Fractional laser skin resurfacing (ablative and non-ablative) appears to achieve skin improvements that can get close to conventional ablative laser skin resurfacing but with fewer potential side effects. Examples of branded devices include Fraxel and Pixel, but there are many others.
The process of directing a light source to target a selected area of the skin to damage it is technically known as "selective photothermolysis"; where “thermolysis” refers to ‘decomposition by heat’ and “photo” refers to ‘light’. Unlike with selective photothermolysis, where the whole of the selected target area is damaged; “Fractional Photothermolysis” seeks to only damage certain zones, (producing tiny dot-like treated areas on the skin), leaving the other zones within it perfectly intact; hence only causing fractional damage. This allows the skin to heal much faster than if the whole area was treated. The costs for fractional laser skin resurfacing depend on the area(s) being treated and the type of device being used plus any additional single patient disposable items required by some systems.
The Palomar Starlux 1540 laser is an Erbium:Yag laser and is described as a Non ablative Fractional laser which operates in the 1540 nm wavelength spectrum.
There are basically 2 different types of lasers used in skin laser treatments. These are called ablative (also commonly called resurfacing) and the non-ablative types of lasers. What this means in simple terms is that with the ablative types of treatments the top surface of the skin must be removed, to varying depths, in order achieve a fresher and improved skin surface. In the non-ablative treatments the deeper parts of the skin are treated without removing the top layer of skin. In other words the non-ablative lasers by-pass the surface of the skin, and leave it unaffected, whilst targeting the deeper skin layer.
Ablative laser treatments, are very effective in the treatment of aged, wrinkled, sun damaged skin and deeper acne scars by causing a controlled surface burn leading to the removal of some portions of the skin surface. This results in a smoother skin surface. However this type of laser does have significant side effects and requires a long healing period. Non-ablative laser treatments on the other hand have little or no side effects and almost no healing time as they leave the top surface untouched. However they usually require numerous treatments over many months and ultimately have more limited results, particularly in the treatment of wrinkles and acne scars. Different conditions obviously require different approaches. As such both, non ablative and ablative treatments have their indications, advantages and disadvantages. The Starlux 1540 laser is a non ablative laser.
In general, all skin laser treatments are differentiated into Flat beam and Fractionated laser devices. In the Flat beam type of lasers, the laser beam is delivered as one coherent, homogenous column of laser energy that treats in its entirety that section of skin, wherever it strikes. With Fractionated lasers however, the laser beam is instead comprised of many minute parallel columns of micro-beams, that are separated and have tiny gaps between themselves. When a fractionated laser beam strikes the skin surface there will be areas of tissue which the tiny columns of laser energy will affect but concurrently there will also be areas of unaffected portions of tissue which represent the gaps between the columns of laser. The Starlux 1540 is designed as a fractionated non ablative laser.
As described previously, a fractionated laser that is non ablative will penetrate deep into the skin, bypassing the skin surface, leading to a sufficient heat build-up and injury deep within the layers of skin. This in turn initiates the body’s own natural healing process to promotes new collagen and elastin production. As a result of this new collagen and elastin production the skin, in time, becomes 'revolumised' and plumper. Of equal importance in the above concept however, are the areas of skin the fractional laser leaves untouched. For every micro-thermal zone the laser targets and treats intensively, a gap of surrounding tissue remains unaffected and intact. These unaffected areas overall allow the skin to heal much faster and with less risk of complications than if the entire area were treated at once.
Because the Starlux 1540 leaves the surface of the skin untouched and its energy is delivered in a fractionated way, it is a great treatment when we need to target and improve the deeper sections of the skin by kick starting the body’s own natural healing ability to increase the collagen and elastin production within the skin. In essence this can increase the volume of the skin and as a result it can ultimately improve the skins texture, tone, and pore size as well as improve fine lines and wrinkles. Moreover because it is a non-ablative laser leaving the outer skin layer intact, healing time is minimal and significantly accelerated.
Simply put, it's more powerful than other lasers of its kind. It also offers greater energy per microbeam (up to 100 mJ), and has a greater depth of penetration (up to 1 mm) than many other competing devices. This stimulates a better response within the skin and the surrounding deep tissue, resulting in more effective corrections and long-term dermal remodelling. In addition, the Starlux 1540 delivers its beams much more uniformly with even penetration compared to some other lasers.
