Hi everybody,

I'm an Asian and have suffered from acne scars for over 5 years. Last week, I met doctor James A. Heinrich (his website: pacificcoastcosmetic.com) and he advised me to have 3 treatments with DeepFX and 1 treatment with ActiveFX after that. They quoted me $4,800.

My questions are:

1. I've heard that there is only 1 treatment needed with DeepFX, why he advised me to have 3 treatments?
2. Is the new laser treatment Fraxel re:pair better than DeepFx? Fraxel should be better for Asian skin?

Thanks,

Liemonline,

Fraxel re:pair (CO2) and DeepFx (CO2) are probably equivalent. I am not aware of any head to head or split face studies but they both use deep CO2.

I would be very concerned about postinflammatory hyperpigmentation (PIH) with either laser (they treat very deeply into the dermis: 1 mm or 1000 microns). Asians are much more prone to PIH than Northern Europeans.

The Fraxel re:store (Glass Erbium: 1550 nm) is safe in Asian skin if you treat “lightly” (low fluence (< 45 mj) and low treatment level (<5)) and use pre and post care PIH prevention medications (hydroquinone, etc). Acne scars in Asians respond well to Fraxel Re:store even at these low settings.

Remember Fraxel is not Fraxel. There are two different Fraxels. One coagulates and one ablates. The Re:pair ablates and is CO2 (10,600 nm). The Re:store coagulates and is Glass Erbium (1550 nm).

If you do more treatments you get better results. Three treatments is better than one. You will probably get great results with 3 DeepFx Treatments. $4500 for three treatments is an excellent price ($1500 per treatment).

Dr. Heinrich is one of the most experience laser physicians in the country. He was one of the experts in a recent DeepFx Webinar Round Table discussion.

IF he can reassure you about the PIH (postinflammatory hyperpigmention) issue, I would say to go forward. Perhaps you could ask him to answer your questions (and my concerns) on this blog so we can all benefit from his expertise.

Another question that I would ask is how much downtime will there be per treatment and what will the treatment intervals be? I would also ask him to be very specific about the downtime. Absolute, Relative or Social. Absolute is when you have to be home. Relative is when you can pick the kids up at school without getting out of the car (hat, sunglasses and scarf). Social is when you are still mildy red but you can go to work and live your life (might need some makeup if you are female).

I would be happy review his answers and give you my opinion.

CHMD

Thanks for your answer. He advised me to use Luma for a month before the procedure. He also told me that there was high risk with hyperpigmentation in Asian skin but he was sure that it could be cured easily by following strictly his advice.

Good luck. Let us know how it goes.

What did he say about the Downtime for each treatment?

Liemonline:
I noticed on his website that he has a CoolTouch device (not sure which one that is). However, the CoolTouch 3TC (1320nm) should be your first option. Go to www.cooltouch.com to find out more. This 1320nm platform is very safe for darker skin people.
It has been shown that using using something like TriLuma (HQ 4%) BEFORE the procedure makes no difference in reducing the risk of PIH. It is the immediate and judicious use of HQ 4% AFTER the procedure is the way to go. If you are a young woman in reproductive age I would recommend something a bit less aggressive than TriLuma such as SkinMedica EpiquinMicro which has HQ 4% with Retinol (not Tretinoic Acid) and no steroid. The key to the cream for someone like you is to enable you to use it 1-2 times DAILY for 1 month. Tretinoic acid and steroid can cause enough dryness and inflammation to your skin that you might decide to stop using it which is not what the intention be.
Check out this link posted by FoxyDog1064:
http://www.geocities.com/foxydog1064/

Look under: Hyperpigmentation. I consider this to be a very good guideline. Many of these Dermatologists are people of colors.

I don't think infrared (1300nm) works for acne scars. Cutera's Titan definitely does not work for acne scars (in my opinion). I would suggest Fraxel Re:store (1550 nm) for "patients of color". Again, the PIH issue with DeepFx is a real issue that Lumenis and their Luminaries are ignoring or pretending does not exist. See www.geocities.com/pih_pih to see some PIH from ActiveFx in a patient of Italian background. Asian PIH would be worse.

Thanks for all the advice but I really don't know what is right to me. Dr. Heinrich told the downtime would be 3-6 days. He also showed me some photos of actual patients and added that the downtime would be shorter after each treatment.

He didn't mention anything about CoolTouch at the previous appointment. The only thing he told me that DeepFx would work for me up to 80%. I'm so worry about hyperpigmentation may occur after the treatment.

