Dr Hussein uses various techniques to tighten the eyelids with laser.
Laser Coring is a very effective treatment for eyelid tightening and lines in the following patients.
- Younger patients (typically less than 40yrs of age)
- Younger patients that suffer with hereditary early onset skin laxity and excess
- Darker skin patients (Fitzpatrick 4-6) as they do not tend to have loss of elasticity or sundamage issues
- Under eye lines in younger lighter skinned patients who still have good elasticity
The key advantage of Laser Coring is reduction in skin laxity and excess but much faster recovery versus full ablation CO2 around the eyes. There is also less post inflammatory hyperpigmentation risk around the eyelids in darker skinned patients. If it does occur it will clear more quickly versus full ablation as the laser used (Acclaro Ultraclear 2910nm) is a cold ablation laser and gives very little heat to the tissue surrounding the drilled out laser cores allowing for swift healing and low downtime.
Full Ablation CO2 Laser is the technique of choice in the following patients:
- Older patients typically 40-45yrs plus.
- Patients of a lighter skin type (FP1-3) as this has more predisposition to sun damage or loss of elasticity.
- Patient with eyelid skin is that thin and crepey and lacking in elasticity poor (indicated by poor recoil in a snap test)
- Patients with sun-damaged eyelid skin and has photodamaged (sometimes pre-cancerous) cells that need removing with full ablation.
- Sun damaged patients with skin that is significantly thickened by solar elastosis.
Full ablation is the gold standard in periorbital skin rejuvenation however recovery with full ablation is longer with initial recovery lasting 10-14 days and redness lasting for several weeks.
How does Laser Coring Eyelid Tightening work?
Laser Coring works by removing skin tissue. The laser will drill out full thickness columns of skin that equate to removal of a specific surface area of skin tissue. By doing this there is now missing skin tissue. As the cores collapse the treated skin contracts as the multiple open channels close and contract by process of wound healing and wound contracture.
This net removal of surface area results in reduction in laxity and tightening of the eyelid. The process can be performed on the upper and lower eyelids. Indeed it can be performed in any area of skin laxity on and off the face such is the versatility of laser coring.
The procedure is performed under local anaesthetic. This means that when the treatment is being performed you will not feel any discomfort. The local anaesthetic injection will make the eyelids puffy. But this will settle within a few hours post procedure. Metal eyeshields are inserted so it is important not to drive to and from the treatment session.
Your vision will be a little blurred after the removal of eyeshields. In general an eyelid coring procedure under local anaesthetic injection will take around an hour. Please allow 2 hours in clinic to give yourself plenty of time. Immediately after the procedure there may be a small amount of bleeding and weeping from the laser cored areas.
Healing
As laser coring is performed with cold ablation laser the advantage is that healing is fast. Acclaro Ultraclear Laser Coring Technology is patented. It is a system that allows all skin types to be treated. The advantage is that redness has significantly faded by week two and unlike full ablation concealer or foundation can be worn by day 14.
Medical Downtime following Laser Coring is about 1 week. Social inconvenience caused by redness will be another week after which concealer/makeup can be used.
- One week medical downtime and woundcare
- Redness for a further week
- Makeup / concealer can be applied at 2 weeks
Treatment at a Glance
For more information, please see the FAQs section.
Procedure Time
Typically allow 30 minutes for anaesthetic. One hour for the procedure. Typically in-clinic time two hours.
Number of Treatments
A single treatment is sufficient
Downtime
Medical Downtime 5-7 days
Social downtime - 2 weeks prior to make up
Redness and pigmentation may take 2-3 months to completely settle
Frequently Asked Questions
Common areas of the face that require Laser Coring are as follows:
- Eyelids/skin around the eyes
- cheeks/buccal laxity
- Jowl and cheeks
- Double chin/neck/submandibular area
- Temporary Hyperpigmentation – taking up to 3 months to resolve
- Prolonged redness taking anywhere between 2-4 months to settle
- Infection – This risk is reduced by compliance with aftercare
- Bleeding – It is normal to encounter a couple of days of bleeding and oozing after the procedure
- Scarring – this would occur if there are untreated complications such as infection or inflammation that is not controlled. This is why Dr Hussein will monitor your healing closely on the Virtual Round.
- Dr Hussein will monitor your recovery by means of the virtual ward round daily for the first two weeks after the procedure.
- After this it is routine to drop to phot monitoring for a couple of times a week.
- Following this you can notify Dr Hussein of any unexpected problems using the ward round phone. This however is unlikely.
