pigment lightening, they still do not minimize the pigment as well as light based sources. I like to incorporate the topicals to be used for maintenance treatment in conjunction with light based technology.
Solar lentigenes (sun spots), dyschromia (generalized pigmentation) and melasma are some of the most common complaints that patients come in to see me for in consultation.
We start with discussing the importance of sunscreen (see previous blog entry on Sunscreen Essentials) and topical medications for pigment lightening.
If the pigmentation is superficial then the most common treatment modality that I recommend is IPL (Intense Pulsed Light).
This is a broad band light source which targets melanin and small blood vessels to help even out the complexion. It typically takes 2-4 treatments, separated by 2-4 weeks to achieve the end result. Patients can go back to make-up immediately after because the overlying skin (epithelium) is intact. The areas of pigmentation become a bit darker and texturized (like a coffee grind or chocolate chip) for about a week after IPL and then flake off.
This is wonderful treatment modality for the décolletage area, Poikloderma of Civatte on the neck (where necks look dirty from pigment and vessels) and for hands.
For the legs, you have to be careful with settings because legs have a tendency to be quite sensitive.
When pigmentation is a bit deeper, then I prefer to hit the dark area with an Alexandrite laser. Either Q swtiched modality such as Nd:YAG for darker skin type patients or Alexandrite for lighter patients. I also use another Alexandrite laser that is part of my Elite MPX unit to target the pigmentation. I shorten the pulse duration so that the pigment can effectively be fragmented. This is good for discrete lesions and usually pigmentation is much improved after 1-2 treatments.
Finally, the most aggressive way to target pigmentation AND wrinkles is with a fractional CO2 laser. This laser ablates or vaporizes the epidermis down to the mid-dermis in a fractionated pattern (like a pin cushion) so that there are intervening zones of untouched tissue. Even though the skin looks like is has been confluently treated, these untouched micron sized zones allows for a much quicker healing than traditional CO2 laser and carries a much lower risk rate.
Typically, the "downtime" for this laser is about 4 days, meaning that the skin will be edematous (swollen) for the first several days and only aquaphor is to be worn. Then after 4 days, you can return to sunscreen and make-up.
I will cover fractional CO2 in greater depth at a later post. (photos at www.cosmeticdoctalk.com)
Until next time.....