June 4, 2025 • 38 mins
Laser skin treatments: what works, what doesn’t, and how to choose the right one
Wondering which laser treatment is best for your skin? Dermatologists Dr. Brenda Lutowski and Dr. Jen Haley break it all down, what lasers really do, which ones target dark spots, redness, wrinkles, and why no single device can fix everything.
They cover popular options like Fraxel, IPL, and Softwave, with clear tips on what to expect, how to prep, and how to get the best results.
If you’re curious about laser facials, skin tightening, or resurfacing, this episode gives you the facts, minus the hype.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to Listen to your Skin by Moon Skin, the
podcast where science meetsnature to celebrate the story of
your skin.
Your skin is a living canvas,ever evolving, deeply personal
and uniquely yours.
Each week we'll dive into thescience of healthy skin, share
empowering stories and uncovertransformative self-care rituals
.
We're here to help you embraceevery phase of your journey with
(00:22):
confidence and care.
Hi everyone, welcome back toListen to your Skin by Moon and
Skin.
I'm your host, dr Jen Haley,and I have my favorite
dermatologist that's local toScottsdale back on the show to
talk about lasers today, drBrenda Lutowski.
Welcome back, thank you, jen.
Thank you so much for having me.
I love having you so in all theways of friendship and also
(00:43):
fully respect as a colleague.
So, of course, I want to talkabout lasers.
I think that in some respects,society is very familiar with
lasers and in some respects notat all.
So can you break it down?
Lasers 101, what is a laser forthe skin?
Speaker 2 (01:03):
A laser is simply targeted light or focus light
that goes into the skin and thenit's absorbed by something and
it has its effect, and thatsomething is called a
chromophore.
And so we have lasers thattarget brown, where something
called melanin is thechromophore.
We have lasers that target red,where something called
(01:25):
deoxyhemoglobin is thechromophore.
We have lasers that target red,where something called
deoxyhemoglobin is thechromophore.
And then we have lasers thattarget water, where we're more
interested in resurfacing of theskin, excuse me.
And so these lasers are very,very focused and each one tends
to specialize in doing adifferent thing, but we can
(01:49):
really safely and effectivelytreat brown spots of the skin,
red spots of the skin, includingrosacea scars, etc.
And then we can resurface theskin, meaning create new
collagen and therefore have someskin tightening and texture
improvement due to the action ofthese lasers.
Speaker 1 (02:13):
So lasers that address pigmentation basically
will.
They can treat hair, they cantreat tattoos, they can treat
sunspots, and the difference isbased off of, like, how deep
they go in the skin.
So there's a lot of sciencethat goes behind laser
technology, and one of thethings that I've seen so often
(02:35):
over the last 20 plus years ispeople will often mistake that
one laser can do everything.
So what I want you to breakdown is kind of categories of
lasers if you can and what theycan do, and what kind of
categories of lasers if you canand what they can do and what
they can't do, because you know,a laser that's really good at
treating hemoglobin or bloodvessels, for instance, is not
going to be the laser you wantfor wrinkles per se, necessarily
(02:55):
.
So I don't think peopleunderstand that.
What I see often is these medspas will have one laser and
they'll promise someone theworld with that one laser and
they don't deliver and oftenthey cause scarring because they
don't understand the scienceand the physics behind how the
lasers have to work.
Speaker 2 (03:13):
I think that's such a great point.
There are so many differentlasers out there and sometimes
it's hard for even me to keeptrack of them.
We were talking about thatoffline and that's because the
number of lasers out there are,because each laser can kind of
specialize in a different thing.
And the reason why you go intoa practice and sometimes it can
(03:39):
be a little overwhelming becauseyou look at someone's menu of
services like you can look atour menu of services you see we
have this laser, we have thislaser, we have this laser it's
because each laser can safelyand effectively best treat one
category.
So what are those categories?
Like you said, there's laserhair removal, there's tattoo
(04:00):
removal and there are alsolasers for brown spots.
I would put those in a category.
Lasers for red spots I put thatin a category and lasers for
resurfacing just totalrejuvenation.
In addition, there'senergy-based devices.
So those also have littleniches that they focus on and so
(04:28):
it can get very confusing.
I think the key is it can getvery confusing to the consumer.
I think the key is reallyfinding a practice and an
educated provider whether that'sa physician or someone working
under the physician who can helpto guide someone, and even if
(04:49):
that particular practice doesn'thave the laser that's going to
be the best for that category orthat condition, they can be a
resource and refer them out toanother practice who does have
the laser.
Speaker 1 (05:03):
Right, okay, so I'm thinking as we're sitting here,
because we previously did thepodcast on Botox,
neuromodulators and fillers, andnow we're talking about lasers,
and then, of course, we andother energy-based devices, and
then we have things we wantpeople to do at home like
skincare, or do withestheticians maybe microneedling
and chemical peels, say, I am40 years old, I spent quite a
(05:28):
bit of time in the sun.
I've got some broken bloodvessels on my face, some brown
sunspots We'll leave melasma outof this just sunspots, because
not all brown spots are createdequal.
Some brown spots, such as theones I struggle with which you
know you've helped me with thisthey can get worse with certain
types of lasers.
So someone who's able todiagnose your brown spots is
(05:51):
very important, because I'veseen litigations regarding
someone making a diagnosis ofbrown spots and it being melasma
or the hyperpigmentation or thebrown spots after acne scarring
, which respond very differentlythan sunspots to lasers.
So, okay, I've got brown spots,I've got some broken blood
(06:12):
vessels, I have some wrinkles onmy face and coarse skin.
Where do we start?
Oh my gosh.
And where does the budget kindof go with all of these things?
If we could talk hundreds,thousands, yes.
Speaker 2 (06:26):
Yes.
So I love doing thishypothetical situation because I
I just think it's so fun.
This is this is what I do everyday.
It is so much fun.
So I would start in thishypothetical 40 something year
old patient with sun damage, andhow appropriate.
Since we're in Arizona, I wouldstart by suggesting some laser
(06:49):
resurfacing.
In our practice we have theFraxel laser, which is my
favorite skin resurfacer, if youwill, and this is a laser that
has two different wavelengthsand it focuses on heating the
skin to produce collagen, and sothe new collagen is going to
(07:11):
cause someone's skin to looktighter, to look more exfoliated
.
The pore size will shrinkbecause of the new collagen
contracts the skin, if you willand it just looks healthier and
younger.
In addition, the exfoliationthat occurs as part of the
healing from the Fraxel and also, most likely, the heat, the
(07:34):
intense heating from the Fraxelit actually makes the skin
healthier.
So this device is FDA approvedfor the treatment of precancers
or actinic keratosis, and italso has been shown to reduce
the risk of non-melanoma skincancers.
So here in Arizona, I thinkit's really important someone in
that age category startthinking about not only how they
(07:57):
look now, but preventativemodalities for the future.
I think it's the perfect option.
You mentioned capillaries.
I have seen capillaries improveafter Fraxel just because the
health of the skin has improved.
Although, speaking ofchromatophores, it's actually
not a laser that has thattargets that chromophore.
(08:18):
So if someone has ongoingcapillaries, especially around
the nose, cheeks or chin area,then we have another laser in
the practice that specificallytargets those and we would do
that after the fraxel.
Speaker 1 (08:35):
At the same day or at a different day.
Speaker 2 (08:37):
Typically I will encourage for that particular
scenario a different day,because oftentimes those
capillaries will improve whenthe skin gets healthier.
So sometimes patients are nolonger bothered by the
capillaries after the fraxel,but I will treat patients same
day with multiple lasers, justdepending on the goals that we
(08:57):
want to achieve.
Speaker 1 (08:58):
Okay, you know it's so interesting and I'm going to
admit this.
I'm going to admit this becauseyou know I to admit this.
I'm going to admit this becauseyou know I always admit
everything.
So I've had Fraxels with youevery six months for years now,
for four or five years, and Ididn't even know it did all of
this and I keep thinking, oh, Ineed to do something more heavy
duty.
But now I'm realizing why Idon't think I have needed to do
(09:20):
anything more heavy duty,because doing that consistently
has really made a difference inmy skin and I didn't realize
that it had all of thosebenefits.
