Archive for the ‘IPL and Radio Frequency (RF) skin treatments’ Category
Photofacial is one of the most popular treatments for skin rejuvenation and with good reason. Photofacial can treat a variety of skin conditions including skin discolorations and redness, but with all the different light devices and treatment names being used there is a lot of confusion about this versatile treatment.
What can be treated with IPL.
Photofacial uses Intense Pulsed Light (IPL), which is well absorbed by chromophores that have color such as melanin and hemoglobin (think red and brown). It works best for brown spots and vascular skin conditions. IPL treatments can help stimulate collagen production, can kill acne causing bacteria and some IPL devices can also be used for hair removal.
The most common conditions treated with IPL include:
- Broken capillaries
- Flushing/ Facial redness
- Sun damage/Age spots
- Brown Spots
What is in a name?
Photofacial is a photo rejuvenation treatment that uses Intense Pulsed Light (IPL) technology. Photofacial is known by many different names with a variety of spellings including: PhotoFacial, Fotofacial, FotoFacial RF, Photo-Rejuvenation, Photoderm, BBL or simply IPL. These are essentially all the same thing, however some names may be trademarked, associated with a specific device or a developed treatment protocol. Dr. Patrick Bitter, Sr. developed the procedure PotoFacialSM in 1988 and Dr. Bitter Jr., is the developer of the FotoFacial™ and PhotoFacial™. BBL is Sciton’s trademarked name for their IPL machine, which is said to be the most powerful IPL device. You do not need to be overly concerned with the name being used to describe an IPL treatment, instead focus more on the device being used and the experience of the technician performing the treatment.
What device should be used for a Photofacial?
Photofacial is a treatment and the devices used is Intense Pulsed Light (IPL). Some people will use an LED device and call it a Photofacial, however this is not a true Photofacial. LED devices are commonly use in spas, they have lower energy and do not produce intense light.
Due to the increasing popularity of Laser and IPL treatments and the growing industry there has been an explosion of new devices on the market. Many of the new devices are less effective. As Laser Technicians we look for a device that gives us more precise control. IPL treatment settings do not work by simply turning a dial up or down. We control things such as the pulses, pulse duration, the amount of joules used and cut off filters. Devices that use a larger selection of cut-off filters are more effective because they allow for treatment of vascular and pigment lesions at different depths. In the authors opinion the best IPL devises are Scitons BBL and the Lumenis One/M22.
How many treatments are needed?
The first treatment will generally provide significant correction, however for best results a series of treatments are recommended. The exact number of treatments will vary depending on the condition being treated, the desired patient results, how the skin responds and how compliant you are with pre and post skin care. A very generic protocol would be a series of 5 treatments scheduled 3 weeks apart, however it is better to work on a plan that is designed specifically for your skin and your lifestyle.
What to expect after a Photofacial (IPL/ BBL).
There generally isn’t any down time with Photofacial, however if you have a lot of sun damage you may not look great for a week or two. Immediately after your treatment your skin will be a little pink and slightly warm. It is normal for it to feel like a mild sunburn, windburn or razor burn, but if you experience an excessive or lingering heat you should communicate this to your technician.
If you have brown spots they will darken up and gradually flake off over the next two weeks. Freckles tend to look darker, skin with a lot of discoloration may look “peppered” before it flakes off. If you have treated non-facial skin such as neck, chest, hands or arms it may take three weeks and some spots may take even longer. You may be able to speed up the process with a microdermabrasion 7-10 days after your treatment. Swelling and redness may also occur, you can apply cold packs to help with swelling and some people find an over the counter antihistamine helpful.
It may feel hot. If the skin does not cool down quickly after treatment it is very important that you go home and apply cold cloths until it is no longer hot. Take a large, clean bowl fill it with ice, add water and put clean washcloth in the bowl. Ring out excess water and apply cold cloth to treated area. When the cloth is no longer cold, trade it out for a cold one. Continue to do this until the area is no longer hot (this could take hours).
How can I improve the results of my Photofacial treatment?
The most important thing you can do is follow all pre and post care instructions, this includes not tanning, avoiding heat immediately post treatment and using the recommended topical skin care. If you are treating skin discolorations you will most likely need a skin care regimen that includes tretinoin and 4% hydroquinone. If you are treating rosacea you will need a topical vitamin-C. Everyone will need an approved sun protection with Zinc Oxide, the SPF should be over 30.
IPL treatments can be combined with other technologies for enhanced results. I will often use a vascular laser in my treatments for treating broken blood vessels or add Radiofrequency (RF) for skin tightening. Other possabilities include blue light for acne, laser resurfacing and laser hair removal. A microdermabrasion may be done prior to treatment to cause vaso diolation which can enhance results of an IPL treatment for those with facial reddness.
If you really want to increase your results you may want to do a PhotoDynamic Therapy (PDT) treatment. PhotoDynamic Therapy uses Levulan (aminolevulinic acid) also known as ALA to photosensitize the skin prior to a photofacial Adding Levulan results in a higher level of correction of freckles, sunspots, skin discolorations, broken blood vessels and redness. You will also have the added benefit of an aggressive acne treatment and treating Actinic keratosis (AK’s).
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Blue Light RF is an acne treatment that works to kill acne causing bacteria and shrink oil glands, reducing oil production. Blue light can be done alone or added to other skin treatments like facials and chemical peels to enhance results.
