One of the most confusing and daunting tasks for patients is deciding which one of the newest Lasers or devices is the best treatment for facial wrinkles &/or age spots. I have seen hundreds of patients who come in telling me that they have tried this laser and that laser with little benefit or that each dermatologist or plastic surgeon they have consulted has suggested a different Laser, cream, peel or the “latest device” in their office or spa.
In order to properly rejuvenate the aging face, the nature, texture and tone of skin has to be improved in addition to any lifting type of procedure. For example a Facelift surgery will treat sagging jowls but will do very little to reduce fine and medium depth wrinkles and lines on the face. Immediately after surgery the face looks very youthful and most fine and medium lines will be invisible due to swelling but as this swelling resolves, the lines reappear.
Age spots and blotchy hyper-pigmentation is also a tell-tale signing of aging and treating these issues at the time of other aging face procedures will not only add “icing to the cake” by improving the general appearance of the skin, it will also ensure longer lasting results from the other co-procedures (such as a Facelift) by having improved the general condition of the skin.
So what are the best options for treating wrinkles, lines and hyper-pigmentation? Should you invest in multiple Fraxel, IPL or Plasma treatments or should you go for the “controversial” CO2 Laser, or possibly even consider the older methods of surgical Dermabrasion or Chemical peels?
The answer is complex. There is no “best treatment.” They all work to different extents and the “best treatment” depends on the patient. Factors such as skin color, location of lines or wrinkles (e.g.: crows feet vs. peri-oral lines), amount of “down-time” the patient can afford, patient’s lifestyle such as outdoor work or hobbies and the resultant sun-exposure, time of year, and finally cost, are all factors to consider.
All such treatments fall under the category heading of “Resurfacing.” Resurfacing involves removal or stimulation of different layers of skin resulting in changes and improvement in skin color, texture and tone. Stronger and deeper modalities will result in more significant improvement but also require more “down time” for recovery and in inexperienced hands can result in scarring or other complications. Weaker or “lunch-time” type procedures require a series of treatments spaced at regular intervals but also require patience on the part of both doctor and patient in order to see meaningful results.
As a final note, surgical Dermabrasion, as well as Chemical peeling have become lost arts replaced by machines and lasers. There are very few devices that can equal or match the effectiveness of Dermabrasion for treatment of smokers’ lines, or a Phenol / Bakers Chemical Peel for the treatment of crows feet lines. One such impressive device is the controversial CO2 laser. The CO2 laser has received bad publicity recently due to horror stories of patients who have been scarred or “over treated” with this powerful laser. When used by a skilled plastic surgeon or facial plastic surgeon, this laser can yield unparalleled results treating deep lines as well as age spots and hyperpigmentation.
The ultimate decision as to which treatment option is the right one for you needs to take into account many factors. One such factor is the skill and training of your surgeon. You should be certain to find a surgeon who performs multiple different forms of Resurfacing and only then can you be sure you are being offered the best treatment option for your skin and needs. 
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