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Truth time. If you could go back to your teenage self, Freaky-Friday style, and make one change – do one thing differently, what would it be?

I’m guessing lots of y’all are yelling muttering: WEAR YOUR FRIGGIN SUNSCREEN. I get the most frustrated about this especially in the middle of winter, when that flattering summer glow has completely faded and left behind only the forehead wrinkles it was sneakily giving me all along.

However, while we were aging unaware under our Banana Boat or Bain De Soleil SPF4’s, modern medicine wasn’t sleeping. This is the new age, when you can effectively choose the way you want to look through the rest of your life. Past mistakes no longer have to dictate your present and future self. The good thing is, we now have many excellent options to fix poor skin condition. The bad thing is, it can be overwhelming deciding which one really is the best for your particular skin and lifestyle.

We turned to Dr. Kosari at Dermatology, Laser & Vein Specialists of the Carolinas to answer our questions about two of the latest non-invasive treatments that it seems have been raved over by everyone from Jen Aniston to Kim K —  Fraxel and Intense Pulsed Light (IPL).

What is the difference between Fraxel and IPL? Both seem to be equally non-invasive, effective, high-tech skin treatments. In some sources, the two are compared as laser (fraxel) vs light (IPL). Isn’t laser a light though? Whats the simplest way to understand the difference?

That is an excellent question. You are correct in that the Fraxel device is regarded as a laser device targeting water as a chromophore (a target in the skin that absorbs the heat from a laser). As water in cells absorb the heat from the laser, the cell is destroyed. Fraxel has a dual setting. One setting treats superficial photodamage such as age spots while the other can address deeper concerns such as fine wrinkling or scarring from acne or surgery.

Intense pulsed light (IPL) is not a true laser. Whereas a laser emits one specific wavelength, IPL can emit along a broad spectrum of wavelengths creating a bright flash of light. Due to this phenomenon, IPL can be used to treat age spots, redness or flushing, and hair removal.
Both treatments are very safe and can be used off the face on sites such as the extremities, neck, chest or back.

 

How does your doctor choose which one is best for you, based on your particular skin issues? (fine lines, redness, tone, sun/age spots, etc):

Both devices can treat multiple concerns at the same time. For example, IPL can treat freckles and redness from rosacea while Fraxel can address age spots and wrinkling. During a consultation, you and your physician will have a discussion about your desires from treatment and an appropriate plan can be agreed upon.

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How does recommendation on the treatments differ for varying skin colors? (very light skinned-dark skin) [I read there may be issues with some lasers for women of color?]

There is no reason why patients of darker skin tones cannot reap the benefits of a laser. However, care must be taken to prevent hyperpigmentation. It is critical that the devices be handled by experienced providers comfortable with the procedure and that have sound knowledge of appropriate settings. In our clinic, only physicians operate devices to ensure patient safety. We also tend to “prime” the skin prior to treatment by emphasizing the importance of sun protection and the use of a lightening agent before and after a treatment.

 

What is the downtime (and/or the amount time you may have swelling or redness) for IPL light treatment vsFraxel (Laser) treatment?

There is minimal downtime with either procedure. With Fraxel, one can expect redness, minimal swelling, and subtle peeling that completes within 5-7 days of treatment. With IPL, there is minimal redness and swelling that is usually confined to the cheeks. Healing with IPL is usually completed by day 3 but occasionally will require up to 5 days.
With either procedure, appropriate treatment will cause pre-existing brown age spots to turn darker before flaking off.

 

How long do results last in IPL compared to other treatments? What will either of them NOT fix or address?

Depending on what target is being treated, IPL can have near permanent results. For example, if the main goal of treatment is to rid of freckles, one can expect IPL to clear those lesions. This holds for redness as well. There are people who have an increased tendency towards developing freckles and redness on the face. These patients may require annual therapy to maintain the desired effect. Of course, appropriate skin care after your treatment is very important in maintaining results.

 

When is the best time of year to do this? [I read this is when you do NOT have any sort of tan?]

Whether in the summer or winter, it is important to keep up with sun protective measures prior to and after a laser or light procedure. Tanning results in increased melanin deposition in the skin. As these treatments can have an effect on melanin, the response may be exaggerated and unwanted.
Sun protective measures include the use of a broad-spectrum sunscreen with an SPF of 30 or more and a wide-brimmed hat at all times. Regardless of the season, it is best to avoid excessive sun exposure 2 weeks before and after your procedure.

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I have read that IPL and Fraxel treatments are actually not mutually exclusive, and that in fact many people start with one therapy and move to the other. Are there extra benefits when the two treatments coincide?

If so, which might be best to start with?

Although both devices can treat brown spots, they really don’t have much else in common. Fraxel is also great for collagen remodeling, improvement of fine wrinkles, and scarring from surgery or prior acne. Fraxel is FDA approved for treatment of actinic keratoses, sun-induced scaly lesions that are pre-cancerous in nature, and is better suited for a specific type of flat brown freckle called a seborrheic keratosis.

IPL has the ability to address flushing or redness secondary to dilation of facial blood vessels often seen in rosacea. It can also be used for laser hair removal.

The best approach to a treatment plan depends on the desires of the patient. One approach may be to treat with IPL to correct redness and freckling followed by Fraxel for correction of fine wrinkling. The best opportunity for the patient to communicate with their physician is during the consultation. Be sure to have all of your questions and concerns addressed before committing to any procedure.

 

As a doctor, what is your recommendation for prepping at home before an IPL treatment?

Sun protective measures including adequate use of sunscreen and a wide-brimmed hat are the most important steps to take to ensure successful treatment. Depending on the treatment chosen, use of a lightening agent such as hydroquinone may be initiated as well.

Aggressive over the counter or prescribed topical medicines meant to scrub or exfoliate the skin should also be avoided.

Preparation is key to success with any laser or light device. After your consultation you should be well informed about all the precautions you need to take to prepare for your procedure. Make sure your physician takes the time to explain all expectations and answer any questions you have.

 

The moral of this story is – lets not live the last half of our lives regretting those days of playing in the sun. Why not make the change now to repair the past, so you can move on with your life in peace?

And the other moral is, I guess those chic trendy hats don’t have to be only for the Fashion Bloggers anymore ;).

 

Our warm thanks to Payman Kosari, MD for his patience and time.

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Dr. Payman Kosari is a board-certified dermatologist.  He received his Bachelor of Science degree in Biology from the University of California, Los Angeles before earning his Medical Degree from the Chicago Medical School. He completed his internship at Cedars-Sinai Medical Center and relocated to North Carolina for his Dermatology residency at Wake Forest Baptist Health. Dr. Kosari specializes in the treatment of pediatric and adult disorders of the skin, mucosal membranes, hair, and nails and has had extensive training in the diagnosis and treatment of skin cancers including malignant melanoma. He has a particular focus in venous disorders & associated treatments such as endovenous laser ablation and sclerotherapy.

 

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