Blue Light has a very short wavelength of about 450-495nm, and is used to treat acne because it has the ability to kill acne causing bacteria in the skin. There are two basic types of blue light treatments used to treat acne, passive blue light and direct contact blue light. Passive blue light involves sitting in front of or laying under a blue light for a specific amount of time. Direct contact blue light uses a a hand piece with a crystal tip, which is applied directly to the skin by the laser technician. Both types of blue light can be used alone or used to activate Levulan for Photodynamic therapy. Blue light treatments are not painfull and do not require any amount of down time.
Blue Light RF uses a combination of Intense Blue Light Energy (similar to IPL) and Radio Frequency with direct contact. The synergistic optical energy is effective in treating two key factors involved in acne, bacteria and oil production. The blue light works to kill P. Acne bacteria while the RF energy causes sebaceous gland atrophy (shrinks the oil gland) which decreases oil production.
How many treatments are needed.
When done alone as an acne treatment, a series of blue light treatments are recommended. The exact treatment protocall will depend on the grade of acne being treated. In most cases a series of 8 treatments are recomended, 2 treatments a week for 4 weeks. When levulan is used treatments are done less frequently.
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I have been getting a lot of emails from people all over the world that have received burns from an aesthetic laser or IPL (photofacial) treatments. I should clarify, that these are not people that have been treated by me. The question I am always asked is “what should I do to treat laser burns?” I can’t really give an accurate treatment protocol without seeing someone in person. What I will do, is tell you what I usually recommend to clients I have seen that have been burned. I also want to explain why burns occur.
How to tell if you have been burned?
It is normal for skin to feel hot during laser and IPL treatments, but you should expect the skin to cool down quickly. Your laser technician can give you an idea how long you should expect the skin to feel hot. For example if you are having a laser hair removal treatment or a photofacial, your skin should cool down almost immediately. It should feel something like a hot rubberband snap, without any lingering pain or heat. If it feels extremely hot and is not cooling down you should alert your technician as they are doing the treatment. This will allow the technician to adjust the treatment settings. The technician can also take immediate action to cool the skin and possibly prevent a burn, or reduce the severity.
If you suspect that you have been burned, be sure to discuss it with your Esthetician or Laser Technician before you leave the office. Make sure you understand what to expect and how to treat your skin at home. Schedule an appointment for a post treatment follow-up, and never hesitate to call the office if you have questions or concerns.
Usually, you will know almost immediately if you have a burn. In some cases however, the skin may not feel that hot until you go home. As soon as you suspect a burn, you should call your and speak to the laser technician.
If you are not satisfied or confidant with the post -treatment care you are receiving from the laser technician, ask to speak to the medical directer. Hopefully, there is a doctor is the office. If you have gone to a med-spa chain, there may be a medical directer for several locations. You should first make every attempt to work with the staff at the clinic where the laser treatment was provided. If you are not satisfied with the level of care, then seek a second opinion. You want to get professional treatment as soon as possible. Information provided here or anywhere on the internet can not replace personal treatment by a skin professional.
I have a burn, now what?
The recommended treatment for burns, will depend on the degree of the burn. In most cases a burn from an aesthetic laser is a first degree burn. Second degree burns can also occur from laser treatments and third degree burns are not likely. If you suspect that you have been burned severely and find the pain intolerable or if the burn covers a large portion of the body, you may want to go to the emergency room. In most cases, it is not necessary to make a trip to the emergency room, however in rare cases you may need some medical attention. Be sure to let the laser technician know as soon as possible. They should be aware so they can review the treatment settings used and asses if there is an issue with the equipment. They should have you return to the clinic as soon as posable, so that they can give you post treatment instructions. You may also be scheduled to see the doctor or a nurse if necessary. It is the patients responsibility to communicate with the provider, return to the clinic for post treatment visits, and follow post treatment instructions.
Actual first aid treatment will depend on the type of burn.
- Cool the skin as quickly as possible (within the first few hours). This is critical!
- While driving home after the treatment, aim the air conditioner toward the treated area if possible.
- When you get home soak a washcloth in a bowl of ice water, ring out the excess water and apply the cold wash cloth to the treated area. Switch out the cold cloths every couple minuets. When you feel the wash cloth become warm, it is the time to switch it out.
- Do not apply ice directly to the skin, and do not leave cold packs on the skin for an extended period of time. On for ten minuets, off for ten minuets.
- Do not apply an occlusive ointments such as aquaphor or vasaline, unless instructed by your laser technician or doctor, as it can trap in the heat. After the skin has had time to cool, and the skin begins to heal you may then be instructed to use an ointment to protect the skin.
– Do not open or pop blisters. Opening the blisters will make the area more vulnerable to infection
- It may be recommended to loosely wrap the area in gauze
- You can apply a topical hydrocortisone cream and/or antibiotic cream to the burn.
- Watch the skin for sighns of infection
After the burns have healed:
Once the burns have healed, the concern becomes how to treat and prevent scars. The most important thing you can do is protect the area from further injury, this includes avoiding sun exposure. Be sure to use a Physical SPF 35 or higher with Zinc Oxide. You can also prevent and treat hyper pigmentation ( dark skin discoloration) by using a 4% Hydroquinone cream and Tretinoin (Retin-A). Topical Serums that contain Vitamin – C , and products with growth factors (TNS Recovery Complex) can aid in collagen production, improve skin healing and reduce inflammation. If the burn marks are old you may need something like a medium depth chemical peel, to treat the scars.
