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Guide to Facial Rejuvenation

Facial Rejuvenation — The Role Lasers & RF Play

By: Brian Sidella – Owner/Founder of Forever Young MedSpa

1st some facts…

Back in 2005 when we first opened up Forever Young MedSpa we thought… we had it all. An IPL for spots, a fractional laser for skin rejuvenation, the VelaSmooth for Cellulite and fat reduction, Botox, Restylane, Juvederm & Collagen fillers. The belief at that time was to directly fill the lines with a syringe of filler and use Botox on the dynamically caused wrinkles, follow with an IPL and or laser treatment and that was state of the art back then.

What’s different now & how skin ages

In the world we live in today science is continuously evolving and probably always will. We are however light years away from where we were in 2005. We have more than a dozen fillers of varying molecular weights (thinner and thicker) to treat different areas and depths of the face/eyes/neck. We have four FDA versions of Botox and we have entirely new classes of laser/RF treatments along with PDO threads and PRP, all of which play a role in non-surgical facial rejuvenation.

We now know that we need to address the underlying causes of lines and wrinkles which begin with the loss of fat or facial volume. In January 2021 a landmark 14 year study, quantified for the 1st time ever, how much facial fat (volume) the average person loses in their face.

CT, Ultrasound, and MRI scans were done in year one and then every year following for the next 14 years on hundreds of patients’ faces. The findings were amazing.

The average patient between the ages of 30 & 65 will have lost 6cc’s of fat every 11 years. 18.4% of the fat loss was deeper and 11.3% of the fat loss was superficial. This is why we need to have different dermal fillers that are designed for superficial (Restylane, Belotero, Restylane Silk, Versa & Restylane Refyne) as well as deeper injections (Restylane Lyft, Restylane Defyne, Voluma, Sculptra & Radiesse).

As one example, say you’re a 52-year-old 1st-time-filler patient and you want to get back the facial volume you had when you were 30. The study proved that each 11 year period saw a facial fat loss of 6cc’s. So, from 30 to 41 6cc’s were lost and from 41 to 52 an additional 6cc’s was lost. A total of twelve 1ml syringes would be required to replace the fat loss due to the aging process and to get this patient back to a baseline level.

12 syringes sound like a lot but as you will read, it is really not. In fact, 12 syringes are about equal to how much Restylane or Juvederm would fit into just two household teaspoons. Now picture two teaspoons of product spread across a person’s face. Not much at all but when patients are properly re volumized, the results are very impressive.

Conversely, we’ve seen time and again patients who need 8-12 syringes of filler who can only purchase a few syringes due to budget, not be happy with their results because the change is only slightly better. We often tell patients to save up to get a proper re-volumization or use Care Credit and pay over time so they will be very happy with the results they see as well as results their friends and family will notice.

Why are laser and RF treatments required for best results?

Botox relaxes the muscles that cause dynamic muscle group lines and wrinkles, fillers replace lost volume as stated above but Lasers and RF treatments are extremely important as they each have different and unique properties. Most of us know that we all have seven layers of skin but… let’s take a closer look.

(Photo below)

Illustration showing layers of human skinWhen we receive microdermabrasion treatments (DiamondGlow) we are removing or reducing the Stratum Corneum or very top layer of the skin. Past that there are an additional six layers of skin & fat. Lasers are outstanding for rejuvenating the top three layers of the skin. RF however penetrates far deeper than lasers and is effective in remodeling the deeper layers with new Collagen and Elastin fibers. By using both laser and RF Microneedling treatments, we can now reverse the loss of Collagen & Elastin in all the layers of the skin & combined with Botox & fillers, the results are remarkable.

What’s new with Laser & Radiofrequency Treatments?

While we have always had RF and laser treatments since way back in 2005, the technology we use today is simply light years better. We are constantly evaluating new systems. Back in 2012 we made the decision to only bring on new devices that are revolutionary, not evolutionary and we now have 3 new revolutionary devices and each treats different areas.

Tetra C02 (CoolPeel) – We began testing C02 lasers back in 2011 and nearly every year since then, we evaluated 1 or more new C02 lasers per year. We knew that for surface-level skin remodeling, the C02 is vastly superior to other laser waveforms. We never purchased a C02 however for a few reasons. The downtime was weeks with bleeding/oozing, infection risk, hyper/hypopigmentation concerns, and the treatments & recovery period were painful.

Each new generation of Fractional C02 lasers improved upon the prior generation but each still fell short of what we knew our patients wanted which was great results with minimal to no downtime, no wound care concerns, and low to no pain.

