Back in the good old days, say about 10 years ago, there were only a few ways to fix sun-damaged skin—peels, or ablative laser skin resurfacing using the CO2 or Erbium laser. Those lasers usually required some form of sedation or even anesthesia and were associated with several weeks of downtime during which the skin healed from what amounted to a deep second-degree burn. They often left the treated skin a lighter color.

If you didn’t want to undergo that kind of therapy the alternative was for your aesthetician to do a peel and peels became the stock-in-trade of aesthetic medicine for brown spots, large pores, softening lines and wrinkles, as well as for improving acne. For a while it seemed that every skin care guru was devising a proprietary peel, from Jessner to Obagi, using tri-chloro acetic acid (TCA) and other acids in some arcane combinations.

With the advent of the non-ablative lasers such as CUTERA’s™ Genesis and XEO and the Intense Pulsed Light (IPL) systems, skin improvement could finally be achieved without downtime. When fractional skin resurfacing with FRAXEL and other technologies was developed in about 2002, lasers took another giant step forward and it became possible to achieve, without downtime, many of the results previously only possible with the ablative lasers.

Aesthetic medicine is nothing, however, if not dynamic. What is hot one day is not the next and peels, it seems, are now coming back into vogue. Formulated with many innovative ingredients along with TCA such as azelaic acid, salicylic acids, and glycolic acid, the new generation of peels such as the VI Peel are more effective with less downtime. Even more important is the idea that these peels can offer a less expensive and yet viable alternative to laser therapy for certain skin problems.

And as with all aesthetic and laser medical procedures it is important make yourself as knowledgeable as possible, to review before and after pictures, to know who is doing the procedure, how it will be done, and to know how many your Doc’s office has performed.

Richard M. Foxx, MD is the Founder and Medical Director of The Medical and Skin Spa in Indian Wells, CA. He may be reached at 760-674-4106 or at drfoxx@medicalandskinspa.com

BROWN SPOTS

Richard M. Foxx, MD

Perhaps the single most common question I get from patients concerns brown spots. They seem to plague everyone, particularly here in SoCal. And the problem definitely increases with advancing years.

Brown spots, also known as lentigenes, liver spots, or melasma, arise when the pigment called melanin is deposited in melanocytes, or pigment carrying cells, in the dermis. We see it most often in response to long-standing sun exposure, but it may be made worse by certain environmental factors and hormone challenges such as pregnancy or contraceptive pills.

The treatment of brown spots at our office runs the gamut from a series of exfoliative skin treatments and the use of pigment-blocking products to state-of-the-art minimal-downtime laser treatments. Improvement can be achieved over a three to four month period with a series of dermal planing skin treatments which mechanically lighten the spots followed by daily use of a skin product containing hydroquinone. Hydroquinone blocks the uptake of the melanin pigment into the cells. It is not a bleach, however, and the entire process takes several months before a result is seen.

Adding pulsed light treatments hastens the process. The dark cells melanocytes preferentially absorb light, break apart, and come to the surface where they flake away. At least three to four treatments are required over three months, however, as the depth of the spots varies.

By far the most effective method at this time is FRAXEL®. Developed about seven years ago by a group at Harvard, FRAXEL works by placing approximately 2000 columns of laser energy, each smaller than a hair, in a square centimeter (about the area of a dime). Twenty percent of the skin is treated at each of four visits with 80 percent left untreated. The amount of untreated skin results in very little downtime.

The columns of skin that are vaporized by the laser are replaced by healthy new skin over the next few weeks and many of the brown spots are removed.

It is important to understand that no brown spots treatment is permanent. Any brown spot treatment program I a long term commitment and must be accompanied by regular facial treatments, the use of good products, topical anti-oxidants such as Vitamin C, and the daily use of a sunscreen with an SPF of at least 30 and UVA blockers such as Zinc, Titanium, Mexoryl®, and Parsol®.

Doctor Foxx is the Founder and Medical Director of The Medical and Skin Spa, a medical skin clinic in Indian Wells, CA, at Hyatt Grand Champions Resort, one of the country’s only resort-based medical spas.  He may be reached at drfoxx@medicalandskinspa.com or at 760-674-4106