The Obagi Nu-derm system is your best bet for treating scars or hyperpigmentation from burns, it incorporates the use of prescription strength Hydroquinone and Tretinoin. This is a prescription strength skin care line, available at many dermatology and plastic surgery offices. The treatment protocol is patient specific and a skin care professional will determine the best way for you to use these products. If you have had a recent burn it may be suggested that you skip the use of some products such as the Exfoderm. I usually recommend using a 1/2 gram of the Clear AM and PM, and mixing a 1/2 gram of the Blender with a 1/2 gram of Tretinoin. The strength of Tretinoin and frequency is something that needs to be determined after a personal consultation. Non-facial areas such as the neck, chest, hands and arms are treated differently than facial areas, this is another reason you need to be seen for a follow-up.
Skin Medica’s TNS Recovery Complex has a potent growth factor blend that strengthens the skin’s natural ability to regenerate itself. Although this product is not specifically indicated in treating burns, in my experience it seems to aid in healing. I was in a car accident and the air bag left me with several abrasions and burns. The areas that I treated with TNS seemed to heal much quicker. I use this product any time I am trying to improve skin healing, and it never disappoints.
The top ingredient in TNS Recovery Complex is Human Fibroblast Conditioned Media (TNS®) → A physiologically balanced, naturally secreted and stabilized combination of multiple human growth factors, cytokines and natural proteins responsible for the production of collagen and other extracellular matrix proteins.
Obagi-C Rx contains a patented combination of 4% hydroquinone and 10% Vitamin C. It reaches the dermal layers of skin to address discolorations and has powerful antioxidant therapy. The vitamin-C will also help reduce inflammation.
Is Clinical Pro Heal is a vitamin serum with a 15% Vitamin C, Vitamin E and Vitamin A. It also has 0.5% kojic acid that evens skin pigmentation. It has soothing and healing properties and reduces inflammation. Pro Heal is recommended for treating sunburns, rosacea and insect bites.
Is Clinical Hydro-Cool Serum contains Hyaluronic Acid ,Vitamin B5, Kojic Acid and Menthol. It is a hydrating serum that calms cools and soothes irritated skin. You can use this product alone or add it to another product.
Why you may have got burned
There are several variables that can lead to laser and IPL burns. One of the most common reasons, is that the skin is tan at the time of treatment. It’s important to understand that IPL and all lasers are absorbed by a specific chromophor. In many cases the targeted chromophor is color. We want the energy to be absorbed by the color in hemoglobin to target blood vessels and the color in melanin when targeting unwanted hair or skin discolorations such as freckles. When your skin is tan at the time of treatment, the energy is not just absorbed by the intended target, it is also absorbed by the surrounding tissue as well. Tan or dark skin will hold on to more heat, resulting in a burn. This is also a concern for skin of color. People with darker skin tones need to be careful to go to a skin professional that understands how to treat their skin type. This is not to say that if you have dark skin you are not a candidate for laser, however there are some lasers that are more appropriate for dark skin. It may also be recommended to precondition skin in advance.
I don’t find machine malfunction to be a common reason that laser burns occur, however it does happen. In my opinion some of the most severe burns are a result of a problem with the equipment. I believe that this can be hard to prove, because the laser manufactures are not likely to admit any fault.
In some cases the technician performing the treatment may be at fault. Technician error is a growing cause of laser burns, simply because the industry is growing. There are a large volume of new laser technicians entering the industry. Some of these new technicians will be knowledgable and talented, unfortunately a greater number will not. A “good” laser technician needs to have a good understanding of laser technology and skin. This comes with experience and continued education. Not all lasers work exactly the same, so a laser technician needs training for each laser they work with. The more experiance a technician has with lasers in general as well as a specific laser will reduce the posability that thier clients will be burned. In addition to understanding the technology being used, the technician should understand how skin will react and determine if someone is a good candidate for treatment. They should also determine if someone needs to precondition their skin before treatment and what is a good post treatment protocol. Keep in mind that even the best laser technician can encounter an unexpected complication, and burns are an inherit risk of laser and IPL treatments.
I can not stress enough the importance of going to a qualified, experianced laser technician with a good repution.
You Play A Role
Nobody wants to hear that they have some responsibility, but in many cases it is the ugly truth. I don’t think anyone deserves to have a burn or complication and I am sincerely sorry when it happens. However, everyone should except the role they play in their treatment. For example, you should not be tan when you have a laser treatment. It is the patients responsibility to inform the laser technician if they have had ANY sun exposure or even spray tan to the treated area. Patients are also expected to inform the laser technician of any medication or skin care products they are using. You also need to communicate with the laser technician during and after the treatment, and let them know what you are feeling. Be sure to follow all pre and post treatment instructions, such as avoiding heat and sun exposure. If you don’t follow the pre and post treatment instructions, you run the risk of a complication.You play an active part in your own treatment, and that begins with choosing a qualified and experienced laser technician. If you chose to go to a specific med-spa based on price or location, you should understand the risk involved.
