The Painful Path to Perfect Skin
Lasering my face was never really on my agenda until I became a beauty writer. Then — while learning about the beauty industry's latest offerings, wearing less and less makeup regularly, and staring at the pore-less faces of the world's most beautiful celebrities everyday — I turned 30. Suddenly, a little laser resurfacing treatment stopped seeming like a luxury reserved for the Kylie Jenner's of the world.
It also helped that I was interviewing Orange County's top dermatologists for a piece for Locale Magazine at the time, which gave me access to the top skin experts in the area. My own dermatologist — Dr. Neda Mehr of Pure Dermatology & Cosmetic Center — had made the list, and recommended 2-3 sessions of Photodynamic Therapy (PDT) to address my skin concerns.
The treatment is known for amazing things. It removes sun damage, shrinks oil glands, refines pores, re-texturizes skin, removes acne scars, and even treats cancer. It's also one of the only treatments to cure cystic or hormonal acne for months at a time. Essentially like a light-powered peel, PDT inflicts a controlled injury to the dermis, resulting in a healing process that stimulates collagen production long into the future. This means you continue to reap the anti-aging benefits, like a reduction in fine lines and wrinkles, over the long-term. (Ok, I'll be honest — if it can delay the need for a facelift at 50, I'm willing to discuss it.)
photodynamic therapy (pdt).
If we're being technical, PDT isn't actually a laser treatment; it's the combination of blue-light therapy performed in conjunction with the application of a photosensitizing drug, ALA, or Levulan Kerastick. While a regular blue light facial won't even leave you red, the drug turns the blue light into a machine of destruction for any of your damaged skin cells. It works because the drug is only absorbed by the sun-damaged or irregular cells. When the blue light is turned on, they're completely vaporized, leaving your regular skin intact.
Since sun damage is essentially what determines the treatment's rigorousness, it follows intuitively that your first treatment will be the worst. I had 30 years of sun damage to erase from my face, including a past that included tanning beds and a bad case of SPF-negligence in my youth. Even knowing that the recovery would be the worst, I was happy to erase the signs of photo-aging from my face — it's the number one cause of premature skin aging.
You may not know this, but I am actually a certified tanning expert (with Honors, haha) from my former days working at an upscale salon in NYC during grad school.
That's how I know that UVA — the "bronzing" ray — is associated with premature aging, wrinkles, fine lines, hyper-pigmentation, etc., in addition to the damage that comes from the "burning" ray, UVB. Once I discovered there's a way to remove the damage I had wrought on my face, I REJOICED. Plus, after going through what it takes to remove it, I now take way better care of my skin. (Think: Hats, glasses, and sunscreen galore.)
While blue light facials by themselves are common and therapeutic, known for shrinking oil glands, refining pore size, stimulating collagen production, and killing off acne-causing bacteria, these photo- facials become much more powerful with the addition of the aforementioned drug. With the photosensitizing agent, it becomes a photo-facial on steroids, hence "Photodynamic Therapy."
A photo of me getting numbed before my second round. The sad look in anticipation of my hellish recovery ahead makes me laugh!
First, your dermatologist will cleanse your face to prepare you for the process. I opted to get a light, in-office peel first to make my skin extra-receptive to treatment. Peels remove the dead skin cells on the surface of your face, making subsequent products and treatments more effective, but I wouldn't recommend this step unless you're really committed. After the peel, if you get one, rinse your face thoroughly — until all tingling stops.
You can also get your face numbed at this point if you're worried about what comes next, but this will add on 40 minutes to your total treatment time. (See above.)
Next, the light-sensitizer, ALA, is applied to your skin. Some say that it tingles a little. You'll have to sit and allow it to absorb anywhere from 40 minutes to a number of hours. Some practices have patients go home overnight to allow for maximum absorption, although I think this is intended for skin cancer patients rather than those with cosmetic or acne concerns.
While the ALA is on your face, which can tingle a bit, you'll want to avoid light sources and sit in a darkened room. Even the UV light from your cell phone or TV can activate the ALA and make your skin tingle, so you'll want to dim the settings on your electronics. It's important to avoid activating the drug as much as possible prior to the introduction of the blue light.
Once the ALA absorbs, you're ready for the blue light — unless you've opted in on a cosmetic addition, as well, in the form of an IPL treatment. For those interested, this is an exciting way to boost the efficacy of pigment-erasing IPL treatments. Naturally, I had to try.
Angelina Jolie revealed to InStyle that she gets occasional IPL treatments. I also read in Cosmopolitan that she once got a similar treatment sequence to mine called "The Triad" from Dr. David Colbert of The Dermatology Group. (Photo via Harper's Bazaar)
To IPL or not to IPL?
