Originally created 04/08/01

Wrinkle laser wins following



The warm pulse against Vickie Kerzic's face leaves no mark in its wake. But months after the pass of the laser on her skin, it might make the lines on her face less noticeable.

Mrs. Kerzic, 44, was undergoing a form of noninvasive plastic surgery using a new kind of laser that Evans plastic surgeon Keith Davis is offering at his Plastic Surgery Pavilion of the South. The laser, called an NLite laser, was developed in Europe and is gaining acceptance in this country.

The advantage of the NLite over other lasers such as the CO2 laser is it doesn't destroy the outer layer of skin while stimulating the layers underneath to produce more collagen. The strengthened skin shows wrinkles less easily, Dr. Davis said, though the effects can be subtle and might take three months to show. But there is far less to recover from with the NLite, he said.

The idea for what is called laser skin resurfacing began with patients with superficial burns on their faces, Dr. Davis said.

"Years ago, burn surgeons realized that people with superficial burns on their face were reporting back to them that their skin looked significantly more youthful (when it healed)," Dr. Davis said. So in the early 1990s, physicians began looking for something that could deliver that type of superficial burn and came up with the CO2 laser.

"The problem with CO2 lasers as the popularity rose was now patients realized that they pretty much looked like Night of the Living Dead for a month (after the treatment)," Dr. Davis said. "There were severe restraints on what they could do socially. They couldn't go out in the sun for six months to a year."

In order to get down to the collagen-producing layer, the laser destroyed the outer layer of skin, leaving the tender layer underneath exposed and open to other complications.

"So then they started looking to see if there was a wavelength of light that could go through the skin but not affect the epidermis but only affect the collagen," Dr. Davis said. Physicians in Wales developed the NLite, a form of pulse dial laser that targets the red hemoglobin and deoxyhemoglobin in the blood vessels just underneath the outer layer of skin.

"It irritates the blood vessels, and when blood vessels become irritated they become what we call leaky," said Diane Duncan, a plastic surgeon in Fort Collins, Colo., who will present her findings on the NLite in May at a meeting of the American Society for Aesthetic Plastic Surgery. The irritated blood vessels secrete inflammatory factors such as histamine and procollagen, Dr. Duncan said.

"These inflammatory mediators stimulate the process of fibroblast formation or new cells within the dermis, thickening it right underneath your wrinkles," Dr. Duncan said. "Basically what it does is props up the wrinkles so there's not a weak point underneath the wrinkle anymore."

That in turn makes the wrinkle less noticeable. Dr. Davis said he expects a 50 to 85 percent reduction in noticeable lines from the laser treatment.

It just takes a while. It can be three months before the effect is noticeable and the slow change might not be recognized even by the patient, Dr. Davis said.

"Patients come back and say `I'm not sure how I look better but people are coming up to me, saying, "What have you done? Have you changed your hair? Have you lost weight?"' Then when we pull out their pictures, they can see the results," Dr. Davis said.

It is also less expensive - about $1,200 vs. $5,000 for the other laser - Dr. Davis said. It is attracting younger patients, baby boomers in their 40s and 50s, who might not have considered having something done before, Dr. Duncan said.

"I actually see more people coming into the office who probably would never have come in," said Dr. Duncan, who estimated that NLite patients now account for more than 20 percent of her practice's revenues.

The idea of having some work done had occurred to Mrs. Kerzic before "but the downtime was probably too much," she said. With the NLite procedure, she lies back on a chair as if sitting pool side, and Dr. Davis moves the laser around her face, the yellow light flashing as he goes. In a matter of minutes, she is getting up and walking out of the office. That is another advantage for patients, Dr. Duncan said.

"They may not want anyone to know they've had anything done," Dr. Duncan said. "They come in at lunchtime and have the NLite done and go out to dinner that night, and no one will ever know they've had something done."

And it does make a difference, said Mrs. Kerzic, a recovery room nurse at Doctors Hospital Surgery Center.

"My face looks brighter," she said.

Reach Tom Corwin at (706) 823-3213.