Dermatology Clinic In the News

Houston, Texas

2005

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Versatile fractional laser shows promising results
Oct 21, 2005, Dermatology Times
By: Patty Reiman

Chicago - The buzz continues to build surrounding fractional photothermolysis - a new approach to laser technology that can treat a number of conditions with minimal downtime.

Paul M. Friedman, M.D., director of the DermSurgery Laser Center in Houston, calls it "breakthrough technology with multiple potential indications."

He explained this newer modality at the American Academy of Dermatology's Academy '05, held here.

The mechanism of action for fractional photothermolysis is the targeted treatment of millions of microscopic areas of thermal damage, with the adjacent tissue left untreated. This healthy untreated tissue surrounding the treatment areas expedites healing and re-epithelialization of the treatment areas.

"This is a very intelligent way of approaching photo-damaged skin. Instead of resurfacing the entire face, you are delivering very small laser treatment zones," Dr. Friedman tells Dermatology Times.

Excellent results for photodamaged skin

Dr. Friedman has been using the 1550 nm Fraxel laser since last fall and says the device provides excellent results for the treatment of photo-damaged skin and can even be used to treat skin on the neck, chest, arms, legs and hands, as well as the face. The risk of scarring with fractional photothermolysis is much less than it is with traditional ablative techniques when used off the face.

In addition to treating photo-damaged skin, Dr. Friedman has extensively used the device to treat acne scars, melasma, rhytids, dyschromia, and poikiloderma of Civatte. He considers this modality to be an "excellent treatment option" for dermal melasma because it targets areas of dermal melanophages and controls the condition much better than bleaching creams.

"This laser has been embraced by a majority of top laser surgeons in the country, and they have all been excited with the results to date and the safety of the device," Dr. Friedman says.

He says it has potential application for the dermatology treatment of surgical scars, post-inflammatory erythema, striae, actinic keratosis, and disseminated superficial actinic porokeratosis (DSAP).

Multiple micro treatment zones

Fractional photothermolysis works in the skin via multiple microthermal treatment zones (MTZ). One MTZ is 50 microns to 70 microns in diameter and is surrounded by a zone of untreated tissue, which is the unique feature of this modality. Each treatment session targets just 17 percent to 20 percent of the skin.

With each pass of the robotic handpiece over the treatment area, the fractionated laser's Intelligent Optical Tracking System randomly creates multiple treatment zones in a consistent pattern that is laid down evenly, regardless of velocity. Laser passes are repeated horizontally and vertically. An average of 2,000 MTZs are created per square centimeter of treatment area.

With untreated tissue surrounding each MTZ, wound healing is expedited and re-epithelialization is rapid. Tissue in the epidermis is coagulated, and collagen is denatured between 400 microns and 700 microns.

"Necrotic debris and melanin are eliminated by keratinoctye migration and rapid expulsion," Dr. Friedman explains.

He says transient side effects can include mild erythema that lasts one to three days, and mild edema that resolves within three days in most patients. Temporary bronzing of the treated area can persist for two weeks. Discomfort during the procedure may be eased with topical anesthesia and cooling provided by the Zimmer air cooling device.

Full-face treatments for photodamage require 20 minutes to 30 minutes, while neck and hands can be done in 10 minutes. Because the laser targets only a fraction of skin tissue with each pass, multiple treatment sessions are required, usually consisting of three to five office visits with a two- to four-week wait between each session.

Although fractional photothermolysis achieves superior results for treatment of fine wrinkles, texture and overall photodamage, Dr. Friedman says it has not yet attained the same quality of results to treat deeper lines that traditional resurfacing procedures have.

He also says the laser technique and treatment parameters may be tailored to the particular patient indication. These parameters need to be standardized through further study.

"Additional controlled studies are needed to determine optimum treatment parameters, intervals and future applications. As we optimize treatment parameters, the potential is even greater than what we have already seen."

New Laser Treatment Takes Years Off Face
Laser Treats Face Spot-By-Spot
KPRC-TV, May 26, 2005 HOUSTON News2Houston

Have you ever wished you could touch up your skin the way you can with a digital picture? A Houston woman said a new dermatology laser treatment did just that for her -- it erased years of sun damage, age spots, and wrinkles with a simple "zap."

Lori Conneally is a big fan of the Fraxel laser treatment, which was approved by the Food and Drug Administration in March.

"After the first (treatment), it was such a huge, amazing change that I was a believer," she said. "It didn't hurt at all. There was one part I was laughing because it was tickling me."

The procedure begins with a blue dye and numbing medicine applied to the face.

Dr. Paul Friedman, with DermSurgery Laser Associates, said the dye helps him pinpoint which areas of the face to apply the laser.

"The Fraxel laser is a unique type of technology that treats sun-damaged skin pixel by pixel or spot by spot," he said.

It made Conneally the perfect candidate, since acne scarring and years of sun exposure were beginning to take its toll.

"I've never had good skin," she said. "I don't want to look different in any way. I just want to look better -- refreshed."

