| I started off in medicine as a dermatologist (I still am actually, board certified and all). It was 1985, my second son was days old and I hung out my shingle: “Mountainview Dermatology”. I even had a logo. (1) No one had even heard of “cosmetic dermatology” because it had yet to be invented. The first injectable had just been approved: Zyderm collagen. What a revolutionary event. One could actually correct a wrinkle in minutes, unfortunately the results lasted mere weeks but it was a start! The only other things we were doing right off bat that belonged to dermatology and were cosmetic were sclerotherapy (the injection of tiny superficial leg veins with solutions to encourage them to go away) and chemical peels. My medical practice consisted of myself and a “Gal Friday”, Diane. Not a politically correct term today but very descriptive. It was very much a solo private practice. Diane did everything, from reception to medical assisting to billing. I did everything else, which consisted of adult, pediatric and consulting dermatology. I did as much collagen and sclerotherapy as I could but cosmetics amounted to a small percentage of my day. Laser entered the picture in 1987 when I added a continuous wave CO2 laser. I used to literally burn off tattoos. Men married to Amy who had Mary tattooed on their arm flocked to my office. No problem, I could easily remove that name in one treatment, replace it with a scar and the patient would be grateful. It was state of the art laser as we knew it. The turning point in my career and the birth of cosmetic dermatology (1B) occurred with the introduction of the UltraPulse CO2 laser by Coherent.(2) This was the first machine that produced dramatic improvement in wrinkles with low risk. I had 30 patients scheduled for resurfacing before the laser was delivered. Before I purchased this 6 figure testament to human ingenuity I thought long and hard about my future. I knew that I could not do everything perfectly. I hated the thought of leaving my general dermatology patients but in 1990 I closed the dermatology practice and went 100% cosmetic. It was like jumping off a cliff, no turning back.(3) I resolved to be the best , the queen of laser. With the dive off of the cliff came a new look for the office. We became Van Dyke Laser & Skin Care and the logo went from human figures to laser lights.(4) Additional lasers came fast and furious, technology accelerated. Photoderm was the original IPL (Intense Pulse Light) and was sold as a treatment for veins and brown spots. This was an early machine that required advanced knowledge to operate. Later IPLs became much more user friendly and less likely to burn. The unfortunate nickname of the Photoderm was Photoburn. We used this machine for awhile and then abandoned it, waiting for something better to come along.
The something better was the VersaPulse laser, approved in ’96 and added to the practice in ’97. It addressed the vein and brown spot issues and also tackled tattoos. This was actually 4 lasers in one box. Facial veins could be easily treated with one, the other 3 were for pigmented lesions including all colors of tattoos. Finally we could remove the offending decoration and leave little or no mark (of course it could take a dozen treatments).(5)
Next came the Conbio Erbium laser, kinder and gentler wrinkle removal. A great addition to our armamentarium.
The very first hair removal laser won FDA approval in 1995 and I was on board. What a concept, never have to shave anything again! To bad it did not work. The SoftLight by Thermolase was probably the worst equipment decision I have made. Within 6 months patients let me know they were not seeing the promised result. Within a year I had refunded much of the money we had collected. Yes, there were some happy patients but they were the exception and the laser had to go.
It took a long time before I looked at another hair removal laser. LightSheer by Lumenis came out in ’99, three years later I felt it had proven itself in the field and added it to the family. I have never regretted that one. It has been and still is the gold standard for permanent hair reduction.(6)
Meanwhile laser resurfacing was going strong yet patients wondered if they could get the wrinkle reduction and tightening without weeks of recovery. In 2000 NLite non ablative laser and Thermage (7) radiofrequency showed us that yes indeed, destruction (ablation) was not necessary to gain some nice results. NLite was so gentle that there was no recovery. It worked wonders on fine lines around the mouth and lips for the majority of patients treated.
Thermage provided real skin tightening without downtime but this first model was pretty painful and the majority were not overwhelmed by results.(8) Thermage has been dramatically improved over the decade and we now see great results with much less discomfort. This is a good example of a good technology that needed tweaking and got it. The manufacturer listened to the physician’s concerns and made a better machine. Today Thermage is one of our most popular treatments.
