JUL-AUG 2019

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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Page 48 of 68

SPLITTING ENERGY 46 JULY/AUGUST 2019 | Med Esthetics © GETTY IMAGES "Lentigines typically respond very well to multiple treatment modalities," says Dr. Morton. "Regarding fractionated op- tions, we most often use the nonablative 1,927nm fractional laser. After one to two sessions, we see reliable and marked results with one week or less of downtime that consists of redness, swelling and mild scaling of skin." Because the nonablative options work so well for improv- ing discoloration, Dr. Morton rarely considers the more aggressive ablative lasers. "In addition to the fractional 1,927nm devices, numerous nonfractional, nonablative lasers are very effective for brown spots, including the alex- andrite, Nd:YAG, ruby and even KTP lasers," she says. If melasma is the main concern, however, lasers are not fi rst line treatments. Lasers and other light-based devices can exacerbate the condition and must be used with cau- tion. "The expected recurrence of melasma can sometimes make a large monetary investment for laser treatments dif- fi cult for patients," says Dr. Morton. "When patients do opt to proceed with laser treatment, it is wise to choose lower, conservative energy settings. The 1,927nm wavelength is available in a low-power device called the Clear + Brilliant (Solta Medical), which can be helpful for melasma with less risk of exacerbation." Joan Vos MacDonald is a freelance writer based in Kingston, New York. "Again, combining many different modalities usually yields the best results, depending on the type of scar, the patient's skin type and location on the face or body," says Dr. Lee. Dr. Morton adds that the device and settings used will largely depend on the depth of the scar. "Most people who treat burn scars would likely agree that the fractional ablative devices—CO 2 or Er:YAG—are important for collagen remodeling and softening of thickened scars," she says. "The ablative fractional lasers have led to great improvements in quality of life for people with scars sec- ondary to burns or other traumatic events." The deeper and thicker the scar, the more powerful the laser should be, notes Dr. Goldman. "For deep, thick scars, the Lumenis SCA AR FX fractional CO 2 is the best device," he says. SKIN CONCERN: HYPERPIGMENTATION When treating pigmentation concerns, identifying the cause is the fi rst step in choosing your treatment modality. "Lentigines typically respond very well to multiple treatment modalities."

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