Laser Questions

I laser every day, however more complex cases of full laser resurfacing are performed on a Thursday.

Simple cases of laser include V Beam vascular laser, fractional lasers, Fraxel, Picofacials and ‘spot’ treatments. These can be performed on any day of the week. 

Complex cases include fully ablative laser resurfacing, also known as laser face lifts. Face lifts and eye rejuvenation using surgery or laser are also conducted on a Thursday. This is because I book out the main laser operating theatre for the entire day. For major cases, we also do a post-laser check on a Friday, and this gives you the weekend to heal.

All laser skin rejuvenation Brisbane procedures are conducted at Westside Laser Dermatology. We have 2 large laser operating theatres and other laser rooms for smaller procedures.

Laser suites are Queensland Health Accredited and maintained at the highest health and safety standards. 

I ensure that every laser treatment is comfortable and well tolerated. For simple laser procedures such as treating rosacea, red spots, and broken capillaries, the in built cooling system in our laser machines pre-cools the skin before laser energy is delivered. No skin numbing is required prior to the laser.

Fractional laser treatment including Fraxel, Pulse Fraxel (IPL and Fraxel), , RadioFrequency eMatrix and INFINI RF Skin Needling all do not require sedation. In fact our specially formulated numbing cream will alleviate 90% of pain.

For larger procedure we take 60 minutes prior to laser as the ‘anaesthetic time’, during this time you will relax in our laser suites before moving to the laser room. Fully ablative laser resurfacing is done under twilight sedation in our main laser operating suite.

Anywhere from 2 days all the way to 7 days. Fractional laser therapy, as the name suggests only treat a fraction of the skin’s surface. How much of the skin’s surface can be controlled by us. Energy levels, depths and the number of passes, and the type of laser will also determine how quickly you recover. Generally, longer recovery times are associated with better results.

I make it a point to tailor every laser treatment for each patient. This sounds complicated but the results will be better that giving everyone a standard program. This optimises results and decreases the number of treatments needed.

Here are a few examples of recovery times following fractional laser- Fraxel laser.

• Fraxel laser for sun damage – only one treatment needed. 5-7 days downtime
• Fraxel for acne scars 5-6 days downtime
• Fraxel laser on the chest and neck area- 7-9 days to heal
• Fraxel laser to the arms- 7-10 days to heal
• Fractional Picosecond laser- 6 to 12 hours to heal- only suited for Ethnic skin types for pigmentation and skin rejuvenation 

The recovery process can be sped up by following specific instructions that will be discussed post laser. For females, a special make up (stocked in associated pharmacy), called Lycogel can be worn day one following some forms of laser therapy.

The usual restrictions apply after your laser procedure- no sun exposure for at least 3 weeks- even longer in darker skin types. Exercise post procedure will also need to be limited. We will guide you accordingly. Looking after your skin after laser will give you the best results with the least amount of complications.

The amount of laser sessions needed to improve or cure a condition is extremely variable. Generally, if we use a laser with less energy levels, your healing will be quicker, but more sessions are needed- acne scarring and skin rejuvenation are classic examples.

The number of laser treatments will also depend on your skin type – darker skin patients such as Asian or Middle Eastern patients will require more treatments as energy levels will need to be lower compared to fair skin patients.

Downtime also plays a huge role in the number of laser sessions required. For example- one ‘high density’ Fraxel laser for sunspots with a downtime of 7 days is equal to 3 low density treatments with a downtime of 4 days.

The skin condition also dictates the number of treatments needed. Here are a few examples –

• Acne scarring- depends on type of scar; from one to six treatments.

• Broken capillaries and redness- one to two treatments

• Laser stretch marks treatment – three to four treatments

• Skin rejuvenation – one to two treatments

• Freckle removal – one to two treatments

• Rosacea and redness- one treatment to five laser treatments

• Chest and neck laser rejuvenation – three to five treatments

• Sun damage treatment – one laser session, two if sun damage is severe

• Spider vein laser treatments- one to three sessions

• Tattoo laser removal – highly variable, 3- 20 session

• Hair removal using our Gentlelase system- 5-8 treatments

I will give you a realistic expectation and the number of sessions required once a full examination and history is obtained- remember, each and every treatment performed is different as everyone is unique. Laser skin rejuvenation Brisbane branch of Lasers and Lifts enables the best treatments with access to over 30 lasers. 

