What is Laser

LASER (Light Amplification by the Stimulated Emission of Radiation) is a device that creates a uniform and coherent light that is very different from an ordinary light bulb.

Lasers deliver light in an almost-perfectly parallel beam (collimated) or a focused beam of a single wavelength.

Laser output can be continuous or pulsed and is used in a myriad of applications. Gas lasers are used to cut steel and perform delicate eye surgery, while solid state lasers create the ultra-high-speed, minuscule pulses traveling in optical fibers traversing the backbones of all major communications networks.

Lasers in Aesthetic Medicine
Most Common Lasers Used in Medical Aesthetics
Spectral colors and wavelengths 

How Does a Laser Work?

A laser is an optical oscillator, which is made out of a solid, liquid or gas with mirrors at both ends. To make the laser work, the material is excited or “pumped,” with light or electricity. The pumping excites the electrons in the atoms, causing them to jump to higher orbits, creating a “population inversion.” A few of the electrons drop back to lower energy levels spontaneously, releasing a photon (quantum of light). The photons stimulate other excited electrons to emit more photons with the same energy and thus the same wavelength as the original. The light waves build in strength as they pass through the laser medium, and the mirrors at both ends keep reflecting the light back and forth creating a chain reaction and causing the laser to “lase.”

In simple laser cavities, one mirror has a small transparent area that lets the laser beam out. In semiconductor lasers, both mirrors often transmit a beam, the second one being used for monitoring purposes.

The combination of spontaneous emission first, and then stimulated emission, causes the laser to “lase,” which means it generates a coherent beam of light at a single frequency.

Who Invented It?

In 1957, the laser was conceived by Gordon Gould, a graduate student in physics at Columbia University. When Gould filed for patents in 1959, he found that Columbia professor Charles Townes and Arthur Schawlow of Bell Labs had already filed for them. The year before, AT&T had, in fact, demonstrated a working laser at Bell Labs. In 1977, after years of litigation, a court awarded Gould rights to the first of three patents and later to all of them. He finally reaped millions in royalties.

Learn more about how lasers work

See how lasers work

Lasers in Aesthetic Medicine

Lasers and optical technologies play a significant role in aesthetic and reconstructive surgery. The unique ability of optical technologies to target specific structures and layers in tissues to cause chemical, mechanical, or thermal changes makes them a powerful tool in cutaneous rejuvenation, hair removal, fat removal, and treatment of vascular lesions such as port-wine stains, among many other procedures. With the development of epidermal cooling, lasers and optical technologies have become more versatile and safe. The constant improvement of existing applications and the emergence of novel applications such as photodynamic therapy (PDT), nanoparticles, spectroscopy, and non-invasive imaging continue to revolutionize aesthetic medicine by offering a minimally invasive alternative to traditional plastic surgery. Lasers and optical technologies are headed toward safer, easier, more quantifiable, and more individualized therapy. 

Lasers and light-based treatments are extremely useful and now standardized techniques in the management of different stages of photoaging. To obtain the most successful results, protocols involving single or combination systems can be used, depending on skin photodamage. In the last years, the trend is to choose noninvasive or minimally invasive treatments, with the aim of reducing the risk of side effects, complications, and downtime. Selective photothermolysis obtained with lasers and with intense pulse light is an extremely valid procedure, in particular in types I and II, according to the Glogau classification. Photodynamic therapy is another effective tool in photoaging treatment, especially in the presence of precancerous conditions. In mild and severe photoaging, ablative laser resurfacing is a particularly successful technique, although requiring a very skilled hand. The new systems, such as fractional photothermolysis, seem to be the very next future to face up to resurfacing procedure with high efficacy and less risks. Obviously, lasers and light-based treatments alone might not be sufficient to control all aging symptoms. For this reason, many other treatments (botulinum toxin, dermal filling agents, chemical peels, systemic and topic antioxidants) can be used in combination to improve the final clinical outcome.

Benefits of Laser/IPL Surgery

Lasers offer patients and dermasurgeons the following general benefits:

• Improved therapeutic results
• Reduced risk of infection
• “Bloodless” surgery with most lasers
• An alternative to traditional scalpel surgery, in some cases
• Less scarring, in most cases
• Precisely controlled surgery, which limits injury to normal skin
• Safe and effective outpatient, same-day surgery for many skin conditions

Types of Lasers/IPLs

Different types of lasers and IPL are used to treat a variety of skin conditions, birthmarks and growths and cosmetic complaints. Presently, no single laser or IPL is capable of treating all skin conditions, but certain lasers can be tuned to a variety of colors of light or coupled to a robotized scanning device to expand their clinical effectiveness. An experienced physician may evaluate the individual condition and suggest the appropriate type of laser and/or IPL system to achieve the best results.

