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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Some people wonder why OB/GYN practices offer LHR. Isn’t it the realm of plastic surgeons and dermatologists?

For gynecologists laser hair removal is a natural transition and a perfect fit as they can perform these procedures in discrete areas of the female body in a comfortable setting of a medical office. Permanent reduction of hair in women care clinics also tends to be more affordable as these treatments are typically focused on small areas and can be combined with regular office visits.

How does laser remove hair?

Highly controlled flashes of laser beams are selectively absorbed by hair follicles lying below the surface of the skin. The absorbed light heats the hair, which damages and destroys the regrowth potential of the follicle- all without damaging surrounding tissue. Hair follicles are usually in different growth cycles at different times in relation to one another. Since the follicle must in active growth in order to be affected by the laser, several treatments spread over several months are required to assure the destruction of all hair follicles.

Areas treated: bikini area, underarms, and face.

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Why the newer fractional technologies are so popular?

The latest fractional laser technologies offer a better balance of efficacy, patient tolerance and lack of side effects compared to older lasers.

For better results the depth of the laser beam penetration and the depth of skin resurfacing are important. But even more important is an optimal combination of depth, microspot size, density, as well as the ratio of ablation to coagulation.

Depth is a simple term that indicates how deep the thermal damage extends into the skin tissue. It is the depth of the microcrater or hot cylinder.

Microspot size is the diameter of the microscopic wound.

Density is the percent coverage over the skin surface, e.g. 20 percent density means 20 percent of the skin surface is damaged.

The “ratio of ablation to coagulation” can be explained as follows: one pulse of laser beam produces a crater (coagulation area), which is 100 µm wide, and the lateral thermal damage (area of ablation) of 50 µm in radius (100 µm in diameter) ; therefore in this case, the total width of coagulation is 100 µm, and the total width of ablation is 100 µm, therefore 1:1. This ratio is an indication of the downtime. Coagulation is a type of thermal damage, which greatly influences wound healing.

The problem is that no one knows the precise best recipe among all of these variables to achieve the best ratio of cosmetic enhancement to days of “downtime.”

CO2 and Erbium laser skin resurfacing is a very efficient procedure to remove wrinkles, acne scars, blemishes, growths, and sun-damaged skin blemishes. The laser allows the body to produce new collagen and generate new skin. The result is usually “years younger” skin. Improvement continues as the aged and sun-damaged deep collagen areas continue to regenerate and repair for three to six months after treatment.

How long will the improvement last?

No one can say for sure, but many laser physicians believe that you can expect the results to last for several years. How long may depend on your unique skin type and upon your post-treatment skin care. Think of the laser as “turning back the clock” so to speak, so that your skin again resembles its fresher appearance of years past. Your new skin remains dynamic and alive and it should take many years before your skin appearance manages to catch up with where it was before your treatment. Much depends on how carefully you protect your new skin from damaging sun-exposure. You have a second chance at slowing down the sunlight-related aging process. (more…)

Treatment of pigmentation is a complex subject. Determining the type of lesion will help to establish which laser or light device to use and what parameters to set.

Hyperpigmentation is a broad descriptive term, offering us little information about etiology or pathophysiology of the lesion. Dividing this expansive category into primary versus secondary helps with treatment decision-making and predicting outcome.

Moreover, hyperpigmentation can stem from epidermal, dermal or a combination of these locations. Discrete lesions, such as lentigines, ephelides (primarily epidermal lesions) and nevus of Ito or Ota and decorative tattoos (primarily dermal lesions), show the most favorable response to laser and light-based therapies.

Postinflammatory hyperpigmentation would be the main component of the secondary hyperpigmentations. Melasma can also be considered in this category, as it generally behaves similarly to postinflammatory hyperpigmentation after laser treatments, showing the most unpredictable response to laser and light-based therapies.

Primary pigmented lesions are generally easier to treat than secondary lesions. For localized lesions on the trunk and face, the Q-switched lasers are very successful at removing pigmentation. These include Q-switched ruby (694 nm), Q-switched alexandrite (755 nm) and Q-switched Nd:YAG (both 1,064 nm and 532 nm). For darker skin types, choose the longer-wavelength Q-switched lasers, as their emissions have less absorption by melanin and hence less competition/absorption from normally pigmented skin.

To learn more about the use of IPLs, long-pulsed dye laser (LPDL) and Q-switched lasers for the treatment of solar lentigines, photoaging and flat seborrheic keratosis read The right tool: Lesion type determines which laser, light device is best choice, opinions of Joely Kaufman, M.D., assistant professor of clinical dermatology at the University of Miami Miller School of Medicine and director of lasers for the University of Miami Cosmetic Group, and Vic Narurkar, M.D., the chair of dermatology at California Pacific Medical Center and director and founder, Bay Area Laser Institute, and associate clinical professor of dermatology at University of California Davis School Of Medicine.