But one of the things I donotice after you do the
treatment on me is because I'mreligious about wearing a hat.
My forehead doesn't get much ofa reaction, but even though I
wear sunscreen very thickly andvery deliberately, the lower
(09:42):
part of my face, where the hatdoesn't cover it, definitely
lights up more.
Let's just say that.
Speaker 2 (09:47):
Is that typical?
That is typical.
I also think it has to do withcirculation issues and gravity
issues as well.
But for sure, I'm advisingpatients to stay out of the sun
about a week to 10 daysbeforehand longer for patients
with darker skin, and then aweek to 10 days afterwards.
And you're so good and diligentabout staying out of the sun,
(10:11):
even though you have a veryactive lifestyle.
But a lot of times we willactually postpone patients'
lasers till the fall and winterand early spring here.
Speaker 1 (10:21):
Okay, interesting.
Yeah, I feel like now's a goodtime because people don't go out
in the summertime, at least inArizona.
We're opposite other places asfar as our indoor season.
Okay, so the Fraxel is good forthose things.
What about photo facial or IPL?
Are people still doing that andwhat are the indications for
that?
Like, what's the ideal kind ofpatient?
Speaker 2 (10:41):
So there is a device that looks and acts like a
device, like a laser, called IPLintense pulse light, but it's
actually not technically a laser.
So we were talking about lasersbeing very specific bands of
light or very specificwavelengths of light.
Ipl is actually broadband lightand we can put filters in it to
(11:01):
make it act like a laser.
So yes, to answer your question, it is being done very, very
commonly and it really, in myopinion, does well for brown
spots, but it will help with redas well.
Doing the IPL consistentlyactually can keep the skin
really tight and healthy as wellas helping the brown and red
(11:25):
spots.
So in my practice, if a patientdoesn't want to do Fraxel, they
don't want to have the downtimefor Fraxel.
You will hear me recommend theIPL treatment and recommend the
IPL treatment a couple times ayear.
I think it's a really, reallygreat treatment for patients who
don't want any downtime, likefor a stronger skin resurfacing
(11:49):
treatment.
Speaker 1 (11:50):
Okay.
So IPL or BBL is another namebrand, right?
That's a lighter kind oftreatment.
Yes, Less downtime, usuallyless reward, that's correct,
Okay.
So we've got those two covered.
Now if someone is looking to dolaser hair removal I don't know
if you still see this.
I know when laser hair removalfirst came out and we were doing
(12:11):
it 20, 25 years ago peopledidn't seem to understand that
if you have red hair or if youhave blonde hair, your hair has
to be darker than your skin.
So even if you'reAfrican-American, as long as the
hair is darker than the skin,we can target the hair versus
the skin.
We don't want to burn the skinin the process of getting rid of
the hair.
Is that the same as the lasersnowadays, or do we have better
(12:33):
technology for addressing hairremoval, and are people still
doing a lot of hair removal?
Speaker 2 (12:39):
People are still doing a lot of hair removal.
It's extremely popular and, yes, we are still met with the same
challenges in hair removal.
It still works the best on dark, coarse hair.
That's like the ideal hairremoval hair, if you will, and
the finer it is, the harder it'sgoing to be to get rid of.
(12:59):
The lighter it is, the harderit's going to be to get rid of,
and I do tell patients if it'swhite or light.
Nothing's going to work at itat this point.
We do have technology that'sactually FDA approved but it's
not available in the US at thispoint.
That may make a difference withlight hair, but time will tell
(13:20):
if that's going to be awidespread treatment here.
Speaker 1 (13:23):
I think we'd have to learn to pigment the hair bulb,
wouldn't we?
And then target the pigment inthe hair bulb, because hair dye
is not going to work becausewe're not getting it in the bulb
.
Speaker 2 (13:32):
You're right, there's no melanin there from the dye.
This particular technologyheats the hair follicle in a way
that the hair follicle becomesextremely heated without having
the chromophore there.
Speaker 1 (13:47):
It kills the root.
You're not just tearing likethe upper part of the grass,
you're getting the root outExactly.
It's the only way, okay.
Okay, so we have hair removal.
What about tattoo?
Because I think I mean over theyears, you know those little
gang tattoos, you see, that areput in by amateurs.
Those are fairly easy to remove.
They take one or two treatments, but for the most part, I find
(14:07):
that the multicolored tattooscan be quite challenging to
remove.
What kind of guidelines do yougive people and what should they
look for if they're looking todo tattoo removal?
Speaker 2 (14:17):
Because when I used to do it, it was a lot of
treatments and quite expensiveand quite painful that basically
still sums it up it's alwaysmore expensive to get rid of the
tattoo than it is to get thetattoo by many fold.
Tattoo removal is still met withchallenges.
Part of the technology thatmakes tattoo removal successful
(14:40):
or not is the speed with whichthe beam is the light is going
into the skin, and so nowadaysthere is a type of laser called
a pico laser, and that usuallyis done with more success than
some of the older lasers,although I have heard cosmetic
(15:01):
doctors going back and fortheven with some of those older
technologies.
If the pico laser isn't working, we don't currently do tattoo
removal in my practice.
So if you came in with a tattoo, that's an example of when I
would refer someone out to atrusted physician to do that
tattoo removal for you.
But it is fraught withchallenges.
One of the challenges isactually what's in that ink that
(15:23):
we're seeing in the skin andthe different proportions of ink
.
Each artist out there is justthat an artist and has different
concoctions, and that cantranslate into an unpredictable
tattoo removal experience.
Speaker 1 (15:40):
Do you remember out of I think it was out of Boston
one of the main tattoo laserguys in our world had created a
tattoo ink that can be removedwith one laser treatment?
Do you remember that years agoand no one took it?
Because it's like art.
Imagine creating art and thenknowing that somebody can erase
(16:00):
it Like nobody.
No tattoo artist wanted to takethat on.
That's a really greatperspective.
Speaker 2 (16:04):
I do remember that and it is kind of sad that that
technology was kind of a flop.
But I think most tattoo removaldoctors would really really
love it if people would just usethat ink.
Speaker 1 (16:19):
Right?
I mean, just as someone who'sseen thousands of people naked,
I love asking the story behindthe tattoo and asking the story
behind somebody's scar, becausescars and tattoos tell stories
of our lives, and we also seethat people have so many tattoos
that they wish they didn't have, because of what you believe at
one time in your life, youdon't believe 20 years later.
(16:39):
So there's pluses and minusesto everything.
Always For sure, right?
Okay, so we talked aboutpigmentation.
We talked about photo facials.
We talked about hair removal.
We talked about photo facials.
We talked about hair removal.
We talked about tattoo.
We talked about removing orhelping reverse some sun damage
with the Fraxel.
Say, I've done two Fraxeltreatments, I'm still dealing
(17:04):
with some coarseness of my skin,some more sun damage, and I
want to step it up.
Where would somebody go fromthere?
Speaker 2 (17:10):
So there is a laser called the CO2 laser that is
more aggressive than a fraxellaser, which is a non-ablative
fractional erbium laser.
So there is an ablative lasercalled fractional CO2, and it
will give the patient moredowntime.
(17:30):
It usually costs more money andit for sure hurts more, but
that is a laser that's moreaggressive than the Fraxel.
Now, is it worth it or not?
It depends on each individualand their skin.
Speaker 1 (17:46):
Right, Okay, we used to do that under general
anesthesia and that was the dayswhere we overdid it and people
had the porcelain doll faces.
You know, I think things havegotten so much more balanced and
natural nowadays where weunderstand we need to do
multiple treatments of somethingwithout being so aggressive to
keep like everything as naturallooking.
Speaker 2 (18:07):
I think safety is always first.
So the traditional CO2 wasablative and non-fractionated
and, to your point, was fraughtwith complications.
I've seen so much scarring outthere, like you said, porcelain
doll face, hypopigmentedscarring, infections that had
(18:27):
occurred, and even hypertrophicscarring, meaning the scars are
raised, especially around thejawline.
From there, fractional CO2 wasdeveloped and that's a more.
That's a much safer technique.
However, the results are notthe same and so, to your point,
(18:50):
they need to be done morefrequently and unfortunately for
the patients that means moredowntime, more costs.
But it is a safer way of doingthings and I think ultimately
that's the goal, right, I agree.
