The Best Cosmetic Treatments for Aging Skin
We spoke to Schweiger Dermatology Group’s Dr. Sue Ann Wee about which methods she employs to help her patients achieve their dream skin, regardless of how old they are.
What’s the best laser to treat hyperpigmentation?
SAW: Clear and Brilliant Permea and Fraxel Thulium lasers are non-ablative fractional lasers that are effective at removing superficial brown pigmentation. Intense pulse light devices such as Lumecca are very effective at removing superficial hyperpigmentation as well; however, IPL must be limited to lighter skin types. Melasma is a specific type of hyperpigmentation that is challenging to treat as it can always recur even if it is mostly cleared. Laser and light based devices are second-line treatments and should always be performed by experts in laser dermatology.
What’s the best laser to treat aging skin?
SAW: Fine lines can be treated effectively with Clear and Brilliant laser resurfacing, performed 3-4 weeks apart at the minimum, and on average 2-6 treatments. The number of treatments ultimately depend on the patient’s goals. For moderate wrinkling, I use the Fraxel Dual laser, usually between 2-6 treatments. This laser is incredibly popular because it comprehensively treats other signs of sun damage such as discoloration and it is proven to make the skin healthier. If patients have severe wrinkling, then fractional ablative procedures such as fractional CO2 and Fractora radiofrequency device can be performed.
When treating wrinkles, how do you decide which treatment to use?
SAW: Wrinkles are an inevitable fact of aging. They come from three main causes: muscles of facial expression, the breakdown of collagen and supporting structures in the skin, and from the effect of volume loss that we experience as we age. Often, the first sign of aging shows up as forehead lines or subtle wrinkles between the eyebrows or around the eyes. In this case, small amounts of botulinum toxin are effective to relax the muscles of facial expression that are the root cause of these lines, thereby not only improving the lines but also preventing the lines from getting deeper. If the wrinkles are coming from volume loss, then I will also use injectables such as hyaluronic acid fillers to artfully restore volume loss. For example, the nasolabial folds (better known as “laugh lines”) are largely a side effect of loss of volume in the cheek area. So, rather than just filling in or applying laser to that line, I can improve the actual nasolabial fold most naturally by restoring volume in the cheek, under eye area, and under the nasolabial fold area.
How do you determine which lasers to use?
SAW: For very early photo aging and superficial wrinkles that start in the 20s and 30s, I find that gentle infrared fractionated non-ablative laser like Clear and Brilliant is a great “starter” laser and has virtually no down-time. If wrinkles are moderate or more severe, then infrared fractional lasers with more energy such as Fraxel Dual is an excellent choice. These infrared lasers have a long wavelength and thus can penetrate more deeply and trigger collagen formation in the dermis of the skin where it matters most. For severe wrinkling and associated lax skin, fractional ablative (or cutting type) lasers and devices such as fractional CO2 laser and Fractora laser can be used.
What are the most common misconceptions about laser treatments?
SAW: I have had patients think that lasers will thin their skin. Lasers give very controlled injuries to the skin that allow for boosts of collagen formation and tissue remodeling in the skin that is otherwise slowly declining in it’s ability to produce collagen. So, this is untrue in the hands of an experienced laser dermatologist.
What age is a good age to start for lasers?
SAW: Lasers can be started at almost any age depending on the condition that we are treating. For example, port wine stains that cause red discoloration can be treated during infancy. Acne scarring can be treated in teens. And superficial wrinkles can be treated as early as the 20s and 30s. In fact, many laser and other devices show greater tissue remodeling response in younger age group
What’s your personal favorite laser?
SAW: One of my personal favorite lasers is the Fraxel Thulium laser. It’s a wonderful laser because I can use it to treat sun damage and discoloration across all skin types. It is also FDA approved for treating precancerous spots, so it’s great to be able to have a treatment that makes the skin more healthy while improving the visible signs of sun damage.
Dr. Sue Ann Wee treats patients at Schweiger Dermatology Group’s Broadway location in Manhattan. Dr. Wee is a fellowship-trained and board-certified New York City cosmetic, laser, and general dermatologist practicing. She earned her undergraduate degree from Stanford University and her medical degree from Stanford Medical School. She completed her dermatology residency at New York University at the prestigious Ronald O. Perelman Department of Dermatology.