|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.
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.
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.
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.
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.
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.
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.
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.
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.
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, 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 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.
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.)
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.)
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.
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.
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.