Skin boosters and melasma lasers, how to choose: Finding the right treatment, Part 2

Dry or sensitive skin is mainly treated with skin boosters, while melasma, blemishes and age spots are treated with laser pigmentation treatment. Before you start, it helps to know that each skin booster is good at different things, and that melasma isn't something you erase in one or two sessions but a condition you manage over time.

In Part 1, I divided concerns into “contour” and “skin” and covered sagging and hollow faces. In Part 2, I'll move on to skin concerns. Lifting sagging areas won't improve melasma, and treating melasma won't lift a sagging face, so your skin needs its own separate plan.

If dry or sensitive skin is your concern: skin boosters

These concerns can mostly be addressed with skin boosters, the area of aesthetic medicine that has advanced the most over the past five years.

People now start taking care of their skin at an ever younger age and keep having treatments later in life, so the patient base is widening at both ends, and advances in skin boosters have played a big part in that.

Clinically, a skin booster is defined as “any nourishing ingredient injected into the skin to improve it.” They can be classified in many ways, but by the effect patients actually notice, they fall into four main groups:

1. Improving dehydrated skin, pores and texture

2. Restoring volume and improving firmness

3. Repairing and protecting a damaged skin barrier

4. Calming inflammatory skin conditions such as acne

Most skin boosters offer two or more of these benefits.

Rejuran

Take Rejuran, one of the best-known skin boosters. Its main benefit is repairing and protecting a damaged skin barrier, but it also helps with dehydration, pores and texture, and with calming inflammatory skin conditions. The downsides are that the effect is short-lived, so repeat treatments are needed, and above all, it tends to be quite painful.

Sculptra (PLLA) and Radiesse (CaHA)

Sculptra and Radiesse, used when the face has very little volume, mainly restore volume and improve firmness, but they also work well for dry skin and texture. Once they take effect, the results last two years or more, but the downside is that it can take three to six months before you notice a difference.

Exosomes (ASCE and others)

Products such as ASCE, known for containing exosomes, are a type of stem cell extract. They're good for calming inflammatory skin conditions such as acne but relatively weak in the other areas.

NCTF 135 and Jalupro

NCTF 135 and Jalupro, once widely used, combine hyaluronic acid with essential amino acids, vitamins and other ingredients, and work well for dehydration, pores, texture and inflammatory skin conditions. But since Rejuran arrived, they've been used much less often.

Hyaluronic acid skin boosters (Restylane Vital Light, SkinVive) and Belotero Revive

There are also newer skin boosters based on pure hyaluronic acid, such as Restylane Skinboosters Vital Light and SkinVive, as well as a glycerol-based product called Belotero Revive.

These products are especially good for dehydration, pores and texture, and also help with fine lines around the eyes, between the brows and around the mouth. They hurt much less than Rejuran, and one session lasts about four to six months, while three sessions last about a year to a year and a half, so many people ask for them.

Re2O and CellREDM

Re2O and CellREDM, the newest products, start from a different place than the ones above.

All of the products above work by stimulating collagen production, so it usually takes one to two months for your skin to make new collagen. Re2O and CellREDM, by contrast, are derived from human tissue and deliver extracellular matrix (ECM), including collagen, directly, so you may notice improvements in pores and redness relatively quickly.

That's why they've become the most sought-after products these days. But they're relatively expensive, and although they work faster than older products, they can't solve every concern in one go.

Beyond these, dozens, even hundreds, of skin boosters are flooding the market. Even doctors find it hard to keep track of every product. Many haven't been proven effective, and even well-known products, though similar in effect, target different concerns, so it's best to have a thorough consultation with a doctor before treatment.

If melasma, blemishes or lentigines are your concern: laser pigmentation treatment

In these cases, laser treatment is the foundation. Unlike the lifting, volume treatments and skin boosters I described above, melasma and blemishes are a problem of melanin pigment in the skin. No matter how much you lift and fill the face or inject regenerative ingredients, the color itself won't fade or disappear.

So melasma, blemishes and solar lentigines (age spots) must be treated with laser pigmentation treatment.

With major advances in laser technology, the trend has moved away from treating the skin by stripping it, as was done in the past. Treatments now protect the epidermis while making the dermis healthier. The aim is treatment that leaves the skin healthier afterward, not more sensitive.

Melasma: something you manage, not erase

Melasma is the hardest to treat. Many people think of it as something a laser can erase in one or two sessions, but it's better to think of melasma not as something to cure but as something to manage, like high blood pressure or diabetes.

Melasma often involves melanin not only in the epidermis but also in the dermis, and it reacts very sensitively to UV light, hormones and skin irritation, so overly aggressive treatment can actually make it worse.

So the key to treating melasma is not a strong laser but low-energy laser toning as the base, combined with pigment lasers, vascular lasers and regenerative treatments depending on the skin's condition, and, if needed, injections of brightening ingredients or skin boosters.

Recently, there have also been reports of stubborn melasma improving considerably when stem cell treatment was added.

Blemishes and solar lentigines (age spots): relatively responsive to treatment

Blemishes and lentigines are lesions where melanin pigment has built up in one spot, and unlike melasma, they have very sharp borders.

These are treated with lasers that selectively target pigment (ruby, Clarity, MaxG, Pico toning and others) at relatively high energy, and most improve noticeably within one to three sessions. The treated spots scab over, and the scabs fall off on their own after one to two weeks.

Trying to remove a deep age spot all at once with too much energy raises the risk of hyperpigmentation. In these cases, treatment often has to be split into about three sessions.

Summary: for skin treatment, look at both the equipment and the doctors

With major advances in laser technology, pigmentation treatment has become a field where good equipment and skilled medical staff both matter. The days when every clinic was much the same and the cheapest one was the best are over.

These days in particular, laser treatment can even leave sensitive skin healthier than before, and melasma treatment has improved a great deal, so be sure to consult a doctor before treatment.