|YAG 1064 nm Lasers||Intense Pulsed Light (IPL) Devices|
|Applications||Hair Removal, Photorejuvenation, Skin Tightening, Active Acne treatment, Telangiectasias (spider veins), Rosacea, Sun & Age Spots, Pseudofolliculitis Barbae.||Hair Removal, Photorejuvenation, Sun & Age Spots, Rosacea.|
|Efficacy||High power to dermis: more energy to follicles, vessels, collagen, sebaceous glands.||High power absorption in epidermis: less energy to deep dermal structures.|
|Comfort||Less painful due to shorter pulse durations.||Very painful due to tendency to super heat epidermal melanin. Skin cooling gels or equipment needed.|
|Risk of Side Effects||Safe on all Skin Types.||Higher risk of burning skin; not recommended for use on skin types 4-6 or tanned skin because of pigmentary risk.|
|Consumables||Few or none.||Frequent head replacements (on average after 30,000 pulses), filters and gels – annual cost $5,000-$10,000.|
We stumbled upon an old (March 7, 2007) article in ABC News – Spa Left Woman With Skin ‘Like Raw Meat’ – a story about a 52-year-old stay-at-home mom who saw the ugly side of medical spas. She went to one in Panama City, Fla., for what she thought was a routine procedure – laser treatments to remove sunspots on her back and chest.
“They put a topical ointment on my skin called Leveline, which intensified the laser,” Miles said. “After it was over, I was already burning. During the treatment, it was very excruciating pain, but I was lead to believe that this was normal.”
The pain, which she said felt like someone pressing hot curling irons in to her back, was not normal. After leaving the spa, she said that her back was on fire and that she was vomiting from the severe pain. When she finally looked in a mirror, Miles was shocked at what she saw.
“It looked like raw meat. I had horrendous blisters all over it. It was in a zebra-stripe type pattern. It was scary,” she said.
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.
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:
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.
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:|
|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|
|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.
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.
In the Western world, more than 10% of the population have at least 1 tattoo. If the tattoo is removed, the tattoo pigment particles in the skin can be selectively destroyed by means of selective photothermolysis by different types of medical aesthetic lasers. This treatment requires laser pulses of short durations (nanoseconds) and high intensities (fluenses).
Dr. Wolfgang Bäumler, Department of Dermatology, University of Regensburg in Germany reports on 12 patients who received treatments with improper treatment parameters. In all patients, his group diagnosed hypo- or hyperpigmentations and scar formation at the treatment site. In particular, the pulse duration of the light sources or lasers applied were considerably longer than those required by the principles of selective photothermolysis. The light intensities of those devices are normally not sufficient to destroy the pigment particles. Instead of destruction, the pigment particles in the skin are heated up and the heat is conducted to the adjacent tissue causing unspecific tissue injury.
Lasers and especially intense pulsed light sources with more than 1 millisecond pulses and low light intensities are clearly not suitable to be applied for laser tattoo removal.