Speaker 1 (19:04):
Okay, so what about?
I hear these words?
So we talked about Fraxel,pixel, tixel.
What are Pixel and what's Pixeland Tixel?
Speaker 2 (19:13):
Oh my gosh, there's so many terms, there's so many
lasers out there.
I can't even keep them allstraight anymore.
So there are so manycompetitors and I think for most
people just going to someonewho has those categories of
laser treatments.
Speaker 1 (19:31):
Because there's names even under the category.
So each category is a category,but then there's different
names under there Exactly.
Speaker 2 (19:36):
It's hard to keep up with it is, and that's where you
really have to trust your laserdoctor and trust that they are
investing in the best devicesfor their patient's interests.
Speaker 1 (19:49):
Okay, so what about if somebody was on a GLP-1
analog?
They lost some weight and nowthey're noticing some sagging
around their face?
I know there's huge variationsin how much sagging people have
and there's only so much devicescan help with or filler can
help with.
What is your sagging?
Your sagging device Like whatdevices would you go to for?
(20:10):
You know, maybe some jowls orsome loose skin, what?
What device would you go to forthat?
Speaker 2 (20:18):
So I have two sagging devices or non-sagging devices,
yes, non-sagging devices.
The first one that I tend torecommend most frequently for
that specific problem is RFmicroneedling, is utilizing RF
microneedling.
Our device that we have iscalled the Agnes.
(20:39):
It's a very, very strong deviceand so it can really tighten
skin in a very precise way.
So for the jowling I often usethis device.
It has a tiny, tiny littleneedle in it and then it
delivers heat through the baseof the needle.
So this needle goes into theskin and then the heat comes out
(21:02):
or the radio frequency comesout the base of the needle and
therefore the energy goes verydeep into the skin and results
in more tightening and lifting.
So oftentimes people who've hada lot of weight loss or just
aging in general and theygenetically have more jowls, I
can use it in a precise way toreduce some of the redundant
(21:26):
tissue here and then tighten theskin back here.
So we reduce this, make itflatter, tighten in the jawline
and therefore define the jawline.
And a lot of times this devicewill be used for patients who
don't want to do filler.
Best case scenario we firsttighten the skin like this and
(21:47):
then we use filler tostrategically replace some of
the structure and volume that'sbeen lost, and that's really the
best case scenario.
Speaker 1 (21:56):
Give us the best results okay, that's really nice
because we've heard we talkedabout this before we started
recording about some of the rfmicroneedling.
You know, getting rid ofpeople's fat, which, if you're
using it for redundant tissue,that's great.
But like where?
When do you know where to useit and when not to use it, and
what should people look out forbasically, if they're
(22:16):
considering using this device?
Speaker 2 (22:18):
That's a great question, because there have
been reports of unwanted fatloss.
So there can't.
These devices are really greatbecause, for instance, this one
that I have can reduce fat, butin a way that I wanted to, so
double chin area, gel area, etc.
There are some devices outthere that have gotten too hot
(22:40):
and have resulted in unwantedfat loss, and so, again, I think
this really underscores theneed for someone you trust to be
doing the procedure and pickingthe right device for your
condition.
Speaker 1 (22:52):
Right, yeah, it really the same device can do
multiple things.
So okay.
And then you had mentionedearlier with Softwave.
Can you talk about thetechnology of Softwave and what
it can do, what it can't do?
Speaker 2 (23:05):
So this is an ultrasound device.
It falls into that category ofultrasound treatments, and the
device we've chosen in ourpractice is called Softwave.
I love, love, love thistechnology because, number one,
it's completely non-invasive.
That means there is nothinggoing into the skin.
Not even a little tiny Botoxneedle is going into the skin.
(23:27):
So it is strictly ultrasoundwaves that are focused and that
go to a certain depth in theskin and then they work their
magic.
And then the second thing thatmakes it so nice, especially
here in Arizona, is that theseultrasound waves are focused to
the middle part of the skin orthe dermis, and so it skips.
(23:49):
The waves skip the epidermis,so there is no collateral damage
in the epidermis and thereforewe don't have to worry about
skin color and sun exposure.
So safe in all skin types andsafe if someone's been out in
the summer, which is really nice.
It makes it a very good summertreatment, especially here in
(24:11):
Arizona.
And so the ultrasound waves goin, they heat the skin and that
causes some collagen production.
It causes elastin production.
What does that do?
It makes the skin glow, itmakes the skin a little bit
tighter on the surface becauseof the new collagen, and it
(24:32):
makes the skin look healthier,just like the Fraxel, because
the end result for each one iscollagen production.
But some of that heat also goesa little bit deeper and can
actually heat the connectivetissue or the SMAS, connecting
everything in the face.
So we do get more lift with anultrasound device because we can
(24:56):
have the energy go a little bitdeeper into the skin and
tighten or lift the SMAS andthat lifts everything up.
Speaker 1 (25:06):
Okay, that's really interesting.
So when you're first talkingabout ultrasound, I'm thinking,
oh, like when I was pregnantthere was an ultrasound, but
it's different technology.
Speaker 2 (25:13):
It's heating, yes exactly, and that has to do with
the way that the ultrasoundwaves are targeted and focused.
Speaker 1 (25:20):
Okay, so it's heating the deeper layers, is there?
Are there any other devices outthere that go by name brand
that do have that kind of aneffect?
Speaker 2 (25:30):
Yes, so there's also a device called Ultherapy that
has been around for years andyears and in fact the company
just released a second versionof it and that's also widely
available.
We just happened to choose thesoftware version because we like
the technology better and itgives an extremely predictable
result.
Speaker 1 (25:50):
Okay, how painful is this?
Because I'm going to disclosethat I had Ultherapy maybe eight
years ago and I had children,naturally with no pain medicine.
So I thought I had a good paintolerance.
But when they touched myforehead I said I'm out of here,
I don't care that I had to pay,I'm not having this pain.
It was really, really painful.
Speaker 2 (26:11):
So I mean we're going to be real here.
This is real and I'm so sorryto the all therapy company, but
it is an extremely it works.
It is an extremely painfulprocedure and that is also one
of the reasons we chose softwaveover all therapy, because it's
much more tolerated than the alltherapy.
(26:34):
So I also have had children,but none of them were natural,
drug free childbirth.
I like to be comfortable and soI can do this treatment with no
problem at all and it's oververy quickly.
It's very tolerable.
Jen, knowing you, you wouldprobably be asking our nurse to
(26:56):
give you two treatments in oneday because you thought it was
so easy.
Speaker 1 (26:59):
Okay, thank you.
I just had to get to the pointbecause you know there's so many
good procedures out there and Ithink people need to understand
, like the cost of things, whichI know you can't really say
because the cost varies so muchby geographic location so we
can't really say but I mean,most procedures in the laser
world are going to run in thethousands but also like the
(27:21):
amount of downtime.
So it sounds like with softwavethere's not a lot, maybe a
little swelling.
Speaker 2 (27:26):
There's zero downtime with softwave and in fact I
think patients usually leavelooking better than when they
walked in.
There's kind of this instanttightening that occurs, but like
everything that stimulatescollagen, you will see the best
results after several months.
So no downtime with Softwave.
And again, this is somethingthat can go into the cosmetic
(27:47):
consultation how much downtimeis tolerable for someone?
So if someone has some downtime, they want a really great
result.
You know we talk about theFraxel.
If it's summertime, they've gota lot of social events or it's
graduation season, softwave is areally great option and you
start seeing the results rightaway and they only improve over
(28:10):
time.
So yes, and then cost is also afactor of course for everyone.
But the great news is, withsome of these technologies, like
the Fraxel, like soft wave, wedon't have to do them frequently
.
In our practice we recommendfor most patients a Fraxel
(28:30):
annually and patients can domore than that or more
frequently have the treatment.
However, if in an idealsituation, they're doing other
things, like you said, there'sso many things out there now
that we recommend and we askpatients to do so.
If they're doing other things,we recommend and we ask patients
(28:51):
to do so if they're doing otherthings, I will often add to
their mix Fraxel annually,softwave annually.
So these things may be costlyinitially in the low
mid-thousands, but you don'thave to do them frequently.
