Lasers 101: The Why's and How's of Cosmetic Lasers, Part One

Lasers 101 - The Why's and the How's of Cosmetic Lasers, Part One

This series is a three-part sequence entitled,?Lasers 101 - The Why's and the How's of Cosmetic Lasers.?Part One will offer a 35,000-foot view of laser basics. Part Two will dive deeper to discuss the fundamentals of laser physics and how to safely treat various skin types. Part Three will specify the difference between Intense Pulse Laser (IPL), LASER, and NG Yag and apply the principles of each to best address treatment objectives. Treatment objectives include: Skin rejuvenation, acne scaring, skin discoloration, vascular aesthetics, tattoo removal and laser hair removal to name a few.?

The name ‘Laser’ is an acronym for?Light Amplification by Stimulated Emission of Radiation. The concept of Stimulated Emission is derived from the quantum theory of radiation from Alfred Einstein. The first laser employed ruby as a lasing medium that derived its power from intense flashes of high-energy light. It was developed by Theodore H. Maiman in 1960. In the same year, approximately ten lasers were created which made use of different lasing media such as gaseous, solid, liquid, and semi-conductor.?1

Many believe a laser to be a beam of light; however, the laser beams instead are a constant stream of photons. Photons are particles of light that are released when an atom’s electrons return to their ground state, either independently or via another energy source. Laser treatments use the power of high-intensity light in different wavelengths that are tailored for treating specific skin conditions.?2

When a laser beam, or stream of photons, interacts with a layer of the skin, it does so through the transfer of energy. Upon hitting the skin, the laser can do one of four things: reflect, transmit, scatter, or absorb.?

In aesthetics, the goal is to absorb the photons and limit their transmission, reflection, and scattering. To be absorbed, photons require a chromophore.3?A chromophore is a material that is present in the tissues (endogenous) or outside of the tissue (exogenous), which both absorb specific wavelengths depending on its absorption coefficient.?The absorption coefficient describes?the intensity attenuation of the light passing through a material.?

Examples of endogenous chromophores are melanin, hemoglobin, water, protein, peptide bonds, aromatic amino acids, nucleic acid, urocanic acid and bilirubin.?Exogenous compounds are colors of tattoo ink that act as chromophores.

In fractional laser skin resurfacing, the laser delivers precise microbeams of light into the lower layers of skin, creating deep, narrow columns of tissue coagulation, while sparing surrounding tissue from insult. The coagulated area stimulates a natural healing process that results in the creation of healthy new tissue. this controlled dermal damage stimulate fibroblast formation to induce neocollagenesis and collagen remodeling.?

There are two types of fractional lasers: Ablative versus non-ablative.

Ablative lasers vaporize the skin tissue, while non-ablative lasers allow the skin to remain intact. Therefore, ablative lasers are more aggressive providing visible, dramatic results, utilize electromagnetic waves to erode the entire epidermis and upper layer of dermis. Ablative lasers are more aggressive and therefore often require a longer recovery time. Ablative lasers are used to treat skin challenges that accompany advanced age, such as deep wrinkles, uneven texture, and dyspigmentation. For those who desire less side effects associated with ablative lasers, non-ablative lasers are a good option.?

Non-ablative lasers do not target superficial layers instead,?they work by heating up the underlying skin tissue (without visible trauma to epidermis) and promotes the growth of new collagen.?Since non-ablative lasers are less disruptive to the epidermis, the downtime is likely minimal. Non-ablative lasers provide rejuvenating results while improving the appearance of dyspigmentation, texture, tone, and wrinkles, without lengthy downtime. Under the umbrella of ablative and non-ablative there are a host of laser types, all with varied energy sources and settings.?

CO2 Lasers - Ablative

This type of ablative laser uses carbon dioxide, or CO2, to create an infrared beam of light. The CO2 laser is one of the most widely used surgical lasers because the energy it generates is absorbed well by water, which is present in great quantity in the body’s tissues. It’s precise and carries few side effects.?2

Nd:YAG Lasers - Ablative

Nd:YAG lasers use a neodymium-doped yttrium aluminum garnet crystal to produce an infrared wavelength that allows dermatologists to reach a deeper layer of tissue beneath the skin than many other types of lasers. It can be used to treat spider veins, varicose veins, birthmarks, facial veins, and hemangioma tumors. It’s also effective against brown pigmented age spots.?2

Erbium Lasers – Ablative or Non-Ablative depending on settings

Erbium lasers use a white metal to create an infrared beam. They’re also effective when used for laser skin resurfacing. They’re known for causing reduced burning sensations and pain than some other types of lasers used for skin resurfacing.?2

Pulsed Dye Lasers – Non-Ablative

Pulsed dye lasers produce a yellow wavelength light that can easily penetrate red pigments, making it particularly effective for treating inflamed blood vessels. It’s also one of the leading laser treatments for acne and the treatment of scars. PDL lasers use an organic dye that’s included in the lasing medium.?2

IPL Lasers – Non- Ablative

IPL lasers, or intense pulsed light lasers, are designed to create an intense pulse of light that’s perfectly suited for penetrating red and brown pigments. The primary uses for IPL lasers in a dermatological setting are for treating brown patches such as liver spots and relieving inflamed blood vessels beneath the skin’s surface.?2

Lasers can be used for a wide array of skin and cosmetic conditions with the objective to improve the skin’s overall texture, tightness, and tone.?

