Fraxel Laser Treatment for Skin Aging

Foreign. Talk about fraxel laser and bio stimulation with different bio stimulatory agents done at the same time. Now, fraxel has been around for 20 years, many different versions of it. We were one of the first uses of fraxel in North America back in 2004. It was a unique laser that replaced the previous gold standard, which was a carbon dioxide laser. Now, the carbon dioxide laser was great for skin tightening and skin remodeling, but had a substantial downtime. It was called ablative laser, where your face after, typically we're doing the face and there was things like bleeding, possibility of infections. You had to take antibiotics and downtime was substantial. The healing took about a week to 10 days, two weeks in some cases, and the skin was red for a couple of months. Fraxel came out is a special erbium glass fiber laser that was non ablative, meaning that it did not cause open wounds. But it's still called a similar tissue injury that had a much shorter downtime. That was the first breakthrough. The second breakthrough, it was just called a fractionated laser. So fractionated laser means instead of taking off entire section of tissue, it would drill little holes into the tissue and cause areas of injury called MPZs, micro thermal zones. Micro thermal zones. And this was a breakthrough technology where we could do a really aggressive laser treatment and let the patient get back to work and, you know, the next day and not have any open wounds and then maybe some redness and peeling that occurs a few days. But is this some social downtime? It doesn't keep you from doing things. So that was a significant breakthrough. Again, carbon dioxide laser had been the standard of care for years. And it's, it's still used. We still use it in certain circumstances, but the fractionated laser have just leapfrogged over the conventional carbon dioxide lasers. We can set the fraxel to any depth. It goes right through the skin, right from the outer layers of skin through the basement membrane, which is where the stem cells are out, all the way through the epidermis into the collagen, the deep dermis, and even in the subcutaneous tissue. So we get any depth we want with fraxel based on how we set the settings. And then we have a certain density of tissue that remove. So imagine when you aerate your yard, I don't think it's done that, but you're. You aerate your yard and actually pulls little plugs out of the yard and actually stimulates growth. Fraxel does the same thing. Typically when we're Doing Fraxel laser resurfacing. We're doing anything from a very light treatment where we're removing 5% of the surface area up to about 55, 57%. And staying in that range really controls the downtime. As we get more towards 50%, we're getting a little more downtime again. Downtime, social downtime in the sense that you might have some redness and peeling, but there's no downtime in terms of having an open wound or risk of infection. So this could be done and you go out in public the next day or even the same day. The fraction when we do go over 50%, we call that Fraxel Advanced. We're going around 5%, we call it clear and brilliant salient. Anything in between is more of a regular fraxel. Now, the Fraxel laser has two different wavelengths. It's called the Fraxel dual. That's a name the company uses. There's a 1550 laser, which is really the workhorse of the past, say 17 of the last 20 years. In the 1927, which is more a newer laser technology added around 2010 or 11, we use these together. It allows to target both the deep collagen and the superficial epidermis. So to put in perspective of depth, your skin is little less than a millimeter thick, or what we'd call a thousand microns. A thousand microns is a millimeter approximately. The skin around the under eyes might be 3 to 600 microns deep. And then the tip of the nose might be more like 1100 microns. Around the mouth, about a thousand microns. So The Fraxel, the 1927, goes almost precisely 200 microns deep, which goes right through the epidermis. The epidermis, which is the outer layer of skin, the skin that's turning over constantly through the basement membrane where your stem cells are at. That's more for superficial things like sun damage, peeling fine lines. In the fifth, that's the 1927. That does the superficial layer about 200 microns. And the 1550, we can set that in depth up to about 1300 microns. And that's more for deep collagen remodeling. For, like, things like acne scarring, deeper wrinkles, and deeper tightening, we use them both together. So we do a superficial treatment and a deep treatment in the same treatment. Typically, when we do this allows the skin to regrow. So if we're removing approximately 20% of the deep tissue and approximately 30 of the superficial tissue, we're getting a 50% coverage altogether. We get strong regrowth of your skin. And the way it works is you can actually remove significant portion of the outer layer of your skin all the way through the basement membrane