Burns and other complications are an inherit risk of aesthetic and laser treatments, you should understand and except all risks before you consent to treatment. You should also understand that additional products or treatment may be needed at an additional cost to you. It is important that you communicate with your laser technician and return to the clinic for follow-up visits.
Achive a more youthful, toned and lifted appearance
Target signs of aging by tightening lax skin including, jowls, neck, sagging under the eyes, droopy brow, and nasolabial folds. ReFirme is a noninvasive procedure that instantly tightens skin with out any discomfort or down time, offering a fast treatment for sagging and wrinkled skin.
ReFirme is a FDA cleared non-invasive Skin Treatment procedure that enables you to comfortably achieve a more youthful, toned and lifted appearance without enduring down time.
An average treatment takes about an hour. You can see results immediately after your first treatment, however results are accumulative, so a series of treatments are recommended. A series of 5 treatments are recommended, scheduled about 3-4 weeks apart. You can expect results from a single treatment to last up to 6 weeks and after a series of 5 treatments, results last up to 6 months.
ReFirme is an ideal treatment before photo’s or special events.
There is absolutly no down time! After a treatment you look good enough for a night out, in-fact many celebrities will have a skin tightening treatment before they hit the red carpet.
ReFirme can also be used in conjunction with other skin treatments including Fotofacial, Microdermabrasion, The Oxygen Facial and Chemical Peels.
ReFirme™ is a FDA cleared non-invasive skin treatment that uses Bi-Polar Radio Frequency and Light energies to precisely heat the dermal tissue within the targeted treatment area. The precise heating ensures a safe, effective, fast treatment with no downtime. Fine wrinkles are reduced, noticeable lifting can be observed on sagging skin and the texture of your skin becomes smoother, more luminous and toned.
Imagine a skin treatment that has the ability to treat sun damage, rough skin, freckles, skin discolorations, redness, broken blood vessels, rosacea, acne, kill acne causing bacteria, reduce oil glands, minimize pore size, improve appearance of some acne scars and treat precancerous Actinic Keratose. Believe it or not, such a treatment does exist! The skin treatment I am referring to is PhotoDynamic Therapy (PDT). PhotoDynamic therapy is a non-invasive, non-ablative treatment with little to no down time.
PhotoDynamic Therapy (PDT) is a 2 part skin treatment that uses the light activated drug therapy, Levulan (aminolevulinic acid) also known as ALA. Levulan is a topical agent that is used to photosensitize the skin prior to light based treatments such as IPL (photofacial) and blue light acne treatments.
Adding Levulan (ALA) to a photofacial IPL treatment, is a bit like putting your photofacial on steroids. The Levulan photosensitizes the skin, allowing the IPL energy to be better absorbed by the targeted pigmented and vascular chromophores. This results in a higher level of correction of freckles, sunspots, skin discolorations, broken blood vessels and redness compared to photofacial alone. Although, Levulan in it’s self does not penetrate to dermal layers of the skin, the heat and inflammatory response caused by PhotoDynamic Therapy does reach the Papillary dermis. This heat stimulates the fibroblast to produce collagen.
PhotoDynamic Therapy is unique because Levulan is absorbed by abnormal cells, such as those of Actinic keratosis (AK’s). Aminolevulinic acid is also absorbed into the oil glands and hair follicles. When the Levulan is activated by the appropriate light or laser it damages the oil glands and reduces P. acne bacteria. Acne can be affectively treated by using Levulan to pretreat the skin before IPL (photofacial) or Blue light treatments.
How is the treatment done?
First your skin is pretreated with an acetone scrub, to remove oil from the skin’s surface. Sometimes microdermabrasion is also preformed before the Levulan is applied. Microdermabrasion will remove dead skin cells and cause blood vessels to dilate, which will result in a more effective treatment with IPL. After the skin is prepped the Levulan Kerastick is cracked open and applied to the skin. Aminolevulinic acid (ALA) doesn’t sting or burn like acids used in chemical peels. The ALA is left on the skin to “incubate”. The incubation time can be anywhere from 1-8 hours, a longer incubation time can cause more reaction as well as more correction. Non-facial skin generally requires a longer incubation time. Once the Levulan is applied, you must avoid sun exposure for 40 hours. Topical anesthetic may also be used. After the Levulan has been on for the determined amount of time, the skin is then treated with IPL and/or Blue Light. The light will activate the ALA. Blue Light is used specifically to treat acne and can be done alone or with IPL.
The degree of post treatment reaction will depend on the amount of skin damage and how aggressive the treatment is done. The Luvulan can be left to “incubate” longer, before it is activated for a more aggressive treatment. Those with a lot of sun damage or active acne can expect to have more reaction. Some people will experience little to no side effects. Similar to photofacial, pigmented spots will become temporarily darker, until they flake and peel off. The treated area will likely appear pink or red for the first few days and peeling may also occur and last for up to 7 days. Some may also experience mild swelling that lasts a couple days. It is important to avoid sun exposure for the first 40 hours post treatment, sun block will not protect skin against photosensitivity reactions caused by visible light. Sun exposure can cause stinging, burning, redness and swelling to the treated area.
How many treatments are needed?
The amount of treatments needed will depend on the skin condition and level of correction desired. There is significant improvement with each treatment. Some people may be satisfied with a single a treatment, however for optimal results a series of treatments are recommended. Treatments can be scheduled as soon as 3- 4 weeks apart.