I'm going to have another appointment with Dr.Pilest tomorrow (totaldermatology.com) to see if he has another solution for my acne scars.

I will probably have my first treatment after 1 month from now on. I will post some photos of the progress.

CHMD

I agree with you re:store is the way to go. At least the safest. There is a large volume of literature to support this. A lot comes from Dr. Henry Chan out of Hong Kong and some others. I think Dr Chan is on Reliants payroll but his articles from 2004-2008 are based on data starting 2001. He includes different light sources and RF as well as topicals in comparison for treating PIH, dyschromias, acne scars and rhytids on asian skin.

The problem with fractional erbium is you have to hurry up and wait. I see some disappointed pts early on because it takes a while for the collagen to grow. I try to get f/u at 6 months after the last treatment. At this point even the "non-believers" are usually pretty happy.

pmdoc

I tried pre and post with HQ, could not really say if there was less PIH. Some swear by 2 wks pre treat. Now I just treat post unless pt is worried or high maintenance, that way they feel proactive.

I think you are right to use Tri-Luma sparingly. Medium potency corticosteroid wont cause atrophy in 4-8 wks but I bet it can delay neocollogenesis, besides if you use tri-luma too long adverse rxn is bluish tint to skin. I don't know which component causes this but Ive seen it in darker skin types

Just want to add a bit of taste to the discussion on PIH in type 4 skin when doing fractional CO2 laser.

For the past 6 months I have treated about 30 patients, in about 100 sessions, for acne scars. All are Hong Kong Chinese with type 4 skin.

I don't use Lumenis or Reliant because they are far too expensive. I use a different but very similar machine( if not better ) from Korea, called CoLaGen. Forget the brand and stick to the parameters:

~ 1.2 mm beam size (similar to deep fx)
30 - 60 mJ per pixel
repetition of individual beam 2 - 3
distance ~ 1mm, works out < 10% of resurfacing
usually 1 pass, sometimes 2 passes on heavy scarring area.

Results:

Downtime :(that all scabs come off) ~ 7 days
PIH : none when using 30 - 40mJ, just 2 or 3 with mild pinkiness ( not black colour) that resolved in 1 - 2 weeks when I used 60mJ.
Improvement: good after 1, excellent after 2 treatments, although some poor responders with only moderate improvement after 3 treatments.

Note: I don't use HQ at all pre or post treatment.

I hope that will give limeonline something useful in terms of PIH.

pmdoc:

Although I have not used cooltouch, but over the years I have come across so many patients disappointed with cooltouch treatments for acne scars before they came to see me. That told me that cooltouch does not work well for a high portion of patients.

CHMD:

1. Fraxel re:store is not the way to go when comparing to fractional CO2 in treating acne scars.

a. In the official Reliant web site there is an article which shows before & after photos after FIVE treatments. The improvement shown there is just about what I get in ONE (may be TWO) treatment in some of my best responded patients.
b. Fraxel re:store is not the safest. There have been quite a few PIH experienced by some doctors using it here in Hong Kong.
c. One doctor who has used fraxel re:store for the last 2 years, but has recently purchased the same machine I am using, and apparently she is no longer using the fraxel re:store anymore since then.

In your other bolg with over 80 points of discussion about the webinar, you summarised the recommendation of not using deep fx in treating the eyes areas. I would like to let you know that I have treated many full facies including the upper and lower eyes.

The tightening effects for lax upper eyelids have been amazingly good after 1 treatment only. No scarring and no PIH.

(welcome to see 1 case of acne scar, type 4 skin, and 1 case of upper eyelids, type 3 skin on my website: www.drhealthbeauty.com)

I do this after I heard a Thai doctor doing this with the deep Fx on his Thai patients (skin types 4 -5 you know). That was a seminar organised by Lumenis.

Sometimes the so called experts may not be totally right for good reasons. Some non-experts may be gathering experiences in new things faster than they do, but they are still not experts in a sense, because they don't publish and don't speak out, just work quietly in a corner of the world.

Don't know how they feel about this if they hear what we are doing in this part of the world, quite to the contrary of what they suggest, with good results though.

dr stephen
Hong Kong

Thanks for all the information, Dr. Stephen. It's very helpful. I'm Asian and I always prefer visit an Asian doctor. However, it's hard to find an experienced Asian dermatologist in my city.