- You will have a three month review following the procedure as a final assessment
- Tumescent anaesthesia is slightly painful due to multiple small needle pricks
- Following the tumescent the procedure is virtually pain free.
- After the procedure, pain is not usually an issue. Opening the mouth wide will create a tight sensation over the first couple of weeks
- The face should not be washed until the day after the procedure and is not painful
- Use of the DrH healing ointment will help the skin to heal with a lower risk of infective complication and reduce inflammation.
- Strictly comply with the virtual ward round and aftercare sheet guidance
- Click on the booking form link and complete
- Information is not used for any marketing purpose – It is essential medical information
- Follow the booking form process and you be will be contacted by one of my medical team to arrange your consultation.
- Following consultation your treatment can be booked. This is usually no earlier than 2 weeks following the consultation. This time is important to allow full consideration of the procedure by the patient.
What is Laser Coring?
- Laser Coring is a technique performed with a new device developed in the USA by Acclaro.
- This Laser is called the Acclaro ULTRACLEAR laser.
- It is a new wavelength that has been developed and is new laser technology.
- It uses 2910nm Mid-infrared laser to vaporise the skin
- The vaporisation of skin tissue is called ablation
- Laser Coring uses COLD ABLATION
- COLD ABLATION reduces the healing time of the skin and recovery is much faster vs more conventional hot lasers such as CO2. It is also much easier to control pain during the procedure due to the fact that the laser vaporises skin and does not heat the surrounding skin significantly.
A lot of research work has been performed over the last 5 years with skin coring technologies. The basic premise behind this new area of treatment is to remove skin tissue essentially by hole punching the skin with small hole punches.
Why was Laser Coring Developed?
A lot of research work has been performed over the last 5 years with skin coring technologies. The basic premise behind this new area of treatment is to remove skin tissue essentially by hole punching the skin with small hole punches.
Evolution of Laser Coring?
Doctors have been experimenting with this technique by using a range of tools to remove the skin.
Initially multiple surgical punch excisions using a punch excision tool were tried. One of the problems here was that cored-out channels were too wide and regular spacing of the channels was difficult when delivered by hand. The technique was also cumbersome as doctors had to use forceps to remove the tiny plugs of skin from the channels.
This methodology risked scar formation due to the larger size of channels. Poor cosmetic outcome was a problem due to spacing of the cored-out channels being human hand-eye co-ordination dependent. It is extremely cumbersome and slow especially when narrow gauge mechanical punch excision tools have to be used.
Rotary mechanical hair follical extraction punches speeded up the process and allowed for safer narrower cores of skin to be removed. However bleeding, hand eye co-ordination and slow hand and forcep removal of tissue plugs made this pioneering but still a little primitive. However results were promising in terms of contraction of skin and initial work done in the upper eyelid area and loose cheek skin showed promising results.
Ellacor was a great leap forward in skin-coring. This device was an computer controlled mechanical device used for creating regularly spaced full thickness holes within the skin of small enough diameter to allow healing with normal healthy skin tissue. The internal diameter of the Ellacor skin Coring Needle is under 500 micrometers. This led to the development of the term MICRO-CORING which is used to describe mechanical device based skin coring.
How does Laser Coring work?
Laser Coring is a modification of fractional laser. Conventionally fractional lasers are used to drill microchannels into the skin. These microchannels are typically 180-200micrometers in width. Laser Coring essentially uses a laser to core out sections of the skin with much larger channels typically double the diameter of a fractional channel.
Conventional CO2/Erbium YAG laser fractional microchannels work by delivering microchannels into the skin that create tissue remodelling and collagen synthesis around the fractional microchnnel. This causes increase in skin thickness and density. This is why it is used to treat atrophic (indented) acne scars and rejuvenate and plump the skin.Fractional CO2 and Erbium YAG laser was developed back in 2004. It is an evidence based technique that is well published in medical literature and is used for the following:
- Acne scar treatment
- Skin rejuvenation
- Keloid & Hypertrophic Scar Treatment
- Surgical, Burns and Trauma Scar Management
- Skin rejuvenation
- Treatment of sun-damaged skin (photodamage)
- Laser Assisted Drug Delivery (creation of channels within the skin to allow medication to penetrate the skin)
Laser Coring has two distinct advantages over conventional fractional laser
Laser Coring removes much more skin tissue due to the wider channels that are drilled. This leads to a greater quantity of removal of poor quality skin and replacement with newly regenerated tissue. Laser Coring does not just create thermal injury and micro-ablation to remodel skin it allows a much larger quantity of old skin damaged or scarred skin tissue to be replaced by new healthy tissue. This creates a much greater tissue regeneration and remodelling effect versus conventional fractional laser. These Laser Coring channels can be drilled through the entire thickness of the skin whereas most fractional lasers are only treating the upper portion of the skin.
