Archive for the ‘IPL (Intense Pulsed Light), BBL (BroadBand Light), Photofacial’ Category
It is not enough to know that the risks of treatment exist, but to understand why they exist, so that you know what precautions can be taken to reduce the risk of a complication.
How Safe are IPL and Cosmetic Laser Treatments?
Laser and Intense Pulsed Light (IPL) devices have been used in the medical community for over 25 years, and the amount of treatments performed has increased exponentially since then. According to the” American Society of Plastic Surgeons”, over a million Laser Hair removal treatments were performed in 2017 alone, which is up 48% from 2000. Laser Resurfacing (including fractional laser) is up 244% from 2000. According to a study published in the “Journal of Clinical and Aesthetics and Dermatology” the existing evidence base of over 25 years of use, to date has not raised any concerns over the long term safety. With millions of laser and IPL treatments successfully performed each year, these treatments are considered generally safe, however all of these treatments come with inherent risks.
The risks associated with laser and IPL treatments include lack of results, burns, blisters, infection, hyper-pigmentation, hypo-pigmentation and in severe cases scars. Prior to treatment patients sign an informed consent, not only consenting to treatment, but also that the understand and except the risks associated with treatment.
Why Do The Risks Exist
(This is about to get technical, but it is important)
Laser and IPL devices work on the principle of photothermolysis or selective absorption. There are a variety of wavelengths and each wavelength targets a specific chromophore, such as water, hemoglobin/blood or melanin. The laser used in treatment will depend on what your intended target is. For example, if you want hair removal or to address brown spots, a laser with a wavelength that is well absorbed by the melanin (color) is used. The goal is for the ratio of absorption in the intended target (in this case hair or a brown spot) to have greater value than the that of the surrounding skin. To put it more simply, we want the skin to be lighter than the hair or brown spot. The more contrast between the color of the brown spot or hair, compared to the color of surrounding skin, the more effective the treatment. It also makes the treatment safer, because the heat is confined to the targeted lesion, without damaging surrounding tissue. If someone is tan or has had unprotected sun exposure, the melanin levels in skin increase, so now instead of just the intended target absorbing the laser energy, the surrounding tissue will also absorb the energy. This is why tan skin is prone to a burn. The same concern applies to darker skin types. A majority of cases occur due to incorrect parameters being selected, based on patients skin color or ethnicity.
This explains in part, why there are more burn complications resulting from IPL and Laser Hair Removal treatments compared to laser resurfacing. There is also a misconception that these treatments are less aggressive and some how easier to perform. In fact, it could be argued that IPL is among the most technique dependent treatments. Part of what makes IPL devices so popular is it’s many applications. (I’m about to get technical again, only to demonstrate my point) IPL has such great versatility because, unlike lasers which only use a single wavelength, it uses a broad band of wavelengths. In each treatment, a provider must select an appropriate “cut-off” filter, based on which wavelengths you want to filter out. In addition to choosing the appropriate filter, the provider must select the energy used, pulse duration and with some of the more advanced devices the provider can select the number of pulses in each shot along with the delay time between these pulses. All of these parameters can allow an experience laser technician to provide a safer and more effective treatment, however there is also more chances for error.
Another risk factor that is rarely discussed, is the reliability of the equipment. As these aesthetic laser treatments have become more popular, so has the demand to produce them. It should not be assumed that just because a device is new, that it is better. Often, when a device or technology has been used with success, we will see other versions being produced by competitors, which may be cheeper, less effective and possibly less safe. Not all devices are created equal, I often use the comparison of a smart phone vs a flip phone. Both are phones, both can perform basic tasks such as texting or making a phone call, but we understand that a smart phone has many other uses and is technically superior.