Celebrities like Angelina Jolie swear by IPL treatments to keep their famously beautiful complexions perfect and even in tone, free from any aberrant pigment (i.e. hyper-pigmentation, freckles, acne scars, etc.). Any and all surface pigment is removed from the IPL laser, which is rendered 2-3x as effective with the ALA. While this means a more difficult recovery, it also means you'll need fewer treatments to look celeb-level perfect.
Since I write about celebrity beauty professionally, I elected to have the peel, IPL, and PDT all done in one session for the trifecta of skin-perfecting treatments. Warning: Do not do so unless you are prepared for a recovery that looks like something from a horror film and up to two weeks of downtime. We're talking full-on resurfacing going on, approaching fraxel-laser intensity; it is not for the faint of heart.
FYI: Fraxel laser treatments are generally reserved for older women, 50 and above, with deeper wrinkles and resurfacing goals. Although, true beauty queens like Kim Kardashian, who look flawless foundation-free, are rumored to maintain their perfection with regular fraxel laser treatments. The results are amazing, but it's common industry knowledge that you suffer for them.
As a former clinician and therapist, I also want to share that unless you research thoroughly and mentally prepare yourself for the brutal recovery ahead, you will panic and think something went horribly, horribly wrong. I am prone to exaggerating, but in this case, I am not. I am being totally serious about this: It's hard.
Even I had a moment of panic, frantically wondering, "How could my skin can ever come back from this?!" It can feel claustrophobic underneath skin with a construction paper-like texture that looks and feels like a mask made of one giant scab. I guzzled CBD, avoided the mirror, and drew on my stress-reduction techniques regularly during this week. Oh — I also stayed inside as much as humanly possible to avoid the bright So-Cal sun, but of course my new neighbor saw me with my face wrapped up like above.
After IPL, you can go straight into PDT for around 15 minutes, depending on what your dermatologist suggests. The procedure itself was relatively painless for me, although some patients have described searing pain once the blue light switches on. It feels warm and can burn a little, but you have a handheld fan to keep it under control. I have gone through these treatments both with and without numbing, and felt that IPL was more uncomfortable than PDT without numbing.
Immediately after, rinse your face thoroughly with cold water again, wrap your face to keep UV light off, and avoid the sun like a vampire for 2-4 days post-treatment. Rinsing your face post-treatment helps cool you down, removes any lingering ALA, and can also help reduce any residual anxiety (yes, it's true), so do so thoroughly — even if your face feels tender and uncomfortable to touch. Depending on how deeply your ALA absorbed, the texture of your skin might feel like sandpaper, but don't be afraid to rinse it.
I felt that the more thoroughly I rinsed my face with cold water, the better I felt afterward. The last thing you want is for the ALA to continue being activated by the sun. You can tell because light activation makes it tingle — if you feel tingling, run to the shade, away from the window, away from the TV, whatever. Seriously: RUN, don't walk, away from the light.
Before leaving the office, you'll want to apply SPF — your face won't be raw yet — and formulas like Epionce that contain skin-soothing ceramides make all the difference in the world. Wearing SPF — even when you're indoors — is recommended post-treatment.
To get home, you'll need to wrap up your face to completely shield yourself from the sun, so bring a big sun hat, glasses, and a scarf or protective covering. During recovery, grabbing a medical-grade barrier cream helps make up for the lack of dermal protection on your newly resurfaced face.
I know this looks ridiculous, but this will be your life for the next few days post-treatment. Exposure to the sun can cause blistering and serious burns.
Literature suggests anywhere from 2-10 days of recovery time. That's a broad window anyway, but depending on variations in treatment, add-ons you opt for, and your unique reaction as a patient, times vary. Following my initial treatment, which included the peel and IPL treatment in addition to PDT, I was solidly out of commission for at least two weeks.
Having completed my second and third rounds of PDT, I can vouch that subsequent treatments' reactions become proportionally less severe. The more severe your reaction, the more drastic your results, but recovery is like something out of a horror film. Remember: This procedure is creating a controlled injury to your skin, stimulating your skin's collagen production as it hustles to resurface your wound. Ouch.
Again, since I got a peel + IPL + PDT, my recovery was more intense than regular PDT:
Recovery was brutal. I have seen post-fraxel photos that look less disgusting than mine did. It was extremely uncomfortable downtime and I found out from my dermatologist's office that they stopped offering this treatment trio. (You can still request it, which I did.)
My entire face swelled, and parts of it deepened to a shade of purple. It scabbed over entirely before slowly and painfully peeling. IPL caused all pigment darken and shed early on, leaving an even, but dark red, complexion behind.
The corners of my mouth became so dry they cracked — as did parts of my skin — making it difficult to eat, let alone sleep, without ice packs for my face. I was an oozing, gag-worthy mess, and the recovery was so gruesome that I was reassured of my boyfriend Tom’s love for me because he didn't move out. (I can now 100% confirm that he's a keeper. Love you, T!)
