Dr. Dean Kane Q & A. 
Q. When looking at before & after photos of patients who have had identical treatments, same treatment locations, same number of treatments & post-photos take the same number of months post-treatment of coolsculpting or thermage (& similar non-invasive treatments), you can see that some patients have dramatic results and others seem to have almost no change. Is it patient age or treatment location or body size or post-treatment diet/lifestyle or doctor’s skill or length of treatment? Thanks.
A. This is a very perceptive question requiring a very complex answer. The simple answer is every patient is different and needs to be matched to their best option to achieve a particular result.
The more complex answer is based on the following and many other individual factors:
- Age: younger patients will tend to have thicker firmer dermis, thinner epidermis and more fat with rounded contours in more pleasing places
- Aging: the physiologic changes associated with skin laxity, shifting / thinning / separation of soft tissues accelerate in your 30’s.
- Environment: more weather and UV exposure will oxidize tissues, injure skin and age the tissues faster.
- Metabolism and disease: each of us carry a unique set of genes which will accelerate or decelerate and repair aging and damaged tissues.
- Familial and ethnic quality: you inherited these traits.
- Personal care: use of retinoids, care for acne, tobacco, alcohol, etc
- Patient perception on what they hope to achieve based on exposure or education to any / all available options
- Individuals with thicker dermis, oilier skin and more pigmentation will tend to age slower but may present with more pigmentation damage. They will tend to take longer for scar thickening to reduce.
- Those with thinner, northern European thinner, less resistant (to folding and creasing) dermis, drier more reactive skin will age earlier and show more aging skin changes. They will tend to “heal” faster with less scar thickening.
- Patients with more reactive red tones in their skin (due to more active histamine and inflammatory response) such as a ethnic history with Irish and American Indian backgrounds will swell more but may also respond better to technology which creates redness and inflammation.
- Cost
- Recovery, onset of effect and duration
- Amount of involvement in the procedure or after-care
- MD, RN, aesthetician skills
- Availability of differing procedures, technology
- Desired results
