By: Dr. Sharyn A. Laughlin, MD

I’ve been using laser technology in my dermatology practice since the mid-1980’s and needless to say that I’ve pretty much seen and played with them all. My husband and I pooled our savings together to buy our first laser. It was this massive, hugely expensive machine but we felt it was worth the investment to be able to treat port wine stains and other vascular lesions. We now currently have about 20 different light-based systems in my practice, Laserderm™, in Ottawa. They all offer a different type of precision and tailored results so I love that we can offer our patients the perfect customized solution for their needs. With that being said, here are some of my favourites based on your age range. Of course, it goes without saying that having a good skincare early on, will determine the level of photo and chronological aging that someone has and what level of intervention is needed on our part as well.

Ages 15-25: Teenage to Early Adult Skin

Acne is still one of the most common concerns in this age demographic so we’ll assess their skincare and also make sure that they are not exacerbating the condition with poor quality make-up and skincare. In terms of in-office treatments, I like using what we call Photo-Dynamic Therapy or PDT. We use a medical grade red light or the light system known as Broad Band Light (BBL), and combine it with topical treatments called Levulan or Metvix. The combinations of the different types of visible light (red,blue and even yellow) in combination with the topical medication penetrate the skin to kill the bacteria P. Acnes that contributes to acne, and we’ll also aim to reduce inflammation and red tones and provide overall healing.

For acne scarring, we are able to offer an array of services depending on the type of scar. For pink ones, we’ll use the Pulsed Dye Laser to remove the redness and the BBL to promote healing and reduce inflammation. For textural scars like pits, we’ll typically start with something like a fractional resurfacing. This means that the skin is partially ablated with small pixel sized wounds that penetrate deep into the dermis with a laser like the Fraxel or Profrac XC. We can also use a device that adds radio-frequency in combination with ‘needling’ all in the attempt to stimulate collagen and elastin. We’ll sometimes add Platelet Rich Plasma (PRP), which is the plasma taken from the patient’s own blood and is full of epidermal growth factors and layer over top of the treated area in an attempt to get it deep into the skin’s surface to promote healing. We’ll also use injectable fillers like Sculptra™ that actually stimulate the patient’s own collagen and elastin fibers to soften the appearance of the scars over time.

Ages 25-35- The Young Adult and the First Signs of Aging

This is the age bracket where the very beginning of photo-damage and aging begins to occur. We like to recommend that even at this early age, patients consider what we call Photo-Facials using systems like the BBL. Compared to a more esthetic facial like what you might get at a spa, photo-facials are not relaxing in the least but they are really effective at getting rid of brown and red tones and stimulating collagen and elastin over time. We normally start by recommending a series of treatments in the cooler months (i.e. not summer when people will get more sun exposure and be more likely to be tanned) to clear up any excess red tones like with mild rosacea and brown pigmentation. These are the ‘corrective’ part of the treatment series and by doing them in a series, we can increasingly but safely get more aggressive. People can then ‘maintain’ their results every year with 1-2 treatments. As long as they preserve their results with religious use of sunscreen and good skincare, they can continue to do ‘maintenance’ on their skin for most of their adult life and they will require a lot less aggressive intervention later.

We’ve also been seeing a lot more of this demographic getting preventative cosmetic injectables. It is definitely more of a high maintenance investment that people have to decide if they can afford to sustain from such a young age. It requires visits roughly every 3 months to maintain the effects over time. At this age, we’re really doing very micro-adjustments. I’ve said to my patients for the past 40 years since I first trained on injectables, you want to look stunning, not stunned. We’re also seeing people get cosmetic fillers like Juvederm™ for pure beautification, ie. they want to enhance their lips, cheeks or even chins for subtle face shaping. We do not judge but at the end of the day, we also have a light hand. My daughter, Sara, the CEO of The Sunscreen Company™ has always called it the ‘mother’s love’ approach. In other words, a mother wouldn’t ever try and make their daughter or son look like someone else or fit some standard mould of beauty. They appreciate your face for the way it is with all of its idiosyncrasies. If an injector has a ‘style’ (which you can often tell by looking at their own staff or patient testimonials) then maybe that injector is not for you.

Ages 35-55 years old: More Involved and Consistent Intervention

Aging concerns at this stage do become pronounced with more visible signs of wrinkles, pigmentation and textural changes. We often hear from both men and women that they are more concerned about how their appearance makes them seem emotionally. They are more distressed about looking tired or sad or angry than the individual wrinkle or collection of them. We’ll use injectable fillers to provide volume to improve these ‘social attributes’ so people look more rested. Again, the overall approach is to make someone still look like themselves.

In terms of light-based systems, we’ll start to upgrade regular Photo-Facials with layering additional treatments like the Halo™. People will notice at this age that they’ve lost a glow or luminescent quality to their skin and the Halo™ is lovely for giving that back with minimal downtime. We’ll also use some of the same technology as for acne treatments like with fractionated resurfacing with the Fraxel or Profrac XC and layering in radio-frequency needling or Platelet Rich Plasma. We have lots of ways to upgrade treatments especially for those that have not had the best skincare routines up to date. We can therefore get people to a good baseline with more robust corrective measures.

We’ve also pioneered a women’s health program since many women post-partum can have a multitude of issues when it comes to their pelvic and vaginal health. With many patients, their initial desire will be to ‘invest’ their dollars where people can see the results, i.e. their faces. But over time concerns like vaginal laxity, stress incontinence, dryness and orgasmic health will start to creep into the conversation. That’s the beauty of our relationships and treatment times with our patients, there is time for sustained ‘chats’ and women especially will start to share concerns that have bothered them but have decided they will just persist with. We work with a network of health care practitioners when appropriate but it’s nice that we also have some unexpected solutions for our patients that cater to a whole-body approach. It’s still skin even if the sun doesn’t shine on it.

55 Years Older and Up:

I would love to see more people consider full ablative rejuvenation for their photo-damaged skin. Not every practitioner handles this technology because it’s a very specific skill set that involves as much artistry as technical know-how. I’ve been doing it now for over thirty years and it gives the most dramatic results from a photo-rejuvenation point of view but it also helps to prevent a lot of pre-cancerous and even cancerous lesions by fully removing them. It completely removes layers of skin, erasing and buffing the skin so people have completely new complexions. Unfortunately at this age, we also see people for a lot of anti-cancer treatments. I’ll use a lot of topical treatments with Aldara, which is an immunotherapy based topical. It’s not admittedly a pleasant treatment while the patient is using it but it does deliver great results.

So there you have it! Choosing my favourite laser and in-office procedure is a little bit like choosing my favourite daughter, I have one but I don’t tell the others, I’m only half-joking. Skincare is always the beginning of the journey for people to get the skin they want but we’re blessed now a days to have a variety of options to get people to the best possible outcome. Our motto at Laserderm™ is the right technology in the right hands and we’ve been caring for people with that attitude for almost forty years.

A Derm’s Favourites: My Favourite In-Office Procedures Based on Your Age

By: Dr. Sharyn A. Laughlin, MD