Layering Energy Sources for Optimal Clinical Outcomes in Aesthetic Treatments

The field of aesthetic medicine is rapidly evolving, with new technologies and approaches emerging regularly. One such approach that is gaining traction is the layering of energy sources to address various aesthetic concerns. This strategy is particularly effective because no single modality can tackle all aesthetic issues, and most patients present with multiple concerns.

The Concept of Layering

Layering in aesthetic treatments refers to the use of multiple modalities, either in one session or across multiple sessions, to achieve the best possible outcome. This method is akin to a multifaceted approach where each modality employed targets a specific issue, resulting in a comprehensive treatment plan.

Benefits of Layering

Comprehensive Treatment: Layering allows for a more thorough and holistic approach to treating aesthetic concerns.

Enhanced Outcomes: Patients often see better results in a shorter duration with fewer visits.

Personalized Plans: Each layer can be customized to the patient's specific needs and skin type exiting the cookie-cutter approach.? Bespoke programs assure the patient (and you) that all their aesthetic concerns are being addressed according to their skin requirements, safety needs, budget, tolerance for downtime and discomfort as well as schedule preferences.

Challenges of Layering

Despite its benefits, layering is not without its challenges. It requires a deep understanding of various modalities, skin types, and the interactions between different treatments. Practitioners must be skilled in deciding what to layer, when, and on whom. Advanced training in layering modalities is crucial and typically should involve:

1. Understanding Energy Sources: This includes comprehending different types of energy sources like laser, radiofrequency, ultrasound, and others. Each energy source has unique properties and interactions with human tissue, which must be thoroughly understood.

2. Technique of Layering: This refers to the skillful application of these energies in layers, or at different depths and intensities, to achieve the desired clinical outcome. This layering technique is essential to maximize efficacy while minimizing damage to surrounding tissues.

3. Specific Modalities and Devices: Each device or modality that uses these energy sources might have unique characteristics, settings, and methods of application. Understanding these specifics is crucial to safely and effectively use the device.

4. Clinical Outcomes: The ultimate goal is to achieve the best possible clinical outcomes. This involves not only the technical application of the modalities but also understanding the biological response of the tissues to these treatments.

5. Reducing Risks of Adverse Skin Effects: Safety is paramount. Advanced training should include a strong focus on how to minimize the risk of burns, scarring, pigmentation changes, or other adverse effects on the skin.

Considerations for Specific Skin Types

Particular attention must be paid to patients with skin types IV to VI. These skin types are more prone to adverse effects like post inflammatory hyperpigmentation (PIH), burns, and scarring. Hence, caution is paramount to avoid excessive heating and ensure safety.

Order of Layering Treatments

A general guideline is to start with less aggressive, non-ablative treatments and progress to more aggressive, ablative treatments. This progression ensures minimal risk and maximizes patient comfort.

Using Chromophore Dependent Modalities

First Phase: Treatments targeting melanin and oxyhemoglobin chromophores should be performed initially.

Second Phase: Modalities focusing on water and protein should follow.

Energy Adjustment and Post-Care

When layering modalities in the same day, each should be reduced in total energy by about 15-20% to minimize the risk of adverse effects. When layering heat-inducing treatments in aesthetic procedures, the role of epidermal cooling through methods such as cold air chillers, cold packs, and contact-cooled tips becomes crucial. This cooling process is essential to prevent bulk overheating and to protect the epidermis from unexpected and unintentional damage. Additionally, post-treatment care becomes even more critical. A strict home care routine ensures minimal social downtime and promotes faster recovery with less risk of adverse events.

?Program Structures

Same Session Layering

Stacking a series of treatments (2 or more) in sequence, in the same appointment.

Advantages: Quicker results, fewer overall appointments.

Suitable for: Tolerant to downtime patients, those with limited time for multiple appointments and those with more resilient skin.

Considerations: Higher risk, more social downtime, and potential posttreatment effects like erythema and edema. Clear communication with the patient about these risks is essential.

Outcome: Results are seen quickly over less appointments but the downtime between appointments may be more significant than a multisession approach.?

Multisession Layering

Performing the treatments one at a time, over successive appointments.

Advantages: less risky than layering energy sources, heat and side effects are easier to predict.

Suitable for: Patients averse to risk and downtime, those with fewer constraints on return visits. Patients who are very sensitive and darker Fitz types may benefit from this approach.

Considerations: Patients can get discouraged and drop out as the results take longer to be visible over a longer treatment plan. Less efficient per appointment per staff as a multi-approach will lead to less room turn around and individual treatment prep (think about a program that has 15 treatments. In a single modality program that would be 15 room preps, 15 face cleansing preps and 15 post treatment care steps. In a layered approach that can be 3-5 face cleansings, 3-5 room preps and 3-5 post treatment care steps).

Outcome: Results take longer to manifest as effects are observed over more appointments.?

Conclusion

Layering energy sources in aesthetic treatments offers a promising path to address multiple concerns effectively and efficiently. While it presents certain challenges, the tailored approach, when executed with skill and care, can yield superior outcomes with high patient satisfaction. It's a paradigm that underscores the importance of customization and careful planning in aesthetic medicine.