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POWWOW!THE FRACTIONAL CO,LASERS GENTLY ZAPSKIN BY PROJECTINGPIXELATED DOTS.ALSO A FAN OF DOTS:ROY LICHTENSTEIN.HERE, TH E ARTIST'STHUNDERBOLT[1966),

BEAUTYHEALTH &

FITNESS I

easydoes t

In the past, laserresurfacing has

been epically harshor barely noticeable.

Catherine Piercyreports on the

breakthrough that'sfinally getting it right.

•t's a bright winter morning whenI arrive at dermatologist DeborahSarnoff, M.D. 's, Park Avenue lasercenter for a sneak peek at the NextBigThing in dermatology. My mindis racing with visions of the latesthigh-tech wizardry: 3-D laser-lightgoggles, wrinkle-obliterating body­suits, skin-searing wands. You know.

So imagine my surprise whenSarnoff swings open the door to

a pristine white treatment room andreveals ... an eggplant, perched ina reclining chair atop its own papersurgical gown.

"I know, I know," she says with alaugh. "But you've got to see this."

And then, like the Jetsons-esquehostess of some far-out futuristic culi­nary show, she aims a nearby laser headat that dark, ripe flesh, and fires, sear­ing a square grid of tiny, tightly packedpink dots onto its surface (andfilling theair with the scent of cooked eggplant).

What Sarnoffhasjust demonstratedis fractional carbon dioxide resurfac­ing, and it may be the biggest break­through in laser skin care in nearlya decade. The spot-eradicating, line­smoothing results, swears Sarnoff, aregood enough "to t~rn a prune-face"back into a taut, juicy plum, and they

have the most conserva­tive dermatologists feelinggiddy with excitement.

THE BACKSTORYIf the new class of frac­tional carbon dioxide laserssounds vaguely familiar, that's becausetheir name, like the technology behindthem, merges the best of two well­established lasers-the mighty CO2

and its gentler cousin, fractionalizedtherapy-into a single power tool.

Searing through the uppermostlayers of the skin in a single uni­form sheet-delivering, in effect,a second-degree burn to the face­the original CO2 lasers, with their1O,600-nanometer beams, seemed agodsend when they debuted in the ear­1y nineties. Dermatologists hailed theirability to diminish severe sun dam­age and dramatically tighten skin in

just one treatment, but theynow acknowledge that theirreputation as "blowtorches"was no coincidence. "DoyOll have three weeks to hidefrom your friends, family,co-workers?" asks DavidGoldberg, M.D., a clini­cal professor of dermatol­ogy at New York's MountSinai School of Medicine,of the CO/s downtime,which included two weeksof raw, oozing, "weeping"skin and up to six monthsof lingering redness.

The kinder fractionalprocedures of recentyears-lasers like Fraxeland Affirm-delivered theirweaker 1,550 nm of erbiumenergy in a series of micro­pixels (rather than a singlebeam), projected on the skinas a checkerboard grid. Bypoking selective holes in theskin's surface, they left whatSarnoff calls "a tiny islandof healthy skin behind" forevery dot they vaporized.The result: pinkish skin thathealed in up to two days anda noticeable improvementin fine lines and sun spots(after three to five $1,500treatments). "The conceptof Fraxel was genius, inthat it redefined the way wethought about deliveringlaser light," says Manhat­tan dermatologist MacreneAlexiades, M.D. But forwomen with deeper wrin­kles, severe sun damage, and

limited reserves of time and patience,"the results were mediocre at best."

Combine the principles of each-afriendlier, fractionalized delivery sys­tem with all the strength, depth, andreach of the original CO2-and you'vegot the new fractional CO2 . While thechief function of any laser is to tem­porarily wound the skin, triggeringthe production of fresh new collagenfibers as it vaporizes old, damaged tis­sue, none of these new hired guns­which go by the brand names FraxelRe:pair (from Reliant Technologies),UltraPulse ActiveFX (Lumenis),and SmartXide DOT beauty>154

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WHAT'S NEXTLike any emerging technology, the firstgeneration of fractional CO2 s are worksin progress. Lasers, says Goldberg, "arelike laptops-your new model is con­stantly being updated." If the old CO2

was the truck-size monitor on your firstMacintosh, the fractional CO2 is yournew MacBook Air: fabulous but soonto be tweaked in exciting new ways.