The treatment of redness, whether it is caused by red spider-veins, broken capillaries, early acne scars, or rosacea is a procedure I perform on a daily basis. The most commonly used laser is the 595 V Beam laser, followed by the 755 and 1064 laser by GentleLase- known as the Pro Max System.

1. 755 Alex Gentlase laser- this laser can be used to treat deeper blood vessels including stubborn red blood vessels on the nose, as well as lesions on the lips.

2. 1064 Nd Yag long pulse by GentleLase Pro Max can treat blood vessels on face, and legs. In special ‘paint mode’ this can help reduce redness from rosacea.

3. IPL- as previously mentioned this is NOT a laser, but it stands for Intense Pulse Light- this is used as an ‘all rounder’ and can be good for resistant cases of rosacea and early red acne scars (also known as macular erythema).

Depending on the type of skin condition you may require several treatments, or just one.

Redness on the side of the neck is a condition called poikiloderma. This is very common in Brisbane- over 50% of women over the age of 50 will have some evidence of poikiloderma.

Lets talk about the cause of this condition then explore ways to treat it.

What causes redness on the sides of the neck in women? The cause is thought to be due to several factors including UV (very high index if you live in Brisbane), perfumes and sprays, as well as a genetic component- people with fair skin are more prone to this condition.

Poikiloderma consists of 3 colours- white (your normal skin colour), subtle shades of brown, and red. So, how do we treat this condition?

1. Sunscreen and sun protection forms the absolute cornerstone of treatment. You will need to wear a high factor SPF on the sides of your neck at least twice a day. This can fade brown areas (especially if you are tanned), and help prevent poikiloderma once it is treated.

2. A fading agent is often used. I like either a mix of Lytera, vitamin A creams and HQ bleaching cream. This can help reduce the brown areas if there are any.

3. Lasers- the laser of choice is a vascular laser- several treatments are needed for optimal outcomes. My go to laser is the V BEAM 595.

4. IPL, or intense pulse light can be used to treat poikiloderma. In fact this non-laser treatment can improve brown and red at the same time. Some patients undertake one or two sessions of IPL before switching to the Vascular laser, depending on the balance of red to brown.

5. Fraxel 1927 with V Beam- this can be an excellent treatment for poikiloderma. Most patients will require 1-2 Fraxel laser sessions, followed by 2-3 Vascular laser treatment. Of all the combinations, this one works the best.
6. Ultherapy or Ulthera – this is not a laser but a high energy ultrasound device. Ultherapy is designed not to treat the surface of the skin, but tightens collagen, and can decrease the cobble stone appearance of sun damaged necks.

Neck rejuvenation is one of the most commonly requested ‘skin makeovers’ I get asked, and with today’s technology, remarkable results can be safely and effectively achieved.

No. IPL is used to treat superficial skin conditions such as pigmentation and redness. Even then, lasers are better at treating these conditions compared to IPL. The best lasers to tighten skin around the eyes and remove wrinkles are resurfacing lasers.

If there is mild wrinkling, I use fractional CO2 CORE or FRAXEL CO2. If wrinkling is severe, I use a combination of erbium laser and CO2- a treatment I pioneered called ‘Hybrid Laser Resurfacing’. Only one treatment is need for a marked improvement.

If there is a significant amount of loose skin, I use a surgical technique called Blepharoplasty to remove skin, then resurface at a later date with a laser. Review my before and after pictures on eye rejuvenation to gain an understanding of what can be achieved.

The reality of treating sun damage and pigmentation for typical Queenslanders is – where do we start and where do we end? Sure we can treat sun damaged chest and necks, but the problem arises as to where do we ‘cut off’ treatments? The neck leads to the shoulders, back, arms, and chest. The answer lies in feathering treatments not sharp cut offs.

