Trish: Hey, well, I’m here again today with Dr Jayson Oates and he’s a specialist facial ENT and surgeon from Academy Face & Body, in WA. You’ve also-
Dr Oates: Hi, Trish, how are you?
Trish: Good. How are you?
Dr Oates: Yeah, good.
Trish: Sorry, I’ll snap that in quickly. You also practise from Crows Nest, in Sydney.
Dr Oates: Yes.
Trish: Awesome. So, Doctor Oates, now going to have a bit of a chat about lasers and why lasers? Why you would choose each particular one and what you use there and why you use it. A bit about the legislation. You can help shed a bit of light on that, for our listeners.
Dr Oates: Yeah. Well, that’s one of the difficult things for the public. Is, they hear about lasers and there is actually so many different kinds of laser. Each laser has its own particular benefits and uses. For different kinds of issues, we use very different kinds of lasers.
So … The most common thing I’m using lasers for, is for rejuvenating the skin. My preference there is the CO2 laser. So, when we say CO2, it’s carbon dioxide in the atmosphere. CO2 laser that’s in a tube. That laser targets water, so it is absorbed by water in the skin. It very rapidly heats it up and turns it into steam and it vaporises the skin.
The CO2 laser is the archetypal cosmetic laser. It was the first one that was available for any cosmetic purpose. So, that’s been 40 years, maybe now.
Trish: Wow, right.
Dr Oates: It’s been in and out of fashion in that time. The technology, fortunately, has gotten better and better. The CO2 laser is more what we call a hot laser. In fact, all lasers are hot when you get zapped by them. But, with the CO2 laser, puts more energy into the skin and heats the skin up more.
That is a benefit, when you’re trying to get rid of wrinkles and creases in the skin. So, if you really want to tighten up the skin, you’ve got to put more heat in. That’s where the CO2 laser is great.
I’ve heard it also means it’s got a slightly longer healing time. So, it’ll be very common for my patients, when I do a fully ablative laser resurfacing, to have … Healing skin that lasts for seven to nine days. In that time, they’re using Vaseline and ointments on their skin.
Because, when you don’t have skin, it’s not there doing what it’s meant to do. Skin is there to keep the outside out and the inside in. So, when you don’t have the skin, it dries up, very quickly. In the first couple of days, it tends to ooze and weep a bit.
You’ve got to protect it from bacteria, so we usually have people on antibiotics. At the end of that, say, nine days, when the skin is healed up, it’s still really bright pink. That’s an ongoing downtime. But, once the skin has grown back after that week or so, at least you can start putting makeup on.
But, when I do really intense laser resurfacing, then some people would be pink, for even up to three months. So, that’s the CO2 when I’m using it as fully ablative. One of the big developments in the last six to eight years has been fractionated lasers.
So, fractionated lasers usually means that they’re doing it in lots of little dots. So, with all the computer controllers that we have with the lasers now, you can make dots that are very close together. Dots that are far apart.
You could turn the energy up, you could turn the energy down. With the pulse of the laser, you can make a long pole, which puts more heat in. Or, you can make it a very short pole, so perhaps not have as much heat.
That makes differences in how long it’s going to take to recover and how much difference it’s going to do.
Trish: The results?
Dr Oates: Yeah, the results that you get. So, the way it works, as sort of everything in cosmetic surgery is, when you have a little downtime and your low-risks, you tend to get small results. When you have a big downtime and there are more potential risks, then you end up having a bigger result.
Trish: So, tell me, with the CO2 laser, is that a surgical procedure where you have to have a general, or do you do it in the rooms?
Dr Oates: So, our office here in Perth is a licensed hospital for twilight sedation. So, when I’m doing a fully ablative resurfacing, yeah, I give people sedation and I put in lots of local anaesthetic. Yeah, they basically sleep through it.
When we’re doing the fractionated lasers, and often, that’ll be called, say, the dot laser. When we’re doing a very light one, it’s often called the Madonna peel, because, supposedly, Madonna had a series of these. That’s why her skin was looking really good.
So, for those, it’s just a local anaesthetic cream, we’ve got a cold-air machine that takes some of the heat out as you go. So, then, it doesn’t have to be done in an operating theatre.
Dr Oates: So, for our clinic in Sydney, where we don’t do sedations for lasers, we just do the fractionated lasers and then light-to-medium lasers there.
Trish: Okay. Because I remember seeing someone who’d had the ablative one done, years ago. It was about 20 years ago and the difference in her face was phenomenal. She was a 46-year old woman and I swear to God, her skin looked like she was about 25. It was amazing.