Uncertified refurbished devises or devices that have been purchased second hand may have defects that cause serious complications. An even bigger concern is knock-off and counterfeit devices. In 2014 there was an article published in the journal “Laser in Surgery and Medicine” warning of counterfeit devices. They found that the problem was more prevalent than most physicians and consumers imagined. The article pointed to 29 knock-off versions of CoolSculpting and at least five counterfeit versions of Ultherapy. Many of these counterfeit devices are produced in China and South Korea, and look remarkably similar to the real thing. These counterfeit devices are unregulated and not approved by the FDA, they are also illegal to purchase, however they are purchased from distributers and online. These counterfeit devices do not have the safety mechanisms required, and have resulted in many reported cases of injury.
Reduce the Risk – Check List
Does the laser technician have the proper certification and training?
Regulations vary by state. As of August 2018, Arizona certifications will be renewed with the Arizona Department of Health Services (Bureau of Radiation Control). In Arizona a Certified Cosmetic Laser Technician must also be specifically certified for each laser application they provide. The approved applications are clearly listed on the certificate which must be posted. A certification only guarantees that the technician has met the minimal requirements to obtain a certification, so ask about their level of experience and any additional education they may have received. Good questions would include, how long have they been a laser tech, how long have they worked at that specific clinic, how long have they been providing the specific treatment your interested in.
Does the clinic have the proper license and certifications
The clinic must also be licensed and have all the laser devices registered with the appropriate regulating agencies. The certificates must be posted and it will include a list the devices that clinic has registered.
Who and Where is the Medical Director?
Alway ask who the Medical Director is, and if they are on site. Many med spas hire a medical director who is never or almost never on site. You want to know, that if you need medical attention or a prescription ( such as burn ointment),that they will be available. In my experience, there is more accountability when it is an actual medical practice with direct supervision from a doctor.
Is the device being used authentic used and reliable
The best way to determine if the device is authentic, is to go to the manufacture website and use the provider search. Most Laser manufactures will have a place on their website where you can enter a zip code and it will list approved providers in that area. You can also ask if they purchased it new, directly from manufacture and if they regularly service their device.
Red Flag Price
The most advanced lasers are obscenely expensive to purchase and maintain.Technicians that are highly qualified and experienced demand higher wages. All of the cost of providing the service is reflective in the price of treatment.
Disclose medical conditions, medications, supplements and topical products used.
Don’t just skip through your patient intake forms, those questions are there for a reason. Some medications and supplements increase photosensitivity and many medical conditions can inhibit healing. Always let your provider know if you are on accutane, antibiotics, pregnant or trying to become pregnant. Also inform your provider of topical products you use, such as retinoids, acne products and skin cancer treating drugs. Discuss any changes prior to each treatment.
Disclose sun exposure history
This is the big one! Your provider must know exactly how much sun exposure you have had, prior to EVERY treatment. Do not make any assumptions about, what counts. Everything counts! Tell them which sunscreen you use, and it’s even better if you bring it with you. Tell your provider your typical dosage, how much you apply to an area and how frequently. Also discus your ethnicity. Some people have lighter skin, but their ethnicity may make them more susceptible to a complication.
Discuss with your provider the potential risks
Be sure that you clearly understand the risks involved and how likely they are to occur. This is the time your provider should let you know what things you can do to reduce the potential of having a negative reaction. This may include, preconditioning skin prior to treatment, avoiding unprotected sun exposure, avoiding heat post treatment, waiting until you have finished a certain medication. Don’t underestimate the value of taking a comprehensive approach to address your concerns. The treatment you seek out, may not be the most appropriate treatment to start with.
Prior to treatment, ask your provider how they would address any complications
Do not wait and see if you will a problem to find out if your provider would be able to address it. Some side effects or complications, such as swelling and bruising will simply require time to resolve. There are things that can reduce the duration of a bruise or swelling, however it is not required. Other complications, like an infection, a burn or hyper pigmentation need to be addressed quickly. If a provider does not already have a plan for addressing a complication, it would be wise to get a second opinion before having a treatment.
