Laser for Acne
Why choose laser over medications?
Laser treatment focuses on the mechanism in the skin that supports acne. Unlike Accutane and oral antibiotics, there are no oral medications taken, therefore there are no side effects to worry about. Unlike oral antibiotics, once the treatment series is completed, there are no flare-ups. I have follow up pictures of patients as far back as almost 5 years after their initial laser treatments who have had no further recurrences. Unlike Accutane, those who completed the treatments to the point of no further acne breakouts have not needed follow up treatments down the line over the ten years that I have been performing this laser acne treatment.
In summary, Pulse Dye laser treatment has no negative systemic effects and provides a lasting solution for the acne.
Are all lasers alike?
Not at all!!! Most light sources (which are what lasers are considered) focus on P. Acnes, a microorganism that lives in the sebaceous glands and is considered causative in the red (inflammatory) pimples in acne. Once treated by a light source, P. Acnes temporarily disappear from the sebaceous glands and the acne seemingly stops. However, P. Acnes recolonize the sebaceous glands after a period of “recovery” time, and the acne flares again. This happens with various LED type treatments as well as IPL and other similar devices.
What is new in lasers since the PDL?
Actually, there is an exciting new modality I have been using, called Fractora. As the name hints, it's a fractional technology, using radiofrequency (RF) divided into microspots. The treatment is delivered via very thin needles that enter the skin and deliver the RF deep into the skin. This is a most effective way to heat and disable the sebaceous glands in the skin, hence decreasing oil production and the resultant pimples which follow. The effect is not only great on the acne itself, but also causes an amazing improvement in acne scars. This happens because the needles as well as the RF-generated heat result in a tremendous and exuberant collagen production by the skin after each treatment. In practice, we see a smoothing out of the skin and the scars getting more and more shallow. A number of before and after biopsies performed have confirmed the reduction in the depth of scars by about 50% after just 4 sessions! The treatment changes the appearance of the skin and along with it, the appearance of the patient. It's easy to imagine how much better and more confident they feel about themselves. For a young person, it opens up a whole new way of social interactions, one of self confidence and self assurance. The positive outside and inside effects are just amazing.
What are the problems with traditional treatments for acne?
Acne is often treated with oral medications, which carry their own problems.
- Mild to moderate acne is handled with oral antibiotics as well as topical agents. The antibiotics usually provide only partial improvement of the acne; however, antibiotics have their own potential side effects. Worst of all, once withdrawn, the acne usually flares right up. To my dismay, I often see young people who have been on oral antibiotics for many years. I consider this a bad long term strategy for a young person, for the obvious reasons.
- Cystic acne, which is more severe, is traditionally treated with Accutane. This is a medication with a long list of potentially severe side effects, and is therefore very tightly controlled by the FDA via the iPledge program. Accutane has to be taken for 6 months, accompanied by required monthly pregnancy and other blood tests, a low cholesterol diet and consistent monthly follow up visits. In addition, even the milder side effects, such as excessive dryness of the skin and sun sensitivity, can be a problem for some patients. Accutane is hard to tolerate in the summer due to extreme sun sensitivity and in the winter due to cold, wind and indoor dry air due to heating. Worse than that, many patients experience a flare-up of acne after completing the 6 month treatment period for Accutane, and often need a second 6 month treatment protocol, and some even require a third one.
Why is treatment with the Pulse Dye Laser (PDL) unique?
The PDL targets the red color in the cystic lesions on the skin. Red is the color of inflammation, supported by blood vessels which bring nutrition and oxygen to the cysts. Once treated with the PDL, the cysts lose the support needed for their existence and go away. As every acne patient knows well, the cysts tend to recur in the same spots time after time. Once the infrastructure that supports them is no longer available, the cyst no longer can come back. This is the reason for the long term results experienced by my patients.
What about PDT?
PDT (Photodynamic Therapy) makes P. Acnes more susceptible to light treatments. It may be useful for technologies which aim at eliminating P. Acnes. However, you may remember from above that the Pulse Dye Laser doesn’t target P. Acnes, rather the entire underlying support structure of the cysts. As such, PDT is not necessary to make it work better. In fact, adding PDT just makes the treatments more expensive (about $100 per treatment for the material) and adds significant peeling and downtime to the treatment.
In my office, Pulse Dye Laser treatments without PDT yielded fantastic and lasting results, and allowed me to keep the prices lower and the unpleasant after effects less.
