Light Amplification by Stimulated Emission of Radiation (LASER) was originally described as a theoretical concept by Albert Einstein in 1917 and has since 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 or reduction of pigment changes in the skin such as freckles
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 Intense Pulse Light (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 to 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 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 handpieces 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 principle 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 (fewer 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:
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 Photo-rejuvenation.
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 types.
Erbium Laser has a wavelength of 2940mn (Sciton). It is great for ablating the skin (i.e.laser resurfacing) and can be used for the removal of moles, improving fine lines and correcting 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 Cosmos Clinic’s opinion, given the plethora of options we have at our disposal today.
Fractional Lasers – or “Fractional” Laser Resurfacing is a 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 laser beam treats a small “fraction” of the skin, leaving intact, the undamaged skin around each treated area to act as a barrier and a reservoir for rapid healing. This makes it useful for acne scarring and fine lines around the mouth and eyes.
2. Intense Pulse Light(IPL)
IPL is intense pulse light; not a laser. This is a common misconception in the marketplace. They are broadband lights which have the ability to target multiple Chromophores (e.g.pigment, capillaries and collagen). The Sciton BBL (Broad Band Light) is an example of a high-quality IPL that enables multiple targets in a single treatment.
3. Light Emitting Diode(LED) Lights
LED Lights(Ominlux) produce (non-coherent, monochromatic light through spontaneous emission, as compared to lasers which produce coherent, monochromatic light through stimulated emission. This means that LEDs have a light which has a low peak power output is therefore incapable 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. Cosmos Clinic uses it for Photodynamic Therapy which helps with active acne and pigmentation.
Doctor’s Warning & Safety Information
Lasers should only be used by medical practitioners as they are very powerful tools particularly if they are used for resurfacing.
IPL’s are used by many non-medical practitioners with varying results. You can find hair removal clinics popping up everywhere but many are operated by inexperienced operators.
There is no regulation as to who can use a laser or IPL in NSW, ACT or SA, nor a standard course as yet.
The Therapeutic Goods Administration (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 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 for me or are there other alternatives?
What is the 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 potential side effects?
What qualifications and experience does the operator have?
How many treatments are required?
Resurfacing Treatments: Depending on the depth of skin removed the number of treatments varies from 1 to 3. Current studies show that it is safer and just as effective to have 3 lower grade treatments 1 month apart as compared to 1 heavy-duty treatment.
Hair Removal: Generally spaced 6 weeks apart, the number of treatments required depends on the area of the body being targeted. The legs and arms require 6 to 12 treatments. The face and bikini, however, usually requires just 4 to 6 treatments for permanent hair reduction. 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: The number of treatments required will depend on the cause of the pigmentation. Freckles and sunspots can be removed with a single treatment using the Ruby Laser or Erbium Laser. Alternatively, with the Green KTP Laser and IPL, removal may take 3 to 6 treatments 1 month apart. Melasma is much more difficult to treat and will require more patience.
Capillaries: Generally, patients will require 3 to 4 treatments 1 month apart, and a maintenance treatment once a year.
Photo Rejuvenation: Patients will usually require 3 to 4 treatments 1 month apart, followed by maintenance treatments every 3 or 4 months.
Skin Tightening: This can be achieved with infrared lasers and requires 3 treatments 1 month apart to achieve a 20-30% improvement.
Acne Treatments: 3 to 12 treatments will be required, with blue, red or yellow light(or a combination) spaced 2 weeks apart.
Mole Removal: A scab will form following just 1 treatment.
What does Photo-Rejuvenation mean?
Photo-Rejuvenation is the process of using light energy to stimulate collagen remodelling, and remove irregular pigmentation and/or enlarged blood vessels from the skin surface. The stimulation of collagen will help with the removal of fine lines and skin tightening.
Possible Complications of a Laser Treatment:
Lasers and IPLs should not be used in patients who are tanned or those on Roaccutane. Care must be taken with dark-skinned patients as they are prone to discolouration. There is no evidence that laser light affects the foetus but Cosmos Clinic 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 for Laser Treatments?
A good candidate is a patient who has researched their condition and their treatment options and is able to comprehend the steps needed to achieve the desired outcome.
Post Treatment Consideration?
Fair-skinned patients are less prone to side effects
Pain factor and management, and follow up care
You may require the application of local anaesthetic cream prior to some laser treatments
Post-treatment care involves avoiding the sun. If resurfacing is performed an occlusive dressing like Vaseline needs to be applied 3 times a day
Do not pick at any scabs that may form as it may lead to scarring
Take home LED light are the new craze in the US.
Fractional Laser Technology will continue to improve so that lasers will be able to penetrate deeper with less downtime
All in one units: where you can dial up a wavelength, exposure time, energy and decide whether you want the beam to be fractional or not. In Cosmos Clinic’s opinion, the Sciton Laser leads the way in this technology and is the only laser used at all Cosmos Clinics. It is the best all in one unit currently available on the market. It has a very powerful and specific IPL, two infrared lasers (1064nm and 1320nm), a non-fractional and a fractional erbium. Just about any treatment can be done with the one machine(including pigment, hair and skin tightening treatments). Soon a Q switch modality will be added and this will allow tattoo removal to be performed as well.