At Veritas, we have assembled a comprehensive array of lasers at our disposal. Patients often inquire about the rationale behind investing in such a variety of lasers, as many other clinics typically limit their use to a few. Some of the lasers in our inventory include Fotona Versa 3, Fotona Verde, Starwalker Pico NdYAG, Starwalker Pico KTP, Starwalker Partial Pico, Expert Yellow Laser, Fraxel Couple, Fraxel Fix CO2, and Fotona Sup:ER. Notably, these are only the ones we use for treating pigmentation.
So, why do we adopt this approach when others might find specific lasers more specialized and cost-prohibitive to acquire and maintain? The reason behind this strategy is our belief that, especially in pigmentation conditions, combination treatments are more extensive and effective. Some patients express concerns when I recommend a combination of lasers for treating their pigmentation issues.
Questions I have encountered include:
- Are multiple lasers necessary?
- Are combination treatments riskier than traditional ones?
- Is the money truly well spent?
In my previous article on combination treatments for melasma, I discussed various reasons why combination treatments have become the preferred approach when dealing with conditions that affect multiple layers of the skin.
Many of my patients are familiar with High-Intensity Focused Ultrasound (HIFU) treatments used in face and body tightening. HIFU machines have various transducer handpieces, each at a specific depth, delivering ultrasound energy into different layers of the face to trigger collagen renewal. Our facial anatomy consists of various structures that complement and should be seen in relation to each other, not in isolation.
For example, a HIFU Ultraformer 3 procedure that I perform for patients concerned about facial skin laxity utilizes probes of:
- 4 MHz, 4.5-mm focal depth targeting SMAS layer
- 7 MHz, 3-mm focal depth for deep dermis tightening
- 5.5 MHz, 2-mm focal depth suitable for treatments around the eyes
- 7 MHz 1.5mm focal depth for upper dermis rejuvenation
By using different handpieces, I can deliver focused and precise energy to each layered structure from the upper dermis to the lower dermis and subcutaneous tissue, down to the deeper SMAS layer.
Interestingly, no one has questioned the use of multi-depth handpieces for HIFU, but some patients do a double-take when combination lasers are recommended to them.
In reality, the concept is entirely identical. If only one HIFU handpiece of an appropriate depth or energy were used indiscriminately from skin down to the deeper supporting structures, it might result in diffuse heating throughout the layers, increasing the risk of burns, hyperpigmentation, or fat atrophy.
Therefore, by using multiple lasers to treat a condition, we can choose the most suitable tool to target specific parts of disease pathways while minimizing unintended side effects on non-related areas.
What Advantages Do Combination Laser Treatments for Pigmentation Have Over Single Lasers?
When assessing the effectiveness of combination laser treatments, patients often have several concerns:
- How much of my pigmentation can the treatment actually clear?
- How much time will the entire treatment cycle take?
- Am I going to spend weeks or months recovering?
- Will my skin be damaged permanently?
- Will I be left with unsightly scarring?
- How much am I going to spend in total?
All valid concerns - let's go through the benefits and see if we can address these concerns one by one.
Benefit #1: Combination Lasers for Pigmentation Are More Efficient (And Cost-Effective!)
"Efficient" is a frequently used term in aesthetic medicine. When I refer to efficiency in this context, I mean that the total number of treatments needed to achieve similar results is reduced.
I'm not referring to the idea that a combination laser session is more efficient because it involves a shorter recovery period compared to a single laser session entailing a longer recovery period. Ultimately, the amount of downtime associated with a treatment largely boils down to the procedure being used, not the laser. For instance, the Starwalker Fractional Pico is a laser treatment that can result in anything from just a mild redness to a fully bruised face after treatment.
However, with combination treatments, fewer sessions overall are required, and that typically translates to an overall reduction in treatment cycle duration.
While we can't display post-treatment photos due to PHMC regulations, I can show you some images of how former patients with pigmentation looked before treatment and explain why a combination approach was used to treat them.
Here is a photo of one of my patients, a 54-year-old Chinese woman with significant, patchy melasma on her cheeks. What she has is a "mixed" pattern type of melasma, involving both epidermal and dermal components.
Previously, using an older approach, I would have needed to perform 8-10 sessions of Starwalker Pico at $288 per session to see a 45-60% improvement in her condition. Using a combination approach, I managed to see an almost 70% improvement in her condition, using fewer sessions of combination lasers at a slightly higher cost of $328 per session.
Benefit #2: Combination Lasers for Pigmentation Cause Less Damage to The Skin
Lasers, when used in combination, do not cause more damage compared to when they are used individually.
That is a complete myth.
When combination treatments are tailored for our patients, we select lasers that target specific components involved in pigmentation development at specific layers of the skin (e.g., vessels within the dermal layer).
Each laser in our arsenal has a specific wavelength and pulse duration. A laser used to treat the epidermis (surface layer) of the skin might cause unnecessary surrounding damage if it were also used for pigmentation that is located deeper in the dermis (deeper layers).
By combining different lasers, I am able to customize treatment for different targets and tissue layers, according to the individual needs of a patient's skin and condition, thereby truly minimizing unnecessary damage caused.
Heart surgeons don't perform a complex heart bypass surgery by only using one surgical instrument - an operation cannot proceed without the operating theater being fully kitted out with surgical instruments. Why should lasers be any different?
My Conclusion?
Combination laser treatments do not differ much from what aesthetic patients already understand - personalized tools to treat various aspects of a condition.
At the same time, let us remember that combination lasers are not magic procedures that significantly reduce downtime or increase healing - it would depend on the type of lasers used. However, by being more precise and efficient, combination lasers for pigmentation allow pigmentation to be treated with fewer total sessions needed, and thus reduce overall investment as the need may have arisen for the entire treatment cycle.
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