The Starlux 1540 fractional skin resurfacing treatments are effective only when performed in a series of sessions because each session treats only 20 to 25 percent of the skin. By treating micro-islands of skin, the surrounding untreated skin drives the healing process, filling in the treated area with healthy, more youthful looking skin. Clinical studies suggest that on average, an effective treatment regimen is 3 to 5 sessions, spaced about 2 to 4 weeks apart. Depending upon your condition and schedule, we may choose to space treatment sessions even further apart. Effects are both immediate and progressive. A series of treatments at 4-6 week intervals may be required to achieve the desired results. Severe, deep scars caused by acne or surgery may require more treatments for optimal results. Your treatment practitioner will be able to give you more information about StarLux® Fractional nonablative skin resurfacing treatment and expected outcomes.
Although many people may notice a positive change in their skin tone and texture within a few days due to the inflammatory swelling effect of the treatment, optimal improvement is usually only visible in about 2 to 3 months. This time frame and treatment structure allows for complete healing and replacement of damaged tissue with new collagen and elastin, as well as viable healthy skin cell growth.
To prepare your skin for treatment, it will be cleansed. Because the Palomar Starlux is so powerful precise and selective, there's no need for special tints or topical anaesthetics. Prior to application of the laser energy we usually cool your skin with a specialised tool that is rolled on your skin. Once you feel comfortable we then apply the laser handpiece directly to your clean skin. The handpiece also uses strong built-in cooling technology that protects the outer skin layer and minimizes discomfort, thus enabling practical use of high energies without anaesthetic.
Most patients describe the treatment as having a 'prickling' sensation. The prior and intermittent skin cooling along with the handpiece's own cooling alleviates most discomfort.
During the first 24 hours after treatment, your skin will experience a wide range of changes. This will vary from feeling and looking mildly sunburned, sensitive, warm, swollen or even feeling tight. Regardless, as the skin surface is left intact and undamaged there will be no oozing or open areas. These sensations and changes generally fade and improve within the first few hours. Some puffiness around the treated area however may linger on for a few days. Make-up can be applied after the treatment to cover any noticeable skin changes. Over the next few days, it is quite common for the skin to appear slightly bronzed after the treatment. This too of course can be covered with make-up. In some patients who have more significant scars or wrinkles we may feel the need to use higher settings. As a result, in these patients there may be some mild peeling or flaking in addition to the redness for 3-4 days after treatment. Using a moisturizer will help reduce the appearance of any dry flakes. Bear in mind that every time you have a treatment, the aforementioned conditions will be repeated, although do not expect exactly the same reaction each time after every treatment.
Wearing a sunscreen of SPF 30 or higher twice a day is especially important. Avoid direct sun exposure during the healing process and for the first 3 months after treatment. During this time, whilst out in the sun, it may be helpful to think about wearing a hat to reduce sun exposure.
The Palomar StarLux 1540 Fractional non-ablative lasers can be applied to stretch marks or depressed scars on any area of the body, including the face, chest, arms, and hands. However for fine lines, plumping up of the skin and improving pore size and skin texture, better results are often seen in the facial region due to the better healing qualities and suitability of the skin quality in this area.
Palomar, the company that produces the Starlux 1540, has some of the most extensive research and development in the laser sector, albeit perhap less marketing exposure. As a result of this research and development, the Starlux 1540 has passed the stringent American Food and Drug Administration (FDA) testing and gained approval for use in the treatment of scars and stretch marks. By delivering its microbeams in individual short pulses, rather than a continuous wave, there is less discomfort with the treatment. Furthermore as the Starlux1540 features built-in cooling technology to reduce any overheating effects, this protects the skin from any associated damage that sometimes can be seen with other types of laser systems. Moreover as the Starlux is a non ablative type of laser, this leaves the outermost layer of skin intact to act as a barrier to the elements while the deeper tissues heal and tighten.