I talked to Dr. Pilest (totaldermatology.com) this morning and he seems to be a very experienced doctor. He was very friendly and made me feel comfortable. No doubt that he has a lot of patients. In just a few minutes, there are many patients coming to the office.

He advised me to go with Fraxel re:store as I'm Asian. He also said that he had many Asian patients. I think that's true because there are many Asian people living in Irvine. Furthermore, most of his staff are Asian. I will need 5 treatments. Hope it will help to reduce my acne scars.

Hi Dr. Stephen,

Thanks for the input. I think we can compare lasers if we talk about size of column, depth of penetration and % surface area covered.

I will give my best opinion of Fraxel and Active/DeepFx parameters.

This is what I know about the DeepFx:
Ablates 0.12 mm columns (120 microns)
Density 1: 5%; Density 2: 10%; Density 3: 15%; Density 4: 20%; Density 5: 25%
Depth: 20 mj goes 1 mm deep???

This is what I know about ActiveFx:
Ablates 1.3 mm columns
Density 1,2,3,4,5: 75%, 80%, 85%, 95%, 100%
Depth: 125 mj gets you 300 microns (0.3 mm) of ablation depth

I don’t know much about the Fraxel Re:pair.

Fraxel Re:store:
Diameter of COAGULATION varies with the treatment level and the energy
Energy of 6 j/cm2 gets you to 0.5 mm (500 microns)
Energy of 45 j/cm2 gets you to 1.2 mm (1200 microns)
Treatment level of 4 is about 11%
Treatment level of 7 is about 20%

So, Dr. Stephen. What is the range of density & depth you use for acne scars and what is the diameter of your ablation?

Are you doing diameter of coagulation of 1.3 mm, depth 1 mm and 10% coverage? This would be similar to DeepFx IF your diameter of coagulation was 0.13 NOT 1.3 mm. Did you mistype your diameter of coagulation?

If you do Fraxel Re:store you have to use the proper settings to avoid PIH. In inexperienced hands, you get lots of PIH with Fraxel Re:store. Asian skin responds very nicely to low settings with Fraxel Re:store.

How deep does 30 mj, 40 mj, 50 mj and 60 mj go with your laser?

Thanks,
CHMD

Dr. Stephen:
Thanks for the info. A few comments to your post:
1)I have not used 1320nm personally but was impressed by the CoolTouch results on the website and since it is a safe nm for colored people
2)When it comes to PIH's, it CAN happen with Fraxel 1500 and CO2 laser. Generally speaking on a tet-a-tet comparison between Fraxel 1550 and CO2 laser, I would bet you that it happens more frequently with CO2 platform. It is important when we talk about risks of PIH's that we don't speak about the risks by generalization but rather sharing among us in identifying WHOM would be at higher risks of PIH's than others REGARDLESS of the laser platforms. Obviously someone in 30-40's in reproductive age and high exposure to the sun would ALWAYS be at much higher risk of PIH's being from Fraxel or CO2.
3) I don't know much of CO2 laser at this time but would disagree with your recommendation on using CO2 under the eyes for people of thinner skin (type I-III). I do Portrait Plasma and am always cognizant of what I can get away with in treating thinner skin vs thicker skin folks. If you read the posts here under "Portrait Plasma: The Power of Gas" you would appreciate the horror stories of people of thinner skin experiencing "skin sizzling and scars" when strong power was applied under the eyes, forehead and neck. We also see this when the first thermage generation tips were introduced in 2002. I am Asian and treat mostly Asian clients. I agree with what you do with CO2 laser in HongKong but would not agree with this for some other ethnic groups for sure.

CHMD,

Yes, I mistyped the diameter, it is 0.12mm , not 1.2mm, sorry.

The only disadvantage of the laser I am using is that the manufacturer does not provide a lot of histology data in terms of penetration, although they quote 300 - 1000 micron. I started my parameters and then modified them, from those used by another korean doctor.

There are 10 densities we can choose from, from 0, then 0.3mm , 0.6mm, 1mm, 1.3mm, 1.6 mm, 2mm,.....to 3mm. I usually stick to 1 or 1.3mm. I think the density matters more than the energy level, in terms of causing PIH, or achieving results. 0.3mm would have too much heat overlap and increase the PIH risk, whereas 2mm or more does not give a good results in most indications.

pmdoc,

I agree with you to a certain extent. I don't dispute the risk of PIH from CO2 at all. That is why I am not going higher than 40mJ for type 4 skin. I am aware of the relatively high risk of CO2.

