Aesthetic Lasers Blog

Archive for February, 2009

This is a common question and we hear a lot of discussions among practitioners about what laser is best for large areas, like legs or a man’s back. We have reviewed several studies published in the last few years, and here is the consensus among our medical panel members.

Alex or YAG?

For individuals with fair skin types I-III each laser will provide good long term results, i.e. 75-80% permanent hair reduction.  The 755-nm alexandrite laser is significantly more painful and it is not unlikely that some individuals, especially men, will quit after the 5th treatment, thus potentially reducing the overall efficacy of the treatment.

Alexandrite (755 nm) is not recommended for skin types IV-VI due to the high level of the absorption of this wavelength by the malanin of the skin. Overheating typically results in dispigmentation or scarring of the dark skin. This laser should not be used on tanned skin for the same reason. Nd:YAG 1064 nm laser is the golden standard for hair reduction on dark and tanned skin.

Can I combine Alex with Nd:YAG?

We have reviewed a sizable body of research to answer this question. Yes, these lasers can be  used in combination.

Several randomized, single-center, within-participant, investigator-blinded, active-controlled clinical trials have been cmpleted with individuals aged 16 to 50 years with skin phototypes III and IV. These are the only two skin types, which could benefit from a combination treatment. Typical results are: the mean hair reduction 18 months after the last treatment, as measured by the assessors from digital photographs, are 75-82% for alexandrite laser, 74-80% for the Nd:YAG laser, and 77-80% for the combination therapy. The incidence of adverse effects (hyperpigmentation) and pain severity were significantly greater in areas that received combination therapy.

The conclusion is what the majority of practitioners already know: do not use alexandrite lasers for skin types darker than III; Nd:YAG lasers are good for all skin types and tanned skin; combination therapy does not have any additional benefit and may cause more adverse effects.

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  • Filed under: CURRENT NEWS
  • A very good study by doctors Kono T, Frederick Groff W, Chan HH, Sakurai H, Yamaki T of the Department of Plastic and Reconstructive Surgery in Tokyo Women’s Medical University, Tokyo, Japan (  just came out.

    Pulsed dye laser (PDL) treatment of hypertrophic port-wine stains (PWSs) on the lips has demonstrated poor efficacy and a potential risk of dyspigmentation. PDL-resistant hypertrophic PWS can be safely treated with much greater efficacy with deeper penetrating lasers such as a 1064-nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser. 80% of the treated patients showed good to excellent improvement without complications.

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  • Filed under: CURRENT NEWS, Laser Clinics, Laser Treatments
  • The first medical lasers to be developed were continuous wave lasers that produced a continuous beam of radiation that was subsequently absorbed by a target. Although this constant laser light could effectively treat certain dermatologic conditions, its use was limited by the fact that the laser energy not only altered the target but also “spilled over” into adjacent tissues, causing unwanted collateral damage and scarring. As our understanding of the interplay between living tissue and laser physics evolved, however, so did our ability to restrict laser damage to a specific target. The concept of selective photothermolysis developed by Anderson and Parrish in 1983 gave us the tools necessary to be more precise and safer with laser energy.

    Selective photothermolysis states that a specific chromophore or target can be selectively destroyed with minimal collateral thermal tissue damage if the laser wavelength matches that absorbed by the chromophore, and if the target is exposed to the laser energy for an interval less than its thermal relaxation time. The thermal relaxation time is the time it takes a given target chromophore to lose 50% of its absorbed heat energy.

    Selective photothermolysis revolutionized laser technology and paved the way for a new generation of lasers that are designed to deliver a set wavelength for a precise duration, resulting in greater specificity and safety. The pulsed, quality Q-switched, and scanned systems are examples of such laser technology. Other so-called quasi-continuous laser systems also attempt to adhere to the theory of selective photothermolysis by limiting pulse durations from a continuous beam source through shuttering or chopping of the emitted laser beam. The usefulness of these systems is often limited owing to their high repetition rates or moderately long pulse durations, causing the target to experience the laser’s energy as if it were a continuous wave.

    Lasers emit a coherent and monochromatic light beam, whereas pulsed lights produce a polychromatic light whose bandwidth is selected by adapted filters. The skin’s chromophores are made up of water, hemoglobin, and melanin, to which must be added the exogenous pigments of tattoos. Each chromophore has its specific absorption spectrum. Lasers’ main mechanisms of action are the photothermal effect and the photomechanical effect.

    With the previously mentioned concepts in mind, the side-effect profile of a specific laser can be predicted in general terms, based on its wavelength and mode of operation. As a group, continuous wave and quasi-continuous lasers have a higher risk of scarring and textural changes through thermal buildup and heat diffusion to normal skin structures. Lasers designed on the theory of selective photothermolysis are more specific and have a lower risk profile.