Schedule a consultation to determine if you are a candidate for PhotoDynamic Therapy, and set up a treatment plan.
Rosacea is primarily a facial vascular disorder in which blood vessels are functionally and structurally abnormal. Currently rosacea can’t be cured, however it can be effectively treated and controlled. Rosacea is a progressive skin disorder, that should be treated when symptoms first begin. Treatment should be aimed at treating the underlying vascular issues associated with rosacea. Vascular Lasers and IPL treatments are extremely effective at treating existing redness and broken blood vessels. In addition to avoiding rosacea triggers, topical products can be used to prevent flushing and further damage that can accelerate the progression of the disorder.
Laser and IPL Therapy
Both Laser and IPL therapy are very effective at treating telangiectasia (broken blood vessels), generalized redness and flushing. IPL therapy can also be enhanced with Levulan to get the added benefit of treating acne, rosacea papules and pustuals.
Lasers that are absorbed well by hemoglobin are used to treat vascular concerns. The laser energy is absorbed by the blood vessel and creates heat within the vessel which damages the vessel wall and permenatly closes that vessel. The treated vessels are then absorbed by the body. Although there isn’t a cure for rosacea, studies show that laser treatment can permantly remove damaged facial blood vessels and with repeated treatment blood vessels will not always be created to replace the old vessel. Facial blood vessels treated with lasers are sometimes replaced with connective tissue. This is good news, because this will permently reduce the number of blood vessels in the face, near to the level of vessels found in healthy skin.
Lasers have a single wavelength that work at a very specific depth. So any idividual laser has it’s limitations. KTP 532 nm and Pulsed Dye: 577 -585nm lasers are well absorbed by hemoglobin and are very effective at treating superfical blood vessels in the face, while Nd:YAG 1064nm lasers are also well absorbed by hemoglobin, they are effective at treating vessels that are located deeper in the skin.
Intese Pulsed Light (IPL)
IPL skin treatments are known by many names including Fotofacial, Photofacial, Photoderm and Photo rejuvenation. Intense Pulsed Light (IPL) differs from lasers because IPL uses a wide spectrum of wavelengths at the same time (for example: 500nm — 1200nm) that can target any chromophore in that range, while lasers have a single wavelength. You can think of the laser like a sniper that can precisely hit a single target with one shot, and IPL is like a grenade that hits several targets at once. IPL uses special cut-off filters that can be selected to target chromophors in a certain range within the skin. When treating rosacea or any vascular concern, the intended target is hemoglobin. The advantage IPL treatments have over laser treatments is that IPL can target vessels at different depths.
Combined Laser and IPL Therapy
Best results are achieved when you combine IPL and Laser treatments. IPL and Laser treatments can be done independently, however combining technologies at the same treatment time will provide a better result. This type of treatment is fairly aggressive and should only be done by someone that is very experienced in combining these technologies.
Oral and Topical Products
Topical Metronidazole Gel
Metronidazole is topical agent used to treat rosacea, available only by prescription. The primary action of Metronidazole is anti-inflamatory. Metronidazole is effective at reducing papules and pustules and has a fairly minimal effect at reducing inflammation. Unfortunately, it isn’t effective for treating broken blood vessels or flushing.
Antibiotics have long been used to treat rosacea, however they work primarily through their anti-inflammatory properties rather than antibacterial. Antibiotics are effective at reducing papules, pustules, and inflammation. The limitation with antibiotics is that they are not effective at treating telangiectasia or flushing.
Antihistamines are effective at reducing facial inflammation, swelling and burning associated with rosacea. Histamine contributes to swelling, itching and burning. Histamine has also been shown to play a role in inflammation and redness.
Sunblock with Zinc Oxide
UV rays can penetrate the skin and activate sensory nerves that release potent vasodilators, as well as creating heat in the skin causing facial flushing. Zinc oxide reflects both UVA and UVB rays, blocking out heat from the sun. Topical zinc oxide also has significant healing properties when applied to damaged skin and has been shown to decrease inflammation in both the epidermis and dermis.
Dimethicone is a silicone based ingredient with moisturizing ability. Dimethicone is also a protective ingredient that has been shown to reduce flushing caused by skin irritants.
Free radicals have been shown to cause structural damage to vascular walls and many free radicals are potent blood vessel dilators. Dietary and topical antioxidants help to block the damaging effects of free radicals.
Studies show that vitamin C can protect blood vessel walls from free radical damage and reverse existing vascular damage. People with rosacea should get plenty of vitamin-C in their diet, and may want to consider a vitamin-C supplement. In addition to being a great antioxidant, topical vitamin-C has anti-inflammatory qualities.
*This post is intended for informational purposes only.
Radio frequency is not the same as laser, however it is often used in conjunction with laser treatments in a clinical setting. Radio frequency (RF) usually refers to oscillations in electrical circuits. Aesthetic treatments use non-ablative (RF) energy in short intense pulses that oscillate through the skin to heat targeted tissue. Radio frequency (RF) is often used to tighten the skin. The (RF) energy penetrates the skin and stimulates the contraction of collagen and the production of new collagen for skin tightening.
[ Read more about Laser technology ]
Radio frequency devices use a variety of delivery systems and penatrate to varying depths. Radio frequency can be monopolar or bipolar. Bipolar devices are often combined with other types of technology such as infrared light.