As for the eyes, base on the so far so good results, I will continue to explore the use in this area, bearing in mind your warning of scarring in thinner skin. Thanks.

dr stephen

I am a TotalFX user. Some information about ActiveFx and DeepFx provided by Lumenis company is useful for tracing post-resurfacing result and side effects.
1. Number of Spots (&% coverage) per Treatment Area (DeepFX):
a)Size2mm: Density1--9(7%), Density2--9(7%), Density3--9(7%),
Density4--25(20%), Density 5--25(20%).
b)Size3mm: Density1--9(3%), Density2--25(9%), Density3--49
(17%),Density4--64(22%), Density 5--81(28%).
c)Size4mm: Density1--25(5%), Density2--49(10%), Density3--81
(16%),Density4--121(24%), Density 5--169(33%).
d)Size5mm: Density1--49(6%), Density2--81(10%), Density3--121
(15%),Density4--169(21%), Density 5--225(28%).
e)Size6mm: Density1--49(4%), Density2--121(11%), Density3--169
(15%),Density4--225(20%), Density 5--289(25%).
f)Size7mm: Density1--81(5%), Density2--169(11%), Density3—225
(14%),Density4--361(23%), Density 5--361(23%).
2. Energy and Ablation depth of DeepFx (0.12 mm spot size)
a) Energy level- 10 mJ------- Ablation depth- 230 μm
b) Energy level- 15 mJ( =133 J/cm2)------ Ablation depth-
230 μm
c) Energy level- 20 mJ------- Ablation depth-700 μm
3. Percentage of Area Ablated (> 5J/cm2) within a Single Pattern of the largest Size
of ActiveFx (1.3mm spot size)
a)Shape line & Rectangle(Most common for treating scars & heavy rhytids)::
Density1--- 66%, Density2---73%, Density3--- 80%, Density4--- 95%,
Density5~9--- 100%.
b)Shape Square & Rhombus(Most common for resurfacing large areas in short time)::
Density1--- 55%, Density2---68%, Density3--- 82%, Density4~9--- 100%.

Dr. Stephen,

The "densities" you mention are confusing. I do not understand. Are they the diameter of the ablated columns? If they are, you are again off by a factor of 10. Please clarify. Thanks.

CHMD

It is the distance between beam.

It works out for 1mm density, there are about 120 MTZ / cm2; and for 1.3mm density, about 70 MTZ/cm2.

dr stephen

Can someone translate the ActiveFX "density" numbers into spacing between the MTZ's, so we can compare Dr. Stephen's treatment parameters?

Sorry, mistyped the ablation depth of DeepFx
b) Energy level- 15 mJ( =133 J/cm2)------ Ablation depth- 450 μm(not 230μm)

CLF,

What is "size"? Is it the size of the spot? Are there many 0.12 mm columns per spot?

For example:
Size3 means the treated area is 3 mm X 3mm. There are defined number of spots (each is 0.12mm) which occupy calculated % of coverage of the treated area.

Today is day 1 after my first treatment. My face now is pink and brown also. I have seen some photos of other patients but their faces are pink after the treatment while my face looks darker. Is it normal when it's brown instead of pink?

Liemonline,

What settings did your doctor use?

I would have used 40 mj/cm2 and Treatment Level 4 for the first treatment.

Liemonline:
That is because of your underlying dense pigmenting melanin cells. You might also experience "stripings" if there are gaps of overtreated vs undertreated skin sections (some melanin cells might become hyperactive, some might be burned out) You may see these after 4 days.

I didn't know settings the nurse used. I didn't ask her.
I see many tiny brown spots on my face where fraxel re:store used. I don't know when I can get out of this.

Brown spots will come up and out by day 5. This are the microthermal zones that were coagulated. Normal.

I see tiny rough scabs on the whole of my face. My face looks darker than it used to be. Here are 3 photos on day 3. I'm wondering if I can go to school this Monday (day 5):

http://s283.photobucket.com/albums/kk306/liemonline/fraxel/

liemonline

I looked at your photos. That is normal appearance for your skin. It looks like the Doctor was a little more aggressive with the surface area (level) then I would have been. Asians and darker Hispanics tend to get that abrasion "scabby" look in the days following the fraxel. What you are seeing is all the tiny points of laser light (pixels) where they entered your skin. To your eye is appears confluent but on a microscopic level they are little "pinholes" with intact skin in between. Be patient those "tiny rough scabs" will start to come off in a day or two. Don't force it just gentle soap and some gentle moisturizer and you should be fine.

