Lasers for Skin Rejuvenation – Sydney and Canberra

Information on Understanding Lasers

Light Amplification by Stimulated Emission of Radiation (LASER) was originally described as a theoretical concept by Albert Einstein in 1917 and since then has grown by leaps and bounds into the complex multi-billion dollar business it is today. Lasers have made it possible to treat what was once thought impossible, with reduced risk and cost to the patient. Lasers of today are capable of producing results including;

• The removal/reduction of pigmentation changes in the skin such as freckles
• The removal of capillaries from most parts of the body
• Permanent hair reduction
• Reducing all kinds of scarring
• Reducing the appearance of fine lines and wrinkles through Collagen stimulation
• Reducing pore size
• Improving facial texture
• Mole Removal
• Removing tattoos
• Tightening the skin
• Vision correction

To truly understand how laser technology works, you must have a concise understanding of the theory or science behind it, the range of different platforms available and the way in which they are utilised to treat different skin types and conditions.

A beam of laser energy is an extremely specific wavelength of light of the same colour, travelling in the same direction while maintaining its intensity over a prescribed distance. This all takes place in unison when the laser beam is fired. The end result is an extremely tight, focused beam of energy concentrated enough to precisely target a specific point. This is where IPL and Laser differ.

For example, when treating broken capillaries in the face, a wavelength of 532nm (nanometers) is selected. Once the laser beam is fired, the energy travels through the skin and is absorbed by the capillary. This is where the colour of the laser beam is important because different colours of light are attracted and absorbed by specific structures within the skin. This process is technically known as “selective thermolysis” In this particular instance, 532nm is a green light which is attracted to capillaries, whereas a 694nm wavelength of light is red in colour and mostly attracted to pigmentation such as freckles. Once a freckle has absorbed laser energy, it is broken down by the body and disposed of. The freckle will crust up, form a scab and then fall off within 1-3 weeks. This amazing technology allows lasers to select their targets without damaging the surrounding tissue.

What causes a laser to target different tissue within the skin is controlled by its wavelength – also known as the energy of the light. Many high end lasers of today are manufactured as multi platform stations which allow for many different wavelengths within the one system, making it very convenient to have multiple conditions treated simultaneously. It also makes it more cost effective for Doctors and specialists who can now purchase one laser machine as opposed to 2 or 3. The other major benefit of these multi platform units is the ability to upgrade.

With the technology moving so rapidly, having the option to upgrade allows for new hand pieces and software to be added while still using the same base unit. Again, this is cost effective and much easier to provide the latest technology and in turn, the best results possible.

There are many medical lasers today , but they all mainly use the principal of selective photo thermolysis, which means getting the right amount (power and exposure time) of the right wavelength of laser energy to the right tissue to damage or destroy only that tissue, and nothing else. This helps to ensure that the heat energy is confined to the intended target while the rest of the skin is left relatively unaffected (less complications)

To perform a laser procedure properly, the operator needs to use a laser with the right wavelength, then select the appropriate power (fluence) and exposure time (pulse width) to achieve selective destruction of the target tissue.

The machines on the market can be broadly broken down into 3 categories

1.LASERS

• KTP laser ( Gemini, Aura) has a wavelength of 532nm. This is a green light which targets capillaries very well and is also useful in removing pigmentation (particularly the Q switch mode). This dual function makes it useful for skin photorejuvination
• Pulse Dye (Candela V beam)- has a wavelength of 585nm. This yellow light targets capillaries very well
• Ruby Laser has a wavelength of 694nm. This red light is useful for treating pigmentation in the Q switch mode
• Alexandrite ( candela gentlelase) has a wavelength of 755nm. This red light has become well known for its excellent hair removal capabilities
• Diode Laser (lightsheer) has a wavelength of 800nm and is effective for hair removal
• Infrared lasers include the 1064nm (Gemini, cutera, sciton), 1320nm (sciton, candela) and infrared range (sciton ST and cutera TITAN). Infrared lasers cause collagen stimulation and are useful for skin tightening, acne scarring and hair removal in darker skin type
• Erbium laser has wavelength of 2940mn (sciton). It is great for ablating the skin (laser resurfacing) and can be used for the removal of moles and improving fine lines and pigmentation. With as little as 2 days downtime significant improvements in skin texture and complexion can be achieved with this laser
• CO2 laser has a wavelength of 10600nm. It can be used for laser resurfacing but the risk of side effects is too great in my opinion , given the plethora of options we have at our disposal today.
• Fractionated lasers- “Fractional” Laser Resurfacing is new technology that delivers results approaching that of deep chemical peels or ablative laser resurfacing, without the discomfort and inconvenience of a lengthy healing period, and with a minimum level of risk. All traditional resurfacing methods remove the entire top (epidermal) layer of skin , creating a visible wound, and loss of the skin’s protective function. With fractional Laser Resurfacing the fractionated laser beam treats a small “fraction” of the skin, leaving intact, undamaged skin around each treated area to act as a barrier and a reservoir for rapid healing. This makes it useful for acne scaring and fine lines around the mouth and eyes
• The Fraxel (1550mn ) was the original fractioned laser but now there is the fractioned erbium (2940nm) and the fractioned CO2 laser. In my opinion the fractionated erbium is probably the best of the fractionated devices.