Dr Oates: Yeah, that’s why I still like doing fully ablated lasers. A lot of people have gone just to the fractionated lasers and don’t do the heavier ones. But, the kind of results that you can get with a really heavy laser resurfacing, you can’t make these changes with surgery.
You can pull the skin tight, but you’ve still got the same skin. If you want to change the quality of the skin, you’ve got to do something to it. The bigger the treatment, the bigger the results.
Trish: Of course. Is that really good for someone who’s got really bad acne scars? Would it work for someone like that?
Dr Oates: So, yes. Acne scars are the other one. I used to do it, a lot of the fully ablative, really aggressive ones, for acne scars. Now, we’re sort of mixing it up, a little bit. We’re using some of the fractionated laser, but turning it way up.
It’s drilling these little holes, that go down several millimetres, into the skin and stimulate the skin and the healing process. That seems to be softening and blending the acne scars really well.
Sometimes, we’ll come over and do a medium-strength laser with it, as well. But, this scarless procedure, where we drill these little holes way down deep, that really makes a good benefit, without some of the long downtime that you have with the strong, fully ablative laser.
Trish: Okay. The treatment takes roughly how long? Say, for the ablative and the fractional. What sort of time?
Dr Oates: Yeah, so the big one takes about an hour. So, we need to do some sedation. It takes a bit of time doing that. The actual lasering itself takes about half an hour. With the lighter procedures, often they’ll only take, say, 10 minutes to do, 15 minutes to do.
So, they’re relatively quick to do. With the lighter ones, you have all these little dots, all over your face. Your face will go quite pink, in the first few hours. Then, it’ll take several days for those dots to fall off.
Trish: Okay. All right. The result is just fantastic. I can see. Tell me, how’s it work? Does it help produce the collagen, or kind of just gets rid of the outer layer of skin?
Dr Oates: It’s a bit of both. That’s the great thing about the CO2 laser, is it’s really strong in the stimulation of collagen. It seems to be the heat that is really responsible for that. It creates more collagen. But, with the drilling holes down deep, into the scars, actually stimulating the body’s healing response.
There’s something about getting the body to do the work itself and do the repair, that actually makes a really good difference, beyond just being aggressive with the laser. Which is the traditional ablative resurfacing.
Yeah, drilling deep in with the laser just really regenerates the skin nicely.
Trish: All right. Well, that sounds great. Now, I know that you’ve got a few other lasers there, like the laser and the MonaLisa and the Stop Snore and a vascular laser. But, do you want to just give us, because I know you haven’t got much time today, but do you just want to tell us a quick, little bit about the laser tattoo removal?
Dr Oates: Yeah. Tattoo removal, we saw a long time ago, more than a decade ago, was going to be something that was going to be big in demand, with the number of tattoos that people are having. The gold-standard for all of that time was the Q-switched laser, known as the C6.
That was the most effective laser around, for tattoo removal. So, Q-switch means that the laser pulse is done in one billionth of a second, with a B. It’s a really short pulse and that fractures, shatters the ink particles. Makes them small enough so that the white blood cells can come and take them away.
It’s a treatment that you need to have a couple of months between sessions, so that the white cells can take away as much of the ink as possible. Then, repeat it. Of course, it was still a slow, slow process. Because, depending on how many colours you have in the tattoo, it might take between six and a dozen treatments. When they’re spaced two months apart, that means it’s spaced out over a couple of years.
More recently, there have been the developments of the picosecond lasers. We don’t have a picosecond laser as yet. But, there’s probably the next thing that we’ll be looking at. The picosecond is now one trillionth of a second. So, it’s even shorter. These short pulses break the particles down into even finer particles.
Dr Oates: Because what seems to work is, going Q-switch first, over the top, break the particles down the first time. Then go over with the picosecond laser and break them down, even further. Because you’re breaking down into even smaller particles, the white cells are taking the tattoos away, more quickly.
So, there’s been a lot of development here, with the picosecond lasers are getting better and better. The first generation was a big step forward, but perhaps didn’t have enough energy. The latest ones that are coming out, are looking like they’re really going to do a good job.
Trish: Yeah, because I know for a fact that they’re really, really expensive, as well.
Dr Oates: Well, see, that’s actually what’s been holding us off. Because, when it’s over a quarter of a million dollars for the laser, the question is, “Well, how much are you going charge somebody to have this treatment?” It always comes down to a balance between how expensive the treatment is going to be and how good the treatment is.