Thirty minutes after the laser was applied to her face, Conneally washed off the dye and was done. "It feels like a warm sunburn sensation for about an hour after the treatment," she said. "I want to look like me -- just the best me I can be.

The redness and swelling will go away in about two days, according to Friedman. Patients also need to apply sunscreen and avoid prolonged exposure to the sun while the face heals.

Typically, patients receive three to five treatments, depending on how much area on the face or neck needs to be treated.

One treatment costs from $500 to $1,500.
Doctors say the effects are permanent.

Laser Zaps Away Sun Damage
KHOU, MAY 24, 2005 HOUSTON 11 News

By Nancy Holland
Life in Texas is life in the sun.

Susan Steffey, like many other Texans, has learned the hard way that sunshine can lead to dark splotches and wrinkles.

Blue dye helps guide the light across Susan Steffey's face.

"The lines were getting very deep here," Steffey explains.

She's back for treatment with another kind of light -- a laser. Blue dye helps guide the laser across her face. Some patients call it "Smurfing."

Steffey says she doesn't even need before and after pictures to know her wrinkles are better -- especially around her mouth.

"Before I did this, I really noticed with stress and with age that this was getting to the point that I was embarrassed and I would always have my hand up and students and friends would say, 'Put your hand down, everybody knows what your lip looks like,'" Steffey says. "So it looks better now -- a lot better.

The laser penetrates deep into the skin -- not a solid beam, but pixels like on a TV screen.
As the body repairs itself, the wrinkles and blotches get better.

"We're stimulating the patient's own collagen production. The other thing about it is we're able to improve the overall appearance of the skin -- not only improving lines but also improving age spots, shrinking pores," explained Dr. Paul Friedman with the DermSurgery Laser Center.
Dr. Friedman says results should be permanent.

Depending on how much dermatology work somebody is having done, the face and hands, or just the face, the treatments take about half an hour to an hour, less time than the average sun worshipper spends in the sun.

And while Steffey will continue to join other Texans in the sun, she won't do it without sunscreen.
The cost can range from $500 to $1500 a treatment and the number of treatments necessary usually ranges from two to five.

Most patients will have swelling and redness for a couple of days and will be very sensitive to the sun several days.

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New Laser Promises Gentler Repairs For Damaged Skin
New York Times, April 14, 2005 Fashion & Style

Laurie Connealy's face showed all the signs of skin damage anyone might expect from years of sun worshiping: brown spots, red patches, squiggly broken capillaries and more wrinkles around her eyes and mouth than a woman her age has to have.

To remove all this sun damage, Ms. Connealy, 46, a schoolteacher in Houston, would have been a perfect candidate for a facial peel with a laser or a chemical solution. But she was unwilling to face the weeklong recovery from the inevitable redness and swelling. Her dermatologist tried milder laser treatments, but they were ineffective.

Then two months ago the dermatologist, Dr. Paul Friedman, offered a new solution, a type of laser called Fraxel. After three treatments, Ms. Connealy said, her wrinkles were softened, her red patches and brown spots were diminished, and a small scar on her upper chest, which she also had treated, was smooth and light enough so she could wear a tank top. "It's instant gratification," she said. "You don't have to wait a week to see the results."

Since January, when the Fraxel became widely available, about 100 machines have reached the market, and doctors report growing demand from patients because of the promise of less injury and less downtime compared with a traditional laser peel. (Prices are higher: $4,000 to $6,000 for the number of treatments usually required. One regular laser peel, which yields comparable results, costs about $2,250.)

"People are now asking for it by name," said Dr. Tina Alster, a clinical professor of dermatology at Georgetown University in Washington.

Laser skin resurfacing is one of the fast-growing areas of cosmetic medical treatments, with 590,000 procedures in 2004, up 300 percent since 2003, according to the American Society for Aesthetic Plastic Surgery. Of the dozens of established lasers on the market, none offers an ideal marriage of effectiveness and gentleness, and so there is steady pressure to invent a better tool. But some doctors say consumers might want to wait to embrace the new technology. "There's virtually a new laser every day," said Dr. Seth Matarasso, a clinical professor of dermatology at the University of California medical school in San Francisco. "Fraxel sounds great. But we don't have long-term results."

The Fraxel laser, which is made by Reliant Technologies, takes its name from the fact that it works on only a fraction of the skin's surface. The device shoots out a cluster of tiny beams to create a pattern of pinpoint burns, each one surrounded by skin that is left untreated, so only about 15 to 20 percent of the skin is affected. The burn is relatively light and heals within a day, compared with 7 to 10 days for a traditional peeling laser.

"We're trying to redo the skin fractionally, in little dots, like a digital photograph," said Dr. Richard Fitzpatrick, an associate clinical professor of dermatology at the University of California in San Diego who worked with one of Fraxel's inventors, Dr. Richard Rox Anderson, the director of laser research at Massachusetts General Hospital in Boston.

That means not only less injury but also less dramatic results than those of a traditional laser peel. Patients are advised to have four or five Fraxel treatments to achieve the benefit they would get from one session with a traditional peeling laser. Doctors have not yet figured out exactly how many treatments are needed in every case, or how many weeks patients should wait between treatments. For those reasons, said Dr. Harold Brody, a dermatologist at Emory University in Atlanta, consumers should "step back and take a deep breath before diving in."

