Lighting Up Your Skin: The Alma Hybrid Laser with Dr. James Wang

[Intro] Hey, everyone. Welcome back to Facially Conscious with myself, Trina Renea, esthetician, Dr. Vicki Rapaport, dermatologist, Rebecca Gadberry, the cosmetic ingredient guru, and our fabulous, overly-educated consumer, Julie Falls. We are gathered here together with you to talk about this crazy world of esthetics. It's confusing out there in this big wide world. 

That's why we are here to help explain it to you all, subject by subject. We will be your go-to girls, and from our perspective without giving medical advice, we will keep things facially conscious.

Let's get started. 

01:00 Julie Falls: Welcome to Facially Conscious. I'm Julie Falls. I'm here with my lovely co-host, Dr. Vicki Rapaport, and Rebecca Gadberry, and Trina Renea.

01:12 Trina Renea: Hi. 

01:12 Julie Falls: And our fantastic resident dermatologist, besides Dr. Vicki, is Dr. James Wang. He is back with us today, Dr. Wang from Metropolis Dermatology in Los Angeles. Several beautiful locations, as a matter of fact. And we're going to discuss lasers again. 

01:35 Trina Renea: Alma Hybrid laser, the new hybrid. 

01:37 Rebecca Gadberry: Well, isn't Dr. Wang a specialist in lasers. 

01:40 Julie Falls: He is a specialist in lasers. I think he has more bells and whistles in the laser department.

01:47 Trina Renea: I think he knows more about lasers than any of us. 

01:50 Rebecca Gadberry: But doesn't have a lightsaber. That's what I want. 

01:54 Julie Falls: He's definitely the go-to. 

01:54 Dr. James Wang: It's coming. It's coming. 

01:55 Rebecca Gadberry: It's coming?

01:59 Julie Falls: Hi, Dr. Wang. You're coming to us today from a conference in Phoenix, correct?

02:06 Dr. James Wang: That’s correct, a national laser conference. 

02:09 Julie Falls: See? Need I say more? Constantly continues education. 

What can you tell us about this Alma Hybrid laser?

02:17 Trina Renea: Well, before we get to that, we're going to do a quick tip of the day from Rebecca.

02:22 Julie Falls: Okay. 

02:23 Rebecca Gadberry: Yes, I have a tip of the day, which comes out of our break room today, also known as the Green Room, where we all gather in between episodes. And what we were discussing is the new home dermaplaning kits and how they affect the skin. And some people have been saying that their product stings after they dermaplane. That means that the product is getting in a lot quicker, or a lot more quickly, depending upon whether you like adverbs or, never mind, adjectives. We were also talking about adverbs today.

Anyway, the point is that when you remove the barrier of the skin, even just slightly, your products get in a lot faster. So either put on less of the product or avoid it all together, especially if you have products in there or ingredients in there that might sting, like AHAs or vitamin C or retinoids. Just common since.

03:21 Trina Renea: All right. Let's get on to the laser, Alma Hybrid laser. I just want to say I was meeting Dr. Wang one evening at his office and one of my clients happened to be there getting this new laser treatment. To my surprise, I got to watch it and it was crazy. I was like, “What in the world is happening?”

So this is, I think, revolutionary as well. Will you tell us about it? It has something to do with CO2 and another laser, right? 

03:57 Dr. James Wang: Correct. I think you're really, really good at scaring our future patients. 

04:02 Julie Falls: She is our resident fright lady.

04:04 Trina Renea: No, it was really cool. I have to say, I saw the results after and she looked amazing. I have to say. 

04:13 Dr. James Wang: So I always joke, you guys are saying I have all the bells and whistles. I think I'm just a tech junkie and this is my version of sports cars. I just collect awesome lasers. I guess that's my hobby.

But, I know, it's not the same. I know. 

04:32 Trina Renea: Unfortunately, you have three stores to put them all in.

04:35 Dr. James Wang: Exactly.

04:36 Julie Falls: We read a lot…

04:37 Dr. James Wang: I build clinics, yeah. I built the clinics just to store lasers. They're just big storage rooms.

04:44 Trina Renea: Like a big garage.

04:48 Dr. James Wang: Exactly, exactly. No, no, but, obviously, I love lasers. I love technology. And so, for me, I'm always interested in things that are just slightly better versions of what we currently have, but things that really kind of move the compass forward. 

So when we get new devices, these are very expensive devices, the reason we get them is because we feel like they are safer and they do more. At this time, I only had one CO2 device in the past. Now, I actually have a few more.

But hybrid was a really nice way for me to learn about CO2 lasers because it has multiple features. The reason it's called hybrid is because it has CO2. And CO2 is a 10,600 nanometer wavelength type of laser. The other wavelength is 1570 nanometers, which is kind of in your range of some of the lasers on the market. Like, your Fraxel has something like this.