The removal of tissue by Laser Coring actually causes the skin to contract. The process of wound contracture and collapse causes the cored-out skin to close the channels. Effectively Laser Coring is removing a percentage of your skin. This creates far superior skin tissue tightening and contraction than conventional fractional CO2 and Erbium YAG laser. This is because the skin has to contract to close the channels.
Essentially a percentage of your skin is being removed by the laser to tighten the skin. This makes the tightening effect much more powerful than tools such as fractional CO2 laser, Fractional Erbium YAG laser, Radiofrequency Microneedling and Focussed Ultrasound.
The great advantage of skin tissue removal and contraction by Laser Coring is that removed skin is replaced by healthy new skin not scar tissue. This is because channels between 350-400 micrometers in width created by Laser Coring are able to close and heal with normal tissue NOT scar tissue.
Laser Coring is therefore creating SCARLESS skin contraction. To do a similar thing via surgical methods would require skin tissue to be removed and then stitched. This creates a scar. Laser Coring allows skin removal and tissue contraction but with no stitches or scars.
The advantage of the 2910nm Ultraclear laser is that the tissue is removed without significant heating or cautery of the wound. CO2 lasers use a higher heat. To make a Laser Coring channel to remove skin tissue using fractional CO2 and Erbium YAG laser would require very high energy and would as a result cause too much collateral thermal damage to the walls of the channel.
This would result in much higher thermal damage to the skin surrounding the cored-out channels. This would potentially lead to healing with scar tissue rather than normal healthy skin tissue. This would be potentially dangerous and would leave multiple point sized white scars in the area that we are trying to tighten. This problem is why Laser Coring has not been able to be easily developed using conventional CO2 and Erbium YAG ablative laser technology.
Acclaro Ultraclear uses 2910nm mid-infrared (Erbium Fiber) laser. This laser is delivered and scanned using a microbeam via a fibre optic delivery mechanism. This allows fast and precise control of the laser microbeam. This new wavelength and technology that allows extremely precise tissue removal without heating the surrounding no targeted skin.
Therefore collateral damage to surrounding unremoved skin is kept to an absolute minimum. In fact less than 5 micrometers of surrounding skin tissue is affected by the 2910nm Ultraclear laser microbeam. CO2 fractional laser causes around 100 microns of thermal damage to the healthy skin tissue surrounding the channel.
This is around 20 times greater than Ultraclear 2910nm laser. Erbium YAG delivers colder ablation but the extremely large channel requires beam delivery of extremely high power. The absorption of the energy from Erbium YAG causes cavitation and superheated gas formation that then results in explosive pressure and heat induced trauma to the surrounding healthy skin tissue. There may be different ways of controlling Erbium YAG laser technology to deliver Laser Coring but none have yet been perfected or bought to market.
Therefore in summary:
- Laser Coring cannot be performed with CO2 (10600nm) laser as too much thermal damage to the surrounding skin occurs. Therefore microchannels with CO2 fractional laser have to be limited to a much narrower diameter that does not allow for adequate tissue removal and contraction for Laser Coring. A consequence of not enough absorption.
- Erbium YAG (2940nm) is so highly absorbed by the skin that to produce a Laser Coring channel that is wide enough to cause the contraction effect requires would using current delivery technology cause superheated gas formation resulting in heat and explosive mechanical trauma to the surrounding healthy skin. Therefore Laser Coring cannot effectively be achieved by Erbium YAG laser.
- Acclaro Ultraclear mid-infrared laser (2910nm) delivered with a scanning microbeam allows just the right quantity of absorption to allow precise drilling of a 380 micrometer channel without any significant residual thermal damage or mechanical trauma to the healthy surrounding skin. True controlled Cold Ablation. Making Acclaro Ultraclear the leader in this new area of laser surgical skin tissue tightening and remodelling.
This is why Acclaro Ultraclear laser is the first true COLD ABLATION laser technology. Cold Ablation means removing skin tissue with laser without heating and damaging surrounding tissue. This is very important for reducing the risk of scar formation and dramatically speeding recovery time. It is a genuine leap forward in the use of laser in scar manangement and skin rejuvenation.
DrH is pleased to be amongst the first dermatologists to offer Laser Coring and cold ablation to UK patients with Acclaro Ultraclear.