Trish: Oh, totally. An example is, my daughter had a laser tattoo removal with a PicoSure and she had three treatments and her tattoos were gone. They were really big, solid ones on her arms. Her girlfriend, who had it done with a Q-switch, it took her 13 treatments and hers were nowhere as good as my daughter’s. So, there was a massive difference between those two, at the time, as well.
Dr Oates: Well, then she’s had a great result then. Yeah, sometimes, well, most of the time it won’t come out in three treatments still. But, that’s fantastic.
Trish: All right. Now, have you got time to tell us about the MonaLisa?
Dr Oates: I’ll have to quickly finish and rush off, so I could pick my son up, there, Trish.
Trish: All right, no problems.
Dr Oates: Yeah. So, the MonaLisa Touch is using the CO2 laser, again. When they first told me about this treatment, I was just thinking, “I can’t see how this is going to work.” It delayed me starting the MonaLisa Touch, probably for 18 months. Which is a real shame, because it’s a fantastic treatment.
It’s especially good for menopausal women, or any woman who’s got low oestrogen levels. That can be because they’ve had to have their ovaries removed, or for cancer reasons. Or they’re on breast cancer treatment, especially Tamoxifen. Tamoxifen is an anti-estrogen medication that is very useful in breast cancer.
But, it causes menopause-type symptoms. It dries the vagina up. It’s dryness, itching, burning and especially discomfort, pain during sex. So, it’s using the CO2 laser, with fractionated settings. Lots of little dots. Yes, it’s inserted into the vagina, with a special device that sprays the laser, all the way around the internal surface of the vagina.
Amazingly, it is virtually painless. Or no sensation at all. Until you get all the way to the outside, so you’re zapping, zapping, zapping, it’s, “Nothing, nothing. Quite comfortable, quite comfortable.” Then it gets a little bit warm when you’re almost out and then, “Ooh, hot.” Then you just turn it down for that last little bit at the outside.
Most women, after having one treatment, will notice a very significant improvement in these dryness and discomfort symptoms. But, usually we’ll do a series of three treatments, spaced a month apart. That will then last them for a year. Then, I would have people come back a year later and usually just have a single session. That’ll keep them going for a further year.
It has been fantastic for menopausal women, especially, yeah, for women who are on breast cancer treatment, women who don’t want to take oestrogen. The new area that it’s moving more and more into is, women who are having some bladder issues. So, some stress and urge incontinence.
The, the question is tightening. Because so women who have had babies feel that they’re not as tight as they were. So, there certainly is some improvement, with tightening. The good thing is, it’s a non-invasive, five-minute treatment. Walk-in, walk-out. As opposed to a surgical tightening procedure, which is quite an involved procedure, with potential risks and complications.
So, a lot of people like the fact that you jump on the table, jump off five minutes later and they’re done.
Trish: Yeah. With that one, I know that it’s actually regenerating as well. So, it helps to regenerate the vagina. Because it loses collagen and it becomes thinner and elasticity is reduced.
Dr Oates: They’ve got really good studies, showing biopsies before and after. Before, the lining is very thin and that’s typical of when there’s no oestrogen around. When you take the biopsy after the MonaLisa Touch laser, it’s nice and thick and moist. It’s back to the way it was in youth, with the oestrogen there.
Yeah, that’s what they feel. The lining of the vagina is very specialised, it has glycogen, which is a sugar in it. As those cells are shed, which is not easy to say when you’re rushing. The lactobacilli converts that into lactic acid and that keeps the lining of the vagina slightly acidic, which is good in preventing infections and thrush.
Lactic acid is actually slightly slippery, when we do lactic acid peels on the face, we can feel it’s got that slippery sort of quality and it’s a humectant, which means it sucks water in. So, it’s moisturising. So, all of those things are really useful. But, that all disappears when you don’t have oestrogen. The MonaLisa Touch regenerates all of that, back to normal.
Trish: Yeah. I know for a fact, if you’re one of those people that coughs or sneezes and has a little bit of pee come out, it can help with that, for sure.
Dr Oates: Yeah, we’ve found it really useful for that. Especially, again, in the menopausal women. They have a very high success rate of improving stress incontinence.
Trish: Oh, fantastic. Look, I know you’ve got to go, because I could talk to you all day about this, but I know you’ve got to go. So, thank you so much for your time today.
Dr Oates: Thank you, Trish. It was really good to speak to you again.
Trish: Pleasure. Look, so, listeners out there, if you’re looking at getting in contact with Dr Oates, you can contact him on www.academyfaceandbody.com.au. Or you can drop us an email at firstname.lastname@example.org. So, thank you very much.
Dr Oates: Thanks a lot, Trish. Bye-bye.