2. Intense Pulse Light

IPL- is intense pulse light, not a laser. This is a Common misconception in the market place. They are broadband lights which have the ability to target multiple chromophores(pigment, capillaries, collagen).

3. LED Lights

LED- light emitting Diode. (ominlux) – LED’s produce ( non-coherent, monochromatic light; spontaneous emission) – compared to Laser’s which produce (coherent, monochromatic light, stimulated emission). This means that LEDs have a light which has a low peak power output and so is not capable of causing the destruction of a chromophore like pigment, hair or capillaries but it can stimulate collagen and has a place in facial rejuvenation. It is also useful for the treatment of active acne. I use it for photodynamic therapy which helps with active acne and pigmentation

Dr’s Warning / Safety Info

Lasers should only be used by medical practitioners as they are very powerful tools particularly if they are used for resurfacing

IPLs are used by many non medical practioners with varying results. You can find hair removal clinic popping up everywhere and many are operated by inexperienced operators who see the use growth potential of the industry

There is no regulation as to who can use a laser or IPL in NSW. No standard course as yet

The TGA recently put in place regulation to stop the use of non TGA approved machines in the hope to stop the flurry of unsafe cheap IPLs on the market

LEDs are safe to use outside non medical practices

Questions to ask your practitioner.

• Is the machine you are using a laser, IPL or LED?
• Is it safe for my skin type?
• Is it the best and safest option me or are there other alternatives?
• Downtime involved. What can I expect to happen after the treatment?
• What results can I expect from this treatment?
• How many treatments will I need?
• What are the side effects?
• What qualifications /experience does the operator have?

What are the number of treatments required?

• Resurfacing treatments – depending on the depth of skin removed the number of treatments varies from 1 to 3. The current studies show that it is safer and just as effective to have 3 lower grade treatments one month apart as compared to one heavy duty treatment.
• Hair removal- Treatments are generally space out 6 weeks apart and the number of treatments depends on the area of the body being treated. The face and bikini usually requires 4-6 treatments for permanent hair reduction . The legs/arms require 6-12 treatments. The laser will only target hairs in the growing phase and since more hairs are in the growing phase in the face, fewer treatments are required.
• Pigmentation- It depends on the cause of the pigmentation. Freckles and sunspots can be removed with a single treatment with the Ruby laser or Erbium laser. With the Green KTP laser and IPL they can take up to 3-6 treatments one month apart. Melasma is much more difficult to treat and will require more patience.
• Capillaries-Usually require three to four treatments one month apart , and maintenance treatment once a year.
• Photo – rejuvenation- require three to four treatments one month apart, then maintenance every 3-4 months.
• Skin tightening- can be achieved with infrared lasers and requires 3 treatments a month apart to achieve a 20-30% improvement in skin tightening.
• Acne treatments- 3 to 12 treatments with blue, red, yellow light or a combination spaced 2 weeks apart.
• Mole removal- one treatment, a scab will form

What does photo-rejuvenation mean

It is the process of using light energy to stimulate collagen remodeling and the removal of irregular pigmentation and enlarged blood vessels from the skin surface. The stimulation of collagen will help with the removal of fine lines and skin tightening.

Possible complications.

• Lasers/IPLs Should not be used in patients who are tanned and patients on roaccutane. Care must be taken in dark skinned patients as they are prone to discolouration. There is no evidence that laser light effects the fetus but I would not perform the treatment on pregnant women
• Redness and swelling is common.
• If blistering occurs patients may experience transient darkening or lightening of the skin which can last weeks to months.
• The risk of infection and scarring is generally very low with non resurfacing treatments but can be a problem with resurfacing treatments

Who is a good candidate

• A good candidate is a patient who has researched their condition and their treatment options and is able to comprehend the steps need to achieve the desired outcome.
• Fair skinned patients are less prone to side effects.
• Pain factor and management, and follow up care.
• A Heat sensation and the flickering of an elastic rubber band is the common description I give to our patients.
• You may require the application of local anaesthetic cream prior to some laser treatments.
• Post care involves avoiding the sun. If resurfacing is performed an occlusive dressing like Vaseline needs to be applied three times a day.
• Do not pick on any scabs that may form as it may lead to scarring.

What’s next?

Take home LED light are the new craze in the US

The fractionated laser technology will continue to improve so that lasers will be able to penetrate deeper with less downtime

All in one unit , where you can dial up a wavelength, exposure time, energy and decide whether you want the beam to be fractionated or not. In my opinion the sciton laser leads the way in this technology. It is the best all in one unit currently available in the market. It has a very powerful and specific IPL, two infrared lasers 1064/1320nm, a non fractionated and a fractionated erbium. So just about any treatment can be done with the one machine- pigment, hair, skin tightening. Soon a Q switch modality will be added and this will allow tattoo removal to be performed

For more information please call 1300 138 797 or email info@cosmosclinic.com.au

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