Dr. Khodr's Monthly Topic: Therapies for Sagging Skin
Lasers and other devices that claim to firm and smooth aging skin are among the fastest-growing cosmetic procedures. But increasingly, doctors who have used the equipment question its effectiveness and criticize aggressive promotions by manufacturers, laser centers and medical spas
Skin-tightening treatments like are hotly marketed by clinics. Web sites before-and-after images that show dramatic improvements in flabby chins, dimpled thighs and sagging tummies. And baby boomers are plunking down hundreds, and often thousands, of dollars for these nonsurgical "face lifts," "body lifts" and cellulite reductions. Total fees for body-shaping treatments alone were $4.2 billion world-wide in 2005, and are expected to rise to $7.5 billion in 2010, according to Medical Insight Inc., an Aliso Viejo, Calif., market-information firm. But for most patients, the results will be modest at best, many physicians say.
Some cosmetic dermatologists and plastic surgeons are increasingly critical of their peers' slide-show presentations with patient before-and-after pictures. The images, these skeptics say, are cherry-picked to show the most dramatic results, not the most typical ones.
There is little published evidence on the efficacy of cosmetic lasers and other techniques. That is partly because the Food and Drug Administration's procedure for clearing such medical devices is much less stringent than for drugs. Most devices get so-called 510K clearance, by merely showing they are similar to an existing, or "predicate," device. The agency may or may not have ever required evidence of effectiveness for the predicate. An FDA spokeswoman says that consumers shouldn't assume that the agency evaluates the effectiveness of low-risk devices like cosmetic lasers.
The technologies differ, but many use energy to heat the skin's inner layers, tighten collagen fibers and stimulate new collagen production. Hybrid devices that combine various instruments and energy sources are also popping up.
What do doctors say?
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About Infrared
The broadband spectrum of 1100 to 1800nm was selected and tailored for ideal water absorption and allows uniform and even heating of the dermis to produce volumetric heating. Volumetric heating, 1-2mm deep, is necessary to produce the desired clinical result and requires sustained temperature increase in the dermis. Further, the infrared light-based approach provides uniform consistent heating independent of skin structure, i.e. dermal thickness or fat layers.
Currently there are three major technologies and therapies for treating sagging skin:
1-Pearl using Laser The Pearl laser replaces the entire top sun-damaged layer of skin with new healthy skin. Simultaneously, it sends heat to deeper layers of the skin stimulating new collagen growth, filling out and decreasing fine lines and wrinkles.
2-Titan using infra red The Titan Procedure is a safe, non-surgical process that uses an infrared light source to tighten skin and reverse the signs of aging. The Titan heats the dermis to cause collagen contraction while preserving the epidermis through continuous cooling. In addition, Titan can stimulate long-term collagen rebuilding that leaves patients with younger looking skin.
3-Thermage using Radio Frequency Thermage is a safe, non-invasive cosmetic procedure that is clinically proven to help smooth, tighten and contour skin to restore a naturally younger looking appearance.
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Most physicians agree that lasers have improved over the years and work well for some cosmetic treatments, such as removal of unwanted hair, tattoos and brown spots. The devices differ from surgical lasers, which use higher heat to cut tissue. They are generally safe in the hands of a trained physician or technician, but side effects can include burns, redness and bruising if the devices are used improperly, doctors say.
The American Academy of Dermatology has no position on the use of aesthetic laser treatments, other than to recommend that a licensed physician be present during treatment. Few medical experts are impressed by the devices' ability to lessen cellulite or tighten skin.
Once devices are cleared by the FDA for one use, physicians and medical spas are free to use them for whatever they choose. And while the manufacturers cannot advertise such "off-label" uses, the medical practitioners are free to do so.
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