IPL, photo-facial, light treatment, laser treatment – whichever name you use, intense pulsed light systems have become the single most popular and affordable light-based device for many aesthetic practices. Their sales are largely unregulated, with most of the devices being used in spas, “medi-spas” and “rejuvenation facilities.” Though universally offered, can IPL treatments differ at these “non-physician facilities” and physicians’ offices?

IPLs are not lasers, and they use a flash lamp to emit noncoherent, nonmonochromatic light. However, if used properly, IPLs can deliver good results for many indications. Understanding how to manipulate your IPL system via pulse numbers, pulse widths, filters, cooling and proper patient selection can let you completely reinvent your laser practice.

Wavelength

The range of wavelengths will depend on the system and on which handpiece or filter you use. There are two types of filters: cut-off and cut-on.

Cut-off filters are the most common and block all wavelengths below that filter number. For example, a 560 nm filter would allow all wavelengths above 560 nm and less than 1,200 nm to be emitted.

Cut-on filters block all wavelengths except for a small range right around the filter number. For example, a 1,064 nm filter might emit light from 1,060 nm to 1,066 nm.

Note that these are not lasers, as they are not mono-chromatic or coherent.

Choosing the right filter is one important parameter in a successful treatment. When thinking about which wavelengths to use, you must consider both the condition being treated and the patient’s skin color.

Since the highest absorption of melanin is at lower wavelengths, higher-wavelength filters — which are less absorbed by melanin — offer protection for darker skin types.

Higher-wavelength filters may also be used for better penetration when doing procedures such as hair removal, when penetration to the dividing cells is crucial for permanent removal. Lower-wavelength filters offer more absorption by melanin and are safe to use on lighter skin types.

Adjust for skin type

The darker the lesion, the easier it is to remove, even with longer wavelengths. When treating lighter lesions, you may need to adjust to a more pigment-absorbing, shorter wavelength. The lower limit will be determined by the patient’s skin type.

In addition to filters, IPL systems can also be adjusted, just as lasers are adjusted, using fluence and pulse widths. The pulse width adjustment parameters and the number of pulses in a row are two of the variables that set IPLs apart from other laser and light systems.

Thousands of pulse sequence variations can be formed by adjusting number of pulses, pulse width and the delay between each pulse. This is one thing that makes IPL systems so user-dependent. One operator may obtain great results using a system, while another may have no success.

Pulse widths

Pulse widths, the length of time of each pulse — milliseconds for IPLs — can be increased or decreased depending on the indication. For darker skin types, longer pulse widths offer additional epidermal protection, as the peak heat is lower than with short pulses of the same fluence, avoiding permanent damage to melanocytes. Longer pulse widths can also be helpful when treating larger vascular lesions. On the other hand, shorter pulse widths are preferred when treating pigmented lesions.

Remember, melanosomes are tiny and have a short thermal relaxation time; the desired pulse width should be as close to the thermal relaxation time as possible.

Small telangiectasias also respond well to short pulse width treatments. By programming a system to string pulses together, the operator is able to deliver more energy while keeping the peak temperatures below the point of epidermal burning. This can be important when treating vascular lesions, which are deeper in the skin.

Cooling

Cooling is another important variable in the proper use of an IPL. The mechanism for cooling the epidermis during treatment will vary depending on the device. Some use contact cooling, while others rely on air cooling. Proper cooling can increase the treatment possibilities and versatility of your device.

It’s important to note that more epidermal cooling is required when treating lesions below the epidermis, while little epidermal cooling is needed when treating epidermal lesions, such as solar lentigines.

Most cooling is operator-controlled, solely by how long the cooling apparatus is exposed to the skin. A few systems have temperature adjustments on the IPL itself. When using a contact dynamic cooling device, the cooling window will heat up as shots are fired through it.

The temperature of the cooling tip will be much warmer at the end of the session than it was at the beginning. Be sure to give the cooling apparatus time to cool itself down again. Inappropriate cooling due to rapid pulsing can lead to complications.

Applications

The clinical applications of IPLs are virtually endless. The classic indications for IPL treatment are the clinical signs of photoaging, including hyperpigmentation, telangiectasias and rhytids.

However, IPL devices have also shown success in treatment of rosacea, acne, melasma, port wine stains, hemangiomas, hair removal, angiokeratomas, hypertrophic scars, poikiloderma of Civatte and lesions of pigmented purpura.

In addition, IPL devices can be used as the activation source for photodynamic therapy. PDT can be used to treat actinic keratoses as well as verrucae.

Studies have also shown that when compared to IPL alone, the addition of aminolevulinic acid to an IPL regimen increases the production of collagen and the improvement of the signs of photoaging. (Marmur et al.) (Gold et al, Dermatol Surg. 2006.)

Safety

Two separate groups have examined the use of IPL after filler injections and found that there was no sign of interaction between the light and the fillers. IPL has also been shown to be safely administered immediately after botulinum toxin injections. (Farkas et al. Aesthetic Surg J. 2008.) (Goldman et al, Dermatol Surg. 2007.) (Semchyshyn, Kilmer, Dermatol Surg. 2005.)

Varieties

IPL systems come in many varieties. Most now come with other attachments, such as hair removal, ablative and nonablative fractional resurfacing handpieces, acne treatment, radiofrequency (RF), infrared tightening attachments and even IPL paired with RF. Choosing the IPL that is right for your practice will depend not only on the IPL portion of the device, but also on what other laser and light procedures you want to offer your patients.

As our understanding of these broadband light sources expands, we are able to offer our patients more tailored treatments. If you aren’t getting the results you are looking for, think about adjusting parameters other than fluence. Lighter skin types can tolerate shorter pulse widths, which may better target pigmentation. More cooling can further protect the epidermis when treating dermal targets using higher fluences.

With more applications than ever, these multipurpose, tunable light devices are likely to remain the workhorse of the aesthetic industry.

More about laser skin treatments on LaserOffers.com


Based on an article published by Joely Kaufman, M.D. in Dermatology Times, May 1, 2009.

Joely Kaufman, M.D., is 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. The Cosmetic Group is involved in research and development of lasers and light devices as well as other aesthetic procedures, such as fillers and toxins.