Speaker 1 (29:06):
Right, yes, that's a good way to think about it.
You brought up a point that Iwant to reemphasize about when
we stimulate collagen.
So while somebody might walkout and notice improvement a
week later of their skin, we'restill stimulating collagen,
which takes the fibroblast threeto six months to form.
So the results are going to bebetter three to six months down
the road than they are a week ortwo later.
(29:27):
So better three to six monthsdown the road than they are a
week or two later.
Speaker 2 (29:35):
So there's a little bit of patience involved in this
and sometimes not stacking toomany procedures in a row and
giving things time to work.
Yes, that's exactly it.
And the thing is with whenyou're doing these lasers or
energy-based devices that reallydo give these predictable
results, you don't have to gocrazy with the frequency of
things, you don't have to bedoing a lot of things.
If you make the rightinvestment, you can actually
feel like you're pretty lowmaintenance and have wonderful,
(29:58):
wonderful results.
So, again, that's somethingthat should be discussed with
your cosmetic doctor.
It's really important to have acosmetic doctor that you trust,
because they should be guidingyou in that sense, and I have
this conversation all the time.
In fact, I think you and I mayhave even had this conversation
before where I say, okay, well,you just have the fraxel, then
(30:20):
you actually don't need to doanything else for a while, and
it really is nice to have thatguidance when there are so many
different options out there.
Speaker 1 (30:31):
And I want to emphasize don't jump from doctor
to doctor, because if you havefiller with one person, or I
sent someone to you who hadBotox with someone else because
they shop around for the lowestprice and then they did filler
with you and they thought fillercaused loss of movement to
their lips and I said fillerdoesn't do that.
(30:53):
Did you have Botox?
And they had had Botox withsomeone else?
So when you go to the sameperson, they understand
everything that's being done toyou and they can provide the
best guidance.
But if you're jumping aroundfrom person to person to person,
that's where I see the mostside effects and the most
problems with everything.
Speaker 2 (31:10):
Yes, and I remember that patient and this is such an
important point because yourbest care really comes from the
trust and communication you havewith your doctor and you really
are going to get the bestresults when you have that
person guiding you through yourskincare treatment hands down.
Speaker 1 (31:30):
Right, okay, I want to be cognizant of your time and
I know you have to get your son.
I just want to cover one morething the skincare prep before
laser treatment and then postlaser treatment.
How would that vary from whatsomebody would do as their
foundational skincare from dayto day in general?
Speaker 2 (31:44):
terms.
Thank you for asking thatquestion.
It is so important.
No matter what light-baseddevice that you're doing,
especially with lasers and IPL,it's important to avoid the sun
before and after your treatment,and patients often do forget
this, even though it'semphasized so much.
But really, what we want to dois have the color cells in our
(32:10):
skin have the melanocytes niceand quiet and sleepy, and when
we're out in the sun it they getperked up and then, when
they're perked up, sometimesthey have this side effect when
they've have laser to releasetheir color and cause
hyperpigmentation color andcause hyperpigmentation, and
(32:31):
that can be a really annoyingside effect.
In addition, if someone has atan when they come in for a
laser, the laser is oftenstronger than it normally would
be if someone didn't have a tan,and so the settings would need
to be adjusted.
The best and safest thing is toavoid the sun before and after.
That's number one.
(32:51):
Number two keeping the skin ashydrated as possible.
So many times we ask patientsto avoid irritating products
before their laser treatments,like glycolic acid, retinols etc
.
And that's because we want skinwith an intact skin barrier.
We want the skin to benon-damaged, nice and hydrated
(33:14):
when someone comes inAdditionally things like
glycolic acid, retinase,retinols.
They can make skin moresensitive to the sun, so again,
we want to minimize sun as muchas possible and then afterwards,
if someone is prone tohyperpigmentation, sometimes we
will use a bleaching cream orhydroquinone to reduce the risk
(33:37):
of hyperpigmentation, andsometimes even a topical steroid
, depending on the patient'sskin tone and personal history
with hyperpigmentation.
Speaker 1 (33:47):
Yeah, I mean, everything you're saying is so
complex and I'm also thinking ofso many more variables that can
happen.
So really, at the end of theday, somebody needs to go to
someone who understands skin andthe physiology of skin, because
if you don't, even if you dothe right laser and you don't
prep it and post care itproperly, you're not going to
get good results.
Speaker 2 (34:07):
Yes, you're really doing a disservice to yourself
if you walk in just kind ofunprepared.
You absolutely will get thebest results possible if you
have that consultation withsomeone who's qualified to do
these procedures and heed theiradvice.
Speaker 1 (34:24):
I hear this all the time and I I just want to
emphasize this why I love goingto you because you give people a
post-care kit and very specificinstructions of what to do for
a week after.
And the last time I had fraxelwith you, I had a friend who
doesn't live in town here whohad I think she had co2 and
(34:45):
plasma and no instructions onwhat to do afterwards.
None and just a yeah.
That is terrifying.
Speaker 2 (34:57):
That is terrifying to me, and maybe she had some
verbal instructions.
But, to your point, I really doappreciate verbal and written
instructions and it's just.
It's so important to know whatyou're supposed to be doing,
what the signs and symptoms areof a complication, so that you
can call your qualified cosmeticdermatologist or plastic
(35:19):
surgeon and that they can helpyou in an early phase versus
letting a potential complicationturn into that Right.
Speaker 1 (35:27):
Yeah, because these procedures, they have downtime,
they cost money.
So, if you're listening to this, if you're an esthetician, if
you're someone who's a potentialpatient, make sure you find out
how to best prep your skin andthen what you should do
afterwards and when it's okay toreturn to your normal skin
routine.
So that's what we're trying toshare here.
Absolutely yeah, okay.
Anything else that I didn't askabout that you think we should
(35:48):
cover, okay?
Speaker 2 (35:48):
Anything else that I didn't ask about that you think
we should cover.
One thing we didn't cover isscarring and how these
energy-based devices,specifically lasers, can be so
life-changing for scarring.
So anyone who's out there who'sstruggling with scarring, we
have so many options.
The game has really changed andwe can be extremely, extremely
effective with scarring,regardless of the cause acne
(36:11):
scarring, surgical scarring, etcetera.
So if you're struggling withscarring, I encourage you to go
to a cosmetic dermatologist orplastic surgeon.
Speaker 1 (36:20):
Are you talking more about acne scarring where
there's atrophy or loss oftissue or hypertrophic?
Do we have good treatmentsnowadays for keloids and
hypertrophic scars?
Speaker 2 (36:30):
They're very challenging still All scarring
is challenging, but I really dothink that we have made a lot of
progress in the way we treatthese scars.
So I would say both types ofscars are highly, highly
treatable Also burn scars andsurgical scars and in general,
one important thing for theaudience to know is the sooner
(36:52):
an intervention is done, thebetter the end result will be,
and that's because we canactually affect the biology of
the scar and help to normalizethe scarring tissue to make it
as much like normal tissue asnon-scarred tissue as possible.
Speaker 1 (37:07):
That makes me so happy because, you know, we get
to see how people feelvulnerable about things having
to do with their skin and how welook and show up in the world.
We're often very self-consciousabout certain things that
people don't often even noticebecause they're worried about
their own things.
But at the end of the day, youknow, if we can make someone
feel better about themselves sothey can show up in that job
(37:28):
interview and ask the girl outon the date and do all of the
other things that they want todo in life, that's really what
it's all about.
Speaker 2 (37:35):
It really is.
It's a huge quality of lifeimprovement to make someone feel
less self-conscious about theirscars.
I love doing it.
Speaker 1 (37:43):
Great, well, it's so great.
The technology is changing somuch and things are just going
to get better and better, and Iappreciate you being at the
cutting edge of all of this andsharing your information today,
Brenda.
Speaker 2 (37:54):
Thank you so much for having me, Jen.
I really enjoyed it.
Speaker 1 (37:56):
So if people haven't heard the other episode, can you
just drop in the comments likehow do people find you?
Speaker 2 (38:02):
So our website is clearedermatologynet and our
social media handle is atCleared clear dermatology.
We'd love to see you in theoffice, thank you.
Speaker 1 (38:11):
Thank you.
Thank you for joining us onlisten to your skin by moon and
skin.
