seeja,

sorry to hear that you did not really have a satisfactory result on fractional co2 laser.

I have not been on this discussion for 2 months, despite this, I have done more cases for acne scarrings, and am pleased to say, I still have almost next to no cases of PIH. An established clinic or a famous doctor is no gurantee to success, which happens very often. He or she could have been too agressive.

RM,

As an example of a recent case, a chinese man came back for the 3rd treatment few days ago. The 2nd treatment was only 3 weeks ago. % of improvement is over 50% on photos. There was no PIH. Parameters I used on this guy is quite typical of what I use, at 40mJ, degree 3, distance 4 ( around 50 MTZ / cm2). However I use lower setting in a lot of other cases, particularly darker skin or tanned skin.

I am actually in Korea at this moment ( feeling bored in the Hotel and hence got time to come on this site ) and today at the factory we took the machine apart to understand all the machine set up inside. I am a bit of an engineer myself as I like to do this kind of dissembly and assembly. I am doing this because I helped to sell 5 machines in HK and I need to do the servicing too!

dr stephen

1. Dear Seeja
What you've gone through could be normal, or abnormal. What I mean is, skin reaction towards lasers all differ
according to their skin types. I had patients reacted my laser like you or ones reacted differently. Things could
happen. I personally think, your case was not the best case. But if you didn't have a burn through CO scan,
then almost everything could come back esp. pigmentation. Don't worry. I think your doctor will use his
laser more gently on you next time.
2. Dear Ricky Lau
Raised scars are not to be treated with MTS. You'd better treat them with Triam inj. with fractional lasers.

Hi Hanobi. I've been away so I didn't check this site. Anyway, I hope you have not done the CO2 laser as yet. My symptoms were all as I wrote. I still have my dark circles which have become really dark after the CO2. Also, you have to stay out of the sun for many months to come.

Dear Seonguen/ Dr Stephen,

Thanks so much for replying. My skin colour is almost back to normal but my dark circles are very prominent now. My doctor has said to wait for a few months and that it will go away eventually. I am wondering whether you have seen this in any of your patients who've had PIH. Did they have dark eye circles and did these go away. I am not sure whether I should apply anything because when I do I feel it becomes darker. I really don't know what I should do at the moment. Would be grateful for any advise. Thanks.

http://fhahnwnrvgtb.com fhahnwnrvgtb
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Dr. Yoon,

What is the purpose of the blood mask before Sellas? Is the improvement comning form MTS or is it from the fractional device?

thanks Dr Stephan

1. Seeja
I had several patients with PIH. PIH from lasers all dissappear eventually.
But, you need to make sure not to have any laser treatments until they do go away.
Ironically, my clinic doesn't really follow what I just said. Since my patients with PIH
feel bad about the color, they keep asking me to have laser treatments, so I do.
PIH dissappear after the treatments, but they do come back!

1) Topical tretinoin + Topical hydroquinon help the PIH get better.
2) Iontophoresis with Vit. C + Tranexamic acid help.
3) Electrophoresis with r-PGA help a lot.
4) Laser toning(by Q-switched Nd:YAG) helps
5) Oral Tranexamic acid with Glutathion help. 3 tab a day.
6) Jessner's(Coomb's) peel or different kinds of superficial to medium depth chemical peel help.
7) Do nothing also helps more than all the others I listed above.

2. CAN MD
Think about "Bastille Technique". Blood has all kinds of regenerating factors.
If you want to do it more in depth. Try PRP(Platet Rich Plasma) technique.
You can either use Regen® PRP kit or make PRP by using a centrifuge.

Thanks.

Hi Seongeun. Thanks so much for your reply. If it does go away then I shall be patient and listen to you and do nothing. My under eye area where the PIH is most prominent, is very traumatised already so am going to let nature do its work slowly. Thanks again for taking the time to reply to this. Seeja

Dear Seeja.
I feel very sorry about your skin. To do minimal or nothing is the best. If you want to do something, taking some medicine(tranexamic acid, glutathion, and vitamin c powder 3 times a day) will help. Electroporation is good too. Laser treatment is not recommended, if you want to do any laser tx. do use them with a minimum energy. If you have a digital camera, you could send me your pictures. Maybe I could give you more tailored advice.
I have 2 emails.
songwriter@nate.com
hisalvation@daum.net
Keep well.

Dear Dr. Stephen,

May I know your parameters for different indications for scars, resurfacing and pigmentations using colagen CO2 fractional laser ?

