Why We Started Combining These Two Treatments

September 4, 2025

Your skin will thank you!

In this article, you'll discover:
  • The medical reasoning behind combining structural repair and surface refinement in a single session instead of months apart
  • How timing these treatments together creates synergistic results that neither could achieve alone
  • What happened when the first patient tried the combination - and why her results exceeded expectations from either treatment individually
  • Why treating aging skin as both a medical and surface issue simultaneously addresses the complete aging process rather than just symptoms
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A patient came in last month completely frustrated. Janet had been doing Vivace RF microneedling sessions every few months for over a year. Her collagen production was definitely improving - I could see the structural changes happening beneath the surface. But she was still dealing with all this surface damage from years of San Diego sun exposure.

"My skin feels firmer, but I still look tired," she said. "All these brown spots and rough patches make me look older than I feel."
At the same time, I had another patient, Lisa, who'd been getting CoolPeel laser treatments to address her sun damage and texture issues. The laser was beautiful for refining her skin surface - clearing up age spots, shrinking pores, smoothing out years of accumulated damage. But she kept saying her skin still felt "loose" and lacked that internal firmness.

Two women, two different treatments, both getting partial results.
That's when it clicked for me. We were treating aging skin like it was either a surface problem or a structural problem, when really it's both happening simultaneously.

Think about it - by the time you're in your forties, you're dealing with collagen loss that's been happening for twenty years. That creates the sagging, the loss of firmness, the way your skin stops bouncing back. But you're also dealing with decades of cumulative sun damage, enlarged pores, uneven texture, and pigmentation changes.

Most providers make you choose. Get the Vivace for structure, then come back in six months for laser resurfacing. Or do the surface work first, then address the deeper issues later. But your skin doesn't age in separate layers - why would we treat it that way?

Here's what I realized: if I could combine both treatments in the same session, we could address the complete aging process instead of just pieces of it.

The timing actually makes this combination more powerful than either treatment alone. When we do the Vivace first, we're putting your skin into active repair mode. Your fibroblasts are waking up, collagen production is being stimulated, your skin is primed for healing.

Then we immediately follow with the CoolPeel while your skin is in this activated state. The laser removes all that damaged surface tissue that would interfere with optimal healing, creating the perfect environment for the new collagen to develop properly.

Instead of two separate healing processes competing for your skin's resources, they work together synergistically.
Janet was our first patient to try the combination. She was honestly a little nervous about doing both treatments in one session, but she trusted the science behind it.

Six weeks later, she looked like a different person. Not just the firmness we'd been building with Vivace, and not just the surface refinement from CoolPeel. Her skin had this depth and luminosity that happens when structure and surface are both optimized.

"People keep asking what I'm doing differently," she told me. "But I can't even explain it because my skin just looks... healthy."
That's exactly what we're after. Not obviously "worked on" skin, just skin that's functioning the way it's supposed to function.
The treatment itself takes about an hour. The Vivace creates warmth and gentle stimulation as the radiofrequency energy wakes up your collagen production. Then the CoolPeel feels like tiny snaps as it removes damaged surface layers with precision.

You walk out looking like you spent a perfect day at the beach - slightly pink but glowing. By the next morning, it settles into natural radiance that keeps improving for months as your new collagen develops.

What excites me most about this combination is how it addresses the reality of aging skin instead of just treating symptoms. We're rebuilding structure while simultaneously optimizing surface quality in a single session.

One session, complete transformation, lasting results. This is the future of evidence-based skin care.

Meet the Author

About Dr. Nanos

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