Due to the longer wavelength of this laser, and unlike many harsher ablative and flat beam lasers, the Palomar Starlux 1540's fractional beams can safely be used on any complexion, dark or light.
As in any medical procedure there is always the risk of side effects. However due to the less invasive nature of this laser, side effects are minimised. Swelling and redness are probably the most common side effects from this treatment. If swelling does occur, it is usually minimal and will subside within a day or two. Redness may occur and will fade within a few days. Occasionally, darkening or skin colour changes in the form of small patches or fine grid like patterns may be rarely seen. This reflects something called post inflammatory hyperpigmentation which is basically a darkening reaction of the skin from the heat effect of the laser. It is more likely to be experienced with darker skin types. To lessen this risk in these indivuals, the settings are usually set lower. In the event this occurs we may prescribe some lightening creams to reduce this. Most times however, with the passage of time this fades without any treatment. Although scarring and infection is a possibility with any medical treatment, the chance of such an occurrence happening with the 1540 Starlux is very low.
As Roaccutane leads to a temporary reduction in the rate of new skin cell migration over any skin wound, it can as a result adversely affect wound healing and subsequent scar formation. It is generally advised therefore, for anyone taking oral Roaccutane, to avoid any treatment which can cause superficial skin injury as this may lead to prolonged or unusual healing. This correlation was initially reported in dermabrasion patients treated for acne scarring and has been assumed to apply to modern techniques as well. However for the newer non-ablative fractional resurfacing, such as the Starlux 1540 we have seen no unusual or delayed healing. Nonetheless as a precaution it is our policy to have our patients wait 6 months after discontinuing Roaccutane before undergoing and non-ablative fractional laser treatment.
This will inevitably depend on your expectations. If you set the bar too high, your expectations of these treatments will never be met. Moreover, as no one can ever predict precisely what result you will get beforehand, this further complicates the process. In the end it’s about having a good relationship with your practitioner who will be in a position to assess you and hopefully understand what it is you are trying to achieve. It is very important for you to make your feelings about what you are looking to achieve, as clear as possible, so that we may be able to discuss this with you, as well as try to inform you as to what possible outcome you may have from your treatment.
In many scars the problem is that of a depression within the scarline. What is required therefore for any improvement in these scars is the production of new dermis or skin to replace the lost dermis and to thicken or plump the skin. The main component of the dermis is collagen, and if the dermis can be induced to produce enough new collagen, the depression will be plumped out and become less visible.
A scar is caused by injury or damage to some or all parts of the skin. These injuries usually include things such as a scratch, a cut, a surgical incision, an acne pustule, a deep burn, or any other trauma that violates any or some part of the skin. In general, if the injury only affects the outermost surface of the skin (called the epidermis) then many times the skin will heal without significant marking. Indeed if you have a noticeable residual mark or scar on the skin after any injury, then this signifies that the injury involved deeper portions of the skin. Moreover if the injury is deeper and if the scar tissue created was not robust enough to fill the damaged area, a depression of varying degree may be seen and thus give rise to a scar that is somewhat more obvious.
The Starlux 1540 works best for more shallow or rolling acne scars. The Starlux 1540 laser beams works by going deep into the skin (dermis) to promote the growth of new collagen in the dermis. This new collagen effectively remodels and fills the deficient dermis thus plumping the skin beneath the depression making the scar appear less deep. In deeper or so called ice pick scars, other treatments such as ablative laser resurfacing, surgical excision, injectable fillers, microneedling or a combination of these, may be more appropriate. In any case, no laser has yet proven to remove scars completely so recognize you will only get an improvement as opposed to removal of your scars.
This of course will depend on the type and extent of the scar. For a superficial acne scar however, we usually recommend 3-4 treatments. Healing and improvement is based on new collagen formation, and therefore will require 3-4 months to see the result. Treatments are recommended at 3-4 week intervals.
You will see some swelling and notice an improvement in the first two weeks after treatment but this swelling is just the immediate effect of the treatment. New collagen production does not begin until about 6 weeks after the treatment, and visible improvement usually is seen by the third month. Remember, we are stimulating the skin to make new collagen, and this takes time. There is no quick fix with immediate results, even with surgery. A healing period is always required. You must also remember that the collagen production continues for six months to a year after the last treatment and so many patients report improvement up to this time.
