Less Scalpel, More Laser and Non-Surgical Techniques

Lasers, fillers, botulinum toxins . . . The arsenal that tackles the signs of aging is ever expanding with the use of less invasive techniques, postponing the need for more invasive procedures.  To present new uses of fractional lasers, one of the most popular techniques, Dr. Cameron Rokhsar, a graduate of Harvard University and a fellow of the American Academy of Dermatology, arrived in Buenos Aires, (Argentina).  Dr. Rokhsar presented his techniques a few days ago, during the Third Annual International Plastic Surgery Symposium held in Buenos Aires.

For what do you use fractional lasers (Fraxel Laser)?

It’s a laser that has a much shorter recovery period than an ablative laser, without post-op down time and without its risks.  The general applications approved by the FDA are rejuvenation, wrinkles around the eyes, fine and medium depth wrinkles, acne, surgical or traumatic scars and melasma.  Everything that can be rejuvenated can be done with this laser.  In the past, we were limited to the face and neck with traditional resurfacing lasers.  Today, we can resurface other parts of the body.  The ablative lasers of yesterday have been largely replaced by fractional lasers.

How does it work on stretch marks?

Stretch marks can be treated with a pulse dye laser.  But afterwards, if you resurface stretch marks with an ablative laser, you would cause a scar.  Now, with a fractional laser, both things are done at the same time, without damaging the epidermis and the risk for scarring.

Does it make them better or does it get rid of them?

It makes them better.  Nothing can eradicate scars or stretch marks.  What you see is that the skin is more taught and the appearance of the stretch marks is improved.

Does it delay the worsening of the stretch mark?

Stretch marks are produced by stretching of the skin during pregnancy, or rapid expansion of the skin, i.e. weight lifting etc.  It’s like a wrinkle.  With treatment it gets better and, if there’s no other abrupt change in volume, these should not appear again.

Can dark circles under the eyes be treated?

Dark circles under the eyes are due to genetic factors, increased vascularity, true pigmentation or a shadowing effect due to fat protrusion.  Depending on the origin of the dark circles under the eye, different treatment approaches can be used.   If the dark circles are truly due to pigmentation, they can be treated with the fraxel laser.  There is no risk to the eye because protective eyewear is used to protect the cornea.

Are these applications approved?

The equipment and each of the applications has been approved.  The only thing that’s in a trial phase is treatment of stretch marks.  It is anticipated that FDA approval for this application will be obtained within the next six months.

For aging due to sun exposure, is it recommended that this be complemented by some other procedure?

I recommend the use of  botox  prior to the use of fraxel to smoothen the wrinkles as the effects of  fractional lasers (Fraxel) will be enhanced on the flat surface created by botox.  Also, it can be used in conjunction with fillers, pulse dye lasers and other pulsed light sources if need be.

Are non-invasive treatments at their peak?

We are at the beginning of fractional systems.  The future involves fractionating various wavelengths of light for other applications including the CO2 laser beam.  Also, ultrasound techniques are going to be advanced for destroying fat (in the United States this is still not approved but in Argentina it is).

What are the possibilities for fractional lasers in the future?

It’s about taking it to the minimum expression.  Before pulse laser had a larger diameter.  If you used too much energy, it would melt the skin.  What you look for is a minimal diameter, microscopic, placing much energy deep in a microscopic column.  It is intended to go as deep in as small a column as possible to obtain the best result.

Will these advancements continue to be used for photorejuvenation?

Yes, the non invasive approaches will only grow the treatment of aging due to sun damage.

What is the future of scalpels, will it tend to disappear or are there techniques that won’t be replaced?

Surgery is becoming less and less popular.  Today, with the technologies available, patients are beginning to treat themselves at a younger age.  The focus has been largely shifted to prevention.

Is the scalpel being passed over?

The use of the scalpel is being passed over and surgery is becoming less popular because of the issues of surgical risk, anesthesia and recovery periods.  For example now I can do a nose job with the use of injections rather than the scalpel. This was unfathomable a few years back.

What is this technique like?

With injections, we can change the shape of the nose for approximately one year and it can be repeated every year.  The procedure takes ten minutes.  I fill in behind the bone to smoothen the nasal profile as well as to raise the nasal tip.  It’s done with resorbable substances, like calcium hydroxyl appetite which is a natural mineral present in our body.