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”Hi, Dr. Corey Mass on Looking Your Best. I have a patient that has wrinkles under the eyes, we call dermatochalasis. A lot of facial aging changes, but I was really concerned about those lines under the eyes and then the little curtains of the perioral lines around the mouth. So I would thought I'd take you on a little tour of what we're going to do and how we're going to do it for treating with fractional laser resurfacing for little lines around the mouth. So come on in, let's take a look.
I am just going to start with some little tiny numbing shots here and an alcohol wipe and then just lift your chin way up for me and I’m just going to go right around, and this will numb the area around your eye. We're going to do around the eye and then a little around the mouth too. There's a little mental nerve they call it. I once did a mental nerve block and the lady said "Well when can I be able to think clearly again?" It’s not really your thinking mental nerve, it’s the name of the little nerve that supplies your lower lip, comes out of a little bulb by the bone there and so I’m going to do a little bit for your lower lip here and it’s just the series of little drops here that I’m going to be giving you.
I've got the memory set so I have presets that I use for treatment. For the lower lids I’m just going to do the modest power setting and I do a single pulse with each step. I can turn that on and off and the density, I go a little more density because she's got pretty good wrinkles so that's going to be for the eyes and then when I step it up a notch for around the mouth and really that's the deep effects so the deep effects is 300 Hz, 17.5 millijoules. You can use different sizes & shape, this is a good one, and it’s important to remember this is a .3 millimeter 300 microdot thermal injury that I’m going to generate when I do did deep effects and the patterns I’ve got it only 20% coverage with 300 microns being the diameter of the area of thermal injury.
So with each little pulse here that I lay down and this is a greed pattern of about 8 millimeters square but if we look on a really microscopic level we'd see that there are really tiny, tiny little holes or little tunnels of thermal injury that based on my setting are going into the dermis, feel that little stinger? Okay I’ll get away from that area, and with that little area of thermal injury, the body is responding and its responding by making new skin cells by stimulating collagen that the collagen producing cells, the fibroblast that live in the dermis, the second layer of skin, and so they're making new collagen and they're also stimulating the remodeling in the reorganization of the existing collagen layer that's already there, which as we age it gets all tangled and matted up. So it doesn’t look like young collagen, it’s all nice even bundles that are evenly distributed and that's what gives our skin all its elasticity, is this nice even bundles of collagen that are laid side by side almost like the wires in an electrical cable, and then as we get older this little bundles or fibers get all tangled up and that's how skin, at least in part, how skin loses its elasticity.
So on that overlapping and what really can't be seen with the naked eye is that along with the scanning pattern these are only the little tiny dots that I’m if you will, drilling using the laser into the skin are only 300 microns. That's .3 millimeters and there's 24 millimeter in an inch. So it's .3 , 1/3 of 1/24th of an inch is the size of the diameter of the hole.
Now the hand piece is connected, this sections is hooked up and this hand piece is a little different and this particular hand piece as I turn it on, is going to have a larger spot side but more importantly when I shoot the device, I’m going to be shooting it in a way that has a much more superficial or scalloping type of injury rather than a deep drilling injury and one can see the pattern that I’m going to be shooting in. I can make this larger or smaller and I’ll take a ton blade please, and then I always check with the tan blade to make sure the pattern is correct.
So if you look at that pattern I separated them and you can see that there is a pattern to this if I keep it real still and square. They're laid down not in even rows but in uneven patterns. So that's the principle and these are much wider dot if we look at the other machine you'd see that the dots were much closer together. And at the end we're going to have you cooling of your skin surface. Feels a little bit like a sunburn but as the local wears off, that “sunburn” feeling will go away. You can literally see the skin contracting there as we do it which is nice because the collagen contraction is a big part of this.
So that's the whole treatment. Our instructions after we do the treatment are pretty simple. We're going to put some biafine on here, which is a special medicine that we have, it is a topical that we will use immediate in the post-operative period.
As always it’s my pleasure to answer your questions, you can find out more information at MaasClnic.com. You're certainly welcome to either send videos, photos or just questions to our video blog at DrMaas.com and I’m happy to answer those questions. As always Dr. Corey Mass on Looking Your Best.”