Dr. Cameron Rokhsar, Dermatologist and Cosmetic Surgeon from New York, reveals his thoughts about efficient laser treatments for dark spots, wrinkles, firming of skin and tackling enemies of skin beauty.

Dr. Rokhsar, fellow of the American Academy of Dermatology, American Society of  Laser Medicine & Surgery, and American Academy of Cosmetic Surgery is a professor of dermatology at Albert Einstein College of Medicine.  When Dr. Cameron Rokhsar is not practicing medicine,  he is conducting research on the hottest  and most innovative cosmetic procedures.  In his office in the heart of Manhattan, New York, where he attends to star clients, the names of whom he intends to keep secret, we sit down with the doctor for an exclusive interview with ELLE.

Brazilian women love the sun.  Are the rejuvenating treatments able to revert the sun damage to the skin? 

Before investing in anti-aging products or procedures, women need to know that sun exposure is the number one cause of  pre-mature wrinkles, dark spots and loss of firmness of the skin.  It may be impossible to change ones attitude towards sun exposure from a cultural point of view, but it should be emphasized that the application of at least SPF30 sunscreen everyday and reapplication every 2-3 hours can reassure the continuous protection that is needed to prevent premature aging and wrinkling.

You regard the Fraxel Laser as the most promising treatments for the skin. What are the principal innovations of Fraxel? 

I’ve been very much involved in the development and early clinical testing of the Fraxel laser one year prior to its introduction to the U.S. market. It treats wrinkles, dark spots caused by the sun, melasma, acne scars and helps with tightening of the skin. It also does resurfacing of the skin, ( a type of peeling that goes deep into the skin to rejuvenate). Recently, the market has received a new version of Fraxel, with quicker sessions and less discomfort. Also, in my opinion, this is the first device through which we are capable of treating stretch marks in a consistent and safe way.

Is the Fraxel laser the only laser approved by the FDA for treatment of melasma?

In a study done by me and my team and published in  the Journal of Dermatologic Surgery in Dec. 2005, we demonstrated that between 50 to 60% of patients can clear the melasma by  75 to 100%. With proper maintenance the results can last for months to years. Some patients have no response to treatment, and in rare cases, melasma can worsen. In any case, I still think it’s the best treatment if compared to chemical peels, intense pulse light and other types of lasers.  Regardless of the treatment modality,  one needs to avoid the sun and use sun protection to avoid recurrence of the problem.

Which treatment is the most efficient to remove freckles and sun spots?

The problem is not removing them. Lasers such as the Alexandrite, Ruby and ND Yag are very efficient in treating sun spots. Unfortunately, they can come back with repeated exposure to sun rays and also can be genetic.

laser and intense pulse light treatments usually cost more than chemical peels. Is the investment worth it?

Peeling or resurfacing, with TCA, for example, has the potential to revert deep wrinkles, but healing of the skin can last up to 10 days,

which could cause infections and scars.  On the other hand, lasers used  for rejuvenation are more precise in terms of skin depth of penetration.  The heat from the laser provokes the contraction of skin and produces new collagen. Another advantage of lasers is that they  can treat specific problems such as, sun spots, and vascular lesions without causing damage on other areas of the skin. In summary, I believe that lasers are more precise, safe and sophisticated way to address various concerns in the skin,  and it is worth the investment.

WITH THE NEW VERSION OF FRAXEL LASER THE TREATMENTS ARE FASTER AND MORE COMFORTABLE

What do you think of the devices that cause tightening of the skin which don’t cause damage to the superficial layers of the skin, like Thermage, Titan and others?

Those machines take the energy ( radio frequency for Thermage and infrared rays for Titan) to below the skin surface, while maintaining the epidermis cool.  The theory is that high temperatures can cause remodeling of  the collagen in the skin.  But I find the concept imperfect because the results are not the same for each person.  These devices  have an estimated ineffectiveness of around 30%. I believe that these types of treatments are more effective in younger patients.  Another important aspect: you need to have patience, since the results take up to six months-the time for healing-to appear.

More gentle lasers,  and pulse light (IPL) is adopted by many dermatologists. Is gentle the same as being less efficient?

The intense pulsate light treatments (IPL, photo facials) is compromised of an array of light of different wavelengths. They usually say it does everything, but not really good at any particular thing. It does a little for pigmentation, a little for texture and a little for blood vessels.  However, I don’t consider IPL doing any of these things as efficiently as some of the lasers that we have available.

In the last two years, new treatments have emerged for cellulite, such as VelaSmooth and TriActive. Do they really work?

It is important to remember that cellulite has no cure because many factors are involved in its development, such as genetics, hormones and weight. VelaSmooth, combines radio frequency and infrared light to oxygenate the skin, and it is one of the most effective modalities currently available. But treatment requires constant maintenance.

UltraShape, UltaContour and Alphatec ultra-sound machines that attack the areas of fat (some studies done by specialists show loss of centimeters in the waist and thighs) can it substitute liposuction?

I believe that non invasive ultrasound technologies for fat reduction are newest frontier in energy based devices.