More than skin deep

Laser technology is being used widely for numerous medical conditions, including various skin problems.

Indeed when it comes to the body’s larg-
est organ, laser companies claim to fix just about anything. Curing skin diseases and removing unwanted hair and tattoos are high on the list, as well as repairing cosmetic issues like wrinkles, acne, rosacea, toenail fungus and more. All of these are done in-office with topical numbing creams (needed in some cases) and offer quick results. But do lasers really work? What are the costs? And are there alternatives to lasers that can improve your skin?

Here is a menu of what lasers can do to help:

1. Hair removal. In the past, the only thing that worked for permanent hair removal was a process called electrolysis, which was slow, painful and took forever to treat large areas. Laser hair removal is now the standard for hair removal and the technology improves every year. “The FDA requires us to say ‘permanent hair reduction,’ not removal,” says Dr. David Bank, director of The Center for Dermatology, Cosmetic & Laser Surgery in Mount Kisco. But most women find that after a few treatments, the results are indeed permanent. In the past, dark-skinned women could not use laser hair removal, because lasers didn’t react well with melanin. But many of the newer lasers can be used on all skin types and colors. Just be sure to ask ahead of time if the physician you choose uses lasers appropriate for dark skin. Costs vary depending on the size of the area treated and how many visits are needed for best results. Treatment for a small area like upper lips can start at $50; full bikini areas start at about $150.

2. Broken blood vessels, veins, rosacea, some scars and fine lines: The Vbeam laser has been a godsend for people suffering from unsightly rosacea or broken blood vessels on the face, as well as many other issues. Using a quick burst of intense light, the broken blood vessels or capillaries under the surface of the skin are destroyed, but the skin is not. Depending on the severity of the condition, more than one treatment may be necessary, but for most cases of small broken blood vessels or mild rosacea the effect is immediate. Post-treatment swelling usually lasts only a day or two. Some rosacea patients form new broken vessels in time, so maintenance treatments may be necessary. “The reason these treatments are so costly,” Bank says, “is the laser technology. It costs a lot to own and operate these machines.” Costs vary widely depending on the area being treated. The average cost starts at about $400. Insurance doesn’t cover this.

3. Deep skin resurfacing for deep acne scars, sun damage, discoloration and wrinkles. CO2 laser resurfacing is the go-to laser for deep scars or resurfacing the skin completely, but people with dark skin should avoid this type of laser as it can produce uneven results in skin color. Unlike more gentle laser treatments, this intense treatment requires a week or more of downtime as your face heals, but the results can be dramatic. The costs, starting at about $2,500, are also dramatic, especially if you need a second treatment for very deep scars and wrinkles.

4. Gentle skin resurfacing for acne scars, sun damage, discoloration and wrinkles. Unlike the CO2 laser, which can make dramatic changes in one treatment and requires downtime, the Fraxel laser is meant to resurface with one or more treatments, has little or no downtime and can be used on all skin colors. “There are two different Fraxel lasers,” Bank explains. “The more intense is the CO2, which requires one or two treatments and is ablative. The Fraxel model is a milder laser that requires more treatments, but is non-ablative.” Fraxel results will be less dramatic than the CO2, but like the CO2 laser, Fraxel also helps build up collagen under the skin and improves overall skin tone and quality while working to remove scars and skin discoloration. Also in the gentler category is the Erbium: YAG laser, which some doctors prefer. Depending on condition and areas to be treated, costs range from $750 to $1,500 per treatment, and the maximum benefit is usually achieved with an average of three to five treatments, spaced two or more weeks apart.

5. Acne. Lasers are sometimes combined with newer light therapies and other acne treatments to control acne, because results with laser and lights are not usually complete or permanent. Diode lasers are often used to prevent future breakouts by destroying the sebaceous glands that produce acne, but they aren’t considered effective for cystic acne (which can respond very well to an oral medication such as Accutane, generic name isotretinoin). In general, lasers are better used for removing post-acne scarring and are not the go-to method of acne treatment at this time. Yet they might be one day, because technology changes rapidly in the laser world. Costs for laser acne treatments range from $200 to $400 per treatment, and more than one is usually needed.

6. Treatment for psoriasis, eczema and vitiligo. The Excimer laser has been an exciting new development for the treatment of psoriasis, eczema and vitiligo (white patches on the skin where the cell production of melanin has stopped). Several treatments over the course of a few weeks are necessary, and insurance often picks up the costs. If you have no insurance, doctors will usually negotiate a price with you.

7. Tattoo removal. It is estimated that about 25 percent of the population in the United States has tattoos, and about half of those individuals will eventually want all or some removed. The easiest tattoos to remove are those with blue or black ink, so keep that in mind if you decide to get a tattoo (because chances are good that you will want it removed one day). There are very specific lasers that are used for this sort of work, such as the Q-switched, Nd:YAG or the PicoSure, which require several treatments. Sometimes, there will be discoloration of the skin remaining (either light or dark patches). Costs vary depending on the size of tattoo and number of treatments needed, but expect to pay between $1,000 and $5,000.

8. Toenail fungus. Using lasers to treat toenail fungus is relatively new, and studies are still being done to assess the effectiveness and to find which laser technology works the best. Lasers might be a good alternative for you to try rather than taking strong oral medications like Lamisil, which has side effects and thus can’t be taken by everyone. There are no side effects for toenail laser treatment. Insurance won’t pay, as toenail fungus is considered “cosmetic” and not medically necessary. And even after you zap the fungus, you must return to good foot hygiene and topical creams, because the fungus can return. The cost is about $1,000 for treatment.

New machines and technology improvements are constantly arriving. Bank says: “Call your dermatologist, tell them what you need and ask if they have the right machines to treat your condition.”

And if lasers are too expensive for you, or maybe you think they are just “overkill” for your fine lines, skin discoloration, brown spots and mild acne, try do-it-yourself at-home skin peels, which, when done correctly, can give your skin quite noticeable improvement for just a few dollars. My book, “The Skin Regime: Boot Camp for Beautiful Skin” (available on Amazon.com), teaches you all the inexpensive do-it-yourself methods. (Bank was the technical adviser for the book as well as this article.) Try the new 1-4-All Peel by The Skin Regime, which can be layered for a mild or strong peel, depending on what is right for your skin type.

To learn more about “The Skin Regime” book and the 1-4-All Peel or to purchase the peel, visit TheSkinRegime.com. To reach Dr. David Bank and his team, call (914) 241-3003 or visit TheCenterForDerm.com.