From
Dr. Diana Ponsky
UltraClear laser skin rejuvenation: technology overview and clinical applications
With Dr. Eve Trancito · hosted by Dr. Diana Ponsky
Chapter 1 of 5
Technology overview
Introduction and UltraClear technology overview
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What the experts said
UltraClear can safely treat all Fitzpatrick skin types (I-VI) for skin resurfacing
People with darker skin tone (higher Fitzpatrick scale) are at higher risk of pigmentation issues after skin resurfacing procedures including lasers and chemical peels
UltraClear uses technology that produces less heat, making it more comfortable for patients, with some settings not requiring skin numbing before treatment
Lesser degree of heat from UltraClear results in less downtime and faster skin recovery from treatment
Laser coring creates micro-channels of tissue that are allowed to contract during healing, providing unique ability to treat skin laxity
3D Miracle is geared towards skin with less complexion changes and younger type skin, treating coloration differences and sun damage
Some patients will need more than one 3D Miracle treatment to achieve desired results
Neck skin is thinner, so more improvement may be expected with just one 3D Miracle treatment in that area
Clear setting treats dyschromia (pigmentary changes), skin texture and tone, and requires topical anesthesia
Clear setting treatments for sunspots or solar lentigines are usually spaced about six weeks to two months apart
Ultra setting penetrates down to the dermal region and can induce collagen remodeling at that level
Ultra setting can help with scar remodeling because it penetrates to the dermal layer of skin
Ultra Clear combined setting helps with deeper wrinkles and skin contraction/remodeling
Ultra setting requires a few more days of downtime, still in the range of about a week
Laser coring requires about 12 days to two weeks of downtime because it goes down to the hypodermal layer
After two days of Ultra treatment, patients should be able to cover redness with makeup
Providers ask for about a week of recovery time and prefer patients not wear makeup every day to allow skin to heal and breathe
In skin of color, hyperpigmentation occurs when something is inflamed, leaving spots from past acne eruptions for long periods
UltraClear laser helps get rid of pigmentary changes from acne faster
For neck laxity like shown in example, surgery is usually discussed first, but if patient cannot have surgery, Ultra Clear or coring could be a helpful modality
Laser coring punches out little bits of uneven skin, allowing surrounding healthy skin to contract and heal around it better
The goal of laser coring is 50% effacement of deep etched-in lines
Laser coring requires about 12 to possibly 14 days of downtime
Most common area for laser coring treatment is the marionette creases around the mouth
Laser coring is used in the submental or under chin area, especially if patient has had one or two facelifts before, as that area tends to crinkle up
Perioral area (around the mouth) is one of the areas very often neglected in facial rejuvenation, and even patients who have been facelifted can continue to age in this area
Fat is a volume enhancer; lasers work above that in the skin level, so UltraClear is safe if patient has had fat transfer
Some ultrasonic devices have gained reputation for getting too deep into fat layer and leaving patients with signs of aging when used improperly; UltraClear does not go deep into the fat layer
For 3D Miracle maintenance, if done quarterly it is great; frequency depends on lifestyle (sun exposure) and other maintenance (Botox use)
If patient gets laser coring with vast improvement, they may not need another session for three to five years
When laser reaches deeper layer where collagen forms (deeper into dermis), controlled injury triggers pathway to remodel collagen
Microneedling is collagen induction therapy using mechanical pins that go into skin
Microneedling will not remove blemishes like pigmentary changes, but can help with acne scarring and fine lines and wrinkles
Microneedling is probably comparable to 3D Miracle, but 3D Miracle can also remove brown spots while microneedling cannot
For older patients, microneedling does not do as much to contract skin or cause collagen remodeling that appears as tightening
Face lifting lifts tissues but does not change the character of skin; brown spots and wrinkles remain, just pulled tighter
Facelift pulls skin tighter but lines and wrinkles etched in remain until a laser runs through it
Laser treatment or coring after facelift is often very helpful around the mouth area and under the chin region
For 3D Miracle, patients can come in every month safely and that would be helpful
For Ultra or coring treatments, spacing is usually six to eight weeks between sessions
With fully ablative CO2 laser, many practices wait a full year between treatments because actual collagen remodeling takes months to a year to finish and see final results
For deeper treatments targeting aging and deep wrinkles, body needs time to heal and undergo collagen remodeling, which can take six months to a year
UltraClear works fine with Botox and Juvederm; they can be done simultaneously with no reason to avoid getting neurotoxin or filler treatment at same time, other than dealing with normal possible side effects like swelling and bruising
IPL targets pigmentary changes; CO2 is for skin resurfacing to treat signs of aging like wrinkles; UltraClear can treat skin surface like IPL and deeper layers like fully ablative CO2 at the same time
Can start with IPL first, but if dark spots are more resistant, turn on Clear function of UltraClear because it can go deeper and be more precisely tuned to resistant brown spots
Aftercare for moderate to severe treatments: day of treatment includes cold washcloths/gauze and moisturizer/ointment to protect skin barrier for 2-3 days; wash with mild vinegar-type wash; no extra products for two days; after 2-3 days can use sunblock and makeup
For 3D Miracle, aftercare is much less intense and most regular skin care can still be used
For laser coring, aftercare timeline is extended; by third day can put on sunblock and makeup and be out running errands; skin can be closer to naked without extra cover-up around 6-7 days out
Erbium and UltraClear are very similar, about the same wavelength; before UltraClear came out, Erbium was the workhorse
UltraClear is a cold fiber laser, more tunable than Erbium, dispenses less heat causing less discomfort, faster and more precise, with healing time shorter by about two days compared to Erbium
With Erbium, treatment would stop at Fitzpatrick skin type 3 or 4, with those patients at extra risk for hyperpigmentation; UltraClear is safer for more skin type varieties
Laser coring safety for African-American skin depends on how dark the skin is and must be assessed case by case; there are protocols to help prevent pigmentation issues
According to literature on UltraClear, laser coring is not necessarily safe for the darkest skin tones and Fitzpatrick types
3D Miracle is a 10-minute treatment with no discomfort and no downtime