It’s been an amazing 15 plus years in the field of Plastic surgery.  Our practice began a venture into skin care in the early 1990’s and we really haven’t looked back.
   
Yes, as many of you know, we have recommended the use of Retin-A, performed peels with TCA and phenol and even done full Co2 laser.  These tools, still in use today continue to be viable options.  But the ever changing, aggressively researched area of fractional laser technology is affording us the opportunity to provide many more options for our pre and postoperative surgical patients.
  
These technologies can be overwhelming and confusing.  This is true not only for our patients, but for us as providers considering having one of the newest lasers in our skin care armentarium.
 
So what does “fractional” technology mean?  Consider a cm2 (cubic square centimeter) being totally ablated from the skin’s surface.  Then imagine that same cm2 with 100/200 microscopic laser holes (sometimes referred to as necrotic columns).  The damage created by these microscopic “laser holes” gives us the benefit of stimulation and turnover of skin cells while leaving intact epidermal cells to recover the wound quickly and efficiently.  Some of this fractional technology is ablative and others are non- ablative.   “Non-ablative” fractional resurfacing has been useful for collagen remodeling and “skin tightening” for several years now. In essence, laser light is filtered and energized and attracted to a chromophore and/or water.  This enables the preservation of the epidermal layer and subsequent skin tightening and collagen remodeling.  Co2 “ablative” fractional resurfacing lasers are targeted through the patients epidermis and recovery becomes shorter and easier than full Co2 laser because of the same principal of intact epidermal cells being present.

Our office has been fortunate to work with both Erbium/glass and Co2 lasers.  Both our lasers provide the practitioner with options for laying down the microscopic laser beams in a columned pattern, or in a “mosaic,” scattered pattern which is a proprietary component of these particular lasers.  This scatter ensures less heat build up and subsequently less discomfort during the procedure.  Another option which is proprietary to this laser system is the combination of laying down individual cm2’s, followed by a dynamic (or scattered) laser beam application to “feather” the edges and therefore ensure a homogenous pattern and more even, visually pleasing recovery.
   
Downtime for all of these fractional lasers is less than total resurfacing via traditional methods.  Redness is usually not an issue past 7 to 10 days and immediate recovery with make up can be appreciated in 5-7 days.
  
Our practice has seen many happy patients after laser treatment and we look forward to the continued use and changes in application of these exciting laser modalities.

These modalities can be used alone or in conjunction with surgery.  So after evaluation of aging changes of the face, a decision has to be made whether or not   surgery or less invasive procedures are indicated.  If the problem is primarily one of skin wrinkles, dyschromia and laxity, laser or skin care systems can be beneficial.  If there is fatty tissue in the jowls and neck, small needle liposuction can flatten and contour the face and neck.  If there are depressions or creases, fat tissue grafting or Restylane can be used to improve these.  If skin care, laser, liposuction and fillers are not enough, then we need to resort to slightly more invasive measures.  A lower facelift, neck lift, or upper and lower eyelid lifts either individually or combined will often make a dramatic difference for people.

It is a certainly fortunate for our industry to have all the tools available for rejuvenation of the face considering the vast differences in our patient’s needs.  Our practice is happy to have had the introduction of the new Lutronic laser systems because they add another dimension to improving the aging face.

Dr. James Caarraway is a practicing clinical plastic surgeon, Director of the Division of  Plastic Surgery at Eastern Virginia Medical School and Director of the Cosmetic and Plastic Surgery Center in Virginia Beach.  Dr. Carraway also is the medical director for the Aesthetic Skin Care Center in Virginia Beach.

Joyce Black is a registered nurse certified in plastic surgery.  She has worked for almost 30 years along side Dr. Carraway both as his surgical nurse and presently as the clinical director of the Aesthetic Surgery Center in association with Eastern Virginia Medical School.