It's an honor to be part ofyour skincare journey and if you
love this episode, make sure tosubscribe.
Leave us a glowing review andshare it with someone who's
passionate about their skincarejourney, and please connect with
us on social to ask yourquestions, which will drive
future educational episodes.
Welcome to Listen to your Skin by Moon Skin, the
podcast where science meetsnature to celebrate the story of
your skin.
Your skin is a living canvas,ever evolving, deeply personal
and uniquely yours.
Each week we'll dive into thescience of healthy skin, share
empowering stories and uncovertransformative self-care rituals
.
We're here to help you embraceevery phase of your journey with
(00:22):
confidence and care.
Hi everyone, welcome back toListen to your Skin by Moon and
Skin.
I'm your host, dr Jen Haley,and I have my favorite
dermatologist that's local toScottsdale back on the show to
talk about lasers today, drBrenda Lutowski.
Welcome back, thank you, jen.
Thank you so much for having me.
I love having you so in all theways of friendship and also
(00:43):
fully respect as a colleague.
So, of course, I want to talkabout lasers.
I think that in some respects,society is very familiar with
lasers and in some respects notat all.
So can you break it down?
Lasers 101, what is a laser forthe skin?
Speaker 2 (01:03):
A laser is simply targeted light or focus light
that goes into the skin and thenit's absorbed by something and
it has its effect, and thatsomething is called a
chromophore.
And so we have lasers thattarget brown, where something
called melanin is thechromophore.
We have lasers that target red,where something called
(01:25):
deoxyhemoglobin is thechromophore.
We have lasers that target red,where something called
deoxyhemoglobin is thechromophore.
And then we have lasers thattarget water, where we're more
interested in resurfacing of theskin, excuse me.
And so these lasers are very,very focused and each one tends
to specialize in doing adifferent thing, but we can
(01:49):
really safely and effectivelytreat brown spots of the skin,
red spots of the skin, includingrosacea scars, etc.
And then we can resurface theskin, meaning create new
collagen and therefore have someskin tightening and texture
improvement due to the action ofthese lasers.
Speaker 1 (02:13):
So lasers that address pigmentation basically
will.
They can treat hair, they cantreat tattoos, they can treat
sunspots, and the difference isbased off of, like, how deep
they go in the skin.
So there's a lot of sciencethat goes behind laser
technology, and one of thethings that I've seen so often
(02:35):
over the last 20 plus years ispeople will often mistake that
one laser can do everything.
So what I want you to breakdown is kind of categories of
lasers if you can and what theycan do, and what kind of
categories of lasers if you canand what they can do and what
they can't do, because you know,a laser that's really good at
treating hemoglobin or bloodvessels, for instance, is not
going to be the laser you wantfor wrinkles per se, necessarily
(02:55):
.
So I don't think peopleunderstand that.
What I see often is these medspas will have one laser and
they'll promise someone theworld with that one laser and
they don't deliver and oftenthey cause scarring because they
don't understand the scienceand the physics behind how the
lasers have to work.
Speaker 2 (03:13):
I think that's such a great point.
There are so many differentlasers out there and sometimes
it's hard for even me to keeptrack of them.
We were talking about thatoffline and that's because the
number of lasers out there are,because each laser can kind of
specialize in a different thing.
And the reason why you go intoa practice and sometimes it can
(03:39):
be a little overwhelming becauseyou look at someone's menu of
services like you can look atour menu of services you see we
have this laser, we have thislaser, we have this laser it's
because each laser can safelyand effectively best treat one
category.
So what are those categories?
Like you said, there's laserhair removal, there's tattoo
(04:00):
removal and there are alsolasers for brown spots.
I would put those in a category.
Lasers for red spots I put thatin a category and lasers for
resurfacing just totalrejuvenation.
In addition, there'senergy-based devices.
So those also have littleniches that they focus on and so
(04:28):
it can get very confusing.
I think the key is it can getvery confusing to the consumer.
I think the key is reallyfinding a practice and an
educated provider whether that'sa physician or someone working
under the physician who can helpto guide someone, and even if
(04:49):
that particular practice doesn'thave the laser that's going to
be the best for that category orthat condition, they can be a
resource and refer them out toanother practice who does have
the laser.
Speaker 1 (05:03):
Right, okay, so I'm thinking as we're sitting here,
because we previously did thepodcast on Botox,
neuromodulators and fillers, andnow we're talking about lasers,
and then, of course, we andother energy-based devices, and
then we have things we wantpeople to do at home like
skincare, or do withestheticians maybe microneedling
and chemical peels, say, I am40 years old, I spent quite a
(05:28):
bit of time in the sun.
I've got some broken bloodvessels on my face, some brown
sunspots We'll leave melasma outof this just sunspots, because
not all brown spots are createdequal.
Some brown spots, such as theones I struggle with which you
know you've helped me with thisthey can get worse with certain
types of lasers.
So someone who's able todiagnose your brown spots is
(05:51):
very important, because I'veseen litigations regarding
someone making a diagnosis ofbrown spots and it being melasma
or the hyperpigmentation or thebrown spots after acne scarring
, which respond very differentlythan sunspots to lasers.
So, okay, I've got brown spots,I've got some broken blood
(06:12):
vessels, I have some wrinkles onmy face and coarse skin.
Where do we start?
Oh my gosh.
And where does the budget kindof go with all of these things?
If we could talk hundreds,thousands, yes.
Speaker 2 (06:26):
Yes.
So I love doing thishypothetical situation because I
I just think it's so fun.
This is this is what I do everyday.
It is so much fun.
So I would start in thishypothetical 40 something year
old patient with sun damage, andhow appropriate.
Since we're in Arizona, I wouldstart by suggesting some laser
(06:49):
resurfacing.
In our practice we have theFraxel laser, which is my
favorite skin resurfacer, if youwill, and this is a laser that
has two different wavelengthsand it focuses on heating the
skin to produce collagen, and sothe new collagen is going to
(07:11):
cause someone's skin to looktighter, to look more exfoliated
.
The pore size will shrinkbecause of the new collagen
contracts the skin, if you willand it just looks healthier and
younger.
In addition, the exfoliationthat occurs as part of the
healing from the Fraxel and also, most likely, the heat, the
(07:34):
intense heating from the Fraxelit actually makes the skin
healthier.
So this device is FDA approvedfor the treatment of precancers
or actinic keratosis, and italso has been shown to reduce
the risk of non-melanoma skincancers.
So here in Arizona, I thinkit's really important someone in
that age category startthinking about not only how they
(07:57):
look now, but preventativemodalities for the future.
I think it's the perfect option.
You mentioned capillaries.
I have seen capillaries improveafter Fraxel just because the
health of the skin has improved.
Although, speaking ofchromatophores, it's actually
not a laser that has thattargets that chromophore.
(08:18):
So if someone has ongoingcapillaries, especially around
the nose, cheeks or chin area,then we have another laser in
the practice that specificallytargets those and we would do
that after the fraxel.
Speaker 1 (08:35):
At the same day or at a different day.
Speaker 2 (08:37):
Typically I will encourage for that particular
scenario a different day,because oftentimes those
capillaries will improve whenthe skin gets healthier.
So sometimes patients are nolonger bothered by the
capillaries after the fraxel,but I will treat patients same
day with multiple lasers, justdepending on the goals that we
(08:57):
want to achieve.
Speaker 1 (08:58):
Okay, you know it's so interesting and I'm going to
admit this.
I'm going to admit this becauseyou know I to admit this.
I'm going to admit this becauseyou know I always admit
everything.
So I've had Fraxels with youevery six months for years now,
for four or five years, and Ididn't even know it did all of
this and I keep thinking, oh, Ineed to do something more heavy
duty.
But now I'm realizing why Idon't think I have needed to do
(09:20):
anything more heavy duty,because doing that consistently
has really made a difference inmy skin and I didn't realize
that it had all of thosebenefits.
But one of the things I donotice after you do the
treatment on me is because I'mreligious about wearing a hat.
My forehead doesn't get much ofa reaction, but even though I
wear sunscreen very thickly andvery deliberately, the lower
(09:42):
part of my face, where the hatdoesn't cover it, definitely
lights up more.
Let's just say that.
