As registered nurse Thena Holmen spreads numbing gel on my face, I begin to grasp that the treatment I am about to undergo is more than just a high-tech facial. Reclined in the dentist-style chair, I do a video screening with a nurse practitioner, who asks me what medications I’m taking and whether I have certain health conditions.
Sometimes called “photofacials” or “photorejuvenation,” or known by brand names such as Clear & Brilliant and Halo, esthetic laser skin treatments sound more like spa services than medical procedures. But the results some clients report — skin tightening, wrinkle reduction and removal of unwanted marks like sunspots — rival what you’d expect from cosmetic surgery.
“My face looks so good and natural and healthy. I do not feel like I’m ever going to need a facelift. I’m 62, and people say I look like I’m in my 40s,” raves Jean Peterson of San Rafael as she leaves Skin Suite Marin, where Holmen has just given her a follow-up treatment with the Fotona laser, the same one she’ll use on me.
I’m 50, and while the wrinkles around my eyes don’t distress me terribly, I have begun, like Nora Ephron, to feel bad about my neck. While I’m not sure the loose skin there would qualify as a wattle, I’m not thrilled with it. And the years of walking and skiing under the California sun wearing too little sunscreen have left a swatch of redness across my nose and cheeks that I’m not crazy about, either. In the treatment room, I tell Holmen about these concerns.
Holmen shows me the Fotona SP Dynamis Pro laser, a hulking white machine that, like the chair, reminds me of the dentist’s office. She shows me the large handheld attachment she’d use to promote the growth of new collagen on my neck, which over the course of weeks — and ideally, several followup treatments — would tighten that sagging skin. She would use a mid-sized attachment all over my face, zapping sunspots and redness as well as addressing wrinkles. Then she shows me a slim wand that she would put inside my mouth, to promote collagen regeneration and tighten the area around my mouth and chin.
Altogether, these steps make up what Skin Suite advertises as a non-surgical laser facelift.
“It’s a really precise, amazing machine,” Holmen says of the Fotona, which, after more than three decades of working with plastic surgeons and in med spas, she purchased just over a year ago to start Skin Suite Marin. “If I wanted to do all those things (without Fotona), I’d probably need three different lasers.”
Step 1: The Neck
With that, Holmen places a pair of metal goggles over my eyes and gets to work on my neck. The machine whooshes loudly. With every pulse of the laser, it emits a high-pitched beep. The laser’s heat is barely perceptible, like the tiniest trickle of hot water racing up my neck, then vanishing.
The idea that flashing a laser on my skin can actually regrow collagen seems far fetched to me. But Dr. Linda Hwang, Chief of Dermatology at Kaiser Permanente San Rafael, confirms that this process is scientifically legit. Hwang explains that lasers cause small, controlled injuries to tissue, stimulating healing.
“It takes you to the state where you’re developing fresh collagen and elastin, much more like when you were in your youth. And we can observe that microscopically,” says Hwang. Like Skin Suite, Kaiser offers several varieties of laser skin treatments, often combined with other esthetic services such as fillers or Botox. Hwang spoke about the potential benefits of laser treatments in general, not specifically about Skin Suite Marin, to which she has no connection.
Step 2: Intraoral
Once my neck is done, it’s time for the weirdest part of my treatment: inside the mouth. Holmen applies laser pulses to the lining of my cheeks, and down into the crevice between my gums and cheek. With the thin wand attachment on, the laser makes different sounds than before; now each laser pulse is accompanied by a sound similar to the pew-pews of tiny blaster guns in a sci-fi movie. After Holmen treats a section of my mouth, she instructs me to lick that area in order to cool it down. Awkwardness aside, this part of the treatment felt uncomfortable but not painful.
While most laser treatments offered at Marin spas and dermatology practices may not work from inside the mouth, all modern esthetic laser treatments have come a long way since the 1990s. Back then, practitioners typically used lasers to “resurface” the entire face, leaving none of the skin intact. This could deliver dramatic results, but with a long healing period and, too often, collateral damage to the skin.
Dr. Faye Jamali compares older lasers to sledgehammers, saying, “Now we have much more fine tuned instruments.” Jamali left a career in anesthesiology to start Mill Valley’s Belle Marin Aesthetic Medicine, where she offers Halo laser treatments, as well as BBL, a laserlike pulsed-light technology, and other cosmetic services.
Step 3: Targeting unwanted coloration
For the third phase of my treatment, Holmen fires up the chiller, which is basically a hose that looks like it comes from a canister vacuum cleaner, blowing out cool air. She hands me the hose so I can direct it at any area I need, while she uses the medium attachment on my forehead. With the chiller on my face, I feel pleasantly as if I’m standing outside in a storm. During this part of the treatment, some of the laser pulses sting, but a blast from the chiller dissipates the discomfort immediately. I smell something like toasting bread.
As she works, Holmen frequently checks in with me to make sure I’m feeling OK. She knows what the laser feels like, as she underwent several treatments herself 14 months ago, while getting trained to use the machine. The results she’s still enjoying have probably convinced some of her clients to get the treatment; when she tells me her chronological age, I do a double take.
Holmen moves on to the redness on my cheeks. This part, I must admit, hurts a little. As she zaps areas of redness, it feels like being flicked with very tiny drops of hot oil from a frying pan. Unlike getting splashed with oil, however, the pain vanishes immediately after the laser pulse ends. At this point, I notice a burning smell, much like the odor a dental drill sometimes gives off.
Peterson says she felt a little pain during her first treatment as well. Holmen always puts a squishy ball in patients’ hands, in case they need something to squeeze.
“I did use that ball and the blower,” Peterson says. “But the next time it did not hurt at all.”
Unwanted redness is often caused by tiny capillaries close to the skin. Lasers can destroy these capillaries, causing them to be reabsorbed by the body.
Step 4: Surface treatment
Holmen calls the final step a “light peel.” She moves the laser across my entire face, but unlike when she was targeting red spots, the pulses don’t hurt.
And then we’re done. My face feels as if I’ve been skiing all day in the sun and wind. It’s not a bad feeling, it just feels like my skin has absorbed a lot of energy — which it has. Holmen spreads a healing cream on my face, then some moisturizer. She reminds me to avoid the sun for a day or two, and says that any swelling or pinkness should resolve in a few days. After that, I should see gradual improvement of my skin over a few weeks. After four weeks, I can return for a recommended second treatment. Ideally, I’d keep coming back three or four times until I’m satisfied with my rejuvenated appearance.
After effects
As I leave the office, my skin feels tight and a bit stiff, probably from the lingering effects of the numbing gel. The next day, I look like I have just a hint of a sunburn. For a couple days after that, my face feels a little chafed. I double-down on moisturizer. Within a week, as predicted, everything seems normal. Maybe even a little better than normal.
I appreciate not having to hide at home afterwards. Some laser clients choose more aggressive treatments that require “downtime” of a week or more, when their skin may be significantly swollen, even oozing or bleeding. That wouldn’t be for me.
“Generally, the lighter the treatment, the less downtime, but possibly the less dramatic results for single treatment,” Hwang explains. “So most of these lighter lunchtime treatments are recommended to be done in series to really maximize results.”