It should also be noted that products, medications and additional treatment needed to treat a complication are not included with the cost of treatment and would be an additional cost to the patient. Do not assume you will get your money back if you are not satisfied or have a complication. You are paying for services rendered and you are consenting to the treatment knowing and excepting the risks involved.
Décolletage is what we call the neckline, or more specifically the area made up of the neck, chest and cleavage. If we neglect this area between our face and breasts, it is sure to age us. Although we can cover up our décolletage, we would certainly be limiting our style and where is the fun in that.
The décolletage is a special concern, because it tends to suffer more sun damage than other areas and women also tend to develop lines between the breast while sleeping on their side. Luckily, there are plenty of options to improve this area, but we have to be patient as correction for non-facial skin is much slower than it is when treating the face. When we treat the décolletage or any non-facial area, we need to treat more conservatively and thus, more often. The skin cell turn over for non-facial skin tends to be slower, so this means the recovery process will take longer, which will require more time spaced between treatments. When treating the décolletage you should treat early and often. Slow and steady wins the race.
When it comes to skin care and anti-aging, the best approach is a comprehensive one. One treatment does not necessarily replace the other. Your skincare provider should work to help you understand which treatments are best for you and the time line that treatments may be done. When budget is a concern, you will need to decide which concerns are a priority for you.
Topical Skin Care
The first step is to use effective skin care products on your neck and chest, every morning and every night, just as you would your face. Most of the skin care products that are used on the face, can also be used on the chest. Some topicals, such as hydroquinone and retinoids need to be used less frequently on non-facial skin to avoid irritation. Some products should be used daily, such as topical antioxidants and an SPF 30 or higher. There are some great products formulated specifically for the neck and chest. Revision skin care formulated Nectifirm for firming the neck and décolletage. NIA 24 Sun Damage Repair for Décolletage and Hands, is formulated with patented Pro-Niacin to repair damaged skin. Consult with your Esthetician, to determine the appropriate protocol for you.
Treatments that use Intense Pulsed Light work to treat brown spots and redness. There is also research to suggest that ongoing treatments will positively effected gene expression in the skin to mimic that of a younger person. Generally a series of 3-5 treatments are recommended, scheduled 3-4 weeks apart. For enhanced results Levulan may be applied prior, this is known as PhotoDynamic Therapy.
Medium depth chemical peels that reach the papillary dermis or upper reticular dermis, such as the Obagi Blue Peel or ZO controlled depth peel will improve skin discolorations, improve texture, laxity, lines and stretchable wrinkles. A medium depth peel on the chest, may take up to 14 days for peeling to be complete. On the up side, peels on the face generally do not look bad during the peeling phase and are easy to tolerate. These peels can be done as often as 4 times a year, however I find that once a year is optimal when combined with other treatments.
Ultherapy is the treatment of choice for the lines that develop between the breasts. Ultherapy works at a deeper level than any other non-surgical treatment, to lift and tighten skin. Ultherapy uses focused ultrasound to target deep into the dermis and even the top of the muscle. Like many other aesthetic treatments, Ultherapy works by creating a wound healing response, but because the targeted areas are at a deeper level we see more tightening and lifting. The increased collagen production in the treated area, can be seen a year post treatment. Most people should plan on repeating this treatment once a year, although younger patients may be able to stretch it out to every two years. Those with advanced photo damage, or who desire more improvement may choose to repeat the treatment in six months. Pain medication may be prescribed, in which case you will need to arrange for someone to bring you in to your appointment and take you home.
Non facial skin does not respond well to “full coverage” ablative laser resurfacing. Non-ablative or sublative fractional resurfacing treatments, such as E-Matrix or Fraxel are more appropriate for treating non-facial skin. These treatments reduce lines, wrinkles and smooth skin texture. Like many other aesthetic treatments, fractional lasers work by creating a wound healing response in the skin, that stimulates the fibroblast in the skin to up regulate the production of collagen. Because laser treatments create heat, we appreciate a different type of wound healing response than we do with other treatments such as chemical peels, micro needling, which is why we see the up regulation of collagen for longer periods of time post treatment.
