Doctor's Answers (1)
I think the question should be more aptly rephrased as “What type of laser treatment is suitable for sensitive and acne-prone skin?” To this point, I must say a lot of this depends on the clinical experience of your doctor. Textbook doctors may sometime run into real-world problems as most of us doctors experienced when we first started treating patients. After more than 10 years, we learn from the exceptions and when textbook protocols don’t apply exactly.
The Asian skin type is rather different from Caucasian skin. In tropical Singapore, we have diverse ethnicities that have adapted to our hot and humid climate. I often see patients with so-called “combination skin”. They present with a medical history of acne and oily skin (hyperseborrea) that can break out in rashes easily. Also, the stress and change in climate associated with travel can lead to breakouts of comedogenic acne. This seems like a confluence of all the conditions we do not want.
I haven’t read a textbook paragraph that tells you what to do in this confusing mixture of factors of possible on-going acne, old acne scars, extraction scars, on-going reactivity whether it’s endogenous (internal factors like hormones, stress) or exogenous (contact due to products or cosmetics) dermatitis.
My experience tells me to just step back, get the bird's eye view of these patients. Take a good look at their history, what the aggravating and alleviating factors are, and most importantly their previous aesthetic treatments. Many a time, the patient knows the answer. It could be that the previous doctor decided to perform an aggressive Fractional CO2 laser to treat the acne scars but caused a horrendous outbreak of acne again! Or an aggressive chemical peel that made things worse.
A few pearls of wisdom: go gentle, tread carefully. The immune system and the pilosebaceous (oil gland and hair unit) unit on the face of these patients are very volatile and can get angry.
Going back to basics. Reduce reactivity and stabilize the skin. In my clinic, we have a very high volume of patients using NEOGEN™ Plasma treatment instead of laser treatment. We find the skin remodeling and collagen stimulation stabilizes the skin. Once the skin is stabilized, we then move on to non-ablative lasers. Meaning, lasers that do not compromise the epidermis or dermis unlike many Fractional lasers. Long Pulse lasers can be used. 1320nm or 1064nm laser are what I use very often. FOTONA™ laser systems are a stable and versatile system to stimulate more repair using a patented FRAC3 setting. There is no downtime and patients come during lunchtime for these treatments.
Take home message: treatment of combination skin types can be challenging. Patients should find a physician with experience handling such skin types for an optimal outcome.