Pulse Fraxel- This treatment consists of two treatments in the one session. First of all Intense Pulse Light is used, followed by Fraxel (a form of fractional laser). One treatment can improve things by as much as 60-70%. This is my preferred laser on this area.

IPL alone- This treatment will require 2-4 sessions, cut off lines are common, however with subsequent treatments these lines fade. In my opinion IPL for chest and neck rejuvenation has been superseded with Fraxel laser.

QSL and CO2 CORE fractional laser- once again for severe sundamage on the chest and neck area. The use of a Q Switch laser can reduce stubborn brown pigmentation, whilst the CO2 CORE can help stimulate collagen and elastin, firming up the chest, and reducing wrinkles.

Ultherapy or Ulthera– this is not a laser but an ultrasound device. This stimulates collagen, and spares the upper layers of skin. Most patients will require 2 sessions spaced 2-3 months apart. Ultherapy is designed to tighten skin and provide a neck lift and decrease wrinkles on the chest. Unlike lasers, Ultherapy is not associated with any downtime. 

Patience is the key to successfully treating the chest and décolletage areas- multiple treatments over months is the safest, but also the most effective method of treating this difficult area. Remember- blending in is the key to success.

This is one of the most frequently requested treatments.

The very first question I ask is – are they old white stretch marks or new purple/pink/ red stretch marks? Why? Because new stretch marks respond much better to treatment than old stretch marks. Here are some facts on treating stretch marks-

• The earlier the treatment, the better the outcome and the higher the chance we have of fading stretch marks. I encourage people to treat red stretch marks, but discourage patients from treating old white ones.

• Red stretch marks can be reduced in diameter, length and colour with laser and creams. I like using a combination of V Beam vascular laser with different vitamin A creams.

• Laser treatment takes approximately 10-20 minutes to perform, depending on the areas involved. Laser is well tolerated, and occasionally bruising can be expected for several days after treatment.

• Vitamin A or retinoid creams can also help remodel fragmented collagen, and help repair the skin, further reducing stretch marks. Stratamark can also be used in between laser sessions. 

• Most patients will require a series of between 3-5 treatments for optimal outcomes. Treatments can be spaced between 10 days to 2 weeks.

• Budget between $550 to $680 per treatment- the price difference is reflective on the areas and extent of stretch marks.

• Expect an improvement, but not absolute clearance of stretch marks. It can be difficult to say, however most patients will receive a 40-80% reduction in the look of early stretch marks.

• OLD STRECH MARKS are characterised by white, often papery lines on areas such as the arms (especially in weight lifters), buttocks, stomach – especially after childbirth. Treatments are possible – however the laser we use to treat old stretch marks is a lot more demanding on the patient. Namely to improve old stretch marks we need to break the top layer of the skin to remodel old collagen.

• Old stretch marks can be improved with a combination of both creams and laser and non- laser methods. Once again Vitamin A cream can remodel collagen, and I often combine this with Fractional lasers or preferably with INFINI insulated energy based radio frequency micro needling and PRP. I find this procedure better than fractional CO2 lasers. With fractional lasers the skin often takes 5-10 days for healing to occur, followed by several weeks of redness or discolouration. This is not seen with the INFINI RF and PRP procedure. Fraxel is simply not powerful enough to treat stretch marks considering newer technology can treat stretch marks with far better results and less downtime. The other non-laser method I often perform is eMatrix radiofrequency, or RF. RF, unlike laser, is associated with less trauma to the upper skin, and hence patients heal up faster. I prefer the use of RF for the treatment of larger areas of stretch marks. eMatrix does not work as well as Infini RF, as the level of energy delivered is not as deep. 

• Old stretch marks can only be improved by 20-30% after 3-5 treatments. Some patients receive a higher percentage if they are lucky. The reason why older stretch marks are harder to remove or fade is that collagen has already been fragmented and ‘settled in’, and to remodel collagen we have to ‘re-break’ and re-form. As a rule, I encourage early stretch mark treatment, and discourage the treatments of old stretch marks, however if patients are motivated and have realistic expectations, I am happy to recommend treatment. Commitment is the key to success in the treatment of stretch marks. 