Fractional lasers generally work in the deeper layers of the skins dermis, an area which is not effected by chemical peels or IPL treatments. The frequency and number of treatments will depend on the level of treatment performed, level of correction desired and condition of skin.
Micro-Needling Collagen Induction Therapy
Aesthetic professionals use micro-needling pens such as the Eclipse or Dermapen, to deliver tiny needles into the epidermal and dermal layers of the skin creating micro-injuries. This begins a natural wound healing or renewal process that will stimulate collagen production in the treated area. There is little to no down-time, and it is surprisingly comfortable. Although, micro needling treatments do not deliver the same level of correction to skin texture as fractional lasers, they are the treatment of choice for scars and stretch marks. Micro-needling is also a good option for early intervention or in between other aesthetic treatments.
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Can you imagine that in 10 years from now, that you could look 2 years younger than you do today? A recent study may have discovered the fountain of youth in a popular skin treatment that utilizes BBL technology, also known as IPL.
PhotoFacial is a popular skin treatment that utilizes IPL (Intense Pulsed Light) technology also known as BBL (Broad Band Light). Traditionally, IPL/BBL technology has been used to treat reds (vascular) and browns (pigmented spots),but new research shows impressive anti aging benefits.The study looked at the effects that BBL treatments had on the skin over a period of nine years. They found that with continued treatments over the nine years, skin looked two years younger than it did before treatment.
Why Does Skin Look Younger
Many of the treatments that we use in aesthetics, benefit from skins wound healing ability to produce collagen. Although IPL/BBL treatments do cause a wound healing response that will stimulate collagen production for the first 3 weeks post treatment, it isn’t exactly long enough to account the level of anti aging results observed. So, then, why did the skin look younger?
The study revealed that ongoing BBL/IPL treatments positively effected gene expression in the skin to mimic that of a younger person. Gene expression is the process by which information from a gene is used in the synthesis or form a functional gene product, usually a protein. Aging is associated with changes in gene expression, which is most evident in the skin.
The study indicates “that patients who maintained a regular annual or biannual regimen of BBL treatments over 5 to 11 years can reduce and delay the long-term signs of skin aging such as photo damage, telangiectases, fine lines and wrinkles, and skin laxity in a natural way.”
BBL has been shown to change the expression of genes associated with aging, longevity, and increased lifespan.
Before Treatment: 43 Years Old | After Treatment: 55 Years Old
After 12 Years of Forever Young BBL treatments, the skin looks younger…
How To Stay Forever Young with BBL/IPL
The protocol that we use for this treatment is more advanced and differs slightly from traditional “Photofacials”. IPL/BBL devices use something we call “cut-off” filters, which are used and changed to target specific chromophores in the skin, for example the color in melanin (browns) or hemoglobin (reds). The best IPL/BBL devices are equipped with several “cut-off filters” that the technician can switch between during a treatment. With a traditional “photofacial” treatment we use these “cut-off filters” to specifically treat brown spots and reds such as broken blood vessels and we work only until we reach what we call a “clinical end point”, which basically means we have treated the targeted lesions. With this new approach we treat with multiple “cut-off filters” and make more passes over the skin than we do with a traditional IPL/BBL treatment. We are not focused solely on treating reds and browns, but also on rejuvenating the skin to act more youthful.
To delay aging, I generally recommend a series of 3-5 treatments, spaced 3-4 weeks a part. A treatment series should be repeated annually or biannually depending on level of improvement desired. I would like to emphasize the importance of a comprehensive approach to aging, as the aging process is multi-faceted and ongoing. Regardless of how great any treatment is, it will never replace the need for treatments that address the other aspects of aging. – One treatment does not necessarily replace the need for another. Consult with your skin care professional to determine which treatments are best for you.