So, there's other things on the market that are in the 1500, 1600 range, but this laser has both. And the cool thing is that it can fire both wavelengths at the same time. 

Now, in the beginning, I did think, “What is this going to do clinically for me?” So, there are things that sound really cool or just for the sake of innovation, and what's most important is that is it going to give someone a real result rather than just being the science is cool. 

So I was interested in this. I was I always demo devices. I always have to fire lasers. I always have to do on people before I buy a laser because I just can't trust before-and-afters. 

Every company is going to show you their best result or doctored images. Actually, we hate the word "doctored" because, obviously, I'm a doctor. I think that's a weird way to use that word, but it's just in colloquial language now. But I do think that it's hard to trust before-and-afters. I have to see with my own eyes. 

So I actually flew to Florida to test out this device. They actually shipped me the laser as well for me to try in my office on my own patients so I can actually see the after effects as well as the result. Both of those are really important. It's not just about the fact but what is the true downtime.

07:16 Trina Renea: So before you bought it, you borrowed the laser for a little while? 

07:20 Dr. James Wang: Yeah. They probably didn't want me to say that, but yes. 

07:24 Julie Falls: That’s smart.

07:25 Rebecca Gadberry: Special treatment.

07:30 Dr. James Wang: Look, I know lasers. So, for me, I know so much about lasers that I just don't want to be— I know when I fire a laser and how it will react with the skin, what it is about. So I don't want someone to just tell me about it. I've worked with enough lasers now where I want to see it and I want to do it. It all matters.

07:51 Trina Renea: So what does it do, the hybrid?

07:55 Julie Falls: He's getting to it.

07:56 Rebecca Gadberry: Slow your roll, kid.

08:01 Dr. James Wang: So the hybrid is used for many different things. The primary thing it's used for is going to be more aggressive rejuvenation than your standard, kind of mild, superficial type, like 1927 nanometer or your Fraxel. It can be too much more than that because it is CO2 is one component to it. 

The issue with CO2 lasers, or at least pure CO2 lasers, is that it's really hard to treat darker skin types. You really, really run the risk of not only hyperpigmentation, but an even harder to treat side effect which is hypopigmentation. When you knock out the pigment in your skin, it's actually much harder to recover the pigmentation than having darkening of the skin and trying to get it lighter. 

And so CO2 can permanently destroy melanocytes if used too aggressively, which is why the first generation of CO2 lasers, which was the first laser to come out decades ago, people got that scarred look on their face. So people think laser and they think about that scarred, immobile, shiny face, that was pure non-fractional CO2 that caused basically full-face scar tissue formation. And no one wants that. 

So the next step was fractional CO2, which is great, but also not super safe for skin type 4 through 6, or darker skin types. 

I found, the intriguing part of this, is that it can fire your CO2 in a pattern with your 1570 and you can control the ratio that they are. So you can do two-thirds CO2, or one-third 1570, or you can do two-thirds 1570, one-third CO2. So I'm really able to customize and control the aggressiveness that I treat it. 

And the 1570 is non-ablative, so it's actually much safer for different skin types, while the CO2 is ablative. The ablative subtypes are going to be the more dangerous ones, technically, but because you're spacing them out a little bit more, it becomes a much safer modality. 

10:08 Trina Renea: So you can use it on darker skin types because you can adjust how much CO2 you're putting there.

10:15 Dr. James Wang: Correct. 

10:16 Trina Renea: But is it resurfacing? Is that what it's doing? Is it for textured skin? 

10:21 Dr. James Wang: It's for textured skin. The primary use is texture and pigmentation. So it will help remove not only textural regularity, but it will also help remove those little sunspots on the skin as well. It's kind of an overall comprehensive improvement in the skin. 

10:40 Julie Falls: Is that the newest CO2 that's available out there now?

10:45 Dr. James Wang: It is. It's the most recent one that's been released. I think CO2 is an overall technology that's been around, actually, it's been around the longest of any technology, but we're trying to improve it to make it safer for all skin types. 

10:58 Trina Renea: So are you using it on darker skin types? 

11:00 Julie Falls: I just was going to say do you have it now in your office? 

11:05 Dr. James Wang: Yes, we have two of them right now. 

11:07 Trina Renea: And you're trying them?

11:10 Dr. James Wang: I am. Yes, I am. So there are ways they were used. There are different ways that we're using a different wavelength. 1570 we're using as a general light rejuvenation, collagen stimulation in very young patients who have no issues with their skin at all. It's really just a light laser toning, which is good for just a little bit of skin elasticity. There may be even some like anti-acne components to it that are nice. That's a pure 1570. 