Laser skin rejuvenation Brisbane- Acne scarring lasers

The laser of choice for acne scars will depend on your skin type, but most importantly your acne scar type. I make it a point to map scars and individualise all acne scar treatments. Some patients will need only one laser treatment. Other patients with mixed scars will require multiple laser treatments, mixed in with other procedures such as Subscion and TCA CROSS.

Here is a review of some of the lasers and energy devices I use for acne scarring-

• CO2 CORE by Syneron Candella. I can use this laser in fully ablative or resurfacing mode, or fractional mode. Most commonly I use erbium laser followed by CO2 Fractional – this gives the best results with minimum downtime.

• Erbium laser by Scition – once again this can be used in fully ablative mode, or Fractional resurfacing. Fractional mode is most frequently used for treating darker skin types- including Asian and Middle Eastern skin types.

• Fraxel 1550 laser- I rate this laser as ‘good’, as it is an all rounder, however it is not as focused as say the CORE CO2 laser. Using default settings, patients will get a good improvement with 3-5 treatments using this machine. I prefer to step out of the ‘default’ setting and combine Fraxel with other lasers in the one sitting. This gives the best results.

• V Beam vascular laser by Candella. This laser is super versatile, as I use this to treat red scars (macular acne scars), as well as the redness post laser (usually at 4 weeks after resurfacing). This laser does not break the skins surface, but targets redness. Downtime is less than 12 hours.

• RF or eMatrix by Syneron Candella. This is not a laser, but treats early acne scars using a mode called RadioFequency. I use this machine to treat early scars, or as part of the Acne Free RF program. Downtime following eMatrix varies from one to three days. I also use this as a final ‘touch up’ to stimulate more collagen after combination erbium and CO2 CORE. Typically patients who have very severe atrophic scarring will undertake the ‘big guns Erbium and CO2 CORE’, followed by monthly RF treatments (3-4 in total). This gives maximal scar remodelling over 4-6 months.
• ePrime RF Needling- this non- laser treatment is reserved for treating acne scars in darker skin types, such as Indian, or African skin. This treatment does not use laser energy, instead it uses RadioFrequency to break down scars, and stimulate collagen production. Unlike eMatrix, this RF energy is delivered deep in to the lower dermis via needles. This machine is excellent for a narrow window of patients, who exhibit rolling, and atrophic scars.
• INFINI RF insulated energy based micro needling current is the best system for treating atrophic, mixed, rolling and tethered scars. The key to why this device outperforms lasers is that the insulation within the micro needling protects the upper layers of skin, allowing more energy to be delivered into the deeper dermal layer, breaking down old acne scars, and stimulating new collagen formation. This device is the unique, and in combination with PRP delivers outstanding results with minimal downtime. It really is a game changer and the device of choice for severe acne scars. 

During your consultation, I will always map out your acne scars and classify them. Acne scar classification includes box-car scars, atrophic acne scars, rolling scars, hypertrophic scars, ice pick scars, and tethered or anchored scars. Based upon your skin colour and scar types, I will then suggest the best method for you- hence all treatments are customised according to your skin colour as well as downtime. I keep reminding patients that even though our center is the best equipped laser center in Brisbane, if not Australia, lasers are not the only answer to acne scar removal- combination treatments directed at your scar type will give you the best results. This includes lasers, TCA peels, fillers, and surgical techniques like punch excision, punch elevation and subscision. 

Melasma or hormonal pigmentation is a special form of facial pigmentation that is common in Brisbane. This is due to the high UV index and the outdoor lifestyle of many us enjoy. The cause of this condition is due to genes, sunlight, and hormones. It is more common in pregnancy and may occur with the contraception pill.

The main-stream treatment of this condition is with bleaching creams, Vitamin A compounds, as well as a series of either high strength Vitamin A or medium strength glycolic AHA, or low strength TCA chemical peels.

