In the evolving world of aesthetic medicine, achieving optimal results for common skin concerns such as hyperpigmentation, skin laxity, and fine lines requires more than just a singular treatment approach. As an aesthetic doctor who has worked with several dozen spas to improve outcomes and reduce complications, I’ve seen firsthand how combining advanced devices with targeted skincare improves patient outcomes. Here I will discuss my favorite regimens to tighten, brighten, and texture improvement.
The Importance of Combining Treatments
Imagine trying to paint a masterpiece without first preparing the canvas. The colors may be vibrant, but they won’t adhere well or last long without proper preparation. Similarly, when treating skin issues, a single modality is often not enough. A patient might see some improvement, but the results are rarely as dramatic or lasting as they could be when treatments are combined. Around 70-80% of patients report higher satisfaction with their results when they follow a comprehensive skincare regimen alongside laser treatments.
As a physician, I encourage all my nurses and aestheticians to consider what we are treating – which cells and pathways. For example, addressing hyperpigmentation requires we target the melanocyte at multiple stages of the life cycle. To remove existing melanin we use AHA and TCA peels, and also use tyrosinase inhibitors to reduce production of melanin to begin with (hydroquinone, kojic acid, azelaic acid, arbutin, and licorice extract). To further disperse the melanin we can use Q-switched Nd laser, PicoSure, and fractional lasers without damaging surrounding tissue. A combo approach over the rest of the patient’s lifetime is often required.
Dr. Chantal Lunderville, L+A Medical + Wellness Editor
Dr. Chantal Lunderville is a board-certified physician specializing in skin health, aesthetic medicine, and Women’s health. She attended medical school at UCLA School of Medicine, followed by a residency at UCSF Family Medicine, and on graduating opened her own concierge aesthetics practice in the San Francisco Bay Area focusing on hormone health, skincare, and longevity.
Since then Dr. Lunderville has grown her practice to include overseeing nurses and aestheticians as medical director to over 15 practices across California, and through Dr. C’s Academy helps to launch new practices across the US and Canada through consulting and online courses in business, compliance, aesthetic procedures including neurotoxin, fillers, lasers, microneedling, and lasers. Read Full Bio
Devices and Ingredients Combinations for For 3 Skin Concerns
To effectively treat common skin issues, it’s crucial to select the right combination of devices and ingredients. Here are some top modalities:
1 Tightening
Microneedling with RF is a powerful tool for skin tightening. This treatment creates micro-channels in the skin, allowing for the deeper penetration of ingredients like tranexamic acid, growth factors, exosomes, or stem cell medium. The RF energy delivers heat to the deeper layers, stimulating collagen production and enhancing skin firmness.
2 Brightening
For pigmentation issues, devices like Moxi, IPL, and Clear + Brilliant lasers can be highly effective. These treatments target the pigment in the skin, breaking it down while also stimulating collagen production. Combining these treatments with brightening serums containing ingredients like vitamin C or Kojic acid can enhance the results. We follow a peel series, alternating with lasers, separated by 2 – 4 weeks for patients, to really target the life cycle of the melanocyte, and explain to patients that treating hyperpigmentation is a lifelong routine and will never completely go away. Emphasizing yearly laser and peel series with daily active ingredients and sun and humidity avoidance is of utmost importance.
3 Texture improvement
Fine lines, wrinkles, and acne scars can be significantly reduced through resurfacing treatments. Microneedling combined with PRX-T33 (a biorevitalization peel) or skincare products rich in peptides, exosomes, and salmon DNA can help smooth the skin’s texture and promote regeneration. Salmon DNA is 100x more hydrating than hyaluronic acid, and is extremely helpful for skin experiencing hormonal changes, environmental pollutants, or lacking proper hydration.
Optimizing Skin Prep and Healing
Preparing the skin before treatment is critical to achieving the best results. A week before a procedure, modalities such as LED, red light therapy combined with hydrodermabrasion, or a facial with an enzyme mask, gentle superficial depth peel (mandelic acid), or nanoinfusion can be used to prep the stratum corneum 1 week before an aesthetic procedure such as laser or microneedling. This enhances the skin’s receptivity to the upcoming treatment and promotes deeper penetration of active ingredients. Medium-depth peels such as higher concentrations of TCA, retinol, and AHAs should be done at least 2 weeks following resurfacing treatments, if appropriate healing has taken place.
Importance of Patient Selection
All of these modalities must be recommended based on your evaluation of the patient’s skin concerns and your exam. While combo therapies can improve healing and outcomes, they also may worsen skin concerns if proper precautions are not taken, particularly hyperpigmentation. Following heat-based lasers I highly recommend incorporating post-procedure skin care with a lipid mask, peptides, ceramides, and adequate barrier support, my favorite being the biocalm line by Nelly De Vuyst, or the Trio Luxe by SkinBetter Science. Some principles I recommend following:
- Use a questionnaire and exam to thoroughly evaluate the Fitzpatrick score. Use caution with higher Fitz scores, VI and above. If you are unsure between scores, go with the higher one.
- Be conservative on laser settings and especially with first-time treatments. You want to see how patients react first to an initial treatment prior to offering repeat sessions, multiple modalities, or additional active ingredients.
- Take a thorough history of medications (especially photo-sensitizing ones), all skin care products, hobbies or time spent outdoors in the sun, and general health or risks for poor healing such as heavy alcohol use or chronic steroids.
- Incorporate a tool such as the Visia which can evaluate the level of hyperpigmentation (epidermis v dermis) to identify patients who are at risk of post-inflammatory hyperpigmentation and melasma which will worsen with IPL and photofacials, and avoid combo therapies such as microneedling with PRX or closely spaced peels for those patients.
Conclusion
In conclusion, combining advanced devices with targeted skincare is the key to achieving optimal results in treating common skin issues like hyperpigmentation, skin laxity, and fine lines. It is also best achieved by creating packages between aestheticians, mid-levels, and physicians within the same practice or across bridge practices. By taking a comprehensive approach that includes proper skin preparation, diagnosis-driven care, and the strategic use of modalities, we can significantly enhance both the effectiveness and longevity of aesthetic treatments, leading to healthier and happier patients.