The device that satisfies this expectation is the long-pulsed Nd:YAG Laser, which I use very often in my practice. It provides 0.3~0.4msec pulse duration in non-contact irradiation (3,000~5,000 shots) and is the safest and the most painless option with slight improvement in skin elasticity. Gentle YAG and Genesis are the most well-known products in this category. Recently, I also use Aegis YAG, a Japanese device that uses long-pulsed Nd:YAG Laser (30 shots per second) that targets the dermis. It causes thermal changes in the dermis without downtime. Aegis YAG is a preferred choice despite pain as it is particularly effective on eyelid wrinkles.
In the past, I also used N-lite (dye Laser), Vbeam, and Smooth Beam (a diode Laser with 1450nm wavelength) but these Lasers are currently not used alone in wrinkle removal at my practice.
If the patient is accepting of downtime, I use fractional Laser. The non-ablative fractional Laser allows a downtime of only a couple of days. The patient can receive the treatment on the weekend and is able to return to work on Monday. Greater improvement comes with a higher frequency of treatments. I currently use Cynosure’s Lux1540xD handpiece which can be mounted onto the IPL ICON. This handpiece has small protrusions on the tip that compresses on the skin during Laser irradiation, which allows much deeper thermal delivery than previous fractional Laser. I find it to have superior efficacy compared to previous devices.
In patients who are okay with a week of downtime, I use an ablative fractional Laser. I use Synderon-Candela’s CO₂RE, a fractional CO₂ Laser. CO₂RE has very high peak power and can minimize damage to surrounding tissues. It has excellent safety and precision. It also has various irradiation patterns and can be used in various applications. I think it is the most advanced device among CO₂ Lasers.
[Advertisement] FCR® (Fractional Prickle CoralCalcium Regentron) – Manufacturer: (www.illglobal.com)]
Infrared, radiofrequency, and HIFU can also be used but we will not go over them as these modalities are for improving the overall elasticity and sagging rather than wrinkles.
Other than the energy-based modality, I use injectables such as hyaluronic acid or botulinum toxin for wrinkle removal. Japanese patients prefer energy-based treatments and often disagree when told injectables are more appropriate. However, recently more patients are willing to try facial injections. About a decade ago, most people thought injectables were risky. As the recognition of aesthetic medicine grows, more people are opening up to various treatment methods.
I use dermal filler in wrinkles in the sagging, indented areas. Fillers are increasingly used for overall contouring and correcting age-related volume loss. I sometimes use it locally to address noticeable indentation. Currently, in Japan, Allergan’s Juvederm and Galderma’s Restylane which were approved by Ministry of Health, Labour and Welfare have the largest market share. However, Teoxane’s Teosyal and Merz’s Belotero are also popular. Merz’s Radiesse is used in deep wrinkles but is more often used in facial contouring.
-To be continued