    Depending on the wavelength and pulse durations delivered, pigmentary changes, epidermal cell injury, textural changes, and crusting and tissue splatter can potentially occur. It is important to remember that even the safest lasers can cause injury if used incorrectly. Repetitive or overlapping pulses, excessive energy or power settings, and improper patient selection can potentially result in a high rate of morbidity with the use of any medical laser.

    Complications might be encountered with any currently available laser systems, however, today’s laser technology is universally accepted as very safe for the patient.

    Lasers used in the aesthetic medicine are divided into ablative and non-ablative groups.

    Among the ablative lasers are the CO2 and Erbium:YAG (Er:YAG) lasers. The predominant use of both is for static wrinkles, as opposed to dynamic wrinkles—those created by smiling or laughing. They can also treat dyspigmentations on the face, neck and other parts of the body. As a general rule, we do not use a laser to replace a knife to cut into tissues, but as a tool to resurface. Thus, procedures done with either CO2 or Erbium lasers are typically defined as “laser skin resurfacing”. If you smile and you get crow’s feet, this is best treated with botox injections. However, if you are sitting at rest and you have fine static lines under your eyes, this is best treated with one of these two laser groups.

    CO2 lasers are largely considered to be the first cosmetic lasers, which are used less and less these days. The most popular laser among plastic surgeons in the U.S. is the Erbium:YAG. It is used most frequently for fine lines under the eyes and around the mouth for the vertical lip lines. Full face resurfacing, both deep tissue resurfacing and gentle laser peels, are also very commonly offered by physicians’ aesthetic practices.  These lasers are also used to treat wrinkles in conjunction with facial surgery, such as a facelift or an eyelid surgery (Blepharoplasty), in one sitting. The big criticism with CO2 was that it caused a lot of undesired pigmentation, and some experts say that the CO2 laser is “unforgiving”, especially in the hands of the less experienced. CO2 typically require a much longer healing time (downtime) and more post-operative care. 

    The Er:YAG laser provides superficial ablation and is generally used for more superficial rejuvenation. Most people now prefer laser procedures that have minimal associated recovery. Erbium is a preferred modality for such procedures as photoaging, acne scars, superficial cutaneous problems, and rhinophyma. Some laser systems provide for thermal-coagulative and ablative properties. These systems are considered as intermediate resurfacing lasers, providing faster healing and results that are typically in between those of the CO2 and standard Er:YAG lasers.

    Up until the mid 1990s, phenol peeling (aka chemical peels) was the most popular technique for treating wrinkles and preceded facial resurfacing laser techniques, but this technique also commonly caused hypopigmentation. Even if you did not go too deep, phenol is melanotoxic and would still cause some degree of depigmentation. Besides, the level of control in the application of chemicals is limited to the expertise of the provider.

    Phenol is now experiencing a resurgence in popularity, as is the CO2 laser. Cosmetic physicians are getting excellent results with phenol peels and CO2 lasers because the chemistry is now much better understood, which allows them to achieve better results with fewer adverse events. Although ablative resurfacing lasers can achieve excellent results, their major drawback is they do cause significant edema and erythema, which may last for many weeks, and they can cause potential scarring. Therefore, the recovery times are relatively long.

    Actifirm Post Laser Gel combines skin-soothers like Aloe and Chamomile with a Mushroom-derived, exfoliating enzyme, Mucor Miehi Extract, to inhibit pain and inflammation, while helping renew your skin to its freshest form. You’ll be looking your best in no time.

    More skin care recommendations by

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  • Filed under: Laser Clinics, Laser Treatments
  • Laser-based devices for aesthetic treatments are the industry “gold-standard,” although the efficacy of devices based on Intense Pulsed Light (IPL) technology is improving and the gap between IPLs and lasers is closing. Laser technology is expected to remain the only effective light-based treatment in specialist areas such as large pigmented lesion removal, tattoo removal and deep vascular treatments, but IPL-based devices are becoming more popular for the more mainstream aesthetic treatments, especially in the high growth market of skin rejuvenation.

    Medical experts, who have used both IPL devices and lasers, would point out the following reasons why they prefer lasers:

    • It is harder to predict results with IPL due to its broad-spectrum of light and multiple wavelengths
    • IPLs are not safe to use around the eye
    • IPLs are not safe on the skin of color and tanned patients

    Despite not quite matching the performance of some premium laser-based systems, IPL technology has its advantages for the core aesthetic treatments such as hair removal and skin rejuvenation.

    Various sources and study groups forecast IPL-based devices to enjoy growth rates of 10-12% in hair removal and skin rejuvenation. Unlike for laser-based devices, the IPL-based device market is more accessible to non-physicians, and hence IPL-based devices are commonly found in spas across the U.S. and Europe.

    As IPL-based devices are not designed to treat complex skin conditions, practitioners do not have to be as highly trained as they do for laser-based devices. IPL-based devices typically come with two simple-to-use handsets, one for each of the most popular applications, hair removal and skin rejuvenation. Adding to the appeal of IPL-based devices for a non-physician is the lower price with respect to a laser-based system, whilst maintaining the core applications essential to a light-based aesthetic practice or medical spa.