I have severe acne scars on my nose. How deep can one go on the nose with a fractional CO2 without damaging the cartilage? thanks

I had the fraxel repair 4 months ago, I had to wear bandages for 2 months. the scars and hypopigmention are horrible! If you would like to see photos email me christine.hoene@lifesafeservices.com. I could not work for weeks and get stares when I am out without makeup. BE CAREFUL. The setting were reasonable, reliant was in the room during the procedure, and I am very healthy.

I see that PMdoc reccomended that the deeper CO2 modalties not be used under the eyes for fear of scarring. I have scarred in this area from an ND yag 1064 vascular treatment before. What is the general opinion here of using Active FX which is much more superficial in thin skinned areas? And also, what is the minimum depth in microns that the Fraxel Repair can treat? Can it treat at a similar depth to Active FX?

VN: This is from the DeepFx Forum (summary of DeepFx Webinar):

Treating Specific Areas:
Eyes: Use ActiveFx. Don’t do DeepFx around eyes (skin too thin?)
Eyes: ActiveFx: 90-100 mj, density 2-3. Downtime: 7-8 days of downtime (what TYPE of downtime?)
Eyes: Upper Lid: ActiveFx: 60-70 mj, density 1
Eyes: Might consider using DeepFx for low lids: 5-10 mj with density 2? This was the experts thinking outloud. They are not recommending this!

Search for "DeepFx" on this blog and you can see the whole summary and discussion.

Dr Stephen,

Not to be offensive,the photos on drhealthbeauty.com are not impressive at all,especially when you compare them to Kenneth's colleagues' photos on http://www.iskin.com.tw/remedy02.aspx?parent_cid=C_00000006&id=P_00000081
.However,you claimed that your patients are very happy with the results.Do you have more photos you may be able to show on the site?Thanks.

Liemonline,any updates??

I have had Fraxel Repair done twice at 70mj - 60%. How deep does the ablation go and how would this compare to DeepFX settings?

I am wondering the same thing:
How deep does the ablation go and how would this compare to DeepFX settings?

I am a TotalFX user. Some information about ActiveFx and DeepFx provided by Lumenis company is useful for tracing post-resurfacing result and side effects.
1. Number of Spots (&% coverage) per Treatment Area (DeepFX):
a)Size2mm: Density1--9(7%), Density2--9(7%), Density3--9(7%),
Density4--25(20%), Density 5--25(20%).
b)Size3mm: Density1--9(3%), Density2--25(9%), Density3--49
(17%),Density4--64(22%), Density 5--81(28%).
c)Size4mm: Density1--25(5%), Density2--49(10%), Density3--81
(16%),Density4--121(24%), Density 5--169(33%).
d)Size5mm: Density1--49(6%), Density2--81(10%), Density3--121
(15%),Density4--169(21%), Density 5--225(28%).
e)Size6mm: Density1--49(4%), Density2--121(11%), Density3--169
(15%),Density4--225(20%), Density 5--289(25%).
f)Size7mm: Density1--81(5%), Density2--169(11%), Density3—225
(14%),Density4--361(23%), Density 5--361(23%).
2. Energy and Ablation depth of DeepFx (0.12 mm spot size)
a) Energy level- 10 mJ------- Ablation depth- 230 μm
b) Energy level- 15 mJ( =133 J/cm2)------ Ablation depth-
230 μm
c) Energy level- 20 mJ------- Ablation depth-700 μm
3. Percentage of Area Ablated (> 5J/cm2) within a Single Pattern of the largest Size
of ActiveFx (1.3mm spot size)
a)Shape line & Rectangle(Most common for treating scars & heavy rhytids)::
Density1--- 66%, Density2---73%, Density3--- 80%, Density4--- 95%,
Density5~9--- 100%.
b)Shape Square & Rhombus(Most common for resurfacing large areas in short time)::
Density1--- 55%, Density2---68%, Density3--- 82%, Density4~9--- 100%.

