At A Glance, Dual Laser Resurfacing
- Best Results1-2 sessions
- Treatment Recovery4-6+ days
- Procedure Time40 minutes
- Skin SpecialistSpecialist laser nurse
- Duration of Results5-10+years
- AnaestheticNumbing + local blocks + sedation or gas
- Back to Work4-7 days
Dual Laser Resurfacing
Dual Laser Resurfacing as the name suggests consists of two laser procedures, in the same wavelength. Think of this as HALO resurfacing with much better results. Dual resurfacing combines a superficial resurfacing procedure with a deeper collagen remodelling wavelength in the one sitting. This gives coverage up top to address sun spots, fine wrinkles, & pigmentation, whilst the deeper CO2 laser treats deep wrinkle & skin sagging below. This is the most cost-effective procedure to transform your skin’s age. The majority of patients will have a minus 10 year reset of their facial skin.
FactsFacts on Dual Laser Resurfacing
- This treatment combines two of the best laser wavelengths, CO2 & 1927
- Dual resurfacing can address sunspots, scars, pigmentation, wrinkles & photoaging
- The majority of patients require only ONE treatment
- Downtime can be tailored from 3 to 6 days
- Expect to achieve up to10 years off your skin’s age
- Results often last beyond 5 years with good post laser skin care
- This combination treatment takes less than 25 minutes to perform
- Pain is minimal as we use numbing gels & anaesthetic gas if required
- This is a cost-effective procedure
What exactly is Dual Resurfacing?
This involves combining two suitable wavelengths for synergistic results. Combination treatment has been used by dermatologists for decades. At Clinic Cutis, the majority of our work involves combining different lasers & energy-based devices.
This form of fusion involves the mix of ablative & non-ablative wavelengths, much like HALO laser resurfacing, except much better. For this type of resurfacing, we use both CO2 fractional ablation coupled with a surfacing ‘polishing’ laser, of the wavelength,1927. The CO2 laser goes deeper into the epidermis, stimulating collagen, whilst the more superficial LaseMD treats pigmentation, fine lines, wrinkles & enlarged pores. Unlike HALO, this form of resurfacing will require only one treatment (in the majority of cases).
Why is this much better than Fraxel Fractional Laser resurfacing?
I still utilize between 3 to 4 Fraxel devices at the practice, so don’t get me wrong, Fraxel is still a good laser, in particular the Fraxel Dual 1927 Thulium wavelength.
The thing with Fraxel is that this laser is protocol driven, meaning that the company focuses on selling multiple treatments over months to half a year. Here is how Fraxel works- settings are predetermined by the company (I actually helped formulate these settings in 2013 as part of my involvement within the Fraxel International Advisory Board). These settings will give results with a good safety margin requiring multiple sessions. The question is – can we achieve better results with ONE treatment whilst maintaining safety? The answer lies in dual wavelength laser resurfacing.
This method uses the similar concept as Fraxel Dual or HALO laser. The difference between the systems is that I can deliver a higher density on-label with the LaseMD system, compared to Fraxel. High density means better coverage. This equates to much better outcomes. Secondly, I combine a CO2 fractional wavelength at a CONSERVATIVE setting. This wavelength can target wrinkles, laxity & collagen without the side effects that are frequently seen with fully ablative CO2 lasers.
As a guide, one sitting of Dual Resurfacing will give better results compared to 3 to 4 Fraxel procedures. This saves time, effort and costs for the patients.
Of course, if you really do want to go ahead with Fraxel, we do have at least 3 devices you can choose from, including the Fraxel 1550, 1927, Diode Clear & Brilliant.
How is this procedure different from HALO Hybrid Resurfacing?
HALO is a good device from Sciton Laser that combines two wavelengths of laser, namely erbium fractional & non ablative 1470nm fractional. This fusion of both wavelengths enables the laser to treat superficial & moderated depth concerns, with a predictable downtime. The problem I have with HALO is that the majority of patients requesting skin rejuvenation in Queensland will require 2-4 sessions for best results. The time, effort & expense associated with on label HALO does not suit the majority of patients.
I do have the capacity to replicate HALO settings as I use the same erbium fractional device from HALO Sciton, abelit a different non-ablative wavelength. Dialling the ProFractional laser to 1/15 maximal strength will equal the MAXIMAL erbium settings of HALO.
I do believe that the fusion of superficial 1927 Thulium & CO2 gives far superior results than HALO. Remember that the downtime can be dialled in as well, namely IF required we can provide a 24 to 48 hour recovery with lower density 1927 & CO2. In fact the recovery following CO2 with a low setting is less than moderate settings on the 1470 wavelength of HALO. It is not that HALO is a bad device, I firmly believe that other hybrid wavelengths give far superior results with equal if not less downtime, once again in the context of tuneable fractional lasers.
What skin concerns can laser resurfacing address?
At Clinic Cutis we use many lasers, often in a mix of wavelengths. This allows us to customise the procedure to the patient’s concern. This form of Hybrid Laser Resurfacing can address the following skin concerns-
Wrinkles & pigmentation: These concerns are the speciality of this form of laser resurfacing. Expect a good improvement in fine to medium depth static wrinkles, & an excellent improvement in pigmentation with only one session.