Most commonly, laser therapies are used for:

·??????Unwanted hair

·??????Acne, scars, and birthmarks

·??????Tattoo removal

·??????Skin rejuvenation

·??????Leg and varicose veins

Unwanted hair:

Laser hair removal is a great option for those wishing to have an effective and sustained reduction in hair. However, laser hair removal does not always provide permanent hair removal. After multiple sessions, patients may still require maintenance treatments to maintain desired results.

The laser system works by targeting the melanin in the hair shaft, hair matrix, and follicular epithelium. The laser produces wavelengths that are between 600 to 1200 nanometers (nm), which are the frequencies at which melanin can absorb the photons.4

Acne and acne scarring:

Laser devices can be a great tool for diminishing the appearance of acne and acne scars. The Food and Drug Administration (FDA) has approved numerous laser devices for the treatment of acne. These devices utilize infrared wavelengths and pulsed dye lasers to achieve results.

For active acne, laser treatment can be used in those that are non-responsive or non-compliant with traditional treatment. Laser therapy can also be used in antibiotic resistance patients by affecting bacteria colonization of the sebaceous glands, and the skin’s inflammatory response.?Acne scarring can also be treated with lasers.?Laser treatments for acne scars are extremely effective when performed in a series over time. Lasers penetrate the top layer of skin allowing for remodeling to occur and the increase of collagen uptake resulting in a smoother and optimal appearance of the treated area.

Skin rejuvenation:

CO2 laser resurfacing has been used for years to treat different skin?issues, including?wrinkles, scars,?warts, enlarged oil glands on the nose, and other conditions. Delivery methods have evolved to include fractionated CO2 which uses very short pulsed?light energy or continuous light beams that are delivered in a scanning pattern to remove thin layers of skin with minimal heat damage.?4???IPL, radiofrequency, ultrasound, and thermal energy treatments are among the many options to choose from to combat the signs of aging.?

Who performs laser treatments?

Although doctors can provide laser treatments, cosmetic laser and light procedures are commonly performed by non-physician providers. Such providers can include physician assistants, nurse practitioners, nurses, or aestheticians who are trained and certified in laser procedure delivery. Patients can receive laser treatments in an outpatient setting, such as at a medical office or medical spa.8

What are the risks associated with laser treatment?

The most common side effects associated with laser treatment are erythema (redness of the skin), burning, and pain. Additionally, more serious adverse events are possible and include crusting, blistering, purpura (rash with purple spots), hyperpigmentation or hypopigmentation, and scarring. Eye protection during laser treatment is essential because a laser can cause severe ocular injury.8

Conclusion:

Aesthetic lasers are effective and safe in treating a variety of skin conditions, including those for cosmetic purposes. Under the care of an experienced professional, patients can utilize various types of laser treatments to achieve their cosmetic goals.

References:

1.???Getting familiar with the basics of Cosmetic Laser Technology (unknown date),?https://medlaserusa.com/blog/getting-familiar-with-the-basics-of-cosmetic-laser-technology/

2.???J. Slega, 2019, Sept. (26).?Understanding the Types of Cosmetic Laser Treatment,?www.dermmd.comhttps://dermmd.com/2019/09/26/understanding-the-types-of-cosmetic-laser-treatment/

3.???Fitzpatrick RE, Ruiz-Esparza J. The superpulse CO2 laser. In: Roenigk R.K, Roenigk H, editors.?Martin Dunitz. J Dermatol Surg Oncol 1994.?Vol. 20. London: New trends in dermatologic surgery; 1993. pp. 449–455. https://doi.org/10.1111/j.1524-4725.1994.tb03215.x PMid:8034839.?[Google Scholar]

4.???Vaidya, T., Hohman, M. H., & Kumar D, D. (2022). Laser hair removal. In StatPearls. StatPearls Publishing.?https://www.ncbi.nlm.nih.gov/books/NBK507861/

5.???Alexiades, M. (2017). Laser and light-based treatments of acne and acne scarring. Clinics in Dermatology, 35(2), 183–189.?https://doi.org/10.1016/j.clindermatol.2016.10.012

6.???Laser and light based light-based treatments of acne. (2013, April 30). Indian Journal of Dermatology, Venereology and Leprology.?https://ijdvl.com/laser-and-light-based-treatments-of-acne/

7.???Loesch, M. M., Somani, A.-K., Kingsley, M. M., Travers, J. B., & Spandau, D. F. (2014). Skin resurfacing procedures: New and emerging options. Clinical, Cosmetic and Investigational Dermatology, 7, 231–241.?https://doi.org/10.2147/CCID.S50367

8.???Alam, M. (2007). Who is qualified to perform laser surgery and in what setting? Seminars in Plastic Surgery, 21(3), 193–200.?https://doi.org/10.1055/s-2007-991187