I am a TotalFX user. Some information about ActiveFx and DeepFx provided by Lumenis company is useful for tracing post-resurfacing result and side effects.
1. Number of Spots (&% coverage) per Treatment Area (DeepFX):
a)Size2mm: Density1--9(7%), Density2--9(7%), Density3--9(7%),
Density4--25(20%), Density 5--25(20%).
b)Size3mm: Density1--9(3%), Density2--25(9%), Density3--49
(17%),Density4--64(22%), Density 5--81(28%).
c)Size4mm: Density1--25(5%), Density2--49(10%), Density3--81
(16%),Density4--121(24%), Density 5--169(33%).
d)Size5mm: Density1--49(6%), Density2--81(10%), Density3--121
(15%),Density4--169(21%), Density 5--225(28%).
e)Size6mm: Density1--49(4%), Density2--121(11%), Density3--169
(15%),Density4--225(20%), Density 5--289(25%).
f)Size7mm: Density1--81(5%), Density2--169(11%), Density3—225
(14%),Density4--361(23%), Density 5--361(23%).
2. Energy and Ablation depth of DeepFx (0.12 mm spot size)
a) Energy level- 10 mJ------- Ablation depth- 230 μm
b) Energy level- 15 mJ( =133 J/cm2)------ Ablation depth-
230 μm
c) Energy level- 20 mJ------- Ablation depth-700 μm
3. Percentage of Area Ablated (> 5J/cm2) within a Single Pattern of the largest Size
of ActiveFx (1.3mm spot size)
a)Shape line & Rectangle(Most common for treating scars & heavy rhytids)::
Density1--- 66%, Density2---73%, Density3--- 80%, Density4--- 95%,
Density5~9--- 100%.
b)Shape Square & Rhombus(Most common for resurfacing large areas in short time)::
Density1--- 55%, Density2---68%, Density3--- 82%, Density4~9--- 100%.

Hi all,
My skin has discoloration of dermal post-inflammatory hyperpigmentation after long-term untreated inflammation due to eczema or infection secondary to eczema. My eczema problem was fixed few years ago, but it left me a dark brown hyperpigmentation. I know it's because the melanins fell to dermis and engulfed by macrophages becoming melanophages. Most of them won't be removed for a whole life. That is what I was told.

I've done lot of researches and i learnt that
1. Most of melanophages due to PIH were under the basal laser and seldom drop further to reticular dermis.
2. Depth of juntion between papillary and reticular dermis is about 0.3mm under the skin.
"Theoretically",
I am wondering if fractional Co2 abrasive laser could help with dermal PIH. As it could remove a depth of skin up to 1.Xmm.
After multiple (10) of fractional abrative co2 laser with settings of low coverage (10%) and 0.3mm depth (ignoring the cost matter)
And what do we expect? It was said that tone and texture would change and look unlike to surrounding skin that is what I heard from patients in REALSELF.
Fraxel re:pair treatment was recommended to performed twice for most of the patient. I am curious about what will happen after 10th treatment.

http://www.struckmd.com/pdf/Transepidermal%20Elimination.pdf
Have everyone seen this research about the non abrasive laser induced transepidermal elimination of elastin?
The author said it is also potential for removing melanophages in dermis.

These are my last hope for my problem.

Hoping someone would share some ideas with me~~ Thanks

Hi all,
My skin has discoloration of dermal post-inflammatory hyperpigmentation after long-term untreated inflammation due to eczema or infection secondary to eczema. My eczema problem was fixed few years ago, but it left me a dark brown hyperpigmentation. I know it's because the melanins fell to dermis and engulfed by macrophages becoming melanophages. Most of them won't be removed for a whole life. That is what I was told.

I've done lot of researches and i learnt that
1. Most of melanophages due to PIH were under the basal laser and seldom drop further to reticular dermis.
2. Depth of juntion between papillary and reticular dermis is about 0.3mm under the skin.
"Theoretically",
I am wondering if fractional Co2 abrasive laser could help with dermal PIH. As it could remove a depth of skin up to 1.Xmm.
After multiple (10) of fractional abrative co2 laser with settings of low coverage (10%) and 0.3mm depth (ignoring the cost matter)
And what do we expect? It was said that tone and texture would change and look unlike to surrounding skin that is what I heard from patients in REALSELF.
Fraxel re:pair treatment was recommended to performed twice for most of the patient. I am curious about what will happen after 10th treatment.

http://www.struckmd.com/pdf/Transepidermal%20Elimination.pdf
Have everyone seen this research about the non abrasive laser induced transepidermal elimination of elastin?
The author said it is also potential for removing melanophages in dermis.

These are my last hope for my problem.