Sunspots, sun damage & pre-cancer: the 1927 NA LaseMD treats the majority of sunspots & precancerous solar keratosis with one treatment. Expect 80-95% improvement with the latter. This form of resurfacing is designed to efface the majority of actinic keratosis. In some cases, focused ‘spot treatments’ are required for stubborn lesions.
Eye wrinkles: This combination suits static wrinkles. We can treat the lower & upper eyelids, feathering to the sides. Majority of cases only require ONE treatment.
Upper lip lines & smoker’s lines: Expect a 40-60% improvement with deep wrinkles, more improvement with shallow to medium depth wrinkles with one session. Further improvement can be made with devices like Tixel & procedures including dermal fillers & muscle relaxants.
Enlarged pores: best for small to medium enlargement of skin pores. For larger pores secondary to acne, we combine TCA CROSS or TCA Paint.
Mild to moderate superficial acne scars: Shallow boxcar scars, pick, ice pick & pores will respond to this treatment. The number of sessions depends on the depth of scarring, your skin type & expectations. In some cases I combine TCA & or surgical subcision with lasers. In other cases I use RFM or radiofrequency microneedling.
Photo Aging including age spots, fine lines, solar elastosis can be treated this combination. One treatment with a recovery of 4-7 days is required in most cases.
For an understanding of what lasers or procedures are best suited for your skin type & concerns, book an appointment with my clinical team or myself.
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How many treatments of Hybrid Laser Resurfacing will I require?
95% of cases will require only ONE laser procedure. That’s correct. Unlike HALO or Fraxel laser resurfacing, this Hybrid procedure can get the job done better than other lasers with much less treatments. A concept to grasp is this; ‘For every extra day of downtime we can realistically deliver an extra 2-3 years of rejuvenation.’ Hence if we dial in say a 3-day downtime (done Friday, back to work Monday), you will get a good result. If you allow 3 additional days of downtime, expect a 10 year ‘rejuvenation’ in most cases. *
*Note this is just a guideline, based upon a typical type 1 to 2 skin type with moderate sun damage over 6 decades. The more sun damage you have the better the results. If you are 35 for example with good skin and a few wrinkles, this treatment may not be suitable for you. A gentler treatment such as Fraxel, Clear & Brilliant, Pico or Tixel may suit your skin concerns.
What area can be treated with Fusion Resurfacing?
This form of resurfacing can address skin ageing including wrinkles & pigmentation involving the face, neck, decolletage, hands & arms. As a guide-
Face- one treatment only in 90% of patients. Recovery of 3-6 days depending on settings.
Chest, Neck– 2 to 3 sessions, spaced 4-8 weeks apart. This area takes longer to heal. As skin is different compared to the face, gentle treatments are advocated.
Arms & Hands– 2 to 3 sessions, spaced 4-8 weeks apart. Healing up to 10 days. Much like the chest and neck, gentle treatments are advocated. I often combine collagen stimulating dermal fillers in this area to hide fat loss (more visible tendons & veins).
What if I don’t require such a treatment, what are my options?
Lots. @cliniccutis has over 25 lasers & EBDs (Energy based devices), everything from good old fashioned Fraxel, through to third generation Picolasers & everything in between.
Gentle resurfacing or level one ‘polishing’ can be achieved with lasers or chemical peels. Options include Clear & Brilliant Fraxel, Jessner Peel, AHA peels, or Picosure- Picoway lasers. Dermal toning & Laser Genesis are other options. Tixel on label is another gentle resurfacing procedure. BBL or IPL is another way of gentle rejuvenation. Non laser procedures also include eMatrix & Genius RFM, we do offer entry level microneedling, dermastamping & dermarollers as well.
Level 2 resurfacing include 1927 Fraxel Dual, LaseMD 1927, light erbium + NA lasers or HALO Sciton, non ablative 1550 Fraxel, non ablative 1540, ProFractional laser, light eCO2, light Ultrapulse CO2, CORE CO2, high pass Tixel.
Level 3 resurfacing includes the above with deeper settings. Most often we combine several different lasers in the one sitting.
Level 4 deep resurfacing is what I do. My go to lasers includes the Sciton Erbium Fully ablative laser, the CO2 by eCO2 Lutronic, & 3 other CO2 devices, including the super powerful Ultrapulse CO2 laser. This form of laser resurfacing is reserved for marked wrinkles & photodamage. Downtime following level 4 resurfacing is about 7 to 10 days. Redness may ensure for 4-8 weeks following deep level 4 resurfacing.
What laser devices do we employ for Dual Laser Resurfacing?
I use both 1927 & CO2 lasers from Lutronic. The 1927 LaseMD Ultra replaces the Fraxel laser as we can lase more areas with higher density compared to Fraxel. This laser treats superficial concerns such as pigmentation & sunspots.
