Laser skin treatments
40 years ago, the first laser treatment for the skin was applied with Argon and Carbon Dioxide (CO2) lasers. These were primarily used to treat benign vascular birthmarks, such as wine stains and hemangiomas. Although this treatment for birthmarks proved to be very effective, there were unacceptable side effects such as scarring. Over the past 20 years, there has been a major advance in laser technology that allows us to treat many skin conditions and birth defects, such as vascular disorders, pigmentation, tattoo removal, scars and wrinkles. Today, there is a broad spectrum of laser and light technologies available for skin improvement and rejuvenation.
Properties of laser light
“Laser” is an acronym for: lnight aamplification by the ssimulated emission of radiation. Lasers are high-intensity light sources with the following properties:
- Monochromatic: the light is of a single wavelength
- Coherent: the light beam waves are in phase
- Bundled, i.e., the light beams travel in parallel
Laser light is produced by a “light source”: a space containing a certain substance is energized, creating light. By using different substances, you get different types of light. For example, a gas (e.g. argon, krypton, carbon dioxide), a liquid (e.g. dye) or a solid (e.g. ruby, neodymium: yttrium-aluminum garnet, alexandrite) is sometimes used. Each medium produces a specific wavelength of light, within the visible spectrum (400 violet to red 700 nm) or infrared spectrum (over 700 nm). The therapeutic goal of a laser treatment is to destroy the target cells without damaging the surrounding tissue. Vascular skin lesions contain haemoglobin (absorbs visible light at 418, 542, and 577 nm) while pigmented skin lesions contain melanin (which has a wide range of absorption in the visible and infrared wavelengths).
What types of lasers are there?
Different types of lasers are used for skin improvement. Older laser technologies such as CO 2 and argon continuous-wave (CG) lasers have largely been replaced by fractional laser systems and quasi-CG lasers. Clinical application is determined by the peak wavelength, the duration of the pulses and how it is absorbed by skin tissue. [table id=64 responsive=stack responsive_breakpoint=” phone”/]
Which skin conditions are treated with which laser?
Vascular injuries
Lasers are highly effective in the superficial treatment of vascular abnormalities such as wine stains, telangiectasia, hemangiomas and pyogenic granulomas. Vascular disorders can be treated with various lasers: argon, Aptd, KTF, krypton, copper vapour laser, copper bromide, pulsed dye lasers and Nd:YAG. Argon (CW) causes a lot of scarring and high rates of non-specific thermal injuries, so it has largely been replaced by yellow light, quasi-CG and fractional laser. Due to its superior clinical efficacy and low risk profile, the Pulsed dye laser is the first choice for most vascular lesions. It has a wide light source (5 to 10 mm) so that even large lesions can be treated quickly. The most common side effects include: bruising (purpura), which can last 1-2 weeks, and pigment spots. Crusting, skin texture changes, and scarring are rarely seen. By adding dynamic cooling during the treatment, discomfort is lower and it is possible to safely deliver more energy to the skin. As a result, fewer treatments are required. Small superficial blood vessels respond much better to treatment than deeper larger vessels (usually in older people), which is why we recommend starting treatment early. You can expect an 80% improvement after an average of 8-10 treatments. Further treatments may be necessary if the lesion persists. Treatment with quasi-CG lasers also gives good results, but the risk of scarring and texture changes is high. The most common side effects include erythema, oedema, and temporary crusting. Intense pulsed light (IPL) is also sometimes used to treat vascular lesions.
Pigmentation spots and tattoos
Melatonin-specific QS laser systems can successfully improve or even completely remove pigmentation spots or tattoos. The following pigment spots are easy to treat: freckles and birthmarks, congenital melanocytic nevi, blue nevi, Ota/Ito nevi and Becker nevi. The short pulse laser systems are very effective because the energy is specifically given to the melanosomes (the pigment cells contain melatonin). The result of the laser treatment depends on the depth of the melanin and the color of the lesion and is fairly unpredictable. We treat superficially located pigment with shorter wavelength lasers, while with the deeper pigment, we need longer wavelengths that penetrate deeper tissue better. When treating dark skin, there is a risk of permanent hypopigmentation and depigmentation. Treated lesions can always recur. Prior to laser treatment of pigment spots, any lesion with atypical features is biopsied to rule out malignancy/malignancy. The QS laser systems can selectively destroy tattoo pigment without causing much damage to the surrounding skin. The pigment is then removed from the skin by white blood cells and macrophages. The choice of laser depends on the color, depth and chemical nature of the tattoo ink. Two to ten treatments are often required for a good result. Yellow, orange, and green are the hardest colors to remove.