Dr. Cruz

Hello

Does anyone here in this forum know little about copper bromide laser? I am thinking of introducing a low cost and an effective skin rejuvenation laser machine at my clinic. Co2 laser is little too much ablative for me and fractional erbium is good but it wont keep the cost of treatment as low as the copper bromide laser. so i will appreciate if anyone here who have used the copper bromide laser can give me some advice on what it can do and whether it is worth to buy it.

Dear collegues,

Does any of you have experience or heard about the Unixel laser? This is a fractional CO2 laser manufactured by a Korean company.

How does Sellas compare with Fraxel:Restore? I visited a doc and he told me that Sellas are 'last' generation vs Restore; that it spits lasers unevenly and the result will not approach Restore.

About MTS, I did not get any results with MTS after doing it 4 times. How come that not many docs do this and some advise it is weak?

Dear dk.
I don't know about Fraxel:Restore.
I tend not to talk about something I didn't experience
with too much confidence.
Since I didn't use it, I don't know its effect.

About the doc you mentioned,
I don't think he knows about Sellas either.
'Cuz Sellas doesn't shoot uneven laser beams.

About MTS, it depends on
1. Your skill
Some doctors make difference. Others don't.
I don't try to look down on you.
But I had more than 1600 MTS cases,
they all came out well.
2. Passes: 1,2, or 3 passes
3. Depth of the needles
0.25, 0.5, 1.0, 1.5, 2.0
To have effects, it should be over 1.0 mm at least.
4. Quality of MTS
Some companies make poor quality products.
They bend, break, and get stuck on patients' skin.
I also had some terrible experiences with those products.
I'd rather pay little more money for a better quality MTS.

Guys, MTSs are quite strong,
and that's why I don't use them any more.
I use Dermastamp instead.
It's far better. I have had 600 cases already,
and the results are good.
It has 0.8mm, and 2.1mm.
0.8mm is not so painful, and 2.1mm needs
local lidocaine inj.

Hi Dr. Seung/Stephen,

I've had had a Fractional CO2 treatment last December 22, 2008. The doctor uses CoLaGen machine for my treatment. She put EMLA first on my face for about an hour, then proceed with the laser treatment for about 15mins. Today, January 10,2009, my skin tone lightened a bit.The texture improved a bit.Not that as rough as before.But the scars look the same. She said that I need 4 treatment to see 50% improvement on my acne scars. Yesterday, I went back to her clinic to do subcision but there was no medicine that was injected to my face. I haven't seen her procedure but i have seen one in youtube. She admittedly said that it's not the same as hers but this treatment prior to my 2nd laser treatment next week will help collagen build up underneath the scars. I'm an Asian. Probably Skin type IV - V.

Can you kind help me on the ff:
1. What are my expectations after 4 co2 laser treatment using the machine CoLaGen from a Korean comany?
2. Can i combine this laser treatment with Obagi Blue Peel treatment? I want to have a smooth, fairer, even-toned skin.
3. What treatment would be best for "RAISED SCARS"?

Please help.

Thanks,

Brian

Dr. Seung/Stephen,

Can you also add what topical ointments should I use after every co2 laser treatment and maintenance as well? ointment to reduce redness on face. Currently, i have copper peptide for post treatment, Heliocare SPF 90 Sunblock GEL, moisturizer. Can you kindly recommend me products that are not oily on the face as I'm an OILY-skin type. Also for skin lightening.

Do you recommend glutathione IV injection combined with glutathione oral capsules for skin lightening? Is this really effective?

Much appreciated for any help.

Thanks again,

Brian

hi brian,
i was considering the Colagen laser for my acne scars.But i am sorry to hear that u had no improvements to ur scars.Could u pls tell me who u had gone to for the treatment.Thanks.

welcome007@gmail.com

MF,
I just did my 2nd treatment/session using CoLaGen machine last Friday. The treatment itself is different in a sense that it's more painful as compared to my first one. I'm aware as discussed by my doctor that the settings will be set higher for every treatment succeded. Today is my third day and my face is still RED and swollen. There's a little improvment though.It's hard to tell.Need to wait when it completely heals.My doctor is located in the Philippines though.

Dr Seung,

I just had my first treatment using Sellas. To my dissapoinment, every pore and scar is still there as before.
Though my face healed very face from the redness and peeling. How many sessions should i undergo before seeing any results for my acne scars/open pores?

