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WINNING COMBINATIONS 30 JULY/AUGUST 2017 | Med Esthetics IMAGES COURTESY OF ©2017 DERMATOLOGY/COSMETIC LASER ASSOCIATES OF LA JOLLA, INC.; BACKGROUND: © GETTY IMAGES To help practices develop their own combination treatment packages to address their patients' varying concerns, downtime requirements and budgetary restrictions, we asked aesthetic practitioners to share their most popular multi-modality antiaging protocols. MINIMAL DOWNTIME: IPL + INJECTABLES When patients complain that they just don't look as good as they feel, Mitchel P. Goldman, MD, of Cosmetic Laser Dermatology in San Diego reaches for neuromodulators, soft tissue fi llers and intense pulsed light (IPL) to create immediate satisfaction. "These are three things that I can do on almost every single patient," he says. "It's my homerun combination. If you just do those three things, the patient will walk out of the offi ce looking and feeling like a million bucks, and you can do it all in 15 minutes. If you add in proper skincare products with some nice growth factors and depigmenting agents, you can deliver longer-lasting results." He performs the IPL fi rst, followed by neuromodulator and then the fi ller. "This is for your run-of-the-mill patient, who stops in after she drops the kids off at school and can't have a lot of downtime," says Dr. Goldman. This dramatic result was achieved by combining fi ller, Botox and IPL in one session. BEFORE AFTER SIGNIFICANT SKIN AGING: THE ULTRA REPAIR For patients who have more signifi cant signs of aging and are able to tolerate a few days of downtime, he moves to a treat- ment he calls the "Ultra Repair." "When a patient needs laser skin resurfacing, for the past 20 years our practice has used multiple lasers at the same time," he says. Patients undergo treatment with pulsed dye laser, Q- switched alexandrite laser, Er:YAG laser and ultra-pulsed CO 2 , all in one session. "We're able to treat the dispigmentation as well as the hypervascularity as well as the wrinkles," says Dr. Goldman. "But it does take about a week to heal. This is our most extreme laser treatment." If the primary concerns are dyschromia and vascularity, but the patient has minimal wrinkles, "then we can go to some- thing in the middle," he says. "We use a fractionated PICO laser along with a Q-switched alexandrite laser and pulsed dye laser or IPL. The patient has two to three days of downtime." One year following Ultra Repair multi-laser treatment. BEFORE AFTER