During recovery, purging also means nasty whiteheads form as pores expel their contents. Try to avoid mirrors and keep hands off. You will also need the right products for post-treatment wound-care in the form of a professional-grade barrier cream, like Aquafor. My secret tip is to slather on LOLI Beauty Date Nut Brûlée ($68) instead.
I highly, highly recommend sleeping as much as possible, as well. Avoid the discomfort and allow your skin to go into its natural reparatory mode. (I found out this happens during sleep from Joanna Vargas herself!)
My second round was much more manageable, but no walk in the park. My face worsened for the next two days following the treatment — the third day is the worst — and began peeling on the 4th and 5th days. The phases of healing were the same, but significantly shorter in duration and in degree of discomfort. Slight redness remained, gradually fading over time, in the areas in which the sebaceous glands were most fried (i.e. under my nose and in my chin area). The results were even better than the first round after moderate peeling with some discomfort.
My final round was easy-peasy compared to the first two, maybe because my face had fewer damaged skin cells to absorb the ALA. I've also wondered if it had to do with thoroughly rinsing my face post-peel and post-treatment. My amazing P.A.-C, Danielle Stark, let me know that my skin also probably adjusted to the intense treatments (and heals more efficiently). Considering what it's been through, it could be in reparative over-drive for months. I also had the most amazing recovery tips from an industry expert, Tina Hedges, that I will share in another post.
Apart from the purging that takes place as your skin rids itself of beneath-the-surface nastiness, the results are pretty incredible once you've healed. I've read reviews that were just as miserable as my experience was, but people are stunned by the results and say they'll go back. Smoother skin, reduced oil production, clearer complexions, and faded or eliminated scars make a huge difference for those whose skin woes have impacted their self-esteem in the past. Remember: the Levulan is literally shrinking your oil glands and pores. Transformation is painful, people! And this drug treats cancer because it's that badass.
If I'd known just how bad it would be going into it, I might not have done it. If you saw the pictures of my healing, which I will consider showing you privately but will definitely not be going on the internet, you'd understand what I mean. I looked and felt like a cooked and miserable monster. My mom was horrified, and I'm lucky that Tom is a fan of horror movies with nerves of steel. Preparing for your recovery is also absolutely essential, so feel free to reach out if you have questions.
The peeling process itself was also pretty painful in my first two treatments. Your skin becomes so dry that it stings, itches, and just plain hurts as it scrapes against your newly resurfaced baby skin. While a regular peel takes off enough layers that you might flake a bit, this resurfacing treatment will leave you raw after rounds 1+2, which is where the Aquafor or Date Nut Brûlée comes in. My nose and chin areas took the worst of it, as that is where my hormonally-impacted oiliness had been out of control. And when I tell you my face was burned to a shade of purple, I am being totally serious.
That being said, the treatment becomes WAY easier each time.
If you're considering getting PDT, these were my life-savers:
(1) Facial ice-pack: Therapearl Face Mask ($13)
(2) Sun hat — don't be vain, get the biggest one possible with SPF: Itopfox Sunhat ($15)
(3) Scarf — mine is a jersey cotton one from American Apparel. Get one that won't suffocate you like: Plum Feathers Infinity Scarf ($10)
(4)Sunscreen — Epionce's contains ceramides which are soothing for your post-treatment skin: Epionce Ultra Shield Lotion SPF 50 ($35)
(5) Barrier Cream — A healing ointment for your skin, like Aquafor ($10) or the comforting Epionce Medical Barrier Cream ($55). My personal favorite is LOLI Beauty Date Nut Brûlée ($68), which I discovered by my third treatment. It's raw and extra-potent.
Even after all the pain and suffering, it was worth it for me. I didn't want to be stuck taking hormone-altering drugs for the rest of my life, and I was super excited about the idea of removing sun damage from my face. I also suffer from an autoimmune condition that makes my thyroid — which controls hormones — pretty finicky, which means that regulating hormones will always be a struggle for me. I was fed up from treating potential breakouts during my 20s, which is why I took the plunge (at 30).
For those who suffer from hard-to-treat cystic acne, PDT can be life-changing. It's basically the only thing as effective as taking Accutane, which can really do a number on your body. Plus the IPL removes hyper-pigmentation, scars, freckles, and any unevenness in skin tone from the face.
This photo was taken after recovering from my second treatment. I should probably add that on this particular morning, I had also used a pearl exfoliant by Tatcha that reflects light from your face — Tatcha Rice Enzyme Powder ($65) — and had used Sunday Riley Power Couple ($85) the night before, so my skin looked a little extra luminescent. But the truth is I would never, ever have taken a bare-faced selfie first thing in the morning without the process described above. I was able to apply just the slightest bit of concealer and step out sans foundation daily.
Now that I can almost imagine what it feels like to a celebrity with KKW-level skin, I'll admit: Going through this gave me even more respect for her. You can call her vain, but she's devoted. (Uh-huh, I'm a shameless Kardashi-fan.)
Have you heard of PDT? IPL? Peels? Comment below.
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