Dear brian, may, and others

I have tried many things to treat acne scars, including chemical peel, microdermabrasion, fractional laser, and excision. None of them work. In fact, acne scarring is incurable and none of the currently treatment can eradicate your scars. It is largely an unmet market. Conventional treatments only offer slight to moderate improvement. Excellent improvement is rare.

I invite you to join us in this thread where we talk about scarless healing
http://www.acne.org/messageboard/Scarless-Healing-t157005.html
Almost all of us here are dissatisfied with conventional treatments including traditional demabrasion, co2 laser resurfacing, deep chemical peel, excision, and the newer fraxel, affirm laser.

We are discussing some soon-to-be-released products including Juvista, Matristem, and Nexagon.
We are also setting up a foudation to fund projects of completely scarless healing around the world, so that completely scarless healing is possible much earlier.

I forgot to post the URL of the scarless healing foundation
it is
http:\\www.hopeskin.org

I've already answered Brian's questions through email.

Dear. May

If you have oily skin,
you need to undergo preparation before Sellas treatment.
Pores need to be cleaned up before treatment.
Otherwise you won't have any success.

I tell my patients that they need at least 3 sessions
to see any difference.

Dr Seong,

Thanks for your reply. Appreciate it a lot. Is it also possible that some scars may look more obvious than before after laser treatments. Why is this so?

May

Dear May,
It's possible. After laser treatments, your skin tries to regenerate in making new vessels to transport nutrients.
So your skin gets red, and that color makes your scar look more obvious.
But after the redness is gone, you'll see that your scars got better.
In some cases, treatments don't go well, and your scars could get bigger and worse.
But that's very rare.

hi everybody...
i am dermatologist working in pakistan and i am deperately looking for some CO2 fractional laser particularly for scarring and skin tightening..I am not in a position to buy expensive American ones and i am also afraid of quality of chineese lasers .....so any expert doctor out there plz guide me what to do...someone from korean company approached me and informed me about the MICROXEL7000 FRACTIONAL CO2 LASER(Scanner Type)
http://www.ezmedi.com/
please guide me about it and do recommend me if any other better than this..
Dr M Jawad Ch
Gujrat Hospital,Bhimber Road,
Gujrat
Paksitan
docjawad81@hotmail.com

Hi Dr. Seoung,
Just to share some of my experience for enlarged pore. I've been using Lutronics spectrapeel methods for years and got the best result for PIH and enlarged pore. Have you ever try this machine?

About the copper bromide laser, or dual yellow from Norseld. I think it the best for skin rejuvenation and asian melasma treatment. Their proper parameter come from joint development with Korean doctor last year. You may see it's protocol from Norseld's website at www.norseld.com. However, some deep epidermal pigment need fractional erbium-YAG for better result.

Hi Dr, Seoung,
I think the permanent make up machine is another great idea. I've used it for more than 20 patients and got the good result. Just like pure ablative fractional skin resurfacing with out coagulation, that's good for asian skin. I'm living in Thailand.

Hi Dr Seoung,

u mentioned that at least 3 treatments (for sellas) are needed to see improvement. Will there be any differences in the results, if these 3 treatments are done 3 months once as compared to 3 direct consecutive months straight?

May

Dr. Jawad
I am a Er:Glass user, so I don't know that much about CO2 fractional laser,
but one thing I can tell you is that Microxel has good reputation in Korea.

Dr. Joup
I've used Lutronics VRM III, and know very well about spectrapeel. I had good results for PIH and melasma, but not so much for enlarged pores.

Yellow laser made a big hit in Korea. About fractional Er:YAG, I didn't get that good results yet. I use Pixel. Since you came with a good report about Er:YAG, I should try it again.
If you have a specific protocol, please let us know.

Dear May,
I make sure that laser treatments have at least 3 weeks interval. But some patients have bad skin rejuvenation ability, so they don't always follow my policy: some have 4 weeks interval, others have 6 weeks.

As long as you follow safety rules, I don't think it matters which way you receive treatments.

Dear Dr. Seoung
I Erbium Yag through Fotona PS02 head. It's a fixed 36-37 pixels according to your seleted guards. Fotona supply 5 diameter guards for PS-02, 3mm; 5mm; 7mm; 10mm; 12mm. I use 5 mm diameter, that mean, about 180 pixels/sq.cm. My energy is 1J/cm2, since fotona didn't publish the final energy per laser column yet so I can't tell the exact energy for each MTZ. I usually done 5-10 pulse stacks and follow by IPL with 610 filter.

