How to Choose the Right LaserWith the power to absolve you of wrinkles, acne scars, unwanted hair, fat, college tattoos and sun damage from all those fun-while-they-lasted Nantucket summers, lasers are one of dermatology's most valued tools. But with growing interest comes growing confusion: Between ablative and non-ablative, fractional and pulsed dye, Q-switch and IPL, how are you supposed to know which laser is right for you? We asked the country's top dermatologists to shed light on what you need to know now about lasers.
How do I know which laser is best for me?
The quick answer: You don't. But a board-certified doctor with years of experience does. Resist the urge to ask for a specific laser by name-don't be swayed by marketing-and instead choose a doctor who has plenty of experience (ask for photos of patients they've worked on) and at least three to five different machines. The best results for any condition are almost always achieved through a combination of laser types.
"The doctors with the most experience will have several machines and can be choosy about which laser and in what order," says Washington, DC, dermatologist Dr. Tina Alster. "I often use two or more lasers. For instance, if someone has red or raised scars, I might use pulsed dye to remove the red and flatten it down, and then follow with a fractional laser to resurface. For fat reduction, I generally use one laser to remove fat and another to tighten." For added peace of mind, seek out a doctor in your area who has published on the topic.
Isn't the newest technology the best technology?
Not necessarily. "Just because someone has a piece of equipment doesn't mean they know how to use it," says Cambridge, Massachusetts, dermatologist Dr. Ranella Hirsch. In many cases, an older laser will be more effective because a doctor has more practice with it. Or it may just be more effective. "The smartest patients don't come in and say, 'I want such-and-such laser,' " says Hirsch. "They sit down and say, 'This is what bothers me. What can I do about it?' "
It's way cheaper at the med spa. Can't I go there?
Most devices are safe, but the laser is only as good as the person handling it. "One of my wisest medical school professors put it to me this way," says Dr. Hirsch. "Doctors aren't there for the 95 percent of cases that have no complications. You're there for the other 5 percent.'" When something goes wrong, says Hirsch, it goes terribly wrong. If you don't have someone who knows what they're doing, you can wind up with permanent damage.
A good doctor will screen you in advance as well as monitor you along the way to check how you're reacting and adjust treatment accordingly. "Every day I have at least one person coming in with a side effect or complication that could have been prevented had the right laser been chosen or the right follow-up been conducted," says Dr. Alster. But it's not just about worst-case scenarios. "You have to understand the tissue to optimize the clinical effect," she adds. "And to understand tissue, you need training."
Fine, then. Dermatologist or plastic surgeon?
It's most important, says Dr. Alster, that whoever you see is board certified, and that skin care is a core specialty. "There is no way a gynecologist is going to resurface someone's face the way I can," she says, "but there are a lot of them out there doing it." If you're only looking for laser treatments or injectables, you're often better off seeing a cosmetic dermatologist who is more likely to perform the work herself instead of having an aesthetician or assistant do it. But if you also want to talk about having, say, an eye lift at some point, says Dr. Hirsch, a plastic surgeon-again, one equipped with at least three to five machines-may make sense.
What's the most responsive area to treat?
Dr. Hirsch sums up the majority of her laser practice as "hair, wrinkles, sun damage, red spots, brown spots," noting that most patients come in for work on their face, neck and décolletage, and hands. "Hands are majorly in demand these days," she says.
What results can I expect?
Everyone's different-genetics matter-but your doctor should be able to provide a range of what to reasonably expect, and how fast, especially after he or she sees how you respond to the first treatment. "It could be three to five treatments, or four to six," says Dr. Hirsch. "Some people may see results after one. But you should always ask, 'What can I expect?' "
Should I use at-home lasers between treatments?
"They're pricey, but I always say that if it buys you one less visit with me, it's worth it," says Dr. Hirsch. "But in my experience, few people stick with them."
Are IPL and LED treatments also lasers?
There are other medical-grade treatments that use light but aren't lasers. Intense Pulsed Light (IPL) and light-emitting diodes (LEDs) both use light to even out skin tone and produce collagen, with IPL being more powerful. These treatments are more often administered by aestheticians rather than doctors, but Dr. Alster recommends they should always be done in a doctor's office, since side effects due to a therapist's inadequate experience can still include blisters, scabs, pigment problems and/or scarring.
Can I have laser work if I just got Botox?
Yes, indeed. Just be sure to disclose any medications, recent sun exposure-even if was just last week's alfresco lunch-or recent cosmetic work so your doctor can choose a laser accordingly. "Many of my patients travel frequently and come back saying 'I got this done in London' or 'I got that injected in Rome,' " says Dr. Alster. "But then they don't know exactly what 'it' was. Always find out. People ask more questions of their car mechanics than of those working on their face."
How do I know when to start getting laser work?
This one's easy, says Dr. Hirsch: "When it bothers you."