Monopolar vs Bipolar
For the purpose of aesthetic treatments Monopolar radiofrequency is delivered by applying a single electrode to the treated area and an opposing electrode that is relatively far removed so that the current goes deeply through the body. Unipolar (RF) penetrates deeper and more intensely than bipolar( RF). Thermage uses monopolar radiofrequency (RF) energy to tighten and contour skin.
For the purpose of aesthetic treatments bipolar radiofrequency is delivered by applying two closely positioned electrodes to the treated area. The electric current travels from one electrode through the tissue and back up to the other electrode, the current that goes between the electrodes is small and shallow. As a result, the tissue in the treated area is heated less deeply and less intensely than monopolar (RF). In aesthetic treatments bipolar RF is usually combined with light or energy based sources, including lasers, intense pulsed light, infrared light, or vacuum assisted. Infrared light heats the tissue down to the deep dermis and acts to “pre-heat” tissue, for improved (RF) penatration.
Bipolar Radiofrequency used with Laser and IPL
Unlike laser and Intense Pulsed Light (IPL) energy, radio frequency is not absorbed by a specific chromophore. When RF is combined with other energy sources such as lasers and IPL, the laser or IPL energy will be absorbed by the targeted chromophore (melanin or hemoglobin), resulting in an increased temperature in the target areas. The increases in tempeture lowers the tissue impedance to those areas and the RF energy will stream preferentially to the warmer areas with lowered impedance. Elōs is the first and only technology that simultaneously harnesses the power of bi-polar radio frequency (RF) and optical energy.
Bipolar Radiofrequency(RF) used with Suction
Bipolar radiofrequency can also be combined with negative pressure ( suction), to help improve and control the absorption of the RF energy. The tissue is suctioned into the hand-piece and the RF energy passes through. The Aluma uses a vacuum-assisted and bipolar radio-frequency (RF) handpiece for skin tightening methods.
VelaShape uses a combination of Infrared light, bi-polar radio frequency (RF) and negative pressure (suction) to heat deep adipose (fat) tissue. Infrared light, tissue mobilization, and suction, all work synergistically with RF to reduce cellulite.
Intense Pulsed Light (IPL) is used in photo-rejuvenation for the skin and hair removal treatments. Broad Band Light (BBL) is essentially the same thing as IPL and is used in the same way. Intense Pulsed Light (IPL) is not actually a laser. IPL emits a non coherent, broad spectrum light, rather than a monochromatic single wavelength like a laser. Basically lasers have one wavelength ( for example: 800nm) with a very specific target, and IPL uses a wide spectrum of wavelengths at the same time (for example: 500nm — 1200nm) that can target any chromophore in that range. You can think of the laser like a sniper that can precisely hit a single target with one shot, and IPL is like a grenade that hits several targets at once.
IPL uses special filters that block unwanted wavelengths. The filters can be changed to “cut off” the shorter wavelengths. The appropriate filter will depend on the depth of the intended target.
The cut off for the wavelength at the deeper end is predetermined, but can vary with each devise.
For example: Lumenis One has a wavelength of 515 – 1200nm,
and has 7 filters: 515, 560, 590,615, 640,695, and 755.
The 515 filter would block out wavelengths above and below 515nm – 1200nm, while the 560 filter would block out wavelengths above and below 560 -1200nm. The deeper wavelength, in this case 1200nm remains the same, while the “cut-off” filter can be changed to block out specific shorter wavelengths.
Each devises may use different wavelengths.
Sciton BBl: 420 -1400nm
Lumenis One: 515-1200nm
iPulse 1200: 530 – 1200nm
LimeLight: 520 – 1100nm
Cynergy XPL: 560 -950nm
IPL is well absorbed by chromophores that have color such as melanin, hemoglobin. The concentration of a specific chromophore peaks at different depths in the skin. The filter used in treatment is decided based on the depth of a desired target and the color of skin. A deeper cut off filter would be used for hair removal, while a shallow filter would be used when treating vascular issues such as rosacea. It is important to remember that IPL targets color in the skin, so tanning must be avoided before treatment. Patients with darker skin should seek treatment from someone experienced in treating their skin type, to avoid complications. IPL treatments can provide beautiful results, but can also cause serious burns. It is the patients responsibility to choose an experienced professional, be honest about sun exposure and follow all pre and post treatment instructions.
There are many variables involved in aesthetic lasers, including the active laser medium, wavelength, and targeted chromophore. Aesthetic lasers can be ablative, non-ablative or fractional. There are also other (non-laser) technology based treatments used in aesthetics such as Intense Pulsed Light (IPL) and Radio Frequency (RF).
The term “laser” originated as an acronym for Light Amplification by Stimulated Emission of Radiation. A laser generates a beam of very intense light. The light emitted by a laser is monochromatic, coherent and collimated.
Monochromatic – the light is of a single wavelength
Coherent - the light beam waves are in the same phase
Collimated - the light beams travel in parallel, all are parallel to each other.
Active Laser Medium Types
The lasing medium is the source of optical gain within a laser. The Active Lasers Medium can be a solid crystal, liquid dye, gas, or semiconductors.
Carbon dioxide (Co2) are gas lasers that are commonly used in aesthetic treatments.
Solid State Lasers
Generally, the active medium of a solid-state laser consists of a glass or crystalline material.