Speaker 2 (09:47):
Is that typical?
That is typical.
I also think it has to do withcirculation issues and gravity
issues as well.
But for sure, I'm advisingpatients to stay out of the sun
about a week to 10 daysbeforehand longer for patients
with darker skin, and then aweek to 10 days afterwards.
And you're so good and diligentabout staying out of the sun,
(10:11):
even though you have a veryactive lifestyle.
But a lot of times we willactually postpone patients'
lasers till the fall and winterand early spring here.
Speaker 1 (10:21):
Okay, interesting.
Yeah, I feel like now's a goodtime because people don't go out
in the summertime, at least inArizona.
We're opposite other places asfar as our indoor season.
Okay, so the Fraxel is good forthose things.
What about photo facial or IPL?
Are people still doing that andwhat are the indications for
that?
Like, what's the ideal kind ofpatient?
Speaker 2 (10:41):
So there is a device that looks and acts like a
device, like a laser, called IPLintense pulse light, but it's
actually not technically a laser.
So we were talking about lasersbeing very specific bands of
light or very specificwavelengths of light.
Ipl is actually broadband lightand we can put filters in it to
(11:01):
make it act like a laser.
So yes, to answer your question, it is being done very, very
commonly and it really, in myopinion, does well for brown
spots, but it will help with redas well.
Doing the IPL consistentlyactually can keep the skin
really tight and healthy as wellas helping the brown and red
(11:25):
spots.
So in my practice, if a patientdoesn't want to do Fraxel, they
don't want to have the downtimefor Fraxel.
You will hear me recommend theIPL treatment and recommend the
IPL treatment a couple times ayear.
I think it's a really, reallygreat treatment for patients who
don't want any downtime, likefor a stronger skin resurfacing
(11:49):
treatment.
Speaker 1 (11:50):
Okay.
So IPL or BBL is another namebrand, right?
That's a lighter kind oftreatment.
Yes, Less downtime, usuallyless reward, that's correct,
Okay.
So we've got those two covered.
Now if someone is looking to dolaser hair removal I don't know
if you still see this.
I know when laser hair removalfirst came out and we were doing
(12:11):
it 20, 25 years ago peopledidn't seem to understand that
if you have red hair or if youhave blonde hair, your hair has
to be darker than your skin.
So even if you'reAfrican-American, as long as the
hair is darker than the skin,we can target the hair versus
the skin.
We don't want to burn the skinin the process of getting rid of
the hair.
Is that the same as the lasersnowadays, or do we have better
(12:33):
technology for addressing hairremoval, and are people still
doing a lot of hair removal?
Speaker 2 (12:39):
People are still doing a lot of hair removal.
It's extremely popular and, yes, we are still met with the same
challenges in hair removal.
It still works the best on dark, coarse hair.
That's like the ideal hairremoval hair, if you will, and
the finer it is, the harder it'sgoing to be to get rid of.
(12:59):
The lighter it is, the harderit's going to be to get rid of,
and I do tell patients if it'swhite or light.
Nothing's going to work at itat this point.
We do have technology that'sactually FDA approved but it's
not available in the US at thispoint.
That may make a difference withlight hair, but time will tell
(13:20):
if that's going to be awidespread treatment here.
Speaker 1 (13:23):
I think we'd have to learn to pigment the hair bulb,
wouldn't we?
And then target the pigment inthe hair bulb, because hair dye
is not going to work becausewe're not getting it in the bulb
.
Speaker 2 (13:32):
You're right, there's no melanin there from the dye.
This particular technologyheats the hair follicle in a way
that the hair follicle becomesextremely heated without having
the chromophore there.
Speaker 1 (13:47):
It kills the root.
You're not just tearing likethe upper part of the grass,
you're getting the root outExactly.
It's the only way, okay.
Okay, so we have hair removal.
What about tattoo?
Because I think I mean over theyears, you know those little
gang tattoos, you see, that areput in by amateurs.
Those are fairly easy to remove.
They take one or two treatments, but for the most part, I find
(14:07):
that the multicolored tattooscan be quite challenging to
remove.
What kind of guidelines do yougive people and what should they
look for if they're looking todo tattoo removal?
Speaker 2 (14:17):
Because when I used to do it, it was a lot of
treatments and quite expensiveand quite painful that basically
still sums it up it's alwaysmore expensive to get rid of the
tattoo than it is to get thetattoo by many fold.
Tattoo removal is still met withchallenges.
Part of the technology thatmakes tattoo removal successful
(14:40):
or not is the speed with whichthe beam is the light is going
into the skin, and so nowadaysthere is a type of laser called
a pico laser, and that usuallyis done with more success than
some of the older lasers,although I have heard cosmetic
(15:01):
doctors going back and fortheven with some of those older
technologies.
If the pico laser isn't working, we don't currently do tattoo
removal in my practice.
So if you came in with a tattoo, that's an example of when I
would refer someone out to atrusted physician to do that
tattoo removal for you.
But it is fraught withchallenges.
One of the challenges isactually what's in that ink that
(15:23):
we're seeing in the skin andthe different proportions of ink
.
Each artist out there is justthat an artist and has different
concoctions, and that cantranslate into an unpredictable
tattoo removal experience.
Speaker 1 (15:40):
Do you remember out of I think it was out of Boston
one of the main tattoo laserguys in our world had created a
tattoo ink that can be removedwith one laser treatment?
Do you remember that years agoand no one took it?
Because it's like art.
Imagine creating art and thenknowing that somebody can erase
(16:00):
it Like nobody.
No tattoo artist wanted to takethat on.
That's a really greatperspective.
Speaker 2 (16:04):
I do remember that and it is kind of sad that that
technology was kind of a flop.
But I think most tattoo removaldoctors would really really
love it if people would just usethat ink.
Speaker 1 (16:19):
Right?
I mean, just as someone who'sseen thousands of people naked,
I love asking the story behindthe tattoo and asking the story
behind somebody's scar, becausescars and tattoos tell stories
of our lives, and we also seethat people have so many tattoos
that they wish they didn't have, because of what you believe at
one time in your life, youdon't believe 20 years later.
(16:39):
So there's pluses and minusesto everything.
Always For sure, right?
Okay, so we talked aboutpigmentation.
We talked about photo facials.
We talked about hair removal.
We talked about photo facials.
We talked about hair removal.
We talked about tattoo.
We talked about removing orhelping reverse some sun damage
with the Fraxel.
Say, I've done two Fraxeltreatments, I'm still dealing
(17:04):
with some coarseness of my skin,some more sun damage, and I
want to step it up.
Where would somebody go fromthere?
Speaker 2 (17:10):
So there is a laser called the CO2 laser that is
more aggressive than a fraxellaser, which is a non-ablative
fractional erbium laser.
So there is an ablative lasercalled fractional CO2, and it
will give the patient moredowntime.
(17:30):
It usually costs more money andit for sure hurts more, but
that is a laser that's moreaggressive than the Fraxel.
Now, is it worth it or not?
It depends on each individualand their skin.
Speaker 1 (17:46):
Right, Okay, we used to do that under general
anesthesia and that was the dayswhere we overdid it and people
had the porcelain doll faces.
You know, I think things havegotten so much more balanced and
natural nowadays where weunderstand we need to do
multiple treatments of somethingwithout being so aggressive to
keep like everything as naturallooking.
Speaker 2 (18:07):
I think safety is always first.
So the traditional CO2 wasablative and non-fractionated
and, to your point, was fraughtwith complications.
I've seen so much scarring outthere, like you said, porcelain
doll face, hypopigmentedscarring, infections that had
(18:27):
occurred, and even hypertrophicscarring, meaning the scars are
raised, especially around thejawline.
From there, fractional CO2 wasdeveloped and that's a more.
That's a much safer technique.
However, the results are notthe same and so, to your point,
(18:50):
they need to be done morefrequently and unfortunately for
the patients that means moredowntime, more costs.
But it is a safer way of doingthings and I think ultimately
that's the goal, right, I agree.
Speaker 1 (19:04):
Okay, so what about?
I hear these words?
So we talked about Fraxel,pixel, tixel.
What are Pixel and what's Pixeland Tixel?
Speaker 2 (19:13):
Oh my gosh, there's so many terms, there's so many
lasers out there.