Just like Dr. Kaufman and Dr. Narurkar, I believe that there is a potential of further development of “do it at home” lasers:

“It remains to be seen what type of contribution the at-home devices will play in the treatment of pigmentation. The newer devices coming to the market look very promising as both preventive and adjuvant therapeutic options.”

Laser lasers and light-based devices for home use cannot be considered as a replacement of medical office treatment, but some of the products in the laser industry pipeline can be used as ancillary tools to enhance the effectiveness of a medical treatment plan.

Still horrified by laser blasting of facial wrinkles followed by months of redness? This is so 90s!

New generation of aesthetic lasers is safer and more selective in treating just what the doctors says you need: wrinkles, age spots, broken capillaries, saggy skin, etc. The result? Faster healing, so you can get back in makeup and return to work with smoother skin in as little as 24-48 hours. Well… it depends. Here is a brief guide to different laser treatments so you can better understand your options.

Ablative Carbon Dioxide (CO2) Resurfacing

This is the skin-wounding original 1990s procedure.

Used for: hard-core lines and acne scars; can also tighten loose skin but is safe only for fair skin types only.

How it works: By blasting and burning away the skin’s top layer, this aggressive single treatment bulldozes wrinkles and everything else in it path.

How it feels: you should not feel anything during the procedure since it is performed under general anesthesia. Recovery time: you are a burn victim for several days with open wounds, which ooze and bleed, followed by 7-10 days of rawness while your obliterated epidermis regenerates, and pinkness for 4-5 months.

Price: $4,000 to $8,000

Efficacy/Results: Excellent (if done right) but in a few months after the treatment.

Ablative  Erbium Laser Resurfacing

Used for: fine to deep wrinkles and acne scars; can also tighten loose skin, doctor must be cautious with darker skin types.

How it works: By evaporizing layers of epidermis (the skin’s top layer).

How it feels: This proceudre is performed under a topical or local anesthesia and you may experience some burning discomfort. Recovery time: depending on the depth of resurfacing, you will feel from slight to mild oozing for 2-5 days, followed by 7-20 days of pinkness, which can be covered by make-up.

Price: $1,500 to $3,000

Efficacy/Results: Good to excellent depending on the depth of resurfacing.

Ablative Fractional Resurfacing

Types of lasers used: either CO2 or Erbium (Er:YAG).

Used for: Smoothing fine-to-deep lines and evening out brown spots in a single treatment. Can also help tighten lax skin and remove some small spider veins.

How it works: The laser beam strikes the skin in thousands of tiny spots, destroying tissue a millimeter deep in those microscopic spots only (think perforated paper). Surrounding skin remains intact, allowing for faster recovery than the original ablative devices but more intense results than the nonablative fractional laser. The hole-punching fires up the body’s wound-healing response, which generates collagen and smooths wrinkles. It’s ablative and therefore riskier for patients of color, but can be executed successfully at a doctor’s office.

How it feels: Typicaly performed with local anesthesia similar to what you’d get in a dentist’s office. After 15 minutes of post-treatment discomfort and an application of ice packs, pain is minimal. For 24 to 36 hours, skin oozes, bleeds and peels, followed by five days of crustiness. Once crust peels, new, pink skin emerges and makeup can be worn; complete healing within two weeks.

Price: $1,500 to $5,000

Efficacy/Results: Average to good.

Nonablative Fractional Resurfacing

Non-ablative simply means that your skin will not actually be resurfaced, i.e. top layer of the skin, aka epidermis, will remain intact.

Used for: Smoothing fine-to-moderate lines, evening out brown/age spots, and improving overall texture and glow.

Downtime: typically none, but the skin may be red for a couple of days.

How it works: The laser penetrates deep into the skin, heats and provides controlled thermal injury to the connective tissue, which stimulates collagen production. No oozing no raw skin. It’s typically performed over a course of three to five 25-minute treatments, one to two months apart. This procedure is safe for darker skin types.

How it feels: like the heat is building up in your skin, but no pins and needles. May feel like a bad sunburn for a few minutes after the procedure is over; afterward, skin is pink and sandpapery for three to five days but can be camouflaged with concealer.

Price: $600 to $1200 per treatment depending on the actual laser modality and doctor.

Efficacy/Results: Average to good depending on a number of treatments.

Intense Pulsed Light (IPL)

Used for: Eliminating brown spots and other sun-induced discoloration and spot-treating broken capillaries. No effect on wrinkles.

How it works: IPL devices are not lasers, unlike lasers they emit a broad spectrum of light. Short pulses of bright white light pinpoint brown pigment cells and redness, which are damaged when they absorb the light and the heat it creates. Safe for most skin types, but a doctor may dial down intensity for darker skin tones to avoid slim risk of de-pigmentation.

How it feels: Like a sunburn. Patients experience slight swelling and pinkness the day of the procedure, but there’s no downtime, which is why it’s often categorized as a “lunchtime” treatment.

Price: $400 to $600 per treatment.

Efficacy/Results: Average and multiple treatments are required.