With so many lasers on the market, patients get very confused on what is what, particularly when it comes to fractional laser technology. Fractional lasers are devices that deliver laser energy in a novel way that has changed the landscape of laser surgery forever. The technology has been around about 4-5 years with advances developing every couple years. Fractional resurfacing offers an improved balance between safety, efficacy and recovery time by treating skin in a ‘pixelated’ fashion.  Although the entire skin surface visually appears treated, microscopically there are treated areas separated by untreated areas. In effect, the healing tends to be quicker and safer. These areas of treatment are called microthermal zones, and they have changed the way we treat the skin.; allowing us to deliver laser energy to greater depths into the skin without increasing risks. Now the name Fraxel is actually a name brand of a laser developed by a company called Reliant that innovated the technology (now it is Solta medical).  Since its release about 5 years ago there are numerous copy cat technologies out on the market – pixel, active FX, matrix, Pearl. Deka, accent and so on. The differences between them all go beyond this discussion but the long and short of it is that I prefer and own the Fraxel brand of technologies. They are, in my opinion, the Rolls Royce of such technologies with the greatest clinical research and certainly the most progressive innovations. They have three different fractional technologies, providing a huge array of clinical applications and a broad spectrum of options for patients who have different needs in regard to results , recovery and risk. I will in, future blogs,  address each of these technologies which represent significant part of my laser practice. Now I am not saying that the Fraxel namebrand is the only effective technology. As with most technologies, the clinical results depends mostly on how the device is used, meaning the skill of the doctor to select the appropriate patient and then use the device to provide an expected result.

So….i am not sure how i felt about Dysport a few months ago when i first posted about it ( i dont remember what i did yesterday for that matter). I do have a decent impression of it after 6 months of very regular use and patient follow up. And the verdict is good. First off, it definetely kicks in quicker that Botox (my own face kicked in, in only 1 day). As for the length of effect- i have found, with the right dose, i can get it to last about as long as Botox, in the right patient. In older patients or those with deeper wrinkles, maybe its length of action is about 10 percent less in time. BUT…which is a surprising plus….i have definetely found that in the many patients that have used Botox for years and are getting decreasing aesthetic returns in both length and quality of wrinkle reduction, Dysport has given this group a new ‘boost’. I compare it very much to a chronic wine drinker who no longer gets that tipsy buzz they used to get. Give that person a gin and tonic and they are on the floor dancin!. I do believe there will be a role in the future to maybe alternate Botox and Dysport in the same patient. Also….on younger patients and 1st timers Dysport has been equally effective. Thus far it represents about 20-25% of my ‘toxin injections’. Botox still is the #1 name brand and for patients that have always done well with it, i see no reason to change. It is nice to have options…no one likes a monopoly. I do believe Dysport will also play a strong role in the treatment of excess sweating. Stay tuned.

Every once in a while there is a headline in a newspaper or beauty magazines describing the hideous scarring that was induced upon an unknowing soul as they received a laser or similar procedure meant to enhance their beauty. In my office, I see these patients several times a week. Fortunately, for me, these were not traumas induced by my own hands. Almost always there is a story that involves a “medical spa” or “ Laser Clinic” or sometimes even worse……a hotel room or the back of a nail salon where someone was performing ‘beauty injections.” Although complications can occur with relatively safe cosmetic procedures performed by highly trained cosmetic physicians, the overwhelming majority of stories involve individuals who are not physicians performing the procedure. A laser is a fancy knife and minimally invasive procedures such as injectables are still technically invasive. An individual wouldn’t allow a non physician to perform surgery with a knife on them …so why do they allow aestheticians, “laser technicians’ , nurses , PA, or individuals with no medical training whatsoever to perform cosmetic treatments on them. I am still trying to figure this one out. As a physician, I am only as good as the experience I have performing a procedure. But most importantly the skill of a doctor shines through not when all is well…but how we perform during the hopefully infrequent occurrence of a complication. Unfortunately, individuals without medical degrees do not have the experience, the prescription pad, or the general tools used to handle complications such as burns, allergic reactions, infections and so on. Yet in many states, such as New York , loopholes exist that allow non physicians to perform several cosmetic procedures including lasers and injectables. When a problem exists patients are left out in the cold. Now sometimes these procedures are performed in a doctors office and sometimes not. Most of the time there is no doctor supervision and therefore quality control is lost. Now I am sure there are nurses and PA and pediatricians and internists who may give a good Botox shot and perform laser hair removal quite well, but if a patient has a unwanted reaction or a burn or a displeasing cosmetic result can they handle the medical , emotional , and legal ramifications of the that reaction…….my opinion is –usually not. Unfortunately, 5-10 percent of my practice is handling complications, most commonly of non physicians in spas or non core specialty doctors trying to “get into the cosmetic game’. In most states, including New Jersey, any individual that uses a laser that is not an MD can be arrested for impersonating a physician. There are no Laser Spas. As u can imagine, the horror stories are therefore fewer and farther between. What will decrease the number of sad stories? Either legislation that delegates specific training requirements of those performing procedures or public awareness of the stories that make patients steer clear of those non properly licensed.