Though they remain unsuitable fordarker skins, which may be prone toheat-related scarring, the new C02s haveslightly more range than their predeces­sors, extending from fair to light-oliveand, in some cases, light Hispanic andAsian skin tones. As for hypopigmenta­tion (small, pennanently colorless patch­es of skin that appeared in patients upto a year after the old CO2 procedureswere perfonned), "fractional technologyseems to have virtually eliminated therisk," says Alexiades, who is currentlyconducting the FDA trials for Deka'sDOT Therapy device. "But it's still early,and there may be limits to how close

together each little dot canbe placed without causinga similar effect."

Not unlike the feeling onemight experience while look­ing at Sunday Afternoon onthe Island ofLa Grande latte,Georges Seurat's pointillistpainting from 1884, with itstiny pixelated dots and earlyNeo-Impressionist overtones,the significance of the new CO2

seems greater than the sum of itsparts. "Ten years ago, I couldn'thave guessed that we'd be deliv­ering carbon-dioxide laser lightwithout the downtime or therisks," says Goldberg. "Just imag­ine what's next." 0

New York plastic surgeon Sam S.Rizk, M.D., sends patients for fractionalCO2 as a skin-tightening "complement"to the muscle-lifting effects of his endo­scopic face- and neck-lifts.

In some cases-lip and forehead lines,cracks at the corner of the mouth­Wexler is using fractional CO2 in placeof fillers like Cosmodenn. As she pointsout, "you don't have to come back ev­ery eight weeks to have it touched up."The new CO2's effects last, by most esti­mates, between five and eight years.

a 50-year-old chest," the new C02s alsotreat "the neck, forearms, and tops ofthe hands"-fragile areas that wereprone to scarring and discoloration un­der the reign of the old CO2•

To combat the first signs of ag­ing, dermatologists like Manhattan'sPatricia Wexler, M.D., are sticking withgentler resurfacers, like the originalFraxel (now called Fraxel Re:store).However, there are instances whereWexler feels the potency of fraction­al carbon dioxide is appropriate foryounger skin-for example, to treat

acne scars in patientsas young as their 20s.

Roy Geronemus,M.D., a dermatologistin New York, is usinghis Fraxel Re:pair todiminish telltale plastic­surgery scars around theface and breasts, and iseven using it aroundsome patients' eyes as

a substitute for surgery. One look at thebefore and after pictures he recentlypresented at the American Society forDermatologic Surgery conference inOrlando, and I can see why: Droopycorners, hooded eyelids, and stubborncrow's-feet virtually disappear after asingle blast. At approximately $2,000a session, "it's a fraction of what you'dpay for an eye-lift," he says. (A full facemay cost upwards of $4,000.)

Lasers,saysGoldb

Therapy (Deka)-inflict anything closeto the harrowing collateral damage oftheir prehistoric predecessors. "In mostcases, we're talking about four to sevendays of what looks like a very bad sun­burn," says Goldberg. "And don't forget,it's usually a one-shot deal."

THE NEW FRONTIERThe innovations don't stop there. Likethe keypad on your gym's ellipticalmachine, the fractional CO2 allowsderms to tailor the intensity of its pitchpattern-the distance between eachlittle dot as well as itsdepth-with the pushof a button. Sarnoffmight set the device"closer together for amore aggressive treat­ment arOlmd the mouthor crow's-feet," fartherapart "on sensitiveareas like the jawline."

When I drop bydermatologist Fredric Brandt, M.D.'s,Manhattan office, he shows me the Lu­menis ActiveFX's newly customizedhandpiece. As I peer at its lens, he flipsthrough an assortment of tiny danc­ing geometric CO2 light patterns­circles, parallelograms, hexagons, andtriangles---that, when projected onto theskin, access "the hard-to-reach anglesaround the nose or mouth." Putting anend to "a 40-year-old face floating above

154 VOGUE APRIL 2009

Goodbye black, hello ... silver.The manicure of this moment isfuturistic, coolly robotic. It looksas though you've dipped yourfingertips in mercury. The nails are

by Minx, and they are metallic, mirror-finish,foil-like "coverings" descended from NASCAR-decal technology. Zoe Kravitz (page 202) is afan. Lauren Santo Domingo-RIGHT, armored insilver-first learned about them from legendaryNew York manicurist Honey. She then hadLisa Logan-the pro behind Beyonce's goldMinx mani-over for a last-minute house callbefore kicking off New York Fashion Week.They won't chip because they're made offilm, not polish, pressed onto the nail bedwith heat (no drying time: brilliant), and theywon't damage nails since they're chemical-free. For salons, minxnails.com.-sARAH BROWN