The laser of choice is the Q Switch Laser performed every second week. You will require a series of at least 5 treatments as a test to see if you respond to this treatment. The before and after photos will reveal if you are a suitable candidate for further laser sessions. Laser skin rejuvenation Brisbane melasma treatments need to be gentle as the UV  Index is high. 

I also use Picosure Focus in some cases of melasma mixed with sun damage and freckles. This laser is form of fractional laser resurfacing, and is ideal for ethnic and Asian skin types. Downtime following Picosure Focus is only 6-12 hours. 3-4 sessions are required for the very best results.

Clear and Brilliant Laser is another type of laser that I use to treat melasma. This laser is unique because it is gentle, with very little downtime (12 hours of mild redness). I use this laser as an ‘infusion laser’ – namely to allow the penetration of anti-oxidants such as vitamin A, B, and Cs into the deeper layers of skin. I use Clear+ Brilliant as a melasma maintenance laser, once the melasma treatment program is completed. 

Another laser that we use is Fraxel 1927 – this laser can improve deeper and more stubborn pigmentation, however must be used in conjunction with creams. A series of 3 sessions are recommended. This laser is the least frequent method I use for melasma facial pigmentation.

In summary-

• Melasma is commonly seen in Brisbane women
• Creams and peels are first line treatment
• I prefer multiple gentle Q switch laser treatments over aggressive laser treatments
• Picosure Focus is excellent for accelerated pigment clearance
• Clear and Brilliant laser is used to maintain your skin’s brilliance after your melasma treatment program is complete
• Fraxel laser can also be used- but this is my least favoured laser 
• Aggressive laser treatment can be effective for some patients, however rebound is often noted- this treatment is outdated
• Never use IPL as a stand alone treatment- this worsens melasma in the majority of times. Laser skin rejuvenation Brisbane- outdated by a decade. 

Over the years I have invented and refined several methods of laser and energy based devices that have gained mainstream use Worldwide.

The most exciting is my technique of HIGH Density Fraxel 1927. This laser treatment uses a special wavelength to treat sun damage and solar keratosis. Research has shown a clearance rate of over 90%, extending beyond one year. This laser also decreases facial pigmentation, pore size and fine to medium wrinkles- all with one treatment. Downtime is only 6 days.

RF Remodelling of early scars. This project was started in 2012, and is still ongoing. I have demonstrated the safety of non-laser energy based devices in remodelling early acne scars, whilst on Roaccutane. This treatment is both safe and effective in the management of early acne scars. It is now used in Australia and New Zealand by many dermatologists.

Fusion laser with Erbium and CO2– this involves heavy resurfacing with erbium laser, followed by fractional CO2. This method of laser resurfacing gives far better results than using individual lasers.

Picosure FOCUS for skin rejuvenation and scar reduction. This is my latest research project and the results are promising. Picosure Focus Fractional laser resurfacing is a no downtime laser that works best on darker skin types. I am using this laser to remodel early acne scars in patients with active acne.

INFINI RF PRP to date has very promising results for the treatment of severe acne scars. This device has revolutionised how I approach acne scars- energy is delivered to break down old scars that lie deep in the skin, whilst insulation of the needles spares the upper layers. I then use your own growth factors derived from your platelets to further help collagen remodelling and aid in skin healing. This combination has given excellent results.

Ultherapy 1927 is an exciting new concept. The Gold Standard of collagen remodelling is with fully ablative CO2 laser, and as you can see within my before and after photos, this can give amazing results with just one treatment. The downside is that this procedure has a downtime of up to 9-10 days, and the recovery is not pleasant. For patients who have mild to moderate skin laxity as well as mild to moderate sun damage, the combination of Ultherapy (ultrasound) to stimulate collagen and Fraxel 1927 to refresh skin texture can give excellent results, without the trauma of healing following erbium-Co2 laser. This combination treatment is best suited for patients who have good collagen, and midl to moderate skin ageing- ideally for patients in the mid 30s to early 50s.