In February 2010 Palomar Medical Technologies, Inc. announced that its Starlux1540™ Fractional non-ablative laser handpiece received the first clearance by the United States Food and Drug Administration (FDA) for the treatment of striae (stretch marks) using a fractional laser. The StarLux 1540 fractional handpiece is the first laser with clinical studies and FDA approval for use with stretch marks. This new clearance allows aesthetic practitioners to formally use the Starlux 1540 to treat unwanted stretch marks. This new clearance expands the broad range of treatments offered by the Lux1540, which is used to treat surgical scars, acne scars, melasma, skin texture changes as well as fine lines and wrinkles.
Stretch marks, also called Striae are of two basic varieties. They are differentiated into White and Red types of stretch marks. Older, more mature stretch marks are commonly white or silver-coloured; newer stretch marks tend to be reddish or purple in color. Stretch marks are exceedingly common. In fact studies have shown s studies that approximately 90% of pregnant women, 70% of adolescent females, and even 40% of adolescent males develop stretch marks. Any time the skin has been stretched too far or too fast, such as during puberty, pregnancy, or weight loss - these unsightly marks appear. And it’s important to point out that it may not be something that can be avoided either if it’s meant to happen. For many people, despite religiously watching their weight during pregnancy or even applying various creams or moisturisers to the skin during weight changes or pregnancy, stretch marks can still will occur. We also know that steroids, both injected and taken orally, are contributory factors in the development of stretch marks. Furthermore very rapid growth spurts during adolescence or even in adults who are weight lifting and have rapid muscle expansion, can also cause rupture of the dermis and striae.
The skin covering our body consists of the outer surface, called the epidermis and a deeper layer called the dermis. The dermis supports our skin, plumps the skin, and gives the skin its substance and elasticity. Elasticity is the skin component which allows our skin to stretch, move and return to a normal shape after being stretched. During pregnancy, the skin of the abdomen stretches to many times its normal size as the baby grows. After the baby is delivered, the skin's elasticity in the dermis, contracts or shrinks to try to bring the abdominal skin back to its original shape. During any skin stretching, if the dermis expands too much or too fast, the dermis can break, split or rupture. These breaks in the dermis of the skin cause a wide depressed scar like mark which is called a stretch mark or striae distensae. In fact if you look at striae under the microscope you will see a defect or space in the dermis where the dermis has been ruptured or split. In addition to the mechanical stretching of the skin, another contributory factor is the hormone cortisone (a steroid type hormone), which our body produces. This hormone is usually produced whenever our body is subjected to any physical or emotional stresses (i.e. pregnancy). Cortisone causes a weakening of the elastin and collagen fibres within in the dermis, through a direct effect, allowing it to tear much more easily than normal. The use of steroid medications, both orally and through injections can also cause striae even without any overstretching effect. Striae may appear on any area of the body but are most frequently found in areas where fat is stored. The abdomen, hips, thighs, breast, upper arms, and buttocks are the most common sites.
Over time of course, these scars or marks gradually diminish, but do not disappear entirely. Having said all this, it’s important to remember that apart from the cosmetic displeasure that these marks elicit, they do not present a health issue.
The only sure fire way to remove stretch marks from any area of skin on the body is to surgically remove that section or portion of skin where the stretch mark exists. This would only apply of course where there are techniques that allow us to remove the skin and place the scar in a hidden position within our clothing (such as with a tummy tuck). Unfortunately in order to perform this type of surgery there is a prerequisite that the skin needs to be loose enough to remove. If the stretch marks are not situated on loose enough skin or if the area where the stretch marks exist is not on the abdomen then unfortunately there are not many options available. There have, and are of course, many other solutions that are offered to treat stretch marks. Unfortunately most of these do not stand up to the scrutiny of controlled scientific studies and as such, results are usually disappointing. Although certainly not a miracle cure, the Starlux 1540 has been the only non surgical treatment thus far that has shown improvement in clinical studies.