I can't even keep them allstraight anymore.
So there are so manycompetitors and I think for most
people just going to someonewho has those categories of
laser treatments.
Speaker 1 (19:31):
Because there's names even under the category.
So each category is a category,but then there's different
names under there Exactly.
Speaker 2 (19:36):
It's hard to keep up with it is, and that's where you
really have to trust your laserdoctor and trust that they are
investing in the best devicesfor their patient's interests.
Speaker 1 (19:49):
Okay, so what about if somebody was on a GLP-1
analog?
They lost some weight and nowthey're noticing some sagging
around their face?
I know there's huge variationsin how much sagging people have
and there's only so much devicescan help with or filler can
help with.
What is your sagging?
Your sagging device Like whatdevices would you go to for?
(20:10):
You know, maybe some jowls orsome loose skin, what?
What device would you go to forthat?
Speaker 2 (20:18):
So I have two sagging devices or non-sagging devices,
yes, non-sagging devices.
The first one that I tend torecommend most frequently for
that specific problem is RFmicroneedling, is utilizing RF
microneedling.
Our device that we have iscalled the Agnes.
(20:39):
It's a very, very strong deviceand so it can really tighten
skin in a very precise way.
So for the jowling I often usethis device.
It has a tiny, tiny littleneedle in it and then it
delivers heat through the baseof the needle.
So this needle goes into theskin and then the heat comes out
(21:02):
or the radio frequency comesout the base of the needle and
therefore the energy goes verydeep into the skin and results
in more tightening and lifting.
So oftentimes people who've hada lot of weight loss or just
aging in general and theygenetically have more jowls, I
can use it in a precise way toreduce some of the redundant
(21:26):
tissue here and then tighten theskin back here.
So we reduce this, make itflatter, tighten in the jawline
and therefore define the jawline.
And a lot of times this devicewill be used for patients who
don't want to do filler.
Best case scenario we firsttighten the skin like this and
(21:47):
then we use filler tostrategically replace some of
the structure and volume that'sbeen lost, and that's really the
best case scenario.
Speaker 1 (21:56):
Give us the best results okay, that's really nice
because we've heard we talkedabout this before we started
recording about some of the rfmicroneedling.
You know, getting rid ofpeople's fat, which, if you're
using it for redundant tissue,that's great.
But like where?
When do you know where to useit and when not to use it, and
what should people look out forbasically, if they're
(22:16):
considering using this device?
Speaker 2 (22:18):
That's a great question, because there have
been reports of unwanted fatloss.
So there can't.
These devices are really greatbecause, for instance, this one
that I have can reduce fat, butin a way that I wanted to, so
double chin area, gel area, etc.
There are some devices outthere that have gotten too hot
(22:40):
and have resulted in unwantedfat loss, and so, again, I think
this really underscores theneed for someone you trust to be
doing the procedure and pickingthe right device for your
condition.
Speaker 1 (22:52):
Right, yeah, it really the same device can do
multiple things.
So okay.
And then you had mentionedearlier with Softwave.
Can you talk about thetechnology of Softwave and what
it can do, what it can't do?
Speaker 2 (23:05):
So this is an ultrasound device.
It falls into that category ofultrasound treatments, and the
device we've chosen in ourpractice is called Softwave.
I love, love, love thistechnology because, number one,
it's completely non-invasive.
That means there is nothinggoing into the skin.
Not even a little tiny Botoxneedle is going into the skin.
(23:27):
So it is strictly ultrasoundwaves that are focused and that
go to a certain depth in theskin and then they work their
magic.
And then the second thing thatmakes it so nice, especially
here in Arizona, is that theseultrasound waves are focused to
the middle part of the skin orthe dermis, and so it skips.
(23:49):
The waves skip the epidermis,so there is no collateral damage
in the epidermis and thereforewe don't have to worry about
skin color and sun exposure.
So safe in all skin types andsafe if someone's been out in
the summer, which is really nice.
It makes it a very good summertreatment, especially here in
(24:11):
Arizona.
And so the ultrasound waves goin, they heat the skin and that
causes some collagen production.
It causes elastin production.
What does that do?
It makes the skin glow, itmakes the skin a little bit
tighter on the surface becauseof the new collagen, and it
(24:32):
makes the skin look healthier,just like the Fraxel, because
the end result for each one iscollagen production.
But some of that heat also goesa little bit deeper and can
actually heat the connectivetissue or the SMAS, connecting
everything in the face.
So we do get more lift with anultrasound device because we can
(24:56):
have the energy go a little bitdeeper into the skin and
tighten or lift the SMAS andthat lifts everything up.
Speaker 1 (25:06):
Okay, that's really interesting.
So when you're first talkingabout ultrasound, I'm thinking,
oh, like when I was pregnantthere was an ultrasound, but
it's different technology.
Speaker 2 (25:13):
It's heating, yes exactly, and that has to do with
the way that the ultrasoundwaves are targeted and focused.
Speaker 1 (25:20):
Okay, so it's heating the deeper layers, is there?
Are there any other devices outthere that go by name brand
that do have that kind of aneffect?
Speaker 2 (25:30):
Yes, so there's also a device called Ultherapy that
has been around for years andyears and in fact the company
just released a second versionof it and that's also widely
available.
We just happened to choose thesoftware version because we like
the technology better and itgives an extremely predictable
result.
Speaker 1 (25:50):
Okay, how painful is this?
Because I'm going to disclosethat I had Ultherapy maybe eight
years ago and I had children,naturally with no pain medicine.
So I thought I had a good paintolerance.
But when they touched myforehead I said I'm out of here,
I don't care that I had to pay,I'm not having this pain.
It was really, really painful.
Speaker 2 (26:11):
So I mean we're going to be real here.
This is real and I'm so sorryto the all therapy company, but
it is an extremely it works.
It is an extremely painfulprocedure and that is also one
of the reasons we chose softwaveover all therapy, because it's
much more tolerated than the alltherapy.
(26:34):
So I also have had children,but none of them were natural,
drug free childbirth.
I like to be comfortable and soI can do this treatment with no
problem at all and it's oververy quickly.
It's very tolerable.
Jen, knowing you, you wouldprobably be asking our nurse to
(26:56):
give you two treatments in oneday because you thought it was
so easy.
Speaker 1 (26:59):
Okay, thank you.
I just had to get to the pointbecause you know there's so many
good procedures out there and Ithink people need to understand
, like the cost of things, whichI know you can't really say
because the cost varies so muchby geographic location so we
can't really say but I mean,most procedures in the laser
world are going to run in thethousands but also like the
(27:21):
amount of downtime.
So it sounds like with softwavethere's not a lot, maybe a
little swelling.
Speaker 2 (27:26):
There's zero downtime with softwave and in fact I
think patients usually leavelooking better than when they
walked in.
There's kind of this instanttightening that occurs, but like
everything that stimulatescollagen, you will see the best
results after several months.
So no downtime with Softwave.
And again, this is somethingthat can go into the cosmetic
(27:47):
consultation how much downtimeis tolerable for someone?
So if someone has some downtime, they want a really great
result.
You know we talk about theFraxel.
If it's summertime, they've gota lot of social events or it's
graduation season, softwave is areally great option and you
start seeing the results rightaway and they only improve over
(28:10):
time.
So yes, and then cost is also afactor of course for everyone.
But the great news is, withsome of these technologies, like
the Fraxel, like soft wave, wedon't have to do them frequently
.
In our practice we recommendfor most patients a Fraxel
(28:30):
annually and patients can domore than that or more
frequently have the treatment.
However, if in an idealsituation, they're doing other
things, like you said, there'sso many things out there now
that we recommend and we askpatients to do so.
If they're doing other things,we recommend and we ask patients
(28:51):
to do so if they're doing otherthings, I will often add to
their mix Fraxel annually,softwave annually.
So these things may be costlyinitially in the low
mid-thousands, but you don'thave to do them frequently.
Speaker 1 (29:06):
Right, yes, that's a good way to think about it.
You brought up a point that Iwant to reemphasize about when
we stimulate collagen.
So while somebody might walkout and notice improvement a
week later of their skin, we'restill stimulating collagen,
which takes the fibroblast threeto six months to form.
