Some stories are too good to be true...

Some are short-lived, like first love.

Still, we hold on to the impossible. Our souls will not find peace without tasting it, even if our minds tell us otherwise.

Have you heard of this awesome new device? The latest miracle of non-surgical facial rejuvenation technology? They say every single celebrity in Hollywood is trying this device developed in Swiss laboratories. It's not too expensive, either. You just have one session - or a couple of sessions - and you get 10 years younger!

Medical LASERs, the ancestors of energy-based facial rejuvenation applications, made a stunning first impression on the medical market and are still used successfully in many fields of medicine. However, their story in plastic surgery was a little different.

Let me tell that story to you:

It's the 1980s. Star Wars is in theaters. Lightsabers, laser guns... Everyone has mastered the concept. We don't know exactly what it is, but we're sure it's something highly technological, and something technological can't be bad, right?

Laser devices quickly made their way into the world of aesthetic surgery in the mid-80s. The skin is treated with laser. A controlled burn is given, and after a few weeks of healing, the skin renews itself, resulting in a refreshed, healthier-looking and wrinkle-free skin. Medical lasers are still one of the key tools at our disposal in the treatment of spots on the skin as well as the treatment of unwanted hair and vascular lesions.

However, our experience in facial rejuvenation has not been as we expected in the long run. Over the years, patients began to complain that their skin in the application area had become thinner, drier and unhealthy. So how did this fairytale, which presented with complete bliss in the first couple of post-treatment months and years, go bad? Patients who were quite satisfied with the treatment and had repeated sessions in the same area were even more victimized in the long run.

This is very important to the prospective patient seeking facial rejuvenation, so please focus your attention. Go grab some tea. I will delve further into medical explanations and try to give you a clear insight in plain language.

Here's what we've learned from research over the years. The laser beam creates controlled heat damage —that is, a burn— in the deep, vascular and living layer of the skin, which we call the ‘dermis’. A healing process begins in this burn area, as we observe in other cases of burns. During the healing process, the blood supply to the area increases, the cell cycle on the surface accelerates, the healing cells migrate to the burn area and produce the protein called ‘collagen’ in abundance there. Indeed, this tissue production is such that the skin looks thicker, more vibrant and healthier than before during the healing phase. The key point here: Since recovery is a very long process, these effects that we observe externally continue for up to 18 months as long as the healing process continues. In fact, when we repeat the application before the end of 18 months, we re-create the damage and rewind the process.

 

 

Problems only emerge when the healing process is over. Vascularization deteriorates. Skin thickness decreases. So does the number of sweat glands and sebaceous glands that regulate the moisture and oil balance of the skin. Most importantly, the protein called ‘elastin’, which gives skin its elasticity, is permanently reduced, and the skin loses elasticity for good. I previously mentioned that the body piles up the ‘collagen’ protein in the damaged area. However, this ‘collagen’ is not as organized as it is in healthy skin. If the collagen in a healthy skin is a ‘lambswool’ sweater, the newly-produced collagen in the skin during the healing process can be compared to wool for two sweaters just left on the table. In the final stages of healing, specialized cells make a coarser and finer weave from this wool ball than the original, but this new weave never attains the quality of the original. And the unfortunate result is a skin that has permanently lost its vitality. Loss of vitality is called ‘atrophy’ in medicine.

Laser technology has evolved over the years to lessen these problems. However, the basic biological principles are still the same. The enormous commercial success of lasers has led to the emergence of various energy-based applications.

These are the reasons why I am skeptical about and do not include in my own practice laser, radiofrequency, ultrasonic energy, concentrated light technologies, and all other technological devices that apply ‘energy’ to the skin, thereby creating a ‘heat damage’ in dermal or subcutaneous tissues. The observation, which lies at the heart of my skepticism, remains valid even in the case of ‘sunburn’, which is the simplest and most basic example of the heat damage mechanism.

Remember and imagine going on vacation and getting a tan. That summer, your skin shines bright in the mirror. It looks more tense, shiny, voluminous and healthy. This effect is so satisfying that -for years- the socialite beauties used to go to the solarium in winter to continue getting a tan. Research and observational studies have shown that the signs of aging appear earlier and skin damage occurs more seriously in individuals who are exposed to more sunlight in their youth. When two twin sisters, one living in sunny “Miami” and the other in gloomy “London” meet at age 50, the more heavily sun-exposed Miami twin will look at least 10 years older than her Londoner twin sister.

While plastic surgeons and dermatologists all over the world recommend sun protection and using facial sunscreen even when there is no exposure to sunlight, I see the cosmetic industry's effort to rejuvenate the skin with technologies that cause heat damage to the skin as a modern contradiction of plastic surgery.

I strongly recommend that you not volunteer for any application whose long-term results have not been scientifically distilled and for which there is insufficient effectiveness and reliability evidence. It’s no harm if you slightly fall behind the pace of technology.

Stay on the safe side.

Stay beautiful.