How many treatments are needed with the PDL?
On average, about 4 treatments are needed, over a 4 month period (once a month). However, the range is 2-8 treatments, depending on the patient.
Are the treatments painful?
The PDL is pretty much painless . The laser feels like a rubber band snapping against the skin. Even my most anxious patients realize right away that the treatments are easily tolerated by all.
The Fractora is a more aggressive modality and some apply topical numbing cream before the treatments.
What type of side effects will I experience?
After each PDL treatment, the red cysts and pimples turn a bruised looking black and blue color. I describe this as exchanging a cranberry to a blueberry. The blueberry color can be covered with makeup, and fades out over a period of 5-7 days. We can provide arnica gel to those in need of a faster resolution of the dark marks.
Regarding the Fractora, the skin looks red for about 2 days, and tiny pinpoint marks may develop where the pins touch the skin. Most patients like to do the treatments on a Friday, so by Monday the are back to their usual skin colle and appearance.
Can the marks be avoided?
Yes. The bruise marks of the PDL can be avoided by using different settings on the laser. However, I personally think that – to paraphrase the old saying - you don’t get what you don’t see, i.e. the treatment is more effective when the marks are visible. However, we do adjust the settings for those patients who are in the public eye (TV, stage) with the caveat that the adjustment may mean more treatments to reach the same goal. The Fractora marks last 2-3 days and there is not much to do about them for that period.
Is the treatment for everyone?
The PDL works well for patients with light to medium dark/ brown complexions. Very dark (African American) skin is at risk of picking up too much of the laser energy by the pigment on the skin, and developing light or dark spots after the treatment. However, some of my dark skinned patients feel that it is easier to cover up a persistent pigment change than a red cystic bump, and opt to pursue the PDL anyway.
Can the Fractora be used on dark skin types?
Yes! In fact, it's safe on all skin types. RF doesn't target particular color in the skin, and is considered "color blind". What this means that it can be used, albeit with caution, on dark complexions. Additionally, the technology also utilizes silicon coated pins, which spare the top layers of the skin, and only work in the deeper layers. As such, the epidermis is protected from the effects of heat and the risk of pigmentation problems is avoided.
How do I know the number of treatments I will need?
It’s hard to predict the exact number beyond the average of 4-6 treatments for most patients. The end of the series comes when the skin simply stops breaking out in the spots treated and remains clear from one monthly visit to the next.
How long before the scars get smoother?
Actually, the improvement starts showing from one treatment to the next. Already after just 4 treatments, a significant improvement is seen. The really great thing is, over time, the skin keeps getting smoother and smoother for many months to come! We have noticed this as far out as one year after the last treatment! Our patients return with less visible scars as time passes, even without further treatments. Obviously, everyone is different, with varying degrees of scarring, and some patients continue to have extra treatments to make their skin even smoother. This is an individual choice. However, even the basic 4 treatments provide a huge improvement.
Do I need topical treatments as well if I do the laser?
Yes. Good skincare is important before, during and after the treatments. However, the topicals used are minimal and does not inconvenience even the busiest of patients.
Will the PDL also get rid of my acne scars?
PDL is not aimed at the acne scars. Once the acne stops breaking out, meaning that no new scars will be formed, the scars can be treated with the Fractora, or with our Affirm Multiplex laser. The Affirm laser is also aimed at regenerating collagen in the skin, thus softening the scars. It's less aggressive than the Fractora! and does well for some patients who are not Fractora candidates. For some lucky patients, however, even the PDL treatments can help smooth the skin to some degree, although it's not ideal for that purpose.
Are the treatments covered by insurance?
Insurance doesn’t pay for laser treatments. For this reason, I maintain the pricing of the acne laser at a promotional affordable price. This way, young students and young professionals, who are most in need of these treatments, can afford them without having to mortgage their future to look good.
I first came to the office in January 2012. I had a huge amount of acne on my back and shoulders and it was getting out of control. I researched the Pulse Dye Laser treatment for acne and decided to give it a shot; six months later I could not be happier with the results. I’ve had one laser treatment per month since my initial visit and the results are fantastic; you wouldn’t believe my skin was so bad five months ago by looking at it now. Dr. Hellman and all other staff members have been extremely helpful through the entire process, and without a doubt it was worth every penny. It was a great experience, exactly what you would want when visiting a doctor. I would definitely recommend this office to a friend.