New in My Practice: Devices

The Staying Power of CO₂ Resurfacing

In each edition, Modern Aesthetics® asks top cosmetic physicians about the newest devices in their practices. This month, DENDY ENGELMAN, MD, a dermatologist at MDCS: Medical Dermatology & Cosmetic Surgery in Manhattan and Hampton Bays, NY, discusses the role that FRACTIONATED CO₂ SKIN RESURFACING continues to play in her practice. She currently uses the Lutronic eCO₂ and Eclipse Equinox CO2 Fractional.

WHAT IS FRACTIONATED CO₂ RESURFACING?

“Fractionated CO₂ skin resurfacing is a revolutionary, non-invasive treatment in which microscopic columns of injury are created—causing minute perforations in the treatment area, while leaving zones of healthy surrounding tissue intact and untouched. The specific zones of injury trigger the patient's natural neocollagenesis. This new collagen rejuvenates the skin and improves its appearance—from erasing fine lines to diminishing age spots, resulting in an overall more youthful appearance. Improvements continue up to six months post-procedure as new collagen continues to rebuild.”

HOW ARE YOU USING THESE DEVICES?

“So many ways! Anti-aging, scar correction, stretch mark improvement, preventative care. The most common ways we use it in my practice are as part of combination therapy: ‘Fractionate and Fill' for my older patients and ‘Baby CO₂' (using a lower energy) to get rid of early sun damage and stimulate collagen renewal as part of preventative care for my younger patients. Fractionated CO₂ skin resurfacing can correct a number of common skin issues, so if my patients come in for a solution for uneven skin tone and can tolerate some downtime, I suggest fractionated CO₂ skin resurfacing as it smoothes out the texture and fills in all the fine wrinkles. In my office, we use fractionated CO₂ skin resurfacing to treat fine lines and wrinkles, such as crow's feet and brow lines; surface scarring, including acne scars; pigmentation issues, such as age spots; sun damage; actinic keratosis; and the appearance of large/dilated pores. In addition to fractionated CO₂, which delivers gentle energy deep into the skin to stimulate collagen production, we offer ablative fractional skin resurfacing to treat more severe skin flaws. This procedure delivers a more intense beam of light which vaporizes the surface layer of the skin. It is generally performed with anesthesia or sedation and entails a two- to four-week recovery time.”

WHAT BENEFITS HAVE YOU SEEN SINCE INCORPORATING THESE DEVICES?

“Fractionated CO₂ skin resurfacing has been used for years, which is a testament to its effectiveness. It's still the gold standard for erasing wrinkles and spots while stimulating collagen production on the face and neck. As we are able to control the level of intensity, it is also very versatile.”

IS THERE A LEARNING CURVE?

“Experience offering the treatment as well as receiving the treatment is always a plus (and in my case a must) when it comes to fractionated CO₂ skin resurfacing. Only with experience are you able to offer patients the most comfortable treatment setting. At my practice, patients are always offered topical anesthetic. Some patients also request Tylenol or an NSAID. They numb for about an hour pre-treatment. Depending on the area, I alter the intensity and the spot size (120 vs 300). When you're done, it looks like your skin has tiny, almost grid-like holes. I follow with SkinCeuticals CE Ferulic Acid, Hyaluronic Acid Serum, and Luxamend, which is a prescription wound-healing cream that speeds up healing. Lastly we apply Aquaphor to create a barrier for the skin. Afterward, there is a lot of education and follow up. I check up later that day, the next day; after a while my patients know to give me daily updates before I call them. The most important thing is to set expectations concerning the feeling of a sunburn. The redness should go away about five to seven days following your treatment. My patients usually get really excited when their dead skin starts to shed. The dead surface skin cells begin to flake off as the newer skin begins to replace it. Using of a good moisturizer will help mask the look of flaking skin. It is also very important to wear sunscreen during the healing process. I like Drunk Elephant Umbra Sheer Physical Defense SPF 30, and if you're looking for color correction, I like the Color FX Drops. Doctors have to be extra-cautious when attempting to treat the neck with high-powered lasers and microneedling devices, as it's prone to scarring, and can take twice as long to heal as the face following such procedures.”