Saturday, July 13, 2024

I Tried the New AviClear Laser for My Hormonal and Cystic Acne

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The launch of the AviClear laser is big news for sufferers of stubborn acne, like me. Since my teenage years, I’ve experienced hormonal cystic acne breakouts. They Increased in severity after I went off birth control in my early 20s, as well as after a failed pregnancy when I was 25. These bouts, which have persisted into my 30s, have left me with a great deal of insecurity about my bare skin.

I’ve leaned on pimple patches (Zit Sticka KILLA Deep Zit Microdart Patches), tried photodynamic therapy using blue light therapy and a photosensitizing agent (which helped for two years then plateaued), and I take 100 mg of spironolactone, on an irregular schedule because of the dizziness it causes. These have all been short-term solutions for a skin concern that has spanned decades. With my current regimen, I tend to get one cystic breakout per month, in the chin and jawline area, and am prone to clogged pores due to an oily skin type.

ZitSticka Killa Deep Zit Microdart Pimple Patches

I was thrilled to learn about AviClear, a laser treatment that was FDA approved last year. It gets results that are being touted as the first-ever treatment alternative to Accutane, the controversial oral medication that can stop acne but may come with side effects (dry mouth, dry eyes, dry skin) and risks including severe birth defects if you become pregnant. “AviClear is the closest outcome to Accutane without all that baggage,” says Corey L. Hartman, a board-certified dermatologist in Birmingham, Alabama. 

By non-ablatively targeting the oil glands under the skin using a 1726 nanometer wavelength laser, Dr. Hartman explains, the device prevents future breakouts and acne scarring without damaging the skin. “It really is revolutionary because it allows you to replace the topical and/or oral acne regimen,” he says. 

Part of AviClear’s “great potential” comes down to its ease of protocol, adds R. Sonia Batra, a board-certified dermatologist in Santa Monica, California. “There are only three in-office treatments, which makes compliance easier and is helpful for busy people and teenagers that have difficulty sticking with at-home regimens.”

In This Story

My AviClear Experience

I have suffered from hormonal acne since my teens. I tend to get about one cystic breakout per month in the chin area (thank you, period), which keeps me heading to the dermatologist’s office monthly for kenalog injections into each individual acne cyst (these anti-inflammatory corticosteroid shots shrink cysts overnight). But even with my treatment arsenal, the aftermath of a cystic breakout leaves me feeling self-conscious about residual hyperpigmentation and changes in skin texture.

For my first AviClear session with Dr. Batra, my dermatologist, I double-cleanse my skin and am wiped down with acetone to ensure no oils or CC cream remain, which would compromise the laser’s efficacy. They don’t numb me for this same reason, although some practices do.

Dr. Batra begins the treatment on my forehead, which is one of the more painful areas of the face to treat. After using many different skin lasers and devices over the years, Ican say this is one of the more uncomfortable devices I have tried. First, I notice how cold the handpiece is, which helps protect the surrounding skin from overheating. (As Dr. Batra performs each pass with the laser, a physician’s assistant continually reapplies water to my face to keep the surface wet for this same protective reason.) The whole thing is uncomfortable because, in addition to the chill of the device and the sudden heat of the laser in the middle, it feels like the device itself  is being pressed hard against the surface of my skin and facial bone structure.

After a few “zaps” I adjust to the cold sensation and feel the hot pulse of the laser in the center of each pass. Honestly, it feels worse than the snap of a rubber band, which the sensation of lasers is often compared to, and I am definitely looking forward to my session ending.

Afterwards, though, I am shocked by the lack of redness on my face considering the intensity of the experience. I had been warned that I might look sunburned for a day, but any redness I have is minimal, only in the evening, and it is gone by morning.

I hadn’t been particularly nervous about my first session, but after going through it, I admit, I am nervously anticipating my second appointment.

My Skin After One Treatment

In the week following the treatment, my skin is especially glowy, which Dr. Batra hypothesizes  is due to microswelling that comes from heating the oil glands. My forehead also looks clearer, but then week two hits: the week before my period, when I always break out. Like clockwork, I erupt into two cystic breakouts — on my cheek and my chin. For reference, my baseline was to get one breakout per month on my chin region, so this is worse than usual. 

Dr. Batra says this is called purging and is to be expected: “The majority of patients I have treated experienced some degree of purging. Once the oil glands are heated and injured, their contents come to the surface of the skin and worsen acne temporarily.” She assures me, however, that the breakouts will last only for a week and that they should lessen with each subsequent treatment in the series. “As the sebaceous glands recover after treatment, they produce less oil [and the oil is] of a thinner consistency — clearer and less sticky.” That means less acne.

Unfortunately, the purge creates post-inflammatory erythema, or darkened spots, that I now cover with concealer (shout out to Kosas Revealer Creamy + Brightening Concealer). To prevent purging and lessen pigmentation moving forward, Dr. Batra recommends I get another laser — NeoSkin by Aerolase — two weeks after each session. “The Aerolase’s wavelength of 1064 nanometers targets capillaries to reduce inflammation, decrease bacteria that contributes to acne, treat pigmentation, and reduce oil gland production,” she explains. “It works synergistically with AviClear because it is absorbed by different targets in the skin.”

