Laser treatments have always been inexplicably associated with aesthetic medicine. Many clinics called themselves Laser or IPL clinics only to realise later that the hottest things around aren’t lasers or IPLs anymore. In fact the frontier technologies in the last few years, like Thermage and Ulthera, are not strictly speaking lasers.
Nevertheless, “laser treatments” remained a term closely linked to aesthetic medicine.
A BIT OF HISTORY
The industry’s obsession with lasers started from ablative CO2 lasers in the 1990’s. For those who have been in the industry long enough will remember the brand of CO2 lasers – Sharplan. By the early 2000’s the industry’s focus had moved on to IPLs and non-ablative lasers. One of the first and best IPL was from Lumenis. The mid 2000’s saw the introduction of skin tightening devices. The most famous among these was Thermage.
And now the interest has swung back to ablative lasers again, abeit in a “fractional” way.
TYPES OF LASERS
CO2 lasers and Erbium lasers were introduced more than 15 years ago. I operated the first Sharplan CO2 lasers when it was available in Singapore. It was so uncomfortable as a treatment, not many people will agree to it. It wasn’t long before I concluded that ablative lasers were not a very elegant way to treat the face. Good perhaps for warts and corns on the feet, but definitely not on the face.
- Things only became seriously interesting for aesthetic medicine in the early 2000’s with the introduction of the first IPL. IPL treatments were prohibitively expensive in those days. But looking back, it was revolutionary. Without breaking any skin, the pigments within could be removed by the IPL. Excitement was in the air and aesthetic medicine in its present form was born. It was also then that I started David Loh Surgery as an aesthetic clinic.
- Following closely along the “no-downtime” theme were a bunch of lasers that came built with a cooling device. Some used a synchronized spray of cryogen, others a chilled crystal for the laser to fire through. Our Cooltouch machine was born of this era and was a rage in those days. Wrinkles could be lightened without breaking any skin. Collagen production increased without any recovery time.
Saturated with copycat versions of the earlier lasers, the aesthetic clinics needed new tools that worked from a different dimension. By the mid 2000s, the skin tightening machines became available. And they weren’t even laser anymore. This time, it wasn’t just about stimulating collagen production, but more about contracting skin to create a facelift effect. The “non-surgical facelift” term was coined for these procedures. Our Titan was from this era. But Thermage, which we did not operate until recently, was the more popular tool in this class. Its popularity was in the whole new dimension it gave to aging skin. For once you can get a non-surgical facelift. Patients can pop into aesthetic clinics over lunchtime for this.
Titan, which we operated initially was a weak tool. If anything, it only mainly decreased wrinkles. By matching expectations properly and honestly, Titan remained a popular treatment in my practice until early 2009. That was the year we started operating Ulthera. And there was no looking back.
In 2013, we finally bought Thermage to complete our range of skin-tightening devices. And we also introduced Thread Lifts to treat moderately severe cases where Thermage and Ulthera would have limited effect. Together with deep volumizing fillers, this makes up our Non-surgical Facelifts and Facial Sculpting service.
And there you have it. The most popular technologies are not laser treatments anymore. Luckily were didn’t call ourselves a Laser Clinic.
Unable to find any new energy source (lasers, RF, ultrasound and Infrared had already been used) manufacturers fractionated older energy sources. “Fractional” means splitting the beam up into many small beams such that there is normal skin between laser treated spots. This decreases the healing time from weeks to just days. One might expect them to fractionate the CO2 laser since it was the most ablative laser from that past era. But, no. The first fractional laser, Fraxel, used an energy source that was typically non-ablative. This was illogical but Fraxel produces great results. And then finally the fractional CO2 became available. I have always believed that if one were to fractionate anything, it should be the CO2.
Instead of moving backwards or sideways, we are now seeing the dawn of a new era with Ulthera. For once, there is a device which combines diagnostic imaging with precision therapeutics. A machine the allows us to use an ultrasound scan to locate the SMAS and deliver a very accurate and precise dose of energy to it. The energy that is used is a focused beam of ultrasound. In doing so, Ulthera lifts the skin and stimulates the production of new collagen.
Focused Ultrasound remained a popular treatment even years after its launch because it produced consistent results. Double blind clinical trials have shown an 89% satisfaction rate by both patient and clinician.
Although the term Laser Treatments is very closely linked to the Aesthetic Medicine industry, the newer and more precise tools-of-the-trade are in fact not lasers anymore. Nor are they light based. Many of them are radiofrequency or ultrasound based. With these newer tools, we can look forward to more consistent and reproducible results. Besides equipment based treatments, the future of aesthetic medicine industry – which is maturing – will be in skill and techniques. Successful doctors will have to invest not so much in equipment, but skills and techniques. Like with filler and threadlift techniques.
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