Like older lasers designed to resurface the skin, the Fraxel burns away old skin cells. This spurs the growth of new cells and stimulates the production of collagen, a protein that is abundant in healthy skin. Ideally, in the process red blotches, brown spots and other kinds of discoloration are burned away; scars are rendered less prominent; and the skin is plumped enough to smooth out rough patches and fine wrinkles.

A single treatment takes about one hour. First, a special blue dye is slathered over the skin to help it absorb the laser light. Then a numbing cream is applied over the dye.

After the treatment the skin looks bright pink and sometimes swells a little. But by the next day most patients can wear makeup as usual, or, if the patient is a man, shave.

"The day of the Fraxel dermatology procedure, I was swollen and red," said Brenda Harvey, 51, a retired insurance executive who had the treatment to erase the ruddiness of rosacea. "The next day you wake up and have a beautiful bronze tan."

When her skin became flaky a few days later, Ms. Harvey said, she "put on a lot of moisturizer," and within a day and a half that was gone, too. "If you do this on Monday, by Friday you'll look absolutely gorgeous, and nobody will ever know you had a thing done," she said.

Because it is gentler than other lasers, Fraxel can also be used on the neck, chest and back, areas that heal more slowly than the face and are prone to scarring, Dr. Alster said. People with darker complexions tend to be the most vulnerable to laser peel damage, often seeing an uneven coloration after a treatment. Fraxel is less likely to have that effect. Gisselda Ricci, 43, of Purchase, N.Y., who has olive skin, participated in a clinical trial of the Fraxel laser at the Laser & Skin Surgery Center of New York. After five treatments the acne scars on her face and neck were diminished. "There are no deep scars anymore," she said.

People with scars like hers or other types of dark spots and patches stand to benefit most from Fraxel treatments. Those with lighter marks may do just as well with alternative treatments. "We have so many wonderful ways to remove pigment with noninvasive treatments - creams, lasers or an I.P.L. device," said Dr. Brody, referring to intense pulsed light, a milder treatment. The chance that a cosmetic device like the Fraxel laser will be used inappropriately or unnecessarily seems to be greatest when it is new. "It's a vicious cycle," said Wendy Lewis, a cosmetic surgery consultant in New York City. "The company brings the device to market, the media write about it, and consumers read about it and force doctors to jump on the bandwagon because their patients start clamoring for it."

During the next year or two, as they wait to see if the Fraxel laser lives up to its billing, some dermatologists say they will use other treatments, like chemical peels and, to erase individual spots, liquid nitrogen. For some people a simple treatment with a prescription cream containing retinoic acid - Retin-A or Renova, for example - is enough to fade spots and stimulate the production of collagen to fill in minor wrinkles, said Dr. Leslie Baumann, chief of cosmetic dermatology at the University of Miami.

"You don't need to wound your skin to produce collagen," Dr. Baumann said. "You're better off using a retinoid than any of these technologies that haven't been proven over the long term." "This fractional approach has the promise of giving us what patients want most," Dr. Fitzpatrick said. "They want a procedure that works, that doesn't cause downtime and doesn't have risk. Fraxel appears to be doing that. Whether it's going to satisfy everyone, we don't know."

Treatment Helps Emotional, Physical Pain Of Acne
KHOU, February 15, 2005 HOUSTON CBS-11

At some point in their lives, 80 percent of Americans get acne. It is the leading reason people go to the dermatologist.

Barbara Johnson is undergoing treatment for her acne.
The tiny pulses feel a little like rubber band pops.
"That stings a little," she says.

It is nothing compared to the pain acne caused. That was the physical kind. "I would have cysts on the side of my face and it would really hurt to take a shower. It would really hurt for the shower to run on my face. Some people can't even fathom that," Johnson says. There was also the emotional kind of pain that bound Barbara Johnson to the house on weekends because she didn't want the world to see her.

The laser shrinks the oil glands that are the root of acne. Three or four treatments may do it for some patients, but others may take twice that many.

After a year without acne, Stephanie Keasler thinks she's better at her job. "It's been a huge confidence booster. You feel better about yourself, which results in better performance across the board basically," Keasler says. When Dr. Paul Friedman was part of the original trials the laser was meant for acne scars. The effect on acne itself was a bonus and it seems to work for men, women and all races.

"In some instances we will do a test spot and perhaps we'll use a little lower energy level for patients with darker skin types, but for the most part we have found the laser to be safe with all skin types," says Dr. Friedman of Dermsurgery Laser Center.

Since the laser treatments became available, they have become increasingly popular, even though insurance doesn't cover them. The cost can be well over $1,000 but Johnson has no intention of quitting -- not when she compares old pictures and new ones.

"I told my husband, 'you know, I could actually retire in three years and I will keep working if I have to just to, to be able to pay for this'," says Johnson.

People say it's not just about buying a laser treatment, it's getting back their self-esteem.

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