Kosas Revealer Super Creamy + Brightening Concealer

My Skin After Two Treatments

Dr. Batra’s plan for alternating AviClear sessions with NeoSkin is working as intended. It’s been three weeks since my second treatment and I am floored by the results. I go through my monthly period zit-free. Only small cystic pimples emerge on the underside of my chin, which are easily hidden and short in duration. The one good thing about having an active breakout for my appointment is that Dr. Batra can choose to treat it with a diluted Kenalog or Cortisone injection, plus she sees exactly where to apply an extra zap of the device. Overall, my skin is the clearest it’s been in years, and I still have one more treatment ahead of me. 

I had to delay my third treatment by two weeks due to scheduling issues. This meant that when I headed in for my final session of AviClear, it was on the exact day of starting my period. The timing is worth mentioning because you can become much more sensitive to pain the week before and during your period. In certain areas, particularly the left side of my face and my upper lip, I found myself involuntarily flinching and jerking with each pass of the laser. For the first time, I requested Pro-Nox (a 50% Oxygen and 50% nitrous analgesia gas) to help make the treatment more bearable. After five deep inhales and exhales through the tube, I felt relaxed, slightly dizzy, and was able to get through to the end of my final treatment.

The Aftercare Rundown

After each AviClear session, Dr. Batra recommends staying off of retinol and other potential skin irritants (including salicylic acid, benzoyl peroxide, tretinoin, glycolic acids, vitamin C, and astringents) for 7 to 10 days. She also recommends religiously applying and reapplying sunscreen, and avoiding the sun when possible. To soothe redness you can use chilled compresses or gel packs, though I feel no need to, and you can wear makeup if you want.

I plan to discontinue retinol for the duration of the three-month treatment plan and opt instead for hydrators because, after the initial week of glowing results, my skin became so dry it was delicate. (Dr. Batra says this is because AviClear had stymied my oil glands.) I probably didn’t help matters when I decided to apply tiny amounts of my prescription acne treatment Aklief, and quickly learned my lesson when my cheekbones, chin, and the tip of my nose became dry and inflamed. 

Now that it has been months since my first treatment, I amn able to apply the over-the-counter retinol Differin, but I’ve only used it on my problem areas: nose, chin, and jawline. For a little extra relief from dryness, I also slather on Shiseido Bio-Performance Skin Filler Serum with hyaluronic acid, day and night, Augustinus Bader The Rich Cream with ceramides during the day, and the new Eighth Day Skin Intensive Moisturizer with ceramides, peptides, and growth factors at night. At night, my final step is to slug with either Furtuna Skin Replenishing Balm or Anfisa An-Balm Radiant Hydra-Balm, which is a miracle for swiftly healing my red, inflamed patches. (For the uninitiated, slugging means applying an oil-rich, occlusive layer over the top of my nighttime regimen to lock in moisture overnight.) 

Differin Adapalene Gel 0.1% Acne Treatment

Shiseido Bio-Performance Skin Filler Serum

Augustinus Bader The Rich Cream

Eighth Day Skin Intensive Moisturizer

Furtuna Skin Replenishing Balm

Anfisa An-Balm Radiant Hydra-Balm

The Brass Tacks

You’re supposed to get three sessions of AviClear — and “studies show that the majority of patients need all three treatments,” says Dr. Hartman. You can expect to pay $3,000 for the series and, Dr. Hartman adds, it is important that they are sold in a package for the best results. (Additional NeoSkin sessions, like the ones I’m having, cost $250-500 on average.) AviClear is not covered by insurance, though Dr. Hartman is hopeful that some insurance coverage might become available down the line.

I will be thrilled if AviClear is truly the answer to my monthly hormonal breakouts. With no post-treatment downtime, it is significantly less disruptive to my schedule than another treatment I tried (photodynamic therapy to shrink my oil glands using a blue light and a photosensitizing agent). Although AviClear is unpleasant during treatment, and the purging is no fun, I think the temporary unpleasantness is worth it — especially compared with the bloodwork, dry skin, and risks of using Accutane.

I am already experiencing improvement. What remains to be seen is whether the improvement lasts. Having completed my third and final AviClear session, Dr. Batra recommends that I give my skin a few months in order to see full results. A few days after the final treatment, I do still have a very small cystic breakout on the underside of the tip of my chin — but it is minimally inflamed and not painful. Should my monthly hormonal breakouts continue, I’ll look into other options — like regular Aerolase treatments or even the new acne topical, Winlevi. At the very least, I am confident that AviClear has drastically improved the severity and frequency of my hormonal acne, and I am hopeful that it will clear it up altogether. 

Acne is hard — and when you’re an adult with acne, it can be especially frustrating when much of the information out there doesn’t take into account the nuances of treating it in adulthood. This story is part of Allure’s Adult Acne Guide, which includes the best tips and product recommendations for treating adult acne. From the products dermatologists use on their own breakouts to first-person reviews of the newest, most promising in-office treatments for stubborn hormonal acne, we’ve got you covered.


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