The IPL (remember photoburn?) Made a comeback with the Quantum IPL in 2000. We added it to our stable of lasers just as the popularity of no downtime rejuvenation was taking off. Photofacial became the popular name for treatments that improved color and texture.
Within 3 years yet advancement was achieved in IPL with the Lumenis One, a more user friendly machine with superior results in photodamage.(9)
2005 brought more change. We streamlined our name, reinvented our logo and moved into a large, luxurious office.(10) We stepped up the customer experience and wrote a mission statement to reflect our philosophy of supplying the very best in technology, professionalism, service and luxury to our patients.
2005 was also the year of the body, no longer was face the only area that could be improved without plastic surgery. Cynosure introduced the Smartlipo, the first laser to melt fat. We used it very effectively for small areas of excess fat such as double chins (11) and love handles. At the same time Thermage introduced Thermage Body skin tightening. We combined the two (Smartlipo and Thermage Body) for tightening and fat reduction.
Thermage Body also gave us a new weapon against cellulite in a single treatment. I couldn’t resist adding Triactive (low level laser plus suction and massage action) to the cellulite fight.(12) We use Triactive as maintenance after Thermage Body and as a multi-treatment standalone for cellulite.
In 1995 I took the leap into cosmetic dermatology based on the UltraPulse CO2 laser. In 2005 again CO2 came alive for me. This time as a fractionated laser, the Active FX.(13) The benefit: great results, only a third of the recovery time and it can be done with only oral sedation; no longer would we need to put patients to sleep to perform excellent resurfacing of the face. Another benefit is that now the neck and chest could be safely treated.
As the first decade of the 21st century drew to a close we added two more awesome lasers. Fraxel:ReStore (14)resurfaces in 3 to 5 treatments with only 2 or 3 days of downtime. Amazing improvement in scars as well as wrinkles and color and patients don’t have to miss a day of work.
The newest is the Lumenis Light Sheer Duet. Yes, we already had the excellent LightSheer, the Duet gave us the ability to treat 3 times faster (a man’s back in 20 minutes instead of an hour or more) with almost no discomfort!
Of course cosmetic dermatology is not all about lasers and neither is Van Dyke Laser & Skin. Collagen gave way to Restylane and Juvederm. (fillers that last a year or more) (15) Artefill (a permanent filler) came and went and came back again. Sculptra arrived to add volume to hollow faces of HIV AIDS patients and stuck around to soften the aging face. Countless fillers came and went so fast that it doesn’t make sense to identify them.
Hands down though, I think we can agree that Botox changed it all. (16) We had an affordable, zero downtime, wrinkle reducer that anyone could have if they so desired. Lasting only 3 or 4 months had its advantages, you could try it and if you didn’t like it just not do it again, no problem. Of course pretty much everyone loved (and loves ) it. Dysport showed up this past year and rivals Botox in every way.
Skin Care exploded over the last 2 and half decades. We started with Retin A, the god father of antiaging. We have grown into antioxidants and collagen stimulators and continue to rely on ever improving sun protectants. Latisse burst on the scene in 2009 as the first prescription eyelash growth product. I never knew how important eyelashes were until we had an easy way to make them grow!
In 25 years of practice I have seen the birth and maturation of a field of medicine: cosmetic dermatology. I have used some of the best products and machines. As 2010 unfolds there are countless indications for lasers with hundreds of machines from dozens of companies. What the next 25 years will bring is hard to imagine but sure to be fantastic. I will check back with you in 2035. |
The men in your life can use some self assurance as well. Matte For Men is a great boutique line out of Tucson. It has been featured in men’s magazines as a “must have”. On a personal note, my husband LOVEs! this product line. It includes a truly protective Antioxidant Shave Gel, Complete Head Lotion SPF 25, Man Powder (yes, men like powder that does not smell like babies) and my hubbies favorite: Complete Cleansing Cloths that he takes out on the golf course to freshen up mid-round.
