Several lasers are used for lipolysis – a recognized technique for fat reduction. It has been demonstrated that (i) fat liquefaction is induced through a temperature elevation of the adipocyte cells, and (ii) fat volume reduction depends on total cumulative energy delivered at the treatment site. Which wavelength (920nm, 980nm, 1064nm, 1320nm, and 1440nm) is the best?

Studies and substantial anecdotal evidence show that the penetration depth of wavelengths between 900 and 1320nm is very similar – around 1.5mm. The only minor difference is at 1440nm, which is more absorbed by subcutaneous fat. The irreversibly damaged volume of tissue is also similar for wavelengths between 920 and 1320nm. Practitioners obtain the total of about 4cm3 with 3750J delivered to the tissue.

With laser lipolysis, thermal elevation of a given volume can be obtained provided that the penetration depth remains in this nominal range. This explains why similar end results can be obtained using 920nm, 980nm, 1064nm, and 1320nm. Thermal build-up is the main factor behind adipocytolysis and skin contraction. Successful outcomes are dependent primarily on the movement of the optical fiber inside the tissue and even and stable delivery of the laser energy. It’s the hands of the surgeon that truly make a difference!

During this harsh economic time, it is important to realize all the great things cosmetic surgeons can offer their patients. There are three main points that I believe are the keys to driving the cosmetic surgery industry throughout 2010.

First is the new, emerging technologies and applications. The advancement of lasers and the prolific results they can provide to the patients continues to impress practitioners. Some of the most significant changes have occurred in the use of fractionated lasers, automated lipolysis and a few specialty areas such as the use of lasers in the treatment of nail fungus.

Second is the great push with gynecologists pursuing cosmetic surgery. The scientific research incorporating the two has created the cosmetogynecology specialty. This specialty is fast growing and includes some of the best OB/GYNs practicing and continuing the education of cosmetic surgery.

Third is the field of the less costly but highly effective cosmetic procedures. For example, there has been a high demand for fillers and laser oriented procedures that require less money and less downtime for recovery. As a result, the patient is saving some money and is able to return to work quicker. It is a win-win situation as long as patient safety is still being practiced.

This is a good video report, which covers most of the things a consumer should know about tattoo removal by a medical laser. Join Neil Sadick, MD, as he performs laser tattoo removal and provides tips for what to expect from the procedure.

Laser Tattoo Removal
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Toenail fungus, aka onychomycosis, is a very common problem. The numbers vary depending on the source, but we are talking 20-30 million in the U.S. alone. Most are mild cases, which are not accounted for because people do not go to the doctor to diagnose their smelly feet with ugly deformed nails.

Several laser companies are working on clinical studies and FDA approvals, but practitioners do not have to wait – they are free to perform off label procedures with the lasers they own or rent.

Anecdotal evidence is growing to confirm that laser treatment of the fungus is a lot more efficacious (75-90% cure rate) than topical solutions (8-10%) and oral medication (30-40%). Lasers are quickly becoming a new way to treat nail infection by selectively irradiating fungi while leaving the nail and surrounding tissue intact.

Onychomycosis is more common among people over the age of 50 who should avoid toxic medication. Podiatrists and other physicians who have started performing these treatments charge from $850 to $1,400 per treatment (all toes have to be treated at the same time). Thus, the market for non-invasive, drug free (only topicals for prevention) and simple laser procedures is huge, a billion-dollar-plus per year huge.

Currently only a few hundred doctors in the U.S. offer the laser therapy and they are not easy to find. A medical referral service called Laser for Toe specializes in setting up free doctor appointments for people with toenail fungus. They can find a laser doc near you.

As I continue to review the Medline English literature and recent international conferences regarding Fractional photothermolysis (FP) technology, applications, and indications, it becomes more obvious that this relatively new modality is one of the most significant milestones in laser technology and skin resurfacing.

Successful conditions treated with non-ablative fractional lasers reported in the literature include acne scarring; dyschromia and fine wrinkling of photoaging on the face, chest, neck, and hands; melasma; poikiloderma of Civatte; nevus of Ota; scars; minocycline hyperpigmentation; telangiectatic matting; residual hemangioma; granuloma annulare; colloid milium; and disseminated superficial actinic porokeratosis.

An advance in 2007 was the introduction of ablative FP (AFP), which results in significantly greater improvement in skin laxity and textural abnormalities. There is no doubt that AFP has demonstrated significantly greater improvement than non-ablative FP in reducing acne scarring and skin redundancy and laxity associated with photoaging.

Through the induction of microthermal zones of injury, FP technology stimulates a robust and rapid wound healing response resulting in improvement in a diversity of aesthetic, inflammatory, and preneoplastic skin disorders.

Further investigation into the technology and diverse array of cutaneous conditions that can benefit from FP will continue and bring additional data to use in determining treatment parameters and identifying new apppliations.

The concept of non-ablative fractional photothermolysis was introduced to the market in 2003 as an answer to the need for effective, yet low risk, skin resurfacing techniques. Unlike conventional ablative (CO2 and Erbium) and non-ablative lasers, fractional ablative and non-ablative photothermolysis treats only a fraction of the skin, leaving up to a maximum of 95% of the skin uninvolved. The undamaged surrounding tissue allows for a reservoir of viable tissue, permitting rapid epidermal repair.

Non-ablative fractional photothermolysis is currently approved by the US Food and Drug Administration (FDA) for the treatment of pigmented lesions, periorbital rhytides, skin resurfacing, melasma and soft tissue coagulation, acne and surgical scars, and actinic keratoses. However, its off-label use is clearly more extended. Many practitioners would agree that this first wave of fractional lasers has delivered very limited clinical efficacy.

See larger chart

In 2007 the concept was further developed, and ablative fractional photothermolysis was introduced, using an erbium yttrium aluminium garnet (Er:YAG) or carbon dioxide (CO2) laser. These devices are FDA cleared to treat wrinkles, rhytides, furrows, fine lines, textural irregularities, pigmented lesions and vascular dyschromia. Read the rest of this article >>>

Warts are ugly but they are common, and there are many ways and means to remove them. I prefer to use a YAG laser to remove warts.

Surprisingly, this simple technique is not very common among dermatologists who typically freeze warts with nitrogen. That is painful and not very effective as in many cases more than one treatment is required.

Digging into the body of research on the subject I found a report on a study published in September 2009 by the Korean Academy of Medical Sciences.

This study was designed to evaluate the efficacy of long-pulsed Nd:YAG laser in the treatment of warts. Over the course of 1 yr, 369 patients with recalcitrant or untreated warts were exposed to a long-pulsed Nd:YAG laser. The following parameters were used:

• spot size: 5 mm;
• pulse duration: 20 msec;
• fluence: 200 J/cm2.

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