Then we use pure CO2 fractional to treat areas like around the eyes where we want to tighten the eyelids, where we want to get rid of the lines around the mouth, the smoker’s lines. We're going to do quite a good job getting rid of those using the CO2 version of it. 

And then we have the mix that we can actually kind of wave on the skin and get a really nice, evenly diffused treatment to help with collagen as well as pigmentation across the entire face, neck and chest, actually. 

12:10 Julie Falls: What's the downtime?

12:14 Dr. James Wang: It's more than your traditional, we've talked about like ultra before. It's going to be more than that. So, on average, you're going to get pink for about a week-and-a-half to two weeks. So Julie, that means four weeks for you. But you also get this sandpapery, slightly darker skin flakes, and that can last up to three weeks. 

And the areas that we really treat aggressively, same we do with that fully ablative fractional CO2 around the mouth or around the eyes, I always tell people maximum time for everything to kind of resolve from the skin is four weeks, although most people, by two-and-a-half weeks, everything is looking normal. But there is a range so I kind of would be cautious about planning events within that period.

13:02 Trina Renea: Yeah, it's better to tell people the full range so that they can…

13:05 Julie Falls: ____. One more question, Dr. Wang. I'm sorry but can I get just one quick question. Somebody comes into you with sunspots and hyperpigmentation. Why would you recommend this over something like a BBL?

13:30 Dr. James Wang: These things give you a lot of different options. I think BBL is great for pigmentation, but if someone has melasma or past sensitivity to BBL or they are on medications that make them photosensitive, the BBL is extremely dangerous as a laser. 

But if we're treating pigmentation diffusely on the skin while wanting that rejuvenation in fine lines and wrinkles, then we would do the fractional CO2 1570 hybrid mode.

But it's really individual. We're blessed with different things that we can do, but many places will only have one or two options. So if you have a BBL, you can use BBL to treat the brown spots. But having these options allows you to treat multiple things in one session. 

14:19 Dr. Vicki Rapaport: And what is the darkest skin type you have used on the Alma laser?

14:26 Dr. James Wang: So the 1570, I've used skin type 1 through 6. So 1570 is extremely safe. It's a non-ablative laser. It just feels warm. It's like prickly heat is what it feels like. The CO2 on the hybrid, I've gone on a skin type 4, a dark skin type 4, which is darker than I usually would do for a CO2. Usually, it's 1 through 3, is kind of what we call this usually safe parameter of CO2.

Now, there are other CO2 devices, potentially, that you can tone it way down and get it safe for skin type 4 but, certainly, you're trading off results when you turn it down that much. 

15:07 Trina Renea: And then so in the hybrid, you went up to a four? The hybrid one? 

15:11 Dr. James Wang: Correct, a dark four, almost a five is the dark I’ve done so far. 

15:15 Trina Renea: How much is one treatment of the hybrid?

15:20 Dr. James Wang: A full-face hybrid will be a couple thousand.

15:26 Trina Renea: A couple thousand?

15:27 Dr. James Wang: Yeah, correct. So, I'd give a range of $1,500 to $3,500, depending on kind of where you go, because an aggressive resurfacing treatment will run you that much, in some places even more. I've seen aggressive resurfacing $5,000.

The nice thing about this one is that the recovery time is not a downtime that if you Google fractional CO2, you see people's faces like melting off. This is not that. It's a dry kind of recovery. You don't get oozing and greasiness. It's a dry, kind of like scaly and rough and pink, but not oozing and pussy or anything like that. It should never be that way with this type of technology. So it's much easier to manage and handle than earlier generations of CO2. 

16:23 Trina Renea: Another thing that it has that I noticed, it doesn't have the checkerboard. It's not in a checkerboard - how do I say that - formation or whatever, where it leaves that look on their face afterwards. The little red lasers move around, like squirm around on there. What is that?

16:45 Dr. James Wang: There's actually a couple of nice features of it. There are modes. We can do checkerboards and then circles or other shapes, but the nice thing about that hybrid mode is that you can wave it like a wand. So you're kind of giving paint strokes. The nice thing about that is that it evenly treats the skin without little skip areas that— you know, whenever someone's doing a laser, we’d be so careful, but there's always a certain area where it's just not perfectly aligned. 

Honestly, from a result perspective, it doesn't matter. It really looks the same. But I think people want to see that everything is evenly treated. And I think having that painting mode makes sure that that does happen. That at the end of a treatment, you don't have any little jagged edges that were treated or you treat someone's neck and it ends right at the jawline versus a little feathering along it, which kind of evenly blends skin. You're not treating the skin that's been treated. 

17:36 Trina Renea: I see. That was, it looks really cool when it's being done. 

