Aesthetic Lasers Blog

Skin care after any laser treatment is very important for healing and for the best overall results of any skin photorejuvenation procedure. Darker skin type patients require extra attention to prevent laser surgery hyperpigmentation.

The melanocytes (skin cells producing melanin – the pigment in the skin) of dark-skinned individuals tend to be more hyperactive to any stimulus, particularly inflammation after laser surgery. Therefore, the use of hypopigmenting agents both pre and postoperatively is of considerable importance. Many combinations of tretinoin, hydroquinone, topical steroid, α-hydroxy acids, kojic acid and/or azealic acid have been advocated by aesthetic physicians.

For the treatment of the hyperpigmentation that follows several laser procedures, many practices favor 0.025% tretinoin cream mixed with 4% hydroquinone to be used initially at night. To assess the degree of irritation, the patient is instructed to apply the cream to back of their ears, and if tolerated, the application is continued on other exposed areas. If any irritation develops, corticosteroid in topical form is added to the combination (1% hydrocortisone).

Patients are typically advised to use 5% glycolic cream in the morning, and if the pigmentation still persists, mild glycolic acid peel (20-30% solution) is performed 9 weeks after the laser procedures. Combinations of Vitamins C and E and glycolic acid as well as many other medical grade skin care products are commercially available and may be very useful for the prevention and treatment of hyperpigmentation after laser skin resurfacing and all non-invasive laser treatments.

Post Laser Relief - after laser skin care

Dr Brandt Anti Irritant Laser Relief

This lightweight anti-redness lotion helps reduce redness, alleviate discomfort after laser treatments and for sensitive and irritated complexions. It binds moisture to the skin and lightly hydrates. Contains Inflacin anti-inflammatory; Pumpkin seed extract to alleviates discomfort and irritation; Hylauronic acid, which binds moisture to the skin; and QuSome, which delivers ingredients deeper and faster to the epidermis.

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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
  • 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.

    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
  • Patients with non-Caucasian skin represent a largely untapped market for aesthetic treatments. Many potential patients are still being told that they cannot get laser or light-based treatments because of their skin type.

    Over one half of the world is brown-skinned. Imagine turning someone away from your practice because you can’t treat that skin type, when we have safe lasers that can treat the darkest Indian and African skin safely. You will never become an expert if you can’t treat brown skin. Dr Fitzpatrick devised his skin typing system of I-VI, with one (I) being your Scandinavian, blue-eyed person and six (VI) being as dark as you can get. Three or four through to six are the skin types that require attention and care. With the right technology and proper technique we can treat all skin types as safely and effectively as we can Caucasian skin (I and II).

    People with colored skin have a thicker stratum corneum, and their fibroblast cells are much more robust. That is why, with skin tightening, people with darker skin can get better results with less energy (fluence). It is important to understand the difference between dark skin and ethnicity. If you had five people and one was an Indian (from India), one was African American, one Korean, one Japanese, and one was Brazilian, and they all had the same skin color, you wouldn’t be able to tell the difference. But if you treated them with the same lasers, with the same settings, the same chemicals , and cosmeceuticals, you would get five totally different results.

    It’s not skin color we treat, it is the ethnicity and all hereditary background that comes with it!

    Intense pulsed light (IPL) and laser devices, which target epidermal melanin, work well on fair Caucasian skin. However, since darker skin has more melanin than light skin, the risk of epidermal damage is higher. The dermis houses the blood vessels, hair follicles, sebaceous glands and fibroblasts, so the ideal device is one that can deliver energy to the dermal layer without damaging the epidermis.

    When traditional devices are used on non-Caucasian skin, post-inflammatory hyperpigmentation (PIH) in the epidermis is the most common adverse effect. If the PIH is deep enough, it may become permanent. Even now, patients with non-caucasian skin treated with less invasive and less aggressive fractional devices experience PIH and erythema. Scarring and keloids may result from more aggressive treatments. One solution is to modify treatment settings to minimise possible adverse effects. When we do this, however, we risk reducing efficacy and wasting patients’ time and money.

    Heavily filtered IPL and Nd:YAG lasers can be safely used on darker skin types. In cases of low light tolerance lasers can be combined with a bipolar radiofrequency (RF) energy for a more effective treatment of non-Caucasian skin.

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  • Filed under: Laser Clinics, Laser Treatments
  • 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.

    Dr Vijay Sharma, the President of the Indian Association of Cosmetic Surgeryand Dr. Kiran Naik of the Chicago Cosmetic Surgery Centre have independently stated that Botox — the biggest fad in cosmetic procedures — is also “the biggest fraud”. The injectible contains bacteria that paralyses muscles on being injected into the skin, giving a ‘youthful’ wrinkle-free appearance.

    But because the effect of Botox is temporary, regular touch-ups are essential. “In the case of frequent use, the damage to the muscles may force a patient to undergo a face-lift at an early age. This scam allows for doctors and dermatologists to set themselves up for a steady income from their patients.” warns Sharma.

    It goes without saying that the glamour business is the biggest hunting ground for cosmetic surgeons. In their ceaseless quest to look picture perfect, many top movie stars have undergone “beautification’ surgeries”, often with nasty complications, but preferred to remain tight-lipped.

    Long term Botox complications are still understudied, but these opinions are hard to ignore. It is quite likely that heavy users of Botox will come back for a more serious surgical treatment, which, of course, will be available at a price. Those voluptuous lips many movie stars are carrying around are a part of their backsides. With age the latter resource will be useful for the Botox repair.

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  • Filed under: Dermal Fillers
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