In 2021 we trialed the Tetra C02 and finally… we found a Fractional C02 which has some very unique properties that we are extremely excited about. How so? A few proprietary exclusive features beginning with the Fractional Coolpeel®. This amazing treatment allows us to fractionally perform “varying depth surface peels” with little to no downtime and incredibly, a very little discomfort.

CoolPeel advance in CO2 laster treatmentThe all-new scanner allows us to customize for each patient how deep or shallow we want their Coolpeel® treatment to be based on what each patient is looking to achieve. We can treat as aggressively as a one-and-done treatment with about a week of downtime or a series of varying depth Coolpeel® treatments with minimal to no downtime treatments depending on the depth we choose for the Coolpeel® treatment. No other C02 offers Coolpeel options. The Tetra’s scanner also allows us to easily select from dozens of patterns to maximize the dot pattern on the skin which is especially useful in getting around the eyes, nose, and corners of the lips.

Next up is speed. Our patients are very busy and want to get in and out and back to work or home quickly. We can perform an entire face Coolpeel® treatment in about 10-15 minutes. We can also treat necks, decollete, and hands!
Lastly, but as important is what about patient comfort? When I was treated with the Tetra and had a Coolpeel® treatment I did not apply any numbing cream because I wanted to feel for myself if a C02 treatment could really be performed without any numbing.

I’d never attempted this with any other C02 treatment as the pain even with numbing was pretty intense. So… without any numbing, I had my Coolpeel® treatment and I’d describe the pain level as about a 2-4, again without any numbing which of course most of our patients will have.

Test Patients who did have numbing cream reported pain levels of 1-2. With any other C02, the pain level even with numbing cream is still 6-8. For the 1st time, patients who cannot numb due to reactions to numbing cream can still have C02 Fractional Coolpeel® treatments that are very tolerable & that’s never been possible before. Patients who are numb will feel little to no discomfort.

Virtue RF Microneedling Treatments

Virtue RF Collagen InductionLook back at the skin chart image at the Dermis layer. This is where most of the skins Collagen & Elastin fibers reside. It’s also commonly the area in which deeper lines/wrinkles extend into and lasers cannot penetrate to these layers.

The Virtue RF Microneedling system nearly painlessly inserts 36 tiny gold needles into that junction of the skin and places the RF energy beneath the skin which is far different than lasers which fires their energy on the surface of the skin.

By targeting the Dermal layer of your skin, both Collagen and Elastin fibers are generated, lines and wrinkles are reduced, and skin tightening occurs.

The Gold Plated Microneedling tip, which is single-use and patient-specific, generates 36 tiny holes with each pulse. On a full-face treatment, thousands of these holes are created and are very important as they remain open for 6-8 hours. This is by design as many patients will add PRP or other topical agents to their Virtue RF treatments. Those holes allow the PRP to penetrate into the skin and work their magic deep into the dermal tissues up to 3.5mm deep.

For patients with acne scars, typically the damage is to both deeper and superficial layers of the skin so both RF and Laser treatments are required for the best results. Prior to the Virtue RF, the most popular RF treatment was the Vivace which we did not purchase as it lacked the power to have revolutionary results. The Virtue RF has nearly three times the power of the Vivace RF system and provides for better, quicker, and more comfortable treatments than any other RF Microneedling system.

Combination Tetra/Virtue RF Treatments

Virtue + CoolPeelFor the 1st time, with this combination therapy, we are able to target and remodel Collagen & Elastin & lines & wrinkles in both the Epidermis and Dermis layers during the same visit(s). We can now significantly improve skin tone, texture, luminosity & pore size, while greatly reducing visible sun damage, fine lines & wrinkles & most importantly, turn back the clock by stimulating the growth of new Collagen & Elastin from the inside out.

Subnovii Plasma Pen

Subnovii before and after photoThis treatment is very specialized and limited to a few but very important areas of our eyes and our upper lip. The Subnovii Plasma Pen allows us, for the 1st time ever, to provide nearly surgical-like blepharoplasty results on the upper/lower lids and around the eyes. There is on average downtime of 7-10 days and pink/redness for a few weeks, but no surgery, anesthesia, stitches, surgical garments, or prescription pain medication is needed. We can also treat the condition commonly called smokers lip for the lines and wrinkles above the upper lip.

So, now you have some great information on lasers and how/why they work. If you’d like to find out more about how Botox, Fillers, and PDO threads provide the foundation of turning back or preventing premature aging, check out our Guide to Reducing Visible Signs of Aging

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