Monthly Archives: November 2010

How Do Lasers Work?

Laser technology for cosmetic usage has been around for the past 40 years, but has come into its own in the past five years, offering men and women a variety of treatments including hair removal, body sculpting and skin resurfacing. Occasionally, a patient will ask me how the laser actually works. Truth is, until recently, nobody has known the exact underlying processes that occur with lasers! Is it the laser light that motivates the collagen to rebuild or is it the heat that the laser delivers?

A researcher by the name of Susanne Dams, with Philips Research Eindhoven, conducted her own studies on lasers to find the answers.

Dams treated cell cultures and human skin with heat shocks of 45 and 60 degrees Centigrade, without using a laser light. (This is equivalent to 113 to 140 degrees Fahrenheit. Water boils at 212 degrees Fahrenheit, so 113-140 is hot but not boiling hot.) Her results show that the heat shocks increased the production of collagen. When laser light was added, the only measureable difference was the ability of the laser to pinpoint the exact location of heat delivery. This is an important part of the treatment, inasmuch as heating smaller areas of skin is safer than heating larger areas of skin. In fact, her study also showed that heating the skin to 113 degrees Fahrenheit for 8-10 seconds was the optimal amount of heat to increase collagen. Above that temperature there is no added benefit and, in fact, causes skin cell damage.

Collagen is a skin protein that gives skin elasticity and firmness, the “bounce back” that young skin enjoys. Beginning in the mid-20’s, our collagen production begins to decrease, leading to wrinkles and sagging skin.

Three ways to increase your collagen levels

Studies show that there are 3 primary collagen-builders for those of us in the over-30 crowd:

  • Laser Skin Treatments:
    • Although the CO2 laser is considered the Gold Standard for skin resurfacing, the after-effects force patients to hide from the world for 2-3 weeks as their faces crust over and peel. Not a pretty site and most people don’t have 2-3 weeks to spend for recovery. Fraxel treatments and even chemical peels can obtain similar results, with little to no downtime. Instead of one big treatment, chemical peels and fractionated laser treatments are divided into 4-6 treatments, giving essentially the same results without the recovery time.
  • Retinoids:
    • Retin-A is the only topical skin treatment that is proven to increase collagen. No matter what they tell you on TV, this is a fact. For those in need of this, I can prescribe Retin-A.
  • Hyaluronic Acid Fillers:
    • Fillers made with hyaluronic acid, such as Juvederm, Restylane and Perlane, have been shown to increase collagen. This explains why, over time, you may need less filler each time you come in for a filler treatment. It’s not because you retain the filler from the last treatment, but because your own collagen is rebuilding.

Some things that damage collagen, by the way, are sun exposure and tobacco usage. If you want to keep your looks, use a good sunscreen and don’t smoke!

To your health & beauty,

Vip Dev, MD



Study Proves that Beauty is Bone deep, not Skin deep

Before/After Face Lift

Over the years, face lifts performed by a plastic surgeon in Bakersfield as well as plastic surgeons elsewhere, have focused on three primary tasks:

  • repositioning the muscles of the face,
  • lifting the fad pad of the cheek back to its original position, and
  • redraping the skin to create a youthful appearance.

Fat or dermal fillers are often used to fill out that part of that face needing a bit more substance, such as the temples and the nasolabial folds, the “parentheses” mentioned in the TV ads.

Recently, however, University of Rochester Medical Center researchers, joined by colleagues from Harvard and Stanford, discovered that the gradual erosion of bone over time may contribute to the aging facial appearance. We all know that as we age many of us become shorter. It’s not a stretch to imagine that other bones get smaller, too. These researchers contend, after studying the CT scans of 120 faces, that the facial bones also shrink with age. Apparently, beauty isn’t skin deep—it’s bone deep.

The 120 CT scans were divided by age into three groups: those 20-36, 41-64 and 65 and older. The facial bones were measured in each age group to see if the facial bones of the older individuals’ were smaller. They were.  This research may lead to future face lift procedures that include bone grafts to the jaw or the use of plastic prosthetics to “beef up” the lower face and create the more youthful results.

If you’re noticing bone loss in your face, come in and talk to me about bone restoration as part of your facial rejuvenation procedure.

To your health and beauty,

Dr. Vip Dev

Three Treatments to Build Collagen

Lots of my patients are interested in looking younger—I guess that goes without saying, right? What they really want is an increase in collagen, the protein that is the building block of young skin. Everyone has collagen in their system—it’s a protein that’s part of your bones, your tendons and your skin. It keeps things strong and elastic. Unfortunately, as we grow older, the levels of collagen in our bodies decrease. This breakdown of collagen is what gives us wrinkles and sagging skin. It breaks down even faster in areas of high use, like around the mouth and the eyes, since we blink about 23,000 times a day and smile as often as possible! Even worse, the breakdown of collagen is like a domino effect—the lower the collagen, the more enzymes are released to tell the body to break down collagen. Vicious circle, isn’t it? Isn’t there something we can do? You bet there is. Here are some ways we can help you build up more collagen for a more youthful face!

I recently read a study performed by the University of Michigan Department of Dermatology. The researchers reviewed several other studies that show three specific treatments that can prevent or delay some of this collagen breakdown.

#1: CO2 laser resurfacing:

CO2 resurfacing has been called the “gold standard” for laser resurfacing for many years. A CO2 laser treatment literally burns away old skin to push the collagen to reproduce. Unfortunately, it takes 3-4 weeks to recover from a deep CO2 resurfacing, as your face is weepy, scabby, and honestly, a real mess. Nobody would go out in public after a CO2 treatment.

I prefer to use Laser Genesis. Our aesthetician, Tasha, uses it here in our practice because it gives a push to collagen growth without leaving you looking bad for several weeks.  The heat generated reduces redness in dilated capillaries, stimulates collagen regrowth by heating up the dermis. Tasha’s patients are surprised that there’s no discomfort involved and in fact, it’s pretty relaxing. You don’t even need topical or cream anesthetic because it’s not painful in the least. After your treatment, you just go back to your normal activities. Every patient’s needs vary but most of our patients need 4-6 treatments for maximum results. True, with a CO2 laser treatment you need only one, but again, the fall-out of CO2 lasering is the nasty looking skin that persists for 3-4 weeks while you’re healing. The Laser Genesis method divides that recovery into smaller laser treatments so you get essentially the same results without the recovery time.

#2:  Hyaluronic Acid Fillers

The researched proved that hyaluronic acid filler, such as Restylane, Sculptra, Juvederm and Radiesse, encourage new collagen growth because the cross-linked hyaluronic acid content helps the fibroblasts to stretch just like they did when you were younger. That’s why, over time, if you stick to a consistent schedule of fillers such as those mentioned above, you’ll notice the wrinkles decreasing. It’s because the skin is building its own collagen.

#3: Vitamin A

Retinol and retinoid treatments (ie, Retin-A) are wonderful to rebuild collagen, smooth wrinkles and eliminate roughness. I write prescriptions for Retin-A for those patients who will benefit from its application. It’s the only topical agent proven to rebuild collagen, is affordable and easy to use.

Collagen can be stimulated as well through microdermabrasion, exercise, sun avoidance (and use of a good sunscreen when you are in the sun). Come in to discuss the options with us here at the California Institute of Cosmetic and Reconstructive Surgery. We do more than plastic surgery—we have dozens of non-surgical treatments to help you maintain a youthful, healthy life.

To your health & beauty,

Vip Dev, MD