where the stem cells are at and the hair follicles. The stem cells around hair follicles were completely re epithelialized or regrow the skin. And that's how we did traditional surfacing resurfacing part about 2004 and 5. It still happens today, but it's just not that common. And this fractional technology was introduced again about 20 years ago and this has become the standard of care where we can a good aggressive deep treatment. Then we really control the downtime and the risks associated with these full resurfacing, fully ablative lasers. So we've been using a Fraxel successfully for 20 years. When it first came out, we were doing about 15% coverage and you do about three to five treatments a few weeks apart and get a full resurfacing. Now we're actually doing about 50 plus percent of coverage just in one treatment. It's kind of a one and done where for most skin conditions your skin looks substantially better from wrinkles, fine lines, you know, acne, scarrings. After one treatment they might do some very light treatments down the road for maintenance where we're doing more like the 5%. So that's the fraxel part and we've been doing that for years, been very happy with it. Then there's a concept of bio stimulation with different products. Biostimulation is adding an ingredient to the skin to help grow collagen to stimulate collagen growth. So what do we use for that? Well, there's really three main products that we use. There's other products that that our use use better lure, we use three main product products. One is called calcium hydroxyapetate. The brand name is Radia and Radiesse was designed as a filler and it came out in 2006, FDA approved for filling, filling the cheeks and whatnot. Then we found that if we, if we take the radius and thin it out and spread it evenly underneath the skin, it causes significant bio stimulation. That's been a technique that's been used for about 10 years. Hyaluronic acid that's found in Juvederm and Restylane and reveness. This also creates biostimulation. If you put it right under skin in a diluted form and we'd call it rasping where we rasp up against the skin with a hyaluronic acid mixed with something else to thin it out. You brush underneath the skin, separating the skin, the tissues below it and it stimulates collagen growth. And then there's PRP or prf, platelet rich plasma and platelet rich fibrin. So those are three things that we're using for bio stimulation. Now again, there are other bio stimulants. These are the ones we're using because the, the track record is very, very well known. It's very solid. So we started combining bio stimulation on the same day in the same service as Fraxel laser. So first off we were doing biostimulation and we were doing the Fraxel laser and biostimulation with prp, prf, calcium hydroxyapatite, hyaluronic acid or combination of those things. It was working pretty good. And the fraxel, we were doing Fraxel treatments and it was working pretty good. And then we decided to try them both at the same service. Same service, same time. The results were more than synergistic. Results were synergistic, meaning that the results were more than the sum of the two. And when we do the fraxel, we're we're treating from the outer surface of the skin, drilling holes in the skin and bio stimulation, we're going underneath the skin and on top of the skin with these different products. And this combination of doing three dimensional skin resurfacing has worked phenomenally for even the most sun damage of skin. Doing a single procedure and getting remarkable improvement. We see when we do acne scarring, severe photo damage, wrinkles, deep even deep groove wrinkles, very aged skin. We can take years off the skin by doing this combination bio stimulation with an advanced laser research resurfacing. Now Fraxel in its normal form was designed to do a certain percentage of coverage. We've, I probably have more experience with this than almost anybody in the country. We were one of the first clinics to buy this in America. And I've been using all the different variations of Fraxel since they've had. We have multiple machines and been doing this for years. We've been able to tweak the machine further and further to get more and more out of it. We can adjust the setting of the machine very easily. We've also been doing filler pretty much longer than almost anybody in the country. When these products first came out, we were allure's already in business. We were using them when calcium hydroxyapatite came out and that was in 06. We've been business for years. When the hyaluronic acids such as Juvederm and Restylane came out, we had been in business for years. We were able to put these in our practice. When PRP first became popular in aesthetic medicine, we had been in business for years. We had a lot of experience, a lot of different products, and then combining them together, you get a synergistic results or something that we've learned in the last few years. We're seeing that in a single treatment with really