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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 messages from people all over the world, that have received burns from an aesthetic laser or IPL (photofacial) treatments. The question is almost always “What should I do to treat laser burns?” It’s important to understand that, nobody can diagnose or treat you over the internet. There is not anything on line that can replace direct medical attention. At best, this information may give you some talking points for you and your provider and help to explain possible reasons a burn may have occurred.
You should always follow up with your provider. All aesthetic treatments come with inherent risks, this includes burns. Your provider should be able to provide you with care, if you have followed with your provider and complied with treatment recommendations, and are not seeing correction in a realistic time frame, then see a qualified provider for a second opinion.
*The information here and any where on the internet does not replace replace personal treatment by a trained professional.
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 typically feels like a hot rubber-band 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. Usually, you will know almost immediately if you have a burn. In some cases however, the skin may feel hotter shortly after treatment. As soon as you suspect a burn, you should call and speak to the laser technician.
If you suspect that you have been burned, be sure to discuss it with your 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. It is important to comply with post treatment instructions. Remember…. your friends, the girl at the cosmetic counter and strangers from online forums are not a replacement for a professional trained in your specific treatment.
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 have followed up with your provider and complied with treatment recommendations and are still 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. 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 immediate 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, to assess the burned area, and give you post treatment instructions. You may also be scheduled to see the medical director (a 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.
What Your Provider Might Suggest:
Actual 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.
– Soak a washcloth or gauze in a bowl of ice water, ring out the excess water and apply the to the treated area. Switch out the cold cloths every couple minuets. When you feel gauze or 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.
– Apply occlusive ointments such as aquaphor or vasoline if instructed, 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. If the skin has been ablated or is “raw” you may be instructed to use an occlusive ointment immediately and apply cold packs over occlusive sheet or ointment.
– Do not open or pop blisters. Opening the blisters will make the area more vulnerable to infection
– You may be instructed to apply a topical steroid such as hydrocortisone cream
– You may be instructed to apply antibiotic cream or ointment to the burn.
– Watch the skin for signs 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 may be instructed to use a4% Hydroquinone cream and Tretinoin (Retin-A) to reduce risk of or even treat hyper pigmentation ( dark skin discoloration). Topical Serums that contain Vitamin – C , and products with growth factors can aid in collagen production, improve skin healing and reduce inflammation. If the burn marks are old and have not responded to topical skin care, you may need something like a medium depth chemical peel, to treat the scars.
Medical skin care systems such as Obagi Nu-derm or ZO Medical incorporate the use of prescription strength Hydroquinone and Tretinoin, which even skin discolorations. These are prescription strength skin care lines, 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 avoid products that contain AHA’s or any other exfoliants, until the skins epidermis has been restored. 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 type and ethnicity are also considerations.
Skin Medica’s TNS Recovery Complex has a potent growth factor blend that strengthens the skin’s natural ability to regenerate itself. This product is not a drug and thus there is no medical claim. Although this product is not specifically indicated in treating burns, in my personal experience it seems to aid in healing. I was in a car accident, where 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.
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 absorb more energy (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 the most common reason for laser burns, if the device is a real FDA approved device, however it does happen. Beware, there are many counterfeit and knock-off devices on the market and these have been linked to burns and complications.These counterfeit devices are not FDA approved and likely do not have the same safety mechanisms as the authentic devices. Often these fakes look similar to other popular device with similar logos and font that can be confusing. I recommend you look for the name of the laser on the device. Most lasers have the manufacture name in an area that is clearly visible. You should be able to look up a manufacture website and find the name of that device and often a list of approved providers. In my opinion some of the most severe burns are a result of a problem with the equipment. If the complication is unusual or thought to be an issue with the device, It should be reported to the device manufacture.
In some cases the problem is in the technique. 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 some 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 experience a technician has with lasers in general, as well as a specific laser will reduce the possibility that their 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, experienced laser technician with a good reputation.
You Play A Role
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. It is also your responsibility to follow-up with your provider if you have a complication, comply with treatment recommendation and return to the clinic for all recommended follow-up visits. Providers can not control your compliance.
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.
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.
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.