The deeper laser is CO2. Why this over other devices that we have including the Lumenis Ultrapulse, Mixto, CORE CO2, erbium ProFractional & others? It is because the spot size is the smallest (shortest PD), it is the most powerful & provides a random scatter of spots. This enables us to provide a denser coverage of the laser, safely. Random spots means less bulk heating. Random spots decrease pain. Lower pulse duration means less collateral damage to the surrounding tissue.
Is this treatment painful?
This treatment if well tolerated with numbing creams applied one hour before the procedure. In some cases, we utilize light sedation or lighter anaesthetic gas. Occasionally we perform blocks to areas such as the lips.
How long does it take to perform this procedure?
30 to 35 minutes at the most. The first pass of Thulium 1927 only takes 15-20 minutes, the second part of the procedure with the CO2 takes less than 12 to 16 minutes to perform.
For the chest & decolletage areas another 10 minutes is added to the procedure.
How long will it take to recover from this procedure?
2-6+ days depending on the settings. We will give you an accurate indication of downtime prior to the procedure. A typical recovery process goes something like this-
- Day 1 redness & swelling
- Day 2-3 Swelling & oozing
- Day 4-5 Peeling & redness
- Day 6-7 Recovery. Make up can be worn after day 5 to 6.
- Day 7 to 18 Redness that improves over a few weeks at most
As a rule, the longer the recovery the better the results. We will discuss the expected downtime with you prior to the procedure. By giving an extra day or two downtime enables us to provide 2-3 years EXTRA rejuvenation. True!
How long will the results last?
5-10 years. The better you look after your skin, the longer lasting the results will be. This form of laser resurfacing gives your skin a second chance. We ‘reset’ the clock by 5-10 years. From there the use of sensible but accurate clinical skin care will maintain the results. Some patients will elect to have level one gentle resurfacing procedures such as light laser or chemical peel every 6-12 months to extend the duration of results.
The reality of anti-ageing is that age always wins. What we do at Clinic Cutis is to reverse, then slow down this process as much as naturally possible.
What are the risks with this procedure?
This procedure can be classed as low risk. It is important to differentiate between expected recovery and actual side effects. For example, redness is not a side effect. This is an expected outcome dependent on the settings of the laser & your skin type (eg. rosacea). The risks are as follows-
- Infection – less than 3% of cases. Easily treated. Most serious is reactivation of cold sore virus. Other sources include staph & others.
- Persistent redness (as opposed to rosacea). Rare. Easily treated with vascular lasers.
- Post laser darkening or post inflammatory hyperpigmentation. About 5%. More common in skin of colour and or high or accidental UV exposure during the healing process.
- Scarring. Extremely uncommon, mostly due to HSV infection.
- Dry eyes. Can be common but transient (less than 10-21 days). Due to skin tightening around the eye area. Easily treated with lubricant drops.
Who performs this procedure?
This procedure is classed as ‘light to medium resurfacing’ and is performed by my procedural dermatology nurses. These nurses have extensive experience in the use of lasers & energy devices. They have assisted me in performing similar but more invasive procedures over the years. The parameters they employ were developed by myself to deliver replicable great results with minimal down time & very low risk.
My primary work is focused on ‘medium to heavy resurfacing’, complex scar cases, birthmarks, surgical work & advanced/difficult/ bespoke dermal fillers. Laser work by my talented team allows me to concentrate on more difficult cases, in addition to a cost saving for patients who desire effective but also relatively cost-effective skin rejuvenation.
Is this treatment suitable for me?
An ideal candidate for this procedure is someone who has visible signs of aging, namely pigmentation, textural laxity, wrinkles, pores & scars. This is classified as a ‘light to medium’ level 2 – 3 resurfacing procedure. To see if this is the correct way to rejuvenate your skin, book a free appointment with my clinical nurses @cliniccutis. Alternatively, you can book a consultation with myself. Consultation fee applies.
Davin’s take on Dual Resurfacing
This combination of lasers, namely non-ablative 1927 & ablative CO2 fractional is probably the best fusion of lasers. Infinitely better than HALO erbium fractional & 1470 nm non-ablative wavelengths. Why is this better than HALO laser resurfacing? Firstly, the non-ablative 1927 gives less downtime compared to the erbium, secondly the use of sensible fractional CO2 laser goes deeper but also stimulates more collagen than the 1470 nm non-ablative wavelength of HALO. Downtime can be dialled in with the density of both CO2 & 1927. With HALO, patients often undertake 3-4 sessions over 6 months to get good results. With this Hybrid laser resurfacing procedure, only ONE session is required to get better results.
Cost saving. As this procedure is considered mild to moderate, patients will have a significant cost saving as Hybrid Laser is performed by my clinical nurses. Additionally, only one treatment is required in the majority of cases. This compares favourably with Fraxel & Sciton HALO which typically requires 3-4 sessions over half a year to get mediocre results.
Concept of balanced rejuvenation. Remember it is a balance between improving skin texture, tone & volume that gives the best results. Lasers improve skin texture and skin quality. Lasers can provide superficial derma tightening. Fillers volumize, which is important to achieve overall skin rejuvenation.
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