So the results are going to bebetter three to six months down
the road than they are a week ortwo later.
(29:27):
So better three to six monthsdown the road than they are a
week or two later.
Speaker 2 (29:35):
So there's a little bit of patience involved in this
and sometimes not stacking toomany procedures in a row and
giving things time to work.
Yes, that's exactly it.
And the thing is with whenyou're doing these lasers or
energy-based devices that reallydo give these predictable
results, you don't have to gocrazy with the frequency of
things, you don't have to bedoing a lot of things.
If you make the rightinvestment, you can actually
feel like you're pretty lowmaintenance and have wonderful,
(29:58):
wonderful results.
So, again, that's somethingthat should be discussed with
your cosmetic doctor.
It's really important to have acosmetic doctor that you trust,
because they should be guidingyou in that sense, and I have
this conversation all the time.
In fact, I think you and I mayhave even had this conversation
before where I say, okay, well,you just have the fraxel, then
(30:20):
you actually don't need to doanything else for a while, and
it really is nice to have thatguidance when there are so many
different options out there.
Speaker 1 (30:31):
And I want to emphasize don't jump from doctor
to doctor, because if you havefiller with one person, or I
sent someone to you who hadBotox with someone else because
they shop around for the lowestprice and then they did filler
with you and they thought fillercaused loss of movement to
their lips and I said fillerdoesn't do that.
(30:53):
Did you have Botox?
And they had had Botox withsomeone else?
So when you go to the sameperson, they understand
everything that's being done toyou and they can provide the
best guidance.
But if you're jumping aroundfrom person to person to person,
that's where I see the mostside effects and the most
problems with everything.
Speaker 2 (31:10):
Yes, and I remember that patient and this is such an
important point because yourbest care really comes from the
trust and communication you havewith your doctor and you really
are going to get the bestresults when you have that
person guiding you through yourskincare treatment hands down.
Speaker 1 (31:30):
Right, okay, I want to be cognizant of your time and
I know you have to get your son.
I just want to cover one morething the skincare prep before
laser treatment and then postlaser treatment.
How would that vary from whatsomebody would do as their
foundational skincare from dayto day in general?
Speaker 2 (31:44):
terms.
Thank you for asking thatquestion.
It is so important.
No matter what light-baseddevice that you're doing,
especially with lasers and IPL,it's important to avoid the sun
before and after your treatment,and patients often do forget
this, even though it'semphasized so much.
But really, what we want to dois have the color cells in our
(32:10):
skin have the melanocytes niceand quiet and sleepy, and when
we're out in the sun it they getperked up and then, when
they're perked up, sometimesthey have this side effect when
they've have laser to releasetheir color and cause
hyperpigmentation color andcause hyperpigmentation, and
(32:31):
that can be a really annoyingside effect.
In addition, if someone has atan when they come in for a
laser, the laser is oftenstronger than it normally would
be if someone didn't have a tan,and so the settings would need
to be adjusted.
The best and safest thing is toavoid the sun before and after.
That's number one.
(32:51):
Number two keeping the skin ashydrated as possible.
So many times we ask patientsto avoid irritating products
before their laser treatments,like glycolic acid, retinols etc
.
And that's because we want skinwith an intact skin barrier.
We want the skin to benon-damaged, nice and hydrated
(33:14):
when someone comes inAdditionally things like
glycolic acid, retinase,retinols.
They can make skin moresensitive to the sun, so again,
we want to minimize sun as muchas possible and then afterwards,
if someone is prone tohyperpigmentation, sometimes we
will use a bleaching cream orhydroquinone to reduce the risk
(33:37):
of hyperpigmentation, andsometimes even a topical steroid
, depending on the patient'sskin tone and personal history
with hyperpigmentation.
Speaker 1 (33:47):
Yeah, I mean, everything you're saying is so
complex and I'm also thinking ofso many more variables that can
happen.
So really, at the end of theday, somebody needs to go to
someone who understands skin andthe physiology of skin, because
if you don't, even if you dothe right laser and you don't
prep it and post care itproperly, you're not going to
get good results.
Speaker 2 (34:07):
Yes, you're really doing a disservice to yourself
if you walk in just kind ofunprepared.
You absolutely will get thebest results possible if you
have that consultation withsomeone who's qualified to do
these procedures and heed theiradvice.
Speaker 1 (34:24):
I hear this all the time and I I just want to
emphasize this why I love goingto you because you give people a
post-care kit and very specificinstructions of what to do for
a week after.
And the last time I had fraxelwith you, I had a friend who
doesn't live in town here whohad I think she had co2 and
(34:45):
plasma and no instructions onwhat to do afterwards.
None and just a yeah.
That is terrifying.
Speaker 2 (34:57):
That is terrifying to me, and maybe she had some
verbal instructions.
But, to your point, I really doappreciate verbal and written
instructions and it's just.
It's so important to know whatyou're supposed to be doing,
what the signs and symptoms areof a complication, so that you
can call your qualified cosmeticdermatologist or plastic
(35:19):
surgeon and that they can helpyou in an early phase versus
letting a potential complicationturn into that Right.
Speaker 1 (35:27):
Yeah, because these procedures, they have downtime,
they cost money.
So, if you're listening to this, if you're an esthetician, if
you're someone who's a potentialpatient, make sure you find out
how to best prep your skin andthen what you should do
afterwards and when it's okay toreturn to your normal skin
routine.
So that's what we're trying toshare here.
Absolutely yeah, okay.
Anything else that I didn't askabout that you think we should
(35:48):
cover, okay?
Speaker 2 (35:48):
Anything else that I didn't ask about that you think
we should cover.
One thing we didn't cover isscarring and how these
energy-based devices,specifically lasers, can be so
life-changing for scarring.
So anyone who's out there who'sstruggling with scarring, we
have so many options.
The game has really changed andwe can be extremely, extremely
effective with scarring,regardless of the cause acne
(36:11):
scarring, surgical scarring, etcetera.
So if you're struggling withscarring, I encourage you to go
to a cosmetic dermatologist orplastic surgeon.
Speaker 1 (36:20):
Are you talking more about acne scarring where
there's atrophy or loss oftissue or hypertrophic?
Do we have good treatmentsnowadays for keloids and
hypertrophic scars?
Speaker 2 (36:30):
They're very challenging still All scarring
is challenging, but I really dothink that we have made a lot of
progress in the way we treatthese scars.
So I would say both types ofscars are highly, highly
treatable Also burn scars andsurgical scars and in general,
one important thing for theaudience to know is the sooner
(36:52):
an intervention is done, thebetter the end result will be,
and that's because we canactually affect the biology of
the scar and help to normalizethe scarring tissue to make it
as much like normal tissue asnon-scarred tissue as possible.
Speaker 1 (37:07):
That makes me so happy because, you know, we get
to see how people feelvulnerable about things having
to do with their skin and how welook and show up in the world.
We're often very self-consciousabout certain things that
people don't often even noticebecause they're worried about
their own things.
But at the end of the day, youknow, if we can make someone
feel better about themselves sothey can show up in that job
(37:28):
interview and ask the girl outon the date and do all of the
other things that they want todo in life, that's really what
it's all about.
Speaker 2 (37:35):
It really is.
It's a huge quality of lifeimprovement to make someone feel
less self-conscious about theirscars.
I love doing it.
Speaker 1 (37:43):
Great, well, it's so great.
The technology is changing somuch and things are just going
to get better and better, and Iappreciate you being at the
cutting edge of all of this andsharing your information today,
Brenda.
Speaker 2 (37:54):
Thank you so much for having me, Jen.
I really enjoyed it.
Speaker 1 (37:56):
So if people haven't heard the other episode, can you
just drop in the comments likehow do people find you?
Speaker 2 (38:02):
So our website is clearedermatologynet and our
social media handle is atCleared clear dermatology.
We'd love to see you in theoffice, thank you.
Speaker 1 (38:11):
Thank you.
Thank you for joining us onlisten to your skin by moon and
skin.
It's an honor to be part ofyour skincare journey and if you
love this episode, make sure tosubscribe.
Leave us a glowing review andshare it with someone who's
passionate about their skincarejourney, and please connect with
us on social to ask yourquestions, which will drive
future educational episodes.
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