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  • Filed under: Device Review, Laser Clinics, RS | IPL and Lasers
  • Medical Spas and a lot of aesthetic physicians have adopted IPL devices to treat a variety of skin conditions, from hair removal to age spots.

    Intense Pulsed Light (IPL) is a non-laser flash lamp light source that emits broad spectrum, high-intensity visible and infrared (IR) light and is used for permanent hair reduction, acne (including photo dynamic therapy, aka PDT), Rosacea, dyschromias and telangiectasias, and age related treatment of facial lines and creases.

    Wavelengths are chosen by selecting a particular wavelength filter or attaching a specific treatment head or hand piece that is configured with the filter already attached. Since IPL medical devices use a ‘pulse’ of light they deliver their energy into the dermis over a longer time than a laser, providing different treatments and usually resulting in significantly more pain for the patient.

    Shorter wavelengths in the visible spectrum are used to target hemoglobin (red skin conditions like acne and Rosacea) and melanin (brown spots). Longer infrared (IR) wavelengths target water in the skin and can treat other conditions. Since IPL devices use a ‘pulsed’ light instead of a high-intensity focused beam like lasers do, IPLs emit more scattered light (feathering) and are less selective than a laser in heating the skin. With IPL devices there are often additional treatments needed to achieve optimal results than with lasers.

    Practitioners more or less agree on the applications of different wavelength available in IPL devices:  

    Wavelength (nm) Used to treat:
    420 acne
    500 pigment
    510 pigment
    515 pigment
    520 pigment and some vascular lesions
    525 pigment and some hair removal
    560 pigment and some vascular lesions
    590 pigment in skin types
    615 larger facial spider veins
    640 superficial leg veins
    650 hair removal
    695 thicker vascular lesions (angiomas, hemangiomas), superficial leg veins, hair removal
    755 thicker vascular lesions (angiomas, hemangiomas), superficial leg veins, hair removal

    Major manufacturers of IPL Intense Pulsed Light devices: Candela, Palomar, Cutera, Lumenis and Sciton. 

    IPL Pros

    • Cheaper than lasers
    • More compact than most lasers
    • Results are comparable to the 810 nm Diode or the 770 nm Alexandrite lasers for hair and to the 532 nm KTP Laser, the 595 Pulsed Dye Laser for the treatment of Rosacea and vascular lesions

    IPL Cons

    • Cannot be used safely on darker skin types (IV-VI) or tanned skin
    • Filters (heads) have a short life span (50,000-75,000 pulses)
    • Filter/head replacement is expensive
    • Many different wavelengths, settings, cooling requiremnts may be confusing for the operator
    • Maintenance and service required Comment:

    More and more experts agree that from the practical standpoint Nd:YAG 1064 nm may have established itself as the single most versatile wavelength for all of the treatments mentioned above. For all skin types and tanned skin.

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  • Filed under: Laser Clinics, RS | IPL and Lasers
  • Skin Ablation by Aesthetic Lasers

    Ablative treatments smooth roughened skin, periorbital rhytids, remove pigmented lesions and minimise acne scarring. Dr Peter Crouch discusses the latest advances and the tried-and-tested methods

    Until the development of laser skin resurfacing in the 1980s, mechanical abrasion and chemical peeling agents were the mainstay of treatments targeting acne scarring, wrinkles and tired, aged skin. Controlled ablation promised the prospect of restoring a more youthful, radiant appearance. Non-ablative remodelling of existing tissue is only one method of stimulating positive change and is the key strategy with IPL and radiofrequency treatments and has been outlined in previous articles in this series. The approach with most non-ablative treatments is to provide a controlled thermal stimulus sufficient to denature and contract collagen while avoiding surrounding tissue damage. Most non-ablative procedures utilise thermal (heat) energy for immediate tissue contraction (short-lasting), followed over the next few months by collagen remodelling and regeneration (longer-lasting).

    Ablation literally means destruction, and there are several approaches for removing unwanted tissue and to promote increased tissue turnover as part of healing. Depending on the depth of ablation, skin resurfacing, smoothing of periorbital rhytids, removal of pigmented lesions and minimisation of acne scarring are all possible outcomes of expertly delivered skin ablation. In the months following ablative treatment, the body’s natural healing processes produce new replacement tissue, resulting in healthier, more even, smoother skin and a more youthful appearance.

    The ideal tissue-ablation device would cause little pain and discomfort, have little or no downtime, be affordable, show demonstrable results after each session and cause no unwanted side-effects. As tissue ablation can effectively remove unwanted targets and the ablation is more related to tissue water content and is relatively more indiscriminate, ablative techniques rely more on targeting precisely where the treatment beam ablates rather than using the wavelength of the treatment beam to discern one target from another based on pigmentation—that is, a specific chromophore, or the presence of, for example, haemoglobin. Because the wavelengths often used for ablation specifically target tissue water, the fluence often determines, fairly precisely, the exact depth of ablation.

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