Lasers 101: A Guide to Procedure Selection for the patient and a focus on Intense Pulsed Light (IPL): The photofacial/fotofacial revisited
When considering ANY cosmetic procedure, the first question one must ask himself or herself, as a patient, is, “What am I trying to improve?” Rather than jump on catch words for example, like “resurfacing,” and wanting “fraxl,” the key question is again, “what bothers you?” And what logically follows is, “will a certain procedure benefit that problem?” The next inherently linked and important question to consider is, knowing the benefits, “what are the risks?”
To sum up:
- What is my goal as a patient? What do I want to improve?
- Will this procedure help? What other procedures could do the job?
- What are the risks vs. benefits of the proposed procedure vs other procedures that make this one the procedure of choice?
Intense Pulsed Light or IPL, in the right hands, is pretty ideal for treating brown spots, also known as sun spots or liver spots with very little risk or “downtime.” So, if you are looking at your face and saying to yourself or my receptionist, “I have a few sun spots on my face,” you should not necessarily be asking for a resurfacing procedure or the fraxl. While ablating or getting rid of a significant percentage of the surface of your facial skin, will likely get rid of the epidermal lesions, it is also most likely not necessary and a more costly, more invasive, riskier procedure. However, if you suffer more from blotchy pigmentation as opposed to discrete brown spots, then the resurfacing procedure would likely be superior for you. On the other hand, IPL can selectively target the hyperpigmented lesions/sun spots/solar lentigos….and have them form a VERY superficial crust that flakes off of the face typically in 7 days, with minimal downtime and minimal risk, again, when performed in the right hands.
I did a 2 year cosmetic fellowship that included intensive training on multiple lasers including an IPL machine. I published a peer-reviewed article in the journal Dermatology Surgery for a study done in conjunction with Estee Lauder. I recently did another study for Estee Lauder with my newer IPL machine.
What else is IPL good for besides brown spots? It is also particularly beneficial for treating blood vessels or telangiectasias on the face – again with little downtime or risk. However, unlike the treatment of brown spots, treating blood vessels can take more than one treatment and difficult cases can take up to 3 to 5 treatments.
This is where the term “photofacial” came from. The patient would typically get 3 to 5 treatments spaced 3 to 4 weeks apart. The average patient would have this procedure done for a fair amount of redness/rosacea/broken blood vessels with or without the brown spots discussed above. Additional benefits include a decrease in pore size, improvement in skin tone, stimulation of collagen production with a concomitant decrease in fine lines and wrinkles; HOWEVER, these latter benefits are usually much more subtle than the improvement in the redness/blood vessels and resolution of the brown spots, and I do not typically encourage patients to have IPL unless they have the aforementioned brown spots and/or blood vessels/redness . The MIXTO fractional CO2 system is far superior to IPL and in my opinion, to other resurfacing lasers as well, for stimulating collagen production and decreasing fine lines and wrinkles.
To conclude, if you have brown spots and/or blotchiness, “broken” blood vessels, telangiectasias, capillaries, or rosacea, IPL has a very favorable risk/benefit profile and could be the treatment of choice for you! For more background information including a history and comparison of “resurfacing” or ablative lasers vs. non-resurfacing ones, please see my upcoming blog on the Mixto laser – the state of the art in fractionated CO2 lasers.