LAUSR

The holy grail of rejuvenation remains elusive despite the development of many devices which purport to achieve “Skin Tightening,” a term that the FDAdoes not recognize. And despite the accuracy of the data in this excellent study, it is unlikely that any really useful degree of skin tightening will be achieved for the full face by closure of these fractionally ablated holes. While such a technique might be of value over a relatively small area, there will be issues when applying this to the full face because of the lack of grasp of the contractile adhesive dressing (CAD) to skin that is bleeding or oozing tissue fluid. In the image 2B, one can see that the CAD applies its force because of good adhesion on untreated skin from 4 to 5 cm beyond the treated area. While the distinction between fractionatedCO2 holes (50 micron coagulation cuff) being stiffer than the Er:YAG holes (33 micron coagulation cuff) might be true, the former will tend to bleed less than the latter which is quite relevant when attempting to have the CAD become adherent to the wounded skin. It was one of the great disappointments of the fractionated ablative laser that 50% vaporization did not result in 50% “tightening.” The body is just too good at repairing itself. That and the fact that the cylinders of vaporized tissue do indeed have this sponge cuff of coagulated tissue which tends to hold them open until they are filled with coagulum and other healing elements. These very same elements though hold promise for therapeutic delivery of stem cells, PLLA, aminolevulinic acid, and other components that are being used for wound healing, skin cancer treatment, and dermal plumping. Not wishing to be a curmudgeon, there will indeed be circumstances when this will have clinical value, particularly in those areas which are relatively small. But our patients are going to want more than a few localized areas be tightened, and as such I’m dubious about the longevity of this otherwise promising approach.