The Age of the Machines
By Brian P. Maloney, MD, FACS

High-tech, colored laser beams, radiofrequency skin treatments and other technological advancements indicate clearly that the technology boom is here.

While some cultures focus on natural, organic and time-tested, simple skin rejuvenation procedures, Americans have proven to be ‘early adapters’ and have developed a thirst for the latest and greatest. There is a great desire to improve upon the old.  If it involves a machine or fancy laser light the feeling is, ‘Sign me up.’

The real question we need to ask:  ‘Is the new technology going to provide a better service for our patients and clients--or is it a fad that will disappear tomorrow?’ 

I see many patients each week looking for a new type of wrinkle treatment or facelift which they have just learned about. Many are seduced by high priced public relations campaigns as they see a product on the latest talk show circuit. Maybe it was the full page glossy advertisements in the hot fashion magazine. Typically it is not from a satisfied neighbor.

Unfortunately many patients have such high expectations for the new treatments that even if they achieve a good result they may be disappointed because it is not perfect. Ah yes, perfection, truly a noble goal but rarely achieved when it comes to the human body.

Why is that? Why can’t aestheticians, nurses and doctors achieve this on a more regular basis? The first reason is the fact that medicine is not a science, it is an art. Many people don’t understand it.

Coal mining is a science. Coal can be graded and the quality remains consistent. When it comes to the human body, everyone is different. Everyone has different skin qualities, small pores, large pores, light, dark, oily, and dry variations, to name a few. Under the skin our bodies are likewise different.

A doctor may treat one hundred people with the same exact treatment and witness one hundred different responses. Botulinum toxin injections and most of the currently available wrinkle fillers are great examples. The public perception is that they work in everyone, but the reality is that they may not work in some people. This is because the person may have been exposed to the material and have developed antibodies which can inactivate the material or shorten the effect. Therefore, past exposure to some agents may determine if we break it down quickly or exhibit an allergic reaction to it.

The other variable is that some people have a genetic make-up that may affect how their body responds to the treatments. It is very important that patients understand there is no universal treatment, and some people will respond better than others.

The other challenge related to new technology involves the training of the person performing the treatment. Several years ago I participated in the Food and Drug Administration (F.D.A.) evaluation of a laser for hair removal. I initially went to a course and received a piece of paper saying that I had attended a training session. I then spent time in a doctor’s office learning his tricks for success.

As I began treating patients I learned that each had different concerns. Facial beard hair was very different from underarm or back hair. After a couple of years I felt that I had mastered the technology, and I consider myself blessed with a good scientific mind and good eye- hand coordination. During this time I encountered doctors that did not have the passion or level of interest in trying to maximize the treatment.

Eventually the laser was approved by the Food and Drug Administration for permanent hair removal. It sounded great until I was told that permanent hair removal was defined as no growth of hair through one growth cycle. This to my surprise is defined as ninety days!

Is It For Real?
This leads me to my next point.   Despite all the glitz and promises we see on television and glossy advertisements, is the technology truly an advance?  In this age of spin, dentures become dental appliances and removal of dead skin becomes exfoliation—let the buyer beware.

Many companies that launch new products begin advertising them directly to consumers. They go right to the public promoting all the benefits of the latest scientific advancement. Clients or patients then call their aesthetician or cosmetic surgeon and inquire about this latest advance. Offices then scramble to do their research and evaluate the treatment and determine if it is of benefit to their patients.

As one begins looking into new technologies and machines, ask about scientific studies that compare the new technology to existing procedures. Before undergoing the treatment, patients should understand the potential positives and negatives. Most patients have heard about the great potential benefits they could achieve, but the question is, how many patients reach this level?  Hopefully if it is very infrequent, the technology will not be available.

Approval by the F.D.A. gives the patient one level of comfort. Unless patients are participating in an approved F.D.A. study it may be illegal for the doctor to subject the patient to a treatment. Silicone injections are an example of this.

With lasers, as long as a laser or treatment has been F.D.A. approved for one area of the body it can be used at the doctor’s discretion on other areas. Not all technologies are regulated by the F.D.A. and the treatment may therefore not require this level of testing. You can call the F.D.A. or visit their web site to determine if the technology you are considering has been evaluated or is currently being studied, or is not necessary for the F.D.A. to evaluate.

Offices that provide the service one is seeking should be able to show before and after photos. If not, ask why. Have they just started performing the treatment? What kind of training has the operator completed?

Everyone’s results vary.  The technician should be able to discuss the spectrum of results they have been able to achieve. I personally like to see a neat organized, clean office. My personal feeling is that detailed charts should be kept and consent forms signed before the treatments.

Let’s look at some of the latest trends. From high-tech lasers to low-tech home products, all one needs to do is pick up a magazine and see home electrolysis pens, microprocessor controlled blemish devices, muscle firmers, smoothers and toners. Home care machines have boomed. 

Microdermabrasion is a great example of one of these products. It has been a great addition to the aestheticians’ armamentarium, and it provides an exciting treatment option for all skin care clients but especially those with sensitivities to chemical peels.

These machines started out with various types of sand (small particle solid) and could be quite messy. Newer versions are much improved, no longer leaving a sensation of having fallen asleep face down in the sand at the beach. Home treatment versions are generally less effective than the ones used by aestheticians. 

Is the age of machines an improvement or is it all hype? In our office I generally caution patients that we should look at treatments that have proven the test of time, thus giving a consistent result.