Wrinkle-Blasting Laser Treatments Soar
A cosmetic surgery technique called laser resurfacing is soaring in popularity as men and women flock to clinics to get their wrinkles smoothed out.

Over the past three years, the number of procedures has increased 456 percent among men and 215 percent among women, according to new numbers released today by the American Academy of Cosmetic Surgery.

Laser resurfacing involves pulses from a carbon dioxide laser to minimize wrinkles and lines. The laser vaporizes water molecules in skin cells, damaging the surrounding tissue. In response, the skin produces more of the protein collagen, which fills in wrinkles.

While the recession has dampened enthusiasm for many popular cosmetic procedures, dewrinkling seems to be somewhat immune. "These laser procedures are looking to be recession proof," according to a statement from the academy.

Does it work?

Studies suggest the laser resurfacing does indeed reduce wrinkles, at least for a time.

Wrinkles are caused by a structural breakdown inside the skin. Some existing treatments effectively counteract the breakdown by stimulating the growth of new collagen from cells called fibroblasts. As skin ages, fibroblasts collapse and there is an increase in the production of collagenase, which breaks down collagen, researchers at the University of Michigan explained in writing about a study they did on all this last year. People in their 80s have four times more broken collagen than people in their 20s, they said.

To some, this is an indictment against nature.

"What it's doing is dissolving your skin," said lead author of the Michigan study, John J. Voorhees. "What you've got is a vicious cycle. You have to interrupt it, or aging skin is just going downhill."

Aging is a downhill slide? Heavens to Murgatroyd, we must do something! And of course more and more people are. However, some cosmetic surgeries, such as silicone injections to the face and liposuction to remove fat (and lots of other stuff), have been shown to be destructive and ultimately far less effective than most people expect. Bad side effects are common among many popular procedures.

Laser resurfacing appears less sinister, studies suggest.

Voorhees and colleagues, in reviewing dozens of studies done since the early 1990s, found three types of treatments to be effective: topical retinoic acid, carbon dioxide laser resurfacing and injections of cross-linked hyaluronic acid. "These treatments all improve the skin's appearance — and its ability to resist bruises and tears — by stimulating new collagen," the researchers wrote in the Archives of Dermatology. The work was funded by the university and the National Institutes of Health.

"We have shown that if you make more collagen go in, it provides an environment in which fibroblasts recover and make more collagen," Voorhees said.

Is it safe?

Another study at University of Michigan last year concurred that laser resurfacing works, but it highlighted some side effects.

"In addition to structural changes, the healing process frequently leads to pigmentary [coloring] changes," wrote the study authors, P. Daniel Ward and Shan R. Baker. "These changes in skin pigmentation may be desirable, such as when patients wish to remove solar evidence of aging; however, changes in pigmentation after treatment can often be a troubling adverse effect."

Ward and Baker studied 47 people (42 women and five men, average age 52) who had carbon dioxide laser resurfacing on their entire face between 1996 and 2004. Of those, 45 percent had no complications. But 14 developed acne or small, white cysts called milia. Eight found their skin darker (hyperpigmentation). One got an infection and one developed sagging eyelids.

"With the exception of one case of hyperpigmentation, which resolved within two years of treatment, hypopigmentation [lightening of the skin] was the only long-term adverse effect," the researchers wrote. "This complication was present in six patients (13 percent). The patients who developed hypopigmentation were more likely to have a greater response to treatment."

Does it last?

Skin resurfacing can only delay the inevitable, however. We all still age, get wrinkly, and die.

A small study done in 2003 — admittedly things may have change since then, of course — found that within three months of undergoing facial laser resurfacing, 23 patients of 27 patients (85 percent of the study group) said it met their expectations. But after 30 months, only 13 patients (54 percent) were still satisfied.

"We definitely encountered patients who never expected to get a wrinkle again," said Sonia Batra, chief resident in dermatology at Stanford University Medical Center, where this study was done. "There was a perception that rather than reset the clock, the procedure should halt the clock. That was just unrealistic."

Here's what the FDA says about lasers as wrinkle treatments:

"Several manufacturers have received FDA clearance to claim treatment of wrinkles, while others may claim skin resurfacing. Patients have reported reddening of the skin, which lasted from one to four months. Pain was mild and could be treated with over-the-counter analgesics. Consumers should bear in mind that skin abrasion, whether achieved by lasers, chemicals or abrasive materials, means removing one or more layers of skin, which can be painful and could cause redness, swelling or scarring, depending on how each person heals."

According to today's report, the most popular "non-invasive" cosmetic procedures in 2008 were Botox injections, laser hair removal and hyaluronic acid wrinkle treatments. The top three most performed cosmetic surgical procedures (these would be the invasive types) in 2008 include: liposuction, blepharoplasty and breast augmentation.

Robert Roy Britt is the Editorial Director of Imaginova. In this column, The Water Cooler, he looks at what people are talking about in the world of science and beyond.