- Black: QG ruby, alexandrite or Nd: YAG
- Blue and green: QG ruby, alexandrite
- Yellow, orange, red: QG Nd: YAG or PDL
As with other laser treatments, pigment and textural changes such as scars can also occur.
Hair removal
With a laser, we can remove dark hair quickly and it can take 3 to 6 months for regrowth to return. Multiple treatment cycles are required and the length of time between treatments depends on the part of the body being treated. Laser treatments are less painful and much faster than electrolysis. Complications are rare, but superficial burns, pigmentary changes, and even scarring can occur. Increased growth of fine dark hair in untreated areas close to the treated one has been reported. Suitable devices include long-pulsed ruby and alexandrite lasers, diode (810nm), millisecond Nd:YAG, and IPL.
Wrinkles, scars, and sun-damaged skin
Fractional CO 2, erbium: YAG lasers and Q-switched lasers are successful in reducing and removing wrinkles, acne scars and sun damage. Fractional Q-switch lasers are used for non-ablative skin improvement; “non-ablative” refers to heating up the dermal collagen while leaving the skin undamaged. Multiple treatments are often necessary to make the skin beautifully smooth. This treatment has virtually no side effects and can also be used in the summer (Fractional CO). 2 laser is generally regarded as the gold standard by which all other facial rejuvenation systems are measured. A 50% improvement is often seen in patients who have a CO 2 undergo laser treatment. Side effects include post-operative tenderness, redness, swelling, and scarring. The redness and tenderness last a few weeks to months. Secondary skin infection such as herpes reactivation is also a potential problem until healing occurs. Extreme care should be taken when treating dark-skinned individuals because permanent loss or variable pigmentation may occur in the long term. Erbium: YAG provides similar results and side effects to CO 2 laser. Despite their side effects and long recovery time, the Fractional CO 2 and the erbium: YAG lasers to provide excellent results. The Fractional Q-switch laser could well become the gold standard.
Other uses
We also use laser to remove viral warts by evaporation (CO) 2 laser) or destruction of the dermal blood vessels (PDL) but evidence suggests this is no more effective than standard wart dyeing or waiting for spontaneous clarification. Laser can be used to improve a variety of skin lesions such as viral warts, seborrheic keratoses and skin cancer (by evaporation or cutting mode), treating acne (due to its toxic effect on acne bacteria) Proprionibacterium acnes).
Laser safety
Safety measures depend on the laser system that is being used and in which environment. They must include:
- Experienced! well-trained staff
- Eye protection for patients and staff
- Warning signs outside the treatment room
- Using non-reflective instruments
- Avoiding flammable materials.
Adverse effects of laser
With laser treatments, you basically burn the skin. So it is not surprising that the following effects could occur.
- Temporary pain, redness, bruising, blisters and/or crusting
- Infection including reactivation of herpes simplex
- Pigment changes (brown and white patches), which may be permanent
- Scars, fortunately, are rare
References:
- Alexiades-Armenakas MR, Dover JS, Arndt KA. The spectrum of laser skin resurfacing: Nonablative, fractional, and ablative laser resurfacing. J Am Acad Dermatol 2008; 58:719-37
- Tanzi EL, Lupton JR, Alster TS. Lasers in dermatology: four decades of progress. J Am Acad Dermatol 2003; 49:1-31
- Cantatore JL, Kriegel DA. Laser surgery: an approach to the pediatric patient. J Am Acad Dermatol 2004; 50:165-84
Other websites:
- Medscape Reference:
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