limited downtime. Typically you're gonna have redness and puffiness about three to four days and some peeling that starts about day four through about day five or six. And again, it's not. These are not open wounds. You can go out in public, you know, no risk for infection. Some people would wear a mask or something to kind of COVID up some of the peeling that occurs. Or put some. You can put makeup on pretty heavy and hide it. And then you see the results as soon as a week. But it continues to get better for about two months. But this is one of the services. Right away at one week, your skin looks remarkably better. And it continues to get better for a few months. So you can have a situation where you're doing something very preventatively. We don't recommend that treatment because it's just not necessary. If your skin looks pretty good, you might do a very light fracture treatment, which is clear and brilliant. Combine that with platelet rich plasma to make it heal faster and get better results. That's the one end of the spectrum where your skin looks good and you want to preserve it. That's clear and brilliant. Using a 1927 or 1550 laser at about 5% coverage, we go down to about 400 microns, which is about half the thickness of the skin. And it's to a shallow as 200 microns. Between 200 and 400 microns deep, about 5% coverage with platelet rich plasma or platelet rich fiber. And that's a good, say, beginner that has virtually no downtime. In other words, if you go out in public the next day, nobody knows you had anything done. You can kind of feel your skin feels a little sandpapery. But there's no real social downtime with that. And that can be done preventatively. Some people might do that, let's say every quarter just to kind of stop the aging from occurring. Then somebody has more photo damage, brown spots, pigment irregularities and some minor wrinkles. We'll do something a little more aggressive. We'll do The Fraxel advanced laser, which is a very pretty aggressive laser. It's got a social downtime of roughly a week along with a bio stimulation of just PRP platelet rich plasma. So that's level two. That's for moderate damage. So mild sun damage or no sun damage, we're doing preventative treatment with clear and brilliant. Clear and brilliant functions very effectively as a medication delivery system. So after you do your clear and blowing, your skin's very, very good at absorbing vitamin C and retinols for the week or so afterwards. That's a great way to just sort of stop, stop things a little bit. Next step up advanced fraxel. Fraxel Advanced only available in lure with PRP which is a bio stimulator. And then on top of that we use these bio stimulating products like hyaluronic acid under the skin or calcium hydroxyapatite. PRP on top the skin and Fraxel through the skin. So these are the ways and that's for the more advanced photo damage to me hasn't done anything and they've had a lot of sun damage. Their skin really looks almost too old for their age. We can actually turn the clock back. We'll show you some images that, that demonstrate that. And this does not take away the need for good skin care. So if you were a sun worshiper and you say I want to keep worshiping the sun. Well, I mean you could do that and you could do these services to turn the clock back but you got to do some skin care to maintain it or you're kind of wasting your money. And that's the real is that if you're not going to ever wear sunblock or do any skin care, if you do Fraxel probably you're going to get your stuff back and you know, obviously you turn the clock back by doing this. The, the success of skincare after laser resurfacing is really so cost effective. We generally won't treat people if they refuse to do skin care. Because you're spending significant amount of money for this fraxel and biostimulation and the investment in skin care of a few hundred dollars a year kind of just makes it stay there versus letting it go back the way it was by re damaging your skin. Won't spring back to where it takes a long time. You got to re damage all your skin. But it makes no sense to do this and not take care of your skin. Doesn't mean you have to stay indoors or totally avoid the sun. I'm talking about using vitamin C in the morning, retinol probably every other night, glycolic moisturizer and some kind of SPF. And there's even some non mineral based. SPFs are really kind of advanced coming along now that are biological. So these are the aspects to skin rejuvenation we do like to emphasize, you know, just some kind of medical grade skin care doesn't have to be done every day, maybe every other day for prevention. So we have clear and brilliance with a little bit of bio stimulation, just prp. You can also use something like Exosomes, which is a stem cell product that would be equivalent to prp, maybe a little more effective. Next step up is fraxel advanced with PRP or Exosomes. Next up is advanced frax with bio stimulation with calcium hydroxyapetate or hyaluronic acid. So thank you very much.