Hoping someone would share some ideas with me~~ Thanks

How do they manage to "FIX" your eczema?

hank you very much for this useful article. I like it.
camfrog indir
camfrog yükle
mirc indir
mirc

Hi all,
My skin has discoloration of dermal post-inflammatory hyperpigmentation after long-term untreated inflammation due to eczema or infection secondary to eczema. My eczema problem was fixed few years ago, but it left me a dark brown hyperpigmentation. I know it's because the melanins fell to dermis and engulfed by macrophages becoming melanophages. Most of them won't be removed for a whole life. That is what I was told.

I've done lot of researches and i learnt that
1. Most of melanophages due to PIH were under the basal laser and seldom drop further to reticular dermis.
2. Depth of juntion between papillary and reticular dermis is about 0.3mm under the skin.
"Theoretically",
I am wondering if fractional Co2 abrasive laser could help with dermal PIH. As it could remove a depth of skin up to 1.Xmm.
After multiple (10) of fractional abrative co2 laser with settings of low coverage (10%) and 0.3mm depth (ignoring the cost matter)
And what do we expect? It was said that tone and texture would change and look unlike to surrounding skin that is what I heard from patients in REALSELF.
Fraxel re:pair treatment was recommended to performed twice for most of the patient. I am curious about what will happen after 10th treatment.

http://www.struckmd.com/pdf/Transepidermal%20Elimination.pdf
Have everyone seen this research about the non abrasive laser induced transepidermal elimination of elastin?
The author said it is also potential for removing melanophages in dermis.

These are my last hope for my problem.

Hoping someone would share some ideas with me~~ Thanks

Hi all,
My skin has discoloration of dermal post-inflammatory hyperpigmentation after long-term untreated inflammation due to eczema or infection secondary to eczema. My eczema problem was fixed few years ago, but it left me a dark brown hyperpigmentation. I know it's because the melanins fell to dermis and engulfed by macrophages becoming melanophages. Most of them won't be removed for a whole life. That is what I was told.

I've done lot of researches and i learnt that
1. Most of melanophages due to PIH were under the basal laser and seldom drop further to reticular dermis.
2. Depth of juntion between papillary and reticular dermis is about 0.3mm under the skin.
"Theoretically",
I am wondering if fractional Co2 abrasive laser could help with dermal PIH. As it could remove a depth of skin up to 1.Xmm.
After multiple (10) of fractional abrative co2 laser with settings of low coverage (10%) and 0.3mm depth (ignoring the cost matter)
And what do we expect? It was said that tone and texture would change and look unlike to surrounding skin that is what I heard from patients in REALSELF.
Fraxel re:pair treatment was recommended to performed twice for most of the patient. I am curious about what will happen after 10th treatment.

http://www.struckmd.com/pdf/Transepidermal%20Elimination.pdf
Have everyone seen this research about the non abrasive laser induced transepidermal elimination of elastin?
The author said it is also potential for removing melanophages in dermis.

These are my last hope for my problem.

Hoping someone would share some ideas with me~~ Thanks

Hi all,
My skin has discoloration of dermal post-inflammatory hyperpigmentation after long-term untreated inflammation due to eczema or infection secondary to eczema. My eczema problem was fixed few years ago, but it left me a dark brown hyperpigmentation. I know it's because the melanins fell to dermis and engulfed by macrophages becoming melanophages. Most of them won't be removed for a whole life. That is what I was told.

I've done lot of researches and i learnt that
1. Most of melanophages due to PIH were under the basal laser and seldom drop further to reticular dermis.
2. Depth of juntion between papillary and reticular dermis is about 0.3mm under the skin.
"Theoretically",
I am wondering if fractional Co2 abrasive laser could help with dermal PIH. As it could remove a depth of skin up to 1.Xmm.
After multiple (10) of fractional abrative co2 laser with settings of low coverage (10%) and 0.3mm depth (ignoring the cost matter)
And what do we expect? It was said that tone and texture would change and look unlike to surrounding skin that is what I heard from patients in REALSELF.
Fraxel re:pair treatment was recommended to performed twice for most of the patient. I am curious about what will happen after 10th treatment.

http://www.struckmd.com/pdf/Transepidermal%20Elimination.pdf
Have everyone seen this research about the non abrasive laser induced transepidermal elimination of elastin?
The author said it is also potential for removing melanophages in dermis.

These are my last hope for my problem.

Hoping someone would share some ideas with me~~ Thanks

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