Solid state lasers include Ruby, Aexandrite and Erbium.
Semiconductor-based lasers are also in the solid state, but are considered as a separate class. Diode is a semiconductor based laser used in aesthetic treatments.
A dye laser is a laser which uses an organic dye as the lasing medium. A dye can usually be used for a much wider range of wavelengths which makes them suitable pulsed lasers. Pulsed Dye Lasers are used in aesthetic treatment.
Electromagnetic spectrum is the range of all possible wavelengths and frequencies. Wavelength is the distance over which the wave’s shape repeats ( peak to peak).Wavelenghths are measured in micrometers (microns) and nanometers (nm) Frequency is the number of oscillations per second, measured in hertz.
Energy is the amount of joules (J/cm) delivered. A laser technician adjusts the energy of each treatment, based on factors such as skin type and condition. The laser technician can also control other factors such as spot size and the length and duration of the pulse.
Lasers used in aesthetic treatments target a specific chromophore generally melanin, hemoglobin or water in the tissue. The targeted chromophore is determined by the wavelength. The concentration of a specific chromophore peaks at different depths in the skin. For example hemoglobin in the blood is best absorbed at a shallow wavelength and water is best absorbed at deep wavelengths. Melanin is best absorbed somewhere in the middle (500nm-1064nm), the exact depth can vary, depending on the desired target. For example if you are targeting pigment in the hair follicle a deeper wavelength (640nm-1064nm) would be used, however most lasers used for hair removal are Diodes (800nm-900nm).
Melanin and hemoglobin in blood vessels have color that absorbs the light emitted by specific lasers. Lasers that target color are usually used for hair removal, treating vascular issues such as rosacea and broken blood vessels, and skin discolorations such as freckels. Tanning is contraindicated with laser treatments that target color, tan skin will absorb more heat, increasing the probability of a burn. Tanning can also interfer with the desired results of treatment, because there is less contrast between the intended target and the surrounding tissue. Lasers that are used for hair removal target the color in the hair, so grey or blond hair will not respond well. (There are some lasers that claim to treat grey or light hair).
Water constitutes 80% or more of soft tissue, so lasers that target water are generly used for resurfacing. Lasers with deep wavelenghts such as Co2 or erbium lasers are strongly absorbed by water. The Smoothbeam laser is a 1450nm diode laser that targets water in the skin and is used to treat acne by shrinking the oil gland.
Argon 488 and 515 nm, is a gas laser that emits a blue green light which is strongly absorbed by both hemoglobin and water,used for photocoagulation. Argon lasers are rarely used for aesthetic or dermatologic treatments.
KTP 532 nm, a brilliant green light well absorbed by hemoglobin and melanin used photoablation and photocoagulation. The Iredex DioLite 532 nm KTP that is Diode Pumped, it is used to treat vascular lesions and hyperpigmentation.
Pulsed Dye: 577 -585nm, a yellow light that is well absorbed by hemoglobin in blood. Pulsed Dye Lasers (PDL) are especially useful for the treatment of vascular lesions, including spider veins, strawberry birthmarks and port wine stains.
Ruby 694 nm, uses a synthetic ruby crystal that emits red light that is strongly absorbed by blue and black pigment, and by melanin in skin and hair.
Ruby lasers are used for laser hair removal, tattoo removal and treating pigmented lesions including freckles, liver spots.
Alexandrite Laser 755nm, emits a deep red light and is absorbed by melanin. Alexandrite permits deeper penetration into skin than the ruby, and is used for Laser Hair Reduction.
Diode 800-900nm, emit near-infrared light. Diodes in the 800-900 nm range are absorbed by melanin and used for laser hair removal. The Smoothbeam uses a diode with a 1450nm, it targets water in the skin and is used to treat acne and build collagen.
Nd:YAG 1064nm, laser emits a near infrared beam that can be absorbed by all tissue chromophores, however it is strongly absorbed by hemoglobin. Nd:YAG lasers are used for photocoagulation and photoablation, commonly used to treat broken blood vessels.
Er:YAG 2940nm, emits a mid-infrared beam which has an absorption peak for water. Its used is to ablate tissue for cosmetic laser resurfacing. Also known as Erbium.
CO2 10,600nm, is a gas laser emitting a mid infrared beam which is strongly absorbed by water. Co2 lasers are capable of cutting or vaporizing tissue, and are used for deep laser resurfacing.
Ablative, Non-ablative an Fractional
Non-ablative lasers heat the layers of skin beneath the surface without removing the epidermis (top layer of skin).
Ablative procedures remove the epidermis. Carbon dioxide and Erbium lasers are ablative lasers used in aesthetic treatments. Ablative laser treatments are used for resurfacing, and leave skin raw.
Fractional lasers can be ablative or non-ablative treatments, and target only a fraction of skin at a time, leaving the surrounding tissue intact.
