Triple Light for Tightening May Also Add Volume

LAS VEGAS — Using three light forms to hit three targets effectively tightens skin and can add facial volume without fillers, Dr. Javier Ruiz-Esparza said at an international symposium on cosmetic and laser surgery.

"This is an entirely light-based procedure without any mechanical or medical improvement to heat multiple targets in multiple layers, with three energies in succession," Dr. Ruiz-Esparza said. "We call this approach 3-D rejuvenation."

The 3-D skin rejuvenation system from Cutera (Brisbane, Calif.) targets the deep dermis with infrared light for skin tightening; mid-dermal fibroblasts, melanin, and hemoglobin with a 1064-nm Nd:YAG laser to promote new collagen formation; and superficial melanin and hemoglobin with a 560-nm intense pulsed light to treat surface dyspigmentation.

This triple combination improves natural skin quality and fine wrinkles. "You can get quick improvement in a matter of 6 weeks without downtime and without pain," said Dr. Ruiz-Esparza of the University of California, San Diego. "So far, everything we have done with Nd:YAG has been aimed at improving planar, bidimensional signs of photodamage, such as solar lentigo and telangiectasias," said Dr. Ruiz-Esparza, who is a consultant for Cutera.

Now, this system—laser and pulsed light in combination with the Titan infrared light source—can also add volume. With this approach, new collagen forms and adds uniform volume to the face and neck "never seen before with any other technology," he said.

Maximum volume effects are observed at 3 months as the healing process promotes collagen creation. Some volume augmentation for lips might be possible too, although this is a work in progress, he said.

A meeting attendee asked about the end point for the Titan treatment. "I have found the last passes are the ones that count the most," Dr. Ruiz-Esparza said. There is more tightening after initial heating of the skin. "If you quit too soon, you will not get the same results," he noted.

Stop periodically and check for contracture of the skin. "You can continue treatment until it starts to hurt the patient. You don't want to go overboard and end up with erythema and edema," Dr. Ruiz-Esparza said.

For a patient who is skeptical about Titan treatment, treat one side and have the patient sit up and look in a mirror. The benefits of treatment will become even more pronounced when the patient smiles. "You can see it in every race—the dramatic difference between the treated and untreated sides," he said.

If patients remain unconvinced, send them home with just one side treated and tell them to come back if they see a difference, he said. This approach usually works because contraction on one side will persist and be visible for days or even weeks later.

The best tightening with Titan is often seen in what Dr. Ruiz-Esparza calls "area 1"—the cheek and either side of the mouth. "If I can get contraction in area 1, I can do a lot for the patient." Area 2 is the lateral aspects of the neck. Area 3—the forehead and temples—"is the one that gives me the least reliable result," he said.

Although dermatologists are well versed in the benefits of showing patient progress with photographs, Dr. Ruiz-Esparza said there are limitations. "We should stop trying to show results with still pictures. It's a pain in the neck because you need the same lighting, room, and expression." Instead, he proposed showing results with a postoperative video taken from every angle around the patient's face. "This hides nothing," he asserted.

Photos before (left) and after the procedure show some progress. But often, a postoperative video taken from different angles can show results more clearly. Photos courtesy Dr. Javier Ruiz-Esparza