You may try Nd-YAG 1064 nm after fractional Erb-YAG too.

dr seong
many thanks and hopefully i will buy it soon..

Hi Dr. Shaharom Sulaiman ,
Smartxide in Thailand just quote the list price for me. It's more expensive than the Lumenis eCO2 (about $62,000). Will try another Korean machine next few week and will tell you the outcome.

Hi
I have been using the sellas 1550 from jan 09. I was reading all the old posts regarding this machine.
My practise is type IV - VI skin basically.

I suggest 4 - 6 sessions for my patients
We are not super aggressive since I am carefull about possibilty of PIH.

I have been getting consistent and very good results so far in all my patients for acne scars and accident scars.
Does anyone else have experience on indian skin???

I have been using 169ppa at 7 - 9mj. At over 10mj on face patients get PIH.

Recently I have started a trial for striae, any thoughts or pearls regaring settings for this would be appreciated.
Beofre this I was using the palomar 1540.

My patients had half & half while I was changing technologies and they seem to prefer Sellas.
But anesthetic is must in all my patients as it is a painfull procedure.

The palomar is more easily tolerable. But results are superior in the Sellas.
Any thoughts on this???

This sounds really nice. I should give it a try also

Good luck with your acne scars.

I would like to hear the answer to that question.

I would like more information about the Sellas fractional laser system.

Dear. Dr Chytra V Anand
The reason why you have a higher possibility to get PIH after 10 mj
is because of high density setting.

Low density - High Energy
or
High density - Low Energy

is safe.

But you don't have to go too deep like 1024 ppa density.
As for me, I go with 100 PPA always.
But for higher density, I add additional passes.

With 100 PPA you can go up to 20mj or 25 mj,
but you need to be very careful with burns.

If you have contact cooling device, you can apply the cooler
right after Sellas.
I shoot Sellas, then put the cooler right away, then shoot Sellas again.
About 3 times I repeat it.

And another tip.
Go with 2mm Tip, then you can have more pricise treatment with
smaller size scars and enlarged pores.

For striae,
Moving mode, 100 PPA, 10-20mj,
Biggest round shape.

Go about 2-3 passes,
then the indented lesions will arise.

Then change the shape into
smaller size(striae diameter size),
then go about 1-2 passes.

Apply EGF or PRP, or Growth factors.

2 weeks intervals.

Indian skins,
IV-V skin type is fine,
but with VI type skin,
Give it 1-2 trial treatments
with half the price or 1/3 price.
If the patient doesn't come with complications(pigment-wise)
then charge the full price, and adjust the Energy and Density.
I personally prefer 49 PPA.

I recently purchased Sellas Evo.
It's more sophiscated.
Laser beam quality is better, and
down time is shorter.

Dear Doctors,
I am a 57 years old Asian with tan skin.
My face has uneven tone, pigmentation and fine lines especially around my eyes. I too have dry skin. However, I do not have acne scar. Will the Sellas 1550 Erbium Glass Fractional Sytem help to improve my skin and get rid of my pigmentation? Your advice is greatly appreciated. Thanks.

Dr Seong,

Is ND Yag laser good for open pores problem? which is the best type of laser for this problem?

Many thanks for your advice Dr. Seong.
Can you also please advise me - how long does skin tightening last using the RF system. Do all RF brands produce the same result? Most aestheticans claim theirs is better than others. If I go for the RF treatment, do I still need to go for the Sellas system too? Look forward to your kind reply. Thanks and best regards.

Dear Dr. Joup
Thanks a lot for sharing your protocols.
I forgot to mention it.

Dear Annie
About Nd:YAG and pores, you'd better ask Dr. Joup.
He has better results than mine.
I believe that there are different ways to handle pores problem,
and Nd:YAG is one of them, but that's not my preference.
I use Nd:YAG for melasma + pores patients, not pores only patients.

Dear Nana
There are different brand names for RF machines.
There're low grade RFs, and high grade RFs.
Low grade RFs are for esthetic shops,
but high grades ones are for clinics and hospitals.
Their price ranges are different.
As far as I know, low grade ones are below 10,000 $,
but high grade ones are at least 30,000 $ and up to 150,000 $ or more.

Most of high grade ones last about 1 year at least
according to what they say,
but I think it depends.

Since our skins are under aging process,
it could last less.

Sellas is good too, but you asked about RFs,
So I will give you some big names;
Tenor, Relax F, Arneb, Polaris, Thermage,
Soprano(ST program), Davinci, etc.

Hope you find an exprienced good doc with
good machine.