Most Common Lasers Used in Medical Aesthetics

Carbon Dioxide (CO2) Laser The CO2 laser system works on 10600 nm wavelength and can be used in several ways: “focused” for cutting skin without bleeding; “defocused” for superficially vaporizing skin; and “ultra pulsed” for facial resurfacing. By delivering very powerful, rapid pulsing or scanning of the latest generation of CO2 lasers, laser surgeons are able to resurface the skin for cosmetic improvement. This technique removes fine lines and wrinkles of the face, smoothes acne scars, and rejuvenates aging and sun-damaged skin as it contours the skin surface. When the CO2 laser’s energy is defocused and not continuous (pulsed), the dermasurgeon can treat warts, shallow tumors and certain precancerous conditions. When the CO2 laser energy is continuous and focused into a small spot of light, the beam is able to cut the skin. It is used in this way to remove skin cancers, to treat a variety of non-vascular and pigmented lesions and for eyelid operations. This technique is also used to remove warts and for some surgical incisions.

Erbium (Er:YAG) Laser

The erbium:YAG 2940 nm (Er:YAG) laser produces energy in a wavelength that gently penetrates the skin, is readily absorbed by water and scatters the heat effects of the laser light. These properties enable laser doctors to remove thin layers of aged and sun-damaged skin tissue with exquisite precision while protecting healthy surrounding tissue. The Er:YAG laser is commonly used for skin resurfacing to improve moderate facial wrinkles, mild surface scars or splotchy skin discolorations. Newer Er:YAG lasers have an extended pulse duration that allows them to act in a similar manner to the CO2 laser.

Yellow Light Laser

Through the use of an organic dye, short pulses of yellow-colored light (578 nm) are produced. A popular yellow light laser is the pulsed dye laser. Because yellow light is more precisely absorbed by the hemoglobin than other colors, these lasers are effective in the treatment of blood vessel disorders, such as port wine stains, red birthmarks, enlarged blood vessels, rosacea, hemangiomas and red-nose syndrome. Certain yellow light lasers may also be used to treat stretch marks and are safe and effective for infants and children.

Green Light Laser

The green light (511 nm), in contrast, is used for the treatment of benign brown pigmented lesions, such as café-au-lait spots, the “old age” spots commonly found on the backs of the hands and lentigines or freckles. Green light lasers are also used for the treatment of small blood vessels on the face and legs.

Red Light Laser

The red light spectrum produced by the ruby or alexandrite light laser is emitted in extremely short, high-energy pulses due to a technique known as Q-switching. The Q-switched ruby or alexandrite laser systems were initially used to remove tattoos, but are now commonly used to treat many brown pigmented lesions, such as freckles or café-au-lait spots.

When the pulse duration of the ruby or alexandrite lasers is lengthened, it is effective in removing unwanted hair for long periods of time, sometimes even permanently.

Spectral colors and wavelengths

This chart shows colors of the visible light spectrum, and the associated wavelengths in nanometers. Ranges are traditionally given as: ultraviolet light, 100-400 nm; visible light, 400-750 nm; and infrared, 750 nm-1 mm.

Major laser wavelengths

This chart shows common types of lasers, and the major wavelengths associated with them.

Q-Switched Neodymium YAG (Nd:YAG)

Delivering infrared light, it is used to remove tattoos and deep dermal pigmented lesions, such as nevus of Ota. This laser can also be tuned to produce a green light for the treatment of superficial pigmented lesions like brown spots, as well as orange-red tattoos.

KTP

The KTP emits a green light and is capable of treating certain red and brown pigmented lesions. When the pulse duration is lengthened, the Nd:YAG laser is also effective in removing hair and an inflammatory condition termed pseudofolliculitis barbae for months and sometimes permanently. This is particularly useful in the treatment of dark-skinned patients.

Non-Ablative Lasers and Light Sources

Instead of heating and removing the top skin tissue, non-ablative (non-wounding) lasers work beneath the surface skin layer to improve skin tone and texture and minimize fine lines with few side effects and a speedy recovery. Light-based devices that produce a broad spectrum of light (wavelengths) with computer-controlled parameters of energy delivery (Intense Pulsed Light, or IPL) can be adjusted according to a patient’s skin type and condition. This technology is primarily used for the treatment of benign red and brown lesions, hair removal and facial skin rejuvenation.

Laser Hair Removal and Leg Veins Removal

Laser technology is presently being utilized for efficient and long-lasting body hair removal. The laser energy causes thermal injury to the hair follicle, stunting hair growth. Several laser hair-removal systems, including the diode laser, the long-pulsed alexandrite and Nd:YAG lasers and the IPL, are being used successfully with long-lasting results.

Until recently, lasers were used primarily for superficial facial veins. Thanks to the newest technologies, leg veins may be effectively treated with a variety of lasers and intense pulsed light systems.

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