Inevitably we've all seen and heard various adverts purporting to eliminate stretch marks. Many of these products, often contain things like cocoa butter, vitamin E, glycolic acids as well as other ingredients. Although they are probably not harmful, they probably won't help either. To date there has only been one scientifically performed study that looked at whether these types of products (basically topical moisturizers and lubricants) can prevent and/or remove stretch marks. It was found, through a weak correlation that some daily topical treatments may lead to slightly fewer stretch marks being formed during pregnancy (but not the reduction or removal of existing ones). However it's important to note that even though cocoa butter, which is a widely promoted 'anti-stretch' product and a reasonably good moisturizer, it has never proven its ability to completely prevent the appearance of stretch marks or remove existing ones.
The Starlux 1540 fractional erbium non-ablative laser beam goes deep into the dermis to heat the collagen to approximately 66 degrees Centigrade to promote the growth and production of new collagen to replace the collagen lost in the dermis in the stretch mark. In addition, it causes collagen shrinkage which tightens skin. The regenerated new skin cells and the collagen thickening, changes the stretch mark tissue until it more closely resembles the surrounding normal skin. Multiple sessions are needed to show visible improvement. Sometimes secondary treatments may also be helpful to further improve the appearance of the stretch mark, once you have completed your Starlux treatments. Such treatments might consist of a light based or laser system such as Intense Pulsed Light (IPL) or a Pulse Dye laser to improve the appearance of any redness. Furthermore the of use of a type of microdermabrasion (such as the Hydrafacial) or a light chemical peel may give further improvement by providing some light epidermal exfoliation to soften the appearance of the stretch mark.
This will depend on the number of stretch marks and the size of the area treated. Unfortunately these treatments do take time. A lower abdomen for example can take up to an hour or more. Larger areas can take even longer.
Once your treatment is over, your skin will be pink but otherwise is usually normal. There is typically no blistering, peeling or skin injury which requires dressings and wound care. A soothing ointment is applied after your treatment and you go home.
Typically 5-6 treatments scheduled 3-4 weeks apart are required.
You will usually see some improvement after a month from the end of the second or third treatment. However new collagen production does not start to peak until about 3 months. After that it’s usually about 6 months after your final treatment before you see a final result. Remember, we are stimulating the dermis of your skin to repair and heal the dermis with new skin plumping collagen and skin tightening. In many instances i.e. in pregnancy, it took 9 months to form the stretch marks, so expect that it will take at least 6 months after your last treatment to see a good result and at least a year to see a full result. Depending on the severity of your stretch marks, you may need more treatments to get continuing improvements and when done you may need yearly touch up treatments for the first year or two afterwards.
In a recently completed clinical study, two independent physicians assessed 25 subjects for improvement in the appearance of their stretch marks after undergoing treatment with the Starlux 1540 laser. The first physician observed 50% or greater improvement in all subjects and 75% improvement in 24% of subjects. The second physician observed 50% or greater improvement in 96% of subjects and 75% improvement in 8% of subjects. Additionally, and perhaps more importantly, all of the treated subjects reported improvements of 50-100% in the appearance of their striae and all were satisfied with their results. Additionally, study subjects were followed for up to 15 months after their treatments and no recurrence of striae were observed. Anecdotally and encouragingly, researchers were unable to see the treated stretch marks in three subjects six months after treatment.
There are some non surgical treatments that may improve the appearance of stretch marks although the improvements may be variable and not always consistent. Therefore: Tretinoin cream - (Retin-A, Renova) may improve the appearance of recent stretch marks - those less than six weeks old and still pink or red in color. It works by helping to strengthen and rebuild the skin collagen, making the stretch mark more similar in appearance to your normal skin. Microdermabrasion / Skin Peels - gently removes the skin's topmost layer, which may result in new skin growth that is more elastic. This therapy is an option for older stretch marks and although it doesn't fundamentally alter the stretch mark it might help it blend in with the surrounding skin a bit better. Excimer laser and Pulse Dye - The excimer laser does nothing for collagen or elastin growth. Instead, its aim is repigmentation by stimulating melanin production. If it works, the old and lighter streaks become similar in color to the surrounding skin, and therefore less visible. The Pulse Dye laser helps to reduce the redness in a newer stretch mark.
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