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◗ Aesthetics Section

Fractional CO2 Therapy Combats Aging Skin
With Minimal Risk and Downtime
by Kevin A. Wilson

Reducing the aged appearance, especial-
ly in the face, is perhaps the most sought-
after cosmetic treatment. “Aging skin is
characterized by stretching, sagging and
loss of elasticity, pigmentary alterations,
and disorganization of collagen bundles
which causes wrinkling,” says Thomas
T. Jeneby, M.D., board-certified plastic
surgeon and Medical Director of The
Plastic & Cosmetic Center of South Texas.
“Smoking and exposure to solar radiation
exacerbate these processes.”
Noticeable and even dramatic results before After
are possible with modern procedures, the
most effective and well-known of which
Before and after photos of results with DOT Therapy.tm
is facelift surgery. For skin tightening, the
Courtesy of Eclipsemed, Ltd.
gold standard has long been ablative CO2
laser resurfacing, in which a thin layer of
epithelial tissue is vaporized with a CO2
laser, causing collateral thermal damage to tinued. “For someone who works, taking the efficacy of ablative methods. Optical
deeper tissues. The natural healing process three or more weeks off isn’t appealing, scanner technology creates patterns of mi-
creates healthier, younger-looking skin. even if they expect remarkable results.” croscopic ablative wounds over the treat-
Simply put, the downside of cold steel In response, the number of safer, less ment area with a CO2 laser at a depth
surgical and ablative laser techniques is invasive modalities with low risk and and power sufficient to cause visible skin
that they ask a lot of the patient. Post- downtime has skyrocketed, but at the tightening during the natural healing
procedure care is extensive, discomfort expense of efficacy. “Nothing replaces a process. Because the surrounding tissue
during recovery is unavoidable, and down- facelift,” explained Dr. Jeneby. “And deep is spared, re-epithelialization is rapid and
time is lengthy. Risk of complications thermal damage is required to promote downtime is minimal. Fractional CO2 re-
such as infection or scarring is significant. sufficient reorganization of collagen to surfacing has been shown to stimulate the
A 2005 survey by the American Society create the tightening seen with ablative wound healing response, promote neocol-
for Aesthetic Plastic Surgery1 documented techniques.” lagenesis and create a tightening effect.3
reductions in some surgical aesthetic The development of fractional pho- The SmartXide DOTtm Laser (DEKA),
procedures, with concurrent increases tothermolysis,2 which uses proprietary a fractional CO2 device, allows practitio-
in the number of patients undergoing scanner technology to create patterns of ners to perform fractional CO2 resurfac-
nonsurgical procedures. “The patient is microscopic subsurface wounds with an ing safely, easily and quickly. Treatment
always looking for miracles with no pain erbium-doped glass fiber laser, was a land- with the SmartXide DOTtm is called
or downtime,” says Deborah S. Sarnoff, mark in aesthetic medicine. By preserving Dermal Optical Thermolysis, or DOT
M.D., Associate Clinical Professor of Der- barrier function as well as surrounding Therapy.tm “People love the results, even
matology at New York University Medical tissue, re-epithelialization is rapid and on lower settings,” said Dr. Sarnoff. “In a
School. Dr. Sarnoff is in private practice downtime is minimal. “The downside of week, temporary edema gives the skin a
in Manhattan and Long Island. using the erbium laser is that it causes less glow that attracts compliments. Collagen
Also, the past decade has seen aesthetic thermal damage than the CO2,” said Dr. reorganization takes a few more weeks.
medicine become more accessible to the Jeneby. “This was a plus because it speeds It doesn’t completely erase wrinkles or
average person, which has positively influ- healing, but it limits efficacy.” replace a facelift, but it does a great job
enced public perception. “Now more Fractional CO2 resurfacing, a new quickly and safely, even with a single
than ever, we see women from two in- modality, combines the safety and low
continued on next page
come families coming in,” Dr. Sarnoff con- downtime of fractional techniques with

