What is the Best Treatment for Eye Wrinkles

Aging, environmental exposure and muscles that fold the skin around the eyes hundreds of times a day provide a triple threat to the tissue around the eyes. The results are wrinkles, textural changes, laxity and discoloration. In order to get the best results in this area you need to treat both the skin and the underlying muscle.

I start my patients with Botox. This quick, effective and safe procedure treats the muscle under the skin and keeps it from folding the overlying skin. This prevents further damage, gives an immediate decrease in the lines and provides a slight raise in the lateral height of the eyebrow all without making the face look altered or frozen. Next I turn to resurfacing in order to address the wrinkles, pigmentation, texture and laxity of the skin around the eyes.

We have used Titan, Laser Genesis, IPL, chemical peels, Fraxel and many other modalities all with modest results. The combination of the Active FX with Deep FX (i.e. Total FX) is the only procedure outside of full CO2 resurfacing that I have seen consistently excellent results for fine, moderate and even deep lines. Downtime should range from about 5 day to 2 weeks depending on how aggressively your provider performs the treatment. To learn more about these great procedures visit us at the Colorado Center for Photomedicine.

Active FX vs. Fraxel vs. Pixel vs. Profractional What’s the Difference

There are quite a few fractionated resurfacing lasers out there so allow David Verebelyi, MD the chief of laser surgery at the Colorado Center for Photomedicine to help shed some light on the subject.

So exactly what is resurfacing and what are fractionated lasers. What makes one fractionated laser different from other? Resurfacing is a procedure where layers of damaged skin are removed usually by vaporization from a laser. It can be used to get rid of brown pigment caused by sun damage, decrease wrinkles, shrink pores and tighten skin. Vaporization is the process of using heat to instantly evaporate water out of the exposed tissue. Resurfacing not only removes the tissue on top but also heats the tissue below the level of vaporization causing collagen contraction and stimulation.

So then what is fractional resurfacing? If resurfacing is like mowing a lawn where every blade of grass is cut to a somewhat shallow depth then fractional resurfacing is more like aerating a lawn. Fractional resurfacing pokes small but deep holes in the skin, but leaves a certain amount of the skin completely untouched. Because these patch of undamaged skin patient heal much faster with minimal side effects. Fractional resurfacing was developed at The Wellman Center of Photomedicine at Harvard around 2001. The original fractional laser did not destroy any tissue (non-ablative), it simply applied heat in order to stimulate new collagen formation. This non-ablative (non-vaporizing) procedure required multiple treatments and has some significant limitations on efficacy. Around 2005 we started testing fractionated ablative (tissue vaporization) CO2 lasers (Active FX, Deep FX, Fraxel Re:pair) and found that in a single treatment we could achieve results that were not attainable after 5 or 6 treatments with the non ablative fractionated lasers. The downtime of about 5-7 day was a huge improvement over traditional CO2 resurfacing (think mowing the law) that can take several months to heel.
Now the market is saturated with fractionated products and it is hard for the patients to figure out which one is the best for them. The first thing that separates these devices is the actual type of laser. There are two main lasers used for resurfacing CO2 and erbium. The Active FX, Deep FX and Fraxel Re:pair are CO2 lasers. The Pixel and Profractional are erbium lasers. The CO2 lasers heat tissue much better causing more skin contraction and more collagen stimulation. They also cause much less bleeding than erbium lasers. The clinical results speak for themselves as much more skin damage can be removed with by a CO2.

Between the CO2 platforms FX (made by Lumenis) and the Fraxel (made by Reliant), the FX is much preferred by patients. In 2007 Dr. Robert Weiss performed a split face study at Johns Hopkins using the Active FX on one side and the Fraxel Re:pair on the other. Nine out of ten patients preferred both the comfort of the procedure and the results of the Active FX.

Ok so the Lumenis FX gives the best results and the most patient preferred procedure. So then what is the difference between Active FX, Deep FX and Total FX? The Active and Deep FX are different heads that can be attached to the laser. The Active FX is more shallow (about 1/3 mm) and wide which is better for skin tightening, decreasing pore size and removing pigmented sun damage. The Deep FX is a narrow beam that goes deep (up to about 2mm) into the skin in order to treat wrinkles and scars. The Total FX is more a marketing term that describes using both heads during the same treatment (which is how the procedure is normal done). To learn more about this procedure visit us at the Colorado Center for Photomedicine.