[ Read more on Fractional lasers ]
Some of the lasers used in aesthetic treatments:
Iredex DioLite – 532 nm KTP Diode Pumped – Non-Ablative
Candela Vbeam – 595nm Pulsed dye laser (PDL) – Non-Ablative
Candela GentleLASE – 755 nm Alexandrite – Non-Ablative
Lumenis LightSheer – 800nm Diode – Non-Ablative
Syneron eLaser / Comet – 810nm diode laser ( with RF) – Non-Ablative
Syneron Matrix IR – 915nm diode (with RF )- Non-Ablative/Fractional
Sciton Profile – Nd:YAG 1064 nm – Non-Ablative
Lumenis Multi-Spot – 1064 Nd:YAG – Non-Ablative
Candela GentleYAG – 1064nm Nd:YAG – Non-Ablative
Fraxel re:fine – 1410nm Erbium – Non-Ablative/Fractional
Cynosure Affirm – Nd:Yag 1440nm – Non-Ablative/Fractional
Candela Smoothbeam – 1450 nm diode laser – Non-Ablative
Fraxel re:store – 1500nm Erbium laser – Non-Ablative/ Fractional
Sciton Profile -2940nm Er:YAG – Ablative /(additional attachment to Profile base)
Sciton ProFractional – 2940 Er:YAG – Ablative/Fractional
Lumenis UltraPulse – 10,600nm Co2 – Ablative/ Fractional
Fraxel re:pair – 10,600nm Co2 laser – Ablative/ Fractional
Sometimes a little information can be a dangerous thing.
This is intended to help provide some very basic information of cosmetic / aesthetic lasers. There are many factors involved with laser aesthetic treatments and not everything can be included in this post. Aesthetic laser treatments can be complicated and should only be performed by a qualified and experienced technician.
Cosmetic Laser Warning!
What you need to know before choosing to do a cosmetic procedure.
On one complaint website, there were 1,437 complaints regarding laser treatments and over 600 for one specific laser center. If you decide to go to a discount laser center because you are looking for a low cost, you are taking a gamble. Some clinics hire inexperienced, even unqualified technicians to do treatment and rarely have a Doctor on site. A clinic may have a “medical director” on staff whom acts as a medical director for several locations. A med spa with a medical director on staff does not mean it is the medical practice of that person and the medical director may never actually be in the clinic. I have even heard of cases where the “medical directer” was in another state. Med Spas often set sales quota’s for employees, so technicians are pressured to rush treatments. I call this type of practice ” turn em’ & burn em’ “. I don’t blame the technicians, it’s just a poor way to do business. These types of laser centers usually have a very high employee turn over rate and many unhappy customers.
Increasing popularity for Laser, IPL and RF treatments has lead to an increase of treatment complications. A poorly done laser treatment can lead to burns, hyperpigmentation, hypopigmentation, ocular injury, scars and a simple lack of results. Most complications are preventable and all are manageable. The increase in complications is primarily due to lack of training, experience, and medical supervision. It is important to know that it is not just the technology, it is also the technique that determines the result of a treatment. Cosmetic and laser treatments can be complicated and are best done by an experienced technician. Laser and IPL treatments all come with some inherent risk, which you should understand and except before you consent to treatment. Burns and other side effects can result even when treatment is performed by the best and most experienced laser technicians.
With all the new products and technology available today it is easy to be confused, when choosing a treatment. Laser, IPL, LED, Infrared, Radiofrequency and fractional resurfacing are all energy based technologies and each have different indications. A knowledgeable esthetician / laser technician can educate you on energy based treatments in addition to other treatment options. In some cases a chemical peel, Botox, or a cosmetic filler may be a better option than laser. A consultation with an experienced esthetician can help you to make an educated decision on treatment.
It’s easier to stay out of trouble than to get out of trouble.
Patients play an active role in their treatment.
Tanning is a contraindication to most laser and IPL treatments, it is the patients responsibility to use proper protection from UV rays and inform technician of any possible sun exposure. Follow all pre and post treatment instructions, including keeping skin cool. Patients that are noncompliant may be responsible for treatment complications. Anyone with dark skin is at increased risk for complications, and should look for an experienced technician that specialize in treating dark skin.
When choosing to do a cosmetic procedure always look for someone who is experienced with proper training and a successful reputation. Do not base decisions regarding laser treatments, solely on price. A poorly done treatment will cost you more in the long run. Laser clinics should not operate the same as a tanning salon or health club. Laser treatments are serious and should be treated as such.
Are they telling you what you want to hear?
Regardless of the technology, laser hair removal usually requires a minimum of 12 treatments on the face and 8 treatments on non-facial areas. In most cases periodic treatments are needed to maintain results. Laser technicians that tell you that you will only need 5 treatments are not necessarily lying to you intentionally, this is often what they are told by the companies that manufacture lasers. Same applies to claims of safely treating tan skin or effectively treating light hair, although it may be possible don’t count on it.
Questions to ask:
Are you a licensed esthetician and certified laser technician in this state?
Is there a Doctor on location?
How long have you been doing laser treatments?
How long have you been in this clinic?
Have you treated my skin type before?
If you have been burned
Most complications are manageable, and can often be completely resolved. Treatment protocol will depend on severity of burn. In some cases the “burns” are not as severe as they look. If it is just superficial redness with speckles of dark, you may even get a nice result. Unfortunately some burns may need medical attention and can lead to scarring. If you have been burned, return to the laser clinic immediately for follow up care. Proper treatment of the skin post treatment can make all the difference.
The marks in the above photo appear to be from an IPL treatment, however I would not say this is anything to be alarmed about. The marks may look bad, however with appropriate home care she may even have a nice result.
Laser and IPL Burns
These are photo’s found on the internet that show various examples of burns from laser and IPL.