176 ❘ ANTI-AGING MEDICAL NEWS SUMMER 2008
◗ Aesthetics Section

FRACTIoNAl Co2 THERApy continued from page 176

treatment. For the usual mix of wrinkles,
fine lines, crêpe-like neck, loose skin, and
mottled pigmentation, it’s my treatment
of choice.”
According to Dr. Sarnoff, patients
receive topical anesthetic for 30 min-
utes, without occlusion, followed by a
thorough cleansing. During treatment,
patients will wear goggles or, if the eyelids
are to be treated, orbital shields. Treat-
ment typically requires only a single pass
but more can be layered, or “stacked,”
on tougher areas. “Average treatment Figure 1: Wound shapes from fractional CO2 resurfacing devices. Some devices create deep wounds that
time with the device itself is less than 15 cause unnecessary pain and edema but not enough collateral damage (left), and some lay down patterns
minutes, and downtime will be anywhere of shallower, wider wounds that leave less undamaged epithelium and increase healing times (right).
from three to seven days, depending on The SmartXide DOTtm creates wounds deep enough to promote neocollagenesis and narrow enough to
the treatment settings, which are quite allow rapid healing (center).
flexible,” she said.
Flexibility is a key feature of the Smart-
Xide DOT.tm “You can adjust DOT pat- combine treatment with other things CoNTACT INFoRmATIoN
tern density to treat at differing degrees of such as dermal fillers.”
aggressiveness,” said Dr. Sarnoff. “Adjust- “Whether it’s aging skin, acne scars, Thomas T. Jeneby, M.D.
ing the energy level (up to 30 watts) melasma from birth control pills, or sun The Plastic & Cosmetic
would help you treat dyschromia, for ex- damage, anyone from their late thirties Center of South Texas
ample. Changing dwell time controls the to sixties with wrinkles, spots, or acne is Deer Oaks Business Park
depth of the wounds. This lets you treat an ideal candidate for DOT Therapytm as 7272 Wurzbach Bldg 8
other areas of the body such as the décol- long as their skin isn’t too dark and they Unit 801
letage or the back of the hand, which typ- don’t smoke,” said Dr. Jeneby. Because San Antonio, TX 78240
ically don’t heal as well. You can even flip smoking inhibits healing, Dr. Jeneby +1 210 270 8595
a switch and go fully ablative.” Aggressive performs a urine dip test before and one tjeneby@yahoo.com
parameters enhance efficacy. Conservative week after treatment.
settings reduce downtime. “You may also The SmartXide DOTtm laser device is Deborah S. Sarnoff, M.D.
switch to a pen-shaped handpiece to do distributed by Eclipsemed, Ltd. in the U.S. Cosmetique Dermatology, Laser &
work freehand,” she added. Learn more at www.dottherapy.com. u Plastic Surgery, LLP
The shape and depth of the wounds
31 Northern Boulevard
created by the laser set the SmartXide REFERENCES
Greenvale, NY 11548
DOTtm apart from competitors. Opti-
+1 516 484 9000
mal ablative thermal damage is created 1. ASAPSS. American Society for Aesthetic Plastic Sur-
gery Survey, 2005.
+1 212 794 4000 (Manhattan office)
in a deep, rounded cone 350 μm wide.
deborah.sarnoff@cosmetiquemd.com
Competing systems may create deeper 2. Manstein D, Herron GS, Sink RK, Tanner H, Anderson
RR. Fractional photothermolysis: a new concept for
wounds that cause unnecessary pain and cutaneous remodeling using microscopic patterns of Kevin A. Wilson
edema, and are too narrow to effectively thermal injury. Lasers Surg Med, 2004;34(5):426-38.
General Partner, WilWrite LLC
stimulate neocollagenesis; or saucer- 3. Hantash BM, Bedi VP, Kapadia B, Rahman Z, Jiang K, 5111 West Genesee St.
shaped wounds that are too shallow and Tanner H, Chan KF, Zachary CB. In vivo histological
evaluation of a novel ablative fractional resurfacing
Camillus, NY 13031
wide, leaving little undamaged tissue and
device. Lasers Surg Med, 2007;39(2):96-107. cell phone: (315) 559-0455
increasing healing times (Figure 1).
yohajin@aol.com
DOT Therapytm is also useful for other
indications, such as acne scars, for which
KEvIN A. WIlSoN has written dozens of
the pen-like handpiece is especially handy.
articles on a variety of topics and de-
“I’ll go freehand to sculpt the periphery of vices in aesthetic medicine. He also has
the scar before using the scanner hand- helped prepare scientific literature for
piece for the full face,” Dr. Sarnoff said. numerous aesthetic device compa-
nies and practitioners around the world..
“It’s a dynamite combination. I also like to

SUMMER 2008 ANTI-AGING MEDICAL NEWS ❘ 177