17:43 Julie Falls: It's really exciting. You wait long enough, things come out that— I know someone who's been wanting to do something for facial lines and actually had a face lift and, in addition to the facelift, was going to also address lines around her mouth. I'm thinking now, thank goodness she didn't do that because her downtime will be so much easier with this kind of thing.

18:10 Dr. Vicki Rapaport: And Dr. Wang, are you familiar at all with phenol peels?

18:15 Dr. James Wang: I am. We don't do too much in our practice, but that is absolutely another way to get deep enough to address some of those lines. Vicki, do you do them in your practice? 

18:15 Dr. Vicki Rapaport: No, I'd love them for my patients. I send them to the one guy in town that I know has been doing it for 30 years, but I'm just curious about this laser versus a phenol peel versus just the old school CO2. Do you have a preference over those three in terms of the depth for somebody who's very wrinkled and really needs an aggressive treatment?

18:52 Dr. James Wang: I think, certainly, your phenol peel as well as an ablative non-fractional laser is going to go a lot deeper. But my concern with phenol peels as well as non-fractional CO2 is the possibility of that permanent hypopigmentation as well as like near-permanent erythema as well. And so even though it may take two to three sessions using this laser to get deep ____ [19:19] gone, I just feel like it's a slightly safer, more graduated option for it.

So I think phenol peels can be great. I think CO2 ablative is, of course, great. But this just gives it a safer safety profile. 

19:38 Dr. Vicki Rapaport: Got it. But you think that the same results can be reached. You just have a multiple, they would need multiple of these Alma treatments versus, I mean, like an old school CO2 or even phenol. You really think that those same results could be achieved with this one?

19:51 Dr. James Wang: I think so. It just will take multiple sessions to get you there. 

19:55 Dr. Vicki Rapaport: That's pretty impressive. 

19:57 Julie Falls: It sure is. 

19:59 Trina Renea: But like if you just wanted your upper lip, if you had lip lines and you're like, “I just want to get rid of those,” could you do that laser three times or something in that area you said you were getting good results with and not treat the rest of the face and still have the skin it won't look different than the other part of your skin?

20:21 Dr. James Wang: Right, and that's what we're seeing. Oftentimes, we do just treat around the eyes or around the mouth and we have not seen any clear demarcation in those areas, because we're not going so aggressive that we're actually depigmenting the skin, which some of the other technologies can. 

So just always be careful. I think peels are great but, also, they can be very destructive if they're overdone. 

20:46 Trina Renea: Right. Okay. All right. Well, thank you, again. Thank you for sharing about the Alma Hybrid laser. It's good to know because people in other cities who might be introduced to this, they can listen to this episode and hear all about it before they go and jump in.

21:07 Dr. James Wang: Absolutely. Very exciting times.

21:10 Trina Renea: Yeah. We're going to have Dr. Vicki do our takeaway today. 

21:14 Dr. Vicki Rapaport: I am going to do the takeaway from today's Alma laser episode. I would like to remind everybody that the laser technology is constantly changing for the better. So when you're interested in a laser that you might have heard or a friend has done, look it up online, find a provider near you, and then make sure it's the right thing for you. 

Because, for instance, Julie went to Dr. Wang to get a certain kind of treatment, and all he said was, “You're really red.” She didn't go in there thinking she was going to have a red laser treatment, but she was so thrilled with the results. 

So the point is trust the expert, but also find out how long they've had the laser, how long the laser existed. You don't really want a 20-year old laser at this point. Those are old technologies and the newer technologies are going to give you better results quicker. 

22:07 Trina Renea: Thank you, Dr. Wang for joining us. Thank you for telling us about this laser and we'll have you back for another episode on more lasers. 

22:15 Julie Falls: Thank you, Dr. Wang. We can't wait to hear what you also take away from your conference. 

22:19 Dr. Vicki Rapaport: Oh, yes. 

22:20 Rebecca Gadberry: Oh, yeah, I want to hear that. 

22:21 Dr. James Wang: Of course. All right. 

22:21 Trina Renea: I bet you're learning so much from all you doctors sharing all the new things. It must be amazing. 

22:30 Julie Falls: I know. It must be so interesting. 

22:32 Dr. James Wang: Yeah, it is. It is great. You never stop learning. That's my takeaway. 

22:36 [crosstalk] 

22:39 Rebecca Gadberry: That is for sure. I was going to say, you're the Jay Leno of lasers. He collects cars, you collect lasers.

22:51 Trina Renea: All right. We'll see you later. 

22:52 Dr. Vicki Rapaport: Okay. Bye-bye.

22:52 Dr. James Wang: We'll see you next time. Okay. Bye-bye. 

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